Cocaine Overdose: Signs, Symptoms, and Treatment

What Is a Cocaine Overdose?

A cocaine overdose occurs when someone takes enough of the drug for it to reach toxic levels in their system – cocaine toxicity.[2] This can occur from either taking too much cocaine, mixing cocaine and alcohol, or mixing it with other substances, such as an opioid.

Cocaine Overdose Symptoms

When someone takes cocaine, they experience a rapid increase in core body temperature, blood pressure, and heart rate. With an overdose, these effects are elevated and accompanied by other effects.

The symptoms of cocaine overdose include:

• Hypertension
• Altered mental status
• Seizure
• Chest pain
• Nosebleed
• Headache
• Paranoia
• Neurological deficits
• Hyperthermia
• Vascular spasm (brief, sudden, severe narrowing of arteries)
• Weak or nonexistent distal pulse
• Extreme sweating
• Restlessness and confusion
• Extreme itching
• Blurred vision
• Vision loss
• Excited delirium[3]

It’s crucial to recognize the signs of a cocaine overdose and act quickly. Cocaine overdose can quickly lead to death from complications like a stroke, heart attack, or seizure.

How Much Cocaine Does It Take to Overdose?

Unlike some drugs, a cocaine overdose isn’t dictated by the dosage alone.[4] Someone can overdose on cocaine from a few hundred milligrams, while someone else can consume several grams without an overdose.

Several factors affect how much cocaine is tolerated and the potency of the cocaine itself. Blood cocaine concentrations are influenced by several factors: 1) the cocaine dosage, 2) the route of administration, 3) the binding strength and rate of cocaine to plasma proteins, and 4) the individual’s metabolism rate.

As a street drug, cocaine is often cut with other substances to increase the profit margin for dealers. This leads to significant variations in the purity, potency, and overdose risks from batch to batch.

Cocaine Overdose Treatment

A cocaine overdose is a medical emergency. If you suspect a cocaine overdose, call 911 to get medical assistance.[6] Wait with the person until help arrives, if possible. The Good Samaritan Law provides legal protection for those who assist in an overdose situation, potentially shielding both you and the person overdosing from certain legal repercussions.[6]

If the person is not breathing or responsive, you can start cardiopulmonary resuscitation (CPR) if you know how. Otherwise, it’s best to wait for emergency medical personnel. You can turn the person on their side to prevent them from choking if they vomit.

If the person has a seizure, don’t hold them down! Move objects out of the way to prevent injury and wait until the seizure passes.
If the person feels hot, you can use a cold compress to decrease body temperature. Apply it to the areas on the body where veins are close to the surface, such as the wrists, neck, chest, and temples.

Unlike opioids, naloxone can’t reverse the effects of a cocaine overdose, but it can be administered if an opioid is also suspected.[7] However, if you suspect the person took cocaine and an opioid – intentionally or unintentionally – you can administer naloxone without causing harm.

Cocaine Addiction and Treatment

Even with casual use, cocaine carries a risk of overdose or adverse effects, but these risks increase with ongoing use. Because cocaine produces a rapid high that fades quickly, people are inclined to “binge” to chase that feeling. Over time, this can lead to tolerance and addiction.

Cocaine addiction, or a cocaine use disorder, is classified as a stimulant use disorder by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The criteria include:

• Using cocaine more frequently or in larger doses than intended
• Trying to limit or stop cocaine use unsuccessfully
• Spending an inordinate amount of time getting, using, or recovering from cocaine use
• Having strong cravings for cocaine
• Experiencing problems with work, school, home, or family because of cocaine use
• Using cocaine despite physical or mental health effects
• Requiring more cocaine to achieve the same effects
• Continuing to use cocaine despite issues in interpersonal relationships
• Having withdrawal symptoms from limiting or stopping cocaine use.[8]

The risk of using cocaine isn’t just an overdose. With long-term use, cocaine can have devastating effects on the body and brain. This can lead to brain damage and cardiovascular damage. Fortunately, treatment for cocaine addiction can be effective.

Step 1

The first step is usually medical detox, which provides care and supervision while the drugs clear the system. Cocaine withdrawal isn’t usually life-threatening, but it can be extremely uncomfortable – even enough to cause relapse.

Step 2

Once detox is complete, inpatient and outpatient treatment programs are available.

Inpatient treatment takes place in a hospital or residential setting for intensive care and supervision, as well as therapies like individual counseling or behavioral therapies.

Outpatient treatment includes many of the same therapies but offers more freedom to balance treatment with day-to-day responsibilities. This is ideal for people who want to pursue treatment without disrupting their lives and don’t require round-the-clock monitoring.

Step 3

Treatment programs are tailored to the needs of the individual, but they typically combine traditional therapies like peer support groups with evidence-based behavioral therapies. The two leading therapies for stimulant use disorders are cognitive behavioral therapy (CBT) and contingency management.

CBT is built on the concept of unhelpful thoughts leading to problematic behaviors. By identifying and confronting these thought patterns, the person can replace them with healthier thoughts and change their behaviors.

Contingency management provides incentives to treat people living with stimulant use disorder by reinforcing positive behavioral changes.