Crack Overdose – Risk Factors & Symptoms

Cocaine is a very powerful stimulant that is used to produce feelings of euphoria and increased energy. Cocaine is extracted from the leaves of the coca plant and exists in the form of its hydrochloride salt (cocaine hydrochloride). Cocaine is generally snorted or injected, but tends to burst when heated. Crack is cocaine in its freebase form without the hydrochloride group. Crack can be obtained from cocaine hydrochloride by heating it with baking soda or ammonia and water.

Crack melts on heating and can be inhaled or smoked. Crack cocaine is rapidly absorbed and produces an immediate and intense euphoric effect relative to other forms of cocaine. Crack, rather than being a different kind of drug, is simply a different way of administration of cocaine. Use of crack cocaine may result in an overdose due to its rapid effects and inability to monitor the amount smoked.

How Do Crack Overdoses Occur?

A crack overdose can occur regardless of the amount used, frequency of intake and the route of administration. However, high doses of the drug, repeated use and routes of administration that result in a rapid increase in drug concentrations in the bloodstream increase the chance of overdose.

The rapid effects produced by crack cocaine increase its potential to cause an overdose. The effects of smoking crack are more rapid than that of injecting or snorting cocaine. However, intravenous injection of cocaine is associated with the highest rates of overdose, followed by smoking crack and snorting cocaine. Crack cocaine is also often used with other substances such as alcohol, cannabis, benzodiazepines and opioids. Using crack with other substances tends to result in more severe adverse effects.

Crack Overdose Signs and Symptoms

Crack cocaine is a psychostimulant and results in the activation of the sympathetic nervous system. Some of the physical signs of a crack cocaine overdose include:

• Increased heart rate
• Arrhythmias ( irregular heartbeat)
• Hypertension
• Hyperthermia or elevated body temperature
• Excessive sweating
• Seizures
• Rhabdomyolysis or breakdown of skeletal muscle
• Dilated pupils
• Headache
• Nausea and vomiting
• Tremors

The psychological symptoms of a crack overdose include:

• Agitation
• Psychosis
• Hallucinations
• Paranoia
• Anxiety
• Panic

What Happens When You Overdose on Crack?

Cocaine, being a stimulant, results in feelings of euphoria and increased energy and alertness. A crack cocaine overdose is characterized by excess stimulation of the sympathetic nervous system (fight or flight response). Some of the common signs of a cocaine overdose may include tremors, dilated pupils, chest pain, nausea, palpitations and breathing difficulties. Some of the psychological symptoms may involve anxiety, panic, hallucinations and agitation. Other common effects of an overdose include hyperthermia and seizures.

Dangers of Overdose

Some of the more dangerous or life-threatening effects of a crack cocaine overdose include rhabdomyolysis, renal failure, seizures, hyperthermia and cardiovascular toxicities. Some of the cardiovascular complications caused by crack use include dysrhythmias, myocardial ischemia and infarction, cardiomyopathy, hemorrhagic and ischemic stroke.

Chronic cocaine use can lead to coronary atherosclerosis and left ventricular hypertrophy. These anatomical changes can increase the chances of a cardiovascular event due to acute cocaine use.

Crack Overdose Statistics

According to the 2023 National Survey on Drug Use and Health report, about 5.0 million (1.8%) of individuals over the age of 12 were using cocaine at the time of the survey.

In 2022, 27,569 deaths in the United States involved cocaine. This is a 73.5% increase since 2019. Out of cocaine-related deaths in 2022, the majority also involved an opioid — most often, fentanyl. It is not possible to determine if the overdose deaths were from crack cocaine or cocaine in its powder form because the statistics do not distinguish between the methods used.

Crack Overdose Deaths

Seizures and hyperthermia are among the leading causes of death due to a crack cocaine overdose. These symptoms are often accompanied by pulmonary and cerebral edema. Other common causes of death due to cocaine overdose include respiratory failure and cardiovascular toxicities.

Some of the common life-threatening cardiovascular toxicities caused by cocaine include arrhythmias, stroke, myocarditis, aortic dissection, myocardial ischemia and infarction. Death may also be caused by hyperthermia and psychotic agitation (delirium accompanied by agitation involving fear, panic, violence) and subsequent respiratory arrest.

Risk Factors for Crack Overdose

Crack cocaine overdose can occur in anyone who uses this highly potent form of cocaine, but some groups are more prone than others. The risk factors often include frequency of use, overall physical health, and access to harm reduction resources. Overdose can result in severe physical and psychological harm, including heart failure, seizures, and extreme anxiety or paranoia.

High-Risk Groups

Individuals with existing heart conditions or high blood pressure are especially vulnerable, as crack cocaine significantly increases heart rate and blood pressure. Those who mix crack with other substances, such as alcohol or opioids, also face elevated risks due to the combined stress on their cardiovascular and nervous systems.

Contributing Factors

Chronic users may develop tolerance, prompting higher doses to achieve the desired effect. This escalation boosts the likelihood of accidental overdose. Moreover, inconsistent street purity can be dangerous: if a batch is unexpectedly potent, a user might ingest more than their body can handle.

Psychological and Environmental Factors

Stressful life events, untreated mental health conditions, and exposure to environments where crack use is common can heighten overdose risk. Some people may turn to crack cocaine to cope with trauma or ongoing stress, increasing their frequency and quantity of use.

The Role of Socioeconomic Status

Poverty and limited access to healthcare, education, and stable housing can also contribute to increased risk. Individuals in underserved communities often encounter barriers to treatment and support services, making it more difficult to break patterns of substance abuse.

Are There Gender Differences With Cocaine Overdose?

While crack cocaine can be addictive and dangerous for anyone, gender may influence patterns of use and overdose risk. Biological, social, and cultural elements all play roles in shaping men’s and women’s experiences with the drug.

Men and Women: Varied Patterns of Use

Men typically use crack cocaine at higher rates, potentially increasing their chances of overdose through more frequent or heavier consumption. In contrast, women may use crack as a response to factors such as relationship stress or emotional distress, which can also elevate overdose risk if use becomes chronic.

Biological Factors in Women

Hormonal fluctuations and differences in body composition can influence how women metabolize crack cocaine. These variations might alter the intensity of drug effects or increase the likelihood of severe outcomes.

The Importance of Individual Factors

Ultimately, each person’s circumstances—genetic predispositions, mental health status, and personal history—shape their vulnerability to overdose. A better understanding of these unique factors can inform more effective prevention and treatment strategies for both men and women.

Crack Overdose Treatment

If a cocaine overdose is suspected, call 911 immediately. Resuscitation with the help of CPR may be helpful and in case of hyperthermia, cold compresses may be used to keep the individual’s body temperature down.

Treatment for crack cocaine overdose generally involves supportive care and often involves management of symptoms related to cardiovascular toxicities, seizures, and hyperthermia. Drug overdose treatment requires careful monitoring of vital signs, including heart rate, blood pressure, body temperature and electrolyte levels throughout the treatment process. Respiratory support may be necessary for breathing difficulties and intravenous fluids may help combat the adverse effects of rhabdomyolysis such as kidney failure.

Benzodiazepines are the first line of treatment for sympathetic nervous system symptoms, including agitation, seizures, hypertension and cardiovascular symptoms like tachycardia. Antipsychotics like haloperidol may also be used along with benzodiazepines for the treatment of extreme anxiety and agitation.

Crack has a short-half life and a majority of patients recover within 24 hours of observation in an emergency department.

Crack Overdose Prevention

A crack cocaine overdose can occur at even low doses and in first-time users. Cocaine use at any dosage is dangerous. Furthermore, cocaine is highly addictive and chronic cocaine use has tremendous negative consequences on the physical and mental health of the user. Given the dangers of both acute and chronic crack cocaine use, abstinence from cocaine use is recommended.

Chronic users may find it difficult to discontinue use and must seek professional help. Use of alcohol and other substance with cocaine must also be avoided.

If you or a loved one suffers from crack cocaine addiction, the Recovery Village Ridgefield can help. Recovery Village Ridgefield specializes in the treatment of substance abuse disorders co-occurring with mental health disorders.