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Dose and purity

Generally, the more of the drug you take or the higher the dose, the more intense the effects of the drug will be. Larger doses of cocaine can be fatal. Cocaine poisoning can also produce faster, irregular and weak heartbeats, lung failure, heart failure and burst blood vessels in the brain.

Cocaine is usually cut or diluted with other substances, which can mimic its taste or appearance. As  cocaine is an illegal drug, it is not regulated so there is usually no way of telling if it has been contaminated until after you have used it.

Related to this, cocaine costs anywhere between $300 - $400 a gram. So you risk spending a lot of money and getting something crap that only lasts about ten minutes and makes you want to have more.

Using cocaine with other drugs

Prescription medication - Mixing cocaine with prescription medication can have serious effects. If cocaine is mixed with some anxiety and ADHD medication and some antidepressants such as SSRIs (selective-serotonin reuptake inhibitors), St John's Wort, or MAOIs (monoamine oxidase inhibitors), the effects can be especially serious such as dangerously high blood pressure, seratonin toxicity, heart attack, stroke, kidney failure, overheating and fits.  If used with medications for psychotic disorders such as schizophrenia and HIV, medications can stop working.

If you are planning to take any illicit substance or alcohol while you are going to be on medication that is about to be prescribed to you, talk with your doctor. Unless they have immediate concerns for your safety it will remain confidential. Each drug is different and interactions can be unpredictable and very dangerous. This is especially so if you’re on any highly specialised drugs (e.g. for heart problems, neurological – brain and nerves – problems, blood thinning medications or drugs for cancer).

Overdose: What it is and what to do

There are several toxic reactions that can occur following the use of cocaine. Cocaine toxicity is often referred to as cocaine overdose. However, toxicity is not necessarily a result of high doses and can occur with the use of smaller doses. It may also depend on the presence of other drugs (which can mask the effects) and pre-existing conditions.

Symptoms which are consistent with cocaine toxicity include:

• nausea and vomiting
• chest pain
• tremors
• increased body temperature
• increased heart rate
• seizure
• extreme paranoia
• extreme anxiety
• panic
• extreme agitation
• hallucinations
• delirium.

Some of these symptoms are consistent with what you may normally experience when using the drug, and therefore you may not realise that you've experienced a stimulant overdose.

What to do if someone loses consciousness

• Call an ambulance on 000 - police do not routinely attend overdoses.
• Do not leave the person alone.
• Put the person in the recovery position.
• Loosen any tight clothing that might restrict their breathing.
• Keep them warm – unless the fainting is due to overheating. 
• If they stop breathing, perform CPR until the ambulance arrives.

What to do if a friend become paranoid or delusional

If a friend becomes paranoid or delusional and begins displaying irrational behaviour after cocaine, it’s likely is they may be experiencing drug-assisted psychosis. This experience is temporary, lasting from a few minutes to twelve  hours.

If this happens:

• allow the person plenty of personal space
• avoid arguing
• avoid sudden movement toward the person
• Do not try to reason with the person
• express sympathy for the person’s emotional distress but don’t buy in to their delusions
• If the person becomes threatening, call an ambulance or the police and ask for a plain-clothed police officer.  Police do not routinely attend overdoses unless it is suspected that there is violence or threatening behaviour occurring.

What to do if someone feels tense and anxious

• calm the person down and reassure them that everything is alright
• talk quietly and explain that the feelings will pass
• keep them away from loud noises and bright lights
• encourage them to breathe slowly and deeply to prevent hyperventilation.

What to do if someone is overheating

• move person to a cool area - either outside or a chill out zone  
• remove excess clothing
• encourage them to sip non-alcoholic fluids such as soft drinks
• pat the back of the neck and wrists with a cold wet towel
• do not leave the person alone as overheating can cause the person to lose consciousness.

What to do if someone has a fit

• call an ambulance on 000 - police do not routinely attend overdoses
• do not restrict the person in any way
• remove any objects from around the person that could cause injury.

Mood, environment and personal factors

Mood

How you are feeling when you use cocaine can influence how the drug will affect you.  If you are feeling anxious or depressed the drug may only enhance these feelings.

Environment

The setting in which you choose to use cocaine can influence the effect it will have on you. Some tips for reducing harm:

• use the drug in a place where you feel safe and relaxed to reduce the chance of anxiety attack or paranoia
• have a close friend (who knows what you’ve taken) nearby in case anything goes wrong
• have condoms on you – you never know what might happen
• plan keep some money aside for a taxi so you can get home safely if you’re out.

Personal factors

Personal factors such as weight, height, sex and general health all influence the way in which a drug may affect you. 

Drink plenty of fluids, eat well and sleep well if you are planning on taking drugs to better equip your body to deal with the substance.

Tolerance and withdrawal

You can quickly develop  a tolerance to cocaine so that you need increasingly larger amounts to achieve the same effect.

If you are using cocaine again after taking a break keep in mind that your tolerance for the drug may have gone down and you may not need the same dose as previously to get the same effects.

Cocaine withdrawal may occur when a heavy user cuts down or quits using the drug. Cocaine withdrawal often has no visible physical symptoms that may accompany withdrawal from drugs such as alcohol and heroin.

Symptoms of withdrawal may include a strong craving for more of the drug, fatigue, lack of pleasure, depression, anxiety, irritability and agitation.

Treatment

Unlike drugs such as heroin or nicotine, there are no medications that either block or mimic cocaine’s effects without unacceptable side effects.

Some pharmacological treatments which have been used to treat cocaine dependence include dexamphetamine, which is a pharmaceutical stimulant approved in Australia for sleep and attention disorders, and Modafanil, a new type of wake-promoting drug approved for the sleeping disorder, narcolepsy.

It has been suggested that a combination of psychotherapy and pharmacology may be more effective in treating cocaine dependence than either approach on its own.

Method

• Injected: Sharing needles may pass on infections such as HIV/AIDS, hepatitis B and C. If you're going to inject:
  - Obtain clean syringes from a needle and syringe program (NSP) or chemist. The Alcohol and Drug Information Service (ADIS) in each state should be able to provide you with the locations of NSPs within your state.
  - Use pure water. To ensure water is pure you can boil it or pick it up from the NSP. An NSP will not judge you; their job is to provide you with safe and clean needles/syringes and the information you need.
• Snorted: Use clean, disposable applicators - such as rolled up new post-it notes.  Research suggests that blood-borne diseases, including Hepititis C, can also be spread through sharing of bank notes or other applicators used to snort cocaine. Hepatitis C and other germs may also be spread by using an unclean surface such as a toilet lid or dirty table, or rack out lines using credit cards. Snorting cocaine tears the lining in your nose.  People with chronic cocaine problems can have nose problems related to this (some high-profile people have basically been told if they snort cocaine once more they'll lose the middle bit of their nose).
• Smoked: If you smoke:
   - Don’t share pipes:Like needles, pipes can pass on blood diseases like hepatitis C.
   - Use a screen in your pipe to protect your lungs from toxins and damage.
   - Protect your lips from the intense heat of a pipe by wrapping the end in something (e.g. paper or cardboard).

Driving after using cocaine

Cocaine speeds up the activity of the brain and other parts of the central nervous system. The way in which cocaine can effect your driving include:

• impaired ability to react appropriately
• poor concentration and judgement
• overconfidence in driving skills that is not necessarily supported by an actual improvement in driving ability
• feelings of increased confidence, which  increase the chances a person will take unnecessary risks
• feelings of aggression, which can  lead to dangerous driving
• drowsiness as the cocaine wears off, which may increase the risk that the driver could suddenly fall asleep.

The 'come down' effects (for example, exhaustion, mood swings and depression) after using cocaine may also impair your driving ability.

Remember: you may think that you can change your driving to counteract any impairment to your driving ability, however, the effects of cocaine may mean that you have an altered view and experience of reality.

This means that your actions and responses might be significantly different to what’s actually needed, and you’ll be unaware how much your driving skills are affected.

Pregnancy

Cocaine use during pregnancy can affect development of the foetus. Cocaine increases the heart rate in both the mother and the unborn baby, reducing the supply of blood and oxygen to the baby. This means the baby is more likely to be small and grow slowly after the birth. Cocaine use during pregnancy may cause bleeding, miscarriage, premature labour or stillbirth.

Some research has shown that children of women who use cocaine may experience long-term mental or physical effects. A number of foetal abnormalities have been reported including malformations of the brain, skull, genito-urinary tract, heart, limbs and/or face.