Cocaine

Cocaine is a powerful stimulant substance originating from the Erythroxylum coca plant, a bush that is native to South America. The United States Drug Enforcement Agency (DEA) classifies cocaine as a Schedule II substance under the Controlled Substances Act, making it illegal — apart from its limited used as a surgical anesthetic for ear, nose, throat, and eye surgery.

Immediately after use, the effects of cocaine range from euphoria, increased arousal and stimulation to intense mental health and physical symptoms, including paranoia and hallucinations, rapid heart rate, tremors, and abnormal body movements.

Chronic use of cocaine may cause more permanent problems with memory and brain function, and can lead to cocaine addiction, otherwise known as cocaine use disorder.

Cocaine is used in two forms: a powder form and a solid rock form.

• Rock cocaine, otherwise known as “crack cocaine,” is made from mixing powder cocaine with baking soda and water. This mixture is boiled and hardens into a breakable rock. These pieces of rock cocaine are called “crack cocaine” due to the crackling sound heard when the rocks are heated and smoked.
• Powder cocaine is typically sniffed directly into the nose or dissolved in water and injected into a vein.

There are an abundance of cocaine “street” names, many appealing to youth. Some terms refer to the form of cocaine, the route of cocaine use, or the combination of substances (for example, marijuana plus cocaine).

• Overamping: a negative reaction to using stimulants; while different from overdosing, it can be life-threatening.
  • Symptoms can include chest pain, breathing difficulties, elevated blood pressure, accelerated heart rate, elevated body temperature, anxiety, paranoia, aggression.
  • Tips to prevent overamping: stay hydrated, replenish electrolytes (Gatorade™ is a good source for electrolytes), seek medical attention, find a quiet and calm space, protect the head in case of seizure.
• Physical health effects: Cocaine mainly impacts the heart and circulatory system. Notably, cocaine is a major cause of heart attacks for those under the age of 45 years old in addition to strokes and sometimes fatal rhythm disturbances of the heart.
• Mental health effects: Cocaine is associated with worsening or new onset mental health symptoms or disorders, which can be severe.
• Additional health effects are related to HOW the substance is used:
  • Smoking – burns in the throat and lungs, lung spasms.
  • Inhaling through the nose (sniffing) – damage to the lining of the nose and nasal septum.
  • Injection into a vein - skin and blood-borne infections, damage to veins. People who inject cocaine and share syringes or any other equipment used to prepare or use substances are at risk of acquiring or transmitting HIV, hepatitis B or hepatitis C.

Unfortunately, it's impossible to reliably identify the presence of illicit substances or fillers present in cocaine, neither by appearance, taste, nor smell. Therefore, one should plan ahead and assume that risky substances may be present.  

• FENTANYL and its analogues (potent illicitly manufactured synthetic opioids) increasingly are found mixed into cocaine to make the substance more powerful and more likely to cause addiction.  Fentanyl is linked to the sharp increase in overdose deaths connected to cocaine.   

• LEVAMISOLE (a strong anti-parasitic medication used in the past) may be mixed into cocaine to add weight to the sample.  Exposure to levamisole can cause severe skin blisters and ulcers as well as serious damage throughout the body. 

• Many other illicit substances and other fillers such as talcum powder or corn starch also are mixed into cocaine to add weight. 

• Medical and mental health providers may recommend counseling or behavioral therapy for cocaine use disorder.
• Two forms of therapy have evidence as the most effective treatments for cocaine use disorder: cognitive behavior therapy and contingency management/community reinforcement.
• There are no FDA-approved medications to treat cocaine use disorder unlike those approved for opioid use disorder (buprenorphine, methadone, naltrexone), alcohol use disorder (naltrexone, acamprosate, disulfiram) and tobacco use disorder (varenicline, nicotine replacement therapy, bupropion). There are some studies that suggest benefit from several medications already in use for mental or physical health conditions.
• It is important to discuss treatment options with your medical provider to see what may work for you.
• Identifying and treating other co-existing substance use disorders and mental and physical health conditions are essential to maximize treatment options, reduce harms, and improve health outcomes.

• Test your cocaine for fentanyl and its analogues with fentanyl test strips.
• Utilize a harm reduction program for supplies, support, education and linkage to other resources if you use any form of cocaine. Examples of harm reduction programs include: syringe services programs (SSPs), and drug user health hubs (DUHHs).
  • Access a directory of SSPs in New York
  • View a listing of DUHHs in New York
• If you prefer not to attend a program in person or don’t have access to harm reduction services in your community and live outside New York City, you can access www.nextdistro.org, an online mail-based harm reduction service, and order harm reduction supplies delivered confidentially to you.
• When using cocaine, use with a buddy and have naloxone available in case of accidental overdose.
• If using cocaine or other substances while alone, consider calling a hotline like Neverusealone.com while using your substances.

• For help and hope 24/7, call 1-877-8-HOPENY(467369) or text HOPENY(467369). Toll-free and confidential. 

• National Suicide Prevention Lifeline: 1-800-273-TALK (8255)

• Syringe Service Programs (SSPs)

• Drug User Health: Drug User Health