Therapeutic vs. Recreational Use of Cocaine: Avoiding Diagnostic and Judicial Errors Through Interprofessional Collaboration—A Five-Case Report

<b>Background/Objectives</b>: Due to its potent local anesthetic and vasoconstrictive properties, cocaine is sometimes used in otolaryngologic surgical interventions. However, cocaine topical administration is not always adequately documented by practitioners, which can lead to serious legal consequences, particularly in the context of drug-impaired driving (DUID) investigations. This study retrospectively analyzes five road accident cases where cocaine was detected in biological samples after medical interventions. <b>Case descriptions</b>: Following pedestrian-car, or car-car accidents, five distinct patients aged between 30 and 84 years underwent maxillofacial surgery due to significant injuries. Given the severity of the accident and the circumstances, the police requested blood toxicological analysis to determine whether the patients were under the influence of psychoactive substances at the moment of the accidents. <b>Results</b>: The five cases described in this manuscript had blood cocaine concentrations exceeding the Swiss legal limit for drivers (15 µg/L). Since no information was initially provided about the medical use of cocaine after the crash, recreational use of cocaine was suspected. However, subsequent investigations confirmed that the cases involved medical administration. <b>Conclusions</b>: After sinonasal procedures involving the topical application of cocaine, patients may yield positive results on urine and blood drug tests, potentially resulting in serious legal repercussions, including the withdrawal of their driving license. Therefore, practitioners should thoroughly document the medical use of topical cocaine, particularly in DUID cases. These results also raise questions about the benefit-risk ratio of such use, considering that alternatives exist.