Patient information from BMJ

Cocaine use disorder

Last published:May 16, 2022

Cocaine use is common in many countries. Apart from the dangers to physical and mental health caused by long-term use, it can lead to non-medical problems, such as problems with money, family, work, and the law.

If you are concerned about your cocaine use, or about use by someone you know, you can use our information to talk to your doctor about getting help.

What is cocaine abuse?

Cocaine is mainly thought of as a recreational or 'street' drug. But it does have some medical uses. For example, it can be used as a local anaesthetic, for numbing pain in small areas of the body. But when it is used for non-medical reasons, to get 'high', this is called cocaine abuse.

The drug is usually inhaled through the nose ('snorted'), although it can also be injected, or smoked as freebase or 'crack' cocaine.

Cocaine addiction is hard to overcome. But stopping using cocaine can be hard even when you are not addicted, especially if there is social pressure to take it. For example, you might socialise with a group of friends who expect you to use it with them.

Cocaine gives a similar experience to some other illegal street drugs. When used occasionally, it gives the user a short-term high, followed by a 'come-down', when you might feel exhausted, confused, and sometimes paranoid and depressed.

Taking too much cocaine in a short time can lead to an overdose, which can cause death. Many people get treatment for cocaine abuse after seeking emergency medical help for an overdose, or for chest pain caused by cocaine use.

Longer-term use can cause different problems depending on how you take the drug.

• Snorting cocaine can cause serious heart problems and damage to the delicate tissues in the nose.

• Smoking cocaine can cause serious eye problems and severe lung damage ('crack lung').

• Injecting cocaine can lead to infections such as HIV and hepatitis.

• All forms of cocaine use can cause psychosis (losing touch with reality), depression and other mental-health problems, and suicidal thoughts.

The dangers from using cocaine don’t just come from the drug itself. Producers of illegal drugs 'cut' their products with other, cheaper substances, either to bulk them out so they make more money, or to make their effects more intense.

Cocaine is most commonly cut with a substance called levamisole, a drug for de-worming livestock. In humans, levamisole can cause serious health problems, including dangerously low levels of white blood cells and painful sores on the skin.

Cocaine use can also lead to serious non-medical problems, including:

• money problems

• family problems

• violent behaviour

• paranoia

• problems at school or work, and loss of employment

• marriage and relationship problems

• problems with the law.

What are the symptoms?

The symptoms of cocaine abuse vary depending on several things, including:

• how long someone has been using the drug

• how they take it (for example, snorting or injecting)

• what form they take it in (for example, have they taken cocaine or crack), and

• whether they have had an overdose.

Their symptoms will also be different depending on whether they are still 'high' or coming down from down the drug.

Symptoms of short-term cocaine use (not crack cocaine)

If someone you know has recently used cocaine and is still high, the main symptom will be euphoria (feeling happy and excited). Along with this, they might:

• seem wide awake and more active than usual, even late at night

• seem jittery and anxious

• have trouble concentrating

• seem paranoid. This can get worse once the drug wears off and they start to come down.

In more extreme cases, someone might:

• have chest pain

• lose consciousness (black out)

• feel physically weak

• be confused and have trouble speaking

• seem physically clumsy and have trouble doing simple things like walking or holding an object

• have problems with their vision.

Longer-term use

Signs of longer-term cocaine use include:

• salmon-coloured marks on the skin, or signs of skin infection, if they have been injecting cocaine

• damage to the nose (called nasal septum perforation) caused by long-term snorting. This often causes symptoms such as breathing problems and frequent nosebleeds

• an unusually fast heartbeat

• extreme agitation and moodiness

• depression, and

• physical problems similar to those with short-term use, such as weakness, clumsiness, and having trouble speaking.

Symptoms of crack cocaine use

Many of the symptoms of crack use are the same as those for non-crack cocaine.

But people who have been using crack for a long time often have burn injuries to their lips and thumbs, from smoking the drug through small home-made devices, sometimes called 'crack pipes'.

These injuries are sometimes called 'crack lip' and 'crack thumb'.

Symptoms of cocaine overdose

If someone takes a large amount of cocaine in a short period of time this can cause an overdose. This is extremely dangerous and can cause death.

Symptoms of a cocaine overdose include:

• an unusually fast heartbeat

• a very high body temperature

• extreme sweating

• confusion and other signs of mental disturbance.

What treatments work?

The treatments for cocaine abuse depend on the person’s immediate needs.

For example, someone who goes to hospital suffering from the effects of cocaine use, or from an overdose, will need different treatment from someone who asks their doctor for help with addiction problems.

Emergency treatment

There is no specific treatment for the effects of cocaine. Treatments are aimed at relieving someone’s symptoms until they recover. People who go to hospital with problems caused by cocaine use, or with a cocaine overdose, might be given:

• treatment for heart problems

• a sedative medication for psychological symptoms, such as extreme confusion and agitation

• drugs to lower dangerously high blood pressure caused by cocaine

• oxygen, if they are unconscious

• fluids through an intravenous (IV) drip if they are dehydrated

• medicines to control seizures, if they are having them

• ice water baths to reduce a dangerously high temperature caused by a cocaine overdose.

Body packing

Someone can be in particular danger from a severe overdose if they have been 'body packing' or 'body stuffing'.

This is when someone swallows a lot of packets of cocaine, intending to pass them out of their body later when they go to the toilet. They do this to hide the drugs, usually when smuggling or transporting them without anyone knowing.

The danger is that one or more of the packets will break open while still inside the person. This can cause a severe overdose, and the person might need emergency surgery to remove the packets of cocaine.

If you think someone you know is having an overdose because of body packing, call an ambulance straight away.

Treatment for cocaine addiction

The ideal treatment for someone addicted to cocaine involves a drug counsellor or a drug treatment service. But this treatment is not always available, and there can be waiting times. You can talk to your doctor about what treatments are available in your area.

People who have mental-health problems caused by cocaine use, or who already had mental-health problems, might be able to get help from mental health services.

What will happen?

The best thing for someone who wants to stop using cocaine is to get into a drug treatment programme. Many people are helped by these programmes, including those with serious addiction issues.

If you are in one of these programmes you will need to have regular urine tests, to make sure that you are no longer using cocaine.

The mental-health problems that cocaine abuse causes are usually temporary, and stop soon after you stop using the drug.

But many of the serious physical problems, such as damage to the heart, lungs, and nose, can last a long time, and you might need long-term treatment for them. People who inject cocaine can also get serious infections such as HIV and hepatitis.

There are various online resources for people with drug problems. For example, the Frank website (talktofrank.com) provides help and information on many issues around drug abuse. You can also text, email, or call the Frank helpline.