Cocaine is a powerful, highly addictive central nervous system stimulant that produces an intense but short-lived euphoric effect. The substance rapidly alters brain chemistry, leading to significant physiological and behavioral changes that are often immediately visible. These manifestations include signs of acute intoxication, specific marks left by different methods of administration, long-term deterioration from chronic use, and the distinct appearance during the subsequent “crash.”
Observable Signs of Acute Intoxication
Acute intoxication signs stem from cocaine’s potent stimulating effect on the sympathetic nervous system. Physically, the drug causes significant vasoconstriction and a surge in cardiac activity, resulting in a rapid heart rate and elevated blood pressure. This often leads to hyperthermia and profuse sweating (diaphoresis) as the body attempts to cool itself.
A particularly telling physical sign is mydriasis, the severe dilation of the pupils, which often appear unresponsive to light. The person may exhibit muscle twitching, tremors, or general restlessness. Behaviorally, this phase is marked by extreme energy and hyperactivity, often presenting as exaggerated confidence or grandiosity.
Speech becomes rapid, pressured, and often jumbled, reflecting the accelerated thought process. This heightened alertness frequently transitions into irritability, agitation, and anxiety. Users often display paranoia, becoming suspicious of their surroundings.
Specific Physical Markers Based on Administration Route
The physical appearance of a person using cocaine is often marked by the specific way the drug is consumed, leaving localized signs of trauma.
Intranasal Use (Snorting)
Intranasal use causes direct irritation and damage to the nasal passages due to cocaine’s corrosive nature and its blood vessel-constricting properties. Regular snorting often results in a chronic runny nose, frequent sniffing, and recurrent nosebleeds (epistaxis). Over time, this practice can lead to a visible perforation or deviation of the nasal septum. Vocal changes, such as hoarseness, may also develop from the powder irritating the throat and vocal cords as it drains.
Smoking
Smoking freebase or crack cocaine involves heating the substance and inhaling the vapor, which can cause unique thermal injuries. The use of short, often improvised, pipes frequently results in burns or blisters on the lips, known as “crack lip.” Burns can also appear on the fingers, typically the thumb and index finger, from repeatedly handling the hot pipe.
Injection
Individuals who inject cocaine often develop “track marks,” which are visible scars, bruising, or puncture marks along accessible veins. While commonly found on the forearms, these marks may be hidden in less conspicuous areas, such as the hands, feet, or groin. Repeated injection can lead to collapsed veins and skin abscesses at the injection sites.
Long-Term Physical Effects of Chronic Use
Years of cocaine use lead to profound physical deterioration. Cocaine acts as a powerful appetite suppressant, which, combined with hyperactivity and neglect of self-care, results in significant and rapid weight loss. This commonly manifests as a gaunt, emaciated look with sunken cheeks and a frail physique.
Chronic use impairs the ability to maintain personal hygiene, contributing to a disheveled and neglected presentation. Dental health suffers severely, sometimes referred to as “coke mouth,” caused by drug-induced dry mouth (xerostomia), teeth grinding (bruxism), and poor oral care. This lack of saliva leads to widespread tooth decay.
A neurological symptom of chronic use is formication, the sensation of insects crawling beneath the skin. This delusion leads to obsessive scratching and picking, resulting in open sores, scabs, and scarring. The user may also display involuntary movements, such as tics or tremors, and suffer from constant fatigue.
The Appearance During a Cocaine “Crash”
The “crash” period immediately follows acute intoxication, reflecting the depletion of neurotransmitters like dopamine. The person’s appearance shifts dramatically from agitated and energetic to one of extreme fatigue. They become pale, sometimes with a grayish pallor, and their eyes often appear droopy as they struggle to stay awake.
This phase is characterized by lethargy, hypersomnia, and a profound lack of energy. The mental state is dominated by a severe emotional low, including intense depression and anxiety that contrasts sharply with the earlier euphoria. Residual mental agitation or paranoia may persist, contributing to a disheveled and withdrawn look.