Cocaine is a powerful stimulant derived from the leaves of the coca plant. This substance is both a powerful painkiller, so it can be used as an anesthetic, and an intense stimulant. The leaves of this plant have been chewed by native populations to take advantage of their stimulant properties for millennia, but the Western world did not begin to use cocaine until the 1900s.
Originally, this substance was a legal medicine, even included in the original formulas of Coca-Cola. However, the drug has become more and more restricted by the Drug Enforcement Administration, as scientists began to discover more about cocaine’s addictive properties and how it can change brain structure. However, because there are still potential medicinal uses for cocaine (for example, as a local anesthetic), the DEA classifies the substance as Schedule II.
How Cocaine Addiction Leads to Overdose
Although there are some rare, legitimate medical uses for cocaine, for the most part, this drug is used as an illegal intoxicant. This powerful stimulant affects the brain’s reward system, which is tied to emotional wellbeing and motivation. Typically, when a person does something successfully, such as completing a workout or eating enough calories, the brain’s reward system will release dopamine, which makes the person feel good. This encourages the individual to continue performing these activities. However, intoxicating and addictive substances like cocaine can also trigger the release of dopamine, and block this “happy” neurotransmitter from being removed by the synapses. The brain then floods with dopamine, creating a feeling of excitement.
Pure cocaine is most often found as a white powder, while crack cocaine is found in whitish or brownish, solid chunks. Cocaine powder is most typically snorted, while crack is melted into water and injected intravenously. The euphoria from powdered cocaine lasts 15-30 minutes, while the high from crack cocaine typically lasts five minutes.
The flood of dopamine in the brain can cause some people to become addicted to cocaine, because they crave that feeling of excitement and stimulation. Over time, abusing cocaine can change some of the brain structures associated with the reward system, so the individual will begin to develop a tolerance to the original dose of cocaine. When the drug does not create the same euphoria at the original dose, many people will take larger doses or begin to mix the substance with drugs that can enhance cocaine’s effects. This can lead to an overdose.
Cocaine Overdose Symptoms and Long-term Effects
Cocaine’s intensity can create a feedback loop of euphoria for the person taking it, leading to a cocaine binge. This can also occur in people who have developed a tolerance to cocaine and want to re-create the euphoria they felt during their first experience with the intoxicating substance. A cocaine binge involves taking multiple doses, or increasingly larger doses, over a short period of time to induce an intense high. This can lead to hallucinations, extreme paranoia, aggression, irritability, and, sometimes, full-blown psychosis. The individual can rapidly lose touch with reality. There are several physical side effects from a cocaine binge, including cardiovascular and brain damage.
Unlike opioid drugs, there are no prescription medicines that can counteract a cocaine overdose. Even when a person receives immediate medical treatment for the overdose, they may still experience long-term side effects, including heart arrhythmias, a loss of gray matter in the brain, the need for dialysis, damage to the nasal cavity or veins from the method of ingesting, or a respiratory condition that is unique to people suffering from cocaine addiction.
Helping Someone Who Is Overdosing on Cocaine
The only way to help a person suffering a cocaine overdose is to call 911, so they can get emergency medical treatment as soon as possible. There are no drugs that reverse the effects of a cocaine overdose or stop the overdose.
While waiting for EMS to arrive, there are a few things you can do:
- Wait with the person to make sure they stay safe. If they are conscious, make sure they do not wander away, and if they are unconscious, monitor their breathing.
- If the person is unconscious, check their pulse.
- If possible, find out how much cocaine the individual ingested and via what method.
It is important to avoid being physically harmed by someone who is suffering from a cocaine overdose, since the person can become psychotic, hallucinate, or become violent. When a person is suffering a cocaine overdose:
- Do not physically involve yourself with someone who is conscious and lashing out, or acting angry or violent.
- Do not attempt to reason with the person if they are hallucinating or psychotic, because they can lash out at people around them.
- Do not allow the person to ingest more intoxicating substances, whether it is cocaine, alcohol, or other drugs.
- Do not force the person to drink water or coffee to “sober up,” because they could choke.
Once the person is receiving emergency medical care, EMTs will administer oxygen to help the individual breathe and make sure their airway is clear. They will also make sure the individual can support intravenous fluids, because one of the dangerous side effects of injecting intoxicating substances is that the person’s veins can collapse. The person may receive benzodiazepines to prevent seizures.
Once the individual is in the hospital, emergency room doctors will:
- Monitor the person’s pulse and breathing.
- Lower the person’s temperature if they are hyperthermic.
- Remove residual cocaine if present.
- Stabilize blood sugar, which can help reduce psychiatric symptoms.
- Treat any stroke or heart attack that has occurred.
- Monitor the individual until cocaine leaves their system, since the drug’s effects are typically short-lived.
None of these medical treatments should be performed by people who are not medical professionals, unless the 911 operator talks the caller through some minor treatments like rescue breathing or hyperthermia treatments, while the person waits for emergency medical services to arrive.
Get Help for Cocaine Abuse
Overall, the trend of cocaine and crack cocaine use in the US is declining. The Centers for Disease Control reports that, although the number of people who reported abusing cocaine or crack cocaine increased between 1991 and 1999, that number began to decrease from 1999 to 2015. Still, about 913,000 Americans met the criteria for abuse of, or dependence on, cocaine, as defined by the Diagnostic and Statistical Manual of Mental Disorders, in 2014.
Overall use of cocaine or crack cocaine may be declining, but emergency department reports of cocaine overdoses are still very high. Nearly 1.3 million ED visits in 2011, per the DAWN Report, were caused in some capacity by cocaine – that was about 40 percent of drug-related emergency room visits that year.
Still, cocaine abuse and addiction are very problematic in the United States. It is important to get immediate help for people experiencing a cocaine overdose, which starts with calling 911 to get emergency medical attention. When the person leaves the hospital, encourage them to enroll in a comprehensive rehabilitation program, so they can overcome their addiction and embrace a healthier life before another overdose occurs.