Cocaine overdose: warning signs, symptoms and treatment

Due to the nature of cocaine’s addictiveness, it’s highly prone to being misused. Taking large amounts of this potent stimulant can result in an overdose. When this happens, urgent action is vital, so you’ll need to know exactly what to do.

Whether you’re worried that someone may be overdosing on cocaine, or you want to know more information before things escalate, knowing how to support someone could help to avoid serious harm.

Read more about the symptoms of a cocaine overdose, the steps to take if it happens and the available treatment options.

Can you overdose on cocaine?

Yes, there’s a risk of overdose when using cocaine.

An overdose happens when cocaine overstimulates the nervous system and cardiovascular system. It speeds up heart rate, blood pressure and body temperature. Too much of it overwhelms the body, especially the heart and brain. The risk of overdose is heightened when cocaine is mixed with other substances or when it’s taken in its more potent form, crack cocaine.

The unpredictability of a cocaine overdose makes the drug even more dangerous. Overdose doesn’t always happen when someone takes high amounts of cocaine. Even a small amount can lead to toxic effects on the body, depending on the person and their health. It can happen when someone has underlying health issues, or if street cocaine is mixed with other toxic substances.

People who use cocaine regularly can still overdose, so no-one can know their limit. Any use of the drug can cause serious complications like heart attacks or cerebrovascular accident – which is sometimes referred to as a “coke stroke”. 

Overdosing on cocaine can cause serious problems if untreated, such as a heart attack, stroke, seizures or even death. Because of this, it’s crucial to get immediate medical attention.

Cocaine overdose symptoms

It’s important to be able to recognise the early and advanced symptoms of cocaine overdose. This helps you to gauge how urgently the person needs help.

Early symptoms of a cocaine overdose include:

• Chest pain
• Extreme confusion
• Anxiety/panic
• Profuse sweating
• Agitation and/or aggression
• Nausea or vomiting
• Fever
• Dilated pupils

Advanced symptoms include:

• Unconsciousness or lack of responsiveness
• Seizures
• A very high heart rate or arrhythmia (an irregular heartbeat)
• Psychosis
• Hallucinations
• Difficulty breathing or respiratory failure
• Hyperthermia (abnormally high body temperature; as opposed to hypothermia, when the temperature drops way below the normal range)

The symptoms of a cocaine overdose can differ depending on how the drug is taken. All methods can lead to overdose, but some lead to faster and more dangerous effects. 

Snorting powdered cocaine creates a slower onset of effects, though it can still lead to high blood pressure, severe anxiety, nosebleeds or heart issues. 

Smoking crack cocaine leads to a faster, more intense high, often leading to agitation, chest pain and a rapid heartbeat. This generally carries a higher risk of overdose than snorting. 

Injecting cocaine produces immediate and intense effects, which can instantly cause a sudden heart attack, seizures or respiratory failure.

Cocaine intoxication vs overdose

Recognising the difference between intoxication and overdose helps you get the right support and could save lives. Being intoxicated with cocaine and overdosing on it can look similar, but overdose is far more severe. Intoxication may include euphoria, talkativeness, anxiety, restlessness and a fast heart rate. The person is usually alert and responsive.

An overdose, however, is a medical emergency, due to the symptoms mentioned earlier. It can happen suddenly; though not always. If you’re in doubt, seek medical help anyway. It’s better to be safe when the effects can quickly turn deadly.

How do you help someone who is overdosing?

If you’re with someone who’s overdosed on cocaine, calling emergency services (999) is an essential first step. Tell the operator you suspect the person you're with has had a cocaine overdose, providing as much information as possible about the situation.

There are things you can do to help right away:

• Keeping the person stable and comfortable until help arrives
• Keep them on their side, which opens their airways and avoids the risk of them choking on their vomit
• Never try to force them to be sick, or give them any other substances
• Try to keep the person calm, particularly if they’re already agitated, talking to them reassuringly
• You can place a wet cloth or towel under their armpits, on their forehead or behind their knees
• Ice packs or bags of frozen foods are also valuable aids if the person is very hot
• Keep them hydrated with water or a sports drink
• Ultimately, listen to any advice the emergency services give you whilst you wait for help to arrive

Once the emergency services arrive, be honest with them about any substances the person has taken. Giving them accurate information supports the person’s chances of receiving potentially life-saving treatment. You won’t get into trouble for disclosing drug use, as healthcare professionals are bound by patient confidentiality.

How much cocaine does it take to overdose?

There are no certainties around the amount of cocaine that leads to overdose., but the likelihood can increase with any combination of factors. If cocaine is pure, its potent effects are concentrated and can provoke a stronger reaction. However, if cocaine is mixed with other substances, there’s an increased risk of toxicity from the chemicals potentially present in those cutting agents.

Some people may also have higher tolerances to cocaine than others, though there aren’t any guarantees of safety. Tolerances can change and there could be unknown changes in health circumstances that lead to someone overdosing.

The way that cocaine is taken can change the risk of overdose, too. Even if a small amount of cocaine is ingested, it can cause an overdose if it’s mixed with other substances like alcohol, or opioids like fentanyl. Injecting and smoking cocaine also increase the overdose risk, even with low amounts.

Treatment for cocaine overdose

If someone overdoses on cocaine, emergency services will usually rush them to A&E, where they’ll be immediately stabilised. They’ll be kept in hospital to monitor their vital signs, such as heart rate, blood pressure, breathing and body temperature. Doctors may administer sedatives to manage agitation or seizures, and medication to control high blood pressure or an irregular heartbeat.

After stabilisation, detoxification is needed to manage symptoms safely. Hospitals or specialist drug detox facilities can support this. 
If someone has been misusing cocaine for a prolonged period of time, it’s important to address the psychological aspects of addiction. Drug rehab is designed to help people remain abstinent from cocaine and prevent relapse, through therapy, counselling, support groups and other interventions. 

At Priory, we provide leading private cocaine rehabilitation services across a network of UK addiction hospitals and wellbeing centres.