The High and Crash of Cocaine

The High and Crash of Cocaine

Cocaine is known for its short and intense “high” or rush of euphoria. Stimulant drugs like cocaine increase the functions of the central nervous system, including heart rate, blood pressure, respiration, and body temperature. It makes a person feel energized, alert, focused, talkative, excited, and happy. Individuals under the influence of cocaine will not feel the need to sleep or eat. Dopamine, one of the brain’s neurotransmitters, floods the brain, creating a surge of pleasure. Generally, a cocaine “crash” follows the high, occurring as the drug leaves the system. Individuals may be extremely fatigued, lethargic, depressed, and both mentally and physically exhausted during the crash, often sleeping more than normal.

Cocaine’s rapid onset and short duration of action make the drug a target for binge use, which means that individuals may take multiple doses of the drug back-to-back to try and extend the cocaine high. Excessive and regular cocaine use may cause negative side effects when intoxicated instead of the pleasant and intense high. These side effects may include psychosis, hallucinations, disorientation, tremors, agitation, violent behaviors, restlessness, anxiety, aggression and paranoia. Cocaine may also commonly be mixed with other drugs like heroin (called a “speedball”) or alcohol, which can increase potential side effects and risk factors.

The Drug Abuse Warning Network (DAWN) reported that in 2011, there were over a half- million emergency department (ED) visits related to the abuse of cocaine in the United States. For ED visits related to negative interactions with an illicit drug, cocaine was the number one reported drug in 2011.

Overdose and Excited Delirium

One of the most dangerous side effects of cocaine use is toxic overdose. A cocaine overdose generally causes heart attack, stroke, or dangerously low respiration levels, and it can be life threatening. The National Institute on Drug Abuse (NIDA) reports that more than 5,000 people died from a cocaine overdose in America in 2014.

Cocaine speeds up heart and breathing rates, and elevates blood pressure and body temperature. When the body can’t break cocaine down safely, cardiovascular complications arise. Combining cocaine with other drugs may increase the risk for an overdose as well. Per NHTSA, cocaine overdose may include the following symptoms:

  • Headache
  • Stomach pain
  • Hostility
  • Irregular heart rate
  • Nausea and vomiting
  • Sweating
  • Dilated pupils
  • Chills
  • Enhanced reflexes
  • Hallucinations
  • Fever
  • Trouble breathing
  • Convulsions
  • Seizures
  • Delirium
  • Confusion
  • Bleeding in the brain
  • Heart failure
  • Stroke
  • Respiratory failure
  • Loss of consciousness

Another potential short-term side effect of cocaine abuse that can be fatal is called excited delirium, which is indicated by a dissociative state, fear, shouting, aggression, agitation, violent behaviors, enhanced strength, and hyperthermia. The Western Journal of Emergency Medicine (WestJEM) reports that excited delirium often leads to cardiopulmonary arrest and even death. Cocaine overdose and excited delirium are considered to be medical emergencies with potentially fatal outcomes. With proper and swift medical intervention, these consequences may be potentially reversed. If an overdose is suspected, get immediate professional help.

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Side Effects Related to Specific Methods of Abuse

Cocaine can lead to overdose regardless of the manner in which it was abused; however, different methods of abuse can have a variety of specific side effects as well. For example, ingesting cocaine (which is fairly uncommon) can create problems with the gastrointestinal system and a reduction in blood flow that can even potentially cause bowel gangrene. Snorting cocaine can permanently damage the nasal septum and sinus cavities, and cause chronic nosebleeds, a perpetual runny nose, difficulties swallowing, and hoarseness. Snorting cocaine can irreversibly damage a person’s sense of smell, erode the nasal cavity, and cause respiratory issues. Smoking cocaine can lead to burns on the hands, fingers, and mouth from “crack pipes,” and also cause respiratory distress, chest pain, damage to the lungs causing them to bleed, and a chronic cough.

Individuals who inject cocaine puts themselves at a higher risk for developing a blood-borne infectious disease, such as HIV/AIDS or hepatitis, which may be transmitted from sharing dirty needles. These diseases are not curable, but may be effectively treated and managed. Scars, or “track marks,” may be the result of perpetuated intravenous (IV) drug use. Skin infections and collapsed veins may also be consequences of this method of abuse.

Powdered cocaine is often “cut” with unknown additives. When injected, an allergic reaction, or other negative and unintended reactions to these additives, may occur. Individuals who abuse cocaine may also pick at their skin and develop skin rashes.

Side Effects Related to Specific Methods of Cocaine Abuse

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Long-term Consequences of Cocaine Abuse

Cocaine damages the heart. Long-term use can increase the risk for heart attack, as the American Heart Association reports that regular abuse can cause the heart muscle to thicken, arteries to get stiffer, and blood pressure to be chronically elevated. The DEA further reports that cardiac arrhythmias and ischemic heart conditions may also be side effects of cocaine abuse.

Stokes, seizures, respiratory distress or failure, chest pain, headaches, abdominal upset and nausea, blurred vision, and muscle spasms may be additional consequences of long-term cocaine abuse, Psychology Today publishes. Cocaine constricts blood vessels and may therefore disrupt normal blood flow. Malnutrition and unhealthy weight loss due to the appetite suppression that cocaine incites can also be side effects of regular cocaine abuse. The cessation of cocaine use and introduction of healthy habits may be able to aid in reversing some of these damaging effects.

Cocaine may actually cause the brain to age prematurely and reduce its grey matter volume, especially in the regions related to memory and executive cognitive functions, Psychology Today reports.

Long-term Consequences of Cocaine Abuse

When someone abuses cocaine, levels of dopamine in the brain are elevated, and the neurotransmitter is not reabsorbed at normal rates. This causes an imbalance of brain chemicals. When cocaine leaves the body, dopamine levels drop, which plays a role in creating the feelings of depression and general sense of unhappiness that accompany a cocaine crash. The perpetuated up-and-down pattern established by regular cocaine abuse can cause the brain to stop producing and moving its naturally occurring chemical messengers around the central nervous system properly. A drug dependence has then formed, and an individual may need cocaine in order feel pleasure in everyday activities.

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Dependence and Withdrawal

Many of the side effects of cocaine abuse may heal with prolonged abstinence and proper medical or mental health treatment. A longer duration of abuse can cause more lasting effects that may take longer to recover from. An individual who is more heavily dependent on the drug may take a little longer to recover from its effects, for example.

Some of the effects of cocaine on the brain may linger and may not completely dissipate, although in general, they can be managed through therapies and pharmacological tools. Each individual may recover from cocaine abuse differently and with variable methods, meaning that recovery times may not be identical from person to person. Generally speaking, the earlier a person stops using cocaine and gets appropriate care, the more completely and quickly the side effects may be reversed.

Cocaine Dependence and Withdrawal

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