An Overview

Cocaine is a stimulant drug abused for its euphoric effects. While it serves a legitimate medical purpose as a topical anesthetic for surgeries, it is more commonly encountered as a powerful and addicting illegal drug.

Usually sold as a white powder or rock-like substance (crack cocaine), users will snort, smoke or inject cocaine to feel its energizing, euphoric effects. In an attempt to increase profits, dealers will often dilute cocaine with other substances such as talc, baking soda, cornstarch, or drugs such as methamphetamine and fentanyl.

Popular street names for cocaine include “coke,” “blow,” “crack,” “snow,” and “rock.”

Cocaine Statistics

Cocaine use remains a major problem in the United States. The National Institute on Drug Abuse shares the following statistics regarding cocaine use:

• 5 million cocaine users aged 12 and older (0.6% of the population)
• The most common age group of users is 18-25
• 913,000 Americans addicted to cocaine
• Cocaine is responsible for nearly 40% of drug abuse-related emergency room visits

Cocaine vs. Crack – What’s the Difference?

Cocaine comes in two main forms, powdered cocaine, also known as “cocaine hydrochloride,” and crack cocaine. Pure powdered cocaine is a white, crystalline powder that can be snorted and injected. It cannot be smoked in this form because it is inactivated by high temperatures such as exposure to a flame. To make the drug smokable, it must be converted into a form known as “crack.”

Crack cocaine is made by mixing cocaine powder, baking soda and water, then boiling it until a solid rock-like substance is formed.

The table below highlights the differences between powdered cocaine and crack cocaine.

Powdered Cocaine Crack Cocaine

Cost High costLow costPhysical appearanceWhite, crystalline powderBrittle, rock-likeRoute of administrationSnorted, injectedSmokedOnset of effectSnorted – 1-5 minutes

Injected – Immediate

Smoked – ImmediateDuration of effectSnorted – 15-30 minutes

Injected – 20-60 minutes

Smoked – 5-10 minutes

While all forms of cocaine are dangerous, crack cocaine’s low cost makes it particularly dangerous because it is more accessible. Due to its low price, ease of use and intense effects, crack is often considered to be more addicting than its powdered cocaine counterpart.

How is Cocaine Taken?

Most users choose to snort powdered cocaine, however it can be injected or smoked as well.

• Snorting – When snorting cocaine, the user will often make “lines,” narrow strips of powder arranged on a flat surface. These lines are then snorted, or taken up through the nose, where the drug diffuses through the membranes of the nose. Long term effects of snorting cocaine involve diseases such as perforated septum (a hole in the lining that separates each nostril), nosebleeds and a permanent loss in sense of smell.
• Injection – Cocaine is easily dissolved in water and can be injected directly into a vein. When taken this way, the drug is immediately introduced into the bloodstream and its effects are nearly instantaneous. Users who inject cocaine and share needles are at a high risk for acquiring blood-borne diseases such as HIV and hepatitis C.
• Smoking – When smoked as crack cocaine, the drug diffuses across the lungs and into the blood. Similar to injection, when cocaine is smoked, the effects hit instantly and last for 5-10 minutes. Smoking crack cocaine long term can damage the lungs and cause respiratory problems such as asthma.

How Does Cocaine Work and Why is it So Addicting?

Cocaine works by stimulating our brain’s “reward pathway,” a primitive part of our brain responsible for reinforcing positive stimuli necessary for survival. For example, when we are hungry and eat food, our reward pathway “rewards” us for eating by releasing dopamine, leading to a pleasurable and satisfying feeling. Cocaine hijacks this system and enhances its effect, tricking our brains into rewarding us for cocaine use.

Effects of Cocaine

Cocaine abuse is associated with significant side effects. Short term effects of cocaine may include the following:

• Dilated pupils
• Increased blood pressure
• Increased or irregular heartbeat
• Heart attacks
• Tremors, muscle twitching
• Paranoia
• Seizures

All amounts of cocaine can produce these effects, however the higher the dose, the more likely and severe these effects will be. Injecting and smoking will produce stronger effects that appear faster, while snorting will produce more mild effects that may taker longer to set in.

Long term effects of cocaine use include the following and will vary depending on how the drug is taken:

• Snorting – loss of smell, perforated septum, chronic bloody nose
• Smoking – asthma, respiratory infections, chronic cough
• Injection – high risk of HIV, hepatitis C and skin or soft tissue infections, collapsed veins

Cocaine Overdose

Since cocaine is often diluted with other ingredients, including dangerous drugs such as fentanyl, its true strength is nearly impossible to determine. This opens up the possibility of a dangerous overdose.

Overdose on cocaine is life-threatening and may involve the following symptoms:

• Extremely high heart rate
• Irregular heart rhythm
• High blood pressure
• Hallucinations and extreme paranoia or anxiety
• Seizures

No antidote for cocaine exists – treatment for overdose is often supportive and will involve treating the symptoms.

Cocaine Addiction

Cocaine is a powerfully addictive drug; users can become addicted even after a single use. Repeated use of the drug may lead to addiction.

Signs and symptoms of addiction may include the following:

• Weight loss – Since cocaine is a stimulant drug, it causes a decrease in appetite. Over time, a lack of appetite can cause the user to lose weight. Many long-term users are malnourished and may be severely underweight.
• Drug-seeking behavior – Someone who is addicted to cocaine will often focus all their activities around acquiring the drug. They may exhibit extreme drug-seeking behavior such as lying and stealing from friends and family.
• Physical appearance changes – Depending on how the drug is being taken, users may exhibit deterioration in their physical appearance such as weight loss, lack of hygiene and nose-related problems.

Tolerance, Dependence and Withdrawal

When used repeatedly, tolerance will develop to the euphoric effects of cocaine, where more of the drug must be taken to achieve the same effects.

Long term use can cause a user to become dependent, where they require the drug to feel normal. If dependent, the user will suffer withdrawal symptoms if the drug is not taken.

Withdrawal symptoms of cocaine include:

• Agitation and restlessness
• Depression
• Increased appetite
• Extreme drug craving

There are no notable physical withdrawal symptoms, however this does not make cocaine easy to quit, as the drug craving associated with cocaine withdrawal can last months after quitting.

Addiction Treatment

Since withdrawal from cocaine is not physically dangerous, addiction treatment does not require admittance to a treatment center or rehab, however a user may still benefit greatly from the support of a therapist specializing in substance use disorders.

• Fioricet (butalbital + Tylenol + caffeine)*
• Fiorinal (butalbital + aspirin + caffeine)*
• Luminal (phenobarbital)
• Mysoline (primidone)
• Seconyl sodium (secobarbital)
• Pentothal (thiopental)