Table 3 Themes, subthemes and example quotations extracted in the study

Cocaine use (n = 231)

Purity of cocaine (n = 81)

Cocaine cut with other drugs (n = 45)

It’s just that sometimes people add amfetamines, RC (research chemical) stimulants, or whatever else uppers they have, and more often than not, these substances have a worse crash than cocaine does. So, it’s not that better coke has a better crash, it’s just that bad coke is often cut with substances that have a nastier crash than cocaine, and so bad coke often has a worse crash than good coke.

Purity of cocaine is better at source and varies between geographical locations (n = 11)

I still get really good girl. I can do five shots out of a 20 bag good enough to give me the train. But I’m also in Florida, closer to the source, and in a port city so that might explain it.

Impure cocaine affects ADEs and quality of come down (n = 21)

I agree that lesser quality coke gives you a harder comedown.

Approaches to check purity (n = 4)

If you have a lot and want to test it the movie *** actually gives you a very accurate way to do so by putting it on a hot plate and gage what temperature it melts out.

Purchase of cocaine (n = 14)

Dark web sources (n = 4)

Shared a gram of absolute bash with a mate at the start of the week, simply because he brought it round. Was awful, can’t have been more than 30% cocaine. Darkweb stuff is where its at!

Linked to organise crime (n = 4)

Keep in mind that it is almost impossible to purchase cocaine that does not support organised crime groups which exploit some of the poorest people on the planet.

Online sources (n = 1)

Street drugs are so cut to shit these days. That’s why I only get my drugs online.

Source from friends (n = 2)

Gave the rest of it to my mate for just under an ounce of weed.

Street source (n = 3)

The stress of massive amounts of coke daily combined with the anxiety stemming from having to deal coke and MDMA to support my habit was just too rough after a few years.

Cost of using (n = 31)

Highly expensive (n = 26)

Coke is crazy expensive and there is no way I can use quantities needed for even moderate addiction.

Cocaine use led to poor finance (n = 5)

This is my life too. I’m in the UK too. I’ve spent £1000 on it this last seven days. I have a good job and career. One that does test you. I’ve just been lucky. Watching this post and nodding my head. I have a problem.

Administration of cocaine (n = 83)

Chewing (n = 2)

When chewed, coca acts as a mild stimulant and suppresses hunger, thirst, pain and fatigue.

IV (n = 23)

I also dont sniff it, I prefer the intravenous route of administration. So mine is very intense when it comes to both the high and come down.

Orally (n = 1)

It (cocaine taken orally) was wonderful back in the day, and you didn’t have needless dangers of cocaethylene when you mix coke with alcohol, or you could just snort/smoke/inject coke like everyone else.

Parachuting (n = 2)

I used to parachute coke sometimes to save my nose. It has a longer onset obviously but it lasted longer too.

Rubbed into gums (n = 1)

It’s also rather common for people to do “nummies” with the remaining scraps of cocaine that they have - basically rubbing the powder over their gums for an extra rush.

Smoking (n = 12)

I’ve been smoking rock (crack cocaine) daily for about four years now. It took a very long time to learn to control my usage to the point that I could hold down a job.

Snorting (n = 42)

Cocaine really is amazing if you do it responsibly. I experimented by snorting a few and completed a report paper I was cramming on for my class at the university. I got and it was due to the ‘enhanced’ focus I had while doing the homework.

Alternatives to cocaine (n = 9)

Amfetamines (n = 1)

The only stimulant I do daily now is a cup of coffee to wake me up. I never cared for stimulants (I prefer opiates/opioids), but if I did, I’d choose amfetamines over coke. They’re less expensive and much longer-lasting, which means more bang for your buck, if you ask me. I’d rather take one dose of amfetamines a day than have to redose several times a day with coke.

Cathinones (n = 1)

Cocaine is both highly euphoric and, to a degree, subtle. If you have been doing cathinones (for example) you may be expecting a twice-strong half-fun experience.

MDMA (n = 1)

I think coke is highly overrated .iff you wanna get high, try some Ecstasy or MDMA

Methylphenidate (n = 5)

Methylphenidate (Ritalin) is used often for becoming cocaine free. People say good things about it. I think that if you can get Concerta (extended release Ritalin), it would be great for your situation. You could take one pill which would hold you for quite some time.

N-Ethyl Pentedrone (n = 1)

Coke is expensive and shitty. If you want a decent stimulant, go for something like N-ethyl pentedrone.

Polydrug use (n = 13)

Use of cocaine and Marijuana (n = 3)

At 15 I couldn’t conceive of a primo (cocaine laced marijuana cigarette) and had never heard of one, and I just kept taking larger and larger pills on the blunt as it wasn’t irritating my throat and lungs like usual.

Use of cocaine and Alcohol (n = 2)

Anytime I have done a couple lines before going drinking I can confirm that it becomes too easy to drink like a fish, I find that the alcohol isn’t really felt...until much later...when it gets ugly. I never experienced a heavily elevated high from the blow but considering how much spiced rum I consumed last time I am lucky not to have visited the hospital.

Use of cocaine and BZD (n = 1)

Teamster guy is right, don’t panic, everyone’s heart races. Fix the chest pains by changing your breathing from short chest breaths to deep stomach inhales. It’s the dichotomy of euphoria to he’ll on earth when you come down and run out. Also if you can get any benzos (Xanax), pop 0.5 mg.

Use of cocaine and LSD (n = 1)

I’ll begin with the LSD. Soon after meeting with a fellow user to drink some beer and do some lines, a friend called suggesting we drop acid (LSD). At this point the cocaine high was already in effect, and as cocaine typically does, it had become my first priority. I felt somewhat uneasy about the notion of dropping acid (LSD) due to the longevity of its effects, but I found that once a tab was offered to me in person, I popped it right in my mouth with little to no consideration. This weakening of inhibition and conscious consideration is a direct effect of the “everything is alright” euphoric rush of cocaine.

Use of cocaine and heroin (n = 3)

Alright I got out of prison last week and decided to get high over the weekend. Things got really out of control and by Saturday I had a ball of coke, a gram of heroin, and a fresh 10-pack of syringes. I pretty much mainlined like 2.5–3 g of coke over the course of 34 h. At about one in the morning I shot a small shot of heroin like 15 min after my last shot of coke.

Use of cocaine and MDMA (n = 1)

The first time I sniffed up coke was when I was at a huge house party, already rolling on MDMA and drinking. Back in 2013ish and I had a blast. Though I do not recommend this combo of drugs.

Use of cocaine and Psycadelics (n = 2)

Eating mushrooms while high on cocaine took on a similar but unique, and ultimately more pleasant dimension. Each time I ate about 1.1–1.5 g of mushrooms while riding the cocaine train.

Reasons for use (n = 47)

I know that in a social situation it can help lead to cocaine use but I’m keeping an eye on that, this is early days.

Self-medication with cocaine to control depression (n = 3)

Depression symptoms: gone. Social anxiety: gone. Seemed to last all night (I was drinking, too, didn’t know as much about drugs as I do now) and didn’t notice a at all. A little too good, and while I’d take it again, I definitely do not want a comedown source because I can see myself easily becoming addicted.

Self medication to control cocaine comedown (n = 33)

As for dealing with a coke comedown in the future, make sure you’ve got some benzos (benzodiazepines) to help you get by. Otherwise the following day will not be pleasant one bit, depending on how much you’ve done.

Self-medication to overcome cocaine ADE (n = 7)

Aw, K (Ketamine) is my drug! It used to help me with the paranoia on coke.

Measures to stop cocaine use (n = 17)

Congratulations on being able to stop it completely. It took me a lot of rehab and a lot of psychiatry to finally rid myself off it but when I did I never touched it again.

Alertness (n = 1)

I had been drinking and high of marijuana the first time I was offered a line so I noticed that it sobered me up and made me more alert almost instantly. However I was really disappointed that I felt no feelings of euphoria.

Clear headedness (n = 1)

I did cocaine on a bunch of occasions in the past and I never felt much. Just a clear head.

Control depression (n = 5)

Cocaine will fix some common problems such as boredom, depression, social anxiety, etc.…

Enhanced focus (n = 4)

Cocaine really is amazing if you do it responsibly. I experimented by snorting a few ‘and completed a report paper I was cramming on for my class at the university. I got and it was due to the ‘enhanced’ focus I had while doing the homework.

Euphoria (n = 25)

The first time I did coke I was already addicted to speed. I did a couple of lines I felt a rush and euphoria. At first used on weekend but eventually went to using everyday went from Adderall to coke then crack .

Increased Confidence (n = 2)

As much of a dark past me and Coke have had, I must say that there is nothing quit first bump. You will feel unbelievable. Confidence through the roof and having a bett you ever thought possible.

Increased energy (n = 5)

I had plenty of energy, had a noticeable smile on my face and felt a irresistible urge to fight someone.

Increased sociability (n = 5)

Luckily their friend there with me to talk to since cocaine makes you sociable lol. On an off week, snort real lines and have so much fun at clubs, casinos and strip clubs.

Increased talkability (n = 2)

I felt invincible and I could talk and talk and talk, which was great because I was kind of shy.

Increased self-confidence (n = 1)

Cocaine also doesn’t keep you up partying for days, months, etc. - it’s nothing like amfetamine (Speed) and doesn’t energise you in that way. It (Cocaine) just raises your self-esteem and makes you feel about ten feet tall.

Relaxation (n = 1)

And then I stay on that sweet pot where every line gives me that brain activeness and good feeling, while my body stays sooooo relaxed and even the heart beat stays on a comfort level. I am actually writing this after using near 2 g and I am sitting, and writing about my experience with this mix (mixture). In fact, if i dont do the two lines that are in front of me in the next 10 min, ill be sleeping here on the chair.

Sexual arousal (n = 8)

Orally, it (cocaine) worked and the high lasted for 30 mins, and I remember chatting about non-sexual things yet getting very aroused.

Adverse events (n = 353)

NS (n = 174)

Addiction (n = 24)

Addiction, fear, pain, mental health issues, and death is the ultimate ending in at least 99/100 cases.

Anger (n = 3)

I had plenty of energy, had a noticeable smile on my face and felt an irresistible urge to fight someone.

Anxiety, panic attacks, paranoia, seizures and sweating (n = 97)

The anxiety /heart racing happens when you do to many lines in a short period. Not only will you be able feel your anxiety but others around you will be able to tell your paranoia due to visible signs of agitation and your eyeballs sticking out of your head.

This then seems to trigger the psychosomatic part where I feel side effects of anxiety and paranoia kick in afterwards. Although my tongue may be swollen, I can still calm myself down in that state to recognise that I am still breathing air in and out through my nose, and even through my mouth.

Dehydration (n = 4)

Cocaine is very dehydrating so you need to drink a lot of fluids

Depression (n = 6)

Still feeling very depressed, and feeling pressure in my head, and head pulsating. I really hope this goes away soon.

Headache (n = 9)

I get just as bad of a headache from doing poor quality cocaine as I do from lack of sleep. Usually though I can trace my “lack of sleep” headache back to being dehydrated and hungry.

Nausea (n = 4)

After about an hour of consuming coke like this my nose is completely clogged and I become very nauseous.

Numbness (n = 17)

As soon as I snorted my face went all numb and I got a decent little rush. When I kept snorting it the high resembled somewhat of a meth high for me. I went through that bag very quickly.

Overdose (n = 2)

There is definitely risk of OD’ing (overdosing) on crack, essentially what will happen is as the user closes their eyes takes in the hit they will probably just fall back and appear to be passed out but will soon begin to go pale as the heart has stopped, essentially the risks are the same as for powdered cola (cocaine hydrochloride), seizures, heart attacks etc. as for doses I’m not sure it all has to do with tolerance, but I mean an inexperienced user with top quality crack taking a full 0.25 hit in one go I’d put my money on it that they’ll OD (overdose).

Psychosis (n = 8)

I’ve experienced cocaine psychosis, to be honest I think it was worse than meth (methamfetamine) psychosis.

CV (n = 60)

Arrythmia (n = 10)

Cocaine can interfere with your heart’s electrical system and disrupt the signals that tell each portion of your heart to pump in sync with the others. This can lead to arrhythmias, or an irregular heartbeat.

Atherosclerosis-related coronary artery disease (n = 1)

In fact, 28% of people who died suddenly after cocaine use showed severe atherosclerosis-related coronary artery disease.

Cardiotoxicity (n = 7)

Is cocaine cardiotoxic? Yup. Can we say for certain what dose/frequency causes it? No. Some people can have horrible reactions from as little as 20–50 mg of cocaine, others can go through 3 g or more.

Chest pain (n = 1)

It doesn’t sound surprising to me to feel nauseous and chest pain with high dose stimulants where if you lucky will contain probably at least levamisole as adulterants and maybe some others***.

Damaged blood vessels (n = 1)

It has something to do with what’s in cocaine specifically that stresses out the heart in a unique way that Adderall and Ritalin do not. Something to do with the vessels in the heart. People who abuse cocaine often have heart issues, while those who even do meth (methamfetamine) don’t often succumb to the same symptoms or at least not as noticeable.

Increased blood pressure (n = 2)

Lots of possible causes; higher blood pressure, restricted blood flow, not to mention the acidic powder you’ve been firing up into your sinus cavities.

Myocardial infarction (n = 15)

Cocaine-induced heart attacks are not just a risk for individuals who’ve used the drug for years. In fact, a first-time user can experience a cocaine-induced heart attack.

Sudden cardiac death (n = 2)

“Sudden cardiac death” is a reported consequence of cocaine use. Sometimes otherwise healthy people (usually men in their 30s–40s) will literally have their heart stop when they least expect it, and just like that, it’s all over. It’s not common enough to stop everyone from using cocaine, obviously, but it happens with enough frequency that it deserves a mention. At least it’s a fairly painless exit, with no period of anticipation/fear, I suppose. (“He died doing what he loved... snorting cocaine off **** while blasting **** music...”)

Tachycardia (n = 16)

After this, he didn’t experience anything, no rush, no euphoria, nothing except fast heart beat. My heart went crazy beating and then slows down, and I can feel it stops beating for 4–5 s, and then goes fast again, and it was just having irregular heart beat.

Vasoconstriction (n = 4)

Vasoconstriction isn’t the only issue with cocaine. Cocaine can interfere with your heart’s electrical system

Endocarditis (n = 1)

I won’t go into all the tiny details, but fast forward 6 months. I get an infected abscess, endocarditis, heart surgery, pacemaker.

Lethal (n = 10)

Lethal (n = 10)

Overdose, which can cause seizures, cardiac arrest and death are most directly related to the cocaine serum level in the blood, as well as the general and cardiac health of the user.

Ear, nasal and throat damage (n = 24)

Nasal bleeding (n = 1)

I personally find no benefit of snorting cocaine hydrochloride. The most I have ever had was a nose bleed from snorting a rather large rail.

Nasal damage (n = 18)

Further down the line, cocaine abuse can damage your nose/septum, feelings that you associate with pleasure, i.e. sex, nice food etc., can end up being felt only through taking cocaine.

Nasal infection (n = 1)

Doing coke gives you some risk of a nasal infection, but doing really levamisole cut coke makes that chance extremely higher!

Tooth decay (n = 3)

Crack cocaine will cause several acute issues in the body, namely rapid tooth decay, tachycardia, and lung irritation (as any smoke will cause).

Social harm (n = 17)

Broken relationship (n = 4)

It (cocaine) wont hurt yourself but it will hurt your family and friends, this is what you really should think about. Its not worth so just don’t try it.

Career problems (n = 4)

I started shooting up heroin and cocaine and within a month my arms were destroyed and bruised. I missed my doctor appointment for my FMLA (Family and Medical Leave Act) for work and ended up losing my whole career, and everything I worked in that company.

Homelessness (n = 1)

But friend, 10 years ago, i wish i would have quit with my sons mom. We would still be together probably, i wouldnt have lost everything and for a while even lived homeless because i got to the point where I wanted nothing but heroin and coke (cocaine), then benzos (benzodiazepines) to sleep and start over.

Lying (n = 1)

Once your ability to manipulate and control everyone around you to maintain a secret addiction, the crash and devastation is catastrophic, and not just to you, but to the people you love as well.

Poor finance (n = 5)

I would not advise using cocaine on the daily (even with good quality cocaine, I don’t see it as a really sustainable habit physically - or potentially financially).

Hunger (n = 1)

Being broke, hungry, angry, physically and mentally weak, paranoid errrrr, maybe more. This is what coke does (along with any other substance that gives “instant” euphoria (like sugar).

Self-harm (n = 1)

But boy, when people say “The higher you fly, the harder you fall” they really aren’t kidding. The 3rd time I tried it, I tried to kill myself. Stabbed myself with a kitchen knife in my arm, still have a nasty scar: Something I have to lie about to friends and family.

Cocaine-drug interactions (n = 68)

Cocaine-Alcohol (n = 40)

Alcohol is more dangerous because of the substance it produces in the liver in combination with cocaine and ethanol called cocaethylene. This is similar to the action of acetaminophen and alcohol producing a much more toxic combination than the two individually. Benzos (benzodiazepines) will not lessen the creation of this compound.

Cocaine-amfetamine (n = 4)

It (cocaine) can be cut with active ingredients such as amfetamines, which will too contribute to making the comedown worse.

Cocaine-Aspirin (n = 1)

While aspirin is frequently recommended to decrease the likelihood of heart attack or stroke, this is because it is a blood thinner and decreases the occurrence of blood clots.

Cocaine-benzodiazepines (n = 2)

However benzos (benzodiazepines) and coke (cocaine) can of course be a problematic combo as well, you may take more cocaine than usual due to less side effects (thanks to benzos).

Cocaine-Fentanyl (n = 2)

I can’t comment on quality as I’ve been sober through all of this, but I personally know/knew two people who decided to do some blow one evening a month ago (snorted) and both OD’ed. (fentanyl) - one of them passed away.

Cocaine-GBL (n = 1)

Also GBL (gamma butyrolactone) is used a lot to give poor quality Coke a bit of a minor euphoria, because they can only use a minor amount of GBL or you would pass out - often making you a bit dizzy.

Cocaine-Levamisole (n = 10)

Levamisole is one of the most common cutting agents and it WILL suppress your immune system, in addition to possibly causing heart damage. If you are for some reason getting your supply straight from the source then you should watch your health for different reasons entirely, these arent people you want to associate with.

Cocaine-MDMA (n = 1)

Heart was definitely racing a bit, bro I think it (cocaine) brought out the MDMA euphoria quite a bit (when used together).

Cocaine-methamfetamine (n = 1)

Dealers add meth (methamfetamine) … to get you hooked sooner (meth is more more addictive).

Cocaine-methylphenidate (n = 1)

If I am correct it is just not really known if MPH (methylphenidate) are lacking these effect’s. But my experience with MPH and cocaine (insufflated) is they both feel kinda the same especially the side effects.

Cocaine-Opiates (n = 1)

Cocaine and an opiate mixed together is more likely to be fatal, due to cardiac arrhythmia or delayed opiate overdose due to lower perceived effect, than either substance on it’s own.

Cocaine-Procaine (n = 2)

Cocaine itself actually numbs your nostrils. In fact one of the things people used to use as “cut” was powdered novocaine (procaine), which tricked people into thinking it was “real” cocaine because of the numbing sensation they got from it. It’s also rather common for people to do “nummies” with the remaining scraps of cocaine that they have - basically rubbing the powder over their gums for an extra rush.

Cocaine-Stimulant (n = 2)

... The after effects of stimulants (combined with cocaine) last longer than the initial effect that can have a better feeling because your body is still able to - at first - handle this energy boost.