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Cocaine is a powerful stimulant drug made from the leaves of the South American coca plant. Cocaine is a nervous system stimulant that has the appearance of small, irregularly shaped chunks of a whitish solid. Cocaine can be snorted while in the powered form, injected into the veins after dissolving in water, or smoked. It is also used to produce crack, which is smoked, producing a short, intense high.

Cocaine has two main pharmacological actions. It is both a local anesthetic and a central nervous system stimulant—the only drug known to possess both of these properties. The effects experienced in the early stages of cocaine use include a generalized state of euphoria in combination with feelings of increased energy, confidence, mental alertness, and sexual arousal.

As users come down from their cocaine high, some experience temporary, unpleasant reactions and after effects, which may include restlessness, anxiety, agitation, irritability, and insomnia. With continued, escalating use of cocaine, the user becomes progressively tolerant to the positive effects while the negative effects, such as a dysphoric, depressed state, steadily intensify. Prolonged use may result in adverse physiological effects involving the respiratory, cardiovascular, and central nervous systems. Cocaine use may also result in overdose and death.

Psychologically, the effects of chronic cocaine use are the opposite of the initial effects. These effects can include paranoia, confusion, and an inability to perform sexually. The chronic use of cocaine may also lead to acute adverse physiological effects to the respiratory, cardiovascular, and central nervous systems. Chronic cocaine use can also lead to hospital emergency room visits, prompted by chest pain or palpitations, psychiatric complaints ranging from altered mental states to suicidal ideation, and neurological problems including seizures and delirium.

According to SAMHSA’s 2014 National Survey on Drug Use and Health (NSDUH) (PDF | 3.4 MB):

  • 1.5 million (0.6%) people used cocaine (including crack).
  • People aged 18 to 25 were more than twice as likely to use cocaine compared with other adults.
  • Men (0.8%) were twice as likely to use cocaine compared with women (0.4%).

The use of cocaine is beginning to increase after several years of decline primarily because heroin is becoming more difficult to find and the cost is increasing.