Along with most other recreational drugs, government statistics suggest that more people are using cocaine (also known as coke, charlie, snow, powder, marching powder) and the cocaine derivative, crack (freebase). In the UK, both cocaine and crack are illegal class A drugs. Dealing carries a maximum life prison sentence and unlimited fine, and possession can mean up to seven years in prison and a large fine.

Cocaine is a stimulant made from the leaves of the South American coca shrub. It comes in the form of a white powder, costing between £30 and £100 per gram. Usually snorted into the nose, it provides a feeling of excitement, exhilaration and self-confidence lasting for about 15 to 30 minutes. Cocaine can also be rubbed into the gums, onto the teeth and into the anus or vagina before penetrative sex. Rarely, cocaine is also made into a solution for injection.

Crack is sold in the form of small rocks, which are smoked either in cigarettes or in a pipe. Historically, crack has been associated with poor urban populations, but in fact is used by people from a wide social spectrum.

Cocaine users may take many doses to maintain the high, which can cause anxiety, paranoia and a tolerance for the drug, meaning that larger doses have to be taken to achieve a similar high. Although not addictive in the same way as heroin or opiates, users can become psychologically dependent on the transient high which cocaine provides and find that they suffer anxiety, depression or severe tiredness if they stop using the drug.

Longer-term use of both cocaine and crack can cause severe anxiety, clinical depression, psychotic episodes, aggression, weight loss and malnutrition. Both drugs have also been shown to cause potentially fatal heart problems including heart attack, angina, irregular heartbeat, and inflammation and enlargement of the heart.

In common with most other street drugs, users are rarely sold a pure form of cocaine. The drug is often ‘cut’ with other cheaper drugs such as amphetamines (speed), talc or detergents which can be poisonous or cause irritation, leading to infection.

Snorting cocaine can damage the membrane between the nostrils, leading to bleeding and eventual erosion. There have been reports that sharing snorting equipment may permit the transmission of hepatitis C virus. Rubbing cocaine into the gums, vagina, or anus can cause ulceration, which could increase transmission of HIV or other sexually transmitted infections. Sharing injecting equipment also presents a risk for transmission of HIV, hepatitis viruses, and other blood-borne infections.

Cocaine is not metabolised by the body in the same way as anti-HIV drugs so there does not appear to be cause for concern about interactions between them.

Test-tube studies suggest that cocaine alters the functioning of the immune system in several ways, making immune cells more vulnerable to HIV. Experiments conducted in HIV-infected mice bred in laboratories, found that mice exposed to cocaine had far fewer CD4 cells than mice not given the drug. This suggests that HIV disease may progress faster in regular cocaine users.

However, studies looking at regular cocaine use and disease progression in gay men have produced conflicting results. Some research found no association, but one study found that HIV-positive women who used cocaine were more likely to become ill. Other research has shown that HIV-positive cocaine users are more likely to have hardening of the arteries.

Because drug use may be an indicator of other social issues which may have a negative effect on health – such as poor access to health care, or other health problems – these types of studies can be difficult to interpret.

As with all recreational drugs it is also wise to consider how use could impact on adherence to your HIV treatments. If you are worried about your recreational drug use, then your doctor or healthcare team will be able to refer you to an appropriate source of support.

NAM reminds readers that cocaine use is illegal in the UK, and in many other countries. This factsheet has been produced with UK law in mind. Readers in other countries should be aware that the legal status of cocaine use may differ to that described in this factsheet.