Safer Using – Cocaine

About Cocaine

Cocaine (also known as benzoylmethylecgonine, coke, cola, snow, ski, blow, white, lello etc.) is a stimulant drug extracted from the leaves of the coca plant (Erythroxylum coca) and other related species.1,2  Cocaine predominantly comes in two forms: as a hydrochloride salt or as a freebase (called crack cocaine or simply crack, base, or rocks).1,2 The salt form of cocaine is most commonly snorted (insufflation), but can also be rubbed on the gums or under the tongue (sublingual), or injected.1 Crack cocaine is vaporised in an oil burner pipe (a.k.a. pizzo or pilo pipe).1,2

The leaves of the coca plant are chewed in the Americas for their subtle stimulant effect due to the presence of small amounts of cocaine.1,2 There is some evidence this practice has existed in South America for around a thousand years.1 The cocaine molecule was first isolated from the coca plant in 1855 by Friedrich Gaedcke who originally named it erythroxyline.2 Cocaine was used medically as a local anaesthetic due to its numbing properties up until the first half of the 20th century.3 It has since been replaced by various other local anaesthetics that are not psychoactive and which are still widely used today including procaine (Novocaine), lidocaine (lignocaine/Xylocaine), and eucaine (betacaine).2,3 These local anaesthetics are often used to cut cocaine sold on the street.1

The salt form of cocaine is mostly sold as a white, crystalline powder.1,2 Because of this, it’s very easy for dealers to cut cocaine with other psychoactive or non-psychoactive compounds. 18% of the 83 cocaine samples tested at CanTEST contained an additional substance, such as MDMA, ketamine, dipentylone, procaine, lidocaine, paracetamol, caffeine, and/or creatine.4,5,6,7,8 Ingesting these other substances alongside cocaine may be more harmful than taking cocaine on its own. As such, it’s important to test your cocaine before you take it by either using a reagent test kit at home (e.g., or by taking it to a drug checking site such as CanTEST.

Cocaine increases the risk of heart attack even in otherwise healthy individuals.9 So, people with an existing heart condition should avoid cocaine altogether.

Cocaine Effects

The effects of cocaine can include:1,2,10  

  • Euphoria, mood lift.
  • Stimulation, increase in energy.
  • Numbing of nose, mouth, and/or face.
  • Sweating.
  • Dilated pupils (mydriasis).
  • Decreased appetite.
  • Insomnia.
  • Increased heart rate (tachycardia).
  • Increased body temperature.
  • Dehydration.
  • Restlessness.
  • Muscle tremors.
  • Erectile dysfunction.
  • Urge to take more.
  • Teeth grinding (bruxism).

Cocaine Dosing

Dosages can vary between individuals, so it’s important to start at a low dose and wait before redosing cocaine (start low and go slow).

The following is a rough dosage guide for snorted cocaine (salt form):1

LOW DOSE – 10-30 mg

MODERATE DOSE – 30-60 mg

STRONG DOSE – 60-90 mg

HEAVY DOSE – 90+ mg

Cocaine typically comes on quickly and lasts 1-1.5 hours when snorted.2 When smoked as crack, it is more intense and typically only lasts 5-15 minutes.1

Cocaine Overdose and Cocaethylene

A cocaine overdose can be extremely unpleasant and, in severe cases, can lead to life-threatening complications and even death.11 The symptoms of a cocaine overdose can include:11

  • Paranoia.
  • Panic.
  • Confusion.
  • Restlessness.
  • Agitation or aggression.
  • Rapid breathing.
  • Abnormal heart rhythm.
  • Chest pain.
  • Abdominal pain.
  • Twitching.
  • Convulsions.
  • Increased body temperature.
  • Nausea.
  • Vomiting.
  • Seizures.

Seek medical attention as soon as possible if you believe someone has overdosed on cocaine and:9,11

  • Is losing consciousness,
  • Is having difficulty breathing,
  • Is unable keep down fluids,
  • Is having chest pain,
  • Has a temperature greater than 39°C, and/or
  • Is having a seizure.

Complications of a very severe cocaine overdose can include:11

  • Stroke.
  • Heart attack.
  • Coma.
  • Death.

Mixing cocaine with other substances can increase the risk of undesirable side effects and overdose:12

  • Mixing cocaine with opioids is dangerous since it can allow the user to tolerate higher doses of opioids, which can lead to opioid overdose once the cocaine wears off.
  • Mixing cocaine with tramadol increases the risk of seizures.
  • Mixing cocaine with other stimulants such as amphetamines or cathinones can increase strain on the heart.
  • Mixing cocaine with DXM or NBOMes (sometimes sold incorrectly as LSD) increases the risk of strain on the heart.
  • Mixing cocaine with psychedelics can increase the risk of anxiety.
  • Mixing cocaine with MAOIs (a class of antidepressants which includes tranylcypromine/Parnate) is considered dangerous.

Mixing cocaine with alcohol can lead to excessive drinking since cocaine reduces the sedating effects of alcohol.12 This can increase the risk of liver damage and dehydration.12 Additionally, when cocaine and ethanol are consumed at the same time, they react in the liver to produce a substance called cocaethylene.10 Compared to cocaine, cocaethylene is more potent, it lasts longer, it is more toxic to the heart, and it has been observed to result in a greater rate of mortality in mice.10

Cocaine Toxicity and Withdrawal

According to a study published in 2010, cocaine was the fifth most harmful drug in the UK terms of harm to the user and harm to others.13 Crack cocaine, on the other hand, was the third most harmful, carrying a significantly greater risk of dependence and harm to the user.13

Short-term cocaine use has been observed to increase the risk of heart attack regardless of dosage or frequency of use.9,14 Long-term cocaine use can cause damage to the heart, changes to heart rhythm, and inflammation of the heart.9 Additionally, long-term cocaine use may speed up the aging of the brain by triggering the death of brain cells, damaging blood vessels, and increasing the risk of stroke.10

Stopping frequent cocaine use can lead to withdrawal. The mental and physicals symptoms of withdrawal can include:15

  • Fatigue.
  • A general feeling of discomfort, not feeling well (malaise).
  • Slowed movements.
  • Increased appetite.
  • Sensation of skin crawling or itching (formication).
  • Cocaine cravings.
  • Agitation.
  • Anxiety.
  • Difficulty making decisions.
  • Depressed mood.
  • Suicidal thoughts.
  • Nightmares.

Cocaine typically lasts 1-2 weeks after the last dose, but some people experience symptoms up to 2 months.15 If you are experiencing symptoms of cocaine withdrawal or are concerned about your cocaine use, consider visiting a non-judgemental health professional at the CAHMA clinic, or chatting to a peer support worker at the CAHMA drop-in centre.

Written by Darcy Lynch

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