Cocaine

Levamisole, a common cocaine adulterant, is linked to cocaine/levamisole-associated syndromes

By 2017, 87% of cocaine seized and analyzed in the US contained levamisole.

Cocaine- and levamisole-induced vasculitis (CLIV), is often used as an umbrella term for the vasculitic and necrotic complications seen with levamisole-adulterated cocaine, including both levamisole induced necrosis syndrome (LINES), and cocaine/levamisole-associated autoimmune syndrome (CLAAS).

To stay safer: DanceSafe recommends testing cocaine samples using a specific sequence of reagent testing kits (Morris > Marquis > Liebermann) for more reliable identification and adulterant detection. For detailed instructions, see their official testing guide (PDF), page 4.

Summary sheet: Cocaine

Cocaine
Chemical Nomenclature
Common names	Cocaine, Coke, Coca, Crack, Blow, Girl, White, Snow, Nose Candy, Yayo, Perico,Gear, Chari
Substitutive name	Benzoylmethylecgonine
Systematic name	Methyl (1R,2R,3S,5S)-3- (Benzoyloxy)-8-methyl-8-azabicyclo[3.2.1] octane-2-carboxylate
Class Membership
Psychoactive class	Stimulant, SNDRI
Chemical class	Tropane alkaloid
Routes of Administration
WARNING: Always start with lower doses due to differences between individual body weight, tolerance, metabolism, and personal sensitivity. See responsible use section. ⇣ Smoked Dosage Bioavailability 90% Threshold 2.5 mg Light 5 - 15 mg Common 15 - 30 mg Strong 30 - 45 mg Heavy 45 mg + Duration Total 5 - 15 minutes Onset 3 - 5 seconds Come up 1 - 2 minutes Peak 2 - 10 minutes Offset 1 - 5 minutes ⇣ Oral Dosage Bioavailability 33% Threshold 13 mg Light 13 - 75 mg Common 75 - 150 mg Strong 150 - 225 mg Heavy 225 mg + Duration Total 120 - 240 minutes Onset 30 - 40 minutes Come up 40 - 50 minutes Peak 60 - 180 minutes Offset 10 - 25 minutes ⇣ Insufflated Dosage Bioavailability 60-80% Threshold 5 mg Light 10 - 30 mg Common 30 - 60 mg Strong 60 - 90 mg Heavy 90 mg + Duration Total 10 - 90 minutes Onset 3 - 10 minutes Come up 5 - 12 minutes Peak 7.5 - 16 minutes Offset 10 - 25 minutes After effects Psychological craving and compulsive redosing ⇣ Intravenous Dosage Bioavailability 100% Threshold 2 mg Light 2 - 5 mg Common 5 - 10 mg Strong 10 - 15 mg Heavy 15 mg + Duration Total 5 - 15 minutes Onset 3 - 5 seconds Come up 1 - 2 minutes Peak 2 - 10 minutes Offset 1 - 5 minutes DISCLAIMER: PW's dosage information is gathered from users and resources for educational purposes only. It is not a recommendation and should be verified with other sources for accuracy.
Interactions
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Amphetamines
MDMA
Caffeine
GHB
GBL
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Contaminated currency such as banknotes might serve as a fomite of diseases like hepatitis C

Chronic cocaine use can cause "cocaine nose"—damage ranging from nasal septum perforation (pictured) to cocaine-induced midline destructive lesions (CIMDL)

Cocaine (also known as benzoylmethylecgonine, and informally as coke, cola, snow, blow, white, among others) is a classical stimulant substance of the tropane class. It is a naturally-occurring alkaloid extracted from the leaves of two coca plant species; namely Erythroxylum coca and E. novogranatense that are native to South America. The mechanism of action involves increasing levels of serotonin, dopamine, and norepinephrine in the brain.

Cocaine is one of the most widespread and highly controlled illicit substances in the world. According to a 2007 United Nations report, it was the second most widely used substance in the world, after cannabis. It is considered a major so-called "street drug" and "drug of abuse", alongside heroin and methamphetamine. Due to its high profit margins and longtime steady demand, it has become a staple product trade and smuggling for various transnational criminal syndicates or related organizations who traffic drugs in the black market.

Cocaine use spans all social classes, defying traditional stereotypes that associate the drug solely with either the wealthy or the poor. Although cocaine is an expensive drug—often considered a status symbol among affluent users—studies indicate that its use is proportionately higher among those with higher incomes and education levels, particularly in so-called “middle-class” or wealthy groups. About 25% of adults with ADHD use cocaine, with 10% developing a use disorder. Screening is often advised due to associated health risks.

Subjective effects include stimulation, increased blood pressure, appetite suppression, disinhibition, motivation enhancement, ego inflation, increased libido, and euphoria. Routes of administration include insufflation ("snorting" or "sniffing") and occasionally injection. Oral intake is rare but possible, and possesses a marketly longer duration; 60 minutes as opposed to 10 - 20 minutes when insufflated or 5 minutes smoked.

The typical cocaine high is characterized by a rapid onset and a short duration, featuring a powerful euphoric "rush" that is followed by a marked comedown or "crash" — an experience that can promote compulsive redosing. Excessive use is reported to increase the risk of anxiety, paranoia, irritability, minor hallucinations, mania, and, in rare cases, psychosis.

It is known to have high abuse potential. Chronic use (i.e. high dose, repeat administration) is associated with escalating tolerance and physiological dependence, which can become severe if left untreated.

Additionally, some evidence suggests it poses unique cardiotoxic risks compared to other CNS stimulants, including the entire amphetamine class. Even "regular" use has been linked to the development of permanent heart conditions and it also appears to cause sudden cardiac death in susceptible individuals (see this section for more).

It is highly advised to use harm reduction practices if using this substance.

History and culture

Cocaine (presumably in the form of coca leaves) is among one of the oldest used drugs, with a 1000-year-old collection of ancient “drug paraphernalia” (most likely used ceremonially), discovered in a rock shelter in south-western Bolivia known as Cueva del Chilano which is seemingly traceable to the archaic Tiwanuku culture. The ancient Andean site features traces of five drug chemicals which include cocaine, benzoylecgonine (inactive metabolite of cocaine), bufotenine, DMT, as well as harmine (possibly indicating utilization of ayahuasca). Curiously enough, a decorated “bone snuffer” was also uncovered.

However, it is highly unlikely that it was consumed as “powdered cocaine”, but rather simply with raw, unprocessed coca leaves which can be chewed to create a less intense and less dangerous stimulant effect than modern-day cocaine powder or freebase. The degree of subjective intensity in regards to the stimulating and psychoactive effects felt when chewing coca leaves or consuming it when brewed as a drink (tea) known as mate de coca is perhaps conversely more so comparable to that of caffeine, albeit with many users maintaining the notion of “coca tea” still technically feeling stronger than ordinary caffeinated-drinks like coffee or black tea. One of the earliest documentations of the cocaine alkaloid being isolated from the plant was in 1855 where German chemist Friedrich Gaedcke published a description in the journal "Archiv der Pharmazie", naming the alkaloid "erythoxyline." Five years later in 1860, Albert Niemann describes the isolation of an alkaloid from coca who then went on to call it cocaine. With this chemical partitioning of the infamous alkaloid from the coca plant, the history of cocaine in its contemporary form begins. Western medicine was quick to exploit the various perceived surface-level or postulated benefits of the drug. Thereafter, research publications within the pharmaceutical and medical community commenced.

One such highlight of the papers published would be Sigmund Freud's collection of publications referred to as the "Cocaine Papers" which can be considered partly responsible for the surge in popularity both when published and upon the rediscovery of the papers, around 1974. In these papers, he correctly speculates on the medical use of cocaine as a topical anesthetic due to its numbing effects.: "The capacity of cocaine [...], to anesthetize cutaneous and mucous membranes suggests a possible future use, especially in cases of local infections .... Some additional uses of cocaine based on this anesthetic property are likely to be developed in the near future." Furthermore to cocaine's numbing effects on the lips and mouth being observed by Freud.

Freud notes his studied effects on hunger, sleep, and fatigue. describing; "...exhilaration and lasting euphoria, which in no way differs from the normal euphoria of the healthy person .... You perceive an increase of selfcontrol and possess more vitality and capacity for work .... In other words, you are simply normal, and it is soon hard to believe that you are under the influence of any drug .... Long intensive mental or physical work is performed without any fatigue .... This result is enjoyed without any of the unpleasant after-effects that follow exhilaration brought about by alcohol. ... Absolutely no craving for the further use of cocaine appears after the first, or even repeated, taking of the drug; one feels rather a certain curious aversion to it." The final statement contradicting much of the modern reputation surrounding the cravings cocaine induces following use (compulsive redosing).

Freud also suggests that cocaine be used for morphine withdrawal treatment.

The first major article on the drug and part of the collection of "Cocaine Papers" would be Sigmund Freud's 1884 "Uber Coca." that outlines many major observed effects and offers a scientific breakdown of the potential uses of the drug. Freud observes:

"A few minutes after taking cocaine, one experiences a sudden exhilaration and feeling of lightness. One feels a certain furriness on the lips and palate, followed by a feeling of warmth in the same areas; if one now drinks cold water, it feels warm on the lips and cold in the throat. On other occasions the predominant feeling is a rather pleasant coolness in the mouth and throat" The euphoria or physical euphoria felt from the drug is referenced. The trademark mouth numbing can be read from the experience narration too.

According to a 2007 United Nations report, cocaine is the second most widely used illicit substance in the world, after cannabis. Considering how the late 2010s and early 2020s have reportedly gone on to see even more growth in the production and global usage of the drug as well, this statistical figure appears to still remain quite befitting. According to certain outlets of the press such as VICE News, as of 2022; Scotland is considered to be the world-center for cocaine usage and subsequently, now the possible “drug-death capital within the EU”. In the past several years, cocaine trafficking and general usage has seen what can aptly be described as an exponential growth in various nations and regions throughout the Eastern Hemisphere, with many organized crime groups now having shifted their business models to heavily favor cocaine trafficking often by working directly with major criminal groups in South America. " by adding it after "llicit substance in the world, after cannabis.

In terms of user rates (as of 2007), Spain is the country with the highest rate of cocaine usage (3.0% of adults in the previous year). Other countries where the usage rate meets or exceeds 1.5% are the United States (2.8%), England and Wales (2.4%), Canada (2.3%), Italy (2.1%), Bolivia (1.9%), Chile (1.8%), and Scotland (1.5%).

Etymology

The name cocaine is derived from "coca" and the alkaloid suffix "-ine".

Common names

Cocaine has numerous common or street names, including coke, coca, cola, snow, ski, blow, nose candy, white, and girl. Spanish-influenced names include lello, yayo, yeyo, or yay. More regional to the UK are biff, charlie, lemos, flake among others.

Chemistry

Cocaine is a tropane alkaloid found in the leaves of two coca plants, Erythroxylum coca and E. novogranatense which are native to the Andes in South America. However, coca production in Central America has increased sharply. In 2022, authorities destroyed over 6.5 million coca plants in Honduras, 4 million in Guatemala, and more than half a million in southern Belize. By 2024, the number of coca plantations found and eradicated in Honduras had nearly doubled compared to the previous year, and a record number of processing labs were dismantled across the region. Unlike the Andes, where small farmers typically grow coca, cultivation in Central America is controlled by organized crime groups with backing from major foreign cartels.

Cocaine decomposes when heated strongly so the freebase and hydrogen carbonate salts of cocaine, which have much lower boiling points compared to the hydrochloride salt, are typically used when the substance is to be vaporized and are known as cocaine base and "crack" respectively.

The chemical structure of cocaine consists of three parts; the hydrophilic methyl ester moiety and the lipophilic benzoyl ester moiety, which are located in place of the carboxylic acid and hydroxyl groups of ecgonine respectively. This structure allows for its rapid absorption through nasal membranes and blood-brain barrier.

The presence of the two ester groups makes cocaine relatively unstable in warm, humid environments and cocaine stored in an open container or with a high moisture content will lose apparent potency over time due to hydrolysis to methyl ecgonine or benzoylecgonine.

Synthesis

Disclaimer: This guide is provided for informational and educational purposes only. We do not encourage you to break the law and cannot claim any responsibility for your actions.

While biosynthesis of cocaine is rare and technically challenging, advances in metabolic engineering make it theoretically possible to produce cocaine in laboratories anywhere in the world, potentially eliminating reliance on Latin American trafficking. As the drug currently passes through numerous intermediaries—each seeking to increase profits—it is frequently cut with various adulterants, leading to reduced purity and increased health risks for users. Producing cocaine directly in controlled laboratory settings could significantly reduce such adulteration. This approach may even be useful for very small-scale production in countries where possession of small amounts is decriminalized, even when cocaine is purchased in the same country where it is produced. Cocaine is sometimes adulterated with levamisole by cartels before it reaches end users.

Cocaine Synthesis by Professor Buzz in the Rhodium archive provides an example of a synthetic route to cocaine.

Pharmacology

The most extensively studied effect of cocaine on the central nervous system is the blockade of the dopamine transporter. This substance acts as a reuptake inhibitor and prevents dopamine from being recycled, causing excessive amounts to build up in the synapse, or junction between neurons. The result is an enhanced and prolonged post-synaptic effect of dopaminergic signaling. To a lesser extent, cocaine also exhibits functionally similar effects of reuptake inhibition upon the neurotransmitters of serotonin and noradrenaline. It is this sudden flood of neurotransmitters that causes cocaine’s characteristic high.

The pharmacodynamics of cocaine involve the complex relationships of neurotransmitters (inhibiting monoamine uptake in rats with ratios of about: serotonin:dopamine = 2:3, serotonin:norepinephrine = 2:5). The most extensively studied effect of cocaine on the central nervous system is the blockade of the dopamine transporter protein. Dopamine transmitter released during neural signaling is normally recycled via the transporter; i.e., the transporter binds the transmitter and pumps it out of the synaptic cleft back into the presynaptic neuron, where it is taken up into storage vesicles.

Cocaine binds tightly at the dopamine transporter forming a complex that blocks the transporter's function. The dopamine transporter can no longer perform its reuptake function, and thus dopamine accumulates in the synaptic cleft. The increased concentration of dopamine in the synapse activates post-synaptic dopamine receptors, which makes the drug rewarding and promotes the compulsive use of cocaine.

Subjective effects

Disclaimer: The effects listed below cite the Subjective Effect Index (SEI), an open research literature based on anecdotal user reports and the personal analyses of PsychonautWiki contributors. As a result, they should be viewed with a healthy degree of skepticism.

It is also worth noting that these effects will not necessarily occur in a predictable or reliable manner, although higher doses are more liable to induce the full spectrum of effects. Likewise, adverse effects become increasingly likely with higher doses and may include addiction, severe injury, or death ☠.

The cognitive effects of cocaine can be broken down into several components which progressively intensify proportional to dosage. The general headspace of cocaine is described as one of extreme mental stimulation, increased motivation, increased sex drive, and overwhelming euphoria and/or satisfaction. Subjective experience of the drug can heavily depend quality and purity however which can vary drastically.

Physical effects

• • Stimulation - Cocaine is reported to be extremely energetic and stimulating in a fashion that is comparatively weaker than methamphetamine, but often stronger than that of amphetamine, modafinil, caffeine, and methylphenidate. The particular style of stimulation which cocaine presents can be described as encouraged at low to moderate dosages but forced at higher dosages. This means that at certain dosages, it becomes difficult or impossible to keep still as jaw clenching, involuntarily bodily shakes and vibrations become present, resulting in extreme shaking of the entire body, unsteadiness of the hands, and a general lack of fine motor control. This effect is replaced with mild fatigue and general exhaustion during the offset of the experience. Many users however report relatively limited “energizing“ effects compared to the standard amphetamines, and will not uncommonly even report certain “relaxing” effects or notable euphoria and elation but with limited amounts of actual stimulation.
  • Abnormal heartbeat - Cocaine consistently raises one's heart rate to abnormally high levels which can be potentially dangerous with prolonged or high dosing, especially during short windows of time. Even subtle physical activities such as walking can seemingly induce an unusually fast heartbeat; even compared to other stimulants. Therefore it is recommended for users to partake in a less amount physical activity than is typical, even compared to these other substances due to the drug’s uniquely prominent effect on pulse rate and cardiac output. Cocaine is a particularly cardiotoxic stimulant.
  • Physical euphoria
  • Neurotoxicity - Long-term or recurrent use of cocaine can result in serious neurological harm.
  • Increased heart rate
  • Increased blood pressure
  • Appetite suppression - This component can often be less intense for new or unconditioned users.
  • Bodily control enhancement
  • Bronchodilation - This can sometimes be very apparent and can result in an inability to swallow.
  • Dehydration
  • Frequent urination
  • Bowel movements
  • Increased bodily temperature
  • Increased perspiration
  • Pain relief - One of the few accepted medical uses of cocaine is as a topical anesthetic; namely due to tactile suppression (numbness). This effect seems to be mediated mainly from sodium channel blockage. In recreational contexts, such as with insufflation; this is noticeably felt primarily in the nasal passages, throat, and/or front teeth. A numbing of the whole face though is usually indicative of cutting agents added to the substance such as Novacaine.
  • Pupil dilation
  • Mouth numbing
  • Tactile hallucination - High doses and/or prolonged usage of certain dopaminergic stimulants like methamphetamine and cocaine can lead to hallucinatory sensations of bugs crawling on the surface of or underneath one’s skin (formication). This is typically referred to as delusional parasitosis or more informally as “coke bugs”.
  • Teeth grinding - This component can be considered to be less intense when compared with that of MDMA.
  • Temporary erectile dysfunction
  • Vasoconstriction - Like other stimulants, this can cause users to feel colder in various parts of the body, such as the hands. This can become very dangerous when combined with other vasoconstrictors, such as nicotine.

Cognitive effects

• The mental headspace and cognitive effects of cocaine, is considered as euphoric and elating with a noticeable initial “rush” that quickly levels out into a lesser high before soon fading off within a dozen or so minutes unless (safely) redosed. It is sometimes reported as being more “hedonistic”, manic or distractible compared to stimulants of a similar caliber or strength; such as most amphetamines, but while still often being reported as typically less “scatterbrained” than moderate to high doses of the common xanthine stimulant known as caffeine. It commonly presents noticeably less enhancements in executive functioning compared to other strong stimulants as well. It is also known for its supposed “honeymoon phase”, where the effects of cocaine (especially mental) seem either particularly or disproportionately positive when a user is new to the substance; often with effects like appetite suppression and wakefulness reportedly being less intense with earlier exposures to the drug.
  • Analysis enhancement - This effect is usually only present at low to moderate doses.
  • Anxiety or Anxiety suppression
  • Compulsive redosing - This effect is more prevalent than with any other commonly used stimulant.
  • Cognitive euphoria - When insufflated (snorted), this component almost invariably presents itself first as an initial “rush” feeling within the first 5 - 10 minutes before quickly leveling-out into a lesser degree of mental euphoria for another 10 or so minutes. However, other mental and physical components can outlast this initial highly-sought after euphoric rush stage of the high.
  • Disinhibition
  • Ego inflation - This effect can manifest inconsistently or sporadically, and sometimes conversely; only on the tail-end, with repeated dosing or even paradoxically, in conjunction with other more amicable components such as Empathy, affection, and sociability enhancement; however still markedly less than with MDMA and entactogens.
  • Focus enhancement - This component is most effective at low to moderate dosages as anything higher will usually impair concentration. This effect is still considerably less prominent when compared to amphetamines however, and usually consists of increased distractibility and often an inability to stay focused on a single task at a time. The rewarding feeling, fleeting cognitive enhancements, and unusually euphoric mental “rush” from insufflation has often been cited as being the primary reason for this limited increased focus potential.
  • Increased libido - This may be more prominent or intense in its particular style (compared to similar substances) due to the drug’s alleged effects on testosterone levels as oppose to just the increase in dopamine. It can also be dosage dependent.
  • Increased music appreciation - This component can become less intense or even not present at all after regular or prolonged use.
  • Irritability - Although usually this effect is seen mostly after the peak or during the comedown phase; irritability and/or extreme impatience associated with cocaine intoxication is notorious in its occassional and largely unpredictable potential intensity. It colloquialy known as "coke rage."
  • Mania - This aspect of cocaine is typically one of the main qualities that designates it as being less clearheaded and “functional” when compared to equipotent dosages of amphetamines.
  • Memory enhancement - This is usually only present during the very brief peak effects, but can be unusually prominent; possibly due to cocaine’s increased signaling of acetylcholine in the brain.
  • Memory suppression - This effect is most prevalent in high doses and appears to mostly impact short term memory.
  • Suggestibility suppression
  • Motivation enhancement
  • Ringing in ears - This effect is usually only experienced when cocaine is administered intravenously and is referred to as a "bell ringer".
  • Thought acceleration - This aspect can continue even once the main effects have worn off.
  • Thought organization - This possible effect is regarded as being considerably less prominent when compared to that of amphetamines.
  • Time compression - This can be described as the experience of time speeding up and passing much quicker than it usually would when sober.
  • Wakefulness - This is considered less prominent when compared to amphetamine stimulants, particularly methamphetamine.

After effects

• The effects which occur during the offset of a stimulant experience generally feel negative and uncomfortable in comparison to the effects which occurred during its peak. This is often referred to as a comedown or “crash” and occurs because of neurotransmitter depletion. Many users report however that the severity of the “crash” depends on dose; with apparently low or modest doses sometimes displaying a lack of intensity for the crash compared to other major-neurotransmitter depleting stimulants. Conversely, in high doses it can still be very severe. Its effects commonly include:
  • Anxiety
  • Cognitive fatigue
  • Compulsive redosing - During the offset, almost immediately once the user has come down, they may experience unusually intense cravings for the drug.
  • Depression - Can be severe in higher doses but at times; practically nonexistent in lower doses for a number of users. However when experienced at moderate to severe levels it can also include significant physical bodily discomfort and feelings of dysphoric “emptiness”, sometimes in the chest or nasal passages.
  • Irritability
  • Motivation suppression
  • Respiratory depression
  • Tactile hallucination - This occurs after heavy or prolonged use and manifests as the sensation of insects crawling on one's skin.
  • Thought deceleration
  • Headache

Experience reports

There are currently 0 experience reports describing the effects of this substance in our experience index. You can also submit your own experience report using the same link.

Additional experience reports can be found here:

• Erowid Experience Vaults: Cocaine Reports

Common usage

Cocaine is often adulterated when sold on black markets and this can significantly alter its effects on the body. Even when adulterants are pharmacologically inactive, their combination with the long-term perishability of cocaine due to moisture can lead to vastly differing apparent potencies between dosages of cocaine, and as such, it can be challenging to determine a "typical" recreational dose.

Pure cocaine is very potent and generates perceptible local anesthetic (numbing) effects from 1 mg and perceptible CNS stimulation from 5-7 mg; however, much higher doses tend to be used in recreational settings.

Forms

In order for cocaine (in plastic bag at bottom) to be converted to crack, several supplies are needed. Pictured here are baking soda (a commonly used base in making crack) a metal spoon, a tea light, and a cigarette lighter. The spoon is held over the heat source in order to "cook" the cocaine into crack.

• Cocaine paste: A crude extract of the coca leaf, which contains 40% to 91% cocaine sulfate along with companion coca alkaloids and varying quantities of benzoic acid, methanol, and kerosene.
• Salts: Cocaine is a weakly alkaline compound (an "alkaloid") and can, therefore, combine with acidic compounds to form various salts. The hydrochloride (HCl) salt of cocaine is by far the most commonly encountered, although the sulfate (-SO4) and the nitrate (-NO3) are occasionally seen. Different salts dissolve to a greater or lesser extent in various solvents. The hydrochloride salt is polar in character and quite soluble in water.
• Freebase: “Freebase” is the base form of cocaine, as opposed to the salt form. It is practically insoluble in water whereas hydrochloride salt is water soluble. This prevents cocaine in its basic form from being usable for sublingual usage and insufflation. Freebase cocaine can be treated with ethers, isopropyl alcohol, and hydrochloric acid to turn it into the salt form.
• "Crack": "Crack" refers to a lower purity form of freebase cocaine that is usually produced by neutralization of cocaine hydrochloride with a solution of baking soda (sodium bicarbonate, NaHCO3) and water, producing a very hard/brittle, off-white-to-brown colored, amorphous material that contains sodium carbonate, entrapped water, and other by-products as the main impurities.

  Smoking or vaporizing cocaine and inhaling it into the lungs produces an almost immediate "high" that can be very powerful and addictive. This initial buildup of stimulation is known as a "rush". While the stimulating effects may last for hours, the euphoric sensation is very brief, prompting the user to smoke more immediately.

• Coca leaf infusions: Coca herbal infusion (also referred to as coca tea) is used in coca-leaf producing countries as much as any herbal medicinal infusion would be elsewhere in the world. The free and legal commercialization of dried coca leaves under the form of filtration bags to be used as "coca tea" has been actively promoted by the governments of Peru and Bolivia for many years as a drink having medicinal properties. The leaves are also very widely used by native populations for a variety of purposes including the treatment of altitude sickness.
• Coca leaf chewing: Chewing the leaves (with lime) is also common in producing regions, which numbs the mouth and causes mild stimulation.

Toxicity and harm potential

Warning: Nasal Administration Insufflation can cause nasal damage, bleeding, and—with repeated long-term use—irreversible damage to the nose and surrounding tissues. Sharing snorting equipment (including banknotes) increases the risk of transmitting blood-borne diseases (such as hepatitis C and HIV). To stay safer: Prepare substances into a fine powder before use, and always use your own clean snorting tool. Limit how much you use in each nostril per session, and rinse your nose with saline within 30–60 minutes after use (after the peak effects) to clear out any leftover material and reduce irritation. If with others, don’t let anyone push you to use. Alternatively: Buccal administration may be used as a harm reduction option. This involves placing the powder (for example, wrapped in a small piece of toilet paper) under the lip, allowing it to absorb through the cheek or gum. This method avoids nasal damage, though it may have different effects and risks, such as irritation to the mouth or gums. Learn more about nasal administration risks.

Table from the 2010 ISCD study ranking various drugs (legal and illegal) based on statements by drug-harm experts. Crack cocaine and cocaine were found to be the third and fifth overall most dangerous drugs, respectively.

Radar plot showing relative physical harm, social harm, and dependence of cocaine

Chronic cocaine use has been shown to lead to neurotoxicity, being associated with high morbidity and mortality rates. Its extended use or abuse does also cause short-term downregulation of neurotransmitters.

The most potentially harmful physical effects of cocaine appear to be not neurological but cardiovascular. Severe cardiac adverse events, particularly sudden cardiac death, become a serious risk at high doses due to cocaine's blocking effect on cardiac sodium channels. Moreover, long-term cocaine use may result in cocaine-related cardiomyopathy.

Regular cocaine insufflation, the most popular method of ingestion, can have extremely adverse effects on one's nostrils, nose, and nasal cavities. These include a loss of the sense of smell, nosebleeds, difficulty swallowing, hoarseness, or a chronically runny nose.

"Crack lung" is a term for various pulmonary diseases caused by smoking crack cocaine, and it can develop even after short-term or initial use. While crack lung is usually reversible with appropriate medical care and most people recover fully, in some cases—especially if complications arise—lasting lung damage may occur.

It is strongly recommended that one use harm reduction practices if using this substance.

Lethal dosage

Susceptible individuals have died from as little as 30 mg applied to mucous membranes, whereas addicts may tolerate up to 5 grams daily.

Dependence and abuse potential

As with other stimulants, the chronic use of cocaine can be considered highly addictive with a high potential for abuse and is capable of causing psychological dependence among certain users. When addiction has developed, cravings and withdrawal effects may occur if a person suddenly stops their usage. Addiction is a serious risk with heavy recreational cocaine use but is unlikely to arise from typical medical use.

Tolerance to many of the effects of cocaine develops with prolonged and repeated use. This results in users having to administer increasingly large doses to achieve the same effects. After that, it takes about 3 - 7 days for the tolerance to be reduced to half and 1 - 2 weeks to be back at baseline (in the absence of further consumption).

Cocaine exhibits cross-tolerance with all dopaminergic stimulants, meaning that after the consumption of cocaine all stimulants will have a reduced effect.

Withdrawal symptoms

After taking cocaine on a regular basis, some users will become addicted. When the substance is discontinued immediately, the user will experience what has come to be known as a "crash" along with a number of other cocaine withdrawal symptoms including paranoia, depression, Decreased libido, anxiety, itching, mood swings, irritability, fatigue, insomnia, an intense craving for more cocaine, and, in some cases, nausea and vomiting.

These symptoms can last for weeks or, in some cases, months. Even after most withdrawal symptoms dissipate most users feel the need to continue using the drug; this feeling can last for years and may peak during times of stress. About 30-40% of cocaine addicts will turn to other substances such as medication and alcohol after giving up cocaine.

The misuse of cocaine has a high correlation with suicide. In those who use cocaine, the risk is greatest during the withdrawal phase.

Psychosis

Main article: Stimulant psychosis

Cocaine has a similar potential to induce temporary psychosis with more than half of cocaine abusers reporting at least some psychotic symptoms at some point.

Typical symptoms of sufferers include paranoid delusions that they are being followed and that their drug use is being watched accompanied by hallucinations that support the delusional beliefs. Delusional parasitosis with formication ("cocaine bugs") is also a fairly common symptom.

Cocaine-induced psychosis shows sensitization toward the psychotic effects of the drug. This means that psychosis becomes more severe with repeated intermittent use.

Dangerous interactions

Warning: Many psychoactive substances that are reasonably safe to use on their own can suddenly become dangerous and even life-threatening when combined with certain other substances. The following list provides some known dangerous interactions (although it is not guaranteed to include all of them).

Always conduct independent research (e.g. Google, DuckDuckGo, PubMed) to ensure that a combination of two or more substances is safe to consume. Some of the listed interactions have been sourced from TripSit.

• Mushrooms - Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences.
• LSD - Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences.
• DMT - Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences.
• Mescaline - The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops.
• 2C-x - The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics. A combination of the stimulating effects may be uncomfortable.
• Cannabis - Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences.
• Ketamine - No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill-advised due to the risk of physical injury.
• MXE - Stimulants taken with MXE can lead to hypermanic states much more easily, especially if sleep is avoided.
• Amphetamines - This combination of stimulants will increase strain on the heart. It is not generally worth it as cocaine has a mild blocking effect on dopamine releasers like amphetamine.
• MDMA - Cocaine blocks some of the desirable effects of MDMA while increasing the risk of a heart attack.
• Caffeine - Both stimulants, risk of tachycardia, hypertension, and in extreme cases heart failure.
• GHB - Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the sedative may overcome the patient and cause respiratory arrest. Likewise the G can wear off and leave a dangerous concentration of cocaine behind.
• GBL - Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the sedative may overcome the patient and cause respiratory arrest. Likewise the G can wear off and leave a dangerous concentration of cocaine behind.
• DOx - The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of cocaine can easily lead to thought loops. Coming down from cocaine while the DOx is still active can be quite anxiogenic.
• 25x-NBOMe - Cocaine and NBOMes both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.
• 2C-T-x - Cocaine and 2C-T-x both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.
• 5-MeO-xxT - The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.
• DXM - Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues.
• PCP - This combination can easily lead to hypermanic states.
• Alcohol - Drinking while using stimulants is risky because the sedative effects of alcohol are reduced. These are what the body uses to gauge “drunkenness”. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel alcohol less. Cocaine is potentiated somewhat by alcohol because of the formation of cocaethylene.
• ΑMT
• Opioids - Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.
• Tramadol - Tramadol and stimulants both increase the risk of seizures.
• MAOIs - This combination is poorly explored.

Legal status

• Australia: Cocaine is a Schedule 8 (controlled) drug permitting some medical use, but is otherwise outlawed. Personal quantities under 1.5 grams are decriminalized in the Australian Capital Territory (ACT) as of 28 October 2023.
• Austria: Cocaine is illegal to possess, produce and sell under the SMG (Suchtmittelgesetz Österreich).
• Bolivia: Limited cultivation of coca is legal in Bolivia, where chewing the leaves and drinking coca tea are considered cultural practices, in particular, in the mountainous regions. Processed cocaine is illegal.
• Brazil: Personal use of cocaine is decriminalized although public consumption is considered a crime. It is illegal to cultivate, transport and sell.
• Canada: Cocaine is a Schedule I drug under the Controlled Drugs and Substances Act of Canada.
• Colombia: Even though possession of less than 1 gram of cocaine was legalized for personal use in 1994 by the supreme court, sale and possession are now illegal under the new nationwide police code.
• Germany: Cocaine was listed in the initial version of the Opiumgesetz (Opium Act) of December 10, 1929. In accordance to the Narcotics Act reform of 1981, it is controlled under Anlage III BtMG (Narcotics Act, Schedule III). It can only be prescribed on a narcotic prescription form. If owned illegaly, a quantity of up to 5 grams is regarded as a small amount. In these cases, the prosecution can cease the proceeding.
• Hong Kong: Use and possession of cocaine is illegal unless a license was issued by the Department of Health.
• India: Use and possession of cocaine is illegal with a mandatory 10-year sentence.
• Lithuania: Cocaine is a schedule I substance. Possession, production, and trade are not allowed.
• Mexico: As of August 25, 2009, the Mexican legislature officially legalized small doses of cocaine, heroin, marijuana, crystal meth, and ecstasy for personal use. No action will be taken for those carrying up to half a gram of cocaine.
• The Netherlands: Cocaine is considered an illegal hard drug. Possession, production, and trade are not allowed as stated in the Opium Law of 1928. Although technically illegal, possession of less than half a gram usually goes unpunished.
• New Zealand: Cocaine is a Class A drug. The coca leaf and preparations of cocaine containing no more than 0.1% cocaine base, in such a way that the cocaine cannot be recovered, are both classified as Class C.
• Nigeria: It is a crime to be seen with cocaine.
• Pakistan: Use and possession of cocaine is illegal.
• Peru: Cultivation of coca plants is legal and coca leaves are sold openly on markets. Similarly to Bolivia, chewing leaves and drinking coca tea belong to cultural practices. Possession of up to 2 grams of cocaine or up to 5 grams of cocaine basic paste is legal for personal use in Peru per Article 299 of Peruvian Penal Code. However, the reality of how police treats it might be very different. An important part of Article 299 is that person may not possess two or more kinds of drugs at the same time -- this would make it a criminal offense.
• Poland: Cocaine is listed in "Wykaz środków odurzających i substancji psychotropowych" group "I-N". Use and possession of cocaine is illegal.
• Portugal: Personal use of cocaine is decriminalized. Drug abuse is dealt with by administrative and medical intervention. Trafficking is illegal.
• Saudi Arabia: Use and possession of cocaine is punishable by death.
• Singapore: Possession of more than 30 grams of cocaine results in a mandatory death sentence, but can be issued by the Department of Health.
• South Africa: Cocaine is a controlled substance.
• Switzerland: Cocaine is a controlled substance specifically named under Verzeichnis A.
• United Kingdom: Cocaine is a Class A drug, controlled by the Misuse of Drugs Act 1971. However, medical use by doctors for controlling pain is permitted.
• United States: Cocaine is classified as a Schedule II Narcotic under the Controlled Substances Act of the United States.

Research

A single low dose of cocaine caused structural brain damage in mice, even without noticeable behavioral or metabolic changes. Cocaine increases dopamine, norepinephrine, and serotonin in the rat brain by blocking their reuptake, potentially causing neurotoxicity through free radical formation and excessive glutamate activity. However, repeated cocaine use in rats also raises levels of taurine, a neuroprotective amino acid that helps counteract this excitotoxicity. This suggests the rat brain has a self-protective response, and taurine or its derivatives could help manage cocaine’s harmful effects.

See also

• Responsible use
• Stimulants
• Tropanes
• Dichloropane (RTI-111)
• Amphetamine

External links

• Cocaine (Wikipedia)
• Cocaine (Erowid Vault)
• Cocaine (Isomer Design)
• Cocaine (DrugBank)
• Cocaine (Drugs.com)
• Cocaine (Drugs-Forum)