Clinging to the edge of her bathtub after shooting cocaine, Elle was fading in and out of consciousness. The immediate and intense rush from the drug injection had vanished, and the after-effects – paranoia, anxiety, and even hallucinations – associated with cocaine withdrawal began to set in.

As her heart raced and breathing plummeting, Elle knew something was wrong. The cocaine she had injected into her body was laced with fentanyl, a deadly opioid 50 times more potent than heroin.

While much of the attention on drug abuse in the United States has focused on the heroin and opioid epidemic, cocaine has also been making a comeback. Substance abuse experts believe a greater supply of cocaine in the United States is driving increased demand.

The increased supply of cocaine has also caused a fresh boom in overdose deaths in the United States, according to the latest report from the U.S. Centers for Disease Control and Prevention. While the rate of death from all drugs increased 21.5 percent, the biggest jump was among cocaine users, with a 52.4 percent increase in deaths compared to a 10 percent increase among opioid users. That makes cocaine the second leading cause of drug deaths in the United States. Because cultivation, smuggling, and first-time use are on the rise, cocaine remains a public health concern worthy of attention.

What Is Cocaine?

Cocaine is a powerful stimulant made from the leaves of the coca plant native to South America. The powdered form of cocaine is either snorted through the nose where it attaches to nasal tissue or injected into the bloodstream. Crack – or “free-base” – a form of cocaine that has been processed to make a rock crystal, is smoked.

Compared to other drugs, understanding how cocaine works is less complex. Cocaine disrupts the way the brain communicates with other parts of the body. Unlike alcohol, cocaine increases the level of dopamine to the brain. Dopamine is a neurotransmitter that reinforces or heightens certain behaviors, such as pleasure, movement, and arousal.

The intensity and duration of this euphoria and added energy depend on how cocaine is used. Injection delivers cocaine quicker to the brain and bloodstream, but the change in feelings is shorter in duration than when inhaled through the nose, which may last 15 to 30 minutes. On the other hand, the effects from smoking cocaine may only last five to 10 minutes.

To sustain a “high,” cocaine consumption is required more often. This repeated pattern – or binge – to satisfy changes in the brain can lead to addiction or an uncontrollable desire to seek and use more of the drug no matter what the consequences.

Typically, cocaine withdrawal does not involve visible physical symptoms, such as the vomiting and shaking associated with heroin or alcohol. Daytime television talk-show host Wendy Williams said she was a functioning cocaine addict before she made a name for herself on New York City and Philadelphia radio. But understand this: cocaine withdrawal isn’t exactly a walk in the park either.

What Are Cocaine Withdrawal Symptoms?

By repeatedly changing the way the brain’s reward system functions, long-term cocaine use may lead to addiction. With repeated use, tolerance mounts and the pleasure initially found in the first exposure to the drug isn’t as likely. As a result, some users will increase their dosage to intensify and prolong their high. However, this will only increase the potential for adverse psychological or physiological effects.

Prolonged cocaine abuse may constrict blood vessels, dilate pupils, and increase body temperature, heart rate, and blood pressure. It also can cause headaches and gastrointestinal complications, such as abdominal pain and nausea. Because cocaine tends to decrease appetite, chronic abusers can become malnourished as well.

The most serious health effects of cocaine abuse include heart attacks or strokes, which may cause sudden death. Because of cocaine’s tendency to impair judgment, abusers are prone to risky sexual behavior, which makes contracting HIV (human immunodeficiency virus), even if they do not share needles or other drug paraphernalia, a high possibility.

Health effects of repeated cocaine use vary depending on how the stimulant is administered. For example:

  • Snorting cocaine can lead to a loss of sense of smell, nosebleeds, problems with swallowing, hoarseness, and a chronically runny nose.
  • Ingesting cocaine by mouth can cause severe bowel gangrene stemming from a reduction in blood flow.
  • Injecting cocaine can bring about severe allergic reactions and increased risk for contracting HIV, hepatitis C, and other blood-borne diseases.
  • Binge-patterned cocaine use may lead to irritability, restlessness, and anxiety. Heavy cocaine use can also trigger severe paranoia or a temporary state of full-blown paranoid psychosis in which abusers lose touch with reality and experience auditory hallucinations.

When a cocaine abuser decides to stop using the drug, withdrawal symptoms extend beyond intense cravings and are likely to include:

  • Fatigue or lack of physical energy
  • Lack of pleasure
  • Headaches
  • Muscle tremors
  •  Anxiety
  • Irritability
  • Sleepiness
  • Nervousness, agitation, and difficulty handling stress
  • Extreme suspicion or paranoia
  • Increased appetite

What Are the Stages of the Cocaine Withdrawal Timeline?

Because of the relatively short time required for at least half of the stimulant’s dosage to be cleared from the body, the cocaine high will last only up to 90 minutes. Withdrawal symptoms will emerge shortly thereafter. The cocaine withdrawal timeline usually falls under three stages: crash, acute withdrawal, and post-acute withdrawal.

Stage 1

Crash — This stage develops soon after an abrupt stop in heavy cocaine use and often characterized by acute dysphoria, irritability and anxiety, increased desire for sleep, exhaustion, increased appetite, and a decreasing craving to use.

Stage 2

Acute withdrawal — Increased craving to use, poor concentration, irritability, and lethargy may be present for up to 10 weeks.

Stage 3

Post-Acute withdrawal — Intermittent cravings, anxiety, sleeplessness

Treatment for Cocaine Withdrawal

The intense emotional and physical effects of crashing – the first stage of cocaine withdrawal – can push many users who have decided to stop back to using again.

Although there’s no magic potion to end cocaine addiction, medications can deliver some relief to get users through the initial phase of withdrawal and away from the emotional triggers that can provoke relapse.

The U.S. Food and Drug Administration (FDA) has yet to approve any medications to treat cocaine addiction. However, a medical professional may prescribe some medications that can help restore the brain back to normal functioning and make dealing with cocaine withdrawal that less difficult.

Why Should I Detox?

For cocaine abusers, overcoming the psychological dependence will be the most difficult challenge. That euphoric feeling cocaine once provided isn’t easy to let go. In the meantime, the consequences of searching for that high have been life-shattering. When you realize it is time for a change, professional help is available to get you back on your feet again.

Detox, under the care of highly trained medical professionals, is the first step toward evaluating and overcoming the physical and emotional damage that you have done to yourself. If you are serious about removing cocaine from your life, detox at a residential treatment facility is a good idea.

Here, doctors and certified substance abuse staff can help you deal with cocaine withdrawal symptoms in a safe and secure setting and provide you with the therapeutic support to regain control of your life.

What Is the Next Treatment Step?

Cocaine addiction has controlled every aspect of your life for far too long. Modifying your behavior and adapting to strategies designed to remove you from your addiction to cocaine will take time and assistance from professionals who know what you are going through.

That’s why, after detoxification, educating yourself about the issues that made you turn to cocaine in the first place and the dangerous behavior you continued to ignore is highly recommended.

This stage of recovery may continue at an inpatient facility or on an outpatient basis. Here, you will take part in a customized treatment program featuring behavioral therapies including one-on-one counseling, educational lectures and workshops, and peer support groups that will help you cope with triggers, prevent relapse and give you a picture of what life can be like sober.

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