Signs of Cocaine Use and Intoxication

person sad looking in the mirror

Igor Ustynskyy / Getty Images

What is the most important information I should know about cocaine?

  • Cocaine is a powerful illicit stimulant drug that was the third leading cause of overdose deaths in 2021.
  • If someone you know exhibits symptoms of cocaine toxicity or overdose, contact emergency services immediately.

What Is Cocaine?

Cocaine is a stimulant drug derived from the leaves of the coca plant native to South America. According to a 2022 study, close to 25 million people around the world use cocaine.

Cocaine is an addictive substance that triggers the brain to release a chemical called dopamine, which produces a euphoric high. This high can be addictive, causing people to consume more and more of the substance. The drug can be found in powdered or rock forms.

Recreational use of cocaine is illegal because it is dangerous and can lead to severe health consequences, including stroke, heart attack, and overdose. According to the Centers for Disease Control and Prevention (CDC), more than 24,000 people died from cocaine overdose in 2021.

This article lists the physical, behavioral, and psychological signs of cocaine use and the symptoms of cocaine intoxication. It’s essential to be aware of these signs, symptoms, and health effects of cocaine use to break the habit and get treatment if needed.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

Signs of Cocaine Use

Listed below are some of the physical, behavioral, and psychological signs of cocaine use.

Physical Signs

These are some of the physical signs of cocaine use:

  • Bloodshot eyes
  • Dilated pupils
  • Rapid heart rate
  • Rapid or rambling speech
  • Nausea or vomiting
  • Muscle tremors or twitches
  • Raised body temperature
  • Hypersensitivity to light, sound, and touch
  • Changes in appetite
  • Insomnia or unusual sleep patterns
  • Altered physical appearance
  • Neglected personal hygiene

Psychological Signs

These are some of the psychological signs of cocaine use:

  • Excitement, euphoria and excessive confidence while using the drug
  • Increased energy and alertness while using the drug
  • Depression after the high wears off
  • Fear, anxiety, or paranoia
  • Unexplained changes in attitude and personality
  • Irritability or restlessness
  • Sudden mood swings or angry outbursts
  • Impaired judgment

Behavioral Signs

These are some of the behavioral signs of cocaine use:

  • Neglected responsibilities
  • Poor attendance and performance at work or school
  • Changes in routine, hobbies, acquaintances, and hangout spots
  • Risky or unsafe behavior
  • Secretive or suspicious behavior
  • Bizarre or unpredictable behavior
  • Aggressive or violent behavior
  • Trouble with the authorities for activities like driving under the influence or disorderly conduct

Long-Term Effects

In the long-run, cocaine use can lead to health issues such as:

  • Malnourishment and weight loss, since people who use cocaine generally have a reduced appetite
  • Movement disorders like Parkinson’s disease, which are caused by dopamine irregularities in the brain
  • Impaired cognitive functioning, which can cause difficulties with attention, memory, decision making, impulse inhibition, and motor tasks
  • Psychosis, which is a mental condition characterized by hallucinations (seeing and hearing things that aren’t real) and delusions (believing things that aren’t real)
  • Pregnancy complications, such as premature delivery, low birth weight at delivery, and issues with concentration and self-regulation in the child

Some of the long-term effects of cocaine can vary depending on the way it is consumed:

  • Snorting cocaine can cause nosebleeds, lack of smell, runny nose, nasal damage, hoarseness, and difficulty swallowing
  • Smoking crack cocaine can cause asthma, cough, breathing difficulties, lung damage, and increased risk of respiratory infections like pneumonia
  • Injecting cocaine can cause scarring in the arms or collapsed veins, and increased risk of hepatitis C, HIV, skin infections, soft tissue injuries, and bloodborne diseases
  • Consuming cocaine orally can cause severe bowel issues

Signs of Cocaine Intoxication

Cocaine intoxication is a state where someone is not just high on cocaine but also develops other physical symptoms that make them ill.

Cocaine intoxication can occur as a result of:

  • Consuming too much cocaine
  • Taking an overly concentrated form of cocaine
  • Doing cocaine in extremely hot weather, as dehydration can exacerbate the side effects of the drug
  • Mixing cocaine with alcohol
  • Mixing cocaine with other drugs, such as heroin
  • Consuming an adulterated form of cocaine, which means the cocaine has been mixed with other substances, contaminants, or drugs

These are some of the signs and symptoms of cocaine intoxication:

  • Euphoria and excitement
  • Jumbled speech, sometimes about bad things that might happen
  • Extreme confusion and anxiety
  • Restlessness and agitation
  • Muscle tremors, often in the face and fingers
  • Dilated pupils that don’t contract even when a light is shined into the eyes
  • Rapid or irregular heartbeat
  • Increased blood pressure
  • Pallor or bluish-colored skin
  • Lightheadedness
  • Nausea and vomiting
  • Fever
  • Sweating 
  • Lack of awareness of surroundings
  • Loss of bladder control
  • Rapid or restricted breathing

Signs of Cocaine Overdose

According to the National Institute on Drug Abuse (NIDA), cocaine overdose occurs when a person consumes enough of the drug to cause serious adverse effects, life-threatening symptoms, or even death. NIDA also notes that a cocaine overdose can be intentional or unintentional, and can occur even on the first occasion of use, or at any time thereafter.

Signs that a person is overdosing on cocaine include:

  • Anxiety and panic
  • Changes in heart rate
  • Changes in mood
  • Chest pain
  • Confusion
  • Convulsions
  • Increased body temperature
  • Nausea and vomiting
  • Muscle twitching
  • Rapid breathing
  • Restlessness

Severe cocaine intoxication, or cocaine toxicity, can cause permanent damage that leads to:

  • Seizures, stroke, or paralysis
  • Severe mental health disorders like anxiety or psychosis
  • Reduced cognitive ability and mental functioning
  • Reduced heart function and other heart problems
  • Kidney failure, which may require dialysis
  • Muscular atrophy, which may require amputation
  • Death

There is currently no medication that can reverse the effects of a cocaine overdose. However, medical professionals can provide treatments to stabilize a person's symptoms. If a person is experiencing an overdose of a combination of cocaine and an opioid such as fentanyl, administering Narcan (naloxone) can reverse the effects of the opioid overdose. This medication will not, however, treat the effects of cocaine overdose.

If you believe someone has overdosed on cocaine or another substance, take them to the nearest emergency room or call 911 immediately.

Treatment and Prevention

The only way to prevent cocaine intoxication and overdose is to avoid using cocaine altogether. If you or someone you know is struggling with a cocaine addiction, there are treatment options that can help.

There are currently no medications that have been approved for the treatment of cocaine addiction, but there are several behavioral interventions that can be effective. Some of these include:

  • Contingency managment (CM): This approach uses positive reinforcement to motivate people to stay drug-free. For example, people can earn points that can be exchanged for prizes such as restaurant gift certificates, gym memberships, movie tickets, and other incentives.
  • Cognitive behavioral therapy (CBT): This approach focuses on the thoughts and behaviors that contribute to cocaine use. CBT helps people develop coping skills that help support long-term recovery and abstinence. 
  • Therapeutic communities: These are drug-free residential treatment centers where people learn to change their behaviors as they recover from drug use. Such facilities often involve an extended stay that includes supportive services and vocational rehabilitation to improve long-term outcomes.
13 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. Centers for Disease Control and Prevention. U.S. overdose deaths in 2021 increased half as much as in 2020 - but are still up 15%.

  2. Drake LR, Scott PJH. Dark classics in chemical neuroscience: Cocaine. ACS Chem Neurosci. 2018;9(10):2358-2372. doi:10.1021/acschemneuro.8b00117

  3. Cenci D, Carbone MG, Callegari C, Maremmani I. Psychomotor symptoms in chronic cocaine users: an interpretative model. Int J Environ Res Public Health. 2022;19(3):1897. doi:10.3390/ijerph19031897

  4. National Institute on Drug Abuse. What are the long-term effects of cocaine use?

  5. National Institute on Drug Abuse. Cocaine drug facts.

  6. National Library of Medicine. Cocaine. Medline Plus.

  7. Department of Mental Health and Substance Abuse Services, Tennessee. Warning signs of drug abuse.

  8. Indiana Department of Health. Signs and symptoms of drug misuse.

  9. National Institute on Drug Abuse. Commonly used drugs.

  10. National Library of Medicine. Cocaine intoxication. Medline Plus.

  11. Miró Ò, Dargan PI, Wood DM, et al. Epidemiology, clinical features and management of patients presenting to European emergency departments with acute cocaine toxicity: comparison between powder cocaine and crack cocaine casesClin Toxicol (Phila). 2019;57(8):718-726. doi:10.1080/15563650.2018.1549735

  12. Zimmerman JL. Cocaine intoxicationCrit Care Clin. 2012;28(4):517-526. doi:10.1016/j.ccc.2012.07.003

  13. National Institute on Drug Abuse. Cocaine Research Report.

By Sanjana Gupta
Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.