Cocaine use disorder

The majority of people who use cocaine do not have a use disorder. There is an increased risk of dependence (moderate to severe cocaine use disorder) with heavier use and when cocaine is smoked or injected.

Comorbid medical and psychiatric illnesses, as well as other substance use disorders, should be assessed.

Treatment options are limited with drug counseling as the mainstay.

There is no evidence to support the use of antipsychotic agents for cocaine dependence. Antipsychotic agents may cause QT interval prolongation and, when used concomitantly with cocaine, may compound the risk of sudden death.

Chronic cocaine use can lead to scarring of heart tissue and myocardial hypertrophy and other changes collectively known as myocardial remodeling. These changes constitute the substrate for the occurrence of lethal arrhythmias.

Psychosis can be seen in chronic users as an isolated condition or as a feature of "excited delirium", an agitated confusional state associated with potentially lethal hyperthermia.

Cocaine is a controlled illicit, highly addictive stimulant drug that is usually either insufflated (snorted), injected, or smoked in its freebase form (crack). Cocaine use is normally occasional, with the majority of users not meeting the criteria for cocaine use disorder. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) classifies cocaine use disorder as mild, moderate, or severe defined by the number of symptoms within a 12-month period.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. (DSM-5). Washington, DC: American Psychiatric Publishing; 2013.

See also our topic on Cocaine overdose.