I. The Basics

Cocaine’s Primary Dangers

  • Addictiveness: Cocaine is the second most addictive drug according to a 2007 study. In the study, Dr. David Nutt ranked illicit drugs to show how addictive each one was. Cocaine received a 2.39/3, second only to heroin, which was the most addictive and received a 2.78/3.
  • Risk of overdose: Cocaine is the most common illicit drug involved in hospital emergency room visits and accounts for 4,000 to 8,000 deaths each year in the U.S.
  • Unintended side effects: Cocaine commonly leads to irritability, paranoia (extreme and unreasonable distrust of others), and nausea.
  • Legal risks: Cocaine is a schedule II narcotic, illegal in all states, and is commonly punishable by one year in prison and a $1,000 fine for a first possession offense.
  • Legal Risks: The legal ramifications of possessing heroin and for selling it are significantly higher than many other drugs because the Drug Enforcement Agency (DEA) classifies heroin as a “Schedule I” drug.

Cocaine Background Information

Derived From Coca plant, also known as Erythroxylaceae
Ways Used Snorted, Injected, Smoked (only crack)
Scientific Name Benzoylmethylecgonine
Slang/Street Names for Cocaine Snow, blow, coke, crack, rock, flake, white, toot, base, basa, powder, dust, big rush, pearl, candy, cola, c, big flakes, baseball, nose candy, bump, line, rail, stash, yeyo, bazooka, berni(ce), caviar, Charlie, chicken scratch, coca, cocktail, coconut, late night, marching dust, mojo, monster, sniff, snort, stardust, toot
Slang/Street Names for Crack Cocaine Snow coke, rocks, black rock, chemical, candy, nuggets, gravel, grit, hail, hard rock, jelly beans, cookies, dice, purple caps, scrabble, yam, sleet, tornado, bones, boost, brick, casper, chalk, crumbs, cubes, fatbags, kibbles n bits, moonrocks, pebbles, Roxanne
Slang/Street Names for Cocaine Mixtures Speedball, spaceball, woo-woo, cocopuffs, woolies, boy-girl, candy flipping, bumping up, snow seals, flamethrowers
How Long in Body Up to 3 days depending on level of use
Punitive Legal Measures First offense of cocaine possession may be sentenced to not more than one year in prison, fined not less than $1,000, or both. Larger amounts of cocaine constitute “intent to sell” leading to felony charges and sentences of 2-20 years (1-4 grams) to life (generally greater than 400 grams).
DEA Drug Rating Schedule II

Cocaine and crack are different drugs derived from the same source

Even though crack is often included in the term “cocaine,” the drugs are quite different. Crack and cocaine are both from the coca plant, but their method of extraction and potency differs.

Cocaine is a white powder (hydrochloride salt) and is water soluble. This makes it easy to snort, inject, or take orally. Although typically the purer form (if not cut with other substances, which is common) cocaine powder produces a lower-intensity high with a slower onset than crack cocaine. In its purest form, cocaine retains more of the characteristics of the coca plant than crack.

Crack is true to its name, looking crystalline or rock-like. Crack is often smoked, commonly from a pipe, and is more addictive than cocaine. Smoking crack causes almost immediate changes in the brain and gives users a quick and intense high. Crack is typically not injected since it doesn’t dissolve in water.

II. Cocaine Usage

Global Cocaine Use

According to the United Nations Office on Drug and Crime’s 2016 report, cocaine use has been decreasing across all continents over the past 15 years. The agency estimates that there were about 18.8 million global cocaine users in 2014, and provided the following demographics for cocaine users.

Cocaine Usage in the U.S.

Nearly 25% of all illicit drug users ages 18-25 have tried cocaine

According to the National Institute on Drug Abuse (NIDA), 36,304,200 Americans had tried cocaine in 2014, and over 1.5 million had used it in the past month. The age group with the heaviest usage is 18 to 25 year-olds.

Demographics of Cocaine Usage (2016)
Past Year Usage Lifetime Usage
Cocaine Crack Cocaine Crack
Ages: 12-17 0.6% 0.0% 0.8% 0.1%
Ages: 18-25 5.4% 0.3% 11.7% 1.5%
Ages: 26+ 1.3% 0.3% 16.6% 4.1%

III. Cocaine Addiction

Cocaine hotwires the brain to such an extent that users eventually feel happy only when they are high, making them return to the drug over and over. They quickly become addicted as the intense withdrawal and depression encourage even more drug use. Addiction to cocaine can come with severe side effects like cardiac arrest and even death, making it dangerous for any user.

How Cocaine Addiction Works

Cocaine causes the brain to flood the limbic system with copious amounts of dopamine (the feel-good hormone), making the person euphoric. The limbic system is a set of interconnected regions that regulate reward and motivation, and dopamine is a neurotransmitter that helps control it. The accumulation of dopamine brought on by a cocaine high overstimulates the brain with higher levels of reward than usual, resulting in feelings of intense pleasure.

The limbic system also includes critical memory centers which help us remember what led to those dopamine releases. When someone uses cocaine, these regions of the brain not only imprint memories of pleasure, but also everything associated with taking the drug. From then on, encountering any of those people, places, sights, sounds, etc. can trigger powerful memories and an intense desire to repeat the experience.

Cocaine provides initial euphoria but damages the brain

In situations that naturally cause happiness, such as getting a new job, dopamine fills some of the receptors, but not all. Cocaine chemically changes the brain by filling the majority of the brain’s receptors with dopamine. Persistent drug use trains the brain to require that level of dopamine to feel happy. This pattern is called tolerance. The brain starts to expect a lot of dopamine to make the user feel happy, encouraging the user to increase the dose of cocaine as well as the frequency with which they use it.

Scientists believe that repeated cocaine use also physically alters brain cells in a way that can override decision-making abilities and make the user increasingly impulsive. These abnormalities in brain function can decrease the user’s ability to delay reward, even after years of abstinence. A recent study suggests that these brain changes can take effect after a single use.

Cocaine withdrawal encourages addiction and negatively affects relationships

After the short-term effects of cocaine wear off, the brain goes into withdrawal, wanting more cocaine because the dopamine disappears suddenly. This response is the crux of cocaine addiction – users feel withdrawal after the first hit, typically taking more and binging, which leads to a higher dependence on the drug. Overdose occurs because users continue increasing their doses to a possibly fatal point.

Cocaine use and increased tolerance also affect users’ relationships. Instead of relying on personal interaction and other sources of happiness, users typically withdraw from those interactions as cocaine becomes one of the few ways they can feel happy.

Tolerance increases, along with the brain’s sensitivity and reaction to toxins

A 2012 study found that while tolerance increases, so does the user’s sensitivity to the toxic consequences of the drug, leading to what is called sensitization. With sensitization, the brain reacts more strongly to certain adverse side effects of the drug over time. This means that anxiety worsens, convulsions become more frequent or severe, and other effects from the toxins in the drug occur more regularly.

Likewise, cocaine use causes stress circuits to become more sensitive, giving users negative moods more frequently. Stress paths are connected to the pleasure center in the brain and therefore to dopamine, meaning any stress will trigger the brain to want to relapse and use the drug even more.

IV. Cocaine Effects and Dangers

Effects of Cocaine

Cocaine is highly addictive, sometimes resulting in adverse side effects after one use. The initial, positive response to cocaine often leads to the opposite over time, making people anxious and causing bodily harm. From a panic attack to a heart attack, cocaine’s side effects vary based on the individual and frequency of use.

The tables below show the possible side effects of short-term and long-term use.

Short-Term Effects of Cocaine Use
Body Mind
Initial (direct effects of drug, 5-10 min.)
  • High energy
  • Hypersensitive to sight, touch, and sound
  • Muscle Twitches
  • Constricted blood vessels lead to higher heart rate and blood pressure as well as headache
  • Tremors
  • Euphoria
  • Mentally alert
  • Talkative
  • Vertigo
Lingering (within the hour of taking the drug)
  • Reduces need for food and sleep
  • Abdominal pain
  • Nausea
  • Seizure
  • Heart attack
  • Stroke
  • Coma
  • Death – typically from cardiac arrest or seizures and more common when mixing cocaine with heroin or alcohol
  • Irritability
  • Anxiety
  • Panic
  • Paranoia
  • Violence
Post-Use
  • Fatigue
  • Chemical addiction, sometimes after single use
  • Craving cocaine
  • Withdrawal
  • Depression
Long-Term Effects of Cocaine Use
Body Mind
Chronic
  • When Snorting: Nosebleeds, loss of sense of smell, cartilage inside nose deteriorating, runny nose, difficulty swallowing
  • When Smoking: Worsen asthma, damage lungs
  • When Injecting: Higher risk of contracting HIV, Hepatitis C, and other bloodborne illnesses
  • Fatigue
  • Malnourishment
  • Tears in Gastrointestinal tract
  • Convulsions
  • Increased toxicity for heart and cardiovascular system
  • Stroke
  • Intracerebral hemorrhage (bleeding inside brain)
  • Restlessness
  • Slowed thinking
  • Unpleasant dreams
  • Insomnia
  • Depression
  • Impaired attention, memory, and performing motor tasks
  • Anxiety
  • Panic Attacks
  • Severe paranoia with auditory hallucinations
Withdrawal
  • Fatigue
  • Hunger
  • Insomnia
  • Mood changes include anger and irritability
  • Anxiety
  • Depression
  • Paranoia

Significant Dangers

Cocaine’s potency varies

Cocaine is usually cut with other substances making it difficult to know the potency of the product. The variance in strength could lead to unintentional overdose.

Cocaine cocktails can lead to fatal overdoses

The mixture of cocaine and heroin is typically called a speedball. Cocaine is a stimulant, and heroin is a depressant, which leads to people taking a higher dose of heroin than normal because they don’t notice its effects as quickly. When the cocaine wears off, heroin causes the heart rate to drop, which can lead to death from overdose.

Likewise, the mixture of cocaine and alcohol has been shown to put added stress on the heart. Combining cocaine and alcohol has also been linked to an increase in violent behavior.

The Dangers of Cutting Cocaine
Description Effects/Dangers
Caffeine Common unregulated stimulant Caffeine increases the cardiovascular stress caused by cocaine. Also increases addictive properties.
Diltiazem Prescription calcium channel blocker, vasodilator Counteracts typical blood pressure increase associated with cocaine. Not useful in countering increased heart rate.
Hydroxyzine Prescription antihistamine Cocaine-hydroxyzine interaction unknown
Levamisole Cattle and swine dewormer Skin lesions and deterioration of blood vessels in the skin, potential suppression of immune system.
Lidocaïne Numbing agent, irregular heartbeat treatment, pain reliever Seizures and convulsions can result.
Phenacetin Pain reliever, fever reducer Carcinogenic, no know synergistic reactions.

Effects on Pregnant Women and Teens

Pregnant women are likely to face complications after cocaine use

Pregnant women and their fetuses are a central concern in conversations about cocaine addiction. Cocaine use while pregnant poses very real consequences for both the pregnant mother and the child.

Possible Effects of Cocaine on Mother and Fetus
Body Mind Neurological
Mother
  • Seizures
  • Premature membrane rupture
  • High blood pressure
  • Spontaneous miscarriage
  • Preterm labor
  • Difficult delivery
  • Migraines
(See addiction explanation above)
Newborn
  • Premature delivery
  • Lower birth weight
  • Smaller head circumference
  • Shorter length
N/A N/A
Matured Child N/A
  • Behavioral problems including difficulty self-regulating
  • Difficulties with cognitive performance, information processing, and sustained attention
  • Subtle problems with memory and language

Cocaine’s intensity and addictive qualities are up to 3x greater on teens than on adults

Teenagers (13-18 year-olds) and young adults (typically under 30 years old) constitute the majority of cocaine users. Teens’ susceptibility to peer pressure often encourages risky behavior, and the effects of cocaine use magnify the risk. Additionally, cocaine’s effect on the brain has a significantly higher impact on teenagers as their brains are still developing.

All humans learn to associate actions with their outcomes; scientists call this association “goal-directed.” Over time, cocaine rewires the brain to make more “habitual” decisions, which locks individuals into patterns and reduces how frequently they think about consequences or other options. This is particularly the case for adolescents whose brains are still forming. They have high plasticity and therefore a higher chance for long-term, structural changes to the brain. Teens are also more susceptible to addiction because of heightened neuron activity, meaning they will work harder to obtain cocaine despite consequences or difficulties.

V. Recent Studies and Understandings about Cocaine

Current Research

New research on cocaine addiction is coming out every day, meaning new therapies, hypotheses, and theories are constantly being tested and added to the current body of knowledge surrounding addiction. The following table includes studies about cocaine’s effect on the body and how addiction works.

New Research and Findings
Study Name Type (Controversial, New, Supportive) Analysis
Cocaine’s Effect on Brain and Body 2016 microglia TNF-a NEW – Study suggests a potential cause for cocaine addiction as well as a linked treatment method This study shows a promising potential cause for physiological cocaine addiction. If this pathway is at the core of addiction, the treatment suggested should be relatively easy to implement.
2017 brain activation for diagnosis and treatment plans SUPPORTIVE – Shows the importance of “cues,” mental associations, to cocaine addiction and treatment This study corroborates the findings and intuition of others in the field; addicts reaction to cues is predictive of their potential for relapse and continued use.
How Cocaine Addiction Works 2016 glutamate re-uptake SUPPORTIVE – Provides an update on the state of our understanding of neurochemistry at various phases of withdrawal and relapse Adds to the growing body of evidence showing that cocaine-seeking behavior is variable through the stages of withdrawal and primarily based on previous behaviors.
Other 2017 distress tolerance and cocaine relapse NEW – Past cocaine abuse is predictive of increased distress tolerance Rat trials show that after a one-month period of cocaine abstinence, rats will show a marked reduction in persistence during goal-directed activity. The resulting distress led to increased cocaine relapse.
2016 Omega-3, teens, and cocaine NEW – Dietary link to addiction behavior This study explored the relationship between diet and addictive behavior. One group of rats was fed a diet poor in Omega-3s; the results are tentative, but this group showed a significant increase in stress after a short period of abstinence.

Note: The papers used in the “Current Research” should be taken as unverified due solely to the fact that the research is new and therefore not widely tested. We do however require a CiteScore® from the publishing journal of 3 or more; this third-party service ranks the journals based on metrics that measure overall credibility and prestige. This requirement increases the overall reliability of information in this section to the standard of good peer-review practices of trusted scientific journals.

VI. How to Get Help for Cocaine Addiction

Because of the physical changes to the brain, cocaine addiction can be difficult to overcome, but rehab can help. Rehab programs sometimes provide medications to help while detoxifying, and they also offer a wide range of evidence-based behavioral therapies to help you rewire your brain to overcome cravings and addiction. While there are no cocaine-specific rehab programs, almost all treatment programs treat cocaine addiction and provide a specialized plan based on your needs.

If you are looking for rehab options for yourself or a loved one, find out more about rehab programs for cocaine and how to find one near you in our guide to Cocaine Rehab.