Cocaine has effects similar to those of amphetamines. It may be snorted, injected directly into a vein, or heated and inhaled. When boiled with sodium bicarbonate, cocaine is converted into a freebase form called crack cocaine. Heating crack cocaine releases cocaine vapor that can be inhaled. Inhaling the vapor is usually referred to as smoking, but the crack is not actually burned. Crack cocaine acts almost as fast as cocaine injected intravenously.
Heavy regular users and people who inject the drug intravenously or smoke it are most likely to become dependent. Light occasional users and people who snort the drug nasally are less likely to become dependent. Cocaine may contain many fillers, adulterants, and contaminants, which, when injected, can cause complications such as infections.
Cocaine produces a sense of extreme alertness, euphoria, and great power when it is injected intravenously or inhaled. These feelings are less intense when cocaine is snorted. Because cocaine's effects may last only a short time, users may inject, smoke, or snort it every 15 to 30 minutes. Binges, often over several days, lead to exhaustion and a need for sleep.
Acute cocaine toxicity can be fatal. Cocaine increases blood pressure and heart rate and narrows (constricts) blood vessels. Heart rhythm may be disturbed (called arrhythmias). Cocaine's effects on the heart can cause chest pain, a heart attack (even in healthy young athletes) or sudden death. Cocaine can also cause kidney failure, stroke, and lung problems.
High doses (overdose) can impair judgment and cause tremors, extreme nervousness, seizures, hallucinations, insomnia, paranoid delusions, delirium, and violent behavior. People sweat profusely and the pupils are dilated. Very high doses can cause a life-threatening high body temperature (hyperthermia).
Long-term users may develop tolerance, requiring more and more of the drug to get the same effects. Long-term use may damage the tissue separating the two halves of the nose (septum), causing sores (ulcerations) that may require surgery. Heavy use may impair mental function, including attention and memory.
If women use cocaine during pregnancy, the fetus is more likely to have problems. However, such women usually have many other risk factors for problems in the fetus, including tobacco and alcohol use, poor nutrition, and lack of prenatal care. Doctors now think that these other risk factors are more responsible for problems than the cocaine.
Withdrawal reactions include extreme fatigue and depression—the opposite of the drug's effects. Appetite is increased, and people have trouble concentrating. Suicidal urges emerge when addicts stop taking the drug. After several days, when mental and physical strength has returned, addicts may attempt suicide.
Doctors usually base the diagnosis on symptoms in people known to use the drug. Urine testing can detect evidence of the drug for 2 to 3 days after its use.
Cocaine is a very short-acting drug, so treatment of uncomfortable reactions is usually not necessary. People who are very agitated or delirious or who have seizures or high blood pressure are given benzodiazepines (sedatives), such as lorazepam, intravenously. Nitrates or other antihypertensive drugs may be given intravenously to lower blood pressure or heart rate. Hyperthermia may also need to be treated.
Detoxification and Rehabilitation:
Stopping long-term cocaine use may require close supervision because people can become depressed and suicidal. Entering a hospital or a drug treatment center may be necessary. The most effective method of treating cocaine addiction is psychotherapy. Many self-help groups and cocaine hotlines are available to help people remain free of the drug.
Sometimes the mental health disorders common to cocaine addicts, such as depression, are treated with the appropriate drugs for those disorders.
Last full review/revision January 2009 by Patrick G. O'Connor, MD, MPH