Cocaine (hydrochloride) is a highly addictive drug. It acts as a short lived central nervous system stimulant and local anaesthetic.

It’s extracted from the leaves of coca plants and is usually snorted.

Crack cocaine is the smokable form of the drug and comes as crystals known as rocks or stones. Crack and cocaine powder can be injected but this is very risky. It’s also linked to many harmful effects.

Effects of cocaine

Common effects of cocaine include:

  • anxiety
  • confidence
  • dilated pupils
  • energy
  • euphoria
  • increased heart rate
  • paranoia
  • restlessness

Long term effects of using cocaine

Longer term effects of using cocaine can include:

  • dependency
  • damage to the heart
  • mood swings
  • poor sleeping patterns
  • impotence
  • malnutrition due to suppressed appetite
  • difficulties manging your mental health which may worsen mental health conditions
  • damage to the lips, mouth and lungs caused by smoking cocaine
  • needle-related injuries like infections and, in extreme cases, amputation of limbs

Soft tissue damage

When snorted, cocaine causes the blood vessels to contract. This reduces blood flow to the nose. Repeated use can then damage the nasal structure and tissues. This can cause holes or perforations in the septum (the cartilage between the nostrils).

Common cocaine cutting agents, like levamisole, can also cause soft tissue damage. This includes rashes, wounds and skin rot.

If left untreated this damage can be irreparable so it’s important to speak to your GP as soon as problems arise.

Risks of mixing cocaine with other substances

Using alcohol and cocaine together can be dangerous. They mix together in the body to produce a toxic chemical called cocaethylene. This affects the cardiovascular system and increases the risk of overdose.

Using heroin with cocaine is especially risky and may trigger an overdose. Each drug puts a lot of pressure on the central nervous system and the heart. This can result in respiratory failure.

What to do in an emergency

Phone 999 or go to A&E if:

You or someone else has taken cocaine and has symptoms like:

  • unconsciousness
  • difficulty breathing or they’ve stopped breathing
  • no response to stimulation
  • seizures (fitting)
  • chest pains
  • rapid heart rate
  • severe nausea and vomiting
  • hyperthermia (overheating)
  • hallucinations
  • anxiety or panic

Due to the risks of unpleasant and sometimes fatal side effects, you should completely avoid using stimulants like cocaine if you have:

  • high blood pressure
  • heart disease
  • epilepsy
  • depression or anxiety

Reducing the risks


  • make sure you’re in a safe environment, ideally with people you trust
  • let someone know if you’re planning to use cocaine alone
  • start low, go slow – begin with a small test dose and wait at least 1 hour before taking more
  • drink small sips of non-alcoholic drinks like water or isotonic drinks, but don’t have more than 1 pint in 1 hour
  • always use new equipment
  • if you’re snorting, grind it down as fine as possible and divide it into small lines
  • if you’re smoking cocaine, crush the crack rock into small pieces and smoke using a clean pipe or fresh piece of foil


  • do not share any equipment with others, including pipes, straws and keys
  • do not mix cocaine with other drugs, including prescribed medications or alcohol

Injecting cocaine

Injecting is the riskiest way to administer cocaine.

The effects of injecting cocaine are short-lived. This may lead to people injecting more often which increases harm.

Cocaine powder dissolves in water. You should only use citric acid or vitamin C to dissolve crack cocaine.

Further information on injecting drugs

Further information and support

Further information and advice on drugs and drug use is available:

Last updated:
16 March 2023