Cocaine is a powerful central nervous system stimulant derived from the leaves of the coca plant. It is typically processed into a white powder, most commonly consumed by insufflation, or “sniffing.” This method involves inhaling the powder through the nostrils, allowing it to be absorbed through the nasal mucous membranes. This route of administration leads to unique consequences, ranging from immediate effects on the brain and body to severe, localized long-term damage in the nasal structure.
How Cocaine Affects Brain Chemistry
The experience begins when cocaine powder contacts the nasal mucosa, the thin, vascular tissue lining the nasal cavity. The drug is rapidly absorbed into the bloodstream and carried quickly to the brain, where it interferes with the natural communication system involving neurotransmitters.
Cocaine acts primarily as a serotonin–norepinephrine–dopamine reuptake inhibitor (SNDRI). It blocks the reuptake transporters for dopamine, norepinephrine, and serotonin, which normally clear these signaling molecules from the synapse. This blockage causes a massive buildup of neurotransmitters in the synaptic cleft.
The resulting flood of dopamine in the brain’s reward pathways is responsible for the intense euphoria and pleasure. The simultaneous increase in norepinephrine and serotonin amplifies this effect. This leads to the rapid, stimulating rush associated with cocaine use.
Immediate Physical and Psychological Effects
The effects of snorting cocaine are typically felt within a few minutes and last for approximately 15 to 30 minutes. The increased presence of norepinephrine triggers a powerful activation of the sympathetic nervous system, leading to significant physical changes.
Physically, the user experiences rapid heart rate (tachycardia) and a sharp elevation in blood pressure. Cocaine is a potent vasoconstrictor, narrowing blood vessels and straining the cardiovascular system. Body temperature increases (hyperthermia), and the pupils become dilated.
Psychologically, the immediate effect is intense euphoria, increased energy, and hyper-alertness. Users may feel more confident and talkative, with a temporary suppression of appetite and need for sleep. As the drug concentration drops, the experience quickly shifts to negative effects.
The “crash” often involves restlessness, irritability, and anxiety. Some individuals may experience severe paranoia or temporary cocaine psychosis, characterized by delusions and hallucinations. This rapid transition from pleasure to dysphoria drives the compulsion to take more of the drug.
Specific Damage to the Nasal Passages
Insufflation introduces the drug directly to the delicate nasal tissues, causing localized damage. The primary mechanism of injury is cocaine’s effect as a vasoconstrictor. This action severely narrows the blood vessels supplying the nasal lining, cutting off blood flow and oxygen to the tissue.
Repeated use leads to local ischemia, causing tissue death (necrosis). This commonly results in chronic irritation of the nasal mucosa, frequent nosebleeds (epistaxis), and a persistent runny or congested nose. Dead tissue can also lead to crusting and loss of the sense of smell (anosmia).
Over time, this tissue death progresses to the underlying cartilage of the nasal septum. The cartilage is vulnerable because it relies on the surrounding mucosal tissue for its blood supply. This destruction can eventually result in a septal perforation, a hole in the septum.
A septal perforation can cause a whistling sound when breathing and chronic sinus infections. In severe cases, it leads to the collapse of the nasal bridge, creating a saddle nose deformity. Damage may even extend to cause a palatal perforation, a hole in the roof of the mouth.
Chronic Systemic Health Risks and Dependence
The long-term health consequences of cocaine use extend far beyond the nasal passages, affecting major organ systems. The sustained effects on the cardiovascular system are severe, increasing the risk of life-threatening events. Chronic vasoconstriction and hypertension contribute to the accelerated development of atherosclerosis, the hardening of the arteries.
This damage increases the likelihood of blood clots, which can lead to a myocardial infarction (heart attack). Long-term use also causes persistent disturbances in heart rhythm (arrhythmia) and increases the risk of ischemic or hemorrhagic stroke. The heart muscle may suffer deterioration in its ability to contract effectively.
Neurologically, chronic cocaine use is associated with a heightened risk of seizures and neurotoxicity, causing long-term changes in brain function. Users may develop persistent cognitive deficits, affecting attention span, decision-making, and impulse control. Disruption of neurotransmitter balance can lead to chronic anxiety, severe depression, and psychosis.
Cocaine is a highly addictive substance, leading rapidly to psychological and physical dependence. Overstimulation of the brain’s reward pathways causes them to become less responsive to natural pleasure. This neuroadaptation results in tolerance, requiring increasingly larger or more frequent doses to achieve the desired effect.