What to Know About Cocaine

Medically Reviewed by Jabeen Begum, MD on January 03, 2024
13 min read

Cocaine is a highly addictive drug that ups your levels of alertness, attention, and energy. You may hear it called a stimulant.  It’s illegal in the U.S. Other names for it include:

  • Coke
  • Snow
  • Rock
  • Blow
  • Crack

It comes in a few different forms. The most common is a fine, white powder. It can also be made into a solid rock crystal.

Cocaine plant

The drug is made from the leaves of the coca plant, which grows almost nowhere other than the northern and western regions of South America. People there have chewed and eaten coca leaves for thousands of years to help them stay alert and lessen their appetites. 

How is cocaine made?

To make cocaine, the leaves are chemically processed and treated to form a powder. A German chemist named Albert Neiman first isolated the drug from coca leaves in 1860. In the early 1900s, cocaine was a common ingredient in herbal remedies for all sorts of illnesses. Surgeons used it to block pain before local anesthetic were available. 

In the 1970s, it became a popular recreational drug. It's mostly produced in remote jungle labs in South American countries. Colombia makes about 90% of the cocaine that reaches the U.S.

What is crack cocaine?

Crack cocaine is the drug in rock or chunk form. It gets its name because it crackles when heated up. To make crack, you cook cocaine powder with baking soda. Then, you break it into small pieces, called rocks. To use it, you usually put it  into a glass pipe and heat it. Then you inhale the vapor that results. You can also add it to tobacco or marijuana and smoke it. Crack is stronger and more addictive than the powder form of the drug, 

What is freebase cocaine?

Freebase cocaine is also a solid form of the drug. Instead of using baking soda as you would with crack, you add ammonia to "free" the cocaine base from its natural form. It's most often smoked in a pipe in the same way as crack. For this reason, you might hear the terms "crack" and "freebase" used interchangeably. 

The traditional way to use cocaine is to sniff or snort it into your nostrils. It's absorbed through the tissues in your nasal passages and moves into your bloodstream.

Some people rub it onto their gums. Others dissolve the drug in water and inject it with a needle. When injected, it goes directly into your bloodstream for a very strong and near-instant effect.

When you heat the rock crystal and breathe the smoke into your lungs, you get a high that's almost as fast and strong as when you inject it. That's one reason crack cocaine became popular in the 1980s.

Sometimes, people use cocaine and an opioid drug, such as heroin, at the same time. This is called "speedballing."

Cocaine binge

A cocaine binge is when someone uses cocaine repeatedly in higher and higher doses. People may take the drug until they run out or become exhausted. 


In a 2021 national survey, about 4.8 million people in the U.S. ages 12 or older said they had used cocaine in the past year.  That's 1.7% of those surveyed. The rate was highest in the 18-25 age group (1.2 million people or 3.5%), followed by those over age 26 (3.6 million or 1.6%).

Use of cocaine is less common in the U.S. than misuse of prescription painkillers (reported by 2.4 million people in the 2021 survey), or use of hallucinogenic drugs (2.2 million). 

Disparities in cocaine use

Research suggests that certain communities may be more prone to using drugs, including cocaine. For example, those who identify as LGBTQ are more than twice as likely to use illicit drugs as heterosexual people. LGBTQ adults are also more than twice as likely to have a substance use disorder. 

The 2021 survey found no differences in rates of cocaine use among different ethnic and racial groups in the U.S.

In the United States, cocaine is an illegal drug. It’s classified as a Schedule II substance. That means it has a high potential for abuse.

But doctors can legally use it in limited ways for medical purposes. For example, it may be given as a local anesthetic during some eye, ear, or throat surgeries. 

How long does cocaine stay in urine?

Cocaine generally shows up on a urine test for up to 3 days after you last use it. Someone who uses the drug heavily might test positive for up to 2 weeks after their last use.

The drug sends high levels of dopamine, a natural chemical messenger in your body, into the parts of your brain that control pleasure. This buildup causes intense feelings of energy and alertness called a high. You may feel:

  • Happy
  • Awake and energetic
  • Talkative
  • Restless
  • Less hungry or sleepy
  • Sensitive to touch, sound, and sight

When you're high, you might do things you normally wouldn't, like spend lots of money or have unsafe sex.

Cocaine impacts people differently. Some things that determine how the drug affects you include:

  • Your size and weight
  • Your overall health
  • Whether your body is used to taking the drug
  • Whether you use other drugs at the same time
  • How much you take
  • The strength of the cocaine

How long does it take cocaine to kick in?

Cocaine’s effects start quickly after you take a dose. Smoking it creates a high almost immediately. When you snort it, it takes slightly longer to feel the effects. 

How long does the high last?

The effects fade quickly, but how quickly depends on how you take the drug. The faster it's absorbed into your body, the shorter and more intense the high. For example, the high from smoking it lasts 5-10 minutes. If you snort it, the high may last 15-30 minutes.

Cocaine comedown

Comedown is a term that describes symptoms you feel when you come off the drug. As soon as the high subsides, you may notice:

  • Anxiety or depression
  • Irritability
  • Exhaustion 
  • Sweating
  • Headache
  • Runny nose
  • Body aches and pains 
  • Confusion

These unpleasant effects often make you want to use the drug again. 

Cocaine dosage

A typical dose of snorted cocaine is between 30 and 70 milligrams. For crack, the dose is usually 15 to 50 milligrams. 

 Larger doses of the drug can cause bizarre behaviors, such as:

  • Violence
  • Anger
  • Restlessness
  • Irritability
  • Anxiety 
  • Panic 
  • Paranoia

They could also lead to overdose.

Short-term effects of cocaine

The drug causes temporary physical reactions such as:

  • Dilated pupils 
  • Narrowed blood vessels
  • A high body temperature
  • Increased heart rate
  • High blood pressure

Long-term effects of cocaine

Continued use puts you at risk for physical issues like.

  • Headaches
  • Belly pain
  • Damage to your lungs and other organs
  • HIV or hepatitis if you inject it
  • Bowel decay if you swallow it
  • Loss of smell, nosebleeds, runny nose, and trouble swallowing if you snort it
  • Convulsions and seizures
  • Heart disease, heart attack, and stroke
  • Movement disorders such as Parkinson’s disease
  • Kidney issues
  • Coma 
  • Sudden death

Some of the side effects of cocaine depend on how you take the drug. If you snort it, you might have nosebleeds, loss of smell, hoarseness, nasal irritation, runny nose, or trouble swallowing. Smoking crack can damage your lungs and worsen asthma symptoms. If you inject it, you could develop tracks (puncture marks on your arms) and infections, such as HIV or hepatitis C.

Along with the physical risks, cocaine use can affect your life in other ways.

The more you use it, the more your brain adapts to it. You’ll need a stronger dose to feel the same high. This can lead to a dangerous addiction or overdose.

If you keep using cocaine, your brain’s circuits become more sensitive. This can lead to a negative mood when you don’t take the drug. Your brain may become less responsive to other natural rewards, such as food and relationships.

Stronger, more frequent doses cause long-term changes in brain chemistry. Your body and mind begin to rely on the drug. This makes it harder for you to think, sleep, pay attention,  remember things, and make decisions. Your reaction time may be slower.  

You may develop depression, unpredictable mood changes, paranoia, or even violent behaviors toward yourself and others. You could have hallucinations, meaning you see or hear things that aren’t there. These behaviors can be scary for you and your loved ones.

Drug quality

Since it's an illegal drug, you can never be sure about the quality of cocaine. To make more money, dealers may “cut” the drug with other substances, like flour, baking soda, cornstarch, or talcum powder. They can also add other drugs like amphetamine, fentanyl, heroin, or procaine. 

Cocaine interactions

Combining cocaine with other drugs or substances can cause dangerous reactions. Here are some examples:

  • Cocaine + alcohol can cause toxic effects on the heart.
  • Cocaine + heroin can lead to a heroin overdose, which can be deadly. 
  • Cocaine + LSD/psilocybin/cannabis can increase anxiety, confusion, or paranoia.
  • Cocaine + methamphetamine can up the risk of heart strain.
  • Cocaine + ketamine can lead to poor thinking, coordination problems, and high blood pressure.
  • Cocaine + MDMA can increase the risk of heart attack, heart strain, and psychosis.

If you choose to use cocaine, you should know that it involves many serious health risks. With that in mind, there are ways you may be able to lessen some of its harmful effects:

  • Avoid daily use, even of small amounts.
  • Don't smoke it, since this makes you much more likely to use it to excess. 
  • To protect your heart, don't do strenuous exercise while you're taking it or combine it with other stimulants.
  • Use a saline spray before, during, and after snorting it to lessen damage to nasal cavities and sinuses.
  • Switch nostrils each time you snort.
  • Don’t share snorting devices.
  • Crush it to a fine powder before snorting to protect against cuts.
  • Try to eat well, stay hydrated, and get enough sleep. Staying up for days at a time makes you more likely to have a psychotic episode.
  • Avoid using it with alcohol, since this makes the comedown worse.
  • If you find you're often using cocaine as a coping mechanism, take a break from it. 

If you use cocaine regularly or to excess, you may have long-lasting and serious problems with your physical and mental health. It can affect your heart, brain, lungs, gut, and kidneys as well as your emotional health and daily life -- especially if you become addicted.  

Cocaine use can also lead to a higher risk of infections such as HIV and hepatitis C, particularly if you share needles. 

Cocaine and HIV

Your chances of getting HIV, the virus that causes AIDS, are higher if you use cocaine. The drug can also speed up the progress of an HIV infection. Some research has suggested that cocaine damages the way immune cells work in your body, which could make HIV worse.

Cocaine and pregnancy

There are about 750,000 cocaine-exposed pregnancies each year. Using cocaine during pregnancy can cause problems for both the parent and the developing baby.

If you use cocaine during pregnancy, you could have:

  • Migraines 
  • Seizures
  • Placental abruption (when the placenta separates from the uterus before delivery)
  • High blood pressure
  • Miscarriage 
  • Preterm labor
  • A difficult delivery

Your baby could have:

  • A low birth weight
  • A smaller head
  • Shorter stature
  • Mental and social deficits 

Seek treatment to reduce these risks. 

Cocaine, especially crack cocaine, is strongly addictive for several reasons. For one thing, the high feels very pleasurable, especially when you first try it. But it only lasts a short time. So you might keep taking the drug to prolong the good feelings and put off the unpleasant comedown.  

This cycle can lead to cocaine use disorder, in which you have trouble controlling how much and how often you use the drug even when it has negative effects on your life. Structures in the reward system of your brain change. This makes you compulsively crave or use substances like cocaine. 

With cocaine use disorder, you may become both physically and mentally dependent on the drug. If you stop using it, you'll likely have withdrawal symptoms. Even if you stop using it for a long time, you could still have cravings for the drug. 

How common is addiction?

In a 2021 national survey, about 1.4 million people aged 12 or older in the U.S. said they had a cocaine use disorder during the past 12 months. That same year, about 24,486 people died from an overdose that involved cocaine.

Another reason cocaine can lead to substance use disorder is that each time you use it, your body builds a tolerance. That means you have to use more and more of the drug to get high.

Many people start to build a tolerance after their first use of cocaine. 

At the same time, you might develop what's called sensitization to the drug. That means it takes less of it to cause negative effects like anxiety and convulsions. 

The most important part of any treatment plan is to give up the drug right away. Many people who are addicted to cocaine go through a phase called withdrawal when they first do this. Withdrawal can be difficult, so it may be best to do it with the help of a medical professional.

Cocaine withdrawal symptoms can include:

  • Depression
  • Anxiety
  • Fatigue
  • Trouble concentrating
  • Increased hunger
  • Cravings for the drug
  • Nightmares
  • Chills
  • Nerve pain and muscle aches

The symptoms usually begin about 6-12 hours after your last use. How serious they are varies from person to person.

Cocaine withdrawal symptoms usually happen in three phases:

  • Crash. For the first few days, you feel tired, depressed, and anxious, and you crave cocaine. 
  • Withdrawal. This phase can last several weeks. You may crave the drug and struggle to feel any pleasure. It's common to have low energy, agitation, anxiety, and trouble sleeping. 
  • Extinction. With extinction, symptoms gradually lessen over several months.

If you use a lot of cocaine, or the batch you use is stronger than you expect, you could overdose. An overdose is an emergency. Cal 911 right away if you notice these signs in yourself or someone you're with:

  • Increased sweating, body temperature, or heart rate
  • Trouble breathing
  • Chest pain
  • Nausea or vomiting
  • Confusion, seizures, tremors (shaking)

Watch for these mental signs of overdose, too:

  • Serious anxiety (agitation) or panic
  • Intense paranoia (feeling like people are out to get you)
  • Hallucinations

An overdose often leads to a stroke or heart attack. An ER doctor will test for those conditions and try to treat them first. They may also use medication to treat other complications you have.

Keep in mind that paramedics and doctors are there to help you. They don’t need to alert the police. 




Drug use disorder, or addiction, is a complicated disease that involves changes to your brain structure. Many issues play a role, including other mental health disorders,  your background, and your environment. 

Counseling and other types of therapy are the most common treatments for cocaine use disorder. Sessions with a trained therapist can help you make changes to your behaviors and thought processes. You may need to stay in a rehabilitation center (also known as rehab) for intensive therapy and support. If you do attend rehab, continuing treatment afterward (aftercare) is important to help you avoid relapse. 

The FDA hasn't approved any medicine to treat cocaine addiction. But there are a few medication options doctors are having some success with.

Research to test new drugs is under way. Some of the treatments being studied target these brain chemicals: 

  • Dopamine
  • Serotonin
  • Gamma-aminobutyric acid (GABA)
  • Norepinephrine
  • Glutamate 

The drug disulfiram, which is used to treat alcoholism, has shown some promise for cocaine addiction. Scientists don’t know exactly how it works to reduce cocaine use. 

Cocaine vaccine

In early tests, a vaccine helped reduce the risk of relapse in people who use cocaine. The vaccine activates your immune system to create antibodies that attach to cocaine and stop it from making its way into your brain. But we need much more research into whether the  vaccine  is safe and effective over the long term. 

Cocaine is a drug you can snort, smoke, or inject. It  makes you feel very happy and alert for a short time. But it carries many risks, including overdose and serious physical and mental side effects as well as addiction. If you or someone you know has problems with cocaine use, seek help from a doctor or mental health professional. 

What type of drug is cocaine?

It's a stimulant, which means it speeds up the messages that move between your brain and your body.

Can you die of a crack overdose?

It's possible to die from an overdose of crack or any other type of cocaine. It’s important to spot the symptoms of overdose and get help immediately. Symptoms include a high heart rate and blood pressure, seizures, hallucinations, and trouble breathing. Call 911 if you notice any of them.

Can you overcome a crack cocaine addiction?

it's hard to stop using crack on your own. But with the proper support, many people are able to overcome a crack cocaine addiction. Counseling and rehab programs can help people with crack cocaine use disorders to get off the drug and avoid relapse. To find help, call the Substance Abuse and Mental Health Services Administration (SAMSA) national hotline at 800-662-HELP (4357). The hotline is confidential and operates 24 hours a day.  Or text your ZIP code to 435748 (HELP4U) to find treatment in your area. 

Can you help someone who is addicted to crack cocaine?

The best way to assist someone who is addicted to crack cocaine is to encourage them to get help, though they may not think they need it. Tell them you love and support them but can't support their drug use. You may need to tell them they need leave your home, or that you'll leave, if they don't get help. A therapist or interventionist can help you through this process. To find help, call the Substance Abuse and Mental Health Services Administration (SAMSA) national hotline at 800-662-HELP (4357).