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Cocaine Routes of Administration: Dangers of Snorting, Injecting, and Smoking

Cocaine is a powerful and highly addictive stimulant drug that people use recreationally for its energy-enhancing, euphoric effects.1 People use two chemical forms of cocaine: the water-soluble hydrochloride salt and the water-insoluble cocaine base, also known as freebase cocaine or crack.1 There are different ways a person can ingest cocaine, including snorting, injecting, and smoking, or by rubbing it onto their gums.1

Different routes of administration change cocaine’s effects and intensity. Regardless of the way cocaine is used, the high can be intense but relatively short in the duration of action compared with other potentially addictive substances. These characteristics contribute to binge use, where a person who uses cocaine continues taking the substance to prolong the high.

Any cocaine use exposes users to the risk of developing a stimulant use disorder, the clinical diagnosis for cocaine addiction. However, intranasal use of cocaine may result in a slower, more gradual progression to a stimulant use disorder, which may occur over months to years.3 Intravenous cocaine use or smoking cocaine can also be more closely associated with the rapid development of a stimulant use disorder compared with intranasal use.3 These routes of administration are also linked to a faster progression to a more severe level of a stimulant use disorder, which can develop within weeks to months.3

Using cocaine is not without risk, not just of addiction but because cocaine—even on the first use—can result in severe cardiovascular and neurological consequences like heart attacks, heart failure, seizures, stroke, and even sudden death.1

If you or a loved one uses cocaine, it is beneficial to understand the risks associated with the various methods of cocaine use. This article will help you learn more about:

  • The effects and risks associated with cocaine routes of administration, including smoking crack cocaine and injecting, smoking, or oral ingestion of cocaine.
  • Signs of cocaine use.
  • How to get help for yourself or a loved one with a stimulant use disorder.

Snorting Cocaine

People can inhale the powdered form of cocaine by snorting it, a practice sometimes referred to as intranasal cocaine use.1 Snorting cocaine is the most common route of administration of powdered cocaine.2 When someone snorts cocaine by inhaling the powder through the nostrils, the drug is absorbed into the bloodstream through the nasal tissues.1 The onset of effects after snorting cocaine is slower compared to other routes of administration, but the high lasts longer, with an average duration of 15-30 minutes.1

Risks of Snorting Cocaine

Intranasal cocaine use is associated with several risks to the nasopharyngeal region.2 Regularly snorting cocaine can result in in:1, 2

  • Loss of smell.
  • Nosebleeds.
  • Difficulty swallowing.
  • Hoarseness.
  • Mouth sores.
  • Tooth erosion.
  • Sinusitis (e.g., inflammation of the sinuses).

Regularly snorting cocaine can also lead to irritation or perforation of the nasal septum, the bone and cartilage divider between your nostrils, which can result in chronic nasal inflammation and a runny nose.2, 3 Studies show these problems can develop as soon as 3 weeks after regular intranasal cocaine use.2 People can also develop a deviated septum, which means that the septum is bent or crooked.4

Injecting Cocaine

Injecting cocaine involves dissolving powdered cocaine in water and injecting it into the veins with an intravenous (IV) needle.1 Cocaine injection provides an immediate release of the drug into the bloodstream, which results in increased intensity of its effects.1 The onset of cocaine’s effects via injection usually starts within seconds and last 5-10 minutes.1

Risks of Injecting Cocaine

Risks of injecting cocaine can include:3, 5, 6

  • Collapsed lung.
  • Blood clots.
  • Collapsed or scarred veins.
  • Damage to the blood vessels.
  • Endocarditis (e.g., inflammation of the heart valve).
  • Bacterial skin infections.
  • Bloodborne diseases (e.g., hepatitis C, HIV/AIDs).
  • Lung infections (e.g., tuberculosis).

Smoking Cocaine

Smoking cocaine involves heating the rock crystal form of cocaine, also called freebase cocaine or crack, and inhaling the vapor or smoke into the lungs.5 People may also sprinkle crack on marijuana or tobacco and smoke it like a cigarette.5 Inhalation causes crack to be rapidly absorbed into the bloodstream, with effects beginning within seconds.1, 7 As with injection, the effects from smoking cocaine may last only 5-10 minutes.1, 5

Several factors contributed to the crack epidemic in the 1980s.1, 8 Crack was more economically accessible as it was cheaper to produce and buy. This combined with the instantaneous and intense high contributed to an increase in crack addiction, deaths, and drug-related crimes, particularly within the African American communities of the inner cities.8 While the consequences of crack today are not as substantial as they were in the 1980s, the effects of crack still threaten communities in the U.S. and worldwide. According to the 2021 National Survey on Drug Use and Health (NSDUH), almost 1,000,000 people aged 12 and older used crack cocaine in the past year.9

Risks of Smoking Cocaine

Smoking crack cocaine damages the lungs, which can result in:1, 5

  • Cough.
  • Worsened asthma.
  • Respiratory distress.
  • Pneumonia.
  • Bronchitis.

One study found that people who were chronic cocaine smokers also had an increased risk of pulmonary hypertension, a type of high blood pressure that affects arteries in the heart and lungs, and aortic dissection, or tears of the aorta.10

Recognizing the Signs of Cocaine Use

It’s not always easy to tell if someone is using cocaine. For example, you may observe certain signs when a person is high, but the intensity and duration of the effects depend on the route of administration.1

Some common signs of cocaine use include:5

  • Extreme energy and happiness.
  • Mental alertness
  • Hypersensitivity to sound, touch, or visual stimuli.
  • Paranoia.
  • Irritability.
  • Dilated pupils.
  • Muscle twitches.
  • Restlessness.

Signs that someone may be smoking cocaine can be harder to spot than with other routes of administration. However, you might notice the presence of drug paraphernalia like pipes or rolling papers. You may also notice other signs of addiction, such as problems at home, school, work, or in relationships, or cocaine withdrawal symptoms, such as depression, insomnia, or fatigue.11

Getting Help for Yourself or A Loved One

No matter what route of administration, any form of cocaine use is dangerous. People can suffer from a cocaine overdose after using cocaine just one time, but it can also occur unexpectedly afterward.5 People often mix alcohol or heroin with cocaine, which are dangerous combinations that can greatly increase overdose risk.5

People who use any street drug, including cocaine, also expose themselves to the risk of unknowingly ingesting additives, such as levamisole, amphetamine, or deadly opioids like fentanyl.5, 12 A person may not realize they are using cocaine that has been cut with these substances, which increases the dangers of any form of cocaine use.5 Depending on the additive, a person can experience serious health consequences, including allergic reactions, overdose, and death.1, 5

If you or a loved one is struggling with cocaine misuse or addiction, treatment is available to start the path to recovery.12 While recovery looks different for everyone, it often begins with medical detox, followed by ongoing treatment at an inpatient or residential rehab, or outpatient rehab.

Although there are no medications to treat cocaine addiction, treatment often involves a combination of behavioral therapies (e.g., cognitive-behavioral therapy), and participation in mutual support groups, such as Cocaine Anonymous (CA).5 If needed, treatment can address co-occurring mental or physical health conditions too.13

If you or a loved one are struggling with cocaine misuse or addiction, don’t wait to get help. Contact American Addiction Centers (AAC) at to speak to a caring admissions navigator about your rehab options.

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