Cocaine is a strong stimulant that increases alertness, causes euphoria, and makes people feel powerful.
High doses can cause serious, life-threatening disorders, such as a heart attack Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) Acute coronary syndromes result from a sudden blockage in a coronary artery. This blockage causes unstable angina or heart attack (myocardial infarction), depending on the location and amount... read more or stroke Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply (cerebral infarction) and symptoms that... read more .
The diagnosis can be confirmed by urine tests.
Sedatives such as lorazepam given intravenously can relieve many symptoms.
People who stop using the drug must be closely supervised because they may be suicidal and they require much help to remain free of the drug.
(See also Drug Use and Abuse Overview of Substance-Related Disorders Drugs are an integral part of everyday life for many people, whether the drugs are used for legitimate medical purposes or recreationally (see table Drugs with Medical and Recreational Uses)... read more .)
Cocaine has effects similar to those of amphetamines Symptoms Amphetamines are stimulant drugs that are used to treat certain medical conditions, but are also subject to abuse. Amphetamines increase alertness, enhance physical performance, and produce... read more . 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 take the drug nasally or by mouth are less likely to become dependent.
Cocaine use causes both immediate and long-term symptoms.
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.
High doses 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 Serotonin Syndrome Serotonin syndrome is a potentially life-threatening drug reaction that tends to cause high body temperature, muscle spasms, and anxiety or delirium. Serotonin is a chemical that transmits impulses... read more ).
Cocaine overdose can be fatal. Cocaine increases blood pressure and heart rate, and heart rhythm may be disturbed (called arrhythmias Abnormal Heart Rhythms read more ). Cocaine narrows blood vessels. If it narrows blood vessels in the heart, people can have chest pain, a heart attack Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) Acute coronary syndromes result from a sudden blockage in a coronary artery. This blockage causes unstable angina or heart attack (myocardial infarction), depending on the location and amount... read more (even in healthy young athletes), or sudden death. Cocaine can also cause kidney failure Overview of Kidney Failure This chapter includes a new section on COVID-19 and acute kidney injury (AKI). Kidney failure is the inability of the kidneys to adequately filter metabolic waste products from the blood. Kidney... read more , stroke Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply (cerebral infarction) and symptoms that... read more , and lung problems including difficulty with breathing and coughing of blood ("crack lung").
Long-term users may develop tolerance Intoxication Substance-induced disorders are a type of substance-related disorder that involves problems caused by the direct effects of a substance. Substance-induced disorders include Intoxication Withdrawal... read more , 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. Chronic use can also damage the heart, causing scarring and thickening of the heart muscle and eventually leading to heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more . Cocaine may contain many fillers, adulterants, and contaminants, which, when injected, can cause complications such as infections.
If women use cocaine during pregnancy, the fetus is more likely to have problems leading to miscarriage Miscarriage A miscarriage is the loss of a fetus due to natural causes before 20 weeks of pregnancy. Miscarriages may occur because of a problem in the fetus (such as a genetic disorder or birth defect)... read more .
Withdrawal reactions (cocaine washout syndrome) include extreme fatigue, sleepiness, and depression—the opposite of the drug’s effects. Appetite is increased, and people have trouble concentrating. Suicidal urges emerge when people stop taking the drug.
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A doctor's evaluation
Doctors usually base the diagnosis on symptoms in people known to have used cocaine. Urine testing can confirm evidence of the drug.
Sedatives for agitation, high blood pressure, or seizures
Psychotherapy (for addiction)
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. If sedatives do not control blood pressure, doctors may give nitrates or other antihypertensive drugs intravenously. Doctors avoid antihypertensive drugs called beta-blockers because they can worsen the effect of cocaine on blood pressure. Hyperthermia should also be treated with cooling techniques, such as wetting and blowing air over the skin or using special cooling blankets.
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 Depression A short discussion of prolonged grief disorder. Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to... read more , are treated with the appropriate drugs for those disorders.