What Is Cocaine? Effects, Addiction Risks and Treatment in India

ZorbaCare Research · Evidence review · Medically reviewed by Dr. Sayantani Mukherjee, Psychiatrist · Published November 2026 · 17 references

Key findings

• Cocaine is powerfully addictive. It blocks dopamine from being recycled in the brain, and tolerance develops quickly, pushing people towards higher and more frequent doses [1][3].
• The heart is at immediate risk. In the 60 minutes after cocaine use, heart attack risk was 23.7 times higher than baseline, even in people otherwise at low risk [4].
• Cocaine with alcohol is worse. The combination produces cocaethylene, which lasts longer in the body and is more toxic to the heart and liver; co-use is linked to higher mortality [5][6].
• Use is rising worldwide. About 25 million people used cocaine in 2023, up from 17 million in 2013, and production reached a record 3,708 tons [9].
• In India, use is low but not rare. About 0.10% of Indians aged 10–75, roughly 10.7 lakh people, are current cocaine users [10][11].
• No medicine is approved for cocaine addiction. Across 157 trials, contingency management was the only treatment consistently linked to reduced cocaine use [14][16].

1. What is cocaine?

Cocaine is a powerfully addictive stimulant drug made from the leaves of the coca plant, which is native to South America [1]. People in the Andes have chewed coca leaves for thousands of years, but the purified chemical, cocaine hydrochloride, was isolated from the plant only in the 19th century [2]. Doctors still use it in limited ways as a local anaesthetic, but recreational use is illegal in India and almost every other country [1].

Street cocaine comes in two main forms [2]:

• Powder cocaine (cocaine hydrochloride). A white powder that is snorted or dissolved in water and injected.
• Crack cocaine (freebase). Powder processed with ammonia or baking soda and water, then heated to make a smokable rock. The name comes from the crackling sound it makes when heated.

Street cocaine is rarely pure. Dealers often mix it with cornstarch, talcum powder or flour to increase profits, or with other drugs such as amphetamine, and people sometimes combine it with heroin, a mix known as a “speedball” [1]. A person buying cocaine rarely knows exactly what they are taking.

2. How does cocaine affect the brain?

Cocaine works on dopamine, the brain’s chemical messenger for pleasure, reward and movement. Normally, dopamine is released into the gap between nerve cells, passes on its signal, and is then recycled back into the cell that released it. Cocaine blocks that recycling, so dopamine builds up between nerve cells, and this flood of dopamine produces cocaine’s high [1][2].

The brain adapts. With repeated use, the reward circuit becomes less sensitive to dopamine, so people take stronger and more frequent doses to feel the same high and to relieve the low that follows [1]. Tolerance to cocaine’s effects develops rapidly [3]. This is the cycle that turns occasional use into addiction, and it is why “I can control it” is so often wrong.

Smoking or injecting cocaine delivers it to the brain within seconds and produces the most intense high, while snorting produces a slower, less intense effect [3]. The faster and more intense the high, the stronger the pull to repeat it.

3. What are the short-term effects of cocaine?

Cocaine’s effects appear almost immediately and fade within a few minutes to an hour, depending on how it is taken [1]. Short-term effects include [1][3]:

• Intense euphoria, energy and alertness
• Constricted blood vessels and dilated pupils
• Raised heart rate, blood pressure and body temperature
• Reduced appetite and insomnia
• Restlessness, irritability and anxiety
• Paranoia, especially at high doses or during binges

Because the high is short, people often take repeated doses within a few hours, which drives the dose up and the risks with it.

4. Why is cocaine so dangerous for the heart?

Cocaine raises blood pressure and heart rate at the same time as it tightens the coronary arteries that supply the heart with blood. In the Determinants of Myocardial Infarction Onset Study, which interviewed 3,946 heart attack patients across 64 US hospitals, the risk of a heart attack was 23.7 times higher than baseline in the 60 minutes after cocaine use [4].

The people at risk were not typical heart patients. Of the 38 cocaine users in the study who had a heart attack, 29 had no previous symptoms of heart disease, and their average age was 44, around 17 years younger than the average heart attack patient [4].

The same effects on blood vessels raise the risk of stroke and dangerous heart rhythms. This is why a young person arriving at an emergency department with chest pain after a night out should always be asked about cocaine.

5. Why is mixing cocaine and alcohol especially dangerous?

Most people who use cocaine also drink, often in the same session; one study cited in a 2024 review found 89% of people dependent on cocaine also used alcohol [6]. When cocaine and alcohol are in the body together, the liver produces a third compound called cocaethylene. It has similar effects to cocaine but is considered more toxic to the heart and liver, and it lasts longer, with an elimination half-life of about two hours compared with about one hour for cocaine [5].

That longer half-life matters. The person feels the high fading and may assume the danger has passed, while cocaethylene is still putting strain on the heart. A 2024 systematic review found that, although studies of individual cardiac symptoms were inconsistent, the co-use of cocaine and alcohol clearly leads to higher mortality [6].

For families, this is often the most important fact in this article. Someone who “only uses cocaine when drinking” is not taking a smaller risk; they are taking a larger one. If alcohol is also a problem, our guide to alcohol addiction treatment covers that side.

6. What are the long-term effects of cocaine?

Long-term effects depend partly on how cocaine is used [1][3]:

• Snorting can erode the inside of the nose, causing nosebleeds, loss of smell and, in severe cases, damage to the upper nasal cavity.
• Smoking crack can damage the lungs and worsen asthma.
• Injecting raises the risk of HIV and hepatitis C, and of skin and soft tissue infections.
• Any route can damage the heart and blood vessels over time, and is linked to malnutrition and weight loss.

Mental health effects are just as serious. Paranoia and psychotic symptoms, such as believing people are watching or talking about you, or hearing things that are not there, are common in people who use cocaine heavily. A systematic review found reported rates ranging from 12% in clinical studies to much higher figures in experimental studies, with risk rising with the amount used, the route, early age of first use and conditions such as ADHD [7].

Cocaine also often travels with other conditions. Depression, anxiety, ADHD and trauma can drive cocaine use, and cocaine can worsen all of them. We map these links in which addictions are linked to which mental health disorders, and explain why both need treating together in our dual diagnosis programme.

7. What does cocaine withdrawal feel like, and is it dangerous?

When cocaine use stops, or a binge ends, a “crash” follows almost immediately. Symptoms include strong craving, fatigue, lack of pleasure, anxiety, irritability, sleepiness, and sometimes agitation or extreme suspicion and paranoia [8].

Cocaine withdrawal is generally not as physically dangerous as withdrawal from alcohol, but it is not harmless. The main risks are psychological: severe depression, suicidal thoughts, and relapse or overdose driven by craving [8]. Craving and low mood can last for months after long-term heavy use, which overlaps with what we describe in post-acute withdrawal syndrome.

People in withdrawal often turn to alcohol, sedatives or sleeping pills to cope, which simply shifts the addiction to another substance [8]. For anyone with heavy use, depression, suicidal thoughts or heavy drinking alongside cocaine, a medically supervised detox in a residential setting is the safer start.

8. How common is cocaine use worldwide and in India?

According to the UNODC World Drug Report 2025, cocaine is now the world’s fastest-growing illicit drug market. Production reached a record 3,708 tons in 2023, nearly 34% more than in 2022, and the number of users grew from 17 million in 2013 to 25 million in 2023. The report also notes that traffickers are breaking into new markets across Asia and Africa [9].

In India, cocaine is one of the least common drugs. India’s national survey found that about 0.10% of people aged 10–75 were current cocaine users [10], which works out to about 10.7 lakh people, with Maharashtra recording the highest number of users of any state [11].

Supply into India is growing, however. In October 2024, Delhi Police seized more than 560 kg of cocaine from a warehouse in Mahipalpur, the largest drug bust in the city’s history, followed by a further 208 kg a week later [12]. Seizures of this size suggest a market far larger than older survey data can show.

9. What does Indian law say about cocaine?

In India, cocaine is a narcotic drug under the Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985, and possession, sale and use are criminal offences. Under the Act [13]:

• A small quantity of cocaine is 2 grams, and a commercial quantity is 100 grams. Punishment depends on which category applies, with commercial quantities attracting long prison sentences.
• Consumption of cocaine is punishable under Section 27 with up to one year of rigorous imprisonment, a fine of up to ₹20,000, or both.
• Under Section 64A, a person dependent on drugs who is charged with consumption or with a small-quantity offence can claim immunity from prosecution if they voluntarily seek treatment.

Section 64A reflects the medical view behind this article: addiction is a health condition, and treatment is the route out. This is general information, not legal advice; anyone facing charges should speak to a lawyer.

10. How is cocaine addiction treated?

Unlike opioid or alcohol addiction, there is no approved medication for cocaine addiction. A systematic review of 66 drugs tested in clinical trials found that most were not effective [15]. Medicines are still used in treatment, but for co-occurring conditions such as depression, anxiety, insomnia or ADHD, not as a cure for the addiction itself.

The strongest evidence is for behavioural treatment:

• Contingency management. This approach gives people tangible rewards for drug-free tests. A 2021 meta-analysis of 157 clinical trials involving 15,842 participants found it was the only treatment significantly linked to more cocaine-negative tests (odds ratio 2.13) [14].
• Contingency management with the community reinforcement approach. A network meta-analysis of 50 studies found this combination, which also rebuilds work, relationships and activities that compete with drug use, was the most effective and most acceptable treatment in both the short and long term [16].
• Cognitive behavioural therapy. CBT helps people recognise triggers, manage craving and build alternative ways of coping, and is a core part of most residential programmes.

Treatment also has to cover what sits around the drug. That means psychiatric care for co-occurring conditions, family work, and enough time: NIDA notes that residential or outpatient treatment lasting less than 90 days has limited or no effectiveness [17]. We explain why detox, rehab and aftercare each matter in the three stages of recovery.

If you are not sure whether someone’s cocaine use has become an addiction, our checklist of the signs someone needs rehab can help. If they refuse help, a structured family intervention is often the next step.

11. Where can you get cocaine addiction treatment in India?

ZorbaCare is a voluntary, psychiatrist-led rehabilitation and mental health centre in India that treats drug addiction, including cocaine, alongside co-occurring mental health conditions. Treatment covers medical detox, residential rehabilitation with individual and group therapy, family recovery, and aftercare with online follow-up after discharge.

We have two centres:

• Sahyadri Hills in Mumbai, about 90 minutes from South Mumbai. Families from Pune usually come here too; see our Pune page.
• Bangalore.

Families living outside India can read our guide to rehab in India for NRIs and international families, and our breakdown of how much rehab costs in India helps with planning.

12. Limitations of this review

• India’s most recent national data on cocaine use is from the 2019 survey. Household surveys tend to underestimate illicit drug use, and the market may have changed since then.
• The heart attack risk figure comes from a single large US study with a small number of cocaine users who had a heart attack within an hour of use; the size of the risk is less certain than its direction.
• Most treatment trials were run in the United States and Europe. Contingency management has rarely been tested in India, and how well it transfers is not yet known.
• Rates of cocaine-induced psychosis vary widely between studies because of differences in definitions, settings and patterns of use.
• Seizure figures reflect enforcement activity, not consumption, and cannot be converted into a count of users.

Frequently asked questions

What is cocaine made from?

Cocaine is made from the leaves of the coca plant, which grows in South America. The leaves are processed into cocaine hydrochloride, a white powder that is snorted or injected. Crack cocaine is the same drug processed with baking soda or ammonia into a rock that can be smoked. Street cocaine is often mixed with other powders or drugs.

Is cocaine addictive?

Yes. Cocaine is a powerfully addictive stimulant. It blocks the recycling of dopamine in the brain, producing an intense but short high, and tolerance develops quickly. People then need more cocaine, more often, to feel the same effect and to escape the low that follows, which is how regular use turns into addiction.

Is cocaine withdrawal dangerous?

Cocaine withdrawal is usually not as physically dangerous as alcohol withdrawal, but it carries real risks. The crash brings strong craving, exhaustion, anxiety and low mood, and some people develop severe depression or suicidal thoughts. Craving can also lead to relapse or overdose. People with heavy use or depression are safer starting treatment under medical supervision.

Is cocaine illegal in India?

Yes. Cocaine is a narcotic drug under India’s NDPS Act, 1985. Possession, sale and consumption are criminal offences, with punishment depending on the quantity involved. Consumption alone can bring up to one year of rigorous imprisonment or a fine of up to 20,000 rupees. Section 64A gives immunity from prosecution to dependent users who voluntarily seek treatment.

Is there a medicine for cocaine addiction?

There is no approved medication that treats cocaine addiction itself. Medicines can help with co-occurring problems such as depression, anxiety or sleep. The strongest evidence is for behavioural treatment, especially contingency management, which rewards drug-free tests, along with cognitive behavioural therapy, family work and structured aftercare.

Where can I get cocaine addiction treatment in India?

ZorbaCare is a voluntary, psychiatrist-led rehab and mental health centre in India with locations at Sahyadri Hills in Mumbai, about 90 minutes from South Mumbai, and in Bangalore. It offers medical detox, residential rehabilitation, dual diagnosis care, family recovery and aftercare, including online follow-up for families outside India. Call +91 86695 67929 for a confidential assessment.

Worried about someone’s cocaine use? Talk to our team in confidence about what treatment would look like. Call +91 86695 67929 or request a confidential call back. Residential treatment at ZorbaCare starts from ₹1.5 lakh, with centres in India at Sahyadri Hills in Mumbai and in Bangalore.

References

1. National Institute on Drug Abuse. DrugFacts: Cocaine. July 2018. NIDA DrugFacts (PDF)
2. National Institute on Drug Abuse. Research Report Series: Cocaine. nida.nih.gov
3. US Drug Enforcement Administration. Drug Fact Sheet: Cocaine. 2022. getsmartaboutdrugs.gov
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8. MedlinePlus, US National Library of Medicine. Cocaine withdrawal. Reviewed January 2025. medlineplus.gov
9. United Nations Office on Drugs and Crime. World Drug Report 2025. Vienna; 26 June 2025. unodc.org
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12. The Tribune. Police seize 200 kg of cocaine worth Rs 2,000 crore from west Delhi, second big haul in a week. 10 October 2024. tribuneindia.com
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17. National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide (3rd ed., revised January 2018). nida.nih.gov