Cocaine Frequently Asked Questions

Cocaine abuse and addiction continue to be a problem that plagues the United States. Cocaine is a highly addictive drug, currently a Schedule II substance. Cocaine is categorized as a stimulant.

Like most stimulants, cocaine can heighten activity in the body, including heart rate, blood pressure, alertness, and energy. The most commonly used form of the drug is a white powder which is found in the leaves of the Erythroxylon Coca plant, which has been used in South America for hundreds of years.

First introduced in the United States in the 1880s as a surgical anesthetic, cocaine soon began being used as a common household drug, as well as an ingredient in Coca-Cola and other drinks. It was classified as a Schedule II drug in 1970.


What Is Cocaine?

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Cocaine is one of the oldest known psychoactive substances. The leaves of the Erythroxylon coca bush have been chewed and ingested for thousands of years. Cocaine hydrochloride, the purified chemical extracted from the plant has been abused for more than 100 years.

In the early 1900s, cocaine was the active ingredient in many of the tonics and elixirs that were marketed at the time to treat a variety of conditions and illnesses. It was an ingredient in the original formula for the soft drink Coca-Cola.

The peak of the drug's popularity came in the 1980s and 1990s when it was known by names like the Movie Star Drug and California Cornflakes.​

Cocaine is a very addictive stimulant that directly affects the brain. It is a Schedule II drug which has the high potential for abuse, but can also be administered for legitimate medical purposes, such as a local anesthetic.

However, cocaine is mostly sold on the street illegally as a fine white powder. Many times it is mixed with other substances like cornstarch, talcum powder or sugar to dilute its purity. Sometimes it is mixed with amphetamine or with heroin in what is known as a "speedball."

Cocaine is also sold on the street in a freebase form known as crack cocaine. The base form of cocaine is processed with ammonia or baking soda and water then heated to remove the hydrochloride to produce a smokable version of the drug.​

The term "crack" refers to the crackling sound the substance makes when it is smoked.


What Is Crack Cocaine?

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When powdered cocaine hydrochloride is processed into a smokable substance it is called freebase, or in street terms, crack cocaine. The term "crack" actually refers to the crackling sound the freebase form of the drug makes when it is burning.

Using ammonia or sodium bicarbonate (baking soda) and water, powdered cocaine is heated to remove the hydrochloride. This produces the freebase, or smokable form of the drug.

When users smoke crack cocaine the experience a high almost immediately (usually less than 10 seconds). Because the high is immediate and euphoric and because crack is relatively inexpensive to produce and buy on the street, the drug became extremely popular in the mid-1980s.

The immediate high and the relatively quick "crash" after the first rush, is also the reason that crack cocaine is very addictive.


What Is the Scope of Cocaine Use in the United States?

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The number of current cocaine users has been declining steadily since the 1980s and that decline has continued into the 21st Century. According to the National Survey on Drug Use and Health (NSDUH), in 2012 there were 1.6 million cocaine users aged 12 or older, or about 0.6% of the population.

That number is similar to the 2011 rate (1.4 million and 0.5%) but significantly lower than the current cocaine users between 2003 and 2007 (2.4 million users or 1.0%).

Although the greatest number of cocaine users are young adults between age 18 and 25, from 2005 to 2012 the number of current users in that age bracket dropped from 2.6% to only 1.1%.

Additionally, the number of new cocaine users is also declining. The number of people who initiated cocaine use for the first time during the past year dropped from 1.0 million in 2002 to 639,000 in 2012.

Likewise, the Monitoring the Future survey, which surveys 8th-, 10th- and 12th-grade students annually, has shown a steady decline in past-month cocaine use by students from a peak in the 1990s through 2013.


How Is Cocaine Used?

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Cocaine can been taken by various methods: oral, intranasal, intravenous, and inhalation. Or, as these methods are known on the street, "chewing," "snorting," "mainlining," "injecting," and "smoking."

Except for approved medical use, there is no safe way to use cocaine in any form. All of the following methods of using the drug can lead to absorption of toxic levels of cocaine, possible acute cardiovascular or cerebrovascular emergencies, and seizures, according to the National Institute on Drug Abuse. Any of these can lead to sudden death.


Intranasal administration is snorting, the process of inhaling powdered cocaine through the nostrils. It can also be rubbed onto the mucous tissues and absorbed in the bloodstream.

Typically, when a user snorts cocaine, the drug is placed on a flat surface like a mirror and separated into "lines" with a razor blade or credit card, then the lines are snorted through a straw or a rolled-up dollar bill. In the 1980s it was considered gauche in some circles to snort cocaine with anything but a $100 bill.


Intravenous use or injecting is when a hypodermic needle is used to inject cocaine directly into the bloodstream, which increases the intensity of its effects.

Because powder cocaine is actually cocaine hydrochloride, the salt (HCL) makes it soluble in water so that it can be injected. Problems can occur when cocaine purchased on the street is laced with unknown substances that are not so easily soluble.


Smoking cocaine involves inhaling smoke or cocaine vapor into the lungs where its absorption into the bloodstream can be almost as rapid as injection. This produces an almost immediate and euphoric effect which is one of the reason smoking crack cocaine became so widespread in the 1980s.

The Method of Use Affects the Effects

When cocaine is snorted, its effects begin after a few minutes and last between 15 to 30 minutes depending on the dosage size and the tolerance of the user. A large dose will last slightly longer, but as the user builds up a tolerance to the drug, it takes larger and larger doses to achieve the same effect.

When cocaine is smoked, the effects of the drug begin almost immediately and intensely, but the effect "wears off" quickly—in maybe five or 10 minutes. This is one reason that crack cocaine is so addictive, users tend to smoke more and more of it to try to recapture the feeling of that first, intense high.

When cocaine is injected the effect is immediate and even more intense. Because of the intense and quick effect of smoked and injected cocaine, these methods of use are considered more dangerous because of the potential for addiction and the potential of overdose.


How Does Cocaine Produce Its Effects?

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Many years of scientific research has been required to achieve a clear understanding how cocaine affects the brain to produce its pleasurable effects and the reason it is so addictive.

Scientists have found regions of the brain that seem to be stimulated by all kinds of stimuli—food, sex, and drugs of abuse. One of these regions most affected by cocaine is the ventral tegmental area (VTA) in the midbrain.

The way the brain normally functions, research has found, is by nerve fibers in the VTA extending to another region of the brain called the nucleus accumbens, a key region of the brain involved in reward.

Normal Brain and Dopamine Function

Rewards increase levels of dopamine, a brain chemical or neurotransmitter, which in turn increases neural activity in the nucleus accumbens. Under normal circumstances, dopamine is released by a neuron into the small gap between the neurons (synapse) where it then binds to specialized proteins, known as dopamine receptors, on the other neuron, sending a signal to that neuron.

After the signal is sent, dopamine is removed from the gap between the neurons and is recycled for use in the future.

Reward System Amplified

Science has discovered that cocaine and other drugs of abuse can interfere with this normal communication process in the brain. Cocaine use blocks the removal of dopamine from the synapse causing an "amplified" signal being sent to the receiving neurons.

This amplified signal is what cocaine users perceive as an initial euphoria or high.

But after that initial high, a neurochemical rebound takes place in the brain that causes the reward function to drop below its original normal level. When cocaine is used again, the same level of euphoria is not achieved.

This phenomenon produces a tolerance for the drug in the user, meaning they need higher doses or more frequent doses for the brain to try to achieve the same level of pleasure experienced during their initial use. This cycle of increasing cocaine doses to get the same high can produce an addiction.

Pathological Pursuit of Rewards

Cocaine users develop a tolerance to the "high" they get by using the drug, but they do not develop a tolerance to the emotional low they feel after the high wears off. Consequently, rather than turning to a state of "normal," they revert to a deeper state of dysphoria.

Therefore, they increase the amount of cocaine they use to try to ease that feeling of dysphoria and try to get back to that initial feeling of euphoria. However, they end up experience even deeper lows as the brain reacts to the cycle of intoxication and withdrawal.

That is the point at which the American Society of Addiction Medicine (ASAM) says that the pursuit of rewards becomes pathological and reward-seeking becomes compulsive in spite of the fact that the "high" is no longer pleasurable and the drug does not provide any relief from dysphoria.

Prolonged or chronic use of cocaine plays such havoc with the brain's natural reward system to the point that using cocaine no longer produces its initial pleasurable effects.


What Are The Short-Term Effects of Cocaine Use?

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Almost immediately after taking cocaine, the user begins to feel its effects, whether it is snorted, injected or smoked. Even small doses of the drug can make the user feel euphoric, energetic, talkative, and mentally alert.

Users report a heightened sensitivity to sight, sound, and touch. They can also experience a decreased need for food or sleep, at least temporarily.

Although some cocaine users find that using the drug helps them perform simple intellectual and physical tasks more quickly, other users report that cocaine has the opposite effect.

The method by which cocaine is used can affect how high the user feels and how long the high lasts. For example, snorting cocaine does not produce as intense a high as smoking it, but the high lasts longer. A high from snorting may last 15 to 30 minutes, while a high from smoking cocaine might last only 5 to 10 minutes.

The faster the drug is absorbed into the bloodstream, the more intense the high, but the shorter the duration.

Short-term physiological effects of cocaine can include:

  • Constricted blood vessels
  • Dilated pupils
  • Increased body temperature
  • Increased heart rate
  • Increased blood pressure

Users who take large amounts of cocaine might intensify their high but may experience bizarre, erratic, and violent behavior. They may also experience:

  • Tremors
  • Vertigo
  • Muscle twitches
  • Paranoia
  • Restlessness
  • Irritability
  • Anxiety

According to the National Institute on Drug Abuse, repeated doses of cocaine can produce a toxic reaction closely resembling amphetamine poisoning.

Although it is rare, sudden death can occur on the first use of cocaine or unexpectedly with later doses of the drug. Cocaine-related deaths are often a result of cardiac arrest or seizures followed by respiratory arrest.

Alcohol Increases Cocaine Dangers

Some cocaine users report the drug gives them a feeling of power and confidence. Many times they think they are functioning on a higher level than they actually are. Therefore, driving while doing cocaine can be dangerous especially if you are drinking also.

When drinkers are doing cocaine they have a tendency to drink more than usual because they don't experience the depressant effects of alcohol because of cocaine's stimulant properties. However, when the effect of the cocaine begins to wear off, the drinker is left more intoxicated than he realized, increasing the risk not only of accidents but vomiting, slowed respiration and possible loss of consciousness.

When cocaine and alcohol are used together, they are combined in the liver to form cocaethylene, which intensifies the euphoric effects of cocaine. But, it also increases the strain on the heart and the risk of sudden death.

Withdrawal Symptoms

As the effect of cocaine begins to wear off, you can experience a number of withdrawal symptoms, including irritability, aggression, restlessness, anxiety, insomnia, depression or paranoia.

Because of these unpleasant withdrawal symptoms, many cocaine users report difficulty in "coming down" from the drug. Many users report depression immediately after the drug's effects wear off, which for some can last for days.

Consequently, some users will take more cocaine to avoid the unpleasant withdrawals—another reason cocaine is considered so highly addictive.

Do you think you may need treatment for drug abuse? Take the drug abuse treatment screening quiz to find out.


What Are the Long-Term Effects of Cocaine Use?

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One of the most dangerous consequences of using cocaine is its powerful addictive qualities. Even after one use of the drug, users are not reliably able to predict or control how much he or she will continue to use cocaine or want to use it.

Once someone becomes addicted to cocaine, quitting without relapse become extremely difficult, even after long periods of abstinence. National Institute of Drug Abuse research has shown that even after not using cocaine for long periods of time, exposures to triggers associated with cocaine—or even memories of past cocaine experiences—can set off tremendous cravings and relapses.

When cocaine users continue to use the drug, the brain begins to change its reward system. A tolerance to the drug can develop, meaning that higher or more frequent doses of cocaine is needed to produce the high experienced on initial use.

At the same time, users can become more sensitive to cocaine's anxiety-producing, convulsant and other toxic effects.

Psychological and Physiological Effects

With repeated cocaine binges, when the drug is used repeatedly at increasingly higher doses, the user can risk adverse psychological and physiological effects, including:

  • Increased irritability
  • Restlessness
  • Panic attacks
  • Full blown psychosis involving paranoid delusions and hallucinations

The method by which cocaine is used can produce specific adverse effects. Snorting cocaine can lead to:

  • Loss of the sense of smell
  • Nosebleeds
  • Problems swallowing
  • Hoarseness
  • Irritation of the nasal septum
  • Chronic inflamed, runny nose

Ingesting and Injecting Cocaine

Users who ingest (chew) cocaine can experience severe bowel gangrene due to reduced blood flow.

Those who inject cocaine with needles can develop "tracks" on their forearms and other injection areas. They can also develop allergic reactions, both to the cocaine itself or to additives used to cut the drug by street dealers.

According to the NIDA, many chronic cocaine users lose their appetite and experience significant weight loss and show signs of malnourishment.

More Long-Term Effects

There are other long-term effects of using cocaine over a period of time. Some of them include:

  • Irregular heartbeat, heart attack, and heart failure
  • Neurological incidents, including strokes, seizures, and hemorrhaging in tissue surrounding the brain
  • Sleeplessness
  • Sexual dysfunction
  • Perforated nasal septum
  • Fluid in the lungs, aggravation of asthma and other lung disorders, and respiratory failure
  • Increased risk of traumatic injury
  • Aggressive, violent, or criminal behavior
  • Increased risk of hepatitis, HIV infection, endocarditis, and fungal brain infections (for IV users)

What Are the Medical Complications of Cocaine Abuse?

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The use of cocaine can produce extensive and massive medical complications, the most frequent of which are cardiovascular effects, including disturbances in heart rhythm and heart attacks.

Cocaine use can cause such respiratory effects as chest pain and respiratory failure; neurological effects, including strokes, seizure, and headaches; and gastrointestinal complications, including abdominal pain and nausea.

The repeated use of cocaine has been linked to many types of heart disease. Cocaine has been found to trigger chaotic heart rhythms, called ventricular fibrillation; accelerate heartbeat and breathing; and increase blood pressure and body temperature. Physical symptoms may include chest pain, nausea, blurred vision, fever, muscle spasms, convulsions, and coma.

Adverse Effects of Snorting Cocaine

The different ways that cocaine is used can produce different adverse effects. Regularly snorting cocaine, for example, can lead to loss of sense of smell, nosebleeds, problems with swallowing, hoarseness, and an overall irritation of the nasal septum, which can lead to a chronically inflamed, runny nose.

Ingested cocaine can cause severe bowel gangrene, due to reduced blood flow. And, persons who inject cocaine have puncture marks and "tracks," most commonly in their forearms.

Injection Dangers of Cocaine

Users who inject cocaine may also experience an allergic reaction, either to the drug or to some additive in street cocaine, which can result, in severe cases, in death. Because cocaine has a tendency to decrease food intake, many chronic cocaine users lose their appetites and can experience significant weight loss and malnourishment.

For intravenous (IV) cocaine users, there is, of course, an increased risk of hepatitis, HIV infection, and endocarditis.

Hazards of Cocaine and Alcohol

Research has shown a potentially dangerous interaction between cocaine and alcohol. Taken in combination, the two drugs are converted by the body to cocaethylene. Cocaethylene has a longer duration of action in the brain and is more toxic than either drug alone.

While more research needs to be done, it is noteworthy that the mixture of cocaine and alcohol is the most common two-drug combination that results in drug-related death.


Are Cocaine Abusers at Risk for HIV/AIDS and Hepatitis?

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Cocaine users are at greater risk for contracting infectious diseases, including human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and viral hepatitis.

Sharing contaminated needles and other drug paraphernalia is one cause for the increased risk, but also because intoxicated drug users are more likely to engage in risky behaviors.

National Institute on Drug Abuse research shows that drug use and addiction compromises judgment and the ability to make decisions, which can lead to needle sharing, risky sexual encounters, and trading sex for drugs—by both men and women.

Cocaine and HIV and Hepatitis C

The role of sexual transmission of HIV in drug users has been brought to light by some studies that have shown that those drug abusers who do not inject drugs are contracting HIV at rates equal to those who are injection drug users.

Injection drug users are also at increased risk for contracting hepatitis C (HCV). NIDA research shows that the risk of contracting HCV begins with the very first drug injection. Within two years 40% of injection drug users are exposed to the virus and by five years the risk rises to between 50% and 80%.

The NIDA recommends HCV testing for any patient who has ever injected drugs.


What Is the Effect of Maternal Cocaine Use?

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Scientists have not been able to determine the complete effect that cocaine use by a pregnant woman has on her child, but studies have found some common risks. Babies whose mothers abused cocaine while pregnant are often:

  • Prematurely delivered
  • Have low birth weights
  • Have smaller head circumferences
  • Shorter in length

One reason that researchers have not been able to determine the full extent of maternal drug abuse or specific hazards of cocaine on an unborn child is because if the mother is abusing cocaine, there is likely that other factors may be at play in her life that could also affect the baby.

Other Factors Play a Role

Some of the other factors that could impact maternal, fetal and child outcomes include:

  • Amount and number of drugs abused
  • Use of nicotine
  • Extent of prenatal care
  • Violence in the environment
  • Socioeconomic conditions
  • Maternal nutrition
  • Exposure to sexually transmitted diseases
  • Other health conditions

Cognitive Effects on Baby

Other consequences of prenatal cocaine abuse that researchers have been able to identify include deficits in some aspects of information processing, attention to tasks, and cognitive performance. All of these deficits could hamper the child's achieving his or her full potential, the National Institute on Drug Abuse said.


What Treatments Are Effective for Cocaine Abusers?


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Cocaine addiction can be a complex condition, causing the addict issues not only with the addiction itself but with a wide variety of personal problems. Treatment for cocaine, therefore, needs to be a comprehensive approach to addressing the addict's social, family and other environmental problems.

According to the National Institute on Drug Abuse, cocaine treatment strategies need to include assessment of the neurobiological, social, and medical aspects of the patient's drug use. Many times this includes multiple drugs of abuse.

Additionally, those who are addicted to multiple drugs also often have other co-occurring mental health issues which also must be addressed in treatment.

Pharmacological Approaches

There are currently no medications approved by the U.S. Food and Drug Administration to treat cocaine addiction, although aggressive research is being conducted to find and test new medications that can help cocaine addicts.

Some of the medications currently being tested are those that are FDA approved for other conditions or diseases. Some that are showing promise for cocaine treatment include vigabatrin, modafinil, tiagabine, disulfiram, and topiramate.

New medications are being researched that block the effects of cocaine on various areas of the brain to help prevent relapse in patients who have already quit using the drug. This includes a "cocaine vaccine" that has shown "great promise," the NIDA says.

Behavioral Interventions

There are several behavioral treatments that are being used in residential and outpatient settings to treat cocaine addictions. Currently, they are the only approved and evidence-based treatments available for cocaine and crack cocaine abusers.

Some of these behavioral treatments include:

  • Motivation incentives (contingency management)
  • Cognitive-behavioral therapy
  • Therapeutic communities (residential programs)
  • Support groups (such as Cocaine Anonymous)
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