Cocaine

How is cocaine used?

Cocaine hydrochloride is most commonly snorted. It can also be injected and rubbed into the gums.^{3, 6}

Freebase and crack cocaine are usually smoked.^{3, 7}

Indigenous people of South America have traditionally chewed the leaves of the coca bush for their stimulant and appetite suppressant effects.^{2, 3}

Effects of cocaine

The use of any drug can have risks. It’s important to be careful when taking any type of drug.

Cocaine can affect everyone differently, based on:

• size, weight and health
• whether the person is used to taking it
• whether other drugs are taken around the same time
• the amount taken
• the strength of the drug (varies from batch to batch)
• the environment (where the drug is taken).

Onset and duration

How fast a drug takes effect and how long it lasts can vary depending on how it's taken - for example, whether it's snorted, smoked, or injected.^{8, 9}

• Snorting: effects can be felt in around 3-10 minutes and last for about 90 minutes
• Smoking or injecting: effects are usually felt immediately and last for about 5-15 minutes.⁵

Effects

Effects can include:

• happiness
• increased confidence
• talking more
• feeling energetic and alert
• increased heartbeat and breathing 
• increased body temperature
• increased blood pressure
• anxiety
• paranoia
• irritability and agitation
• headaches
• dizziness
• feeling physically strong and mentally sharp
• reduced appetite
• dry mouth
• enlarged (dilated) pupils
• increased sex drive
• difficulty sleeping
• indifference to pain.^{5, 6}

High doses or frequent use can also cause ‘cocaine psychosis’, characterised by paranoia, hallucinations, unusual thoughts and out of characterbehaviour.^{5, 6}

These symptoms usually disappear a few days or weeks after the person stops using cocaine.⁶

Impact of mood and environment

Drugs that affect a person’s mental state (psychoactive drugs) can also have varied effects depending on a person’s mood (often called the ‘set’) or the environment they are in (the ‘setting’): 

• Set: a person’s state of mind, previous encounters with the drug, and expectations of what’s going to happen. For example, feelings of stress or anxiety before using cocaine may result in an unpleasant experience and make those feelings worse.
• Setting: the physical and social environment where you take cocaine – whether it’s known and familiar, who you're with, if you're indoors or outdoors, the type of music or sounds, and lighting. The ideal setting to take cocaine will vary based on the individual and drug they’re using. For example, one person might enjoy cocaine in a loud or busy social setting, while another may prefer a quieter environment.¹⁰

Being in a good state of mind, with trusted friends and a safe environment before taking cocaine reduces the risk of having a bad experience.¹⁰

Overdose

If you take a large amount of cocaine or use a strong batch, you could overdose.5

Your risk of overdose can also increase if you mix cocaine with alcohol or other drugs, including medications.

Cocaine overdose can cause death.⁵

Call triple zero (000) and request an ambulance if you or someone else has any of the following symptoms (emergency services are there to help and can provide more instructions).

Signs of cocaine overdose can include:

• unconscious or non-responsive
• spasms or seizures
• feeling tired or fatigued
• heart attack symptoms such as:
• difficulty breathing
• sharp pain/discomfort in chest, arm, shoulder, back, neck, or jaw
• severe agitation, confusion, or panic
• hallucinations
• racing heartbeat
• hot, flushed (red), or sweaty skin
• very large pupils.^{11, 12}

Mixing cocaine with other drugs

Mixing cocaine with other drugs can have unpredictable effects and increase the risk of harm.

Mixing includes using more than one drug (including alcohol or medications) at the same time, or one after another. You should also consider what drugs you’ve taken in the last 24 hours.

• Cocaine and psilocybin/LSD/cannabis: can intensify anxiety, paranoia, confusion, or thought loops.
• Cocaine and opioids/GHB/GBL: can increase the risk of heart strain and respiratory arrest.
• Cocaine and methamphetamine: can increase the risk of heart strain.
• Cocaine and ketamine: can impair thinking, coordination and increase blood pressure depending on amount taken.
• Cocaine and alcohol: can feel less intoxicated due to the stimulant effect of cocaine and lead to drinking more.
• Cocaine and MDMA: increases the risk of heart strain, heart attack and psychosis. Cocaine can also reduce desirable effects of MDMA.

‘Polydrug use’ is a term for the use of more than one drug or type of drug at the same time or one after another.¹³

Polydrug use can involve both illicit drugs and legal substances, such as alcohol and medications. 

Reducing harm

There are ways in which you can reduce the risks associated with using cocaine:

• Stay hydrated. People can become dehydrated when using cocaine, take small sips of water regularly. 
• Try to eat regularly even if you are not hungry. Eat fresh healthy food such as fruit and vegetables that are high in vitamins and nutrients. 
• Try to rest and get sleep.
• Regular use of cocaine can increase the risk of heart attack or other heart problems. Using less frequently and smaller amounts may reduce this risk.^{14, 15}

If snorting

• Crush into a fine powder, as crystals can cause cuts.
• Rinse your nose with water before and after to protect your nose from irritation.
• Use your own straw, or a disposable one, and avoid money notes to reduce the risk of infections or transmission of viruses like HIV or Hep C.
• Switch nostrils and take breaks to avoid nasal damage.^{5, 14, 16, 17}

If injecting

• Always use new needles – never share needles or other injecting equipment. Use your own spoon/cup and tourniquet. Use new barrels, filters, sterile water, and swabs. Safely dispose of used equipment.
• Visit a needle and syringe program for sterile equipment, disposal of used equipment, and expert medical advice.^15-17

Heroin found in or sold as cocaine:

• ‘Start low, go slow’, pace yourself by taking a small amount to start with, and leave time between doses. 
• Never use alone, make sure someone nearby has naloxone on hand and a phone to call for help if needed. 
• Check for drug alerts and use drug checking (pill testing) services, where available.

Coming down

In the days after cocaine use, you may experience:

• irritability and paranoia
• mood swings
• feeling uncomfortable
• exhaustion.⁶

Learn more about drug comedowns here. 

Long-term effects

Long-term effects can vary depending on how much, how often and how cocaine is consumed.

Regular use may eventually contribute to:

• dependence
• lung conditions such as bronchitis
• anxiety, paranoia and psychosis
• sexual dysfunction
• kidney failure
• stroke
• seizures
• high blood pressure
• irregular heartbeat
• heart disease.^{6, 18}

Snorting cocaine regularly can also cause:

• runny nose and nose bleeds
• nose infection
• damage to the tissue separating the nostrils (nasal septum)
• loss of sense of smell.⁶

Cocaine and mental health

The relationship between cocaine use and mental health is complex.

Use of cocaine is associated with mental health conditions such as depression, anxiety, and psychotic disorders.^{19, 20}

However, we can’t say if using cocaine causes these conditions. There may be other reasons that explain the link.²¹

For example, some people may use cocaine as a way to cope with stress, depression, or other mental health concerns.^{21, 22}

Using cocaine may also worsen the symptoms of schizophrenia, psychosis, and bipolar disorder.^{19, 23}

Anyone with a history of these issues should avoid or use less cocaine.

More research is needed to fully understand the links between cocaine use and mental health concerns. 

Tolerance

Regularly taking cocaine can lead to developing a tolerance, which means you need to take larger amounts to get the same effects.²

Tolerance should return to normal within about 1-2 weeks of not using cocaine.²⁴

Dependence

People who regularly use cocaine may become dependent. They may feel they need to use cocaine to go about usual activities like working, studying and socialising, or just to get through the day.²

People may be more likely to become dependent on cocaine depending on how it is taken.²⁵

For example, injecting/smoking cocaine is associated with worse long-term health outcomes compared to snorting cocaine.²⁵

Withdrawal

Withdrawal refers to the symptoms that can occur when someone who is dependent on a drug, or who has been using it regularly over time, stops or reduces their use.²⁶

Withdrawal can include physical symptoms (such as headaches, or nausea) and psychological symptoms (such as anxiety, or depressed mood).²⁶

Symptoms - including how strong they are and how long they last - will vary depending on the type of drug and a person’s history of use.²⁶

If you, or someone you care about, is planning to stop taking cocaine after using it for a long time, it’s important to speak with a medical professional for guidance and supervision.

Phases of withdrawal

Withdrawal symptoms usually start around 6-12 hours after the last use.

Withdrawal usually happens in three phases:

• Crash – feelings of depression or anxiety, cocaine cravings, extreme tiredness (experienced in the first few days)
• Withdrawal – cocaine cravings, lack of energy, anxiety, agitation, disturbed sleep, and an inability to feel pleasure (can last for several weeks)
• Extinction – withdrawal symptoms can occur over several months, gradually subsiding).⁶

Pregnancy and breastfeeding

Before pregnancy

There is limited information about the impact of cocaine on fertility. Some research suggests that cocaine can impact sperm quality.²⁷

If you’re trying to get pregnant, it’s best for both you and your partner to avoid using cocaine.²⁷

During pregnancy

Similar to other stimulants, it is recommended, and safest, to not take cocaine while pregnant.^{27, 28}

The impacts of cocaine use on the baby during pregnancy are not well understood. 

Research indicates that babies who are exposed to cocaine throughout pregnancy are more likely to have:

• lower birth weight and height
• pre-term (early) birth
• slower growth as infants
• small head circumference.²⁹

These risks increase significantly if you take high doses, take it often, or take it later in your pregnancy. There are still risks associated with taking cocaine in small amounts, infrequently, or early in the pregnancy.²⁹

After pregnancy

It’s recommended to avoid cocaine use while breastfeeding because it can pass to the baby through breastmilk.²⁸

Cocaine use during pregnancy can sometimes cause temporary symptoms in babies after birth.

This is known as neonatal abstinence syndrome (NAS). NAS symptoms can include:

• irritability
• shaking
• muscle stiffness
• feeding or sleeping difficulties
• increased activity.^{27, 30}

NAS is easily diagnosed and treated, and not all babies will experience symptoms.30

There’s research that suggests that after birth, children who were exposed to cocaine during pregnancy may experience long-term mental or physical effects, such as poorer language abilities, shorter attention span or being more disorganised.²⁷

Getting help

If your use of cocaine is affecting your health, family, relationships, work, school, financial or other life situations, or you’re concerned about someone, there is help and support. 

• Call the National Alcohol and Other Drug Hotline on 1800 250 015 for free and confidential advice, information and counselling about alcohol and other drugs.
• Stimulant Treatment Line offers free counselling and support for people who use stimulants, such as methamphetamine (ice), cocaine and ecstasy: 1800 101 188
• Search our Help and Support directory to find your preferred support, by adding your location or postcode and filtering by service type.