Cocaine
coke · bag · powder
A short, intense high, and these days a real chance it's cut with fentanyl.
Educational only. Not medical advice. Information can change, so verify specifics with a current source. Dosing, interactions, and legality vary by location. In a crisis call 911 or 988.
US overdose deaths involving cocaine in 2023
higher sudden-death risk when mixed with alcohol
Don't drive impaired, on anything. Alcohol, cannabis, stimulants, and the rest all slow your reaction time, judgment, and coordination, and stimulants can push you into aggressive, reckless driving. Using two at once stacks the impairment. It is illegal in all 50 states, and a DUI is the same charge whether it was alcohol or another drug. The bigger point: impaired driving kills people who had nothing to do with your night. If you feel different at all, you drive different. Hand over the keys, get a ride, or wait it out.
Cocaine is a strong, short-acting stimulant made from the coca plant. It's usually a white powder people snort, and as crack, smoked. The high comes on fast and fades fast, which is a big part of why people keep chasing it.
It's not a fringe drug. In 2023, about 3.1% of US 18-to-25-year-olds, around a million people, used cocaine in the past year. What's changed is the supply. The bigger danger now is what else is in the bag.
Most drugs nudge dopamine up. Cocaine jams the off-switch. It blocks the transporter that normally clears dopamine out of the synapse, so dopamine floods the reward circuit and stays there. That's the intense euphoria, and an unusually strong pull to do it again.
With that much dopamine flooding through, the brain dials its own system down. The reward circuit gets less sensitive, so you need more for the same high and feel flat and low in between. That's what drives the crash and the constant redosing.
Short term, you get intense euphoria, energy, talkativeness, and alertness, while your heart rate, blood pressure, and body temperature climb. As it wears off, the crash sets in: fatigue, irritability, and a flat, low mood that pulls hard toward another bump.
Over time the reward circuit adapts, which drives tolerance, heavier use, and dependence. It's also hard on the body directly. Any amount can be a toxic dose, and it can trigger heart attacks, strokes, and seizures, including in young, otherwise healthy people.
Based on about a gram on a typical weekend at roughly $100 a gram. Real spending swings a lot with how often you use and local prices, so run your own in the savings calculator.
The supply is the biggest risk. Dealers increasingly mix fentanyl into cocaine, and you can't see, smell, or taste it.
US overdose deaths involving cocaine rose to about 29,449 in 2023, largely because of fentanyl showing up alongside it.
Even uncut, cocaine strains the heart enough to cause chest pain, dangerous rhythms, a heart attack, or a stroke, sometimes on a first use. Mixing it with alcohol makes your liver produce cocaethylene, a longer-lasting byproduct tied to an 18 to 25 times higher risk of sudden death than cocaine alone.
- Assume it could contain fentanyl, because you can't tell by looking. Test it with fentanyl test strips and carry naloxone (Narcan). Cocaine isn't an opioid, but the contamination is what's killing people, and naloxone reverses that part.
- Never mix it with alcohol. Your body makes cocaethylene, which is harder on your heart and sharply raises the risk of sudden death.
- Don't use alone. If you do, call the Never Use Alone line (1-800-484-3731) so someone can send help if you stop responding.
- Start small and go slow. The crash drives compulsive redosing, so space it out and set a hard limit before you start.
- Don't stack it with other stimulants or with opioids. The heart and overdose risks pile up fast.
- Know the red flags: chest pain, a racing or irregular heartbeat, a severe headache. Call 911. Cocaine causes heart attacks and strokes even in young, healthy people.
W.I.R.E. is an educational harm-reduction resource, not a substitute for a doctor or crisis professional. In an emergency call 911. For free, confidential help anytime, call or text 988 (Suicide & Crisis Lifeline) or 1-800-662-4357 (SAMHSA).
We work to cite and update every claim, but we cannot guarantee it is complete or current. Verify anything you act on with an authoritative source, especially dosing, drug interactions, and legality, which change over time and vary by location.
LAST FACT-CHECKED · 2026-06-16