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Cocaine use disorder
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Cocaine use disorder

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Synopsis

Cocaine is a tropane alkaloid derived from the coca plant (Erythroxylum coca), which has pharmacological properties. It is a stimulant commonly seen as an illegal street drug available in different forms:
  • Cocaine base is usually smoked. Street names include freebase, crack, rock, twinkie, gravel, electric kool-aid, purple caps, black rock, scramble, window pane, supercoke, and yam.
  • Cocaine salt is usually absorbed through the mucous membranes (intranasal or oral) or injected. Street names include white lady, white dragon, nose candy, coke, blow, happy dust, aspirin, foo-foo dust, lady, Big C, coconut, Florida snow, devil's dandruff, and flake.
  • In a paste form, it is has been called pasta, basuco, and bazooka.
The effects of cocaine are described as a state of hyperalertness, energy, and euphoria.

Cocaine is identified as a Schedule II drug in the United States under the Controlled Substances Act.

DSM-5 Criteria:
Cocaine use disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) now combines the former concepts of substance dependence and substance abuse into a single diagnostic concept defined as mild, moderate, or severe.

The DSM-5 criteria address conditions and behaviors of an individual using cocaine that include urges or cravings, large amounts of time spent on cocaine activities, failure to stop or control use, interference with work, home, school, or previously enjoyed activities, awareness of risky behaviors, and impaired personal relationships related to cocaine use. The user of cocaine may experience a growing tolerance and onset of withdrawal symptoms.

Signs and Symptoms:
Cocaine toxicity, or acute intoxication, refers to the unintended effects of cocaine on the human organs, and which result in substance-related emergency room visits second only to acute alcohol toxicity. Accelerated progression of organ failure and convulsions can result in death within minutes.

A more protracted progression presents with behavioral changes (agitation, restlessness, anxiety, heightened emotions), circulatory changes (hypertension, pallor, pulse rate irregularities), respiratory changes, hyperthermia, and central nervous system signs (sweating, nausea, vomiting, tremor, headache, vertigo, teeth grinding).

Progressively worsening signs of encephalopathy, seizures, breathing impairment, and incontinence may be accompanied by cyanosis, flaccid paralysis, pulmonary edema, cardiac arrest, respiratory failure, and coma.

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.

Diagnosis:
Cocaine use disorder may be diagnosed using a combination of medical history and substance use history, mental health assessment, clinical examination, self-assessment questionnaire, and lab tests. Several assessment instruments are available, including the Tobacco, Alcohol, Prescription Medication, and Other Substance Use Tool (TAPS).

Drug tests may not indicate recent cocaine use, so they cannot be used as a single diagnostic tool to determine chronic abuse. Complete assessment is recommended to address DSM-5 criteria for diagnosing cocaine use disorder and to determine the level of severity. Concurrent use of multiple substances, as cocaine in combination with alcohol, opiates, amphetamines, or other drugs, is not uncommon, so screening for other substances should be done simultaneously. A pregnancy test is also recommended.

Complications:
Severe reactions to cocaine use include cardiovascular, pulmonary, and dermatological complications:
Cocaine use during pregnancy introduces adverse effects on the fetus and neonate, including the risk of preterm birth, underdevelopment of the fetus, placental abruption, and preeclampsia.

Management:
Emergency intervention first addresses the cardiovascular, respiratory, and central nervous system crises of cocaine toxicity. Steps are implemented to avoid life-threatening complications such as cardiac arrest, stroke, hyperthermia, respiratory failure, and rhabdomyolysis. Benzodiazepine may be used to manage seizures and aggressive behavior.

Once stabilized, the patient should be evaluated for recovery management. Patients undergoing withdrawal symptoms typically experience psychological effects, especially cravings, and can benefit from symptomatic relief and substance abuse counseling. Evidence-based treatment plans include psychotherapy, cognitive behavior therapy, motivational interviews, and lifestyle changes.

Codes

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

SNOMEDCT:
78267003 – Cocaine abuse

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 Updated: 04/05/2019
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Cocaine use disorder
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Cocaine use disorder (Acute Cocaine Intoxication) : Tachycardia, Anorexia, Hypertension, Mydriasis, Hyperarousal
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