Signs of Cocaine Use

Signs and symptoms of cocaine use include excitability, weight loss, insomnia, irritability and paranoia. Snorting cocaine may cause a runny nose or nosebleeds. Burns on the lips and fingers and a nagging cough indicate a person has been smoking crack.

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Because cocaine is a stimulant drug, it increases energy, alertness, heart rate, blood pressure and breathing. After snorting, smoking or injecting the drug, a person may feel more confident and talkative than usual.

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Repeated use of cocaine can easily lead to a cocaine addiction. A person who is addicted to the drug will usually exhibit signs and symptoms of cocaine use. The symptoms can include unusual behavior and an array of physical problems.

The euphoric rush of pleasure and energy a person gets from cocaine doesn’t last long. The high from snorting the drug disappears after an hour or so — and the rush from a hit of crack cocaine fades in five to 10 minutes.

As the cocaine wears off, euphoria may give way to anxiety, agitation and depression. Restlessness, insomnia and fatigue are also typical of a cocaine crash, or comedown. Some people may feel and act paranoid.

Signs of Cocaine Abuse and Addiction

Secretive behavior can be a red flag for a substance abuse problem, and people with a cocaine addiction will often try to hide their drug use. As their addiction grows, their lives begin to revolve around the drug. They’ll often neglect people and activities that were once important to them.

Other signs and symptoms of cocaine addiction include:

  • Obsessive thoughts about cocaine
  • Inability to stop using the drug
  • Financial problems (borrowing or stealing money to buy cocaine)
  • Relationship problems
  • Deterioration in physical appearance
  • Risk-taking behavior

People who use cocaine regularly may develop a physical tolerance to the drug. When this happens, they require larger amounts to achieve the same desired effects. They are also more likely to suffer physical withdrawal symptoms when they stop using cocaine.

Addiction can sneak up on a person. Madeleine Ludwig first began using cocaine socially.

“Snorting cocaine made me feel awake and hyper, but I only ever snorted it in social settings like parties or with friends,” she told

But once she began shooting cocaine intravenously, addiction quickly took hold.

“That ‘awake’ effect wasn’t enough for me to want to spend money on it alone,” she said. “However, once I discovered shooting up cocaine, my life revolved around it.”

Short-Term Effects of Cocaine

Cocaine is a stimulant that makes a person move faster, talk faster and think at a higher speed. This heightened state of arousal is often apparent to others.

Other signs and symptoms of cocaine use include:

  • Enlarged or dilated pupils
  • Runny nose or nosebleeds
  • Changes in sleeping and eating patterns
  • Talkativeness
  • Lack of inhibition
  • Higher confidence
  • Excessive enthusiasm
  • Decreased appetite
  • Mood swings
  • Involuntary muscle twitching (tics)
  • Impotence in males
  • Irritability
  • Nausea
  • Paranoia (unreasonable distrust of others)
  • Hypersensitivity to sight, sound and touch
  • Engaging in risky behaviors, such as unsafe sex

One of the most common and concerning medical symptoms of cocaine use is chest pain. Because cocaine constricts the blood vessels, it stresses the heart and cardiovascular system. The risk of having a heart attack increases nearly 24 times during the first hour after someone uses cocaine.

Cocaine Comedown

A cocaine comedown, or cocaine crash, occurs after a binge or when someone stops using cocaine suddenly. During a crash, a person will feel fatigued, depressed, anxious, irritable and profoundly tired. Some people feel extremely agitated, suspicious and paranoid.

A cocaine comedown is actually a form of withdrawal that can last for days. During the crash, a person experiences powerful cravings for more cocaine.

Cocaine Psychosis

Stimulants such as cocaine can cause psychotic symptoms in some people. These symptoms can include seeing or hearing things that aren’t there and having paranoid delusions. People may be convinced that the police or others are following them, for instance, or that their partner is cheating on them.

Aggression and violent behavior are also common. People may have thoughts of suicide or homicide.

Some studies have shown that cocaine psychosis affects 68 to 84 percent of cocaine users. It is usually associated with having a severe addiction to the drug and taking higher dosages of cocaine. Cocaine psychosis appears to be more common after smoking crack than after snorting or injecting powder cocaine.

Long-Term Effects of Cocaine

Cocaine affects almost every part of the body. People who use the drug regularly are likely to experience a number of serious health problems. Some health issues related to cocaine are noticeable.

Dr. Kevin Wandler of Advanced Recovery Systems describes serious health effects associated with cocaine use.

Long-term effects of cocaine use can include:

  • Severe weight loss and malnourishment
  • Headaches
  • Sexual dysfunction
  • Reproductive damage and infertility
  • Movement disorders similar to Parkinson’s disease

Much of the internal damage cocaine causes, however, is invisible. In addition to increasing the risk of heart attack, cocaine can trigger irregular heartbeats and cause a thickening of the heart muscle that can lead to heart failure.

The drug can also cause dangerous spikes in blood pressure that can rupture blood vessels in the brain (hemorrhagic stroke) or tear the aorta (aortic dissection). Both conditions are potentially fatal.

Chronic cocaine use is also hard on the gastrointestinal tract. Because cocaine constricts blood vessels, frequent cocaine or crack use can cut off the supply of oxygen-rich blood to the intestines, causing the bowel to die and rupture. This can also be deadly.

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Signs by Method of Use

Cocaine can be consumed in several ways, and each method of use comes with its own set of problems and dangers. The signs and symptoms of cocaine use can vary depending on whether a person snorts, injects, smokes or swallows the drug.

Effects of Snorting Cocaine

Snorting cocaine can cause severe nasal problems. It makes blood vessels in the nose constrict, cutting off oxygen flow to the nasal tissues. Other chemicals that dealers add to cocaine can also irritate the lining of the nose. Inhaling cocaine can lead to infections of the nasal and oral cavities.

Typical symptoms of snorting cocaine include:

  • Nosebleeds
  • Loss of sense of smell
  • Runny nose
  • Frequent colds or sinus problems
  • Difficulty swallowing

When people snort cocaine for a long time, the nose can collapse. Holes can form in the roof of the mouth, and other parts of the face can become damaged. Approximately 5 percent of people who snort the drug will eventually develop a hole in their nasal septum, the wall of tissue that divides the two sides of the nose.

While some people snort lines of cocaine off tables, mirrors of other hard surfaces, others prefer to snort the drug off a longer fingernail, usually on the pinky finger. A so-called coke nail can serve both as a shovel and snorting surface.

Effects of Smoking Crack or Cocaine

People who smoke cocaine usually smoke a crystal form of the drug called crack, but some will smoke a mixture of powder cocaine and marijuana. More than half of people who smoke crack will develop a wheeze, cough or shortness of breath. Many crack users will also experience chest pain and cough up black mucus or blood.

Other common lung problems associated with smoking cocaine include:

  • Bronchitis
  • Emphysema
  • Airway burns
  • Irregular breathing
  • Fluid in the lungs
  • Hardening of the lungs (fibrosis)
  • Worsening asthma

Smoking crack can cause a condition called “crack lung,” a group of pneumonia-like symptoms that include chest pain, a bloody cough, shortness of breath, itching and a fever. The symptoms usually appear within a day or two of smoking crack. Inhaling crack or powder cocaine can also lead to acute lung injury and respiratory arrest.

Effects of Injecting Cocaine

Injecting cocaine into a vein can cause a more intense high. It also increases the risk of overdose. Speedball, which is a mix of cocaine and heroin, is usually injected.

Red flags for IV cocaine use include track marks (needle scars), bruising and collapsed veins. Injecting cocaine also raises the risks of contracting IV-related viruses, such as HIV and hepatitis.

Effects of Orally Ingesting Cocaine

Some people take cocaine orally by rubbing it on the gums or mixing it in a drink. Others wrap powder cocaine in a small piece of toilet paper or tissue and swallow it. This method of use is sometimes called parachuting or bombing.

According to the National Institute on Drug Abuse, consuming cocaine by mouth can cause severe bowel decay.

Cocaine smugglers and drug dealers sometimes swallow large amounts of cocaine in condoms or balloons to hide it from law enforcement. The packets can easily break open inside the body and cause a fatal cocaine overdose.

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Overdose Effects

Overdose can occur unexpectedly and may even happen the first time someone tries cocaine. Using high doses or mixing cocaine with alcohol or other drugs increases the risk of overdose.

Key signs of a cocaine overdose include a fast heart rate, elevated blood pressure, faster breathing, high body temperature, sweating, widened pupils and agitation.

In severe cases, cocaine overdose can cause a heart attack or stroke. Convulsions, coma and death can occur within two to three minutes.

Other signs and symptoms of a cocaine overdose may include:

  • Nausea, vomiting and diarrhea
  • Tremors
  • Pale skin
  • Chest pain
  • A spinning sensation (vertigo)
  • Apprehension
  • Irregular heartbeat
  • Irregular breathing or gasping for breath

A person who has ingested a toxic amount of cocaine may also act combative or hostile. Hallucinations are common, and some people will describe a sensation that bugs are crawling on them. The slang term for this phenomenon is coke bugs.

If you or someone you know is experiencing a cocaine overdose, call 911 and seek emergency medical treatment.

Withdrawal Effects

While some people experience few withdrawal effects from cocaine, others experience debilitating symptoms.

Common cocaine withdrawal symptoms include:

  • Depression
  • Fatigue
  • Increased appetite
  • Bad dreams and insomnia
  • Slowed thinking
  • Cravings for cocaine

For a heavy cocaine user, these symptoms will typically peak within two to four days and resolve within a week. For some people with cocaine addiction, cravings and depression may last for weeks or months.

Cocaine Paraphernalia

Certain items and equipment are also red flags for cocaine use or cocaine addiction. Typical items used for snorting cocaine include mirrors, small spoons, short plastic straws and rolled-up paper tubes. A crack user will likely have a pipe and lighters, whereas IV cocaine users will possess needles.

Medical Disclaimer: aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

Amy Keller, RN, BSN
Content Writer,
As a former journalist and a registered nurse, Amy draws on her clinical experience, compassion and storytelling skills to provide insight into the disease of addiction and treatment options. Amy has completed the American Psychiatric Nurses Association’s course on Effective Treatments for Opioid Use Disorder and continuing education on Screening, Brief Intervention and Referral to Treatment (SBIRT). Amy is an advocate for patient- and family-centered care. She previously participated in Moffitt Cancer Center’s patient and family advisory program and was a speaker at the Institute of Patient-and Family-Centered Care’s 2015 national conference.

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