Cocaine (Crack)

What is cocaine (crack)?

Cocaine is a powerful stimulant drug that’s extracted and processed from coca plant leaves in South America. Healthcare providers may occasionally use cocaine as anesthesia. More commonly, people use cocaine to boost feelings like being energized, happy and alert. Cocaine is a very addictive substance, meaning people seek out the drug and use it even though they know the choice comes with negative consequences. There are treatments for cocaine use disorder (cocaine addiction), but people often relapse and use it again.

Cocaine

Cocaine is a white powder that people may use by:

• Inhaling it through their noses.
• Rubbing it on their gums.
• Dissolving it in water or other liquid and injecting it into their veins.
• Smoking it (freebasing).

Cocaine highs may last 20 minutes to two hours. Cocaine has many street names like snow, nose candy, coke, Big C, flake and blow.

Crack cocaine

Crack cocaine is processed or “cooked” cocaine. Crack gets its name from the crackling sound it makes as it’s processed or cooked. Crack looks like small brown rocks. People use crack cocaine by heating it in a glass pipe or adding it to marijuana or tobacco.

Crack cocaine highs last about 15 minutes.

While cocaine and crack cocaine highs are brief, the drug may stay in your system for up to three days.

How common is cocaine use?

The 2021 (U.S.) National Survey on Drug Use and Health (NSDUH) concludes 4.8 million people age 12 and older used cocaine in 2020. In comparison, the same survey results show 52.8 million people age 12 and older used marijuana and 1.1 million people used heroin.

What are the risks of using cocaine?

Cocaine use comes with many risks. The most serious risks include:

• Cocaine use can be life-threatening through drug overdose.
• Using cocaine may increase your risk of serious medical issues like heart attack, stroke and HIV/AIDs.
• Cocaine use disorder can disrupt and destroy personal relationships.

What are the effects of cocaine?

When people take cocaine, their blood pressure goes up and their heart races. They may lose their inhibitions about doing things like spending lots of money on stuff they don’t really need. They may start feeling angry or paranoid.

But the most significant effect is how cocaine use changes people’s brains, setting the stage for cocaine addiction (cocaine use disorder).

Here’s how that happens: In a way, our brains are wired for happiness. That wiring is in our reward circuit or pathway. This part of our brain controls our ability to feel pleasure. When we experience something that makes us happy or gives us pleasure, our brains release dopamine. Dopamine makes us feel good, so we find ways to do those things.

Normal amounts of dopamine can make us feel happy, alert and focused. Large amounts may make us feel powerful, euphoric and filled with energy. When people use cocaine, their brains release lots of dopamine. But that cocaine-driven dopamine release or rush fades quickly, leaving them wanting more of those feelings — and the drug. As people keep on using cocaine, their brains get used to the huge overstimulation and they need stronger, more frequent doses.

What are the side effects of cocaine use?

Cocaine use has short-term and long-term side effects. Potential short-term side effects include overdose, addiction (cocaine use disorder) and withdrawal. Long-term side effects may include serious and potentially life-threatening medical issues like heart failure, stroke or infections.

Short-term side effects

Cocaine is a powerful drug that can cause serious side effects that can happen very quickly after you start using the drug.

Overdose

A cocaine overdose is an immediate and potentially life-threatening side effect. An overdose may happen the first time someone uses cocaine. Symptoms may include:

• Seizures.
• Hallucinations.
• Delirium.
• Violent behavior.
• Hyperthermia.
• Arrhythmia.
• Chest pain.
• Difficulty breathing.
• Coughing up blood.

Addiction

Cocaine is very addictive. One study showed 15% of people who used cocaine became addicted to the drug within 10 years. Symptoms may include:

• Noticeable loss of appetite and weight loss.
• Constant runny nose.
• Frequent upper respiratory infections.
• Changes in personal hygiene.
• Sleep pattern changes, particularly sleeping less than usual.
• Loss of interest in friends, family and social activities.
• Loss of interest in food, sex or other pleasures.
• Emotional changes like being angry or impatient for no obvious reason.
• Mental health issues like severe depression, paranoia or experiencing hallucinations.
• Showing signs of withdrawal when you can’t get cocaine.

Cocaine withdrawal

Cocaine highs are very brief, so people who use often have a relentless need for the drug. When they can’t meet that need, they may go into withdrawal. Withdrawal is the term for the physical and mental symptoms people have when they suddenly stop using a drug. Withdrawal symptoms may include:

• Muscle tremors (the shakes).
• Severe headache.
• Fatigue.
• Slowed or disoriented thinking.

Long-term side effects of cocaine use

Over time, using cocaine may increase the risk of medical issues, some of which may be life-threatening. Serious medical issues may include:

• Heart attack.
• Stroke.
• HIV/AIDs.
• Hepatitis C.
• Pneumonia.
• Increased seizures related to epilepsy.

Over time, cocaine use may change other brain functions. For example, it affects the amount of glutamate, a neurotransmitter that sends messages between nerve cells in the brain. Glutamate plays a role in learning and memory. Long-term cocaine use dulls thinking processes and the ability to remember information. Cocaine use may make the brain’s stress receptors more sensitive to stress, so people react more strongly to stressful situations.

What are treatments for cocaine use disorder?

Treatment focuses on cognitive behavioral therapy (CBT). People with cocaine use disorder may benefit from community-based programs. Researchers are evaluating drug treatments that help people stop using cocaine.

How do I find help for cocaine use disorder?

Asking for help is a huge and important step toward recovering from cocaine use disorder. Start with your healthcare provider. They’ll evaluate your overall health. They may refer you to a substance abuse counselor or recommend community-based programs.

How can I help someone who is addicted to cocaine?

It’s important to remember addiction is a chronic disease. It’s not a sign of weakness, bad judgement or other personal characteristics. The best way to support someone coping with addiction is to encourage them to find help. It’s also important to remember cocaine use often has a ripple effect, putting stress and strain on relationships. If that’s your situation, consider participating in a support group.

A note from Cleveland Clinic

Cocaine is an addictive stimulant drug that can change lives and be life-threatening. Using cocaine may change how people’s brains work and increase their risk for many serious medical issues. Finding the next high may seem like the most important thing in their lives. Often, a cocaine high is over in minutes. But the impact of cocaine use can last for months, years or a lifetime. If you think someone you love is using cocaine, encourage them to seek help. Ask a healthcare provider about programs and services for people affected by another person’s cocaine use.