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5 Cocaine Side Effects + Overdose Signs

Written by Joe Cohen, BS | Last updated:
Evguenia Alechine
Jonathan Ritter
Medically reviewed by
Evguenia Alechine, PhD (Biochemistry), Jonathan Ritter, PharmD, PhD (Pharmacology) | Written by Joe Cohen, BS | Last updated:

Cocaine is a dangerous drug that creates intense feelings of euphoria, happiness, and alertness. It has gained infamy over the years due to its association with popular culture and celebrity abuse. Read on to discover some unlikely medical history and learn more about the dangerous effects of cocaine.

What is Cocaine?

Cocaine (benzoylmethylecgonine) is a well-known illegal stimulant widely used all over the world [1, 2].

Because of its highly dangerous, addictive nature and illegal status, we strongly recommend against using cocaine in any amount and for any reason. This post was written for informational purposes only.

The Origins

Cocaine is derived from the leaves of the coca plant (Erythroxylon coca) [3, 4].

In spite of its recent notoriety, cocaine has a documented history of use by the Amara Indians of Peru. This tribe has made use of cocaine for thousands of years by chewing the leaves of the coca plant [5].

This kind of use has fewer adverse effects, presumably due to the low concentration of the active component in the leaves and the laborious act of extracting cocaine by chewing the leaves [5].

Cocaine is the active principle from the leaves of the coca plant. Native Americans have been using it for thousands of years by chewing the leaves.

Modern Use and Abuse

However, everything changed in 1859 when German chemist Albert Niemann purified cocaine [6].

Around the end of 1884, cocaine started gaining publicity and scientific interest. Sigmund Freud praised the drug in his famous Cocaine Papers describing its therapeutic properties in relieving depression and anxiety [7].

Following Freud’s publications, Carl Koller discovered the anesthetic properties of cocaine on the human eye. Purified cocaine became commercially available when Merck started refining and producing it [8, 5].

Without regulatory restrictions, cocaine was initially sold as a therapeutic and consumable product. However, the Harrison Narcotics Act of 1914 in the US banned the distribution of cocaine due to its widespread abuse and addiction [6, 9].

Despite regulatory restrictions, the drug is still sold and used illegally around the world. According to a United Nations report, around 18.3 million people used cocaine in 2014 [10].

Pure cocaine is a white crystal powder that can be snorted, smoked, or injected. It’s called “crack” when smoked (freebase form); street names include coke, flake, snow, and powder [11].

Purified cocaine gained popularity and scientific interest in the late 19th century, only to be banned as a narcotic in 1914. It’s still being used illegally around the globe.

How It Works

Cocaine is highly addictive and produces a feeling of euphoria by causing a buildup of dopamine in the brain’s pleasure center (the limbic system) [12].

Independent of the route of administration, cocaine is rapidly absorbed into the bloodstream and reaches the brain to initiate its psychostimulant effects [6, 12].

Once in the brain, cocaine blocks the reuptake of the neurotransmitters dopamine, noradrenaline, serotonin, and acetylcholine by presynaptic neurons, which boosts their effects [6, 13, 14].

More specifically, cocaine blocks the dopamine transporter SLC6A3, which causes a buildup of dopamine and an overactivation of dopamine neurons [12].

Dopamine reinforces the addictive behaviors in the limbic “pleasure” or “reward” center of the brain (mesolimbic and mesocortical dopaminergic systems) [15, 16].

Psychoactive changes caused by high dopamine can lead to uncontrolled writhing movements, known as “crack dancing” [17, 18].

The sustained effects of the leftover neurotransmitters can cause narrowing of blood vessels, leading to heart complications [19, 20].

Cocaine is a stimulant that works by increasing the levels of dopamine, serotonin, and noradrenaline. This can cause many side effects and lead to addiction.

Short-Term Effects Of Cocaine

Cocaine’s appealing short-term psychoactive effects (intense high) include [21, 22]:

  • Euphoria
  • Increased energy, alertness, or sociability
  • Inflated self-esteem
  • Decreased fatigue

5 Side Effects & Dangers Of Cocaine

Cocaine is a powerful drug that has both short and long-term effects. Studies of both humans and animals have shown that cocaine use can damage the heart, brain, liver, kidneys, gut, and blood vessels [23, 24, 25, 26, 27, 28, 29, 30, 31, 32].

Also, if snorted, cocaine can damage nostril tissues and if smoked, the lungs [33, 34, 35].

Mechanism of Damage

Cocaine increases addictive behavior by impairing dopamine transmission in the brain (nucleus accumbens and dorsal striatum), creating cravings in addicts [36, 37].

Mitochondria are the energy generators of the cell. As shown by cell-based studies, cocaine can accumulate inside the cell and damage the functional and structural integrity of mitochondria, disrupting cellular energy production and resulting in cell death [38].

Animal studies further showed that cocaine could produce oxidative stress in cells and alter mitochondrial DNA [39].

In the heart, this oxidative stress leads to toxicity and cell death, as observed in human cocaine overdose [40].

Cocaine causes addiction and side effects by impairing dopamine signaling in the brain. It also damages the mitochondria and increases oxidative stress.

1) Psychological Disorders

Cocaine can significantly impact the user’s mood and psychological state. Cocaine users have reported a wide range of adverse psychological effects including anxiety, depression, mood swings, paranoia, and panic attacks [41].

Chronic cocaine use can cause symptoms of delirium and aggression [42].

Observational research has shown that cocaine users are significantly more likely to develop depression and psychosis [43, 44].

Although rare, higher doses can cause hallucinations or false sensory perceptions [45].

Abstinence from cocaine use can create withdrawal symptoms like mood disturbances and cravings [46].

Cocaine can cause an array of psychological disorders such as depression, anxiety, paranoia, and aggression. Abstinence leads to mood disturbance and cravings.

2) Sleep Disorders

Cocaine can impair wakefulness and sleep cycles due to chemical changes in the brain [47].

In animal studies, cocaine disrupted normal sleep patterns [48].

More specifically, cocaine can lead to a reduction in REM (rapid eye movement) sleep, which has been associated with depression [49].

Cocaine use impairs the normal sleep cycle, while dependence causes profound sleep problems. Abstinence will produce insomnia and decreased sleep in cocaine addicts [50, 51].

Consequently, sleep disturbances and insomnia can cause depression and even lead to suicide [52].

Cocaine use can cause sleep disorders, thus increasing the risk of depression and suicidal thoughts.

3) Cognitive Impairment

Long-term cocaine use can negatively impact cognitive functions. A preliminary study showed brain impairment in 20 heavy cocaine abusers [53].

Cocaine users have decreased short-term memory, attention, and concept formation compared to non-users [54, 55].

Magnetic resonance imaging (MRI) studies have shown that cocaine decreases the activity in many regions of the brain [22].

It reduced memory and learning performance, and these effects lasted for up to 4 weeks of abstinence in 56 chronic cocaine users [56].

Long-term use of cocaine harms the brain and impairs memory, attention, and cognitive skills.

4) Respiratory Complications

Smoking “crack” (freebase cocaine) can result in pulmonary complications including asthma, injuries, difficulty breathing, wheezing, inflammation, and bleeding of the lungs [57, 58].

The acute respiratory symptoms of smoking cocaine include coughing with sputum, chest pain, shortness of breath, coughing of blood (hemoptysis), and worsening of asthmatic symptoms [58].

Prolonged exposure to cocaine can lead to obstructive pulmonary disease and fever. Other reports indicate that inhalation of (freebase) cocaine could directly damage the pulmonary gas exchange surface [59, 60].

Smoking “crack” cocaine can lead to various respiratory problems, including asthma, lung injuries, shortness of breath, chest pain, and bleeding.

5) Heart Complications

Cocaine causes short-term physical effects such as increased blood pressure, constricted blood vessels, and increased heart rate. By increasing heart rate and blood pressure, cocaine increases the heart’s oxygen demand [39, 61, 62].

A combination of these effects can damage the blood vessels [63].

Cocaine use is also associated with hypertension, irregular heart rates, reduced blood flow to the heart, heart attacks, and sudden heart death. The risk of an acute heart attack is increased 24 times after cocaine use in relatively low-risk individuals [64, 65, 66].

An autopsy performed on 40 subjects who were positive for cocaine revealed that cocaine use leads to inflammation and damage to the heart muscle [67].

Cocaine use increases the risk of heart disease by impairing blood pressure, heart rate, and heart blood flow. It also raises inflammation and damages the heart.

Signs of Cocaine Use

Warning signs of chronic cocaine use include:

  • Redness or inflammation of the eyes [68]
  • Dilated pupils [69]
  • Runny or bleeding nose with swollen, inflamed mucosa [70]
  • Difficulties standing or sitting [69]
  • Behavioral changes like repetition and ritualistic behaviors [71]
  • Emotional changes [72]
  • Incoherent speech [69]

Overdose Symptoms

Consumption of high doses of cocaine can result in overdose or poisoning. The symptoms of cocaine overdose include [73]:

  • Psychosis, agitation, or delirium
  • Seizures or stroke
  • Convulsions
  • Heart problems (irregular heart rate and increased blood pressure)
  • Respiratory problems
  • High body temperature

If you suspect that you or someone you know has overdosed on cocaine, call 911 (or your local emergency helpline) and seek medical attention immediately.

Harm Reduction?

The depletion of dopamine in cocaine users leads to depression, decreased cognitive function, and fatigue. Administration of L-tyrosine may be used to increase dopamine concentrations in the brains of people in cocaine withdrawal (L-tyrosine>Dopa>Dopamine) [74].

Tyrosine can come from nutritional supplements or food sources such as chicken, turkey, soy products, or fish [75].

However, increasing tyrosine may potentially mitigate only a fraction of cocaine adverse effects, and it doesn’t make cocaine use any safer [76].

Many people require medical supervision to successfully overcome cocaine addiction.

Cocaine overdose is a dangerous, potentially life-threatening condition. L-tyrosine may mitigate a fraction of cocaine side effects, but it doesn’t make it any safer.

Treatment Of Addiction: Cognitive-Behavioral Approach

There are many different strategies or treatments for cocaine addiction. One approach is through cognitive-behavioral therapy (CBT). CBT utilizes several important tasks to combat cocaine addiction, including [77, 78]:

  • Maintaining motivation to abstain from drug use by emphasizing the gains/losses through drug use [79]
  • Teaching effective coping skills [80]
  • Identifying and reducing habits associated with drug use [77]
  • Fostering management and tolerance of withdrawal effects such as depression or anger [81]
  • Building and using effective social support and environment to decrease the risks of addiction [82]
Cognitive-behavioral therapy can reduce cocaine addiction by helping people gain motivation, coping skills, social support, and healthy habits.

Medical Uses Of Cocaine

Cocaine itself is no longer used by medical professionals, and coca leaves are illegal in many countries unless they are decocainized first. We therefore strongly recommend against

That said, cocaine does have a history of medical use, and decocainized coca leaves may have some benefits.

Coca Leaves

Besides cocaine, coca leaves contain essential nutrients such as vitamins and minerals and have many health benefits [4].

Chewing coca leaves can help with digestive issues, stress, hunger, and altitude sickness through brain stimulation and mood-elevating properties [83, 84].

Coca leaves also raises the body’s blood glucose level above fasting levels, which can decrease the feeling of hunger [85, 83].

However, refined cocaine is a very powerful stimulant that has a limited number of health benefits. These health benefits do NOT counteract the addictiveness and side effects of cocaine.

Coca leaves contain essential nutrients and a bit of cocaine; they can combat indigestion and improve mood. This doesn’t go for highly addictive pure cocaine.

Topical Anesthesia

Cocaine has numbing properties, and it was originally used in medicine as an anesthetic for surgical practices [86].

When combined with other compounds (tetracaine and adrenaline), it has been used as a topical anesthetic for minor facial and scalp lacerations [87].


Pure cocaine gained popularity in the late 19th century, but it was soon prohibited. Millions of people still use it illegally around the globe. Cocaine produces short-term euphoria and alertness by increasing the levels of dopamine, serotonin, and noradrenaline.

Long-term use causes addiction and an array of psychological disorders, sleep disturbances, cognitive problems, and heart complications. Cocaine overdose can cause severe, life-threatening damage to the heart and brain. Cognitive-behavioral therapy can help cocaine addicts build healthier habits and coping skills in a supportive, safe environment.

About the Author

Joe Cohen, BS

Joe Cohen, BS

Joe Cohen flipped the script on conventional and alternative medicine…and it worked. Growing up, he suffered from inflammation, brain fog, fatigue, digestive problems, insomnia, anxiety, and other issues that were poorly understood in traditional healthcare. Frustrated by the lack of good information and tools, Joe decided to embark on a learning journey to decode his DNA and track his biomarkers in search of better health. Through this personalized approach, he discovered his genetic weaknesses and was able to optimize his health 10X better than he ever thought was possible. Based on his own health success, he went on to found SelfDecode, the world’s first direct-to-consumer DNA analyzer & precision health tool that utilizes AI-driven polygenic risk scoring to produce accurate insights and health recommendations. Today, SelfDecode has helped over 100,000 people understand how to get healthier using their DNA and labs.
Joe is a thriving entrepreneur, with a mission of empowering people to take advantage of the precision health revolution and uncover insights from their DNA and biomarkers so that we can all feel great all of the time.


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