Intravenous (IV) cocaine use involves dissolving cocaine hydrochloride powder in water and injecting it directly into a vein. This method bypasses slower absorption routes like snorting, delivering the substance immediately into the bloodstream. By entering the circulatory system directly, the compound reaches the brain within seconds, producing a rapid and powerful effect.
The Immediate Physiological Impact
Injecting cocaine ensures nearly 100% bioavailability, leading to an immediate and intense onset of effects known as a “rush.” The drug travels to the brain within seconds, triggering a massive release of the neurotransmitter dopamine. This sudden surge of dopamine is responsible for the intense euphoria that characterizes the experience.
Simultaneously, the body undergoes a series of physiological changes. Cocaine acts as a potent vasoconstrictor, narrowing blood vessels and forcing the heart to work harder. This causes heart rate and blood pressure to rise to dangerous levels. Other acute effects include a hazardous increase in body temperature (hyperthermia), dilated pupils, tremors, and muscle twitches.
Health Complications from Injection
The physical act of injecting drugs carries its own set of health risks. Repeatedly puncturing veins with needles can cause them to collapse or form permanent scar tissue known as “track marks.” This damage can render veins unusable for future injections.
Skin and soft tissue infections are common at injection sites. Bacteria from the skin or contaminated equipment can cause cellulitis, a deep skin infection, or abscesses, which are painful, pus-filled pockets. If untreated, these infections can spread and lead to more serious systemic problems.
A primary danger of IV drug use is the transmission of bloodborne viruses. Sharing needles, syringes, or other paraphernalia can directly transmit viruses like HIV and Hepatitis B and C. Additionally, bacteria entering the bloodstream from non-sterile injections can travel to the heart, causing a life-threatening infection of its lining or valves called endocarditis.
Systemic and Long-Term Health Consequences
Consistent intravenous cocaine use inflicts cumulative damage on major organ systems, often accelerated by the high doses this method facilitates. The cardiovascular system is especially affected, with chronic use leading to conditions like cardiomyopathy, where the heart muscle weakens. It also increases the risk of an aortic dissection, a tear in the body’s main artery, and heart attack due to persistent high blood pressure.
Neurological damage is also a major consequence. The strain on blood vessels increases the likelihood of both ischemic strokes (from blockages) and hemorrhagic strokes (from bleeding in the brain). Long-term use can also lead to recurring seizures and lasting cognitive impairments affecting memory, attention, and decision-making.
Other organs are also impacted by the drug’s effects on blood vessels, which can reduce blood flow throughout the body. The kidneys can be damaged by high blood pressure and the stress of filtering the drug and its cutting agents. The liver, responsible for metabolizing cocaine, can also suffer damage from the toxic burden.
Psychological and Neurological Effects
The intense euphoria from injecting cocaine powerfully reinforces the brain’s reward pathways, which can quickly lead to a substance use disorder. This pattern often results in the rapid development of tolerance. This compels individuals to use larger and more frequent doses to achieve the same effect.
This cycle of escalating use contributes to severe psychological consequences like intense anxiety, irritability, and restlessness. Paranoia is a common effect that can develop into stimulant-induced psychosis, characterized by delusional thinking. This state can involve tactile hallucinations (like insects crawling under the skin), as well as auditory and visual hallucinations.
The “crash” following the brief high is marked by an intense period of negative feelings, including severe depression, agitation, and fatigue. The contrast between the euphoria and the crash creates a powerful compulsion to use the drug again. This entrenches the cycle of use and can alter brain structure and function over time.
Overdose and Polysubstance Risk
The risk of a fatal overdose is high with intravenous cocaine use. The rapid delivery makes it difficult to gauge a dose, and the full effect is felt instantly, leaving no time to react if too much is used. Signs of a cocaine overdose include a sudden heart attack, stroke, seizure, or complete respiratory failure.
This danger is amplified by polysubstance use, particularly injecting cocaine with an opioid like heroin, a mixture known as a “speedball.” This combination is hazardous because cocaine’s stimulant effects can mask the depressant effects of the opioid. An individual may not feel the respiratory depression from the heroin, leading them to believe they can handle a higher dose.
The opposing effects of the drugs create an illusion of stability. However, cocaine’s effects wear off much faster than those of most opioids. When the stimulant effect subsides, the unmasked respiratory depression from the heroin can cause a sudden and fatal cessation of breathing.