Cocaine Use and Abuse


Cocaine is an addictive drug that can require treatment at a rehab facility. It is used to increase energy and stay awake. It is one of many herbs, foods, drinks, and drugs that have been used and abused to increase “get up and go.” Cocaine is one of the oldest of these substances.

While the thought of cocaine may bring about images of parties or crack houses, it has actually been used as a stimulant drug for thousands of years. This article will briefly review the history of cocaine, its modern-day use and abuse, misconceptions, and treatment options for addiction.


Cocaine is a substance that is extracted from the Erythroxylon coca bush. This plant is native to western South America and is grown as a cash crop there. The leaves from the coca bush have been used to increase energy, reduce fatigue, and reduce appetite since about 3000 BC. 

Historically, South American natives would chew coca leaves to ingest the drug. The leaves were sometimes used in religious ceremonies or to counteract the effects of living at high altitudes. When the Spanish invaded Peru in 1532, they became acquainted with the effects of coca leaves and used them to keep their Incan slaves under control as they worked in the Spanish silver mines.

Early Medical Use

In 1859, a German chemist named Alfred Niemann was the first to extract cocaine from coca leaves. While not immediately popular in Europe, by the 1880s, the drug was used by the medical community to constrict blood vessels and limit bleeding, particularly during eye, nose, or throat surgeries. Psychoanalyst Sigmund Freud also promoted the use of the drug to treat depression and sexual impotence. Freud was a regular user himself and recommended it to many of his patients.

During the 1880s and 1890s, it was viewed as a “miracle” drug and was added to teas, tonics, elixirs, and the new soft drink Coca-Cola. Famous people of the era, including inventor Thomas Edison and actress Sarah Bernhardt, endorsed its benefits. It remained popular into the 20th century and enjoyed widespread use and promotion by Hollywood’s silent film industry.

Risks Come to Light

By the early 1900s, the adverse effects of cocaine had become more apparent to society. Coca-Cola removed it from its formula in 1903 due to public pressure. Abuse continue to rise, and by 1912, the United States government reported 5,000 cocaine-related deaths that year. In 1914, the United States passed the Harrison Narcotics Act, which made it illegal to sell or use coca and opium products except for medical purposes.

It is still used legally today as a topical anesthetic for mucus membrane surgeries around and in the mouth, nose, and throat. Because of its continued use for medical procedures, cocaine is currently classified as a Schedule II drug under the U.S. Controlled Substance Act.

The Rise of Cocaine Abuse

Until cocaine was banned by the federal government, people freely consumed it in the form of elixirs and tonics. In the early 1900s, people began snorting it, leading to an increase in cases of nasal damage reported by hospitals and in medical journals. After it was made illegal, it dropped in popularity as a recreational drug as the same stimulant effects became available in the 1930s through legal, pharmaceutical amphetamines.

Cocaine Use in the 1970s

Cocaine surged in popularity once again in the 1970s after legislation significantly restricted the availability of amphetamines. It was especially popular among wealthy business people, celebrities, and college students who were attracted by the ability of the drug to increase energy.  It was expensive and was viewed as a “rich man’s drug,” but the street price dropped as it surged in popularity and production.

The Arrival Of Crack

In the 1980s, drug dealers who were looking for more ways to make money began pushing crack cocaine. Crack, given this nickname by the crackling sound it made during processing, was formulated in a way that allowed it to be smoked, giving a shorter, more intense high. This process also made it more addictive. Drugs processed through this method were cheaper to produce and sell. The result was a sharp increase in the use of cocaine, with the number of regular users jumping from 4.2 million to 5.8 million between 1985 and 1989. By the early 1990s, Colombian drug cartels were shipping 500 to 800 tons per year to the United States, Europe, and Asia.

The Effect of the War on Drugs

While the “War on Drugs” of the 1980s and 1990s helped to disband the large cartels, many smaller organizations popped up to replace them. These smaller cartels are still operating in Colombia, the primary source of cocaine production today.

Use of the drug in the United States decreased during the 2000s, reaching a low point in 2012. Between 2012 and 2017, smuggling and new users in the United States rose once again, with 1.6 million new cocaine users reported in 2016 and about 1,100 metric tons exported from Colombia to the United States in 2017.

Street Names

There are many slang terms for cocaine. A few common street names include:

  • Coke
  • Snow
  • Blow
  • Rail
  • Powder
  • Icing
  • Dust
  • Big c
  • Line
  • Toot
  • Bump
  • Nose Candy

Common street names for crack include:

  • Crack
  • Rock Candy
  • Basa
  • Hail
  • Dice
  • Chemical
  • Rock
  • Base
  • Nuggets
  • Sleet
  • Grit
  • Tornado

Current Use and Abuse

In 2018, use in the United States was estimated at about 5.5 million people age 12 and over, including 757,000 people who used crack. The following chart shows the percent of the general population age 12 and older who used cocaine from 2012 to 2018. The chart also shows the percent of users separated by age.

As shown in the chart, overall use shows a slight increase from 2012 to 2017. The rate of use by people age 18 to 25 shows the most significant increase, while use by people age 12 to 17 shows a slight decrease.

How is Cocaine Abused?

People use cocaine by snorting it up the nose, rubbing it on the gums, or smoking crack. Some people mix it with heroin and inject the mixture, which is called a “speedball.” 

Cocaine works by increasing levels of dopamine in the brain, which causes the stimulating effect. Once it has attached to the neuroreceptors that are used by dopamine, the substance also prevents dopamine from being reused and recycled as it normally is, causing the user to take larger and larger doses of cocaine for the same effect. The effects can last anywhere from 10 to 30 minutes, depending on the method of ingestion.

Health Risks

As a stimulant drug, cocaine affects the body by elevating the speed and sensitivity of the body’s systems. Immediately after taking it, a person might experience the following health effects:

Extreme Energy

Mental Alertness



Dilated Pupils

High Blood Pressure

Hypersensitivity to Light, Touch, Sound


Constricted Blood Vessels


Elevated Body Temperature

Tremors or Muscle Spasms

People who use it for a long time can experience more serious health effects. Some of these effects are dependent on the method people use to take cocaine, as follows:


Nosebleeds, frequent runny nose, loss of smell, difficulty swallowing

Oral Intake

Bowel irritation and decay due to restricted blood flow


Coughing, risk of pneumonia and other respiratory infection, asthma, respiratory distress


Scarred or collapsed veins, skin and soft tissue infections, higher risk of contracting HIV or hepatitis C

It is possible to overdose on cocaine. An overdose may occur from taking too much by itself, or by combining it with alcohol or heroin.

Symptoms of cocaine overdose include:

Irregular Heartbeat

Heart Attack



Respiratory Distress


Agitation or Anxiety


People who have overdosed should receive immediate medical attention, especially if cocaine has been combined with another drug.

Withdrawal Symptoms

When a person begins to require more cocaine more often to achieve a high, they begin to experience symptoms of withdrawal when they do not get regular doses. These symptoms can lead to the person taking more, larger doses to avoid withdrawal symptoms. These symptoms include:


Slowed Thinking


Increased Appetite



Misconceptions About Cocaine

It is Not Addictive And Okay to Use Once in a While

The opposite is actually true. It is highly addictive due to its effect on dopamine in the brain. A person who takes cocaine may need higher and higher doses to achieve the same effect and may need to take the drug more often to avoid “crashing” when coming down from a high.

It is Safe

Because cocaine is derived from a plant, many people think it is a safe drug. However, dealers often cut it with other substances to make higher profits. These substances are not always safe to ingest. In addition, it is easy to take too much cocaine or to think it is okay to mix it with other drugs. Both of these actions can lead to dangerous levels of cocaine in a person’s system.

It Does Not Have Side Effects

Cocaine can cause cardiac symptoms such as irregular heartbeat, high blood pressure, heart attack and stroke. It also leads to other side effects such as seizures and respiratory distress. Long-term use of cocaine has been proven to shorten lifespans. 

It Can Help Improve Athletic Ability

Cocaine does give a person a short burst of energy, which may feel like it is helping to improve speed or energy during physical activity. However, since it can lead to an irregular heartbeat and other cardiac effects, it actually impairs athletic ability rather than enhancing it.

It Can Help Study or Work Habits

While cocaine may improve alertness and attention for a short period of time, the depressive effect it has when it wears off can interfere with working or studying, requiring the person to take more cocaine to improve mental alertness. Long term use of cocaine can lead to poorer grades and problems at work.



People who are addicted to cocaine may need to go through a detoxification process when beginning treatment. While cocaine does not stay in the body for a long time, people who have used it repeatedly for months or years may need medical management of the withdrawal symptoms and health effects. If a person has habitually combined it with alcohol or heroin, they will need inpatient medical management of withdrawal from the other substances as well as cocaine.


Currently, there are no medications approved for the management of cocaine addiction. Researchers are currently conducting studies on medications used to treat addiction for other substances and how those medications affect addiction. 

The drug that currently shows the most promise is disulfiram, which is used to treat alcoholism. Researchers are also investigating a vaccine that causes the immune system to bind to cocaine, preventing it from getting to the brain. This vaccine may help reduce the risk of relapse after treatment for addiction.

Therapy and Support

Once symptoms of cocaine withdrawal are managed, other forms of treatment may begin. These include:

Cognitive Behavioral Therapy

This form of one-to-one counseling helps a person recognize abnormal thought patterns associated with cocaine use and teaches the person strategies to help change those thought patterns.

Marital and Family Counseling

Counseling that includes a person’s spouse and/or family members to help heal relationships and address family issues affected by cocaine use.

Therapeutic Communities

Drug-free residences that help people learn to change drug-related behaviors. A person may stay in a therapeutic community for 6 to 12 months and may receive other support services as a part of the stay, including vocational rehabilitation, legal assistance, and mental health services.

Community-Based Groups

12-step programs such as Cocaine Anonymous can help people to maintain the progress they have made during drug rehabilitation. These programs reduce the chances of relapse by providing peer support and community resources for those who participate.

Telephone Counseling

Recent research has shown that people who participated in telephone counseling after completing inpatient rehabilitation were less likely to relapse than people who did not. Telephone counseling is more effective when combined with a voucher incentive system to encourage compliance.13

Cocaine is a Dangerous Drug

The long history of cocaine use and its attractive stimulant effects has caused it to become a pervasive, dangerous drug that has affected many people. While some think it is safe, cocaine causes many health problems and is highly addictive. People who show symptoms of addiction should seek help as soon as possible.


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