Pure cocaine was first used in the 1880s as a local anesthetic in eye, nose, and throat surgeries because of its ability to provide anesthesia as well as to constrict blood vessels and limit bleeding. Many of its therapeutic applications are now obsolete due to the development of safer drugs.

Approximately 100 years after cocaine entered into use, a new variation of the substance emerged. This substance, crack, became enormously popular in the mid-1980s due in part to its almost immediate high and the fact that it is inexpensive to produce and buy.

Cocaine is a powerfully addictive stimulant drug. The powdered, hydrochloride salt form of the drug can be snorted or dissolved in water and injected. Crack is cocaine that has not been neutralized by an acid to make the hydrochlorida salt. This form of cocaine comes in a rock crystal that can be heated and its vapors smoked. The term “crack” comes from the crackling sound made when it is heated.

Health Effects

Cocaine is a strong central nervous system stimulant. Physical effects of cocaine use, including crack, include constricted blood vessels and increased temperature, heart rate, and blood pressure. Users may also experience feelings of restlessness, irritability, and anxiety.10

Smoking crack delivers large quantities of the drug to the lungs, producing effects comparable to intravenous injection. These effects are felt almost immediately after smoking, are very intense, but do not last long.11 For example, the high from snorting cocaine may last 15–30 minutes, while the high from smoking it may last 5–10 minutes.12

Evidence suggests that users who smoke or inject cocaine may be at even greater risk of causing harm to themselves than those who snort the substance. Cocaine smokers may suffer from acute respiratory problems including coughing, shortness of breath, and severe chest pains with lung trauma and bleeding.13

An added danger of cocaine use is when cocaine and alcohol are consumed at the same time. When these substances are mixed, the human liver combines cocaine and alcohol and manufactures a third substance, cocaethylene. This intensifies cocaine’s euphoric effects, while also possibly increasing the risk of sudden death.14 Most cocaine-related deaths are a result of cardiac arrest or seizures followed by respiratory arrest.15

Cocaine is a powerfully addictive drug. A tolerance to the cocaine high may be developed and many addicts report that they fail to achieve as much pleasure as they did from their first cocaine exposure.

Crack is cocaine that has been processed from cocaine hydrochloride to a free base for smoking. Crack cocaine is processed with ammonia or sodium bicarbonate (baking soda) and water. It is then heated to remove the hydrochloride producing a form of cocaine that can be smoked.