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Medical Author:

Roxanne Dryden-Edwards, MD

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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The effects of cocaine can be divided into what goes on in the central nervous system, in the brain, and in the rest of the body. The effects of the drug vary greatly, depending on the route of administration, amount, purity, and effects of the added ingredients. The effect also varies with the user's emotional state while taking the drug. This is based on the user's attitude toward the drug, the physical setting in which the drug is being used, his or her physical condition, and whether or not the person is a regular user. Because cocaine affects every organ system, from the brain to the skin, the following discussion will cover signs (what doctors find by physical examination) and symptoms (what you feel) for major organ systems.

• Central nervous system and psychiatric effects: Users who have pleasurable experiences report varying degrees of euphoria; increased energy, excitement, and sociability; less hunger and fatigue; a marked feeling of increased physical and mental strength; and decreased sensation of pain. Some will feel a great sense of power and competence that may be associated with the delusion or false sense of grandeur, known as cocainomania. There can be talkativeness, good humor, and laughing. Dilated pupils, nausea, vomiting, headache, or vertigo (the sensation of your surroundings or yourself moving or spinning). With or even without increased amounts of coke, these can progress to excitement, flightiness, emotional instability, restlessness, irritability, apprehension, inability to sit still, cold sweats, tremors, twitching of small muscles (especially of the eyes and other face muscles, fingers, feet), and muscle jerks. The effects of cocaine on the teeth may include teeth grinding. The cocaine user may also experience hallucinations (cocaine bugs, snow lights, voices and sounds, smells) and cocaine psychosis. Cocaine psychosis resembles paranoid schizophrenia and can bring on paranoia, mania, and psychosis.

Major effects that usually cause a cocaine abuser to go to an emergency department are severe headache, seizures, loss of consciousness that can be caused by not breathing or bleeding in the brain, stroke, hyperthermia (increased body temperature), coma, and loss of vital support functions (such as low blood pressure, slow heart rate, slow respirations, and death).

• Brain effects: The effects of cocaine on the brain include alteration of responsiveness of the brain to various chemicals. These chemicals or neurotransmitters, such as norepinephrine, dopamine, serotonin, acetylcholine, and gamma-aminobutyric acid, are responsible for most of the complications of cocaine. Infants of cocaine-smoking parents have been brought to an emergency department because of seizures induced by secondhand cocaine smoking. One study of people who sought care in an emergency department reported that 22% complained of anxiety, 13% dizziness, 10% headache, 9% nausea, 9% psychosis, and 9% confusion.
• Ear, nose, and throat effects: Because the majority of users sniff or snort cocaine through their nose, there are a variety of nasal and sinus diseases. Many users complain of nasal irritation, nasal crusting, recurrent nosebleeds, nasal stuffiness, facial pain caused by sinusitis, and hoarseness.
• The mucous membrane of both sides of the septum (the cartilage that separates the nostrils) can be damaged by decreased blood supply, along with drying, crusting, and nose picking. This results in a perforation or hole in the septum with more crusting, foul secretions, nosebleeds, and whistling with nasal breathing, the so-called coke nose.
• Because nasal obstruction is a common complaint, many users self-treat with over-the-counter nasal decongestants, such as Afrin, which adds to the problem because it also closes or narrows the blood vessels. Many users have also realized that this easily recognized and accepted form of self-medication with a nasal spray is a way to administer cocaine in public. After all, who is going to check that it is not a common nasal spray in the dispenser?

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