Cocaine

What it feels like

From the first few minutes to the next day.

The first time, minute by minute

• The first 5 to 30 minutes, It kicks in: Snorted, that's how long it can take to start. Cocaine is a numbing drug too, and the most common thing it's cut with, benzocaine, numbs without giving any high.
• The next 20 to 30 minutes, The high: Euphoric, energetic, talkative and mentally alert, and confident, sometimes enough to do things you wouldn't normally do. You need less food and sleep.
• Half an hour on, It goes: The high fades, but physical effects like a faster heartbeat can outlast it.
• The next day, or longer, The low: Some people feel down, anxious and paranoid.

What it can feel like

• Euphoria: A rush of feeling great, and energy to match.
• Sure of yourself: Excited and confident, and more willing to take risks.
• Talking: Talkative and mentally alert.
• No need to stop: Less need for food and sleep, for a while.
• The edge: Some people feel restless, irritable, anxious, panicky or paranoid.
• Your body: Wide pupils, a faster heart, higher blood pressure and body temperature, and sometimes tremors, vertigo and muscle twitches.

How it gets in changes the ride: the faster it's absorbed, the more intense the high and the shorter it lasts. Smoked, the high is more immediate and may last only 5 to 10 minutes.

If the first time feels amazing

A study followed 202 people from childhood into adulthood. How much they liked and wanted cocaine the first time predicted whether they later became dependent, and how much they used over their lives. So a great first time isn't a sign that it's safe for you. If anything, it points the other way.

What's happening in the brain

A jammed pump, a rush that fades and a wanting that doesn't. The model lights each one as you read.

The jammed pump

Dopamine cells in the ventral tegmental area signal to the nucleus accumbens, a pathway behind reward and motivation. Normally a transporter clears dopamine from the gap between neurons. Cocaine binds to it, so dopamine builds up and the signal to the next neuron is amplified. It blocks the pumps for norepinephrine and serotonin too.

The more blocked, the higher

PET scans let researchers count the pumps. At doses people commonly use, cocaine blocked 60 to 77% of them in the striatum, and the bigger the share, the stronger the high. People had to have at least 47% blocked to feel it at all.

The rush

In brain scans of people dependent on cocaine, areas including the ventral tegmental area, caudate and cingulate peaked early and briefly, and those tracked the rush.

The wanting

The nucleus accumbens stayed active for longer, and that tracked craving more than rush. So did a lasting drop in the amygdala. The feeling of being high and the feeling of wanting more aren't the same thing, and they don't fade together.

Why the second one isn't the first

Tolerance can build within a single session. Experienced users given a second dose 40 minutes after the first had about twice the cocaine in their blood, but felt no higher, and their heart rate and blood pressure didn't rise any further. In an earlier study, this kind of tolerance had faded within 24 hours.

If it keeps going

The dopamine surge teaches the brain that this is worth seeking again. With repeated use, people become more likely to focus on getting the drug than on relationships, food or other rewards. Long-term use is linked to problems with attention, impulse control and memory.

What people say about it

The things people tell themselves, checked.

• Myth: Once can't hurt. In fact: Usually it won't, but it can: in rare cases, sudden death happens on first use.
• Myth: I'm young. My heart's fine. In fact: Even healthy young people can have a fit, heart attack or stroke after using it.
• Myth: I'll just have some more to get it back. In fact: In a lab, a second dose about doubled the cocaine in the blood without raising the high. More in you, not more of the feeling.
• Myth: I tried it and I'm fine, so I'm not the type to get hooked. In fact: Most people who use it don't become dependent, but about 1 in 5 do, and half of those cases come within about 4 years of first use.
• Myth: I know my dealer. It's clean. In fact: Powder fentanyl looks just like other drugs, and you can't see, taste or smell it. A dealer can't either.
• Myth: A drink takes the edge off. In fact: Together, cocaine and alcohol make cocaethylene, which may add to the toxic effects on the heart.

Risks and staying safe

The few things behind most of the harm.

The real risks

• Your heart: It tightens blood vessels and raises heart rate and blood pressure. Among 3,946 heart attack patients, the risk was about 24 times higher in the hour after use. That's a small risk multiplied, but it's real.
• Fentanyl: It can be mixed into cocaine, often without anyone knowing. From 2021 to mid-2024, 79% of US overdose deaths involving cocaine also involved opioids.
• Heat: Stimulants raise body temperature and make it harder to lose the heat.
• Alcohol: The two together make cocaethylene, and mixing raises the risk of overdose.
• Stroke and seizures: Cocaine use is linked to both.
• With regular use: Snorting can cost you your sense of smell and cause nosebleeds; smoking damages the lungs. Over time the reward weakens while it takes less to cause anxiety and convulsions, which raises the risk of overdose.

Keeping it safer

• Not using it, or using less of it, is what prevents a stimulant overdose. Everything below is for people who do it anyway.
• Don't do it alone. Someone who isn't using can give naloxone or call 911.
• Don't mix it with alcohol or other drugs.
• With high blood pressure or a heart condition, it's especially risky.
• Keep naloxone nearby. It doesn't treat cocaine, but it can reverse an opioid overdose if fentanyl was in it.
• Fentanyl test strips give a result in about 5 minutes, but a negative doesn't guarantee it's safe.

When it's going wrong

• Chest pain or tightness, or a racing or irregular heartbeat.
• Overheating or heavy sweating.
• Extreme panic, paranoia or confusion, or seeing things.
• A seizure, or any sign of a stroke: numbness in the face, arms or legs, a sudden severe headache, blurred vision, sudden loss of coordination.

What to do

1. Call 911: If you think it's an overdose. People on too much of a stimulant are often still conscious, so don't wait for them to pass out. Tell the crew everything you know.
2. Give naloxone: If there's any chance opioids are involved, especially if they can't be woken or are barely breathing.
3. Keep them cool and calm: Somewhere safe, with less noise and touching. Offer water or a sports drink, or use a cool washcloth.
4. Stay: Watch them carefully until help arrives.

Calling for help is protected

Since 2017, the Good Samaritan Drug Overdose Act has protected the person who calls 911, the person overdosing and anyone else there from charges of simple drug possession, and from breaching conditions about it in bail, probation or parole. It doesn't cover trafficking or outstanding warrants.

If it's stopped feeling like a choice, treatment works, and most programmes take people who refer themselves. No medication is approved for it yet, so behavioural therapy is the treatment: cognitive behavioural therapy, and contingency management, which rewards staying off it.

Check what you know

Five questions about what cocaine does.

• Fifteen minutes in, you feel like the sharpest person in the room, and you can't stop talking. What's behind it? Cocaine has jammed the pumps that clear dopamine, so the signal is amplified. It binds to the dopamine transporter, so dopamine builds up in the gap, and the high rises with the share of pumps blocked.
• Half an hour later the feeling is going, so you take more. It doesn't feel the same. Why not? Tolerance builds within the session, so the same drug does less. A second dose 40 minutes later about doubled blood levels, but the high didn't rise.
• Your friend is 19 and fit. An hour after using cocaine they have chest pain and say, "I'm too young for a heart attack." What do you do? Call 911. Any sign of a heart attack means calling 911, and healthy young people aren't protected.
• Someone who took what they thought was cocaine has gone limp. They're barely breathing, and you can't wake them. What might be happening? It could be an opioid overdose: call 911 and give naloxone. People on too much of a stimulant are often conscious; being hard to wake with very slow breathing points to opioids, and fentanyl can be in cocaine.
• A friend says: "I loved it the first time and I was totally fine. I'm obviously someone who can handle it." What does the research say? Liking it more at first predicted more risk, not less. In a study that followed people from childhood, how much they liked and wanted it the first time predicted later dependence.