Cocaine is a potent central nervous system stimulant, consumed through various methods including snorting, smoking, and injecting. This article focuses on intravenous (IV) cocaine injection, where the drug is directly introduced into a vein using a needle and syringe. This route bypasses the digestive and respiratory systems, delivering the substance straight into the bloodstream.
The Immediate Physiological Response
Intravenous cocaine injection results in nearly 100% bioavailability, meaning almost the entire dose immediately enters the bloodstream and travels to the brain. This rapid delivery allows the drug to reach the central nervous system within seconds, producing an almost instantaneous onset of effects. The speed and intensity of this route distinguish it from other methods like snorting, where absorption is slower and the peak effect less abrupt.
Once in the brain, cocaine blocks the reuptake transporters for several neurotransmitters including dopamine, norepinephrine, and serotonin. This inhibition leads to an accumulation of these neurochemicals in the synaptic cleft, amplifying their effects. The surge in dopamine, in particular, is largely responsible for the intense, pleasurable “rush” or euphoria experienced immediately after injection.
This powerful neurochemical alteration creates an overwhelming sensation that peaks within approximately 1.4 minutes and lasts for a brief period, typically 15 to 60 minutes. This rapid onset and short duration contribute to the reinforcing properties of intravenous cocaine use, driving a strong desire to repeat the experience.
Health Consequences of Intravenous Drug Use
The physical act of injecting drugs carries localized and systemic health consequences, separate from the drug’s pharmacological effects. Repeated injections can damage veins, leading to collapsed veins and visible scarring, known as “track marks.” When a vein collapses, blood flow is hindered, which can be painful and may progress to deep vein thrombosis.
Non-sterile injection practices or contaminated drug solutions can result in skin and soft tissue infections. Abscesses, painful collections of pus under the skin, and cellulitis, a spreading bacterial skin infection, are common complications. These localized infections can escalate, leading to systemic infections if bacteria enter the bloodstream.
Serious systemic infections, such as endocarditis (an infection of the heart valves), can occur when bacteria from injection sites travel to the heart. Sepsis, a life-threatening response to an infection spreading throughout the body, is another severe risk. Both endocarditis and sepsis can require extensive medical intervention, including prolonged antibiotic treatment or heart valve replacement surgery.
Intravenous drug use carries a significant risk of transmitting bloodborne pathogens. Sharing needles or other injection paraphernalia, such as “cookers” or cottons, can transmit viruses like Human Immunodeficiency Virus (HIV) and Hepatitis C (HCV). Hepatitis C, which attacks the liver, can lead to chronic liver damage, cirrhosis, and liver failure if left untreated.
Systemic Risks of High-Dose Cocaine
The rapid, high-concentration delivery of cocaine through IV injection places immense strain on the cardiovascular system. Cocaine causes immediate vasoconstriction, narrowing blood vessels and increasing blood pressure and heart rate. This combination of increased demand and reduced blood supply to the heart can trigger severe cardiac events, including heart attacks and cardiac arrhythmias.
Cocaine’s effects on the heart also include increasing the risk of blood clot formation and accelerating atherosclerosis, a hardening and narrowing of the arteries. These changes can predispose individuals to life-threatening conditions like aortic dissection, where the inner layer of the aorta tears.
Neurological risks are also pronounced with high-dose intravenous cocaine. The drug can induce seizures, which result from abnormal electrical activity in the brain. It also increases the risk of stroke, both ischemic (caused by a blood clot blocking an artery to the brain) and hemorrhagic (caused by bleeding in the brain).
IV cocaine injection dramatically increases the risk of a fatal overdose. The estimated fatal dose can be as low as 20 mg for highly sensitive individuals, though typical recreational doses range from 30-70 mg, with some chronic users exceeding 1 gram. The immediacy of the drug’s effects leaves little time for intervention in an overdose situation.
Compulsive Use and Psychological Impact
The intense, short-lived euphoria from intravenous cocaine injection, followed by a precipitous “crash” characterized by dysphoria and craving, creates a powerful reinforcement cycle, making it challenging to stop repeated drug use. Individuals often quickly develop tolerance, requiring larger and more frequent doses to achieve desired effects.
This pattern of use frequently leads to severe psychological addiction, where the individual feels an overwhelming compulsion to seek and use the drug despite negative consequences. The “binge-crash” cycle is characteristic, involving periods of continuous use to maintain the high, followed by exhaustion and severe emotional distress.
Intravenous cocaine use carries a significant risk of developing stimulant-induced psychosis. This condition can manifest as extreme paranoia, where individuals may believe they are being watched or persecuted. Such delusions can be vivid and distressing, leading to aggressive behaviors or social withdrawal.
Hallucinations are common in cocaine-induced psychosis, affecting a substantial percentage of users; approximately 83% may experience auditory, 38% visual, and 21% tactile hallucinations. These tactile hallucinations can include formication, the sensation of insects crawling on or under the skin, often referred to as “cocaine bugs.” The severity of these psychological symptoms is linked to the duration and amount of cocaine consumed.