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Cocaine is a psychoactive (mind- altering) drug that affects how we think and behave. It is a stimulant that speeds up our breathing, heart rate, thoughts and actions.
Cocaine is processed from the leaves of the coca bush, which is native to South America. Today most cocaine comes from unregulated growing and refining operations. The drug is available in three main forms.
Cocaine hydrochloride salt is a fine white powder that is often mixed with similar-looking substances such as cornstarch and then rubbed into the gums, snorted (e.g., sniffed through a straw) or dissolved in water and injected.
Freebase cocaine is a smokable substance that is created when hydrochloride salt is removed through heating and an alkaline solution is added.
Crack cocaine is a type of freebase that comes in chunks or rocks and can be heated and vaporized for smoking, or dissolved in water and ascorbic acid and then injected.
Aboriginal people in South America have been chewing coca leaves for centuries for various reasons including increased physical stamina and reduced appetite. In the mid-19th century, cocaine was isolated from the coca leaf and manufactured as a local anaesthetic and as a tonic in medicines and beverages. While no longer prescribed today, some people continue to use the drug to feel more confident and outgoing and to help them focus. Others use it to cope with life pressures or a problem such as anxiety or depression. But like any drug, cocaine can be harmful.
Many people choose not to use cocaine or to use the drug in moderation, because being less in control of their behaviour increases the likelihood of making unwise choices such as spending too much money or having unsafe sex. (About 11% of BC residents have tried cocaine but in certain populations, such as urban club-goers, use is more common.) Using cocaine may help us feel more outgoing at a party, but repeatedly using the drug to address social anxiety may lead to harms to our health or relationships.
When cocaine is snorted, it is absorbed into the bloodstream through membranes in the nose, and when smoked, it is absorbed across the linings in the lungs. When cocaine is injected, it goes directly into the bloodstream.
Once in the bloodstream, cocaine travels to the brain where it triggers an increase in naturally occurring chemicals associated with pleasure. We may experience intense pleasure and even exhilaration, but we also may feel anxious or restless. Some of the factors that can influence how cocaine will affect us include our
past experiences with the drug,
present mood and surroundings, and
mental and physical health condition.
Impact on well-being
When we think about cocaine, we may not always remember that it was once used as a treatment for various mental and physical health conditions and was a common additive in Coca Cola and other everyday products. This may be because of the potential for harms involved in using the drug. Small amounts of cocaine can make us feel energetic and more confident when socializing. But using more than moderate amounts may lead to agitation and irritability or overdose. And purchasing any drug in an unregulated market is always risky because we can never know for sure what we are using or buying.
Frequent use of cocaine may lead to temporary psychotic symptoms such as feeling suspicious of others or hearing things that aren’t there. Over time, people who snort cocaine can suffer from chapped nostrils, and the nasal septum separating them can get damaged. Ongoing use also increases our risk of heart problems. A woman who uses the drug when pregnant may give birth prematurely, or the baby may have a low birth weight. Sharing drug-use equipment is associated with infections and blood-borne diseases that may lead to problems of the heart, lungs and liver.
Signs of overdose
Using cocaine involves a risk of overdose. How much and how often we use it affects our degree of risk. And since it is not possible to know the purity and content of the drug, we can accidentally use too much. Cocaine causes the heart to beat faster and blood pressure to rise. Signs of overdose include:
fast or no pulse
fast or no breathing
hot, sweaty skin
If someone you know overdoses on cocaine, call 911 right away. Remain with the person. If the person is conscious, try to walk them around or keep them awake. If the person is unconscious, roll them onto their side into the recovery position so they won't choke if they throw up.
Raise the person's closest arm above their head. Prepare the person to roll toward you.
Gently roll the person's entire body toward you. Guard their head while you roll them.
Tilt the person's head to keep their airway open. Tuck their nearest hand under their cheek to help keep their head tilted.
19.2% of people in BC reported using cocaine in their lifetime (2017)
2.2% of British Columbians used cocaine at least once during the past year
More people use cocaine than amphetamine, ecstasy, heroin and inhalants.
When is using cocaine a problem?
Using cocaine is a problem when it negatively affects our life or the lives of others. Many of us may think this refers only to people who regularly use large amounts, but even a single occasion of use can lead to a problem. For instance, if we share pipes, straws or needles, we are at risk of infection. Or using too much might lead us to make poor decisions that result in problems with relationships or the law. What’s important to recognize is the potential for adverse consequences of use in any context and over time.
One consequence that can develop is tolerance. This happens when it takes more of the drug to achieve the positive effects. If we regularly use large amounts of cocaine, we are at risk of dependence. This means feeling like we need the drug to function and feel normal.
The reasons people use cocaine influence their risk of developing problems. For instance, if a person uses cocaine out of curiosity, only occasional social use may follow. But when a person uses cocaine to cope with a long-term problem such as social anxiety, then more long lasting and intense use may follow.
People who develop a dependence on cocaine may experience signs of withdrawal, including tiredness, disturbed sleep, anxiety, depression, and a craving to use the drug again.
Mixing cocaine with other substances
People sometimes mix cocaine with other substances to experience different feelings or to offset the effects. For instance, a person may use a sleeping pill to help them relax and rest after using cocaine. But combining substances is risky as they can act in unexpected ways. The following are some common combinations and possible results.
Alcohol and other depressants
These are substances that slow down our heart and make us feel more relaxed. Combining cocaine with alcohol or other depressants (e.g., heroin, sleeping pills) puts us at risk of overdose.
These are substances such as methamphetamine that increase our heart rate and blood pressure. Since cocaine is itself a stimulant, using it with other drugs in the same category can intensify these effects and increase our chance of experiencing problems such as chest pain, irregular heart rate or overdose.
If combined with cannabis, the effects of cocaine may increase. This may lessen our control over our behaviour, increasing the chances we may take risks that result in problems.
When prescription or over-the-counter medications are used with cocaine, there is the potential for side effects or for the medicinal benefits to cancel out. Taking the time to read medication labels or consulting with a healthcare professional can reduce these risks.
How to make healthier choices about cocaine
Some of the risks of using cocaine are related to how we use it. For example, sharing equipment such as needles or pipes can lead to infection and transmission of disease. The following are some other useful guidelines to follow.
Not too much. Managing the amount we use in a given period can help to decrease risky behaviours and reduce chance of overdose.
Tip: Buy less so you use less, and set a limit on how much you will use at one time.
Not too often. Limiting how often we use helps reduce harms to ourselves and others over time.
Tip: Reflect on your pattern of use and identify the situations in which you are likely to use. And then try to break the pattern by consciously planning other activities for those situations.
Only in safe contexts. Trusting and feeling safe in your surroundings can make injecting or smoking easier and therefore safer.
Tip: Use with a buddy. Using alone means no one will be there to help you if you overdose.
Cocaine is a controlled substance in Canada. It is illegal to produce, sell, import, export or use the drug. Under current laws, offenders may receive a fine, a prison term and a criminal record that could affect their future employment, travel plans and educational opportunities.
If injecting, wash your hands, rotate your injection site but avoid the neck, clean the injection site, use clean needles and never share them.
If smoking, wash your hands, start with a small amount, use a shatterproof pyrex pipe and your own mouthpiece, inhale slowly and exhale immediately.
If snorting, avoid sharing straws and rinse the inside of your nose with water before and after to help reduce irritation.
To better understand how substances play a role in your life, visit the You and Substance Use Workbook on the Here to Help website: www.heretohelp.bc.ca. The website also features detailed information on substance use and mental health.
You can also find information about a wide variety of substance use issues on the Canadian Institute for Substance Use Research website: www.cisur.ca.
For information on treatment options and resources throughout BC, call the Alcohol and Drug Information and Referral Service at 1-800-663-1441. In Greater Vancouver, call 604-660-9382.
About the author
The Canadian Institute for Substance Use Research, formerly CARBC, is a member of the BC Partners for Mental Health and Substance Use Information. The institute is dedicated to the study of substance use in support of community-wide efforts aimed at providing all people with access to healthier lives, whether using substances or not. For more, visit www.cisur.ca.