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Cocaine

(Crack)

By

Gerald F. O’Malley

, DO, Grand Strand Regional Medical Center;


Rika O’Malley

, MD, Grand Strand Medical Center

Full review/revision Dec 2022
VIEW PROFESSIONAL VERSION

Cocaine is an addictive stimulant drug made from leaves of the coca plant.

Cocaine has effects similar to those of amphetamines Symptoms Amphetamines are stimulant drugs that are used to treat certain medical conditions but are also subject to abuse. Amphetamines increase alertness, enhance physical performance, and produce euphoria... read more . It may be snorted, injected directly into a vein, or heated and inhaled. When boiled with sodium bicarbonate, cocaine is converted into a freebase form called crack cocaine. Heating crack cocaine releases cocaine vapor that can be inhaled. Inhaling the vapor is usually referred to as smoking, but the crack is not actually burned. Crack cocaine acts almost as fast as cocaine injected intravenously.

Heavy regular users and people who inject the drug intravenously or smoke it are most likely to become dependent. Light occasional users and people who take the drug nasally or by mouth are less likely to become dependent.

Signs of Cocaine Intoxication

Cocaine use causes both immediate and long-term symptoms.

Immediate effects

Cocaine produces a sense of extreme alertness, euphoria, and great power when it is injected intravenously or inhaled. These feelings are less intense when cocaine is snorted. Because cocaine’s effects may last only a short time, users may inject, smoke, or snort it every 15 to 30 minutes. Binges, often over several days, lead to exhaustion and a need for sleep.

Overdose

High doses can impair judgment and cause tremors, extreme nervousness, seizures, hallucinations, insomnia, paranoid delusions, delirium, and violent behavior. People sweat profusely and the pupils are dilated. Very high doses can cause a life-threatening high body temperature (hyperthermia Overview of Heat Disorders Humans, who are warm-blooded animals, maintain their body temperature within 1 or 2 degrees of 98.6° F (37° C) as measured by mouth and 100.4° F (38° C) as measured rectally, despite large fluctuations... read more ).

Long-term effects

Long-term users may develop tolerance Tolerance Tolerance is a person's diminished response to a drug, which occurs when the drug is used repeatedly and the body adapts to the continued presence of the drug. Resistance refers to the ability... read more , requiring more and more of the drug to get the same effects. Long-term use may damage the tissue separating the two halves of the nose (septum), causing sores (ulcerations) that may require surgery. Heavy use may impair mental function, including attention and memory. Chronic use can also damage the heart, causing scarring and thickening of the heart muscle and eventually leading to heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more Heart Failure (HF) . Cocaine may contain many fillers, adulterants, and contaminants, which, when injected, can cause complications such as infections.

Withdrawal symptoms

Withdrawal reactions (cocaine washout syndrome) include extreme fatigue, sleepiness, and depression—the opposite of the drug’s effects. Appetite is increased, and people have trouble concentrating. Suicidal urges emerge when people stop taking the drug.

Did You Know...

  • Using cocaine can cause sudden death.

Diagnosis of Cocaine Intoxication

  • A doctor's evaluation

  • Urine tests

Doctors usually base the diagnosis on symptoms in people known to have used cocaine. Urine testing can confirm evidence of the drug.

Treatment of Cocaine Intoxication

  • Observation and monitoring until the person is sober

  • Sometimes sedatives for agitation, high blood pressure, or seizures

  • Psychotherapy (for addiction)

Emergency treatment

Cocaine is a very short-acting drug, so treatment of uncomfortable reactions is usually not necessary. People who are very agitated or delirious or who have seizures or high blood pressure are given benzodiazepines (sedatives), such as lorazepam, intravenously. If sedatives do not control blood pressure, doctors may give nitrates or other antihypertensive medications intravenously. Doctors avoid antihypertensive medications called beta-blockers because they can worsen the effect of cocaine on blood pressure. Hyperthermia should also be treated with cooling techniques, such as wetting and blowing air over the skin or using special cooling blankets.

Detoxification and rehabilitation

Stopping long-term cocaine use may require close supervision because people can become depressed and suicidal. Entering a hospital or a drug treatment center may be necessary. The most effective method of treating cocaine use disorder is psychotherapy. Many self-help groups and cocaine hotlines are available to help people remain free of the drug.

Sometimes the mental health disorders common to people with cocaine use disorder, such as depression Depression A short discussion of prolonged grief disorder. Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to... read more , are treated with the appropriate drugs for those disorders.

More Information

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

  • Cocaine Anonymous World Services: A 12-step fellowship by and for those recovering from cocaine addiction.

  • Dual Diagnosis.org: Resource for those who have co-occurring mental health conditions and substance use disorders, including access to the Foundations Recovery Network programs, which provide integrated treatment.

  • Inpatient.org: Access to inpatient rehabilitation programs for drug and/or alcohol addiction.

  • National Alliance on Mental Illness (NAMI): A national mental health organization that provides advocacy, education, support, and public awareness programs and services.

  • National Institute on Drug Abuse (NIDA): Cocaine-specific information from the federal agency that supports scientific research into drug use and its consequences and supplies information about commonly used drugs, research priorities and progress, clinical resources, and grant and funding opportunities.

NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
VIEW PROFESSIONAL VERSION
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