Cocaine: harm minimisation strategies

General safety tips

Understand your substance

• What it is: cocaine is a short-acting stimulant made from coca leaves. It affects your brain’s reward system and speeds up messages between your brain and body.
• Unregulated supply: non-prescribed drug supply is toxic and unregulated. There is no way to be sure of the drug, the amount or the strength that you think you are taking. In Australia, cocaine is often low-purity and might be cut with adulterants like caffeine, lactose, novocaine; or substances like methamphetamine or opioids. These can increase health risks and make dosing less predictable.
• Test your cocaine: adulterants can significantly change how the drug affects you. If drug checking services are not available, use reagent testing kits to check for dangerous cuts and confirm the presence of cocaine. While not foolproof, they can reduce the risk of taking something unexpected or harmful.
• Effects and duration: cocaine has a short duration. Peak effects occur 20–40 minutes after use, and total duration is around 45 minutes to 1.5 hours – but remains active in the body for longer, even if you don’t feel the effects.

Measure and track your dose

• Start low, go slow: cocaine is often used in small doses (bumps). Start with a small amount to check how it affects you, especially if it's from a new source or batch. Use a milligram scale to measure precise doses.
• Re-dosing: the short duration of effects often leads to compulsive re-dosing. Think about how much and how often you want to use and set limits before starting to avoid impulsive re-dosing or bingeing.
• Avoid "eyeballing": use a milligram scale to measure doses. Cocaine's effects can be intense, and overdose is a real risk with high doses or strong batches.
• Wait between doses: give it plenty of time to take effect before redosing – it may take longer than you expect to feel the effects.

Look after your body

• Hydration: cocaine can make you dehydrated, especially during long sessions. Sip water regularly - about 1 cup (250 mL) per hour when resting, or up to 2 cups (500 mL) per hour when dancing or exercising. Swap in electrolytes to stay balanced but avoid overhydration.
• Food: cocaine can make you not very hungry, but keeping up with good nutrition will help support your body and recovery. If you can’t manage a full meal, try a smoothie or meal replacement drink.
• Prioritise sleep: many of the unwelcome side-effects of cocaine – like irritability or feeling scattered – get worse when you’re sleep deprived.
• Care for your nose: if snorting, change which nostril you use each time. Saline (salt water-based) sprays will help moisturise and protect your nasal passages. Avoid using shared snorting tools to reduce your risk of infection.

Avoid synthetic forms

• Synthetic or unknown blends can affect you in ways you weren’t expecting, and can be harmful. Stick with products you know, and that have been tested, to minimise risks.

Set and setting

Your mindset (set) and environment (setting) can strongly shape how cocaine will affect you. They influence the intensity of the experience, and the level of risk involved.

Set = your body and mind

This includes:

• your current mood and mental health
• stress or emotional load
• how safe and supported you feel
• your physical state (sleep, food, hydration, illness)
• how familiar you are with cocaine
• any medications or other substances in your system.

Cocaine can intensify whatever state you're already in. If you’re anxious, tense, or emotionally unsettled, you may feel more jittery, irritable, or paranoid. Being well-rested, fed, and in a steady headspace can reduce the chance of a negative experience.

Setting = your surroundings

Think about:

• where you are: is it a familiar or unfamiliar space?
• lighting, noise, temperature, and smells
• who you're with and whether you trust them
• the time of day, if you're indoors or outdoors, public or private.

Cocaine can increase energy, talkativeness, and impulsivity, so being in a chaotic or unpredictable environment can heighten the risk of harm. Being somewhere calm, safe, and with trusted people can help you stay grounded.

Mixing and masking

Knowing what happens when you mix substances is important for reducing harm when using cocaine. Some combinations can be dangerous, while others can mask how intoxicated you feel, which makes it easier to misjudge your limits.

• Mixing: combining cocaine with other drugs (especially alcohol, MDMA, or depressants) increases the load on your body and can heighten the risk of heart strain, anxiety, or overdose.
• Masking: alcohol and other depressants can dull the stimulating effects of cocaine, making it easier to drink more than planned or misjudge your limits. Cocaine also masks signs of alcohol intoxication, increasing the risk of alcohol poisoning.

Risky mixes with cocaine

Cocaine and alcohol

• Risks: mixing these can create a compound called cocaethylene, which makes effects last longer than cocaine. It’s also more toxic to the heart and liver. This can significantly increase the risk of sudden death.
• Symptoms: your motor skills and decision-making can be negatively affected.

Cocaine with other stimulants (MDMA, Meth, Speed)

• Risks: mixing stimulants can overwork your heart and lead to psychosis. Although cocaine can reduce the effects of other dopamine releasers, this will also put an extra strain on your heart.
• Symptoms: extreme agitation, high body temperature, hallucinations, and chest pain.

Cocaine and GHB

• Risks: stimulants like cocaine increase your respiratory rate, which can mask some of the effects of GHB. If the cocaine wears off first, then the GHB can overload you and cause respiratory arrest.
• Symptoms: your heart rate and breathing rate can change in unexpected ways. This mix also has risks of severe confusion, unconsciousness, and a high risk of fatal overdose.

Cocaine and benzodiazepines

• Risks: benzodiazepines can mask the stimulant effects of cocaine, which can make you have more cocaine than you can safely handle. This increases the risk of overdose.
• Symptoms: drowsiness, confusion, trouble breathing, and difficulty waking up.

Cocaine and opioids (speedballing)

• Risks: combining the stimulant effects of cocaine with the depressant effects of opioids can confuse your body’s ability to properly know its limits. This can increase the risk of respiratory failure.
• Symptoms: unpredictable heart rate, breathing rate, and a high risk of fatal overdose.

Cocaine and cannabis

• Risks: cannabis can mask some of the stimulant effects of cocaine, which can lead you to consume more cocaine than usual to get the wanted effect.
• Symptoms: increased heart rate, paranoia, and impaired judgment.

Ways to use: from lower to higher risk

Oral (gumming)

• Rubbing cocaine on the gums is a less common way of using cocaine. Because the cocaine is absorbed more slowly, it will avoid nasal damage.
• Risks: can lead to gum disease and tooth decay over time.

Snorting

• This is the most common way of using cocaine. Snorting damages nasal tissues and can lead to long-term issues like loss of smell, runny nose and frequent nosebleeds.
• Safer practices: finely grind the cocaine into small amounts before snorting. Use your own snorting device, like a straw or rolled paper (not money), and clean your nostrils with saline before and after. Switch nostrils regularly to give your nose a break too. Trying these can all reduce harm, plus reduce the risk of blood borne viruses.

Injection (IV use)

• This is a high-risk way of using cocaine. Effects are rapid and intense, but it comes with risks of vein damage, infection, and overdose.
• Safer practices: use sterile needles, never share injecting equipment, and be aware of dosage.

Smoking (freebase, crack cocaine)

• Smoking cocaine is very risky. Its strong and immediate effects can quickly make you dependent.
• Safer practices: smoking cocaine is only possible using freebase or crack cocaine, which is different to the powdered cocaine usually found in Australia. If smoking crack cocaine, use a glass pipe.

Cocaine overdose

Cocaine overdose is a dangerous condition that happens when someone has a large amount of cocaine in a short period. This can affect breathing, heart rate, body temperature, and can even lead to coma and death. Even small doses can lead to overdose depending on the batch, your health, or other substances taken.

Signs of cocaine overdose or overuse:

• being very restless or agitated
• higher heart rate and blood pressure
• high body temperature and being very sweaty
• risk of self-harm or aggression towards others
• hallucinations, or psychosis from sleep deprivation
• seizures or unconsciousness
• chest pain or difficulty breathing.

What to do if you’re with someone who has overdosed or overused

• Call emergency services (000) immediately: tell them clearly what substance was taken, and what symptoms are showing.
• Stay calm and reassure the person: move them to a quiet, cool area to help them relax.
• Cool down: if the person is overheating, apply cool cloths to their skin and provide water if they're conscious and able to drink.
• Put them in the recovery position: if they are unconscious but breathing, turn them on their side to keep their airway open.
• No additional stimulants: don’t give them caffeine or other stimulants. This can make things worse.

Cocaine withdrawal

Cocaine withdrawal can be challenging and can affect you both physically and emotionally. You may experience:

• physical symptoms: feeling tired, increased appetite, not sleeping as well
• emotional symptoms: depression, irritability, anxiety, cravings.

Managing withdrawal safely

• Medical supervision: talk to a healthcare provider if you're feeling strong withdrawal symptoms.
• Look after yourself: stay hydrated and choose healthier foods to help your body recover.
• Rest: good quality sleep and rest is important for recovery.
• Counselling and support: reach out to support groups or try counselling to manage the emotional side of withdrawal. Seeking support from friends and family can also help.