Cocaine Overdose Symptoms & What to Do

A cocaine overdose, also known as cocaine toxicity, can result in life-threatening consequences, including a stroke, heart attack, or seizure. It’s important to be able to identify cocaine overdose symptoms and signs so you can seek help for yourself or someone else.

If you think someone is experiencing a cocaine overdose, here’s what to do:

• Call 911. Tell the operator where you are, describe the symptoms you see, and ask for help.
• Stay on the phone. Don’t disconnect your call until the operator tells you to do so.
• Attempt to calm the person. Some people experiencing a cocaine overdose are combative or aggressive. Don’t restrain them, but use a quiet voice to orient them and help them feel safe.[16]
• Provide basic first aid. If the person stops breathing and you can’t find a pulse, provide CPR (if you’re trained to do so). If they complain of being too hot, help them remove excess clothing and offer cool water to drink.
• Stay with the person. After your 911 call, the operator will send professionals to help. Don’t leave until they arrive.

Signs & Symptoms of a Cocaine Overdose

An overdose on stimulants like cocaine is very different than an overdose on depressants like opioids, alcohol, and benzodiazepines. An overdose on depressants is often dose-dependent and results in severe respiratory depression and slowed or stopped heartbeat. Conversely, a cocaine overdose can occur with any dose and is manifested by many cardiovascular events.

Cocaine overdose symptoms and signs may include the following:[17]

• Dilated pupils
• Dizziness
• Tremor
• Irritability
• Confusion
• Mood swings
• Nausea or vomiting
• Rapid breathing
• Fast or irregular heartbeat
• Warm body temperature
• High blood pressure
• Chest pain
• Panic
• Hallucinations
• Psychosis

A cocaine overdose has the potential to be life-threatening and should be taken seriously. A person overdosing on cocaine is experiencing what is called cocaine toxicity, meaning they have taken a toxic dosage of cocaine.[2]

Notable Dangers of Cocaine Overdose

Cocaine’s adverse effects are caused by inhibiting the reuptake of catecholamines into a person’s nerve endings. Catecholamines are involved in how the body reacts to stress, helping to operate what is often called a person’s fight-or-flight response. [2]

Two notable dangers of a cocaine overdose are the drug’s effect on the way a person thinks and their cardiovascular system’s operations. 

Someone who has taken a dangerous amount of cocaine may act irrationally and even dangerously. They can become paranoid, irritable, and extremely hyper. Especially when combined with the possibility of hallucinations, a person overdosing on cocaine may be incapable of making rational choices or correctly processing the events occurring around them. 

Secondly, cocaine’s effect on the heart and other important systems means the person who is overdosing is at risk of heart attack, stroke, and seizure. In the worst cases, a person who experiences one of these symptoms may die, especially if they have pre-existing medical conditions that make these symptoms even more dangerous than they are for the general population. [7],[8],[9]

Overall, cocaine is a drug that can impact almost every organ in the body. 

Risk Factors for Cocaine Overdose

Americans have seen a rise in cocaine-related deaths, with almost 20,000 people dying of a cocaine-related overdose in 2020, usually when the drug is used in combination with opioids. [3] Mixing cocaine with opioids like heroin and fentanyl is a major risk factor for overdose. And in general, buying street cocaine and using it can lead to an overdose since dealers often cut powdered cocaine with fentanyl, unbeknownst to the user.

Other risk factors include the following:[13,14,19]

• Mixing cocaine with alcohol: This combination can form a deadly chemical in the body known as cocaethylene. This psychoactive substance is particularly damaging to the cardiovascular system and can increase the risk of heart attack.
• Injecting or snorting cocaine: This allows the dose to enter the body faster and produce stronger effects.
• Using cocaine in unsafe conditions: This includes using the drug while experiencing homelessness or while incarcerated. People in these situations may not have bystanders who can call for help.
• Co-occurring mental health disorders: The presence of these can increase overdose risks, especially if people take very high doses in an attempt to self-medicate issues like depression.

A more obvious factor that puts a person at risk of a cocaine overdose is the amount of the drug taken. While no dose of cocaine should be considered “safe,” the more cocaine a person takes, the greater their risk of an overdose.

Smaller individuals will generally need to take less cocaine to experience an overdose compared to larger individuals.

How Much Cocaine Does it Take to Overdose?

Although “overdose” implies that a person has taken too much or a toxic amount of cocaine, the term is a bit misleading. This is because people can experience life-threatening effects like a stroke and even sudden death with relatively low doses of cocaine.

The median lethal dose of cocaine is about 43.54 mg per 1 pound of body weight. For a 140-pound person, that means the fatal cocaine dose would be around 6 grams. [15]

However, this is the median, or middle, which means there have been many cocaine overdoses at far lower and higher doses than this.

In general, a dangerous or fatal cocaine overdose amount will depend on many factors, such as:

• Individual physiology
• Person’s susceptibility to toxins
• Liver function
• Whether they are using other substances
• The potency of the cocaine, since its street form is unregulated
• Whether it’s cut with fentanyl or other opioids

Stages of Cocaine Toxicity or Overdose

Experts have recorded stages of cocaine overdose or toxicity, but keep in mind, everyone is different and while some people may move through these stages, others could experience life-threatening effects right away or experience sudden death. The stages of cocaine overdose may include:[2]

What to Do in Case of an Overdose

If someone you know is exhibiting cocaine overdose symptoms, call 911 right away. Report your location and the symptoms of the person in trouble. The operator will want to know their medical history, which you should try to give as accurately as possible. 

Follow the emergency operator’s instructions closely. It is important to be honest during this call, especially regarding whatever drugs the person took and how much. An accurate idea of what drugs are in the person’s system may be essential to saving their life.

There is no medication that can specifically reverse a cocaine overdose, although medical professionals can treat the symptoms of an overdose to help stabilize the person and keep them safe. Emergency medical care can greatly increase the chances that someone survives and reduce the potential that a cocaine overdose will cause permanent damage. 

The primary goals of emergency overdose treatment are as follows:[4]

• Restore blood flow to the heart
• Get oxygen to the brain
• Stop a person from seizing

Treatment for a Cocaine Overdose

Once hospitalized, the treatment team may use many different interventions to stabilize a person who has overdosed on cocaine, depending on their symptoms. These interventions may include the following:[2]

• Managing fever with Tylenol and cooling measures
• Administering a pregnancy test
• Providing benzodiazepines to manage CNS hyperactivity
• Using medications like diltiazem, lidocaine and verapamil for heart-related symptoms and nitroglycerin to lower blood pressure
• Delivering antipsychotics for agitation or hallucinations

People who have experienced a cocaine overdose typically need to stay in the hospital. An overdose can be associated with medical complications, including heart damage and blood vessel ruptures.[2] Medical teams must monitor their patients carefully as they recover, and if signs of complications appear, professionals need time to treat them.

While recovering in the hospital, people who endured a cocaine overdose may be under the care of nurses who can administer treatments, monitor symptoms, and notify doctors if changes appear. Nurses may also talk with the family about what happened and urge the person to enter a treatment program.

Cocaine overdoses can also cause mental health challenges, including an increased risk of suicidal thoughts.[2] When patients are feeling more stable in recovery, they may be encouraged to describe their mental health symptoms, and they may be referred to counselors when they’re ready to go home.

Protection When You Call for Help

Most states have Good Samaritan laws in place, which prevent legal action against individuals who call emergency services to help people experiencing an overdose, even if the activities engaged in that led to that overdose were illegal.

State laws can vary. For example, some provide sweeping protections for those who call for help, including protection for those using or carrying drugs. Others do not. And two states (Wyoming and Kansas) have no Good Samaritan laws at all.[18]

The Prescription Drug Abuse Policy System keeps an up-to-date map of overdose prevention laws by state. Use this tool to determine what’s legal within your area.

Addiction Treatment After a Cocaine Overdose

Although overdosing on cocaine doesn’t necessarily mean that you have an addiction, it can be a sign—especially when other symptoms of cocaine addiction are present, such as compulsive use regardless of negative consequences.

Once you are stabilized in the hospital, a professional, such as a case manager, social worker, or therapist, may counsel you on cocaine addiction treatment programs. They will even help you transition into a specific program so you can get the help you need.

With comprehensive addiction treatment, you can examine your cocaine use and determine what steps you need to take to get back in control of your life.

Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More