Cocaine has become an issue of grave concern for many countries around the world, and for good reason .
In the United States, for example, cocaine-related, deaths have increased every year for the past 8 years, with a total of 15,883 people dying from a cocaine overdose in 2019 .
Cocaine related deaths have risen 5 times in England wales since 2010. In the UK today, it is estimated that approximately 360,000 people abuse cocaine every month .
Cocaine is the most commonly used drug of abuse among people presenting at emergency departments. In addition, cocaine is the most frequent cause of drug-related deaths .
Cocaine hydrochloride, or simply cocaine, is a central nervous system stimulant drug derived from coca leaves native to western South America.
Cocaine is available in powdered form or a free base crystal form known as “crack”. Powdered cocaine can be taken intranasally, orally, or intravenously, whereas crack is smoked.
Cocaine rapidly onsets feelings of euphoria and exhilaration. It also intensifies sensations of pleasure, enhances self-confidence, and reduces social anxiety.
This magnification of ordinary pleasures and improvement in mood motivates repeated use, making cocaine highly addictive.
PRO TIP: Learn how long cocaine stays in your system.
Taking cocaine increases the amount of dopamine in the brain. Dopamine is a neurotransmitter or a chemical messenger that affects our motivations and how we experience pleasure.
Cocaine also prevents the reabsorption of both serotonin and norepinephrine in the brain, two other chemical messengers that make people feel alert, energetic, and talkative.
The increased quantity of these brain chemicals is responsible for profound feelings of euphoria associated with cocaine use.
However, regular use of cocaine over a prolonged period causes enduring brain changes that can impact overall health in myriad ways.
The brain adapts to cocaine and loses its own ability to produce adequate amounts of dopamine necessary for normal functioning.
Regular users eventually develop a tolerance to the drug, often becoming immune to ordinary, everyday pleasures.
People with a cocaine addiction inevitably depend on the drug to find pleasure in ordinarily pleasurable things.
The length of time it takes for cocaine to kick in depends on the administration method, the purity of the drug, and the individual’s tolerance level.
Snorting cocaine takes longer to kick in and has a longer high than smoked or injected cocaine.
Cocaine that is taken intranasally takes considerably longer to reach the blood and the brain.
Smoked or injected cocaine reaches the blood and brain almost instantly, and they have similar cardiovascular effects as a result.
A cocaine high is characterized by the following short-term psychological effects:
Short-term physiological effects of cocaine use include:
Despite its mostly pleasant short-term effects, frequent abuse of cocaine can lead to serious long-term health implications for vital organs such as the heart and brain.
A more thorough examination of these long-term effects is provided below:
Under the influence of cocaine, the brain becomes flooded with excess amounts of dopamine.
Cocaine also prevents the reuptake of this dopamine, meaning that it inevitably gets trapped in brain cells with nowhere to go.
Over a prolonged period, this causes structural abnormalities which can have serious side effects and may result in the development of life-threatening medical conditions.
A 2013 study of middle-aged people who had used cocaine in the past year or were cocaine-addicted found that they had 50% less grey matter volume than the average brain .
Grey matter cells are important for regulating emotion, memory, and mood. Results of this study indicate that cocaine use may rapidly accelerate the ageing process.
Serious brain-related medical conditions caused or worsened by cocaine abuse are further explored below:
There is growing evidence of the causal link between cocaine use and stroke.
In fact, cocaine is one of the most important risk factors for stroke in adults, particularly young adults .
The neurotoxic effects of cocaine can cause both ischaemic strokes, which are caused by restricted blood flow to the brain, and hemorrhagic strokes, caused by bleeding in the brain .
The use of powdered cocaine is more likely to result in hemorrhagic strokes while smoking crack cocaine results in equal numbers of ischaemic and hemorrhagic stroke.
Ischemic and hemorrhagic stroke brought about by cocaine use can also lead to seizures.
Cocaine can provoke seizures in people who are intoxicated, even if they have no predisposition to epilepsy.
However, cocaine-related, seizures are more often reported in patients with preexisting epilepsy.
Cocaine, acting as a trigger, can aggravate preexisting epilepsy. Cocaine can also make epileptic patients more susceptible to seizures by reducing seizure threshold.
Seizures can occur due to cocaine’s directly toxic effect on the brain, or indirectly by contributing to an unhealthy lifestyle characterized by poor eating and sleeping habits .
According to the scientific literature on cocaine’s relationship to movement disorders, the onset of preexisting disorders can be accelerated by cocaine use.
Cocaine has also been associated with the spontaneous development of involuntary movement disorders known as dyskinesias in people without a predisposition .
The effects of movement disorders like Tourettes Syndrome, idiopathic dystonia, essential-like tremor, and tardive dystonia can be significantly exacerbated by the use of cocaine.
Furthermore, cocaine can cause a return of these disorders in patients who had previously been in remission. Symptoms may even be sustained long after they stop using .
Scientific evidence for the cardiotoxic effects of cocaine is clear.
Most patients who end up at emergency departments after taking cocaine present with chest pain as their foremost complaint .
This is unsurprising considering cocaine is the main risk factor for death from cardiovascular complications for people under the age of 50 .
A study of adults who died from sudden cardiac death showed that they were 4 times more likely to have recently taken cocaine.
Cocaine increases the amount of oxygen that the heart requires and simultaneously restricts blood flow.
This puts cardiac muscles under greater stress as they desperately attempt to pump enough oxygen to the heart.
Most people who take cocaine do so when they are drinking alcohol, a drug that also increases heart rate.
The combination of alcohol and cocaine applies up to 30% extra strain on the heart, on top of the strain caused by the use of either drug on its own.
Furthermore, approximately 70% of cocaine on the street contains levamisole, a parasitic de-worming medication that produces a longer high, and therefore increases the risk of cardiac complications.
The more cocaine you consume the more likely it is that you will develop permanent cardiovascular issues.
Below, we explore some specific ways in which cocaine affects the proper functioning of the heart.
Cocaine use can cause layers of muscle around the heart to become inflamed. This inflammation of the cardiac muscle is known as myocarditis.
Over time, myocarditis can lead to the development of scar tissue, making it more difficult for the heart to pump blood around the body.
Myocarditis is present in the majority of patients dying of cocaine abuse 
Postmortem studies on people who injected cocaine when they were alive have shown that administering a combination of cocaine and adulterants may cause myocarditis .
Cocaine is also a strong risk factor for the development of endocarditis, a relatively infrequent yet potentially fatal bacterial infection of the inner heart lining 
Atherosclerosis refers to the build-up of plaque on artery walls.
Chronic use of cocaine has been shown to cause severe atherosclerosis in the arteries that supply blood to the heart.
Importantly, the extent of the damage caused likely depends on how long a person has been cocaine, and how often they use it .
Cocaine causes atherosclerosis by damaging endothelial cells, making arteries more permeable.
This increased permeability allows for fats, cholesterol, and other harmful substances to clog up and narrow arteries.
In one study, atherosclerosis was observed in over 50% of patients who died as a consequence of cocaine abuse .
The development of atherosclerotic coronary artery disease associated with cocaine use may also cause the formation of blood clots .
Myocyte necrosis refers to the irreversible death of cells located in the muscles of the heart. The restriction of blood flow caused by cocaine has a direct toxic effect on these muscle cells.
Myocyte necrosis changes the shape and structure of the heart.
This structural deformity can cause irregular heartbeats, which may ultimately lead to a disease of the muscle called cardiomyopathy .
A heart arrhythmia is an irregular heartbeat. Due to cocaine’s interference with heart rate, long-term use is likely to cause arrhythmias .
Heart arrhythmias are associated with an increased risk of sustaining damage to the heart .
Long-term cocaine use may also increase the size of specific chambers located on the left side of the heart known as ventricles.
This unnatural increase in size of ventricles can cause heart arrhythmias, which in turn can cause blockages in coronary arteries, blood clots, and potentially a heart attack .
Myocardial infarction, or a heart attack as it is better known, is caused by a restriction of oxygen to one or more areas of the heart. This is more often than not caused by blocked arteries.
The long-term consequences of cocaine mean that chronic users are at higher risk of sustaining a heart attack than those who do not use cocaine .
In addition, cocaine users are 24 times more likely to have a heart attack in the first 60 minutes post-use than any time after that .
People who use cocaine are more likely to report a heart attack as a consequence of using than any other cardiac complication associated with use.
Interestingly, anyone can get a heart as a result of using cocaine, regardless of how often they have used it.
The dose and administration method also seem to be irrelevant when it comes to cocaine-related heart attacks.
The ongoing rise in cocaine abuse across the world has seen more patients presenting with issues related to intranasal ingestion.
The narrowing and corrosive effect of cocaine on blood vessels irritates and reduces blood flow to parts of the nose and throat.
This can cause small holes called perforations to develop, leading to an excessively dry/blocked nose, crusting, and bleeding.
Intranasal ingestion of cocaine can also cause bone destruction in the upper jaw .
The collapse of bone and cartilage connecting the nose to the face and perforations in the roof of the mouth and nasal septum can all come about as a direct result of snorting cocaine .
In extreme cases, chronic users of cocaine can lose their septum altogether, resulting in different-sized nostrils and a crooked nose.
Cocaine is associated with a host of additional health implications for users.
These may include: