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Cocaine use disorder
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Cocaine use disorder

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Contributors: Shea A. Nagle BA, Abhijeet Waghray MD
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Synopsis

Cocaine is a tropane alkaloid derived from the coca plant (Erythroxylum coca), which has pharmacological properties as an indirect sympathomimetic that inhibits catecholamine reuptake in neurons. It is a stimulant commonly seen as an illegal street drug available in different forms:
  • Cocaine salt is usually absorbed through the mucous membranes (intranasal or oral) or injected. Street names include coke, blow, white lady, white dragon, nose candy, happy dust, aspirin, foo-foo dust, lady, Big C, coconut, Florida snow, devil's dandruff, and flake.
  • Cocaine base is usually smoked. Street names include crack, crack-cocaine, rock, freebase, twinkie, gravel, electric kool-aid, purple caps, black rock, scramble, window pane, supercoke, and yam.
  • In a paste form, it has been called pasta, basuco, and bazooka.
Cocaine is identified as a Schedule II drug in the United States under the Controlled Substances Act.

The effects of cocaine are described as a state of hyperalertness, energy, and euphoria. Cocaine toxicity, or acute intoxication, refers to the unintended effects of cocaine on the human organs. Intoxication results in substance-related emergency department visits second only to acute alcohol toxicity. Patients may present with behavioral changes (agitation, restlessness, anxiety, and heightened emotions), circulatory changes (hypertension, pallor, and irregular pulse), respiratory changes, hyperthermia, and central nervous system signs (sweating, nausea, vomiting, tremor, headache, vertigo, and teeth grinding).

Levamisole is a substance used medically as an anthelmintic drug that has been found as a common contaminant in cocaine. Symptoms of levamisole toxicity include skin eruptions, neutropenia, and a vasculitis affecting the tips of the ears, nose, and, when most severe, other larger parts of the body.

Other adverse effects include delusions, paranoia, hallucinations, impaired judgment, aggressive behavior, depressed mood, sleep disturbance, decreased appetite, weight loss, dyskinesia, dilated pupils, tachycardia, and cravings. Chronic use of cocaine can also result in cardiovascular problems including arrhythmias, myocardial infarction, stroke, dilated cardiomyopathy, and cardiac arrest.

Related topics: Cocaine mucosal ulcer, Skin popping substance abuse, Sympathomimetic toxicity

Codes

ICD10CM:
F14.99 – Cocaine use, unspecified with unspecified cocaine-induced disorder

SNOMEDCT:
78267003 – Cocaine abuse

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Polysubstance use disorder – Patients using cocaine are at risk for other substance use disorders.

Schizophrenia and other psychotic disorders – Patients may present with psychosis secondary to drug use or separate from drug use with another underlying psychiatric cause.

Serotonin syndrome – Symptoms include hyperthermia, hyperreflexia, mydriasis, tachycardia, sweating, diarrhea, altered mental status, seizures, and rhabdomyolysis.

Neuroleptic malignant syndrome – Symptoms include hyperthermia, hyporeflexia, rigidity, extrapyramidal symptoms, sweating, and altered mental status.

Myocardial infarction, unrelated to cocaine use

Medication reactions and intoxication with other drugs – Patients may present with an adverse reaction or overdose from a prescribed medication or with intoxication or overdose from various other substances:
  • 3,4-methylenedioxymethamphetamine (MDMA, ecstasy)
  • 3,4-methylenedioxy-N-ethylamphetamine (MDEA)
  • Lysergic acid diethylamide
  • Baclofen
  • Barbiturates
  • Antidepressants – selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), tricyclics, etc (see serotonin syndrome)
  • Antipsychotics – risperidone, haloperidol, etc

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 11/06/2019
Last Updated: 11/19/2019
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Cocaine use disorder
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Cocaine use disorder (Acute Cocaine Intoxication) : cocaine, Tachycardia, Anorexia, Diaphoresis, Hypertension, Mydriasis, Hyperarousal, Restlessness
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