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Cocaine is notorious as a powerful, addictive stimulant drug manufactured from the coca plant native to South America. In the 19thcentury, cocaine was used to treat a variety of ailments, but it was discovered to be very addictive and associated with serious, harmful effects. It is currently a Schedule II controlled substance because, despite some medical utility, it has a high potential for abuse and may lead to severe psychological and physical dependence. Currently, it is used as a local anesthetic for very limited surgical procedures, usually involving the ear, nose, and throat.1
Cocaine is commonly encountered as a fine white powder on the street and sometimes cut with other drugs like fentanyl or amphetamines. The drug is commonly snorted through the nose, but it may also be smoked or injected. People who abuse cocaine often use the drug in a binge pattern—taking larger and larger doses over a period of days or even weeks. This pattern of use can have serious psychological and physical consequences, including overdose.1
People who abuse cocaine are at risk of experiencing a comedown, or intense effects that are opposite to those the drug causes during the euphoric phase as the drug wears off. Comedowns are similar to alcohol hangovers for many people, but some symptoms may be very intense and different from alcohol hangovers. People who experience serious symptoms from abusing cocaine are at risk of bingeing the drug because they may take a lot more of it to offset the comedown symptoms.
In many cases, cocaine abuse occurs because people seek stimulating effects like:1
However, other less desirable effects of cocaine abuse include:1
People who abuse cocaine are at risk of experiencing a comedown as the drug wears off. A cocaine comedown may involve intense effects that are somewhat opposite in character to those the drug causes during the euphoric phase. Comedowns are similar to alcohol hangovers for many people, but some symptoms may be very intense and different from alcohol hangovers. People who experience serious symptoms from abusing cocaine are at greater risk of bingeing the drug because they may take a lot more of it to offset the comedown symptoms.2
Cocaine use is accompanied by an increase in dopamine activity, which leads to the intensely euphoric effects often reported. As the drug wears off, there is relatively less dopamine active in the brain, and that can lead to the opposite of many of these effects: depression, physical slowness or sluggishness, foggy thinking, exhaustion but trouble sleeping, aches and pains, and more.2
It can be helpful to understand where comedown symptoms come from:1
Cocaine hits the brain very quickly, so effects begin soon after the first dose is consumed. Because the drug is metabolized rapidly, the effects wear off in about an hour, which may trigger immediate comedown symptoms. This, in turn, may trigger a binge as the person takes too much to avoid depression or feeling sluggish.3
A cocaine binge may include symptoms like:3
Although some of the symptoms of a cocaine comedown are like those of cocaine withdrawal, these experiences are a little different. While a subjective comedown may be experienced even in first time users, the cocaine withdrawal syndrome may be more problematic. People who develop significant physiological dependence to cocain from consistent use are at risk of experiencing withdrawal.
Cocaine withdrawal may include:1
Phase 1 of cocaine withdrawal: Intense comedown symptoms. Some symptoms will become more intense, some will be less intense, and some will change.4
Phase 2: Decreased cravings, increased inability to concentrate, emotional swings or irritability, and lethargy.4
Phase 3: Intermittent craving associated with addiction even after the drug has long been out of the body.4
Most people are able to detox from cocaine in two weeks with medical supervision. However, some people repeatedly attempt to stop abusing cocaine without medical supervision and relapse. They may develop post-acute withdrawal syndrome (PAWS), which can last for weeks or even months. Psychological symptoms, physical aches and pains, and drug cravings may increase or decrease in intensity over that time.5
Abusing cocaine even once can lead to a binge, which can trigger addiction or an overdose, so it is important to know how to take care of oneself when the depression and flu-like symptoms of withdrawal hit.
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If a person who abuses cocaine goes on a binge, they may experience significant changes in brain chemistry. Psychotic symptoms may arise, or they may experience depression when they eventually detox from the drug. Cardiovascular risks are high. Blood clots, weakened heart muscle, and chronic high blood pressure can all develop in the context of certain types of cocaine abuse.3 Cocaine also reduces blood flow by constricting blood vessels throughout the body, which can result in ischemic injury to various organ systems such as in the gastrointestinal tract. Malnutrition from failing to eat healthy meals is also a risk.
Quitting cocaine is not easy, so it can be helpful to find medical supervision for a safe, supervised detox and then enter a rehabilitation program that provides evidence-based therapy to change behaviors around drugs or alcohol.
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