Cocaine

• What is it?
• How do you take it?
• What does it feel like?
• Side effects and long-term impact
• Overdose
• Drug combinations
• Addiction potential and withdrawal
• Safer Use
• Safer Sex
• Interactions with HIV treatment
• Counseling

What is cocaine?

Cocaine is an active ingredient obtained by chemical processing from the leaves of the coca bush. Other names for cocaine are: coke, blow, crack or nose candy. The leaves of the coca bush are chewed for medicinal purposes or drunk as tea in some South American regions. However, they contain little cocaine (around 1%).

Cocaine is a highly stimulant and (locally) anesthetic substance. In most cases, cocaine is available in the form of crystalline powder.

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How do you take cocaine?

Cocaine is most commonly snorted, rarely injected. It is smoked as a chemically processed cocaine base (“crack”/”freebase”). You can find more info about cocaine bases here.

Since the exact active ingredient content of cocaine often fluctuates and other additives may be present, precise dosing is hardly possible.

When snorted, a common dose of pure cocaine is about 0.5 mg per kg of body weight. Regular consumers often take more due to their habituation. The effect occurs after a few minutes and lasts for about half an hour to an hour and a half.

When sniffing, nasal mucous membranes are strongly irritated. There may be increased nosebleeds and interference with the sense of smell. Possible consequences of long-term use are chronic inflammation and scarring and extreme damage to nasal mucous membranes.

When Slamming cocaine should be dosed much lower – at the beginning the dose should be no more than 10 mg. The effect occurs immediately after spraying and lasts for about 5-20 minutes.

Cocaine is often laced with other, narcotic substances such as lidocaine or tetracaine – if you use the mixture intravenously, your life is in danger.

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What does cocaine feel like?

When illegal substances are consumed, it is usually not known how much active ingredient is in the drug or parts of it. This makes accurate dosing difficult and increases the likelihood of unintended effects.

Cocaine often has extenders added, some of which enhance or prolong the effect. Pay attention to current substance alerts and use drug checking services when possible.

Taking cocaine can feel like:

• euphoria
• feeling powerful and energized
• highly increased self esteem
• urge to move around a lot
• restlessness
• talkativeness
• disinhibition and fearlessness
• reduced pain sensitivity
• greater willingness to take risks
• wakefulness
• not feeling hunger or thirst
• increased libido

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Side effects and long-term impact

Side effects can include:

• Stress on the cardiovascular system: increased heart rate and blood pressure
• Heart muscle spasms
• Disturbances of the heart rhythm function
• Restlessness, feeling nervous
• Anxiety
• memory lapses
• disorientation
• aggressiveness
• Delusions of grandeur
• heart attack

Cocaine triggers a strong desire for more. You probably experience coming down from cocaine as unpleasant: mental and physical exhaustion, low mood, and depressed mood are common symptoms. Here, the urge to top up can be particularly strong in order to bypass the negative mood. Try to find an end to consumption. If you add to it, it makes it harder to stop using and is more likely to lead to (actually unintentional) repeated and excessive use.

The more regular the use, the more likely longer-term health problems will occur. When you use cocaine more frequently over a longer period of time, the following side effects and negative effects become increasingly prominent:

• Exhaustion, fatigue
• Weakened immune system, increased susceptibility to infections
• withdrawl symptoms
• Irritation or inflammation of the nasal mucosa
• Decreased desire and erectile dysfunction
• personality changes
• Irritability
• strong mood swings
• Changed thought processes
• Learning and concentration disorders
• Cardiac arrhythmias
• Twitching, trembling
• seizures
• damage to nerves, kidneys and the liver
• depression
• delusions
• “cocaine-hallicunations” (z.B. insects under your skin)
• heart attack

The psychological craving for the substance is described by users as very strong. It can also occur after a long break from use or abstinence due to certain triggers (e.g., places, people, situations). The probability of psychological dependence is therefore very high. You may develop a psychological dependence after the first use.

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Overdose

symptoms of an overdose are:

• nausea
• vomiting
• Coordination disorders
• paranoid thoughts and paranoia
• depressive moods
• heart attack
• stroke
• Respiratory paralysis

If discomfort persists, chest pain or chest tightness, get medical help. If you encounter a passed out person, check their breathing, provide first aid and call an ambulance (112).

First aid guide for drug-related emergencies (German).

For more information on first aid for Chemsex emergencies in several languages, click here.

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Drug combinations

Generally speaking: Consuming more than one substance at a time puts your body and your mental state under more pressure. Certain effects may be intensified, weakened or delayed by the interactions. The risk of overdose or side effects becomes unpredictable.

• Cocaine + alcohol: The alcohol effect is no longer perceived. This increases the likelihood of alcohol poisoning. The combined consumption of coke and alcohol leads to the formation in the body of the substance cocaethylene, which is considered harmful to the heart.
• Cocaine + nicotine: Both substances constrict the vessels – can lead to stroke.
• Cocaine + cannabis: The combination can promote psychological side effects such as anxiety or panic. Consumed continuously, this combination promotes the development of psychosis and anxiety disorders.
• Cocaine + other stimulant substances (speed, caffeine, crystal meth, …): Heavy strain on your cardiovascular system. Heart palpitations, overheating, circulatory collapse and cardiac arrest are possible consequences. The combination can lead to inner conflict and disorientation, but it can also have a harmonious effect.
• Cocaine + Ecstasy/MDMA: strong cardiovascular stress, overheating possible. The effects of ecstasy are felt less strongly, which can lead to faster refills and MDMA overdose.
• Cocaine + ketamine: Extreme strain on the cardiovascular system. Increased risk of injury – cocaine promotes the urge to move, while ketamine limits the ability to move.
• Cocaine + heroin (“speedball”/”cocktail”): The effects of both substances mutually reinforce each other. It is possible that the cocaine effect is not felt. This carries the likelihood of taking additional doses of either substance, which can lead to overdose.
• Cocaine + antidepressants, beta blockers, MAO inhibitors: extreme increase in blood pressure, life-threatening conditions due to blood pressure crisis are possible!

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Addiction potential and withdrawal

• Cocaine has a high psychological dependence potential. You may develop a psychological dependence after the first use.
• Cocaine triggers a strong desire for more. Cravings can occur even after a long break from use or abstinence due to certain triggers (e.g., places, people, situations). This can make it harder to stop using and cause you to use repeatedly and excessively (actually unintentionally). Unpleasant feelings and upsets when getting down can make it harder to stop using.
• If you slam, the risk of addiction is much higher than with other forms of use.This is due to the extreme kick that occurs immediately after injecting.
• Self-organized “cold” withdrawal (without medical consultations and care) is physically and psychologically stressful and promises little success. With residential treatment, you can effectively work through an addiction. Find out which hospitals in your area offer medically supervised detox and get support.

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Safer Use

• The active ingredient content of cocaine varies greatly, and other substances are often added as extenders. This means that exact dosing is not possible and unexpected effects may occur. Pay attention to current substance warnings and make use of drug checking whenever possible. When consuming, test only a small amount and wait for the effect (do not refill!).
• Always measure out your dose yourself. Do not transfer the responsibility for this to others. That way, you’re guaranteed to stay on top of things.
• It is never okay to administer substances to other people without their knowledge and consent! You endanger the life of a person and are liable to prosecution. If you witness such a situation, get help and protect the person being spiked.
• There is no point in testing cocaine on the gums. Cocaine often has lidocaine added as an extender, which has the same local anesthetic effect.
• Drink lots of water because cocaine dehydrates the body.
• Sniffing puts a lot of stress on your nasal mucous membranes. Chop the cocaine as finely as possible and use your own straws without sharp edges to protect your nasal mucous membranes and prevent infections. Rinse your nose with saline solution after sniffing and make sure you have adequate nasal hygiene.
• Infections are transmissible through shared materials. Use only your own consumption utensils (tubes, syringes, spoons, filters).
• Mixed use makes unexpected and unwanted effects more likely.Avoid using multiple drugs at the same time.
• Coke should not be used alone. Use with people you trust and feel comfortable with. Ideally, there should be someone who can stay sober and help if necessary.
• The effect of alcohol is hardly perceived on coke. This makes you feel like you can drink more, which is not true. This makes alcohol intoxication, coma, and respiratory failure more likely.
• After consumption, you may feel out of tune, drained, or irritable. Plan the phase into your week and take it easy.
• Find an end when consuming and try to be abstinent when getting down. Substance use aimed at shortening your downtime can lead to unexpected interactions and promote dependence.
• Try to keep your own limits on what you consume. If you’re having a hard time staying abstinent, get support. Cocaine triggers a strong psychological craving for more.
• Talk to your doctors about drug interactions. Certain drug interactions pose a high health risk.
• Do not consume in case of mental illness, cardiovascular problems, hypertension, epilepsy, hyperthyroidism, diabetes, asthma, liver and kidney diseases.
• Avoid performing responsible tasks while under the influence of substances.. Leave your car behind and determine for yourself which areas of your life should remain free from consumption.

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Safer Sex

• Cocaine can inhibit and increase the willingness to have unsafe sex. This increases your HIV and STI infection risk.
• The analgesic/numbing effect tempts people to have sex longer and more violently, which promotes injuries and thus infections.
• Cocaine can prolong your stamina. If you use condoms during sex, change the rubber every half hour – or consider another protection strategy.
• Prolonged cocaine use is associated with erectile and orgasmic dysfunction.
• Sex and coke only work with mutual consent and trust. Clarify in advance which sex practices you both want and which you don’t want.
• Consume only so much that you can defend yourself or still recognize your partner’s defensive signals. Caution: Cocaine can also increase your aggressiveness during sex!
• Before getting down to business, get sufficient amounts of sex utensils (gloves, condoms, lubricant) ready.
• Pay attention to your body! If you notice any abnormalities, you should consult a doctor.
• If you have more than one sex partner, get tested for sexually transmitted infections at least once a year and check your vaccination status for hepatitis A/B.

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Interactions with HIV treatment

• Active ingredient Efavirenz (Sustiva®, Atripla® and generics) or active ingredient Nevirapine(Viramune® and generics): In animal studies, the combination with cocaine led to liver damage. More precise scientific findings regarding the effect in humans are not yet available.
• Boosters (effect enhancers, e.g. Norvir®, Tybost®) possibly enhance and prolong the effect of cocaine.
• Take drugs and HIV medication at different times. This might decrease the chance of side-effects. Always keep the dose of drugs low when taking medication at the same time.
• Since it may be a long night, bring enough medication with you and stick to your medication schedule.
• Talk to your doctor about the interaction of your HIV medications with intoxicants.
• Information on interactions between substances and HIV medications . can be found here

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Sources:

• Cocaine– Wikipedia
• Cocaine | drugscouts.de
• Kokain – drugcom
• SONAR BERLIN — SUSTANZEN Kokain (safer-nightlife.berlin)
• Kokain (chemie.de)
• Substanzen / Kokain (saferparty.ch)