Acute cocaine toxicity: warning signs, emergency action and recovery

Acute toxicity means harm caused by a single episode of use or a short run of use, as opposed to the long-term effects of regular use. With cocaine, a stimulant, FRANK lists the common immediate risks as a panic attack, heart attack and stroke if someone takes too much. The page also says cocaine can cause a fit, even in healthy young people.

Cocaine is a white powder usually snorted, though crack and freebase forms are smoked and powder or crack can be injected. FRANK says injecting is much more dangerous than snorting or smoking, and that the effects of smoking crack are almost instant.

FRANK describes how cocaine can make people feel and behave, and the NHS describes general symptoms of poisoning. Taken together, these are the things that should make you worried.

• A very fast or pounding heartbeat, a high body temperature or feeling very hot (FRANK lists a faster heart rate and raised body temperature among the effects).

• Severe anxiety, panic, paranoia, agitation or aggression.

• Confusion, drowsiness or a sudden change in how the person is behaving (the NHS lists confusion and feeling sleepy among the symptoms of poisoning).

• Difficulty breathing, blurred vision or being sick.

• A seizure (fit).

• Collapse or loss of consciousness.

FRANK says that if you or someone else needs urgent help after taking drugs or drinking, you should call 999 for an ambulance and tell the crew everything you know, because it could save their life. The NHS poisoning advice says to call 999 or go to A&E if someone has lost consciousness, has stopped breathing, has severe difficulty breathing or has a seizure, and not to drive yourself to A&E.

While waiting for help, the NHS advises starting CPR if someone is unresponsive and not breathing, putting them in the recovery position if they are unconscious but breathing, and keeping checking their breathing. If someone is awake, keep talking to them. Try to find out what was taken, and keep any packaging to show the ambulance crew. Do not try to make them sick, and do not give them anything to eat or drink.

People often hesitate to call for help because of the legal position of cocaine, which FRANK lists as a Class A drug. The priority in an emergency is the person's life, and telling the ambulance crew exactly what was taken helps them treat the person quickly.

The NHS says people with poisoning need to be treated in hospital because it can make you seriously unwell and can be life threatening. Treatment depends on what caused the poisoning and may include antidotes, a charcoal drink for some poisons, treatment for symptoms such as fluids given into a vein for dehydration, and removing the substance from the body. The NHS adds that people with no symptoms may not need treatment but may still need monitoring for several hours in case they become unwell.

Cocaine itself does not have a specific antidote listed in the sources reviewed for this page, so hospital care focuses on monitoring and treating the effects, such as heart problems, seizures and raised temperature, as clinicians judge necessary. The treating team will usually also ask about other drugs and alcohol, because FRANK warns that mixtures are more dangerous.

FRANK says regular use of cocaine can make people feel depressed, run-down, anxious and paranoid, can bring previous mental health problems to the surface, and may carry more risk if a relative has had mental health problems. It also says some people feel down, anxious and paranoid the next day or longer.

Over time, snorting cocaine damages the cartilage in the nose. Crack smoked regularly can cause breathing problems and chest pain. Taking cocaine in pregnancy can damage a baby, and FRANK lists miscarriage, premature labour and low birth weight among the risks. FRANK also says cocaine is very addictive, because regular use changes how the brain releases dopamine.

The NHS says a GP may be a good place to start. They can discuss the problem and help get you into treatment, usually by referring you to a local drug service, or you can approach a local drug treatment service yourself. FRANK runs a helpline and a service finder. The NHS notes that charities and the NHS provide most drug treatment, and that there are also private organisations, which you would need to pay for.

At a first appointment, staff ask about your drug use, work, family and housing, and agree a treatment plan with you, and you are given a keyworker. The NHS says treatment may include talking therapies such as CBT and self-help groups, and harm reduction such as testing and treatment for hepatitis or HIV. Treatment can take place at home or, where intensive help is needed, as a hospital inpatient or in residential rehabilitation.

Emergency treatment for poisoning is delivered by the NHS through 999 and A&E. Longer-term support is usually through NHS and charity-run drug services, which you can reach through a GP or by self-referral. Private drug and alcohol treatment exists and is paid for by the person, but it does not replace calling 999 in an emergency.