Short answer: Cocaine is a stimulant made from the leaves of the coca plant. It has a narrow medical use as a nasal anesthetic, which is why it is Schedule II rather than Schedule I. Illicit cocaine, sold as powder or as smokable crack, is a major cause of heart attacks and overdose deaths, increasingly because it is contaminated with fentanyl.
Key takeaways
- What it is: Cocaine is a stimulant and local anesthetic and a Schedule II controlled substance in the US.
- Medical use: Nasal anesthesia in procedures.
- Timing: effects start in seconds to minutes and last 5 to 90 minutes.
- Most dangerous mix: MAOIs, which can cause dangerous rise in blood pressure.
- Naloxone: it does not reverse this drug, but give it whenever opioids could be involved.
- Dependence risk: Very high.
- Legal route: no approved US product for personal use; possession without a prescription is a crime.
What is cocaine?
Cocaine blocks the reuptake of dopamine, norepinephrine, and serotonin, which produces euphoria and stimulation. It also blocks nerve signals, which made it the first local anesthetic. FDA-approved 4% nasal solutions are still used to numb and shrink the lining of the nose before procedures.
Cocaine causes euphoria, energy, talkativeness, alertness, and reduced need for sleep and food, along with a fast heart rate, high blood pressure, dilated pupils, and raised temperature.
Quick facts
| Fact | Cocaine |
|---|---|
| Chemical name | Cocaine hydrochloride (powder); cocaine base (crack) |
| Medical brands | Goprelto, Numbrino (4% nasal solution) |
| Street names | Coke, blow, snow; crack, rock |
| Drug class | Stimulant; local anesthetic |
| US legal status | Schedule II |
| How it is used | Snorted, smoked (crack), or injected |
| Onset | Seconds (smoked or injected) to minutes (snorted) |
| Duration | 5 to 90 minutes |
| Half-life | About 1 hour |
How long does cocaine last?
- Starts working: Seconds to minutes
- Effects last: 5 to 90 minutes
- Half-life: About 1 hour
Cocaine itself clears in hours, but its metabolite benzoylecgonine is detectable in urine for 2 to 4 days, and longer after heavy use.
Timing varies with the dose, the form, how it is taken, liver and kidney function, age, and other drugs taken at the same time.
What are the biggest risks of cocaine?
Heart: cocaine is a leading cause of drug-related heart attacks, even in young people without heart disease. It also causes dangerous heart rhythms, aortic tears, and strokes.
Other harms: nosebleeds and damage to the nasal septum from snorting, lung damage from smoking crack, seizures, paranoia, and psychosis.
Levamisole: a deworming drug often used to cut cocaine can destroy white blood cells and cause skin tissue to die.
Warning: Cocaine is frequently contaminated with fentanyl. People who do not use opioids have no tolerance, and many cocaine-related deaths now involve fentanyl. Test with fentanyl test strips and carry naloxone.
What should you never mix with cocaine?
| Combined with | What happens | Risk level |
|---|---|---|
| Alcohol | Forms cocaethylene, more toxic to the heart than either drug | High risk |
| Heroin or fentanyl ("speedball") | Overdose when cocaine wears off; heart strain | Very high risk |
| Other stimulants | Extreme heart strain, overheating | Very high risk |
| MAOIs | Dangerous rise in blood pressure | Potentially fatal |
| Beta-blockers (in emergencies) | May worsen blood pressure in cocaine toxicity | Clinicians use caution |
Check any combination with the DoseUses combination checker or ask a pharmacist.
What are the signs of a cocaine overdose, and what should you do?
Cocaine overdose can cause chest pain, a racing or irregular heartbeat, very high temperature, severe agitation, seizures, stroke, and sudden collapse. Heart attack can happen even with first-time use.
If someone may be overdosing
- Call 911 for chest pain, a seizure, trouble breathing, signs of a stroke (face drooping, weakness on one side, slurred speech), a very high body temperature, or if the person collapses.
- Move them somewhere cool and calm, loosen tight clothing, and cool the skin with water. Do not try to hold them down.
- If they become unresponsive or their breathing slows, give naloxone. Street stimulants are often contaminated with fentanyl.
- For advice when the person is awake and stable, call Poison Help at 1-800-222-1222.
Is cocaine addictive, and what is withdrawal like?
Cocaine is highly addictive. Withdrawal is mainly psychological but can be severe and is a common trigger for relapse.
- Hours to daysCrashExhaustion, depression, increased appetite, cravings.
- Weeks 1 to 10WithdrawalLow mood, poor concentration, irritability, cravings.
- MonthsExtinctionCravings triggered by cues can persist for months.
See the withdrawal timelines and the full cocaine withdrawal guide.
Is cocaine legal?
Cocaine is Schedule II because of its limited medical use as a topical anesthetic, used by clinicians in hospitals and clinics. It is never dispensed to patients to take home.
- Possession: under federal law, a first conviction for possessing any controlled substance without a valid prescription can bring up to one year in prison and a minimum fine of $1,000. Penalties rise with prior convictions.
- Trafficking: trafficking 500 grams or more of cocaine powder, or 28 grams or more of crack, carries a mandatory minimum of 5 years in federal prison. The Fair Sentencing Act of 2010 reduced, but did not eliminate, the gap between crack and powder penalties.
- State law: states set their own penalties, and most drug cases are prosecuted under state law. Penalties range from a civil fine to long prison terms depending on the state, the amount, and prior record.
Outside the United States
| Country | Status |
|---|---|
| United Kingdom | Class A |
| Canada | Schedule I |
| Bolivia and Peru | Coca leaf legal for traditional chewing and tea; cocaine prohibited |
| International | Cocaine and coca leaf: Schedule I of the 1961 Single Convention |
Frequently asked questions about cocaine
Is cocaine used in medicine?
Yes, as a 4% nasal solution to numb and shrink the nasal lining before procedures. It is only used by clinicians.
How long does cocaine stay in your system?
Cocaine itself clears in hours, but its metabolite benzoylecgonine is detectable in urine for 2 to 4 days, and longer after heavy use.
Why is cocaine with alcohol dangerous?
The liver combines them into cocaethylene, which lasts longer and is more toxic to the heart.
Can naloxone help in a cocaine overdose?
Naloxone does not reverse cocaine, but give it if the person is unresponsive or breathing poorly, because fentanyl is often present.
What is the difference between crack and cocaine?
Crack is cocaine converted into a smokable base. It reaches the brain faster, producing a shorter, more intense high and a higher risk of addiction.
Sources
- Goprelto (cocaine) prescribing information, DailyMed, US National Library of Medicine.
- Cocaine DrugFacts, National Institute on Drug Abuse.
- Controlled Substance Schedules, DEA Diversion Control Division.
- 21 U.S.C. 844, Penalties for simple possession, Legal Information Institute, Cornell Law School.
- 21 U.S.C. 841, Prohibited acts A (trafficking penalties), Legal Information Institute, Cornell Law School.
- National Helpline, Substance Abuse and Mental Health Services Administration.
- FindTreatment.gov, Substance Abuse and Mental Health Services Administration.
- International drug control conventions, United Nations Office on Drugs and Crime.
This guide summarizes the sourced DoseUses Cocaine profile, written from FDA labels, DEA rules, and federal health agencies. It is educational and is not medical advice. Last updated October 5, 2026.
