Cocaine

(Crack)

ByGerald F. O’Malley, DO, Grand Strand Regional Medical Center;
Rika O’Malley, MD, Grand Strand Medical Center
Reviewed/Revised Dec 2022
View Patient Education

1

General reference

  • IV injection and smoking: Immediate onset, peak effect after about 3 to 5 minutes, and duration of about 15 to 20 minutes

  • Intranasal use: Onset after about 3 to 5 minutes, peak effect at 20 to 30 minutes, and duration of about 45 to 90 minutes

  • Oral use: Onset after about 10 minutes, peak effect at about 60 minutes, and duration of about 90 minutes

Pregnancy

can adversely affect the fetus; the rate of placental abruption and spontaneous abortion is higher.

Symptoms and Signs of Intoxication

Acute effects

Toxicity or overdose

Binges, often over several days, lead to an exhaustion syndrome or "washed out" syndrome, involving intense fatigue and need for sleep.

People who smoke the drug may develop pneumothorax or pneumomediastinum

Chronic effects

Withdrawal

  • Usually a clinical diagnosis

drug screens.

  • IV benzodiazepines

  • Avoidance of beta-blockers

  • Cooling for hyperthermia as needed

Toxicity or overdose

Body stuffers and body packers may need gastrointestinal decontamination or even surgical removal.

rhabdomyolysis, hyperthermia, and resultant acidosis or multisystem dysfunction.

Hyperthermia can be life threatening and should be managed aggressively with sedation plus evaporative cooling, ice packs, and maintenance of intravascular volume and urine flow with IV normal saline solution.

Phenothiazines are not used for sedation because they lower seizure threshold, and their anticholinergic effects can interfere with cooling.

Abuse

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

  1. Cocaine Anonymous World Services, Inc

  2. Findtreatment.gov: Listing of licensed US providers of treatment for substance use disorders

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