Overview

What is cocaine?

Cocaine is a stimulant drug that is made from the leaves of a coca plant and comes in the form of a white powder or a “rock.” Street names for powdered cocaine include snow, nose candy, coke, Big C, flake and blow. People snort cocaine through their nose, rub it into their gums, or dissolve it and inject it with a needle into their veins. Powdered cocaine can also be smoked via a process called “freebasing.”

Drug dealers mix cocaine with other substances so they can have more of the drug to sell. These “fillers” make the drug even more dangerous because the user does not know how much cocaine he or she is taking or what fillers may have been used. Commonly used fillers include cornstarch or flour or other drugs – such as amphetamines or fentanyl – which can add harmful, and even fatal, side effects to an already unsafe drug.

What is crack?

Crack is cocaine that has been processed so that it can be smoked. It also goes by the street name “rock.” Crack looks like small pieces or shavings of soap, but has a hard, sharp feel. Crack is usually smoked by heating it in a glass pipe, but it can also be mixed into a marijuana “joint” or a tobacco cigarette.

When a person smokes crack (or powder via freebase) cocaine, the drug reaches the brain more rapidly and in higher peak doses than when it is snorted in powder form. The user feels an intense “rush” followed by a “crash” that can produce a strong craving for more of the drug.

What's so bad about cocaine and crack?

Cocaine and crack are dangerous for many reasons. Cocaine and crack use can lead to serious side effects – some life-threatening – including:

Sudden cardiac death.
Brain seizures.
Irregular heartbeat/increased heart rate.
Increased blood pressure.
Heart attack.
Depression.
Stroke.
Violent actions.
Loss of ability to perform sexually.
Addiction, even after one try.

In a person who is addicted, his or her cocaine use becomes an obsession and strong urge that can cause:

Loss of control over his or her life.
A willingness to do anything to get more cocaine.
Spending a tremendous amount of money on his or her habit.
A loss of interest in friends, family, and social activities.
A need to take the drug just to feel “normal."

Symptoms and Causes

How do people become addicted to cocaine?

Cocaine causes an intense flood of chemicals in the brain’s “pleasure” or “reward” pathway—essentially short-circuiting what would normally only be stimulated, or roused, by pleasurable life events. Repeated overloading of this brain circuit by cocaine causes changes in the brain in which nothing seems pleasurable without the drug.

The chemicals released in the brain by cocaine also play a role in maintaining normal feelings of happiness. Reduced levels of these chemicals (as during a cocaine “crash”) can cause intense feelings of depression. The addict will try to avoid these negative feelings by using more of the drug as soon as these symptoms arise.

These actions can ultimately lead to changes in other parts of the brain that result in drug use becoming an obsession and compulsion—like an itch that must be scratched no matter what the outcome. This is why addicts will continue to use the drug despite all of the negative consequences. The obsession with the drug is also referred to as a craving.

In the case of cocaine, addicts also report an intense motivation to try to obtain the “high” that they experienced the first time they ever used, but the intensity of that first experience is impossible to ever achieve through repeated use.

What are the signs that someone is becoming addicted or is already addicted to cocaine?

A person who is becoming addicted or is addicted to cocaine will show signs including:

Periods of severe depression.
Weight loss.
Not taking care of personal hygiene or appearance.
Constant runny nose.
Frequent upper respiratory infections.
Changes in sleep patterns.
Loss of interest in friends, family, and social activities.
Loss of interest in food, sex, or other pleasures.
Hearing voices that aren’t there, or feeling paranoid.
Becoming more angry, impatient, or nervous.
Experiencing hallucinations.
Unable to explain having large sums of money.
Offering sex for money to get drugs.

What are the long term side effects of taking cocaine?

There are many health side effects of cocaine use. Long-term side effects, based on how cocaine is used, include:

From snorting: nosebleeds, running nose, loss of smell, hole in the nasal septum (the wall dividing the two sides of the nose), hole in the roof of the mouth, swallowing problems.
From injecting: increased risk of IV-related viruses, such as hepatitis C and HIV/AIDS, from sharing needles; vein collapse or scarring; heart valve, skin and soft tissue infections.
From smoking: cough, irregular breathing, asthma, increased risk of lung infections including pneumonia and bronchitis.
From absorption through gums in the mouth: mouth sores (ulcers) on the gums and the underlying bone, receding gums, chronic gingivitis (inflammation of the gum tissue), dry mouth, tooth decay.

Other general long-term effects include:

Severe weight loss and malnourishment.
Movement disorders similar to Parkinson’s disease.
Intestinal death and rupture due to constricted blood vessels/lack of oxygen to the intestinal tract.

Management and Treatment

How is cocaine and crack addiction treated?

Recovery often begins with “detox,” the body's physical withdrawal from cocaine. Physical symptoms of withdrawal can begin within a few hours and last up to seven days. The inability to enjoy normal pleasure may take longer to recover.

Withdrawal symptoms include:

Muscle tremors.
Severe headache.
Increased appetite.
Depression.
Tiredness.
Slowed thinking.
Inability to sleep (insomnia).
Bad dreams.

As soon at the patient can begin therapy, he or she enters the next phase of addiction treatment. This involves group participation, counseling, and, often, psychiatric evaluation and treatment. The goal of counseling (also called psychotherapy or “talk therapy”) is to help the addict understand the effects of cocaine use, face the issues that lead to drug use, and learn ways to stay away from cocaine. Another therapy strategy uses incentives to motivate by providing rewards to people who remain drug free. This therapeutic approach is also called contingency management.

Group participation usually involves the “12-step” process that is common to Alcoholics Anonymous and Narcotics Anonymous. If the addict also suffers from a psychiatric issue, such as depression or bipolar disorder, such issues also need to be treated or else they will probably lead the person to go back to using drugs.

Are any prescription drugs available to treat cocaine addiction?

No medications are currently approved specifically to treat cocaine addiction. Researchers are studying the use of medications approved for other conditions to treat cocaine addiction. The medications showing the most promise are psychostimulants, modafinil, bupropion, topiramate and disulfiram. However, due to small study size and inconsistent results, there is no strong support for any individual drug at this time.

A cocaine vaccine is in early testing stage. The hope of this vaccine is to reduce the risk of relapse and the return to cocaine use. The vaccine works by stimulating the production of cocaine-specific antibodies. These antibodies bind to cocaine, preventing it from crossing the blood-brain barrier and stimulating the pleasure center. So far, studies in humans have shown mixed results. Some patients with high levels of antibodies were better in abstaining from cocaine. However, other studies showed no difference in ability to abstain between those with higher levels of antibodies versus those who received a placebo vaccine.

Are there treatments to rapidly reverse the effects of an overdose of cocaine?

No drugs are currently available to rapidly reverse the cocaine overdose itself. However, emergency care would treat the life-threatening side effects – the stroke, seizures, and heart attack – that the overdose may have caused.

Outlook / Prognosis

Can a person die from an overdose of cocaine?

Yes. Serious side effects, including seizures, stroke, heart attacks and irregular heartbeats, can happen even with a single use of cocaine. If enough cocaine is taken or if the cocaine is combined with heroin, fentanyl, or other stimulants or opioids, someone could have life-threatening side effects or even die.

Living With

What advice would you give someone who would like to help someone who is addicted to cocaine?

Most drug users deny that they have a problem, and push family and friends away. You may feel helpless, frustrated, and unable to cope. You can get help by contacting a local drug abuse treatment center. You should also do the following:

Establish appropriate limits and rules with your loved one who may be addicted.
Don’t change your actions to suit the needs of the user.
Don’t cover up for the user when he or she fails to meet responsibilities at work, school, or home.
Don’t make excuses for the addict’s drug use.
Don’t lend money.
Encourage the user to seek help.
Get additional information and help from Al-Anon or Nar-Anon.

Resources

Where can I get help for drug and alcohol treatment?

To learn more about addiction and to find drug and alcohol treatment programs in your area, check the following websites:

Behavioral Health Treatment Services Locator sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) findtreatment.samhsa.gov
Cocaine Anonymous https://ca.org/
Narcotic Anonymous https://www.nar-anon.org/naranon/

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Cocaine (Crack) Addiction