August 2008 Page 1 of 4

Cocaine is a powerfully addictive stimulant drug. The powdered hydrochloride

salt form of cocaine can be snorted or

dissolved in water and injected. Crack is

cocaine base that has not been neutralized by an acid to make the hydrochloride salt. This form of cocaine comes in

a rock crystal that is heated to produce

vapors, which are smoked. The term

“crack” refers to the crackling sound

produced by the rock as it is heated.

How is Cocaine Abused?

Three routes of administration are

commonly used for cocaine: snorting,

injecting, and smoking. Snorting is the

process of inhaling cocaine powder

through the nose, where it is absorbed

into the bloodstream through the nasal

tissues. Injecting is the use of a needle

to release the drug directly into the

bloodstream. Smoking involves inhaling

cocaine vapor or smoke into the lungs,

where absorption into the bloodstream

is as rapid as by injection. All three

methods of cocaine abuse can lead to

addiction and other severe health problems, including increasing the risk of

contracting HIV and infectious diseases.

The intensity and duration of cocaine’s

effects, which include increased energy,

reduced fatigue, and mental alertness,

depend on the route of drug administration. The faster cocaine is absorbed into

the bloodstream and delivered to the

brain, the more intense the high. Injecting

or smoking cocaine produces a quicker,

stronger high than snorting. On the

other hand, faster absorption usually

means shorter duration of action. The

high from snorting cocaine may last 15

to 30 minutes, but the high from smoking may last only 5 to 10 minutes. In

order to sustain the high, a cocaine

abuser has to administer the drug again.

For this reason, cocaine is sometimes

abused in binges—taken repeatedly

within a relatively short period of time,

at increasingly high doses.

How Does Cocaine Affect

the Brain?

Cocaine is a strong central nervous system stimulant that increases levels of

dopamine, a brain chemical associated

with pleasure and movement, in the

brain’s reward circuit. Certain brain

cells, or neurons, use dopamine to

communicate. Normally, dopamine is

released by a neuron in response to a

pleasurable signal (e.g., the smell of

good food), and then recycled back into

the cell that released it, shutting off the

signal between neurons. Cocaine acts

by preventing the dopamine from being

recycled, causing excessive amounts of

Cocaine
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dopamine to build up, amplifying the

message, and ultimately disrupting

normal communication. It is this excess

of dopamine that is responsible for

cocaine’s euphoric effects. With repeated use, cocaine can cause long-term

changes in the brain’s reward system

and in other brain systems as well,

which may eventually lead to addiction.

With repeated use, tolerance to the

cocaine high also often develops. Many

cocaine abusers report that they seek

but fail to achieve as much pleasure as

they did from their first exposure. Some

users will increase their dose in an

attempt to intensify and prolong the

euphoria, but this can also increase

the risk of adverse psychological or

physiological effects.

What Adverse Effects Does

Cocaine Have on Health?

Abusing cocaine has a variety of

adverse effects on the body. For example, cocaine constricts blood vessels,

dilates pupils, and increases body temperature, heart rate, and blood pressure.

It can also cause headaches and gastrointestinal complications such as

abdominal pain and nausea. Because

cocaine tends to decrease appetite,

chronic users can become malnourished

as well.

Different methods of taking cocaine

can produce different adverse effects.

Regularly snorting cocaine, for example,

can lead to loss of the sense of smell,

nosebleeds, problems with swallowing,

hoarseness, and a chronically runny

nose. Ingesting cocaine can cause

severe bowel gangrene as a result of

reduced blood flow. Injecting cocaine

can bring about severe allergic reactions

and increased risk for contracting HIV

and other blood-borne diseases. Binge

patterns of use may lead to irritability,

restlessness, anxiety, and paranoia.

Cocaine abusers can suffer a temporary

state of full-blown paranoid psychosis, in

which they lose touch with reality and

experience auditory hallucinations.

Regardless of how or how frequently

cocaine is used, a user can experience

acute cardiovascular or cerebrovascular

emergencies, such as a heart attack or

stroke, which may cause sudden death.

Cocaine-related deaths are often a result

of cardiac arrest or seizure followed by

respiratory arrest.

Added Danger: Cocaethylene

When people consume cocaine and

alcohol together, they compound the

danger each drug poses and unknowingly perform a complex chemical experiment within their bodies. Researchers

have found that the human liver combines cocaine and alcohol to produce a

third substance, cocaethylene, which

intensifies cocaine’s euphoric effects.

Cocaethylene is associated with a

greater risk of sudden death than

cocaine alone.1
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What Treatment

Options Exist?

Behavioral interventions—particularly,

cognitive-behavioral therapy—have been

shown to be effective for decreasing

cocaine use and preventing relapse.

Treatment must be tailored to the individual patient’s needs in order to optimize

outcomes—this often involves a combination of treatment, social supports, and

other services.

Currently, there are no medications for

treating cocaine addiction, so this

remains one of NIDA’s top research priorities. Researchers are looking for medications that help alleviate the severe

craving experienced by people in treatment for cocaine addiction, as well as

medications to counteract other triggers

of relapse, such as stress. Several compounds are currently being investigated

for their safety and efficacy, including a

vaccine that would sequester cocaine in

the bloodstream and prevent it from

reaching the brain. Research so far suggests that addiction medications are

most effective when used as a part of a

comprehensive treatment program.

How Widespread is

Cocaine Abuse?

Monitoring the Future Survey†

According to the 2007 Monitoring the

Future survey—a national survey of 8th-,

10th-, and 12th-graders—cocaine use

among students did not increase significantly, though it remained at unacceptably high levels: 3.1 percent of 8thgraders, 5.3 percent of 10th-graders,

and 7.8 percent of 12th-graders have

tried cocaine; 0.9 percent of 8thgraders, 1.3 percent of 10th-graders,

and 2.0 percent of 12th-graders were

current (past-month) cocaine users.

National Survey on Drug Use

and Health (NSDUH)†††

According to the 2006 National Survey

on Drug Use and Health, 35.3 million

Americans aged 12 and older reported

having used cocaine, and 8.5 million

reported having used crack. An estimated 2.4 million Americans were current

(past-month) users of cocaine; 702,000

were current users of crack. There were

Use of Cocaine in Any Form by Students

2007 Monitoring the Future Survey

8th Grade 10th Grade 12th Grade

Lifetime†† 3.1% 5.3% 7.8%

Past Year 2.0 3.4 5.2

Past Month 0.9 1.3 2.0

Crack Cocaine Use by Students

2007 Monitoring the Future Survey

8th Grade 10th Grade 12th Grade

Lifetime†† 2.1% 2.3% 3.2%

Past Year 1.3 1.3 1.9

Past Month 0.6 0.5 0.9
August 2008 Page 4 of 4

an estimated 977,000 new users of

cocaine in 2006—most were 18 or

older when they first used cocaine.

Among young adults aged 18 to 25, the

past-year use rate was 6.9 percent,

showing no significant difference from

the previous year.

Other Information Sources

For additional information on cocaine,

please refer to the following sources on

NIDA’s Web site,

www.drugabuse.gov:

• Cocaine Abuse and Addiction—

Research Report Series

• Various issues of NIDA Notes

(search by “cocaine” or “crack”)

For a list of street terms used to refer

to cocaine and other drugs, visit

www.whitehousedrugpolicy.gov/

streetterms/default.asp.

National Institutes of Health – U.S. Department of Health and Human Services

This material may be used or reproduced without permission from NIDA. Citation of the source is appreciated.

† These data are from the 2006 Monitoring the Future survey, funded by the National Institute on Drug Abuse,

National Institutes of Health, Department of Health and Human Services, and conducted annually by the University

of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes

since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at

www.drugabuse.gov.

†† “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during

the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days

preceding an individual’s response to the survey.

††† NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans

aged 12 and older conducted by the Substance Abuse and Mental Health Services Administration. This survey is

available online at www.samhsa.gov and from NIDA at 877-643-2644.

Reference

1 Harris DS, et al. The pharmacology of cocaethylene in humans following cocaine and ethanol administration.

Drug Alcohol Depend 72(2):169–182, 2003.