No, a patient should absolutely not give amphetamine to a cocaine user to "calm themselves"—this is dangerous and contraindicated.
Critical Safety Concerns
Amphetamines do not calm cocaine users; they are both stimulants that produce similar sympathomimetic effects and would compound toxicity rather than reduce it. 1
Why This Is Dangerous
- Both cocaine and amphetamines are stimulants that cause tachycardia, hypertension, hyperthermia, seizures, and increased psychomotor activity through sympathetic nervous system activation 1
- Combining stimulants increases the risk of life-threatening complications including cardiovascular emergencies, severe hyperthermia, seizures, and cardiac arrest 1, 2
- Cocaine produces its toxic effects through catecholamine reuptake inhibition (norepinephrine, epinephrine, dopamine, serotonin), leading to sympathomimetic toxidrome 1
- Adding amphetamine would only intensify these dangerous effects, not counteract them 2
Appropriate Management of Cocaine Toxicity
Benzodiazepines (such as diazepam) are the mainstay of initial management for blood pressure control and psychomotor agitation in acute cocaine poisoning 1, 3
Evidence-Based Acute Interventions
- Benzodiazepines provide significant protection against cocaine-induced seizures and death (p ≤ 0.01) 3
- Rapid external cooling is recommended for life-threatening hyperthermia from cocaine poisoning 1
- Vasodilators (nitrates, phentolamine, calcium channel blockers) are reasonable for cocaine-induced coronary vasospasm or hypertensive emergencies 1
- Sodium bicarbonate is reasonable for wide-complex tachycardia or cardiac arrest from cocaine poisoning 1
Treatment of Cocaine Use Disorder (Not Acute Toxicity)
While amphetamine maintenance has been studied for cocaine use disorder treatment, this is completely different from acute intoxication management and requires medical supervision.
Research Context (Not Applicable to Acute Situations)
- Amphetamine maintenance (0.32 mg/kg/h) in controlled studies showed some ability to blunt cocaine's rewarding effects by sustaining baseline dopamine levels 4
- However, a 2024 randomized trial found that mixed amphetamine salts-extended release (MAS-ER) did not significantly increase abstinence rates when added to behavioral interventions (15.6% vs 12.2% placebo) 5
- The most effective treatment for cocaine use disorder remains psychosocial interventions: Contingency Management plus Community Reinforcement Approach (NNT=3.7) 6, 7, 8
Critical Pitfall to Avoid
Never confuse potential medication-assisted treatment protocols (which require medical supervision and are for chronic use disorder) with acute toxicity management. Giving amphetamine to someone acutely intoxicated on cocaine is medically dangerous and could be fatal 1, 2, 3