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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 that has not been neutralized by

an acid to make the hydrochloride salt.

This form of cocaine comes in a rock

crystal that can be heated and its vapors

smoked. The term “crack” refers to the

crackling sound heard when it is heated.*

Regardless of how cocaine is used or how

frequently, a user can experience acute

cardiovascular or cerebrovascular emergencies, such as a heart attack or stroke,

which could result in sudden death.

Cocaine-related deaths are often a result

of cardiac arrest or seizure followed by

respiratory arrest.

Health Hazards ———–

Cocaine is a strong central nervous system stimulant that interferes with the reabsorption process of dopamine, a chemical

messenger associated with pleasure and

movement. The buildup of dopamine

causes continuous stimulation of “receiving” neurons, which is associated with the

euphoria commonly reported by cocaine

abusers.

Physical effects of cocaine use include

constricted blood vessels, dilated pupils,

and increased temperature, heart rate,

and blood pressure. The duration of

cocaine’s immediate euphoric effects,

which include hyperstimulation, reduced

fatigue, and mental clarity, depends on

the route of administration. The faster the

absorption, the more intense the high. On

the other hand, the faster the absorption,

the shorter the duration of action. The

high from snorting may last 15 to 30 minutes, while that from smoking may last 5

to 10 minutes. Increased use can reduce

the period of time a user feels high and

increases the risk of addiction.

Some users of cocaine report feelings

of restlessness, irritability, and anxiety.

A tolerance to the “high” may develop—

many addicts report that they seek but fail

to achieve as much pleasure as they did

from their first exposure. Some users will

increase their doses to intensify and prolong the euphoric effects. While tolerance

to the high can occur, users can also become more sensitive to cocaine’s anesthetic and convulsant effects without increasing the dose taken. This increased sensitivity may explain some deaths occurring

after apparently low doses of cocaine. 

Crack and Cocaine
Use of cocaine in a binge, during which

the drug is taken repeatedly and at

increasingly high doses, may lead to a

state of increasing irritability, restlessness,

and paranoia. This can result in a period

of full-blown paranoid psychosis, in which

the user loses touch with reality and experiences auditory hallucinations. 

Other complications associated with

cocaine use include disturbances in

hearth rhythm and heart attacks, chest

pain and respiratory failure, strokes,

seizures and headaches, and gastrointestinal complications such as abdominal

pain and nausea. Because cocaine has a

tendency to decrease appetite, many

chronic users can become malnourished.

Different means of taking cocaine can

produce different adverse effects.

Regularly snorting cocaine, for example,

can lead to loss of sense of smell, nosebleeds, problems with swallowing,

hoarseness, and a chronically runny nose.

Ingesting cocaine can cause severe bowel

gangrene due to reduced blood flow.

People who inject cocaine can experience

severe allergic reactions and, as with any

injecting drug user, are at increased risk

for contracting HIV and other bloodborne diseases. 

Added Danger: Cocaethylene

When people mix cocaine and alcohol

consumption, they are compounding the

danger each drug poses and unknowingly

forming a complex chemical experiment

within their bodies. NIDA-funded

researchers have found that the human

liver combines cocaine and alcohol and

manufactures a third substance, cocaethylene, that intensifies cocaine’s euphoric

effects, while potentially increasing the

risk of sudden death.

Treatment ———–

The widespread abuse of cocaine has

stimulated extensive efforts to develop

treatment programs for this type of drug

abuse.

One of NIDA’s top research priorities is

to find a medication to block or greatly

reduce the effects of cocaine, to be used

as one part of a comprehensive treatment

program. NIDA-funded researchers are

also looking at medications that help alleviate the severe craving that people in

treatment for cocaine addiction often

experience. Several medications are currently being investigated for their safety

and efficacy in treating cocaine addiction.

In addition to treatment medications,

behavioral interventions—particularly

cognitive behavioral therapy—can be

effective in decreasing drug use by

patients in treatment for cocaine abuse.

Providing the optimal combination of

treatment and services for each individual is critical to successful outcomes.

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Extent of Use ———–

Monitoring the Future (MTF)

Survey**

MTF assesses the extent and perceptions

of drug use among 8th, 10th, and 12th

grade students nationwide. There was

only one statistically significant change in

cocaine use measured between 2003 and

2004. Tenth-graders reported an increase

in 30-day*** use of powder cocaine,

from 1.1 percent in 2003 to 1.5 percent

in 2004.

Overall annual cocaine use increased in

each grade from the early 1990s until

1998 or 1999 and has subsequently stabilized or declined somewhat. Among

12th-graders, the rate increased from 3.1

percent in 1992 to 6.2 percent in 1999,

declined significantly to 5.0 percent in

2000, and remained stable through 2003

at 4.8 percent. Among 10th-graders, the

rate increased from 1.9 percent in 1992

to 4.9 percent in 1999. 

In 2004, 3.7 percent of 10th-graders

reported annual cocaine use, significantly

below the peak in 1999, though yearto-year changes were not significant.

Among 8th-graders, 1.1 percent reported

annual cocaine use in 1991, a figure that

increased to 3.0 percent in 1996, hovered around that point for several years,

then dropped to 2.0 percent in 2004—

significantly below the 1996 high point. 

Eighth-graders reported a significant

decrease in perceived availability of both

crack and powder cocaine in 2004.

Twelfth-graders, however, reported a significant increase in perceived availability

of both crack and cocaine in 2004.

Community Epidemiology Work

Group (CEWG) 

Cocaine/crack was endemic in almost

all 21 CEWG areas in 2002. Rates of

emergency department (ED) mentions

were higher for cocaine than for any

other drug in 17 CEWG areas. ED rates

increased significantly between 2001 and

2002 in Baltimore, and were highest in

Use of Cocaine in Any Form

by Students, 2004

Monitoring the Future Survey

8thGraders10thGraders12thGraders

Lifetime 3.4% 5.4% 8.1%

Annual 2.0 3.7 5.3

30-day 0.9 1.7 2.3

Crack Cocaine Use

by Students, 2004

Monitoring the Future Survey

8thGraders10thGraders12thGraders

Lifetime 2.4% 2.6% 3.9%

Annual 1.3 1.7 2.3

30-day 0.6 0.8 1.0
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Chicago, Philadelphia, Atlanta, Baltimore,

Miami, Newark, Detroit, and New York.

Cocaine-related death mentions in 2001

were particularly high in Chicago,

Baltimore, Dallas, Newark, San Antonio,

Atlanta, Boston, Denver, San Francisco,

and New York, as measured by one

Federal data source. Reports from local

medical examiner data named Detroit,

Philadelphia, Miami, and Phoenix as sites

with the highest rates of cocaine-related

deaths from 2000 through 2002.

Primary cocaine treatment admissions

were high in 9 of the 21 CEWG areas

reporting treatment data in 2003

(Atlanta, Miami, New Orleans, St. Louis,

Washington, DC, Philadelphia, Texas,

Detroit, and Illinois). Nearly half of adult

male arrestees in Atlanta, New Orleans,

and Chicago tested positive for cocaine

in 2003.

Nationwide, 61,594 kilograms of cocaine

were seized by the DEA in 2002, 3.6

percent more than in 2001 and 35.9

percent more than in 1995.

National Survey on Drug Use and

Health (NSDUH)** ***

In 2003, 34.9 million Americans age 12

and over reported lifetime use of cocaine,

and 7.9 million reported using crack.

About 5.9 million reported annual use of

cocaine, and 1.4 million reported using

crack. About 2.3 million reported 30-day

use of cocaine, and 604,000 reported

using crack. 

The percentage of youth ages 12 to 17

reporting lifetime use of cocaine was 2.6

percent in 2003. Among young adults

ages 18 to 25, the rate was 15 percent,

showing no significant difference from the

previous year. However, there was a statistically significant decrease in the rate of

lifetime crack use among females in the

12 to 17 age bracket.

* 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; any needle use increases a user’s risk of contracting HIV and other blood-borne infections. Smoking involves inhaling cocaine vapor or smoke

into the lungs, where absorption into the bloodstream is as rapid as by injection. 

** These data are from the 2004 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National

Institutes of Health, DHHS, 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. 
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*** “Lifetime” refers to use at least once during a respondent’s lifetime. “Annual” refers to use at least once during the

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

an individual’s response to the survey.

  CEWG is a NIDA-sponsored network of researchers from 21 major U.S. metropolitan areas and selected foreign

countries who meet semiannually to discuss the latest epidemiology of drug abuse. CEWG’s most recent reports are

available at www.drugabuse.gov/about/organization/cewg/pubs.html. 

** *** NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey conducted by

the Substance Abuse and Mental Health Services Administration. Findings from the latest survey are available at

www.samhsa.gov.

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.