Cocaine: Effects, Mixing With Alcohol, Addiction, And More - Healthline

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HealthlineSubscribeEverything You Need to Know About Cocaine

Medically reviewed by Dena Westphalen, PharmD — Written by Adrienne Santos-Longhurst on April 9, 2020

Methods
Coke vs. crack
Effects
Onset
Duration
Comedown
Detection window
Alcohol
Other interactions
Addiction
Risks
Harm reduction
Overdose signs
Getting help

Cocaine — aka coke, blow, and snow — is a powerful stimulant made from the leaves of the coca plant. It usually comes in the form of a white, crystalline powder.

While it has a few medicinal uses, personal use is illegal in the United States.

If you use it, are considering using it, or are around anyone who does, read on. We’ll cover everything you need to know, like what to expect from the high, potential risks, and what to do if things go south.

Healthline does not endorse the use of any illegal substances, and we recognize abstaining from them is always the safest approach. However, we believe in providing accessible and accurate information to reduce the harm that can occur when using.

How is it used?

Cocaine is often snorted, but people also:

dissolve the powder and inject it
ingest it orally
sprinkle it on cigarettes or joints to smoke it
rub it on their gums (gumming)

Some people process cocaine into a rock and smoke it, which we’ll get to next.

Is it the same thing as crack?

Crack is cocaine freebase that’s been processed into a rock. This makes for a more potent, smokable substance.

Cocaine is made from hydrochloride and alkaloid, which is also known as base. Baking soda or ammonium is used to “free” the base by removing the hydrochloride.

The end result is crack. It got its name from the crackling sound from heating and smoking the rock.

What does it feel like?

People use coke for its intense psychological effects, like euphoria and boosted confidence. But it can also produce some not-so-pleasant psychological and physical effects.

Psychological effects

Common psychological effects of cocaine include:

feelings of intense happiness
increased energy
paranoia
feeling more social and talkative
inflated confidence
increased alertness
irritability
anxiety

Physical effects

Cocaine produces several physical effects, including:

dilated pupils
fast or irregular heartbeat
constricted blood vessels
muscle twitches
tremors
high blood pressure
increased body temperature
nausea
restlessness
decreased appetite
insomnia
headache
dizziness
diarrhea
bloody nose
trouble getting or keeping an erection

How long do the effects take to kick in?

Coke’s effects kick in fast, but the exact onset depends on how you consume it.

Here’s the breakdown:

Snorting: 1 to 3 minutes
Gumming: 1 to 3 minutes
Smoking: 10 to 15 seconds
Injecting: 10 to 15 seconds

The reason for the time difference comes from the speed at which it enters your bloodstream.

When snorted or gummed, coke needs to get through mucus, skin, and other tissues. It bypasses all that when you inject or smoke it, allowing it to enter the bloodstream almost immediately.

How long do the effects last?

That also depends on how it’s consumed, along with other variables, like your dose and whether you’re taking other substances.

Here’s what to expect in terms of how long the high lasts:

Snorting: 15 to 30 minutes
Gumming: 15 to 30 minutes
Smoking: 5 to 15 minutes
Injecting: 5 to 15 minutes

Of course, everyone’s different, so things might last for more or less time for some folks.

Is there a comedown?

Yes. A cocaine comedown can last as long as a few days. How much you use plays a role in how hard you crash.

Once the high wears off, coke can leave you feeling depressed and extremely tired for several days. The short-lived high is also often followed by an intense desire to use more and difficulty sleeping.

How long does it stay in your system?

Cocaine typically stays in your system for 1 to 4 days but can be detected for a couple of weeks in some people.

Several factors can affect how long it hangs around in your body, including:

how much you use
how often you use it
how you use it
the coke’s purity
your body fat percentage
other substances you take

How long it’s detectable depends on the type of drug test used.

Here are the general detection windows by test type:

Urine: up to 4 days
Blood: up to 2 days
Saliva: up to 2 days
Hair: up to 3 months

Is it safe to use with alcohol?

Cocaine and alcohol make for a dangerous duo that can sometimes be life threatening.

The combo leads to the production of a metabolite called cocaethylene, which is considerably stronger than cocaine or alcohol alone.

It increases toxicity to the heart, liver, and other organs. It raises the risk of the serious effects already associated with cocaine use, including heart problems and stroke.

Mixing alcohol and cocaine has also been shown to increase cravings for each substance, leading to a higher risk of dependence.

Any other potential interactions?

There are quite a few known interactions between cocaine and other substances, including over-the-counter (OTC) and prescription medications and other drugs.

The most serious cocaine interactions involve:

alcohol
heroin
opioids
antipsychotics
antidepressants

Other potential cocaine interactions include:

anticonvulsants
caffeine
amphetamines
cannabis
psychedelics, such as LSD, DMT, and shrooms
dissociative drugs, such as ketamine (special K), DXM, and PCP
MDMA (molly, ecstasy)

Is there a risk of addiction?

Cocaine has high addiction potential. You can develop a tolerance to it after just a few uses. This means you need more of a substance to get the same effect you once did.

The more you use it, the higher your risk for developing a substance use disorder.

The risk of addiction is even higher with crack cocaine because its effects are more immediate and more intense.

Combining cocaine with alcohol and other substances also increases the risk of addiction.

Signs and symptoms of a cocaine addiction include:

needing more of it to get high
not being able to stop or use less
withdrawal symptoms when you stop using it
continuing to use it in spite of the consequences
negative impact on your personal life, work life, or both
spending excessive time or money on cocaine
hallucinations and psychosis

What about other risks?

Aside from addiction, cocaine poses several other risks.

Heart problems

Cocaine is particularly rough on the heart and cardiovascular system.

Using it can increase your risk for several heart-related issues, including:

high blood pressure
inflammation of the heart muscle
aortic dissection
abnormal heart rhythms
heart attack

Nasal issues

Snorting cocaine can do some serious damage to your nasal tissues.

When you snort coke, the lining of your nasal passages become inflamed. Over time, this can lead to:

loss of smell
nosebleeds
chronic rhinitis
trouble swallowing

Long-term or frequent use can break down tissue, causing sores. In severe cases, the septum (the cartilage between your nostrils) can develop a hole.

Bloodborne infections

Cocaine use carries a high risk of contracting bloodborne infections, including HIV and hepatitis C.

Injecting it carries the highest risk of bloodborne infections, but you can also contract infections by smoking and snorting coke.

All of these methods involve the use of a device, like a needle, pipe, or straw. Sharing any of these can introduce infection into the bloodstream through your veins, or through small cuts or sores in the mucus membranes.

Skin and vein damage

Injecting coke can cause skin bruising and scarring and lead to collapsed veins. Snorting can damage your mucous membranes, causing inflammation and sores in and around your nostrils.

Mental health issues

Long-term cocaine use can cause auditory and tactile hallucinations, causing you to hear and feel things that aren’t there.

Safety tips

If you’re going to do cocaine, keep these tips in mind to reduce some of its risks:

Test your coke. Cocaine is often cut with other substances, some of which can be harmful and even deadly, including fentanyl. You can purchase cocaine test kits at DanceSafe.org.
Be smart about your props. Never share needles, pipes, and straws. Always inspect your devices before using. Check pipes and straws for chips or other damage. Make sure needles are sterile.
Go low and slow. Stick to a low dose and avoid redosing for as long as you can. Consider only keeping a small amount accessible to you during a sesh.
Don’t mix. Combining coke with other substances increases the risk of adverse interactions and fatal overdose. Don’t use coke with alcohol or any other substance.
Avoid it if you have heart issues. Stay away from coke if you have high blood pressure or any other heart-related conditions.
Don’t do it alone. Have someone with you in case things go south and you need help. It should be someone you trust who knows how to spot the signs of an overdose.

Recognizing an overdose

Call 911 or your local emergency services right away if you or anyone else experiences any of the following:

irregular heart rhythm or pulse
trouble breathing
high blood pressure
hallucinations
chest pain
extreme agitation
seizures
loss of consciousness

Don’t worry about law enforcement getting involved. You don’t need to mention the substances used over the phone. Just be sure to tell them about the specific symptoms so they can send the appropriate response.If you’re looking after someone else, get them into the recovery position by laying them on their side with their body supported by a bent knee. This position helps keep their airway open and can prevent choking in case they begin to vomit.

If you’re looking for help

If you’re worried about your cocaine use and want help, you have options. Consider talking to your primary healthcare provider if you’re comfortable doing so. Patient confidentiality laws prevent them from sharing this information with law enforcement.

You can also try one of these free and confidential resources:

SAMHSA’s National Helpline at 800-662-HELP (4357) or treatment locator
Support Group Project
Narcotics Anonymous

Adrienne Santos-Longhurst is a freelance writer and author who has written extensively on all things health and lifestyle for more than a decade. When she’s not holed-up in her writing shed researching an article or off interviewing health professionals, she can be found frolicking around her beach town with husband and dogs in tow or splashing about the lake trying to master the stand-up paddle board.

How we reviewed this article:

SourcesHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Althobaiti YS, et al. (2016). Alcohol interactions with psychostimulants: An overview of animal and human studies.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966675/
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Crack cocaine. (2013).http://www.cesar.umd.edu/cesar/drugs/crack.asp
Drug Enforcement Administration. (2017). Drugs of abuse: A DEA resource guide.https://www.dea.gov/sites/default/files/drug_of_abuse.pdf
DrugFacts: Cocaine. (2018).https://www.drugabuse.gov/publications/drugfacts/cocaine
Gallelli L, et al. (2017). Drug-drug interactions in cocaine-users and their clinical implications. DOI:https://doi.org/10.2174/1874473710666170920143344
Illegal drugs and heart disease. (2015).https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/illegal-drugs-and-heart-disease

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Medically reviewed by Dena Westphalen, PharmD — Written by Adrienne Santos-Longhurst on April 9, 2020

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