Study Explores Cocaine Use, Risks During Methadone Treatment

A new qualitative study offers a detailed look at why cocaine use often continues during methadone treatment, and what keeps people engaged in care despite that ongoing use.

For anyone researching medical detox and opioid treatment, the findings help explain a pattern that shows up often in real-world recovery: methadone can be effective for opioid use, while other substance use continues alongside it.

Why This Study Matters

Published in the Substance Use & Addiction Journal, the study interviewed 21 patients at four opioid treatment programs in Baltimore who had a recent history of both opioid and cocaine use and had recently started methadone treatment.

Researchers from Penn State and collaborating institutions conducted the interviews roughly three months after each participant entered treatment.

The study’s authors note that more than 80,000 people died of drug overdoses in the United States in 2024, and that the shift from heroin to fentanyl, combined with rising stimulant use, continues to reshape the overdose crisis.

Methadone reduces non-prescribed opioid use and is linked to a lower risk of overdose death, but cocaine use among methadone patients has been increasing and can undercut those benefits.

What the Research Found

Three themes emerged from the interviews. First, participants described cocaine use as a response to physical and emotional factors, including trauma, grief, depression, boredom, and cravings that sometimes intensified after starting methadone.

One participant explained using cocaine “to give me energy” while managing depression; another described drugs as something that “lessen my pain away from the problem for a minute.”

Second, participants described cycles of drug use and recommitment to treatment, often triggered by an unwanted relapse, a personal decision to stop using, or growing awareness of the toll addiction had taken on their lives, relationships, and finances.

Third, participants pointed to specific supports that helped them stay in treatment: family and partner involvement, internal motivation tied to future goals like employment or education, relationships with counselors and sponsors, and a digital app that combined cognitive behavioral therapy content with small financial incentives for negative drug tests.

Understanding Methadone and Cocaine Use

Methadone is a long-acting medication used to treat opioid use disorder by reducing withdrawal symptoms and cravings for opioids like heroin and fentanyl. It does not directly treat cocaine use, which explains why some patients continue using stimulants even as their opioid use declines.

The study found that many participants believed their cocaine cravings could interfere with methadone’s effectiveness, a concern that aligns with existing research on how stimulant use complicates opioid treatment outcomes.

Contingency management, an approach that offers small incentives for meeting treatment goals like clean drug tests, and cognitive behavioral therapy have both shown effectiveness for reducing cocaine use during methadone treatment in prior research.

The study’s authors note these approaches remain underused, partly due to staffing and funding limitations, which is part of why digital delivery models are being studied as a more scalable option.

Finding Medical Detox and Methadone Treatment

Never attempt to stop opioid or cocaine use without medical guidance, since withdrawal and relapse both carry serious risks.

If you or someone you know is in methadone treatment and struggling with ongoing cocaine use, ask your provider about contingency management, cognitive behavioral therapy, or digital adjunct tools designed to support engagement.

Detox.com’s directory lists a variety of detox centers that can support your recovery. Call 800-996-6135(Sponsored) to find medically supervised detox and treatment programs that address both opioid and stimulant use.