Cocaine

Most commonly, cocaine is divided into small lines or piles (called bumps) of powder and snorted, but can be administered using other methods. Cocaine causes the user to experience a burst of energy, feelings of well-being or excitement, heightened alertness, suppression of appetite, and euphoria (NIDA, 2020, June 11).

The intensity of these effects will depend on the amount used, how frequently the drug is used, and the route of administration. Generally, the user will experience a burst of energy and feelings of well-being or excitement. Physiologically, the effects of cocaine cause increases in heart rate, blood pressure, and body temperature. Other effects include:

•       Being talkative.
•       Hypersensitive to light, sound, and touch.
•       Suppression of appetite.
•       No desire to sleepy or rest.
•       Numbness in the face.
•       Euphoria.

The effects of cocaine can last approximately 15 minutes to 1 hour (NIDA, 2020, June 11). Once the effects of cocaine begin to wear off, the user will experience a rapid shift from feelings of well-being to feelings of distress, otherwise known as a ‘crash’ (CAMH, 2010a). To avoid negative feelings associated with a ‘crash’, users are more likely to ‘binge’ cocaine, leading to dependence (CAMH, 2010a). Other effects associated with a ‘crash’ or withdrawal include:

•       Exhaustion.
•       Restlessness or inability to sleep.
•       Irritability.
•       Depression.
•       Suicidal thoughts.

Serious and life threatening adverse effects of cocaine can occur at any time but are more common when large amounts of the substance is used within a short timeframe or when used with other drugs/alcohol (CAMH, 2010a). Additionally, cocaine is frequently mixed with other substances like fentanyl, which are unknown to the user at the time of use and increase risk of life threatening adverse effects (NIDA, 2020, June 11). Adverse effects of cocaine use include:

•       Bizarre, erratic, and violent behaviour.
•       Panic, paranoia, tremors, and vertigo.
•       Headaches.
•       Abdominal pain and nausea.
•       Difficulty breathing.
•       Coma, unresponsiveness.
•       Heart attack.
•       Seizures.
•       Stroke.

Snorting

The most common way cocaine is used is by dividing the substance into small lines or piles (called bumps) and inhaling into the nose. Tools including a rolled piece of paper such as a bill, business card, paper straw or other materials may be used to facilitate inhalation (Klasser & Epstein, 2005). Cocaine is absorbed into the bloodstream through the nasal tissues. The effect onset is slower than injection and lasts for approximately 15-30 minutes after use (NIDA, 2020, June 11).

Service Provider Tip: Remind guys that sharing tools when snorting cocaine can increase transmission risk of infectious diseases. To encourage safer use, tool sharing should be avoided, or tools should be cleaned/disinfected between users.

Injection (Intravenous)

A less common way to use cocaine is to dissolve the substance in water or alcohol and inject the substance intravenously. Injection produces a ‘rush’  with 30-45 seconds after use, followed by a prolonged high that lasts 10-20 minutes (CAMH, 2010a).

Service Provider Tip: Remind guys that sharing needles can increase transmission risk of infectious diseases. To encourage safer use, sharing needles should be avoided. Guys should only use a needle once as the needle can become blunt, reusing the same needle can damage veins and increase risk of infection.

Booty Bumping (Anal Insertion)

Cocaine may also be booty bumped by dissolving cocaine in water and using a needless syringe to insert the substance into the rectum. Booty bumping may be a preferred route of administration because the rectum is efficient at absorbing a high amount of cocaine into the bloodstream causing the user to experience a strong effect (Cantrell et al., 2006).

Service Provider Tip: Booty bumping causes damage to the rectum. Encourage guys to alternate between different administration techniques to give the rectum a chance to heal. Remind guys to avoid sharing syringes or to ensure any materials used for booty bumping have been cleaned/disinfected between users to reduce harms.

Smoking (Inhalation)

Cocaine may also be inhaled through smoking the substance which produces effects that are similar to injection. The user will experience an intense ‘rush’ which is followed by a high that lasts for approximately 10 minutes (NIDA, 2016).

Prescribed Substances

Cocaine can produce serious and life-threatening adverse effects when used with certain HIV medications and antidepressants.

HIV Medications

• Ritonavir and Cobicistat are used to boost the availability of other HIV medications in the body by decreasing the breakdown speed of these substances (Nuh, 2020).
• Ritonavir and Cobicistat interact with cocaine by increasing the availability of cocaine in the body, leading to adverse effects (Lee et al., 2021).

Antidepressants

• Monoamine Oxidase Inhibitors (MAOIs) and Selective Serotonin Reuptake Inhibitors (SSRIs) are used to treat depression by blocking the reuptake of the serotonin neurotransmitter in the body.
• Use of cocaine with MAOIs or SSRIs may cause dangerously high blood pressure, increased body temperature, and serotonin syndrome/toxicity.

Recreational Substances

When cocaine is used with other recreational substances, this is known as polysubstance use and can lead to serious or life-threatening adverse effects.

Alcohol

• Using cocaine and alcohol together forms a metabolite called cocaethylene.
• The cocaethylene’s half-life is 3-5x the half-life of cocaine, increasing risk of overdose related to cocaethylene toxicity (Andrews, 1997). Cocaethylene toxicity may include seizures, liver damage, and other serious neurological and cardiovascular adverse events.

Stimulants

• Using cocaine with other stimulants can increase strain on the cardiovascular system, elevating blood pressure to high levels (Lindsey et al., 2012).
• Combining the stimulating effects of cocaine with MDMA will also cause blood pressure to elevate (Lindsey et al., 2012).

Recently, Canada passed the “Good Samaritan Drug Overdose Act.” This means that if police attend a 911 call for an overdose and there are drugs present, anyone in attendance is protected against simple drug possession charges, even if they’re on probation or parole. See this helpful info by the Canadian HIV/AIDS Legal Network. You can download a PDF of it [here].