History and exam
Key diagnostic factors
common
hypertension
Adrenergic arousal due to cocaine use.
tachycardia
Adrenergic arousal due to cocaine use.
chest pain
Adrenergic arousal due to cocaine use. Acute myocardial infarction is more commonly seen in people with cocaine use disorder who have underlying myocardial pathology and/or coronary artery disease.
mydriasis
Adrenergic arousal due to cocaine use.
diaphoresis
Adrenergic arousal due to cocaine use.
tremulousness
Adrenergic arousal due to cocaine use.
agitation (mild to severe)
Possible psychomotor activation related to cocaine use.
mood changes (e.g., irritability, euphoria, dysphoria, paranoia)
May relate to recent use of cocaine or cocaine abstinence.
suicide ideation
There is a high prevalence of suicide ideation and suicide attempt among people who use cocaine and access health services.[36]
Other diagnostic factors
common
anxiety (panic state: mild to severe)
Possible adverse cocaine effect.
drug-induced formication
A tactile hallucination that resembles that of small insects crawling on or under their skin.
uncommon
previous hospitalisation for medically supervised withdrawal
Increased cocaine use rates in this population.
heat-related injuries (e.g., blisters, sores, and cuts on the mouth) or burns on the thumbs
Possible signs of traumatic injuries related to smoking crack cocaine.
nasal septum ulceration, perforation
Possible sign of intranasal use of cocaine ('snorting').
focal neurological abnormalities
Reports or findings of weakness, altered sensation, difficulty speaking, visual field loss, reflex changes, or coordination problems are sequelae of a cocaine-induced cerebrovascular event.
seizure activity
Cocaine-induced seizure activity is typically isolated, tonic-clonic in nature. If recurrent seizures follow cocaine use episodes, investigation of underlying central nervous system pathology would be in order.
loss of consciousness/altered consciousness
Sequelae of cocaine-induced seizure or cerebrovascular event; may indicate presence of delirium state.
skin lesions (e.g., puncture marks, infections, erosions, necrosis)
Markers of injection (subcutaneous, intravenous) drug use.
dyspnoea
Cocaine contaminated with levamisole is very weakly associated with an increased risk of pulmonary hypertension.[3]
Risk factors
strong
adverse childhood events
history of polysubstance use
There is a higher rate of polysubstance use among individuals with cocaine use disorder.[24]
family history of substance use disorders
Drug use among family members (and close friends) contributes to the risk of ongoing drug use.
history of mental health disorder
Individuals with mental health disorders have an increased risk of developing a substance use disorder.[25]
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