Mixing Cocaine With Other Drugs

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Mixing Cocaine With Other Drugs

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KEY TAKEAWAYS

Using cocaine with other drugs results in:

Cocaethylene production, resulting in 18-25% increased risk of death
Atherosclerotic cardiovascular disease
Increased heart rate [1].

Cocaine And Poly Drug Use

Combined cocaine, alcohol, amphetamines and cannabis use carries a 9-fold increased risk of atherosclerotic cardiovascular disease [2].

The most dangerous combinations of cocaine polysubstance abuse are:

Cocaine and alcohol - create cocaethylene as a by-product that leads to seizures, liver damage, compromised immune systems and an 18-25% increased risk of immediate death vs cocaine alone [3]
Simultaneous use of cocaine and cannabis increases heart rate by up 37 beats per minute [1]
Unknowingly taking cocaine alongside fentanyl causing brain damage

Cocaine Combined With...

Combining Cocaine And Alcohol

Risks Of Combining Cocaine And Alcohol

Polyuse of cocaine and alcohol produces cocaethylene, which incurs an 18-25% increased risk of immediate death vs cocaine alone [3].

Short-Term Effects Of Combining Cocaine And Alcohol

32% of cocaine and alcohol users reported being physically violent [4]
48% increased tolerance to cocaine - causing a higher requirement for cocaine to achieve the original level of euphoria [5]

Long-Term Effects Of Combining Cocaine And Alcohol

Cognitive impairment - cocaine and alcohol users have 50% more impairment in memory, problem-solving, learning and executive function than cocaine users [6]
Cardiovascular diseases - cocaethylene is 10 times more cardiotoxic than cocaine [7]

Mixing Cocaine And Heroin, Fentanyl, Methadone, Or Other Opiates

Risks Of Mixing Cocaine And Opiates

Cocaine and heroin cause combined rhabdomyolysis and ventricular fibrillation, leading to multi-organ failure [8].

Short-Term Effects Of Mixing Cocaine And Opiates

Amnesia caused by hippocampal lesions when combining cocaine and fentanyl [9]

Long-Term Effects Of Mixing Cocaine And Opiates

Brain damage from overdose - if fentanyl is added unknowingly
22% prevalence of asthma and 44% prevalence in bronchial hyperactivity when combining cocaine and heroin [10]

Mixing Cocaine And LSD

Risks Of Mixing Cocaine And LSD

Cocaine and LSD cause a combination of simple hallucinations, pseudo-hallucinations and illusions [11].

Short-Term Effects Of Mixing Cocaine And LSD

Reduced psychedelic experience of LSD
Switching from hyperaware to an out-of-body experience

Long-Term Effects Of Mixing Cocaine And LSD

Risk of seizure due to overstimulation
Serotonin syndrome - between 2-12% increased risk of death compared to cocaine alone [12]

Mixing Cocaine And Cannabis

Risks Of Combining Cocaine And Cannabis

Combined cannabis and cocaine use has a 10% incidence of resulting in drug use disorder [13].

Short-Term Effects Of Mixing Cocaine And Cannabis

Time appears to go quicker
Increased heart rate and blood pressure - increased by up to 37 beats per minute [1]

Long-Term Effects Of Mixing Cocaine And Cannabis

Overdose - cannabis stops blood vessel constriction caused by cocaine, causing cocaine to enter the bloodstream more quickly
Schizophrenia - cocaine and cannabis cause a 6.3% increased risk of schizophrenia [14]

Mixing Cocaine And Ecstasy/MDMA

Risks Of Mixing Cocaine And Ecstasy/ MDMA

Cocaine is used with MDMA to create an immediate high (15 minutes vs 35 minutes). These combined short highs lead to continued use of both substances sequentially, causing overdose.

Short-Term Effects Of Mixing Cocaine And Ecstasy/ MDMA

Hallucinations - cocaine exacerbates the hallucinogenic effects of MDMA/ecstasy compared to cocaine alone

Long-Term Effects Of Mixing Cocaine And Ecstasy/ MDMA

Hyperthermia - both drugs increase body temperature, which can lead to hepatic liver injury, kidney failure, and brain swelling [15]

Mixing Cocaine And Benzodiazepines

Risks Of Mixing Cocaine And Benzodiazepines

Cocaine and benzodiazepines combined causes overdose as users develop a sensitivity to benzodiazepines [16].

Short-Term Effects Of Mixing Cocaine And Benzodiazepines

A 6% increase in cocaine usage when it is combined with benzodiazepines [17]

Long-Term Effects Of Mixing Cocaine And Benzodiazepines

Increased sensitivity to benzodiazepines from cocaine use [18]
Hides symptoms of a cocaine overdose (e.g. increased heart rate, sweating, or shaking) that are typically recognised externally

Mixing Cocaine And Amphetamines And/Or Crystal Meth

Risks Of Mixing Cocaine And Amphetamines And/Or Crystal Meth

Combined cocaine and methamphetamine use decreases activity of frontal limbic moral processing, causing an inability to recognise and process other's emotions [19]

Short-Term Effects Of Mixing Cocaine And Amphetamines And/Or Crystal Meth

Tweaking - behaviours such as jaw clenching, teeth grinding or obsessive organising
Short-term effects of serotonin syndrome - elevated heart rate, sweating and high body temperature

Long-Term Effects Of Mixing Cocaine And Amphetamines And/Or Crystal Meth

Sleep deprivation - our clients have reported being awake for up to 18 hours
Long-term effects of serotonin syndrome - tremors and seizures

Mixing Cocaine And Nitrous Oxide

Risks Of Mixing Cocaine And Nitrous Oxide

Cocaine and nitrous oxide combined to cause a breakdown in the nasal respiratory epithelium and the septal and nasal mucosa, leading to nasal collapse [20] [21].

Short-Term Effects Of Mixing Cocaine And Nitrous Oxide

50% reduction in withdrawal symptoms from cocaine use [22]
Tachypnea - rapid shallow breathing

Long-Term Effects Of Mixing Cocaine And Nitrous Oxide

Emphysema and pneumorrhachis [23]
Suffocation - via nitrous oxide intake through a plastic bag or balloon

Reasons Behind Mixing Cocaine With Other Drugs

Prolonged High

A cocaine high is shorter than other stimulants (e.g. ecstasy 3-6 hours; LSD 12 hours), causing cocaine users to combine with other stimulants to prolong a high [24] [25].

Avoiding Side Effects

Users combine cocaine with depressants such as benzodiazepines and cannabis to avoid side effects when coming down from euphoria.

Our clients report that poly usage may cause:

Either increased or decreased high (dependent on the drug)
Feeling more placid/ less likely to act out on violent thoughts
Fewer cocaine withdrawal symptoms
Reduced craving for cocaine
Increased ability to function through day-to-day life

Experimenting

Reasons for experimenting with poly-drug usage include:

Increased tolerance for cocaine alone
Speedballing - believing that concurrent cocaine and heroin use will reduce the side effects of each substance
Peer pressure - drug addicts develop strong social bonds between themselves and rationalise each other's usage

Who Is Most Likely To Mix Cocaine With Other Drugs?

Early Exposure To Alcohol And Drug Use

11-14-year-olds who have been previously exposed to smoking or drinking are 104% more likely to poly use cocaine [26].

Risk factors that predict polydrug abuse include:

Family dysfunction - divorced/absent parents or abuse
Neurodiversity - autism, ADHD or dyslexia
Low-income families [27]

Alcoholics

Chronic alcoholics may mix cocaine to:

To experience longer periods of euphoria from alcohol
Counteract fatigue caused by alcohol

Cocaine abuse in alcoholics is symptomatic of those who are attempting to hide alcohol abuse by appearing to have more energy.

This may lead to developing a cross-addiction [28].

LGBTQ+

LGBTQ+ individuals may use multiple substances:

Those participating in the LGBTQ+ club culture enjoy mixing stimulants and depressants to counteract side effects and balance the effects of each substance [29]
Social stigma and prejudice due to sexual orientation may lead to experimentation
The increase of Chemsex amongst the LGBTQ+ due to peer pressure, the normalisation of taking drugs for Chemsex and Chemsex encouraging high-risk sexual behaviours [30]

Psychological Effects Of Combining Cocaine With Other Drug Use

Poly cocaine use results in sensation-seeking behaviour such as:

Sharing needles, syringes or other injecting equipment
Greater readiness to commit crimes for drugs

Polysubstance abuse of stimulants causes delusional parasitosis, also known as cocaine bugs, due to the user believing that insects are crawling over their body.

Patients of delusional parasitosis experience feelings of isolation, low self-esteem and depression, which can continue after treatment.

Cocaine Alongside Substance Use Internationally

In the USA, there is a 5-fold increase in death rates due to poly use of cocaine and fentanyl as opposed to cocaine alone. Fentanyl is added due to it being cheaper and easier to obtain than cocaine [31].

62.58% of Albanian cocaine users also use cannabis, and 15.02% also use heroin [32].

This comparatively low amount of polydrug use is due to Albanian gangs smuggling cocaine into the country [33].

In Iran, 51% of those who died from drug abuse had two forms of opiates, stimulants or antidepressants detected in post-mortem samples [34].

Polydrug use is attributed to the high amounts of opium produced in Iran.

95% of regular users in Nigeria poly use cannabis, cocaine, heroin or tranquilisers.

As 46% of Nigerians live below the poverty line, polydrug use is caused by looking for cheaper alternatives to use with cocaine, such as tranquilisers [35].

In Australia, 95% of drug-induced deaths involving 4 or more substances included cocaine. Polydrug use is due to accidentally mixing multiple substances [36].

Reasons for cocaine poly drug abuse internationally are:

The legalisation of cannabis - 44.7% of legal cannabis users progress to another illicit drug [37]
Difficulty smuggling cocaine into countries - causing drug dealers to cut together supplies with other drugs
The lower price of producing crystal meth and fentanyl vs cocaine - lowering prices by mixing man-made lab-based drugs and selling them as pure cocaine

When Using Cocaine Combined With Other Drugs Is Not Intentional

Cocaine is 'cut' with other street substances or agents to increase the amount of cocaine that can be sold, thus increasing profit; these include:

Flour
Paracetamol
Talcum powder
Baby powder
Boric acid
Chalk
Baking soda

Potential side effects indicating other substances have been added to cocaine are:

Overdose - fentanyl is up to 100 times stronger than cocaine
Infection - levamisole kills white blood cells
Diarrohea and dehydration - from laxatives
Lethargy - from benzodiazepines

There is also a risk of cross-addiction, as the user becomes addicted to the other drug unknowingly during cocaine abuse.

How Using Cocaine With Other Drugs Affects Detox

Whilst cocaine detox is usually undertaken without any medication to substitute its effects, cocaine mixed with other drugs requires medication such as:

Chlordiazepoxide, Acamprosate, Benzodiazepines, Naltrexone and Gabapentin
Diazepam and Valium (amphetamine and cannabis withdrawal)
Methadone, Buprenorphine, suboxone and lofexidine (opiate withdrawal) [38]

In polydrug users, the rate of seizures and DTs is increased by 1.1%, and the rate of infections or cardiac complications is increased by 1.8% [39].

Based on our clinical observations, when professionally managed, polydrug detox presents similar risks to detoxing from one drug, assuming professional oversight.

The average detox for polydrug abuse takes between 14-28 days, significantly longer than the average of 7 days for singular drug/alcohol detox.

How Using Cocaine With Other Substances Affects Recovery Attempts

Polydrug users are 6% less likely to attend treatment than cocaine users [40].

Higher brain function improved by 10% in those who had been abstinent from polydrug use for 1 year. Whereas brain function levels were 5% lower than those who had never taken drugs [41].

When Using Cocaine With Other Substances Actually Reduces Risk

Cocaine And Cannabis

The polyuse of cocaine and cannabis reduces latency of cocaine's effects by 1.34% and reduces duration of side effects by 1.34% [42].

Cocaine And Antidepressants

Those who take fluoxetine or desipramine detoxed from cocaine with fewer depressive symptoms and cravings compared to those who did not use any form of antidepressants [43].

Cocaine And Peyote

Combining cocaine with peyote (a cactus with psychoactive properties) causes a reduction in anxiety caused by cocaine use [44].

About the author

Harriet Garfoot

Harriet Garfoot BA, MA has an Undergraduate degree in Education Studies and English, and a Master's degree in English Literature, from Bishop Grosseteste University. Harriet writes on stress & mental health, and is a member of the Burney Society. Content reviewed by Laura Morris (Clinical Lead).

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Last Updated: April 25, 2024