Cocaine use disorder

Healthcare setting

The US Preventive Services Task Force (USPSTF) recommends that clinicians screen for unhealthy drug use in adults 18 years or older, when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred. Screening in this context refers to asking questions about unhealthy drug use. For adolescents, the USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for unhealthy drug use, meaning that clinicians should use their judgement about screening by asking questions about drug use in adolescents.[45]US Preventive Services Task Force. Final recommendation statement. Unhealthy drug use: screening. Jun 2020 [internet publication]. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/drug-use-illicit-screening

In the UK, the Alcohol, Smoking and Substance Involvement Screening Tool - Lite (ASSIST-Lite) is recommended to screen for substance use in adults aged 18 years and older. Two versions are available, one specifically for use in mental health settings.[46]Public Health England. ASSIST-Lite screening tool: how to use. Apr 2021 [internet publication]. https://www.gov.uk/government/publications/assist-lite-screening-tool-how-to-use

The American College of Surgeons recommend that trauma centres carry out bedside screening for substance use problems in all physical trauma patients considered to be at higher risk of substance use disorders due to the presence of risk factors, e.g., positive urine drug screen results, suggestive history or examination findings, or positive answers to pre-screening questions such as social history questions enquiring about drug use.[47]American College of Surgeons. Best practices guidelines: screening and intervention for mental health disorders and substance use and misuse in the acute trauma patient. Dec 2022 [internet publication]. https://www.facs.org/media/nrcj31ku/mental-health-guidelines.pdf

Work setting

There are various point of care tests that are used in the workplace for workplace drug screening. These universally employ immunoassay tests to screen for different drug classes including cocaine. Urine or oral fluid (saliva) drug testing may occur in the course of employment for those in particular occupations (law enforcement, transportation, military) or as a prerequisite for employment. Whether or not 'For Cause' testing is permitted depends largely on union contract stipulations. The results of workplace testing must always be confirmed by additional testing, usually liquid chromatography/tandem mass spectroscopy (LC/MS/MS).

Pregnancy

Healthcare workers should ask women about substance use, including alcohol and tobacco, at all antenatal visits. Self-report screening has been shown to be accurate (compared with urine toxicology) in women using cocaine.[48]World Health Organization. Guidelines for identification and management of substance use and substance use disorders in pregnancy. Nov 2014 [internet publication]. https://www.who.int/publications/i/item/9789241548731 The UK National Institute for Health and Care Excellence also recommends discussing recreational drug use during postnatal care if appropriate, and providing information and further care as required.[49]National Institute for Health and Care Excellence. Postnatal care. Apr 2021 [internet publication]. https://www.nice.org.uk/guidance/ng194 The UK drug misuse and dependence guidelines cover testing and assessment of women with substance use disorders who are in their childbearing years.[34]Department of Health and Social Care. Drug misuse and dependence: UK guidelines on clinical management. Dec 2017 [internet publication]. https://www.gov.uk/government/publications/drug-misuse-and-dependence-uk-guidelines-on-clinical-management