Cocaine is a stimulant drug that produces an extremely euphoric reaction when taken; however, compared to other drugs of abuse cocaine has relatively short effects.
How Long Are the Effects of Cocaine?
Peak plasma levels of the drug referred to the highest concentration of the drug in the bloodstream following use. This is strongly related to the intensity and duration of effects that the drug produces. According to the book Pharmacology and Abuse of Cocaine, Amphetamines, Ecstasy and Related Drugs:
- The peak levels in plasma concentrations of cocaine are reached 30 minutes after snorting about 100 mg of cocaine.
- Injecting 30 mg of cocaine results in peak plasma levels after five minutes.
- When 50 mg of cocaine is smoked, peak plasma levels are produced within 45 minutes.
- Orally taking 140 mg of cocaine results in peak plasma after one hour.
For the most part, after one takes cocaine, it does not remain in the system very long. A measure known as the half-life of the drug refers to the amount of time it takes a drug in one’s system to be reduced by half of its original concentration. Cocaine has a very short half-life, and in most cases, it is typically an hour or less.
Cocaine is often not detectable in an individual’s urine within 24-48 hours of discontinuing the drug, although very chronic users of cocaine who use large amounts of cocaine may have detectable levels for longer than 48 hours.
The organ in the body that is responsible for metabolizing and breaking down all substances ingested in the body is the liver. When the liver metabolizes cocaine (or any other substance), it breaks down the substance and its smaller compounds that are called metabolites. These metabolites are more easily eliminated from the body. A major metabolite for cocaine is called benzoylecgonine, which is often measured during urine analysis to determine if someone has used cocaine. Metabolites for cocaine have variable half-lives that range between 15 and 50 hours or more, and they are often able to be detected in urine for much longer periods of time than the drug itself.
Depending on the type of test used, the presence of cocaine in someone’s system can be detected in various ways.
- Metabolites for cocaine can be detected in someone’s perspiration weeks after they use the drug.
- Cocaine metabolites can be detected in urine samples for up to three days, but individuals who are chronic users may have metabolites in their urine for up to two weeks.
- Cocaine in blood samples is often detectable for 12-48 hours and typically not much longer.
- The drug may be detectable via hair follicle tests for months after discontinuation and for even longer in very heavy, chronic users.
Several different factors influence the amount of time that cocaine remains in an individual system.
- Individual variability in metabolism plays an important influence in the amount of time that cocaine or any drug remains in an individual’s system.
- The amount and frequency with which one uses a drug like cocaine have profound influence on how long the drug remains in the system. The relationship is positive, such that individuals who use larger amounts, or who use cocaine more frequently, will retain metabolites in their system for longer periods of time.
- As can be seen by the list above, the mode of administration, or how one uses cocaine, such as via snorting, injecting, etc., leads to different absorption rates and will affect the amount of time the drug remains in the system.
- There is no standard purity level for cocaine that is adhered to across all sellers and distributors. The purity of the drug will influence the time that the drug remains in a person’s system; individuals who use purer forms of the drug retain metabolites for the drug in their systems longer.
The notion of withdrawal occurs as a result of the development of physical dependence on a drug. Physical dependence consists of two symptoms: tolerance and withdrawal symptoms. Tolerance is a relatively common occurrence in individuals who take drugs for any significant length of time. Tolerance occurs when a person needs a higher dose of the drug to produce the effects that were once produced at lower doses.
Withdrawal symptoms occur when the person’s system has learned to only function optimally when the drug is in their system. This occurs after consistent use of the drug for at least a period of 5-6 weeks and in some cases longer depending on the drug. The longer a person uses the drug, the more intense the withdrawal symptoms become. When the levels of the drug in the system drop below the level that is optimum for normal functioning, the person begins to experience very serious physical and emotional symptoms that can include strong cravings, anxiety, nausea, and even seizures (depending on the drug).
When a person takes cocaine, there is an extreme release of the neurotransmitters dopamine and norepinephrine. This potent release of these neurotransmitters results in a number of effects, including the feelings of euphoria that cocaine produces. When the person stops using cocaine, they inevitably experience what is known as the “crash.” This crash is a result of extreme depletion of neurotransmitters that occurs once the person stops using the drug. Moreover, the crash occurs when individuals actively using cocaine run out of cocaine and stop using it or when a person decides to stop using cocaine altogether and tries to become drug-free. This extreme crash consists of feelings of depression, apathy, and hopelessness, and it results in cravings for cocaine.
People who continue to use cocaine habitually will often keep using the drug to avoid the experience of the crash. Individuals attempting to recover from a cocaine use disorder often find that they experience severe cravings, depression, and issues with their motivation to remain abstinent as a result of the crash. They also often find themselves experiencing lengthy periods of anhedonia, or difficulty experiencing pleasure in things that used to give them pleasure.
Individuals who attempt to recover from cocaine use disorders will also experience:
- Increased periods of anxiety
- Increased periods of sleepiness
- Increased appetite
- Mood swings and periods of irritability
- Suspiciousness or paranoia (in some instances)
- Cravings to use cocaine to deal with the depression and other symptoms that the crash brings
Interestingly, withdrawal from cocaine does not produce many of the severe physical symptoms in most people that are noted in the withdrawal process from drugs like alcohol, benzodiazepines, or heroin. Withdrawal from these drugs often produces extreme chills, nausea, vomiting, sweating, etc. as part of the withdrawal syndrome, whereas those symptoms are rare for individuals who are just withdrawing from cocaine.
One of the classic descriptions on the effects of remaining abstinent following chronic cocaine abuse was published in the Archives of General Psychiatry in 1986. The description of a three-phase withdrawal process can still be found in many sources today. This description follows:
- The crash: The first phase consists of the aforementioned crash following the discontinuation of cocaine. The crash can last for hours or even days. As mentioned above, individuals generally feel issues with depression, anxiety, irritability, sleepiness, increased appetite, problems experiencing pleasure, and very strong cravings for cocaine. Research has indicated that some physical symptoms, such as irregular heartbeat, dehydration, trembling, and even heart attack and seizures, can occur, but seizures are very rare.
- Withdrawal: This phase is the formal withdrawal phase that can last as long as 10 weeks and often presents with periods of irritability, periods of fatigue, strong cravings to begin using cocaine, and issues with attention and memory.
- Extinction: During this phase, the individual may still experience cravings when they are in the presence of certain triggers that remind them of their previous cocaine use. These triggers can include stressful situations or being in the presence of certain friends whom they used the drug with or in places where they used cocaine. Over time, these connections become weaker if the individual does not give into them.
Much of the follow-up research indicated that the above phases are not quite as discrete as in their original descriptions, but that the process follows the general progression listed above from crash, to withdrawal, to extinction without specific dividing points that would indicate separate phases of withdrawal. Individuals go through very acute symptoms for the first several days and then progress to more generalized symptoms over the course of several weeks.
The withdrawal process from cocaine does not appear to be as serious as withdrawal from alcohol or benzodiazepines where individuals with chronic and severe addictions to these drugs may develop life-threatening seizures (seizures may occur in some individuals during cocaine withdrawal but these instances are extremely rare); however, because of the severe apathy and depression that many individuals experience as a result of discontinuing cocaine, they are at risk for self-harm from accidents or even suicide attempts. Any individual going through a withdrawal syndrome who relapses and begins using their drug of choice is at serious risk for overdose, as these individuals tend to binge during these relapses and use significantly more of the drug then they can tolerate.
Many of the same factors that influence the amount of time that the drug remains in one’s system mentioned above also influence the severity and length of the withdrawal syndrome in individuals with cocaine use disorders.
Cold Turkey or Withdrawal Management?
Even though going through withdrawal from a cocaine use disorder is not associated with severe physical symptoms, there are several reasons for an individual with a cocaine use disorder to choose a withdrawal management program (medical detox) as opposed to trying to quit the drug “cold turkey.” According to the books Concepts in Chemical Dependency and The American Society for Addiction Medicine: Principles of Addiction Medicine these include:
- Relapse rates for individuals in recovery are extremely high during the first few weeks of abstinence. Formal withdrawal management programs allow for one to withdraw from the drug under the supervision of a physician who can administer medications to reduce cravings and to reduce the negative symptoms one experiences during the withdrawal process.
- Many individuals recovering from substance use disorders also have comorbid (co-occurring) psychological or psychiatric disorders that can contribute to the potential for relapse. These can be identified and treated in a formal treatment program.
- Any other medical emergencies or needs can be identified and addressed in a formal withdrawal management program.
- Enrolling in a formal program allows one to also interact with other individuals in recovery and learn from their experiences.
- Individuals who enroll in formal withdrawal management programs have significantly higher success rates in recovery than individuals who attempt to quit on their own or go “cold turkey.”