Cocaine Use: Recommendations in Treatment and Rehabilitation

1. Introduction

In Canada, the increasing rates of Hepatitis C, HIV/AIDS and overdose deaths have been associated with cocaine use among people who inject drugs, particularly in Vancouver and other large urban centres. The purpose of this report is to promote the use of effective interventions by providing information on cocaine and its effects, and identifying best practices in treatment and rehabilitation for individuals with cocaine-use problems. Issues of accessability to treatment for different population groups are not covered in this report, since they are addressed in other Health Canada reports on best practices, for example, Best Practices - Substance Abuse Treatment and Rehabilitation (Health Canada, 1999).

Following the introduction, section two of this report describes the historical context of cocaine use in North America, section three reviews available data on the prevalence of cocaine, and section four describes cocaine's short-and long-term effects. Sections five and six review the treatment literature on pharmacological and behavioural treatment interventions, and make recommendations for best practices.

This report is based on a literature review of medical, psychological and sociological journals. Studies referenced in the report were reviewed for methodological rigor. A bibliography of studies of sufficient quality for reference purposes is attached, as well as a brief list of key program resources available through the Web.

For purposes of evaluating response to pharmacotherapy, only studies that used randomized, double-blind procedures were selected. For the evaluation of behavioural treatment, studies that were included used

random assignment and a credible control or comparison treatment procedure. PsycLit and Medline were the primary sources of studies. For both, the search words "cocaine" and "treatment" were entered. The search included all articles to the end of 1997.^*

* Note: Some selected references dated after 1997 have been added to this report.