Addiction Drug Use Cocaine What Is in Cocaine and How Is It Made? What you should know about the dangerous hidden ingredients in cocaine By Elizabeth Hartney, BSc, MSc, MA, PhD Elizabeth Hartney, BSc, MSc, MA, PhD Elizabeth Hartney, BSc, MSc, MA, PhD is a psychologist, professor, and Director of the Centre for Health Leadership and Research at Royal Roads University, Canada. Learn about our editorial process Updated on May 16, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print 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. Cocaine, also known as "coke" or "blow," is a fast-acting nervous system stimulant. It is the most potent among all naturally occurring stimulants and is extracted from the leaves of the coca bush. With further processing, the coca leaves become cocaine and crack that is sold on the street. However, because it is often cut with a variety of different ingredients, you really don't know what's in the cocaine you buy. While some of these fillers do little more than increase a drug dealer's profits, others are very harmful and even deadly. Some are even intended to mimic cocaine's natural properties, which increases the risk to even experienced users. What Is in Cocaine? Cocaine contains a chemical substance called benzoylmethylecgonine. It is found in the leaves of the Erythroxylum coca plant, which grows at high altitudes in the Andes Mountains of Peru, Bolivia, and Colombia, as well as on the island of Java in Indonesia. People chew coca leaves to produce a sense of elevated energy and well-being and reduce appetite. This practice doesn't seem to cause cocaine withdrawal or addiction. When coca leaves are processed into powder and freebase cocaine and crack, the resulting drug is artificially concentrated to produce a more rapid onset of effects. This is also what makes it more addictive. When cocaine is processed by the liver, metabolites form. These metabolites, such as ecgonine methyl ester and benzoylecgonine, pose health risks even after someone uses cocaine. Benzoylecgonine, for instance, is a vasoconstrictor. This means that it narrows the blood vessels surrounding the heart and may cause adverse cardiovascular effects. How Cocaine Is Made During the initial processing, the coca leaves are made into cocaine paste—a white, gray, or dull-brown powder. This intermediate form of cocaine contains 40% to 80% cocaine sulfate. It is sometimes used in this form in South America and some parts of the United States, where it is known by the names pasta or bazooka. This cocaine paste is further refined to produce cocaine hydrochloride crystal, the key ingredient in powder cocaine and crack cocaine. Cocaine hydrochloride crystal is the main psychoactive ingredient in cocaine and it is responsible for producing the cocaine high. It is sold as a white powder that is usually sniffed or snorted up the nose. Users can also take it orally or smoke or inject it. Freebase and crack cocaine, which are types of cocaine that have been further refined so that they can be smoked, are prepared using alkalis. These include ammonia and sodium bicarbonate (baking soda) or solvents, such as ether. What You Need to Know About Freebasing Cocaine Filler Ingredients Before it's sold, cocaine hydrochloride is usually "cut" or mixed with other substances. These fillers may make up to 80% of the final product. The filler ingredients that are cut into cocaine vary greatly, which adds to the danger of the drug. They may include: Additives with psychoactive or numbing effects that can greatly increase the risk of using the drug concoction sold as cocaine. Poisonous fillers that cause harm through toxicity but don't have any psychoactive effects White powders that merely mimic the appearance of cocaine and weaken the effect of the cocaine Various inert white powders are used as fillers, including talc, flour, cornstarch, and various sugars. Other fake ingredients that aren't toxic but simply weaken the drug include baking soda, vitamin C powder, glucose, and baby formula powder. Several other ingredients have been found in some cocaine samples: Quinine, sometimes added for its bitter flavor Thiamin, also known as vitamin B1 Tyramine, a food substance that can induce migraines and is dangerous for people taking monoamine oxidase inhibitors Sodium carbonate, also known as washing soda Magnesium silicate, also known as asbestos Magnesium sulfate, also known as Epsom salts Salicylamide, a non-prescription pain reliever One study of seized drugs identified 26 elements, including forms of calcium, magnesium, sodium, phosphorus, aluminum, iron, manganese, and zinc. Psychoactive Ingredients Cheaper stimulants, particularly other white powdery stimulants such as caffeine, are commonly used to cut cocaine, which makes it more dangerous and increases the risk of addiction. Amphetamines, crystal meth, methylphenidate, ergotamine, and aminophylline are also often mixed with cocaine. Among all the substances that may be cut into cocaine, fentanyl poses one of the greatest risks. It is among the primary causes of a large increase in overdose deaths. Fentanyl is a powerful synthetic opioid analgesic that is similar to morphine but is 50 to 100 times more potent than heroin. As fentanyl is not the same kind of drug as cocaine, it might not seem to make sense that it would be used to cut cocaine. However, this does happen, possibly because of the intense euphoria that both drugs induce in users. Other opioid compounds, such as carfentanil, are being found in cocaine. These are even more potent and toxic than fentanyl. People who use cocaine are often surprised to find that other stimulants are reported on drug tests because they believe they had only taken cocaine. Poisonous Ingredients Although it is relatively rare for poisonous ingredients to be mixed into cocaine, the dangers are severe. Cocaine containing poison is known among users as a "death hit" because it can be lethal. Seek medical help immediately if you or someone you know has taken cocaine and is experiencing adverse effects. A study of the purity of drugs purchased through illicit online sources showed that nearly 40% of cocaine contained levamisole, an anthelmintic medication used to destroy and expel parasitic worms in animals that is not available in the United States. Strychnine is a toxic ingredient that is sometimes mixed with cocaine. It is used in rat poison and can kill humans. Psychological symptoms of strychnine poisoning are similar to the negative effects people sometimes experience from cocaine. These include anxiety, restlessness, agitation, and an increased startle response. Strychnine also causes physical symptoms like muscle pain and spasms, a rigidity of the arms and legs, and the arching of the neck and back. Jaw tension is also a symptom shared by stimulants such as meth and ecstasy, so they may be easily missed. Arsenic, too, sometimes gets cut into cocaine and causes death if consumed in large amounts. Cocaine: Health and Harm Reduction Anesthetic Ingredients Cocaine has a natural numbing effect on the nose, throat, and gums. For this reason, cheap and legal local anesthetics, such as procaine (Novocain), lidocaine, tetracaine, and benzocaine, are often mixed with cocaine. This gives experienced users the impression that the cocaine they purchased is of high quality. These substances do not produce the high of cocaine, but they are used in dental procedures and produce a similar freezing sensation when snorted or rubbed on the gums. A user will sometimes test cocaine by rubbing a little of the powder on their gums. While the gums should go numb if the substance contains cocaine, it may also be due to one of these analgesic cutting agents. In a study of seized drugs, lidocaine was found in more than 66% of cocaine samples seized. Although anesthetics themselves are legally used for medical and dental purposes, they are not without risks. These drugs include clinical contraindications and they may have significant side effects. Additionally, the side effects may be unsafe and distressing to experience while under the influence of cocaine, especially because of the cocaine effects of anxiety and paranoia. How Can Paranoia Symptoms Be Treated? A Word From Verywell Whether you are using pure cocaine or cocaine cut with other substances, it may be time to quit. If you need help with overcoming substance-related problems or addiction to any drug, support and services are available. If you are using cocaine as a way to deal with low self-esteem or if you are self-medicating because you want to hide depression, there are much more effective ways of managing both. Cocaine use is not a solution, because, like all addictive behaviors, it only masks the problem and it actually brings more problems of its own. 12 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. Avois L, Robinson N, Saudan C, Baume N, Mangin P, Saugy M. Central nervous system stimulants and sport practice. Br J Sports Med. 2006;40 Suppl 1:i16-20. doi:10.1136/bjsm.2006.027557 Kudlacek O, Hofmaier T, Luf A, et al. Cocaine adulteration. J Chem Neuroanat. 2017;83-84:75-81. doi:10.1016/j.jchemneu.2017.06.001 Biondich AS, Joslin JD. Coca: The history and medical significance of an ancient Andean tradition. Emerg Med Int. 2016;2016:4048764. doi:10.1155/2016/4048764 Wang J, Deng X, Wu Y, et al. Sub-lethal toxicity and elimination of the cocaine metabolite, benzoylecgonine: a narrative review. Ann Palliat Med. 2021;10(6):6936-6947. doi:10.21037/apm-21-243 Jeri FR. Coca-paste smoking in some Latin American countries: a severe and unabated form of addiction. Bull Narc. 1984;36(2):15-31. Liu C, Hua Z, Meng X. Profiling of illicit cocaine seized in China by ICP-MS analysis of inorganic elements. Forensic Sci Int. 2017;276:77-84. doi:10.1016/j.forsciint.2017.04.014 Ciccarone D. Stimulant abuse: pharmacology, cocaine, methamphetamine, treatment, attempts at pharmacotherapy. Prim Care. 2011;38(1):41-58. doi:10.1016/j.pop.2010.11.004 Rubin R. Illicit fentanyl driving opioid overdose deaths. JAMA. 2017;318(22):2174. doi:10.1001/jama.2017.18602 O'Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM. Deaths involving fentanyl, fentanyl analogs, and U-47700 - 10 states, July-December 2016. MMWR Morb Mortal Wkly Rep. 2017;66(43):1197-1202. doi:10.15585/mmwr.mm6643e1 Frances RJ, Miller SI, Mack AH. Clinical Textbook of Addictive Disorders, Third Edition. Guilford Press. Caudevilla F, Ventura M, Fornís I, et al. Results of an international drug testing service for cryptomarket users. Int J Drug Policy. 2016;3538-41. doi:10.1016/j.drugpo.2016.04.017 Saraghi M, Hersh E. Potential diversion of local anesthetics from dental offices for use as cocaine adulterants. J Am Dental Assoc. 2014;145(3):256-259. 2014. doi:10.14219/jada.2013.33. Additional Reading Hammond B. Levamisole-adulterated cocaine leading to fatal vasculitis: A case report. Critical Care Nurse. 2017;37(4):49-57. doi:10.4037/ccn2017977. Knuth M, Temme O, Daldrup T, Pawlik E. Analysis of cocaine adulterants in human brain in cases of drug-related death. Forensic Sci Int. 2018;285:86-92. doi:10.1016/j.forsciint.2018.02.001 Prieto J, Scorza C, Valentini V, et al. Caffeine, a common active adulterant of cocaine, enhances the reinforcing effect of cocaine and its motivational value. Psychopharmacology. 2016;233(15-16):2879-2889. doi:10.1007/s00213-016-4320-z. By Elizabeth Hartney, BSc, MSc, MA, PhD Elizabeth Hartney, BSc, MSc, MA, PhD is a psychologist, professor, and Director of the Centre for Health Leadership and Research at Royal Roads University, Canada. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Get Treatment for Addiction Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.