May 2006 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 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 alertness, 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
May 2006 Page 2 of 4

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

heart 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 the 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 all injecting drug users, are

at increased risk for contracting HIV and

other blood-borne 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.
May 2006 Page 3 of 4

Extent of Use ———

Monitoring the Future (MTF)

Survey**

Lifetime,*** annual, and 30-day

cocaine use remained stable among all

three grades in 2005. Perceived harmfulness of occasional use also remained

stable in 2005, measuring at 65.3 percent among 8th-graders, 72.4 percent

among 10th-graders, and 60.8 percent

among 12th-graders.

Community Epidemiology Work

Group (CEWG) 

Cocaine-related death mentions in 2003

were particularly high in New York

City/Newark, Detroit, Boston, and

Baltimore, as measured by one Federal

data source. Reports from local medical

examiner data named Texas and

Philadelphia as sites with the highest

rates of cocaine-related deaths from

2003 through 2004.

Primary cocaine treatment admissions 

in 2004 accounted for 52.5 percent of

treatment admissions, excluding alcohol,

in Atlanta, 38.9 percent in New Orleans,

and approximately 36 percent in Texas

and Detroit.

National Survey on Drug Use and

Health (NSDUH)** ***

In 2004, 34.2 million Americans aged

12 and over reported lifetime use of

cocaine, and 7.8 million reported using

crack. About 5.6 million reported annual

use of cocaine, and 1.3 million reported

using crack. An estimated 2 million

Americans reported current use of

cocaine, 467,000 of whom reported

using crack. There were an estimated 1

million new users of cocaine in 2004

(approximately 2,700 per day), and

most were aged 18 or older although

the average age of first use was 20.0

years.

The percentage of youth ages 12 to 17

reporting lifetime use of cocaine was

2.4 percent in 2004. Among young

adults aged 18 to 25, the rate was 15.2

percent, showing no significant difference from the previous year. However,

there was a statistically significant

decrease in perceived risk of using

Use of Cocaine in Any Form by

Students, 2005

Monitoring the Future Survey

8th-Graders 10th-Graders 12th-Graders

Lifetime 3.7% 5.2% 8.0%

Annual 2.2 3.5 5.1

30-day 1.0 1.5 2.3

Crack Cocaine Use by Students, 2005

Monitoring the Future Survey

8th-Graders 10th-Graders 12th-Graders

Lifetime 2.4% 2.5% 3.5%

Annual 1.4 1.7 1.9

30-day 0.6 0.7 1.0
May 2006 Page 4 of 4

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.

cocaine once a month among Americans

in the 12 to 17 age bracket in 2004.

Past month crack use was down for 16-

or 17-year-olds but up for 21- to 25-

year-olds; 21-year-olds also showed

increases in past year use of both crack

and cocaine.

Past month use of cocaine was down

among females aged 12–17 and Asians

12 or older, but up among Blacks aged

18 to 25. There was a decrease in past

year cocaine use measured among

Asians aged 18 to 25.

Following a decline between 2002 and

2003, NSDUH data show an increase

in the number of people receiving treatment for a cocaine use problem during

their most recent treatment at a specialty

facility, from 276,000 in 2003 to

466,000 in 2004.

* 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 2005 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.

*** “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 current 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 of Americans

age 12 and older conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest

survey are available at www.samhsa.gov and from the National Clearinghouse for Alcohol and Drug Information at

800-729-6686.