What is Cocaine?
Cocaine is a powerful drug of the stimulant class that is made from the leaves of the coca plant, native to South America. Cocaine is a highly addictive substance and its common effects include vastly increased energy levels and increased alertness.
What forms does Cocaine come in and how is it used?
Cocaine typically comes in the form of a white, crystalline powder and is most often snorted, although it can also be injected or smoked. Snorting cocaine can irritate and damage nasal linings and can cause accumulated damage over repeated use.
Cocaine can also be Injected; a method which carries very high risk, including death from overdose (since cocaine is active at very small doses, making measuring amounts and overdose easy) and the risk of compulsive re-dosing as the effects of cocaine come on almost immediately are very short-lived.
Cocaine can also be processed to form a solid, rock-like substance known as crack cocaine, which is typically smoked and is known for producing a shorter, more intense high than powdered cocaine. This form is known to be highly addictive, more so than powdered cocaine and can cause significant damage to health and lifestyle precisely because of its addictive nature. Smoking also carries risks of lung damage and inhalation of carcinogenic (cancer-causing) elements.
Cocaine can also be consumed by chewing raw coca leaves, however, this method delivers far less cocaine into the body than powdered or crack cocaine. It will not produce the sensations typically associated with cocaine use and has minimal risk when used in traditional ways, especially when compared with other forms and methods of cocaine administration.
How does Cocaine work in the body and brain?
Cocaine works primarily by increasing the levels of dopamine and epinephrine activation in the brain, along with a smaller spiking of serotonin.
Dopamine is the central chemical involved in the brain’s reward & pleasure centres and also plays a central role in motivating behaviour. For example dopamine is released when we eat or have sex; these are ‘good’ behaviours from the brain’s perspective as they are related to our survival and reproduction, and our brains give us a hit of pleasure (in the form of dopamine release) when we partake in them in order to motivate us to do them again.
Norepinephrine, also known as adrenaline, is the natural chemical most associated with high energy levels and our fight or flight responses. Our brains release adrenaline when we’re in potentially dangerous situations to prime our bodies to either fight or flee, and adrenaline is closely associated to high energy, increased heart rate & blood pressure and high alertness.
Serotonin is a neurotransmitter which has a hand in a plethora of functions in the body, including the regulation of sleep, mood, digestion and a host of others. Cocaine spikes serotonin the brain but in lesser amounts than other substances like MDMA or 2CB.
Our brain cells work by communicating with each other through electrical signals and chemical messengers called neurotransmitters (which is what dopamine and adrenaline are). When the brain sends a pleasure/motivation signal, one cell will fire dopamine molecules to another cell. On reaching the receiving cell, the dopamine molecules sit into receptors on that cell, thereby activating them (much like a lock and key). This activation sends a signal down the receiving cell, at which point the dopamine molecules pop out of their receptors and are taken up into their sending cells by small proteins – this process is called reuptake.
When cocaine is consumed it blocks the reuptake of dopamine and adrenaline into neurons. This causes an accumulation of these chemicals in the brain’s circuits and they continually activate the receptors on the receiving cells. This activation of dopamine circuits leads to the effects of cocaine including, increased alertness, pleasure, motivation to consume more, as well as physiological effects including increased respiration, high blood pressure and heart-rate. Eventually the brain breaks the cocaine down and the neurotransmitter levels in the synapse reduce, which is where the cocaine ‘comedown’ comes from.
Recent research has also shown cocaine stimulates the production of a protein called ΔFosB. This is a gene-transcription factor, meaning it can change the ‘expression’ of the genetic code in a users’ body. ΔFosB has been most closely associated to addictive-personality traits, and the more ΔFosB a person has in their body the more the expression of the genes associated with addictive behaviours is turned up. More on this in the ‘Is cocaine addictive?’ section, below.
What are the effects of Cocaine?
Given that a user administers a standard dose of cocaine, the drug typically brings about a surge of euphoria, alertness, confidence and a feeling of power and energy. Other positive effects can include mental clarity and elevated mood. These effects are typical of first-time or occasional use. Habitual or frequent users may experience fewer positive effects due to the build-up of tolerance.
Bodily effects of the drug include increased heart-rate, increased blood pressure, constricted blood vessels, increased body temperature and decreased appetite. These effects can be especially dangerous to those with existing heart or blood pressure issues, or those with a family history of heart conditions. Cocaine use has been associated with heart attacks specifically due to these effects.
Users also report an increased desire and ability to drink alcohol (should they be in an environment conducive to it, like a party or nightclub) and increased sexual appetite.
Negative effects can include agitation or irritability, due to the drug’s increased adrenaline activation, along with anxiety, impulsivity, possible headaches and decreased ability to think and remember things.
The drug also has local anaesthetic qualities and can numb parts of the body it comes into contact with, like skin, gums etc.
Long term use of the drug has only been associated with negative effects, such as anxiety, depression, paranoia, addictive behaviour, heart problems, sexual dysfunction and respiratory issues.
Cocaine has significant addictive and comedown effects on the body, more on these in the addiction and comedown sections below.
What are the dangers of taking Cocaine? Can they be avoided or reduced?
The dangers of taking cocaine are significant.
The first danger is not getting what you think is cocaine. As an illicit and therefore unregulated substance, cocaine producers and dealers can cut other compounds into the cocaine they sell to either increase profits or alter the effects of the drug. Added chemicals range from the banal to the life-threatening. The most dangerous of these potential adulterants is fentanyl; an opioid 50-100 x more powerful than heroin that has been linked with many drug overdose deaths. Fentanyl or other nasty substances like levamisole – a cattle de-worming drug which can cause skin-rot in extreme cases – has regularly been found in cocaine sold on the street.
To protect against unknown adulterants in any drug, is of utmost importance to test any substance with a reagent test before consuming any of it.
Reagent tests are legal chemicals which offer an easy colour-based test for drugs. Simply and carefully drop a couple of drops of the reagent chemical onto a small amount of what you think is cocaine. The substance will change colour when it reacts with the reagent chemical and you can cross-reference the colour change with the reagent colour chart that comes with the test (or you can search it on the internet). If the colour change (or lack of colour change) corresponds to the correct drug on the chart, you know the substance you have is actually cocaine (in this example). Reagent tests can pick up the presence of dangerous chemicals. This is an easy and inexpensive way to ensure the drug you have is actually what you think it is, and to make sure you aren’t taking something which could kill or do serious damage to you. It is essential to test any and all substances before taking them.
The other significant danger of cocaine use is the pressure it puts on a user’s heart and circulatory system. Cocaine’s increase of adrenaline activation in the body makes the heart pump faster whilst simultaneously constricting blood vessels. This raises blood pressure sharply and can put considerable strain on the heart. Those with existing heart or blood pressure issues are at great risk of harm from cocaine use, and there is even a chance those with no history of heart issues could suffer heart complications, damage or even death from cocaine use.
Frequent cocaine use can damage the heart and blood vessels over time, and heavy users are most at risk from cardiovascular complications. Bingeing on cocaine can result in heart attacks, strokes, organ failure and seizures through overheating. Sometimes long binges can cause psychosis, especially if more is taken instead of sleeping.
The other great danger of cocaine is addiction – more below.
Is Cocaine Addictive?
Cocaine is considered to be highly addictive, and is in fact rated as the third most addictive substance in the world, and the second most dangerous (with heroin being both the most dangerous and addictive, and alcohol the second most addictive and fifth most dangerous substance), according to studies by David Nutt and Imperial College, London.
Cocaine’s highly addictive nature comes from how the drug asserts its mechanism in the brain and body. It is thought to have a high potential for addiction because of its activation of dopamine and adrenaline receptors through blocking the reuptake of these neurotransmitters.
The brain and body need a certain level of activation of these chemicals to mediate normal neural & bodily functions. Due to the fact cocaine changes the level of activation of these neurotransmitters, the brain receives above-average stimulation of their associated receptors (which is where the drug’s effects come from). After time and repeated use of the substance the brain begins to ‘sense’ the levels of activation are too high, and compensates by reducing the number of receptors on the ends of receiving cells.
This is a process called downregulation and means that when users are not using the drug there isn’t enough dopamine or adrenaline activation in the neural circuits. This means users have to consume cocaine to bring the level of activation back up to meet the standard amount of activity – the amount needed just to regulate normal bodily functions. This is where a large part of the addictive nature of cocaine is thought to come from.
The other significant part of cocaine’s addictive nature has been seen in recent research which shows cocaine increases the level of a certain protein called ΔFosB. This protein is increased in cells in a part of the brain known for regulating motivation and reward behaviour – the mesolimbic pathway, the key part of which is called the Nucleus Accumbens (NAc). ΔFosB is a pace setting chemical and a gene transcription factor, which means it acts like a dial on our genes, and genes can govern a great many things like how our bodies work and even our behaviours.
ΔFosB has been most closely linked as the transcription factor that dials up addictive behaviours in a person, and experiments with mice showed that high ΔFosB levels led to a change in their cell’s gene expression, making them far more prone to addictive behaviours. Conversely, the lack of ΔFosB led to the opposite effect.
ΔFosB naturally lasts about 6–8 weeks before it breaks down, so repeated and regular use of cocaine can build it up to very high levels in a cell. When the cells replicate they do so with the new gene expression, meaning new cells will have the same addictive gene dial cranked all the way up (which also means if the person conceives children in this time, the ‘addictive behaviour’ gene can be passed down to the child dialled all the way up). This addictive behaviour default originates in the part of the brain responsible for reward and positive association and causes more addictive patterns in anything the person does, since all reward behaviour flows through the same area of the brain that cocaine affects.
Regular cocaine use can actually change a person’s genes and give them not only an addiction to cocaine, but more of an addictive personality in general.
Are there any health conditions that make Cocaine use 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 a higher risk of serious harm or death.
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.
Does Cocaine have a comedown? How does it feel?
Cocaine does have a comedown and symptoms vary in intensity and duration depending on the user’s personal physiology, the amount taken and how frequently the user consumes.
Comedown symptoms are thought to emanate from cocaine’s hijacking of the brains dopamine and adrenaline supplies and the subsequent effects they have on the body.
Cocaine is a highly energetic substance through its use of the body’s adrenal system, which leads to increased heart rate, blood pressure and alertness. The body uses up a considerable amount of energy while on the drug and therefore fatigue often ensues after it has worn off.
Cocaine can cause feelings of euphoria while it is active in the body due to its increased dopamine activation, but this can quickly give way to feelings of depression and sadness when the drug wears off as the brain does not have enough dopamine left over to properly mediate its natural amount of dopamine activation.
Cocaine can cause feelings of anxiety, especially when the user is coming down from a high, thought to be because the brain does not have enough dopamine, (and possibly serotonin) in its circuits immediately after the drug has worn off to properly mediate the user’s mood. As well as this cocaine modulates the brains excitability network and causes surges in glutamate neurotransmission which could contribute to these symptoms.
Some people may experience feelings of irritability and agitation during a cocaine comedown, a result of coming off an adrenaline and dopamine rush.
Cocaine use can interfere with a person’s ability to concentrate, often especially pronounced during a comedown. This may be due to fatigue, hunger and possibly anxiety.
Many people can experience an increased appetite during a cocaine comedown. This may because the drug can suppress appetite while it is active and so the body is starved of food for that time, whilst also using up large amounts of stored energy. Research has suggested cocaine use can alter the body’s mechanisms of fat storage, metabolism and satiety in a user. Namely that cocaine use seems to increase a user’s appetite for fatty food, while simultaneously altering their metabolism which keeps the fat mass in their bodies low (essentially they eat more fatty food without holding onto as much fat in their bodies). Coming off cocaine seems to bring metabolism back to its original rate but keeps the user’s new craving for fatty foods intact. As a result people coming off cocaine often complain of weight gain.
Cocaine use can interfere with sleep and this can be especially pronounced during a comedown. Some people may have trouble falling asleep, while others may experience restless or disturbed sleep. This is because of the excess adrenaline that may be left in the blood after a cocaine high, as adrenaline is the body’s most energetic hormone.
This list is not exhaustive and other comedown symptoms could appear. Comedowns can last a few hours to a few days, with some lasting a week or two. The only way to completely avoid a comedown is not to take cocaine at all. Symptoms can potentially be minimised in a few ways. Firstly ensure what you have is cocaine and not any other drug or cocaine laced with another other substance (test your substance using a reagent test). Secondly ensure you don’t have any underlying health conditions such as heart issues, blood pressure issues, depression, anxiety, psychosis or others that cocaine use may exacerbate. Thirdly keep the dosage low, as higher doses are almost guaranteed to lead to a comedown.
Can Cocaine be mixed with other drugs?
Drug-drug interactions can often be unpredictable and/or dangerous, especially when it comes to unregulated substances, so it is highly advisable not to mix cocaine (or any other drug) with any other illicit drugs. If mixed, the substances may interact in strange or unforeseen ways which could be seriously threatening to health or life.
Alcohol is often mixed with cocaine, but this combination is more dangerous than either drug alone. The two drugs interact in the body to form another compound called cocaethylene, which causes a longer duration of stressful effects on the body. Alcohol increases the amount of cocaine absorption gets into the bloodstream and by masking some of the sedating and confusing effects of alcohol with a stimulant, users may end up drinking more and not feeling the effects of the alcohol, which is dangerous for over-drinking. Heart rate rises further when the drugs are mixed than compared with either substance alone, posing greater risk to the cardiovascular system.
Mixing cocaine with any other illicit substances like heroin or ecstasy is extremely dangerous and carries a high risk of death, for these substances also act as stressors on the brain and bodily systems and the interactions between them can cause serious harm.
Cocaine should not be taken if a person is on any medication which affects the same systems in the brain and body that cocaine affects. For example anyone on heart, blood pressure or cardiovascular medication should steer well clear of the drug, as should those taking any medications that interact with the brains dopaminergic, adrenal or serotonergic systems (anti-depressants in the forms of SSRIs, SNRIs, MAOIs and others).
Does Cocaine have any medical uses?
Currently, cocaine is regarded as having little potential for medical use. It has been historically used as a local anaesthetic in medicine and dentistry, due to its numbing properties and the fact it can cause local anaesthesia without causing drowsiness, but due to its side effects, addictive qualities and a high potential for abuse, it is not used in any official medical settings or procedures.
What are the harms of Cocaine addiction and withdrawal? Are there any lasting effects?
Cocaine is regarded as one of the most addictive drugs in the world and addiction carries significant dangers not only for the user and their health, but also the user’s life in general (be it professional, social, familial etc.) and also the people close to them. Crack cocaine is particularly addictive, and those who consider themselves as having existing addictive personality traits should steer clear of all variations of the drug.
Cocaine withdrawal can happen when a person binges on large amounts of cocaine and then stops, or when a heavy or frequent user stops or completely cuts down their drug use. Withdrawal symptoms are generally the same type of symptoms as a cocaine comedown, like fatigue, irritability, anxiety and difficulty sleeping, but which can last much longer than a mere comedown (some withdrawal symptoms may last weeks or months). Additional symptoms can present themselves on withdrawal, especially for former heavy users of the drug, like psychosis, paranoia and paranoid delusions/hallucinations like insects crawling all over the skin.
Long term snorting of cocaine can cause damage to nasal linings and the nose in general, and smoking it can cause lasting damage to the lips, nose, air passage and lungs. In extreme cases cocaine has cause damage and even holes in the septum (the middle part of the nose) and possibly the roof of the mouth. Heavy cocaine use can erode blood vessels in the parts of the body it affects (the nose when snorted and mouth & lungs when smoked) due to its blood vessel constriction effects, coupled with the fact these constrictions allow less oxygen to travel through the vessels and reach the parts of the body cocaine effects.
Cocaine use is particularly damaging to the body and brain, especially given its highly addictive nature and potential damage to brain and cardiovascular system, especially when used heavily or frequently.
Cocaine Harm Reduction Advice
Taking cocaine always carries a significant risk of harm to the user and others around them, regardless of if the user is a first timer, experienced or heavy user. The only way of avoiding the dangers of cocaine altogether is not to take the drug. However, there are steps a person can take to minimise the dangers and potential risks of the drug.
Are you buying actual cocaine?
As an illicit drug the cocaine industry is unregulated, so it is impossible to know if the cocaine you buy is pure or mixed in with other drugs or cutting agents. Street drugs are generally impure, with studies showing cocaine has an average purity of 53-68% when bought on the street. The potential for dangerous or life-threatening drugs laced into cocaine is ever-present, and to ensure safety it is imperative to test any substance with a reagent test before consuming any of it. Reagent tests are legal chemicals which can tell you if a drug has any other substance in it and provide a fast and inexpensive way of ensuring you don’t take a substance which could very well kill you. Refer to ‘What are the dangers of taking Cocaine? Can they be avoided or reduced?’ above for a more detailed guide on how to use reagent tests.
Just like any substance the effects of cocaine are dose dependent. Too high of a dose really could mean risk to life due to the drug’s speeding up of the heart and constricting of blood vessels, not to mention a horrendous comedown or a great desire to do the drug again and fall into addiction. Cocaine is active in the milligram range and so estimating a dose by eye can be dangerous. Use a proper scale to measure out a dose and ensure smaller doses to stay safe. Taking too much can lead to health risks during the high and terrible comedown symptoms.
Do not mix
In order to stay safe do not mix any legal, illegal or prescription drugs with cocaine. This includes other illicit substances like ecstasy or heroin, legal substances like alcohol, or medications which affect the same parts of the brain and body cocaine affects. Drug-drug interactions can be dangerous and unpredictable, so it is always best to err on the side of caution.
Be mindful of how often you take the drug
Cocaine is an intensely addictive substance – not only for its hijacking of your dopamine system but also from the fact is dials up the ‘addictive behaviour’ gene in the part of your brain which deals with reward and pleasure. Be mindful of how often you take the substance and how much you take, for it is very easy to fall into a spiral. Frequent use also builds tolerance, which further increases addiction and also vastly decreases the pleasurable effects of the drug itself, to the point they can no longer be felt.