• Addiction & recovery

Cocaine Effects

David Schwartz, MD

October 29, 2021


Illicit substance use has been on the rise in the United States, and cocaine is a key contributor to this growing epidemic. While there has been a lot of focus on the rise in opioid-related overdose deaths, it’s also important to note that deaths from other substances, such as cocaine have also escalated in recent years. According to the Centers for Disease Control and Prevention (CDC), the rate of overdose deaths involving cocaine has tripled from 2012 to 2018.

Cocaine is currently classified as a Schedule II substance with a high potential for misuse. As a result, it’s only legally permitted for medical use, such as local anesthetic, during certain surgeries. And while cocaine is largely prohibited for non-medical use in the United States, it ranks third in terms of illicit substance misuse after marijuana and painkillers.

Intoxication is one of the most widely known effects of cocaine, and it’s often the primary motivation for misusing the substance. The effects of cocaine can vary based on many factors. And people tend to react to cocaine in different ways. 


What Is Cocaine?

Cocaine is a potent stimulant derived from the leaves of the coca plant (Erythroxylon coca), which is native to South America. Purified cocaine was the active ingredient in numerous tonics and elixirs created to treat a wide range of ailments in the early 1900s. It was also used as a pain-blocker by surgeons before the discovery of synthetic local anesthetics. However, research has now revealed that cocaine is a highly addictive substance that can alter the function and structure of the brain with repeated use. 

Once processed, the cocaine leaf extract produces three different versions of cocaine:

  • Cocaine hydrochloride – A fine crystalline white powder with a bitter, numbing taste. It is often mixed with other substances such as lidocaine, talcum powder, or sugar to dilute it before being sold.
  • Freebase – A form of cocaine that is purer than cocaine hydrochloride.
  • Crack – These crystals range from white, cream, or transparent with pink or yellow hues that contain impurities.

How Does Cocaine Work?

Cocaine is a central nervous system stimulant (CNS) that acts on the limbic system responsible for pleasure and motivation. Cocaine works by producing a short-term build-up of dopamine, the “feel-good” hormone, which causes intoxication shortly after ingesting the substance.

When the brain is repeatedly exposed to cocaine, the reward system becomes less receptive to natural reinforcement. Simultaneously, circuits involved in stress become more sensitive, resulting in increased dissatisfaction and negative moods when the substance is not taken. These combined effects make the user more prone to pursue the substance instead of relationships, professional achievements, or other natural rewards.


How Is Cocaine Used?

People often take cocaine on binges. They may consume the substance repeatedly within a short time, at increasingly higher doses, to maintain its effects or take it with other substances like alcohol. Cocaine is primarily used in the following manner:

  • Intranasal – By inhaling cocaine powder through the nostrils, where it’s absorbed into the bloodstream through the nasal tissues.
  • Intravenously – Dissolving cocaine in water and injecting it.
  • Orally – Rubbing the substance onto the gums or by chewing.
  • Inhalation – The smoke is inhaled directly into the lungs, where it’s instantly absorbed into the bloodstream.


How Long Do the Effects of Cocaine Last?

The route of administration determines the duration of cocaine’s effects. The faster the substance is absorbed, the more intense its effects are. 

As such, the general onset time of effects based on the route of administration is as follows:

  • Snorting – Effects appear within one to three minutes and last for 15 to 30 minutes.
  • Chewing – Effects appear within one to three minutes and last for 15 to 30 minutes.
  • Smoking – Effects appear within 10 to 15 seconds and last for five to 15 minutes.
  • Injecting – Effects appear within 10 to 15 seconds and last for five to 15 minutes.

It’s important to note that the duration and intensity of effects aren’t the same for everyone. The amount of cocaine consumed and whether it’s taken with other substances can also affect how long the effects last.

Cocaine Effects - Eleanor Health

What Are the Immediate Effects of Cocaine?

The effects of cocaine can be experienced almost immediately after a single dose and may fade away in a matter of minutes or hours. Small doses of cocaine usually make the user feel content, energetic, talkative, mentally alert, and hypersensitive to sight, sound, and touch. Some users report that it helps them perform simple tasks more quickly, while others report the opposite effect.

Cocaine use may also have the following short-term effects:

  • Constricted blood vessels
  • Dilated pupils
  • Loss of appetite
  • Increased body temperature
  • Increased heart rate
  • Increased blood pressure
  • Tremors
  • Muscle twitches
  • Vertigo (a spinning sensation)

Large doses of cocaine can heighten the intoxicating effects while also causing bizarre, erratic, and violent behavior. Cocaine use can also increase a person’s likelihood of engaging in risky behaviors, such as driving while intoxicated.


Cocaine Effects Associated With Specific Routes of Administration

Cocaine administration via different routes can produce its own set of side effects. For example, regularly snorting cocaine can lead to:

  • Loss of sense of smell
  • Bloody nose
  • Problems with swallowing
  • Hoarseness
  • Chronically inflamed, runny nose

Additionally, individuals who inject cocaine have puncture marks called tracks, most commonly in their forearms. These individuals are at risk of contracting infectious diseases such as HIV and hepatitis C. They also may experience allergic reactions, either to the substance itself or to additives in cocaine. Individuals who smoke cocaine have a high likelihood of developing asthma, respiratory distress, and pneumonia.


Side Effects of Cocaine

Whether used for short durations or extended periods, cocaine use is associated with various side effects such as:

  • Dilated pupils
  • Loss of appetite
  • Tremors
  • Muscle cramps 
  • Paranoia
  • Constricted blood vessels
  • Increased heart rate
  • Increased blood pressure
  • Decreased sexual function
  • Increased body temperature
  • Cocaine use disorder 

Cocaine is incredibly potent, and the physical side effects vary depending on the amount consumed, the user’s body chemistry, and any other substances mixed in it or taken with it.


Long-Term Effects of Cocaine Use

With repeated exposure, cocaine can produce long-term effects such as:

  • Nosebleeds
  • Problems with the sinuses
  • Damage to the inside of the nose
  • Suspicious and paranoid thinking, which can lead to aggressiveness
  • Psychotic reactions (hallucinations and delusions)

Conversely, smoking cocaine has specific long-term effects such as:

  • Breathing difficulties
  • Long-term cough
  • Chest pain and lung damage

Prolonged use of cocaine can cause a blunting of emotions and withdrawal from family and friends. Most importantly, it could cause the development of physical dependence.


Cocaine Effects on the Brain

Cocaine affects the brain in various ways. The build-up of dopamine constantly stimulates the brain’s reward center until its effects wear off. Cocaine activates the brain in the same manner as a real accomplishment does, which is why those who form a dependence seek the rewarding effects regularly. 

In addition to affecting the brain’s perception of reward, cocaine use disorder (CUD) can also affect the brain pathways that respond to stress. According to the National Institute on Drug Abuse (NIDA), cocaine use disorder frequently coexists with stress-related disorders, and stress generally contributes to relapse. Likewise, chronic use of cocaine may also affect many other areas of the brain. 


The Cardiovascular Effects of Cocaine 

While cocaine can negatively affect every organ in the body, its most severe effects are experienced by the cardiovascular system. According to the National Center for Biotechnology Information (NCBI), cocaine can cause various negative effects on the cardiovascular system, including acute conditions such as:

In general, the treatment of cocaine-related cardiovascular problems is the same regardless of cocaine use. However, owing to the multitude of negative effects on the human body, treatment options are limited in people with cocaine-induced cardiovascular disorders. 


What Is Cocaine Withdrawal?

Cocaine withdrawal is a condition that occurs during abrupt cessation or reduction of cocaine consumption. Withdrawal symptoms usually start around six to 12 hours after the last use and may include symptoms such as:

  • Anxiety
  • Restlessness
  • Trouble concentrating
  • Low energy
  • Changing moods
  • Paranoia
  • Depression
  • Intense craving

Cocaine is a highly addictive substance; however, there is a difference between addiction and dependence. Addiction is defined as the inability to stop taking a substance, despite the personal distress it causes. Dependence is the body’s physiological adaptation to a substance. And it’s the development of dependence that foreshadows the onset of physical withdrawal symptoms if the substance is no longer used.


Cocaine Overdose – Signs and Symptoms

Consuming cocaine in high doses can increase the risk of an overdose. A cocaine overdose indicates that someone has taken more cocaine than their body can tolerate. Overdosing on cocaine is more likely if the strength or purity of the cocaine is unknown. Injecting cocaine can further increase the risk of overdose due to large amounts of it entering the bloodstream and rapidly traveling to the brain.

Cocaine overdose can result in:

  • Stroke
  • Respiratory arrest
  • Kidney failure
  • Heart attack
  • Coma
  • Sudden death

The risk of cocaine overdose is compounded when used alongside other substances such as alcohol or other narcotics. For example, cocaine and heroin are highly lethal when combined. This concoction, often known as a speedball, poses a high risk of overdose.

In the event of a cocaine overdose, the first thing to do is call 911, as the situation demands professional medical attention. If the individual is having a seizure, it is important to keep them away from any objects that might injure them due to their body movement. And a cold compress can aid in the reduction of body temperature until the ambulance arrives.

Cocaine use disorder is a complex disease involving alterations in the brain and many social, familial, and other environmental factors. For this reason, treatment of such conditions must address this broad context and any other co-occurring mental health conditions that require additional behavioral interventions.

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