Cocaine Crack: What It Is, Side Effects, Risks & Withdrawal

In 1986 an article in the Journal of the American Medical Association revealed that U.S. health food stores were selling dried coca leaves to be prepared as an infusion as “Health Inca Tea”. In Peru, the National Coca Company, a state-run corporation, sells cocaine-infused teas and other medicinal products and also exports leaves to the U.S. for medicinal use. The free and legal commercialization of dried coca leaves under the form of filtration bags to be used as “coca tea” has been actively promoted by the governments of Peru and Bolivia for many years as a drink having medicinal powers.

While rarely used medically today, its accepted uses include serving as a topical local anesthetic for the upper respiratory tract and as an antihemorrhagic agent to stop bleeding in the mouth, throat, and nasal cavities. Globally, in 2019, cocaine was used by an estimated 20 million people (0.4% of adults aged 15 to 64 years). Cocaine acts pharmacologically as a serotonin–norepinephrine–dopamine reuptake inhibitor (SNDRI), producing reinforcing effects such as euphoria, increased alertness, concentration, libido, and reduced fatigue and appetite. Coca leaves are processed into cocaine paste, a crude mix of coca alkaloids from which cocaine base is isolated and converted to cocaine hydrochloride.

Typical symptoms include paranoid delusions that they are being followed and that their drug use is being watched, accompanied by hallucinations that support the delusional beliefs. Cocaine has a similar potential to induce temporary psychosis with more than half of cocaine abusers reporting at least some psychotic symptoms at some point. A 2021 study found that cocaine use disorder impairs emotion recognition, especially for happiness and fear, with improvement after long-term abstinence. A 2020 study found that men with cocaine use disorder have greater difficulty identifying emotional expression in female faces, affecting relationships and suggesting a target for intervention. In 1989 Fulton County, 40% of homicide victims had cocaine metabolites, especially Black and firearm victims. A considerable proportion of cocaine addicts exhibit hypomanic personality traits that are ego-syntonic with their pattern of cocaine abuse.

Cocaine-dependent patients with high neuroticism scores are more likely to experience cocaine-induced psychotic symptoms, regardless of other drug use factors, making personality assessment important for risk identification and patient warning. Because cocaine use can worsen health outcomes, adults with ADHD should be screened for cocaine use disorder and referred for treatment if needed. Illicit cocaine is frequently adulterated with substances such as fentanyl, levamisole, or local anesthetics, increasing its toxicity. Chronic nasal use may cause destructive damage to the nasal septum, including cocaine-induced midline destructive lesions (CIMDL). Individuals often engage in repeated use by either insufflating it intranasally or converting it to crack cocaine for vaporization.

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Although the chemical synthesis of cocaine is technically feasible, it is generally considered impractical due to its high cost, low efficiency, and challenges in stereoselective synthesis compared to extraction from natural plant sources. Willstätter’s synthesis involved constructing the cocaine structure from simpler precursors, notably via the intermediate tropinone. The first structure elucidation and total synthesis of the cocaine molecule was accomplished by Richard Willstätter in 1898. Recent research points to an important role of circadian mechanisms and clock genes in behavioral actions of cocaine.

• Coca leaves are typically mixed with an alkaline substance (such as slaked lime) and chewed into a wad that is retained in the buccal pouch (mouth between gum and cheek, much the same as chewing tobacco is chewed) and sucked of its juices.
• Drugs which help to re-stabilize the glutamate system such as N-acetylcysteine have been proposed for the treatment of addiction to cocaine, nicotine, and alcohol.
• It reduces blood flow in the gastrointestinal tract, which can lead to tears and ulcerations.3 Many people who use cocaine chronically lose their appetite and experience significant weight loss and malnourishment.

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During the mid-2010s, levamisole was found in most cocaine products available in both the United States and Europe. This syndrome is marked by skin necrosis, often affecting areas such as the ears, face, and extremities, and is thought to result from levamisole’s effects on blood vessels and the immune system. In the body, levamisole is converted into aminorex, a substance with amphetamine-like stimulant effects and a long duration of action. Before trafficking to the United States, the cocaine is frequently adulterated with levamisole. It can also become a serious risk at high doses due to cocaine’s blocking effect on cardiac sodium channels. Cocaine as a drug has a low molecular weight and high water and lipid solubility which enables it to cross the placenta and fetal blood-brain barrier.

The cocaine esterase enzyme and redesigned versions of it have been studied as a potential treatment for cocaine addiction in humans. The report further states that Western Europe’s cocaine market is rapidly expanding, resulting in increased violence driven by traffickers, including organized criminal groups from the Western Balkans. Before the early 1900s, newspapers primarily portrayed addiction (rather than violence or crime) as the main problem caused by cocaine use, and depicted cocaine users as upper or middle class White people. Swabbing can reveal traces of cocaine or other illicit substances, providing evidence of recent drug handling or use. Personal cards-including ID cards and driver’s licenses-are frequently swabbed by inspectors to detect drug residue, as these items are commonly used to prepare lines of cocaine. Physiological and psychotropic effects from nasally insufflated cocaine are sustained for approximately 40–60 minutes after the peak effects are attained.

Cocaine Withdrawal

Another smokable and highly addictive form is cocaine paste, which is an intermediate stage in the processing of coca leaves into cocaine. Learn about causes, symptoms, risks, and treatment for cocaine withdrawal. These include holders, transporters (also called mules), delivery people, counters of cash and incoming drugs, lookouts, backup personnel, and enforcers of debt payments.14 The continued use of cocaine can lead to serious problems, including tolerance, dependence, and eventually addiction. Every month, 150,000 people search for addiction or mental health treatment on Recovery.com. Ask a healthcare provider about programs and services for people affected by another person’s cocaine use.

The drug disulfiram, which is used to treat alcoholism, has shown some promise for cocaine addiction. If you choose to use cocaine, you should know that it involves many serious health risks. Some of the side effects of cocaine depend on how you take the drug.

Psychiatric symptoms

• Street cocaine is commonly snorted, injected, or smoked as crack cocaine, with effects lasting up to 90 minutes depending on the route.
• While some studies indicate that psychostimulant therapy may reduce cocaine use and cravings, the evidence is mixed and further research is needed.
• However, current pharmacoepidemiological trends suggest that cocaine may soon reach the point where, in practical terms, it is no longer used medically in health care as a Schedule II substance.
• In countries where cocaine is illicitly produced, an intermediate product known as cocaine paste—often referred to as “poor man’s cocaine”—is frequently smoked in impoverished communities.
• For crack, the dose is usually 15 to 50 milligrams.

Sigma receptors are affected by cocaine, as cocaine functions as a sigma ligand agonist. Furthermore, a similar response-occupancy discrepancy has been observed with methylphenidate, which also stabilizes the dopamine transporter in an open outward-facing conformation. Re-administering cocaine beyond this threshold does not significantly increase DAT occupancy but still results in an increase of euphoria which cannot be explained by reuptake inhibition alone. Conflicting findings have challenged the widely accepted view that cocaine functions solely as a reuptake inhibitor.

Reduced drug use is a meaningful treatment outcome for people with stimulant use disorders

The extent of absorption of cocaine into the circulatory system after nasal insufflation is similar to that after oral ingestion. In 2024, a systematic review of human studies concluded that, despite some inconsistencies in the findings, the co-use of cocaine and alcohol poses a significantly greater risk of cardiovascular fatalities compared to cocaine use alone. Alcohol interacts with cocaine in vivo to produce cocaethylene, another psychoactive substance which may be substantially more cardiotoxic than either cocaine or alcohol by themselves.

Cocaine (Crack)

Cocaine is considered neurotoxic due to its damaging effects on the brain and nervous system. It is thought to intensify the “high” by releasing dopamine in the brain, acts as a bulking agent, and is a difficult adulterant to recognize. It triggers coronary artery spasms, increases blood clot risk, and accelerates atherosclerosis, especially with long-term use. Low-birthweight babies are 20 times more likely to die in their first month of life than normal-weight babies, and face an increased risk of lifelong disabilities such as mental retardation and cerebral palsy.

This can lead to a dangerous addiction or overdose. The more you use it, the more your brain adapts to it. Smoking crack can damage your lungs and worsen asthma symptoms. If you snort it, you might have nosebleeds, loss of smell, hoarseness, nasal irritation, runny nose, or trouble swallowing. Continued use puts you at risk for physical issues like.

What is cocaine (crack)?

The 2021 (U.S.) National Survey on Drug Use and Health (NSDUH) concludes 4.8 million people age 12 and older used cocaine in 2020. People use crack cocaine by heating it in a glass pipe or adding it to marijuana or tobacco. More commonly, people use cocaine to boost feelings like being energized, happy and alert.

Crack cocaine

Cocaine use damages gray matter Cocaine Withdrawal Guide in brain regions critical for memory, attention, and emotion, leading to cognitive and behavioral impairments. Diagnosis is challenging due to symptom overlap and undisclosed drug use, making clinical suspicion and drug history essential for proper management. These conditions involve immune activation through NETosis and ANCA formation, leading to tissue damage. Clinical studies have shown that taking levamisole at doses of 50–200 mg per day can lead to agranulocytosis in approximately 0.08–5% of patients.

Cocaine is a drug you can snort, smoke, or inject. If you do attend rehab, continuing treatment afterward (aftercare) is important to help you avoid relapse. An overdose often leads to a stroke or heart attack. Withdrawal can be difficult, so it may be best to do it with the help of a medical professional. That means it takes less of it to cause negative effects like anxiety and convulsions.