Cocaine: Say no to blow

What is cocaine?

Cocaine is a central nervous system stimulant and a popular drug of abuse. It is highly addictive. It also has local anesthetic effects, so it is sometimes used for anesthesia during surgery.

It is made from the leaves of the coca plant, which grows in South America. Cocaine hydrochloride is a fine, white crystal powder that is usually mixed with inert ingredients (such as cornstarch or talcum powder) or with other drugs. Street names include blow, big C, coca, coke, flake, and snow.

How is cocaine used?

Cocaine hydrochloride can be snorted (sniffed into the nose), rubbed on the gums, or dissolved and injected intravenously. Free base cocaine is not destroyed by heat, so it is smoked. Smoking or intravenous injection produces a more rapid onset of effects but a shorter duration than other routes of use.

Short term effects of cocaine

Cocaine is a stimulant, which causes feelings of euphoria, as well as increased energy and alertness. It temporarily decreases the need for sleep and food. Physical effects include increased heart rate, blood pressure, and temperature, as well as dilated pupils. Tremors, muscle twitching, abdominal pain, and nausea can occur. Other possible effects include anxiety, irritability, agitation, and restlessness. More serious effects include delirium, panic, paranoia, and erratic or violent behavior.

Cocaine overdose: What are the symptoms?

Central nervous system effects of cocaine include anxiety, irritability, agitation, restlessness, psychosis, tremors, muscle rigidity, seizures, coma, and respiratory arrest. Seizures can be short or prolonged (status epilepticus).

Cocaine can also cause abnormal heart rhythms (such as ventricular tachycardia or fibrillation), heart attack, cardiac arrest, severe hypertension (which can lead to hemorrhagic stroke), and shock. Kidney failure can result from shock or from the breakdown products of muscle entering the kidneys. Death is due to fatal arrhythmias, cardiac arrest, status epilepticus, intracranial hemorrhage, or hyperthermia (very high body temperature).

Is cocaine addictive?

Yes, cocaine is highly addictive. With chronic use, you need to increase the dose to achieve the same high. Stopping cocaine after chronic use results in intense craving and depression. Symptoms of withdrawal include agitation, fatigue, malaise (lacking energy), unpleasant dreams, and slowing of activity. Suicidal thoughts are possible. 

What happens when cocaine is mixed with alcohol or other drugs?

When cocaine is used with alcohol, cocaethylene is formed in the liver. Cocaethylene is more toxic than cocaine alone and increases the risk of heart attacks, strokes, seizures, and death.  It is longer acting than cocaine. Street cocaine is often mixed with other drugs such as anesthetics (e.g., lidocaine, benzocaine), caffeine, ephedrine, methamphetamine, and phencyclidine. It can be adulterated with other toxic substances such as levamisole (an antiparasitic drug) and xylazine (an animal tranquilizer).

Fentanyl in cocaine

Sometimes cocaine and an opioid are used together to blunt the stimulant effect of cocaine with the opioid. When cocaine and heroin are injected together, it’s called a speedball. Most of the ‘heroin’ on the street today is fentanyl. This combination can be dangerous since cocaine’s effect wears off first, resulting in an opioid overdose.

What should I do if someone is having a cocaine overdose?

If someone is having a cocaine overdose, seek immediate medical attention. If someone abuses cocaine, or if you have a question about cocaine use or dependence, use the webPOISONCONTROL online tool to get immediate help, or call your poison center at 1-800-222-1222. Whether online or by phone, expert guidance is always free, confidential, and available 24 hours a day.