From the Guidelines
If you have a wound related to cocaine use, seek immediate medical attention to prevent infection and promote healing. Cocaine can cause tissue damage and impair healing through vasoconstriction, which reduces blood flow to tissues, leading to tissue death, infection, and delayed healing 1. The effects of a wound caused by cocaine use can be severe, and it is essential to prioritize morbidity, mortality, and quality of life when managing such wounds.
Key Considerations
- Clean the wound with mild soap and water, apply an antiseptic like povidone-iodine, and cover with a sterile bandage to prevent infection.
- Medical professionals may need to prescribe antibiotics like cephalexin 500mg four times daily for 7-10 days if infection is present, as cocaine-related wounds are particularly concerning and may become infected easily, especially if the drug was injected 1.
- Stop using cocaine to allow proper healing, as continued use will worsen the wound.
- Watch for signs of infection, including increased redness, warmth, swelling, pus, fever, or red streaks extending from the wound, which require immediate medical care.
Management and Treatment
The management of cocaine-related wounds involves a comprehensive approach, including wound care, pain management, and treatment of any underlying infections. According to the 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction, patients with cocaine-associated chest pain should be evaluated in a chest pain unit, and those at high risk should be admitted to monitored beds 1.
Prioritizing Morbidity, Mortality, and Quality of Life
When managing wounds related to cocaine use, it is crucial to prioritize morbidity, mortality, and quality of life. This involves providing timely and effective treatment, preventing infection, and promoting healing. By seeking immediate medical attention and following proper wound care and management, individuals can reduce the risk of complications and improve their overall outcome 1.
From the Research
Physical Effects of Cocaine Use
- Cocaine use can lead to the development of wounds, which can be a major health care problem 2
- The use of levamisole-laced cocaine is associated with a life-threatening syndrome characterized by a necrotizing purpuric rash leading to tissue destruction and necrotic wounds 3
Wound Care Considerations
- WOC nurses should consider levamisole-induced vasculitis in all patients presenting with unexplained vasculitis-type lesions, particularly when these lesions occur in the context of known or suspected use of illicit substances such as cocaine 3
- Wound care for patients with levamisole-induced vasculitis should be based on principles of moist wound healing, combined with judicious use of therapies with antimicrobial activity and nonadherent dressings to reduce pain 3
Complications of Cocaine Intoxication
- Cocaine intoxication can be complicated by the presence of other drugs, such as atropine, which can lead to clinical pictures that are difficult to discriminate and may have important consequences for treatment 4
Wound Infection Management
- Wound infection is associated with delayed healing, wound chronicity, increased risk of hospital admission, loss of limb or digit, and increased healthcare costs 5
- Identifying and managing wound infection early can contribute to faster wound healing, thus reducing the risk of negative outcomes 5
Treatment of Cocaine Use Disorders
- There are no Food and Drug Administration-approved medications for the treatment of cocaine use disorder (CUD), but psychosocial interventions, such as contingency management, have the most evidence for treatment of CUD 6
- Medication-assisted treatments (MATs) such as psychostimulants, modafinil, bupropion, topiramate, and disulfiram may be considered for patients who do not respond well to psychosocial interventions alone 6