Cocaine Overdose: Signs & Treatment

Cocaine is a powerful and addictive stimulant drug. When a person experiences severe adverse effects or life-threatening symptoms as a result of cocaine use, it can result in overdose. Overdoses involving cocaine can be life-threatening and even fatal, particularly when cocaine is mixed with other substances.

This article will cover the causes and warning signs of cocaine overdose, what to do in the event of a cocaine-related overdose, and what the treatment options for this specific type of substance use disorder are.

What to Do if Someone Is Experiencing a Cocaine-Involved Overdose

A drug overdose is a life-threatening situation. Emergency medical help is essential if you think someone may be experiencing an overdose. If you suspect that someone is experiencing cocaine overdose symptoms, here are some things you can do:

1. Call 911 immediately and stay with the person.
2. If the person is not responsive and you have checked but cannot find a pulse, perform rescue breathing and/or chest compressions to help support the person’s breathing and cardiovascular function. The 911 operator/dispatcher can assist and support you with this over the telephone.
3. If the person exhibits opioid overdose symptoms and you have access to naloxone, administer it as soon as possible. If you are not sure if the person took opioids but they are exhibiting the signs of the opioid overdose triad, it is better to administer naloxone than to not. Naloxone will have no effect on a cocaine overdose but will not harm anyone regardless of what type of substance they may be overdosing on.¹
4. Put the person in the recovery position (meaning on their side with one knee over the other) to prevent choking and rolling, and remain with them until emergency responders arrive.

There is currently no FDA-approved medication available to help reverse the effects of a cocaine overdose.² In today’s climate, however, it is common for cocaine and other illicit drugs to contain fentanyl and other opioids, even if the individual is unaware of it.³ Therefore, administering naloxone may help save a life if a person’s cocaine was combined with an opioid like fentanyl.¹

No matter what substance causes an overdose, it is critical for first responders and trained medical professionals to address a cocaine-related overdose and provide medical support as soon as possible in an effort to stabilize the person who’s overdosed.⁴ While waiting for emergency responders, it’s important to stay with the patient and remain on the line with the 911 operator, who may guide you through doing what you can to help save a life.

What Are the Signs of a Cocaine-Involved Overdose?

Signs of cocaine overdose vary widely but can include:⁴

• High blood pressure.
• Altered mental status.
• Chest pain.
• Difficult or labored breathing.
• Nosebleed.
• Headaches.
• Paranoia.
• Increased body temperature.
• Loss of pulse in the hands and feet.
• Extreme sweating.
• Severe restlessness, agitation, or confusion.
• Diarrhea, vomiting, abdominal pain.
• Blurred vision or loss of vision.
• Itchiness.
• Hallucinations.
• Seizures.
• Irregular heart rhythm.
• Delirium (cocaine-induced delirium is associated with aggressive behavior, hyperactivity, extreme paranoia, hyperthermia, incoherent screaming, and unusual strength).

Cocaine can adversely affect the body in many ways; however, its most lethal effects and consequences are on the cardiovascular system. Life-threatening cardiovascular emergencies involving cocaine toxicity (i.e., cocaine overdose) often manifest as hemorrhagic stroke or rupture of the aorta, heart attack, or shock. In some cases, cardiovascular toxicity may result in kidney failure.

However, cocaine overdose is not limited to cardiovascular-related complications, as it can also manifest as seizures, hyperthermia, or respiratory arrest.⁵ Cocaine-induced delirium may also signal an overdose, and these individuals are often at risk of sudden death.⁶ Given the possible intentional or unintentional co-ingestion of cocaine and opioids, people should be wary of whether the overdose signs they’re picking up on might actually be those of an opioid overdose.

The three signs of an opioid overdose, referred to as the “opioid overdose triad” include:⁷

1. Loss of (or markedly lowered) level of consciousness
2. Pinpoint pupils.
3. Slowed, shallow, or stopped breathing.

What Causes a Cocaine Overdose?

A cocaine overdose occurs when someone uses enough of it that it produces life-threatening symptoms.⁴ The toxic dose of cocaine is highly variable and depends on individual tolerance, the route of administration, and the presence of other drugs, as well as other factors.⁵

A cocaine overdose can occur on first use or anytime as a person uses. Regular use of cocaine will result in developing a tolerance to the drug’s rewarding effects, meaning an increased amount of cocaine or more frequent use of cocaine is required to get high. As tolerance develops, so too does sensitization, where less cocaine is needed to produce toxic effects. This tolerance to reward and sensitization to toxicity increases the potential for overdose in someone who regularly uses cocaine.⁸

The risk of overdose is also increased when cocaine is used in conjunction with other substances, such as alcohol or opioids.

How Alcohol and Opioids Impact Cocaine Overdose

Combining cocaine with alcohol is significantly more dangerous for the heart and cardiovascular system than either cocaine or alcohol alone. This is because the combination of cocaine and alcohol causes the production of a toxic chemical called cocaethylene which increases heart rate and blood pressure more than cocaine alone.⁹ In a 2021 study of drug-related visits to emergency departments (EDs), alcohol was involved in more than half of cocaine-related polysubstance ED visits.¹⁰

Some intentionally mix cocaine and heroin, an illicit opioid, together, which is often referred to as a “speedball”.⁴ Others unintentionally take cocaine that they do not know is cut with illicitly manufactured fentanyl. Fentanyl is cheap to manufacture and it is increasingly prevalent in the illicit supply of cocaine and other stimulants.

To underscore the dangerousness of using opioids in combination with cocaine, consider the study that showed that between 2011 and 2018, the prevalence of cocaine use rose only modestly, about 5.1% annually; however, cocaine overdose fatality rose dramatically after 2012, about 26.5% annually. The study authors largely attribute the dramatic increases in cocaine-involved overdose mortality to the involvement of opioids, especially synthetic opioids such as fentanyl.¹¹ This is still true today. In 2020, synthetic opioids were involved in more than three quarters of fatal cocaine overdoses.² Polysubstance use ultimately increases the risk of overdose, either intentionally or unintentionally, due to both drug interactions (as with alcohol) and by the effects of one drug exacerbating or masking the effects of another drug, as with opioids.¹²

Treatment for Cocaine Addiction

It can feel overwhelming when a loved one is addicted to cocaine. The first step to getting them appropriate care is helping them find professional treatment. To get started, read about family resources for addiction available at River Oaks Treatment Center.

There are multiple levels of care available, and a thorough assessment by a physician or qualified clinician can help determine which level of care is most appropriate to address each person’s unique, individual needs.

Depending on the severity of a person’s substance use disorder, the following types of treatment can be helpful:

• Medical detox for cocaine: A medically supervised detox can be a safe and comfortable way to manage withdrawal symptoms when discontinuing drug use.¹³
• Inpatient addiction treatment: Inpatient or residential treatment is for people with moderate to severe substance use disorders or those who will benefit from 24-hour care and supervision.¹³
• Outpatient drug and alcohol rehab: Outpatient treatment allows for people to receive treatment while continuing to live at home and maintain their daily routines.¹³

Cocaine Addiction Treatment at River Oaks

Our drug rehab in Tampa, FL has compassionate and knowledgeable admissions navigators available to answer questions, provide information, and help guide you through the rehab admissions process. Some insurance plans cover addiction treatment, but it is important to know the specifics of your individual policy. However, there are many different ways to pay for rehab, even if you don’t have insurance.

It is difficult to confront a loved one who is struggling with addiction, but it is vital to have an open dialogue without judgment and offer help. It could save their life.
Call today to help someone you care about find resources to overcome their battle with addiction. You can also fill out our secure to have you or your loved one’s insurance verified right now.