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Generally cocaine users consume a range of other psychoactive drugs as well. There appears to be very little “pure” cocaine use, and few people initially experiment with cocaine: most cocaine users have a prior history of drug use, and often an extensive history of polydrug use. Globally, cocaine users tend to smoke tobacco and drink alcohol, frequently smoke cannabis, and, to a lesser extent, take benzodiazepines and other illicit drugs. Countries such as Australia, Brazil, Canada, Mexico, The Netherlands, Spain, Sweden and Zimbabwe note the use of alcohol with cocaine either to moderate the effects of cocaine or to reduce negative after-effects. These and other countries report the use of cannabis to reduce negative cocaine reactions. Australia, Nigeria, and The Russian Federation report that alcohol and tobacco are used with cocaine to enhance the pleasurable effects of the drug.
Australia and The Republic of Korea note the use of amphetamine and cocaine together to enhance the effects of each drug, and The Netherlands reports the use of “speedballs”, a combination of heroin and cocaine injected together. In South American countries, coca paste is often smoked with tobacco or cannabis, with alcohol, and sometimes with hallucinogens. The majority of coca leaf chewers in Peru do not use it with any other substances, while about a third regularly mix it with alcohol and tobacco use.
Overall, fewer people in participating countries have used cocaine than have used alcohol, tobacco or cannabis. Also, in most countries, cocaine is not the drug associated with the greatest level of harm. Other illicit drugs viewed as more problematic than cocaine are amphetamines (Australia, Brazil, Republic of Korea, Sweden), inhalants (Bolivia, Brazil), benzodiazepines (Brazil), heroin (Egypt, the Maldives), “cheaper and more available drugs (The Russian Federation). The general public in most of the countries surveyed are reportedly poorly informed about cocaine-related harm or drug-related harm in general: specifically, there is little knowledge about the role played by drugs such as alcohol in causing problems usually associated with cocaine use.
Use of cocaine leads to feelings of enhanced energy and may lead to greater stamina, confidence and creativity, though users have mixed feelings about the effect of cocaine use on work. The most common acute problem related to cocaine use is overdose, though these overdoses are often a combination of cocaine with other substances such as alcohol and minor tranquillisers. Death due to cardiac arrest is cited but it is very rare.
Negative physical consequences most commonly reported from cocaine use include: appetite and weight loss, sinus problems, perforated nasal septum, scarring and collapsed veins with injection, and cardiovascular, pulmonary or nervous system damage. Cocaine use in pregnancy has been associated with birth defects, including anecdotal accounts of deformed children.
Cocaine use is associated with impulsive acts which can lead to accidents. However, cocaine users are not thought to be generally at higher risk of accidents, with the possible exception of road accidents among high-dosage regular users who drive trucks.
The USA country profile notes there are widespread myths but few scientific studies of the relationship between cocaine and sexual behaviour. Respondents in two-thirds of the sites agreed that low doses of cocaine intensify sexual pleasure and performance and prolong orgasm, particularly in males. Most sites also report that males regularly offer cocaine to seduce females or (less often) other males, as it is thought to reduce inhibitions.
Some Barcelona and New York informants believe claims that cocaine use enhances sex are a myth. Reports from around half the sites stress that prolonged and high doses of cocaine can produce diminished libido and impotence, though alcohol use may also play a role in this. Regular, high-dose male users reportedly encounter difficulty achieving erection and orgasm. A small number of centres such as Ibadan and Sao Paulo claim that cocaine regularly suppresses sexual behaviour. The sexual behaviour of users warrants fresh study to eliminate sexual and gender stereotypes.
Cocaine use is associated with increased rates of sexually transmitted diseases, and increased HIV transmission, both sexually and via needle sharing. Even occasional cocaine use can lead to impaired judgement, increased risk of unsafe sex, and chaotic sexual behaviour. Although rare, this behaviour can lead to the transmission of HIV or other sexually transmitted diseases. Also, the spread of HIV, Hepatitis B and C and other blood-borne infections is a particular concern among injecting cocaine users. Access to injecting equipment varies enormously across the participating countries, with the result that injectors in some areas consistently use new or cleaned needles and syringes while others face great difficulties in acquiring sterile equipment.
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