What to Know About Cocaine Use

Cocaine is often stored loose in baggies

Sebastian Leesch / EyeEm / Getty Images

Cocaine is a highly addictive drug that 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 and has been used in South America for hundreds of years.

It was first introduced in the United States in the 1880s as a surgical anesthetic. 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 before its side effects and addictive properties were fully understood. It was classified as a Schedule II drug in 1970. In the United States, recreational cocaine use is illegal.

Also Known As: Common street names for cocaine are sometimes based upon the substance’s appearance, effects, place of origin, or to disguise its nature. A few of the more commonly used terms include powder, rock candy, blow, crack, sleet, and snow.

Drug Class: Cocaine is classified as a stimulant. It increases activity in the brain and temporarily elevates mood, alertness, and energy levels.

Common Side Effects: While cocaine can produce short-term feelings of euphoria, it also comes with a number of side effects including decreased appetite, paranoia, extreme sensitivity, irritability, headaches, mood changes, and an increased risk of stroke and heart attack.

How to Recognize Cocaine

Cocaine is mostly sold on the street illegally as a fine white powder. It is often mixed with other substances like cornstarch, talcum powder, or sugar to dilute its purity. Sometimes it is mixed with amphetamine or heroin in what is known as a "speedball." Cocaine is also sold on the street in a freebase form known as crack cocaine. Cocaine looks like white powder or rocks. It is often stored loose in baggies or packed into tight bricks.

What Does Cocaine Do?

Cocaine can be swallowed, snorted, injected, and inhaled. Except for approved medical use, there is no safe way to use cocaine in any form. All methods of use can lead to absorption of toxic levels of cocaine, possible acute cardiovascular or cerebrovascular emergencies, and seizures. Any of these can lead to sudden death.

Cocaine begins working almost immediately except when taken orally. Even small doses of the drug have a temporary stimulating effect on the body, which can make a person feel euphoric, energetic, talkative, and mentally alert.

Cocaine works by interfering with the 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.

The method by which cocaine is used can affect how high a person 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.

What the Experts Say

Cocaine presents a risk of both addiction and overdose. Because it impairs judgment, it can also lead to other risky behaviors such as engaging in needle sharing or unprotected sex. The National Institute of Drug Abuse's Cocaine Research Report states that cocaine use impairs the immune system, making people more susceptible to HIV or hepatitis infection.

There are a number of reasons why people choose to use cocaine in spite of the risks. Although some people find that using the drug helps them perform simple intellectual and physical tasks more quickly, others report that cocaine has the opposite effect.

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

Medical Uses

While cocaine is illegal as a recreational drug, it does have legitimate medical uses. It has both anesthetic and vasoconstrictive properties, which make it ideal for some medical purposes.

Cocaine can be effective:

  • As a local anesthetic
  • For use during upper respiratory procedures
  • For topical use in the form of cocaine hydrochloride

Common Side Effects

Cocaine use can result in both physiological and psychological side effects.

Physiological effects of cocaine can include:

  • Constricted blood vessels
  • Dilated pupils
  • Increased body temperature
  • Increased heart rate
  • Increased blood pressure
  • Weight loss
  • Nausea
  • Abdominal pain
  • Tremors
  • Vertigo

Psychological effects of cocaine use can include:

  • Panic
  • Aggression
  • Irritability
  • Anxiety
  • Depression
  • Repetitive behaviors
  • Poor judgment
  • Hallucinations
  • Paranoia

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.

Signs of Use

The National Institute of Drug Abuse (NIDA) reports that 14% of all Americans over the age of 12 have used cocaine at some point in their lives.

Some signs that someone you know might be using cocaine include:

  • The presence of drug paraphernalia such as syringes, razor blades, pipes, and small plastic baggies
  • Unplanned weight loss
  • Extreme mood swings and behavioral changes
  • Avoidance of social situations
  • Needle marks on the body
  • Frequent nosebleeds or runny noses
  • Changes in personal hygiene
  • Financial problems
  • Signs of withdrawal
  • Lying or stealing

Overdoses can occur unexpectedly, even on the first use. The risk of overdose can increase if cocaine is combined with other drugs or alcohol. Signs of overdose can include vomiting, tremors, and difficulty breathing.

If you suspect someone has overdosed on cocaine, call 911 immediately.

Common Myths

While the use of this substance is sometimes referred to as an epidemic, evidence shows that its use has largely been on the decline since its peak in the 1980s. According to the National Survey on Drug Use and Health (NSDUH), in 2017, 2.2% of people aged 12 or older reported using cocaine in the past year.

Another common myth is that cocaine can improve performance. 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.

Combining cocaine with alcohol can be particularly dangerous. When drinkers are using cocaine, they have a tendency to drink more than usual because they don't experience the depressant effects of alcohol due to cocaine's stimulant properties.

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.

Tolerance, Dependence, and Withdrawal

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

Frequent cocaine use can cause people to develop increasingly higher tolerance. This means that it takes higher doses or more frequent doses for the brain to try to achieve the same level of pleasure experienced during the initial use. This cycle of increasing cocaine doses to get the same high can lead to addiction.

How Long Does Cocaine Stay in Your System?

It is very difficult to determine an exact detection window for how long cocaine can stay in someone's system. The length of time it remains in the system depends on many different factors including body mass, metabolism, and hydration levels. Cocaine can be detectable for 24 hours (by blood test) or up to three months (by hair follicle test).

Addiction

Cocaine addiction can involve both a physical craving for the substance as well as a mental desire to experience the drug's euphoric effects.

One of the most dangerous consequences of using cocaine is its powerful addictive qualities. People have been known to become addicted after just one use.

Once someone becomes addicted to cocaine, quitting without relapse is extremely difficult, even after long periods of abstinence.

NIDA 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.

Withdrawal

As the effects of cocaine begin to wear off, people 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. It is not uncommon to experience depression immediately after the drug's effects wear off. Consequently, some people will take then more cocaine to avoid the unpleasant withdrawals—another reason cocaine is considered so highly addictive. People don’t just use cocaine to get high; they also use it to avoid the unpleasant side effects of not using it.

How to Get Help

Cocaine addiction can be a complex condition that can lead to a wide variety of personal problems. Treatment for an addiction to cocaine, therefore, needs to be comprehensive and address the individual’s social, family, and other environmental problems.

Effective treatment often involves addressing cocaine misuse as well as other co-occurring addictions. It is not uncommon for people who misuse drugs to also have other mental health issues—such as depression or anxiety—that also require treatment.

There are several behavioral approaches used in residential and outpatient settings that are effective in the treatment of cocaine addictions. Currently, they are the only approved and evidence-based treatments available for those who use cocaine or crack cocaine.

Some of these behavioral treatments include:

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

There are currently no approved medications to treat cocaine addiction. However, medications such as antidepressants may be used to treat symptoms of depression or anxiety.

If you or a loved one has a problem with cocaine misuse, there is help available. The Substance Abuse and Mental Health Services Administration (SAMHSA) offers an online treatment locator, or you can call their National Helpline for a referral at 1-800-662-HELP (4357).

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