Cocaine is a central nervous system stimulant and is commonly known as a “party” drug. There is a good reason for this slang term, as cocaine use leads to increased energy and alertness and can reduce the effects of alcohol, enabling someone to drink more. These effects come with a high cost, however, and cocaine use produces a variety of chemical changes in the brain, some may even be lifelong. In this article, we examine the exact mechanism(s) of action that cocaine utilizes to produce its effects.
How Cocaine Affects The Brain
Cocaine is a very potent drug, and it affects a variety of neurotransmitters in the brain. Neurotransmitters are chemicals that are responsible for moderating and sending signals throughout the brain and sending signals from the brain to the body. The most direct influence in the case of cocaine is on the neurotransmitter dopamine, however, it also produces changes in the serotonin and norepinephrine neurotransmitter systems. In essence, cocaine promotes the release of dopamine, serotonin, and norepinephrine while also preventing reuptake, a chemical recycling process used in the brain which also maintains steady levels of these neurotransmitters. Also, because of cocaine’s particular structure, it is easily able to penetrate the blood-brain barrier and strongly impact the levels of these neurotransmitters.
Using cocaine will quickly produce a flood of dopamine, serotonin, and norepinephrine while also acting as a local anesthetic, numbing mucus membranes that are directly exposed to it. The flood of the neurotransmitter dopamine is mostly responsible for the mental euphoria and to a lesser degree the increased physical energy. Increased serotonin also contributes to euphoria in a minor fashion, and produces elevated mood and sense of well being while using the drug. Norepinephrine is both a neurotransmitter in the brain, as well as a hormone in the blood, and promotes the release of adrenaline. Norepinephrine is the main culprit for the stimulant effects, both mental and physical.
Chronic cocaine use and the subsequently increased levels of these neurotransmitters causes the brain to undergo a process called downregulation. This is an attempt by the brain to maintain balance and is a direct response to these heightened levels. Downregulation is the act of the brain turning “down” its sensitivity to these chemicals since they are consistently present at very high levels. This has the effect of producing tolerance, since the brain will now respond in a reduced way when these neurotransmitters are produced. Finally, prolonged cocaine use may alter the signaling pathways and production of these neurotransmitters, particularly dopamine, and result in long-term changes to the user’s brain structure.
The surge of dopamine and norepinephrine produced by cocaine use creates a great rush of euphoria combined with a feeling of giddy energy. This can result in someone feeling like they can barely contain their excitement about life. Music often becomes much more meaningful and energizing and a person may also begin developing grand plans for the future. The increased energy may increase reaction time temporarily as well as create an urge to do anything and everything from board games, dancing, work out, hike, or really anything physical. Likewise, both male and female sex drive may be enhanced while doing cocaine.
The comedown from cocaine is just as intense as the high, although it heads in the opposite direction. The high from snorting cocaine can last around 45 minutes to 1 hour. Cocaine has a very short half-life (studies vary but between 1-2 hours) which means that the body metabolizes and eliminates it quite quickly. This results in plummeting levels of dopamine, serotonin, and norepinephrine and can feel like a crash. The longer someone has been doing cocaine, the worse this will feel. Often, due to the lowered dopamine and serotonin, a deep sense of dread or impending doom accompanies a cocaine comedown. This can cause someone to feel like their world is coming to an end, and further encourages more cocaine use.
Most likely due to a combination of dopamine and serotonin increasing, cocaine users will often feel like the people they are around while using cocaine are their best friends in the world. These neurotransmitter surges can produce great feelings of intimacy and connection while the drug is in a user’s body. Repeatedly stating someone’s feelings for their friends is quite common in groups where cocaine is used. This can result in a feeling of tight-knit camaraderie with others who are around a person when they are doing cocaine.
As mentioned in the section above, someone may feel extremely eager for the future and feel a sense of childlike excitement. Additionally, experiencing an inflated sense of confidence and faith in ones abilities is very common. Similar to the sensory effects, when cocaine starts to wear off, the comedown is very harsh emotionally. All of the positive and energetic feelings are quickly replaced by their opposites, leaving someone feeling drained, alone, and hopeless. Avoiding these negative repercussions may be as responsible for chronic cocaine use as the actual positive feelings produced by doing the drug.
The increase in energy produced by cocaine use can result in a variety of hyperactive or obsessive behaviors. The most common behavior is nonstop talking. This typically involves intricate plans such as starting a business or some form of organization. This can also include uncharacteristic honesty or openness about things a person may not normally discuss. Foot tapping, pacing, and chain-smoking are also done very compulsively while high on cocaine. A cocaine user may also be seen to repeatedly rub their nose or run their tongue around the inside of their mouth, as the numbness produced through cocaine use makes the mouth and nose feel strange or interesting.
Appetite is heavily suppressed through cocaine use, so users very rarely eat while high on the drug. This is primarily due to norepinephrine release, and this also produces a great feeling of anxious energy. A cocaine user may become much more active than they normally are, wanting to go for walks or adventures of some sort. Similarly, sex drive is increased in both men and women who use cocaine so a tendency to seek out sex is very common while high. Finally, cocaine tends to increase risk-taking behavior in general so people may be more prone to making very dangerous choices while using cocaine. This can include doing drugs they normally would not, drinking much more than they normally would, and getting into fights.
How Cocaine Affects The Body
The physical effects of cocaine use are primarily due to norepinephrine release, and the subsequent increase in adrenaline that this produces. This has a far-reaching effect on many different body systems and can increase the risk of overdose or death. Being a stimulant, cocaine will speed up and amplify almost every system it affects. Let’s look at each major body system in turn:
Norepinephrine is a very powerful neurotransmitter, and the norepinephrine-induced release of adrenaline has a massive impact on the cardiovascular system. Adrenaline is a critically important hormone and is most heavily used during the “fight-or-flight” response to boost short term physical and mental performance when facing predators, and thus increase survivability. This misappropriation of the adrenal system can cause heart rate and blood pressure to spike dramatically while also causing arteries to get smaller through vasoconstriction which has the effect of reducing the oxygen which is available to tissues and organs. This can unnecessarily tax other vital organs such as the liver, kidneys, lungs, and especially the heart itself. The way cocaine works increases the demand for oxygen while simultaneously reducing the body’s ability to supply it. This is a dangerous combination and can increase risks to someone’s health and even their life. There are a variety of cardiac abnormalities, heart and organ damage, and conditions of which cocaine is thought to be a contributor.
While the drug cocaine itself has very little direct effect on the lungs, the route someone chooses to do it can introduce complications. People who smoke cocaine (not crack, but freebase cocaine) can do extensive damage to the entire mouth, esophagus, and bronchioles or alveoli of the lungs. Pulmonary edema, asthma, emphysema, bronchitis, and pneumonia are quite common in people who smoke cocaine. Additionally, people who snort cocaine can do severe damage to the nose and sinuses along with the esophagus. When injecting cocaine, the risk of pulmonary embolism is radically increased. Some of the most frequently reported issues, where cocaine has played a role, include wheezing, shortness of breath, chest pain, fever, and coughing up black mucus.
While cocaine increases the function of other systems in the body, it actually slows or even stops digestion. This is a direct result of increased adrenaline levels which, in an attempt to increase survival chances, causes the body to redirect blood from digestion towards functional muscles and vital organs like the heart and lungs. That being said, cocaine itself does pass through the digestive tract after being snorted and can inflict damage on its way through the stomach or intestines. One of the more common issues is known as mesenteric ischemia, which is due to decreased blood flow to the intestines resulting in tissue damage and gangrene. This may then progress to bowel perforation and intraperitoneal hemorrhage (intestinal contents leaking into the abdomen), which is extremely dangerous and frequently fatal if not immediately treated.
Cocaine has some very serious repercussions on reproduction for both men and women. The highest risk is with women who are pregnant, for both the mother and child, although cocaine negatively affected the fertility of all chronic users. The way in which fertility is effected differs between sex, so we will take a look at each in turn:
- Male Reproduction¹: While cocaine hasn’t been implicated in male infertility per se, it has been associated with subfertility in men. This is due to chronic cocaine use (5+ years) resulting in lower sperm counts, lower sperm motility (ability to swim), and a much higher incidence of abnormal sperm in the ones which were present.
- Female Reproduction¹: While comprehensive and controlled human cocaine studies are hard to come by, it is known that cocaine alters hormone levels and regulation. This, coupled with vasoconstriction, may lead to menstrual abnormalities such as very light or absent periods. Furthermore, cocaine has been implicated as a contributor to fallopian tube damage and blockage. Damaged or blocked fallopian tubes is one of the leading causes of infertility in American women today.
- During Pregnancy¹: Cocaine can have a devastating and deadly impact on developing fetuses, possibly resulting in fetal and/or maternal death. Some of the common issues which are attributed to cocaine stem from a reduction in uteroplacental blood flow and circulation due to vasoconstriction. This is most likely responsible for a variety of birth defects such as low birth weight, premature birth, cognitive and behavioral deficits, and a variety of birth defects. Additionally, there is a much higher rate of miscarriage, placental abruption, and intrauterine growth retardation. Cocaine is also passed into the milk of nursing mothers, so even after the child has been born cocaine still poses a risk if the mother is actively using. Finally, there is a greatly increased risk of sudden infant death syndrome in children born to mothers who used cocaine while pregnant.
To find out more about cocaine addiction and treatment, take a look at our cocaine recovery articles below:
- University of South Alabama Department of Obstetrics and Gynecology: Reproductive Risks of Cocaine
- Yale University School of Medicine: Uteroplacental Blood Flow – The Story of Decidualization, Menstruation, and Trophoblast Invasion
- The American Fertility Society: Association of Cocaine Use with Sperm Concentration, Motility, and Morphology