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Cocaine use disorder — Clinical Guidelines

Overview

Cocaine use disorder involves compulsive use of cocaine despite harmful consequences, leading to significant impairment in functioning and potential severe health complications 1 2 5.

Diagnosis

Clinical History: Detailed history of substance use patterns and associated symptoms 1 2.

Physical Examination: Focus on cardiovascular and neurological signs 2.

Laboratory Tests: Toxicology screens for cocaine metabolites 2.

Electrocardiogram (ECG): Essential for assessing cardiac effects, particularly arrhythmias 2.

Management

Behavioral Therapy: Cognitive-behavioral therapy (CBT) and contingency management 1.

Medications: No FDA-approved medications specifically for cocaine use disorder, but adjuncts like antidepressants or mood stabilizers may be considered based on comorbid conditions 1.

Cardiac Monitoring: Close monitoring for arrhythmias and other cardiovascular complications 2.

Supportive Care: Addressing withdrawal symptoms and providing psychological support 4.

Special Populations

Pregnancy: Cocaine use poses significant risks to fetal development; multidisciplinary care is essential 5.

Elderly: Increased vulnerability to cardiovascular complications; careful monitoring required 2.

Key Recommendations

Systematic ECG Monitoring for patients with suspected cocaine use to detect cardiac arrhythmias (Evidence: Strong 2).

Implement Behavioral Therapies such as CBT to address cocaine use disorder (Evidence: Moderate 1).

Avoid Unsupervised High Doses of topical cocaine in clinical settings due to potential severe reactions (Evidence: Expert opinion 6).

References

1 Michopoulos V. Enduring scars of cocaine. Science translational medicine 2017. link 2 Ramirez FD, Femenía F, Simpson CS, Redfearn DP, Michael KA, Baranchuk A. Electrocardiographic findings associated with cocaine use in humans: a systematic review. Expert review of cardiovascular therapy 2012. link 3 Kozell LB, Meshul CK. Nerve terminal glutamate immunoreactivity in the rat nucleus accumbens and ventral tegmental area after a short withdrawal from cocaine. Synapse (New York, N.Y.) 2004. link 4 Malin DH, Moon WD, Moy ET, Jennings RE, Moy DM, Warner RL et al.. A rodent model of cocaine abstinence syndrome. Pharmacology, biochemistry, and behavior 2000. link00181-7) 5 Wallach SJ. Medical complications of the use of cocaine. Hawaii medical journal 1989. link 6 Johns ME, Henderson RL. Cocaine use by the otolaryngologist: a survey. Transactions. Section on Otolaryngology. American Academy of Ophthalmology and Otolaryngology 1977. link

Cocaine use disorder