Does Cocaine Have Any Medical Uses?

Legitimate Applications for Medical Cocaine

Gloved hand holding a vial

MirageC / Getty Images

When someone mentions cocaine, you might immediately think of its misuse and the terrible consequences of dependence on the drug. And it's true, cocaine is most commonly misused as an illicit drug. However, cocaine also has legitimate medical uses.

Medical Uses of Cocaine

Cocaine is an alkaloid derivative refined from coca leaves. Coca leaves grow on erythroxylum coca, a plant commonly found in South America.

There are different ways that medical professionals may use cocaine during procedures or in the treatment of certain conditions.

It's important to note that even though cocaine can be used for medical purposes, it's rarely used in the United States today. There are now many other drugs that are better suited for medical use than cocaine.

Anesthetic

Cocaine is an excellent topical anesthetic. The American Academy of Otolaryngology-Head and Neck Surgery considers cocaine to be a valuable anesthetic and vasoconstricting agent when used as part of the treatment of a patient by a physician. In fact, the group states that "no other single drug combines the anesthetic and vasoconstricting properties of cocaine."

The fact that cocaine has anesthetic properties is unsurprising since cocaine and lidocaine are chemical cousins, and lidocaine is used as an anesthetic during dental procedures.

Cocaine is a particularly effective local anesthetic that works by blocking nerve impulses. Specifically, by blocking norepinephrine uptake, cocaine causes vasoconstriction and anesthesia.

Other Medical Uses

Cocaine is also used during procedures involving the upper respiratory tract. In addition to anesthesia and vasoconstriction of the upper respiratory tract, cocaine also shrinks the mucosa or mucous membranes.

Cocaine used during medical procedures comes in the form of a topical solution. This cocaine hydrochloride solution comes in three different concentrations: 1%, 4%, or 10%. Because of potential toxicity, usually, only 1% or 4% solutions are used.

Risks of Using Medical Cocaine

Though topical cocaine is rarely used in medical procedures anymore, there are still some serious side effects, drug interactions, and contraindications to be aware of.

Side Effects

Topical cocaine may cause the following side effects:

  • Chills
  • Confusion
  • Dizziness
  • Fast or irregular heartbeat
  • Hallucinations
  • Headache
  • Light-headedness
  • Mood changes (nervousness, restlessness)
  • Nausea
  • Stomach pain
  • Sweating

Using cocaine during a medical procedure may be especially dangerous for older adults and for children.

Although possible, it is rare to develop a psychological dependence on cocaine after receiving it as a local anesthetic.

Drug Interactions

Topical cocaine has the potential to interact with a number of other drugs including:

  • Actiq (fentanyl)
  • Adzenys XR-ODT (amphetamine)
  • Alfenta (alfentanil)
  • Buprenex (buprenorphine)
  • Celexa (citalopram)
  • Didrex (benzphetamine)
  • Elavil (amitriptyline)
  • Lexapro (escitalopram)
  • Migranal (dihydroergotamine)
  • Nardil (phenelzine)
  • OxyContin (oxycodone)
  • Roxanol (morphine)
  • St. John's wort
  • Vicodin (hydrocodone)

Be sure to talk to a doctor about any medications you may be taking prior to receiving topical cocaine during a medical procedure. Topical cocaine may also have adverse interactions with cannabis and alcohol.

Contraindications

It is recommended that people who are breastfeeding do not receive topical cocaine. In addition, people with certain medical conditions may be at risk of serious side effects if they receive topical cocaine.

These medical conditions include cancer, chest pain, seizures, fast or irregular heartbeat, high blood pressure, liver disease, heart attack, overactive thyroid, and Tourette's syndrome.

Cocaine As a Street Drug

On the street, cocaine is sold as a crystalline powder. This powder is diluted or "cut" with sugars to increase its street value. Cocaine is also turned into crack. Crack is a yellow-white "rock" processed with ammonia or baking soda.

Powdered cocaine can either be snorted or dissolved in water and turned into a solution that is injected into veins. Crack rock is smoked or "freebased" using a crack pipe.

Actions and Effects

Cocaine is readily absorbed across mucous membranes including the linings of the nose and mouth, which explains why people who misuse the drug snort it or rub it on their gums.

Cocaine works on the brain by blocking the reuptake of dopamine—the "feel good" neurotransmitter. Cocaine also works by blocking the reuptake of the neurotransmitters serotonin and norepinephrine, which also contribute to a short-lasting rush or euphoria experienced after ingestion.

When ingested, cocaine causes euphoria. Other effects of the drug include a boost in self-confidence, vigilance, and well-being. It can also cause increased alertness, restlessness, irritability, and paranoia. Cocaine increases blood pressure and heart rate and can lead to heart attack and stroke.

Cocaine Misuse

The chronic use of cocaine reduces the concentration of neurotransmitter metabolites, thus permanently interfering with brain function. Signs of chronic misuse include an intense craving for more of the drug, irritability, violent outbursts, paranoia, and depression.

Repeated doses may also lead to involuntary motor activity, heart disease, seizures, psychoses, respiratory failure, sexual dysfunction, and death.

Crack cocaine is even more potent, addictive, and dangerous than cocaine powder. People who have used crack only once have become addicted. Furthermore, crack pipes burn so hot that they can damage the lips and mouth resulting in bleeding.

A Word From Verywell

Like many drugs that are often misused, including marijuana or opioids, cocaine does have legitimate and beneficial uses. Please note, however, that the clinical uses of cocaine are absolutely confined to a medical setting when administered by a physician. Cocaine bought off the street is always dangerous.

Was this page helpful?
8 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Otolaryngology-Head and Neck Surgery. Position statement: Medical use of cocaine.

  2. Oka S, Shimamoto C, Kyoda N, Misaki T. Comparison of lidocaine with and without bupivacaine for local dental anesthesia. Anesth Prog. 1997;44(3):83-6.

  3. Middleton RM, Kirkpatrick MB. Clinical use of cocaine. A review of the risks and benefits. Drug Saf. 1993;9(3):212-7. doi:10.2165/00002018-199309030-00006

  4. Richards JR, Laurin EG. Cocaine. In: StatPearls [Internet]. StatPearls Publishing.

  5. Mayo Clinic. Cocaine (topical route).

  6. Sora I, Hall FS, Andrews AM, et al. Molecular mechanisms of cocaine reward: combined dopamine and serotonin transporter knockouts eliminate cocaine place preference. Proc Natl Acad Sci USA. 2001;98(9):5300-5. doi:10.1073/pnas.091039298

  7. American Heart Association. Illegal drugs and heart disease.

  8. Morton WA. Cocaine and psychiatric symptoms. Prim Care Companion J Clin Psychiatry. 1999;1(4):109-113.

Additional Reading
  • Drug Enforcement Administration. Drug fact sheet: Cocaine.

  • O'Brien CP. Chapter 24. Drug Addiction. In: Brunton LL, Chabner BA, Knollmann BC. eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. McGraw-Hill.

  • Prosser JM, Perrone J. Chapter 181. Cocaine, Methamphetamine, and Other Amphetamines. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. McGraw-Hill.