Cocaine use disorder
Cocaine use disorder is a pattern of cocaine use causing significant impairment or distress, distinct from acute intoxication, diagnosed when a patient meets at least 2 of 11 DSM-5 substance use criteria within 12 months. Acute cocaine-associated chest pain is managed first with a benzodiazepine, then nitrates or a calcium channel blocker, while beta blockade is avoided because of concern for unopposed alpha stimulation; no medication is approved for the use disorder itself, so treatment rests on psychosocial care.
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What this article covers
- Overview
A pattern of cocaine use causing significant impairment or distress: diagnosed when cocaine use fits this pattern within a 12-month period; a single intoxication episode does not, by itself, establish the disorder.
- Epidemiology
One of the most commonly used illicit drugs: illicit drug use occurs in 9% of the U.S.
- Risk factors
Co-use with other substances: cocaine is frequently used with cannabis or alcohol, complicating the clinical picture and toxicology screening.
- Pathophysiology
Reuptake blockade at three monoamine transporters: cocaine blocks the dopamine, serotonin, and norepinephrine transporters, elevating synaptic monoamine levels, the shared basis for its euphoric…
- Clinical features
Diagnosis of the use disorder requires 2 or more of 11 criteria within 12 months: more cocaine or over a longer period than intended, unsuccessful efforts to cut down, large amounts of time obtaining…
- Differential diagnosis
Stimulant use disorder (amphetamine-type): monoamine release rather than reuptake blockade, with intoxication lasting hours to about a day, unlike cocaine's 30-minute effect; toxicology and the reported agent distinguish them.
- Diagnosis
The use disorder is a clinical diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, not a laboratory test: confirmed when a patient meets at…
- Management
First, treat agitation, chest pain, or hypertension with lorazepam 1-2 mg IV, repeated as needed and titrated to effect; benzodiazepines are the cornerstone for cocaine-induced agitation and autonomic hyperactivity.
- Complications
Myocardial infarction and cerebrovascular accident: alpha-agonist vasoconstriction can cause ischemia in the coronary or cerebral circulation, even in young patients without atherosclerosis.
- Prognosis
Acute intoxication is short-lived: effects of a single dose last on the order of 30 minutes, and the postuse crash, while distressing, is not life-threatening and responds to supportive care.
- Prevention
Screen all adults aged 18 years or older for illicit drug use: the USPSTF recommends this, provided the physician can arrange access to further diagnostic and treatment services.
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