Although the Drug Enforcement Administration (DEA) lists cocaine as a Schedule II drug – it has some medical use as a very localized numbing agent in ear, nose, and throat surgeries – the potent stimulant is more famous as a highly addictive drug. Beginning in the 1970s, powdered cocaine rose to popularity as a substance of abuse in nightclubs. By the 1980s, the invention of the cheaper, more potent, and more addictive crack cocaine led to an epidemic of underprivileged individuals struggling with addiction.
The drug is abused in several ways – notably, snorting the powder, smoking either the powdered version or crack rocks, or mixing the drug with water and injecting it intravenously. Cocaine is rarely eaten because the stimulation occurs much faster when it is ingested through other means. Any method of abusing cocaine causes severe side effects, including cardiovascular damage, increased risk of heart attack or stroke, high body temperature, kidney damage, depression, increased risk of triggered psychosis, and much more. While all cocaine use is dangerous and leads to potential addiction, some methods have more specific dangers than others.
The most famous method of abusing cocaine involves snorting the white powdered version. Consistent abuse damages the heart and brain, but it can also damage the lungs, stomach, and intestines as small amounts are swallowed or inhaled.
Signs that a person is snorting cocaine include frequent runny noses or nosebleeds, a hoarse voice, intense energy, shortened attention span, and suddenly triggered depression, anxiety, or aggression.
Immediate effects of snorting cocaine include a stuffy nose or nosebleed. These are signs that the mucous membranes in the nose, sinuses, throat, and upper lungs are being harmed. Continued abuse of cocaine by snorting leads to septal perforation; a hole forms in the tissues and cartilage separating the nostrils, which is called the septum. This perforation will grow over time, especially if cocaine abuse does not stop. Once the cartilage has been worn away, the nose may collapse.
Ongoing cocaine abuse can also cause a perforation in the upper palate, or the bone and tissue separating the mouth and nose. Like the septum, the soft tissue over this bone will lose blood flow from cocaine abuse and degrade until the bone is exposed. The bone then suffers damage and can develop holes.
Freebase cocaine, or crack cocaine, is believed to be more addictive than powdered cocaine. This is because smoking the drug forces it to be absorbed more quickly, so the stimulation hits the brain faster. The high wears off faster than with snorting, too, so a person who smokes cocaine may be more likely to begin bingeing the drug; this can lead to an overdose.
People who smoke crack cocaine will experience intense bursts of energy, develop physical tremors, and have a cough or hoarse voice.
Crack lung is the colloquial term for respiratory damage done by smoking cocaine. Powdered cocaine may lace a cigarette or joint, but more often, people smoke the freebase form of the drug by itself. Lung irritation can lead to a chronic cough and harm the immune system; people who smoke crack cocaine are at greater risk for contracting lung diseases like tuberculosis and pneumonia, which are rare in people with healthy immune systems.
A person who smokes crack cocaine may also develop permanent lung damage or lung cancer.
People who inject drugs intravenously or intramuscularly are more likely to damage their skin, develop blood clots, and contract infections – bacterial infections at the injection site or viral infections like HIV or hepatitis C from sharing needles. While injecting cocaine is rare, some people may take the risks associated with this form of drug use because it is the fastest way for cocaine to affect the brain.
People who inject cocaine are more likely to seek out the intense high and relaxation of a speedball – a combination of cocaine and heroin. The opioid heroin is typically injected, so mixing cocaine into heroin may appeal to people who use heroin but do not want to fall asleep or unconscious after injecting it.
Cocaine is cut with numerous additives, from baking soda to fentanyl. People who purchase powdered cocaine may not want their drugs mixed with other substances, but these substances – even those which are inert, like flour – can cause serious problems in the blood when they are injected. Additives increase the risk of blood clots and embolism. If a blood clot makes its way to the heart or brain, it can lead to death.