Crack Overdose

Person laying on the ground next to a syringe and spoon experiencing an overdose

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 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 2017 National Survey on Drug Use and Health report, about 2.2 million (0.8%) of individuals over the age of 12 were using cocaine at the time of the survey in 2017. Out of these 2.2 million individuals, 473,000 were using crack cocaine. The proportion of cocaine users in 2017 was similar to that in 2016 (0.7%).  

In 2017, 13,942 deaths in the United States involved cocaine, which accounted for 19.8% of all deaths caused by a drug overdose and is a 34.4% increase over the previous year, with 10,375 cocaine-related deaths in 2016. Out of the 13,942 cocaine-related deaths in 2017, 10,131 also involved an opioid. 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.

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.

Kaye, Sharlene, and Shane Darke. “Non‐fatal cocaine overdose among injecting and non‐injecting cocaine users in Sydney, Australia.” NDARC Technical Report No. 170, October 2004. Accessed August 5, 2019.

Kariisa M, Scholl L, Wilson N, Seth P, Hoots B. “Drug Overdose Deaths Involving Cocaine and Psychostimulants with Abuse Potential — United States, 2003–2017.” Morbidity and Mortality Weekly Report, May 2019. Accessed August 5, 2019.

Substance Abuse and Mental Health Services Administration. “National Survey on Drug Use and Health Annual Report 2017.” September 2018. Accessed August 5, 2019.

Richards, John R.; Le.Jacqueline K. ”Cocaine Toxicity.” StatPearls, Updated July 2019. Accessed August 5, 2019.