What is cocaine?
Cocaine is a stimulant drug extracted from the coca plant which grows in regions of South America. In the Andean region the leaves, chewed or in tea, are believed to reduce the fatigue associated with the high altitude.
What are the different forms of cocaine?
Cocaine comes in different forms with distinct risks attached.
Powder cocaine (hydrochloride)- usually snorted
This is the most commonly encountered type in most of Europe. The whitish powder contains cocaine in its ‘salt’ form, usually cocaine hydrochloride. Users usually crush and chop it into a fine powder, then snort little lines or piles of it up their noses. On average, about a quarter of the powder is actually cocaine hydrochloride; the rest is just filler and adulterants to boost profits. Some of these are less toxic than cocaine itself, (e.g. sugars) but plenty of other drugs have been identified mixed into cocaine. Sometimes very harmful chemicals have been found like levamisole - a worming treatment used for livestock – which can have devastating effects on the immune and vascular systems, even leading to parts of the face dying.
Powder cocaine is also dissolved and injected by a minority of users. Injecting cocaine carries much higher risks than snorting it, or even smoking it. Overdose and death are more likely. Infections at the injection site and systemic infections like HIV are a risk. Given the typical low purity of cocaine, most of what is injected will be unknown substances. The effects hit hard but fade rapidly, so just minutes after injecting, users often feel a powerful urge to redose.
Crack cocaine- usually smoked
Smoking cocaine typically gives a faster, more intense rush of effects than snorting it, and is associated with a greater level of harms. Powder cocaine, the ‘salt’ form, cannot be smoked efficiently. Crack on the other hand is a crude form of cocaine ‘freebase’ that is made for smoking. It tends to comes in little yellowish, shiny nuggets, called ‘rocks’. They can vary in colour and texture. Smoking any substance can irritate or harm the lungs, and smoking crack can cause serious damage. The heat of a flame causes the creation of other chemicals, like methylecgonidine, which can increase harms. Whilst cocaine powder is widespread across many social groups, crack cocaine is usually associated more with disadvantaged and marginalised people, and the harms of crack addiction may be intensified further in the context of poverty. Crack cocaine reaches the brain and begins to cause effects almost immediately, whereas the effects take around 5-10 minutes to really get going when powder is snorted. This immediacy is part of what makes crack more dangerously addictive.
As well as smoking, some crack users inject, which requires the crack to be dissolved in a suitable acid first. Injecting is generally the riskiest and most damaging method of ingesting cocaine.
The leaves of the coca plant, which contain small amounts of the drug, have minimal risks when used in traditional ways.
How does cocaine work as a drug in the body and brain?
Cocaine is a plant alkaloid, which is a powerful central nervous system stimulant. It causes its effects by disabling mechanisms that mop up and recycle the noradrenalin, serotonin and dopamine released in the brain. This leads to a temporary increase in the amounts of these neurotransmitter chemicals, which stimulates many circuits in the brain. Dopamine is involved in ‘reward’ pathways in the brain, which is thought to be why cocaine can be highly addictive.
Does cocaine have any medical uses?
Currently cocaine has very limited medical uses as a local anaesthetic not a stimulant. For example, it can be an ingredient in a mouthwash to alleviate mouth sores and ulcer pain that can comes as a side-effects of chemotherapy in cancer patients. It also has some surgical uses, for instance nose or eye operations, but other drugs without cocaine’s side effects are usually preferred.
What are the effects of cocaine?
Typically, cocaine very quickly gives a surge of peaceful euphoria, alertness, and a feeling of power and energy. Users (especially when smoking crack) can feel intensely euphoric (the ‘rush’) and afterwards feel super-confident and happy, and urgently wanting to talk, dance, have sex, or otherwise do something with the energy they have. If the cocaine is very dilute, or the user has developed a tolerance, there may be little or no rush. With or without a rush, users typically experience pleasure, free-flowing ideas, and may talk very fast and excitedly. It usually makes users less interested in eating, but more interested in drinking alcohol and smoking cigarettes. Some people notice unpleasant effects too, like feeling anxious or impulsive, or finding the urgent rush of energy and raised heart-beat alarming.
Cocaine is also a local anaesthetic (hence its medical use), causing numbness of the throat and back of the tongue where it drips after being snorted, and a numb mouth when smoked. Sometimes people rub left-over cocaine on their gums which also numbs them. Other anaesthetising chemicals may be added to cocaine to disguise dilution, so the numbing feeling is not a mark of high purity.
Cocaine use typically has unpleasant effects too, as the chemical is cleared from the body, and the brain tries to recover its chemical balance. This is the ‘comedown’, where the user feels washed out, glum or grumpy, anxious or paranoid. Some users struggle to resist taking more cocaine to delay the inevitable comedown.
Whilst most users of powder cocaine manage to control their use so that they are less likely to experience serious harm, a significant minority find it very difficult to resist taking more, to see if they can push their euphoria higher, to recapture the initial rush, or to avoid the unpleasant crash of depression and anxiety that immediately follows moderate or heavy cocaine use. Users can binge, taking more and more every few minutes until their supply runs out.
What are the risks of using cocaine? Can they be avoided or reduced?
Cocaine is one of the drugs that regularly causes death. It also causes thousands of emergency hospital admissions, often with chest pain. Most people who die from cocaine are long-term users who take large quantities and whose bodies, particularly the heart, may have been damaged. The risks are lower when doses are moderate and use occasional. However, cocaine can and does severely harm and kill otherwise healthy people without a history of regular use or addiction.
Taking cocaine raises body temperature, blood pressure and heart-rate, and narrows blood vessels. Bingeing on cocaine can result in heart attacks, strokes, organ failure, and seizures through overheating. Sometimes, a long binge can cause psychosis, especially if more is taken instead of sleeping.
Cocaine, especially when combined with alcohol, can make some people impulsive, arrogant and aggressive, contributing to violent crime.
Are there health conditions that make cocaine more dangerous?
Yes. Due to cocaine’s effects on the cardiovascular system, if you have a pre-existing heart issues, or high blood pressure, cocaine use will have higher risk.
If you have any underlying mental health issues such as psychosis, anxiety or depression, cocaine, or the comedown, may exacerbate symptoms.
Cocaine lowers seizure threshold so if you have epilepsy cocaine could provoke seizures.
Mixing cocaine with other drugs
Mixing drugs makes the effects on your body and mind even harder to predict and manage.
Many people who die after taking cocaine had also taken other drugs at the same time. Alcohol is very often taken with cocaine, but this combination is more dangerous than either drug alone. The two drugs react in the body to form another drug, called cocaethylene. This seems to cause a longer duration of effects which are stressful to the body. Alcohol increases the amount of cocaine that gets into the blood and by masking some of the sedating and confusing effects of alcohol with a stimulant, users may end up drinking more. Heart rate rises further than the drugs cause alone.
Injecting a mix of cocaine with heroin, called ‘speedballing’, is reported to give distinct and intense effects, but this practise is exceptionally risky and addictive. Cocaine masks the sedating effects of the heroin and makes users feel confident, so users may take an overdose of heroin without feeling the warning signs.
Mixing cocaine with other stimulants increases the chance of overloading your body somehow, causing overdoses and even death through heart attacks, getting overheated, having seizures, or the toxic effects of a flood of too much serotonin in the brain.
Taking cocaine could be especially dangerous when taken on top of certain medications, especially ones that work on the mind, such as MAOI antidepressants. Cocaine reduces seizure threshold, which means that it takes less to cause a fit when a person is on cocaine. In combination with Tramadol and other drugs which also reduce seizure threshold, there could be a high risk of seizures.
How addictive is cocaine?
Cocaine, in all its forms, (excepting coca leaves/coca tea) is highly addictive, with injection and smoking crack generally thought to be the most addictive ways to take it. Humans and other animals generally enjoy cocaine intensely and want to repeat the experience. This desire in people seems often to override their awareness of the risks, and for some problem users, leads to crime to fund their habit. Some people use cocaine even when they are suffering from the effects that it is having on their life and health. Whilst the majority of people who use cocaine do so only experimentally or occasionally, a significant minority of people who try cocaine become addicted. Some users find it challenging or impossible not to binge, taking dose after dose, until they run out.
The brain responds to nice things like food and sex by releasing dopamine, which feels good and acts as a reward for seeking out those things. So dopamine is involved in the mechanism of the brain that tells use when something is good. One function of cocaine is preventing released dopamine in the brain from being mopped up again, so it builds up. This is very rewarding, producing a drive to seeking out and take more cocaine. Even so, drugs do not typically strip users of any ability to choose, and many people manage to limit or stop their use of cocaine when they suffer negative effects.
What are the harms of cocaine addiction and withdrawal?
Addicted users who inject cocaine, use cocaine with other drugs, and have chaotic lives, are usually those who suffer the most severe harms. With injection, in addition to the very high risk of overdose and death, there is the risk of infected wounds, heart damage and blood-borne diseases like hepatitis and AIDS.
What are the long-term effects of cocaine to health and wellbeing?
Bingeing on cocaine, especially when a user is neither eating or sleeping properly, can cause traumatic episodes of psychosis; for example paranoid delusions and realistic hallucinations that people are coming to arrest or attack you, or that insects (‘cocaine bugs’) are all over your skin.
Smoking cocaine (more precisely, inhaling hot cocaine vapour) can cause lasting damage to the lips, mouth and delicate lung tissues. So-called ‘crack lung’ can be both painful and disabling to lung function.
Snorting cocaine can cause destruction to the membranes, cartilage and even bone inside of the nose and head, sometimes causing holes in the septum (middle bit) of the nose, and very rarely holes all the way through the roof of the mouth. This, like ‘crack lung’, is partly because cocaine makes blood vessels contract, depriving tissues of the oxygen and nutrients needed to repair damage caused by the toxicity of the drug and the chemicals it can be mixed with.
Cocaine can cause you to compulsively pick at and scratch skin, producing wounds. Taking cocaine can make people anxious and paranoid; it makes nerves more sensitive, and can stop problematic users getting the diet they need to maintain physical health. These effects combine to make people itch and injure themselves in compulsive attempts to get rid of itches and even imaginary insects in the skin.
The highest rates of addictions to cocaine and crack are found in sections of society suffering from deprivation and joblessness. Harmful drug use is often part of a vicious circle, both contributing to, and resulting from the problems in people’s lives. People who are addicted to cocaine are likely in many countries to be arrested and imprisoned. A criminal record can make it harder to break the cycle that damages families and communities as a whole. Addiction can promote crime in order to buy drugs.
Cocaine harm reduction advice
Taking cocaine always carries dangers, and the only way to avoid harm is to avoid taking it. The highest rates of harm caused by cocaine are suffered by a small proportion of addicted users who persistently take large amounts of cocaine, often by smoking or injecting it, often with other drugs. Occasional social users are taking a risk, but they are less likely to get harmed, if they can avoid addiction.
What are you taking and how?
The riskiness of cocaine use varies hugely. Be very cautious about how much you consume, remembering that because purity is so variable, a line from one batch could be the equivalent of 5 lines from another batch. It is always possible to take more, but never possible to un-take what you have already taken! Snorting cocaine is thought to be less frequently harmful than injecting it or smoking crack.
Could you get addicted?
Anyone can get addicted. Having a little, once in a while, with other people around is obviously less risky than taking it in uncontrolled amounts, regularly, alone. However, the addictive qualities of this drug make it quite easy for moderate, social use to slide into chaotic, constant use. Being very vigilant over your use is vital. If you are taking more and more cocaine, more and more regularly, you may be on a slippery slope, as tolerance builds up encouraging higher doses, and cravings intensify. If you are struggling to control your use, or think you are addicted, seek professional help. The earlier you get help, the better the chance of avoiding lasting harm to your life.
Are you considering the harms cocaine can cause to others?
Cocaine addiction often spreads through social and familial networks. Many people who end up struggling with the harms of the drug first try cocaine when it is shared by well-intentioned friends and family. If you offer cocaine to others, there is a small but significant risk that the recipient will become addicted as a direct or indirect result.
European consumption of cocaine fuels the demand that leads to thousands of deaths in South and Central American conflicts between the gangs involved in the drug trafficking, and between them, armies and police forces.
Cocaine myths and misunderstandings
Is cocaine a great drug for sex?
Cocaine is used to enhance sex, but the risks and unwanted effects could outweigh any benefits. Some people report feeling higher sex drive and more sexual confidence on cocaine, and cocaine can give people stamina. However, it affects judgement, reduces inhibitions and increases impulsivity, which raises the risks of regretted experiences and harm. Cocaine can lead to unsafe, unplanned or rougher sexual behaviour, with less condom use, risking unplanned pregnancy, injuries and leaving users susceptible to HIV, Hepatitis B and other sexually transmitted infections. For men, it can also impair ability to achieve and sustain an erection, and make it very difficult to orgasm. There have been rare and painful cases of priapism (when an erection doesn’t pass) from cocaine use. This problem has required surgical intervention that can permanently damage the organ and its function. Sex and cocaine both put added pressure on the heart.
Any short-term benefits should also be balanced against potential long-term harms. People addicted to cocaine often lose interest in sex entirely, or suffer erectile problems.
If it looks good, and powerfully numbs my mouth, is it reliable stuff?
No, it’s virtually impossible to know the purity of cocaine without sophisticated drug testing equipment. Most cocaine contains many fillers and adulterants that can themselves be harmful. Often, other drugs with numbing effects are added to hide the extent of adulteration.