Treatment

• psychological interventions
  • arguably the most useful of the treatments, but will for the most part be conducted outside of the surgery. All treatment is improved by a positive, nonpunitive relationship with a key person, such as the GP or drug worker
• prescribed medication
  • prescribed medication should never be used in isolation from a whole package of care, including relapse prevention
    • drug therapy is only effective for the most part in treating individual symptoms such as depression or insomnia (short-term only) after crack or other stimulant use has ceased
    • there is no substitute medication for cocaine/crack and care must be taken not to attempt pharmacological treatment where there is little or no evidence base for such an intervention.
    • psychological therapies still remain the mainstay of treatment
    • benzodiazepines short term use can be useful to help agitation, to relax and to help sleep
      • should only be used in low doses (starting 30 mg or less of diazepam daily and reducing rapidly) and short-term (less than 2 weeks) - remember they have their own addictive potential
    • antidepressants such as selective serotonin reuptake inhibitors and lofepramine are important only if underlying depression is confirmed
      • should only be initiated after crack or stimulant use has ceased and SSRIs should be used with caution if cocaine use continues, because of the rare occurrence of the ‘serotonergic syndrome’

Reference:

• (1) RCGP (2004). Guidance for working with cocaine and crack users in primary care