Will a patient who uses 0.5 grams of cocaine (Cocaine Hydrochloride) once per week experience withdrawal symptoms when quitting abruptly in a hospital setting?

From the Guidelines

A person using 0.5 g of cocaine once per week is unlikely to experience severe withdrawal symptoms if they stop abruptly while in the hospital, and management can be effectively undertaken in a supportive environment without specific medication for withdrawal 1. The primary symptoms of cocaine withdrawal might include fatigue, depression, increased appetite, irritability, and strong cravings for cocaine. These symptoms are typically manageable without specific medication intervention.

• The relatively infrequent use pattern (once weekly) suggests physical dependence may be limited compared to daily users.
• However, psychological dependence could still be present, and hospital staff should monitor for mood changes, sleep disturbances, and anxiety.
• Supportive care including hydration, nutrition, and rest is usually sufficient, as relief of symptoms (e.g., agitation, sleep disturbance) may be achieved with symptomatic medication for the period of the withdrawal syndrome 1.
• If significant psychological symptoms emerge, such as depression or psychosis, the individual needs to be monitored closely and advice sought from relevant specialists, if available 1.
• The cocaine withdrawal syndrome typically peaks within a few days and resolves within 1-2 weeks, with cravings potentially persisting longer.
• It is essential to note that the management of drug withdrawal, including cocaine, is best undertaken in a supportive environment, with additional psychosocial support considered if necessary 1.

From the Research

Cocaine Withdrawal

• The provided studies do not directly address cocaine withdrawal in the context of in-hospital cold turkey withdrawal 2, 3, 4, 5.
• However, study 4 mentions that SSRIs can reduce depressive symptoms and facilitate abstinence in individuals with cocaine use disorder, suggesting that cocaine withdrawal may be managed with medication.
• Study 2 discusses withdrawal syndromes associated with psychotropic medications, including benzodiazepines and antidepressants, but does not specifically address cocaine withdrawal.

Withdrawal Symptoms

• Study 3 compares the definitions of dependence and withdrawal reactions in the Diagnostic Statistical Manual of Mental Diseases (DSM) and the International Classification of Diseases (ICD), and finds that discontinuation symptoms for benzodiazepines and SSRIs are similar.
• Study 2 notes that all psychotropic medications, including benzodiazepines and antidepressants, can induce withdrawal syndromes and rebound upon discontinuation, even with slow tapering.

Clinical Implications

• Study 5 highlights the importance of considering the risks and benefits of medication use in older adults with anxiety disorders, and notes that benzodiazepine use can lead to dependence and adverse effects.
• Study 4 suggests that SSRIs can be effective in treating depression, anxiety, and substance use disorders, including cocaine use disorder, and may be a useful adjunct to withdrawal management.