Swallowing cocaine is an extremely hazardous route of administration that carries a high risk of severe systemic poisoning. This act, whether intentional (to conceal the substance) or accidental, constitutes a genuine medical emergency requiring immediate attention. The severe consequences stem from the drug’s potent effects on the central nervous and cardiovascular systems. These systems can be rapidly overwhelmed by the dose delivered through the digestive tract, making emergency medical help the only appropriate response.
The Biological Absorption Pathway
When cocaine is swallowed, it must first pass through the gastrointestinal (GI) tract before entering the bloodstream. This process results in a significantly delayed onset of the drug’s effects compared to routes like snorting or injecting. The drug is detectable in the blood within approximately 30 minutes, with peak concentrations reached between 50 and 90 minutes after ingestion.
The drug’s journey involves passing through the acidic environment of the stomach, where some degradation occurs. The majority of the absorption into the systemic circulation happens in the small intestine. This oral route is characterized by a low bioavailability, meaning only a fraction of the total ingested dose reaches the bloodstream unchanged.
Oral bioavailability is estimated to be around 33%, though it can range from 15% to over 60%, depending on the dose and individual metabolism. The drug undergoes extensive first-pass metabolism in the intestines and liver before it can affect the rest of the body. At high doses, this metabolism can become saturated, potentially allowing a disproportionately large amount of the drug to bypass the liver and enter the bloodstream.
Acute Gastrointestinal and Systemic Toxicity
The medical consequences of swallowing cocaine are severe, categorized into local effects on the GI tract and overwhelming systemic toxicity. Cocaine is a potent vasoconstrictor, causing blood vessels to narrow. This action on the blood vessels supplying the stomach and intestines can lead to local ischemia, or reduced blood flow.
This lack of oxygenated blood can cause tissue damage, ulceration, and, in severe cases, perforation of the intestinal wall, resulting in a life-threatening infection. Ingestion often involves drug packets, a practice known as “body packing” or “body stuffing.”
The greatest systemic danger arises from “dose dumping,” which occurs if the packaging ruptures within the GI tract. Whether the packaging is a professionally prepared packet for smuggling or a hastily wrapped quantity, rupture leads to the sudden, massive release of a concentrated dose of cocaine. This dose is absorbed simultaneously, leading to immediate, overwhelming toxicity.
Systemic toxicity results from cocaine’s action as a sympathomimetic, causing a surge of stimulating neurotransmitters like norepinephrine. This leads to severe strain on the cardiovascular system, manifesting as rapid heart rate (tachycardia) and dangerously high blood pressure (hypertension).
These effects dramatically increase myocardial oxygen demand, which can precipitate a myocardial infarction, or heart attack, even in young individuals. Neurological symptoms, including seizures, malignant encephalopathy, and severe hyperthermia, also represent life-threatening complications of this systemic exposure.
Immediate Medical Response and Intervention
Anyone who has swallowed cocaine must be immediately transported to an emergency department for specialized medical management. Clinical care begins with supportive measures, assessing the patient’s airway, breathing, and circulation. Continuous cardiac monitoring is initiated to detect and manage life-threatening arrhythmias, which are common in cocaine toxicity.
The primary approach to managing the drug’s stimulatory effects involves the administration of benzodiazepines, which control agitation, hypertension, and seizures. Managing hyperthermia is also a major concern, as an elevated core body temperature can lead to muscle breakdown (rhabdomyolysis) and kidney failure. Cooling measures are implemented immediately to lower the patient’s temperature.
For cases involving the ingestion of packaged drugs, or body packing, the medical team focuses on GI decontamination. Whole bowel irrigation uses large volumes of a specialized solution to flush the entire GI tract and encourage the passage of the packets. Surgical intervention becomes necessary if the patient develops signs of intestinal obstruction, perforation, or uncontrolled toxicity following a packet rupture.