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When used, cocaine increases alertness, causes euphoria, and leads to an overall sense of confidence and well-being. It’s a popularly used drug because of these effects. Any cocaine use is a risk to your health and safety, but using a high amount of cocaine or consuming cocaine laced with other substances can cause a cocaine overdose, which can be life-threatening.
Rising Risk of Cocaine Overdose in the US
The rate of cocaine use in the United States has held steady at around 2% of individuals (about 6.8 million people) for nearly two decades, but overdose fatalities that involve cocaine have substantially increased in the past 10 years, rising from just a few thousand in 2013 to nearly 30,000 in 2023. Why would this be?
The Increase of Fentanyl in Cocaine
The increase in fatal cocaine overdoses can in part be linked to the fact that drug suppliers now frequently add the potent opiate fentanyl to cocaine because it heightens cocaine’s effects and makes it even more addictive. Fentanyl has a high risk of overdose death because of its high strength. In fact, there were only 730 fentanyl overdose deaths in 1999, but in 2023, there were nearly 74,000 – that’s a 10,000% increase in less than 25 years.
There is no way for a person to tell with the naked eye whether their cocaine has been mixed with fentanyl, and due to fentanyl’s extreme potency (it’s as much as 50 times more powerful than heroin), and the fact that dealers cannot mix the drugs together evenly, taking cocaine laced with fentanyl can easily lead to a fatal overdose. This is why it’s critical to use fentanyl-related safety measures if you use cocaine, such as:
- Use fentanyl test strips, which are available over the counter in most drug stores, to check your cocaine for the presence of fentanyl, and avoid cocaine that has fentanyl detected.
- Carry Narcan (or the generic form, naloxone) with you whenever possible so you can counteract an accidental fentanyl overdose from cocaine use. This is also available over the counter in many drug stores, or there’s a prescription version called nalmefene.
- If you see someone experiencing a possible fentanyl overdose from cocaine use, administer first aid. Despite widespread rumors and myths, you’re not at risk for a fentanyl overdose from skin contact with fentanyl.
Xylazine in Cocaine
Like fentanyl, another substance called xylazine has been increasingly found in mixtures of illicit drugs, including cocaine. Xylazine or “tranq” is a sedative, much like fentanyl and other opioids, but it’s not actually an opioid, so Narcan doesn’t counteract an overdose. The US DEA first found xylazine mixed in with other drugs in the early 2000s, but it started gaining popularity in the early 2020s. The DEA now finds xylazine mixed with cocaine and other drugs all throughout the country, though most commonly in the South and the West.
Due to the dangerous nature of cocaine and the increasing presence of fentanyl and xylazine in cocaine sold in the United States, the emergency room is often an entry point into the health system for people who are addicted to cocaine. If you or a loved one has had to visit the emergency room because of cocaine use, it’s time to get additional help.
Why Does Cocaine Overdose Occur?
Cocaine overdose episodes occur when a certain saturation and toxicity level is reached, which in turn overwhelms the body’s ability to regulate normal functions. In the case of cocaine, because it’s a stimulant, overdose generally causes your body’s critical functions like your heart and brain function to speed up too much and become overworked. While the likelihood of developing signs of cocaine overdose increases when ingesting large doses, toxicity can occur in low doses for some people.
Once an overdose begins, emergency medical help is needed as soon as possible. A fatal overdose of cocaine can lead to convulsions and death in 30 minutes or less in severe cases.
Cocaine Overdose Symptoms
Cocaine overdose symptoms are similar to but more severe than the normal effects of cocaine use. Cocaine’s fast absorption into the user’s system increases the risk of accidental overdose. Injecting cocaine carries the highest risk, although snorting and smoking are still incredibly risky. Because users have different body types, genetic makeups, and health histories, not all users will react in the same way to cocaine, and the amount needed to cause an overdose will vary by user.
Combining cocaine with other drugs, such as alcohol, is very popular and increases the risk of overdose. Cocaine and alcohol form a chemical called cocaethylene when combined. Cocaethylene increases the effects of cocaine and can cause heart attacks, cardiac arrest, or sudden cardiac death. It puts additional strain on the heart and liver and has been linked to severe heart damage and liver disease because of its buildup in the liver over time.
Signs of a cocaine overdose can be physical, mental, and emotional.
Mental/emotional signs may include:
- Agitation and restlessness
- Talk of impending doom
- Excitability
- Hallucinations, such as the sensation of bugs crawling under the skin
- Aggressive and violent behavior
Physical signs may include:
- Nausea or Vomiting
- A headache
- Tremors or excessive shakiness
- Vertigo
- Elevated temperature
- Irregular breathing, difficulty breathing
- Increased heart rate or blood pressure
- Chest pain
- Fever
- Incontinence
- Peripheral cyanosis (blue tint in the fingers or extremities)
- Dilated pupils
- Seizures
- Decreased responsiveness
- Paralysis
- Fainting or loss of consciousness
- Coma
Emergency medical care can treat cocaine overdose symptoms in some cases, but if help cannot arrive in time, if a person overdoses alone, or in especially severe cases of overdose, the outcome will be fatal. Seeking treatment before an overdose occurs is the best way to protect a person suffering from an addiction to cocaine.
Frequently Asked Questions About Cocaine Overdose
If there’s fentanyl in cocaine, will touching cocaine harm me?
No, the risk of experiencing any effects from touching fentanyl, much less a dangerous overdose, is extremely low. Despite prior misinformation and presumptive reports, fentanyl is not easily absorbed through the skin, and there have been no substantiated cases of fentanyl toxicity or overdose from touching fentanyl.
Should I give naloxone for a suspected cocaine overdose?
Yes, it’s generally advised to administer Narcan or naloxone in a cocaine overdose because what appears to be a cocaine overdose may actually be an overdose of fentanyl if there was fentanyl in the cocaine. If fentanyl or another opioid is the culprit, the Narcan could save the person’s life. If it’s a cocaine overdose without opioids present, the Narcan won’t be harmful, so there’s no risk to administering it.
What should I do if a cocaine overdose occurs?
If you believe someone is experiencing a cocaine overdose, call 911 for emergency medical help immediately and follow any instructions the emergency dispatcher provides. Administer naloxone/Narcan if you have it available, in case the overdose is actually caused by fentanyl that was unknowingly in the cocaine.
If you are ready to save yourself a visit to the emergency room and the extreme dangers associated with a cocaine overdose, it is time to get help from treatment and recovery experts.