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36 Cocaine and Crack Harm Reduction Strategies

Cocaine isn’t good for you, there is no safe way to take cocaine or crack, and you’d probably benefit from quitting your habit.

That being said, if you choose to use cocaine or you can’t stop right now, then make use of harm reduction strategies to reduce the potential damage and stay safe to live and play and maybe even quit another day.

Here are 36 cocaine-specific harm reduction strategies. Many are easily adopted, so consider which, if any, might help you stay safe and healthy. Adopting even one new strategy could safeguard your health and well being. Remember, cocaine isn’t only addictive, it also increases your cardiovascular incident risks, so if you take cocaine - whether you’re a causal user or cocaine-dependent - harm reduction makes sense for you.

36 General Cocaine Harm Reduction Strategies

Reducing Nasal Damage

  • Make sure to insert the straw high up into the nasal passage before snorting. This reduces the amount of cocaine that gets trapped by nose hairs. Cocaine left in the nostril can lead to irritation and a damaged septum – and ultimately to a perforated septum.
  • Alternate snorting sessions between both nostrils and after snorting, rinse out your nostrils to clean off any cocaine adhering to your septum. Try water or saline in a spray bottle for this.
  • Make sure to chop up into a very fine powder.

Reducing Injection Risks             

If you don’t already inject, don’t start. If you already inject, switch to safer modes of administration, like smoking.

Cocaine injection is riskier than opioid injection since cocaine users inject more frequently (due to cocaine’s shorter high) because cocaine acts as a tissue damaging anesthetic and because since it’s an anesthetic, you can’t always feel the damage you do.

  • If you choose to inject, to avoid re-using syringes and damaging veins, make sure you have enough injection equipment on hand. If getting from a harm reduction center or needle exchange, tell them you inject cocaine and therefore need a larger supply.
  • Take care of your veins and maintain good injection practices to reduce infection risks. Read our harm reduction guide to heroin injection for a more complete list of safe injection tips.
  • Switch from injecting to smoking or snorting - or at least avoid injecting in very risky sites, like the groin or neck. If you get to the point where you need to rely on very dangerous sites, it's time to stop injecting.
  • Avoid skin popping. Cocaine isn’t easily absorbed into tissue and can lead to constricted blood flow and tissue damage. Under-skin tissue damage can lead to discoloration at the injection site.1

Reducing Smoking Harms

  • Don’t share pipes. Sharing pipes or stems can lead to the transmission of HIV, herpes, hepatitis and other diseases.
  • To prevent cuts and burns, wrap stem ends with tape or rubber.
  • To avoid hand burns, buy a good lighter. A burner type, rather than a flame type, may be preferable, since you’ll avoid inhaling the heat from a close flame.
  • Treat lip cuts and burns with a water-based lip balm.
  • Don’t smoke from drink bottles or cans. This can lead to lung damage through the inhalation of ash, paint and toxic dust (a glass pipe is a much safer alternative).
  • Use a wire screen in your pipe to prevent the inhalation of hot particles.
  • Let the pipe cool down between hits.
  • If chasing, use real tinfoil and not foil from packaged foods like candy bars. This type of foil can have harmful contaminants.2
  • Get medical attention at the first signs of lung damage (don’t wait until it’s too late). See a doctor if your breathing is wheezy or painful after a session. Because of crack’s anesthetic properties, you often can’t feel lung pain until after the drugs wear off.

Avoiding Infection

  • Don’t share snorting straws. Minute (invisible) flecks of blood are often present and these can confer HIV or hepatitis C between users.
  • It’s not just the syringe, you can’t safely share any injection gear; use your own cooker, cotton, tie and water too.
  • Don’t use a rolled-up bill to snort with. These bills are far from sterile and can transfer many common infections when inserted against the mucous membranes of your nasal cavity.
  • Carry and use condoms. Cocaine can increase sexual desire and reduce inhibitions, so plan in advance and stay safe.
  • Get a hepatitis B vaccine or booster.

Avoiding Social and Psychological Harm

  • You know you won’t feel great so plan an easy recovery day after a session or binge.
  • After using, try to get plenty of sleep and make sure to drink lots of water and or juice.
  • Think about how to ease the discomfort of the crash. Know that the worst part of the crash only lasts for 45 minutes to an hour. Try relaxation techniques to calm down during the crash. Some people find eating after a binge can help get you feeling better. Avoid using alcohol during the crash.
  • If your binges tend to get out of control, limit your access to funds before you begin a session so you won’t end-up with nothing to pay the rent. You might try asking a loved-one to hold onto your money for a while or leaving with only a set amount of money and no ATM card.

Avoiding General Physical Harm

  • One way to reduce your use is to set rules for yourself, such as never using before a certain time of day.
  • Eat a good meal before you start using (since it may be a while before eating well again.)
  • Mixing cocaine with alcohol and other drugs increases the risks significantly. People who use alcohol and cocaine together are at significantly elevated risk of heart attack (alcohol and cocaine combine in the body to form toxic cocaethylene).
  • If you skin-pick when high, make sure to have something else to keep in your hands to play with, or if you chew on your lips or grind your teeth, try chewing gum instead.
  • Cocaine is riskier for people with age-related cardiovascular disease, so get checked for cardiovascular heath, and if you have any degree of disease, strongly consider ceasing or at least reducing your cocaine use.3

Avoiding Overdose and Death

Cocaine kills more people than heroin, in fact, it’s second only to prescription drugs as America’s leading O.D. killer, so if you choose to use cocaine, you NEED to take precautions to stay alive.4

  • Get a physical and be upfront with your doctor about your cocaine habits (if you don’t feel comfortable revealing the truth to your doctor, it’s time to get a new doctor!) As a cocaine user you need to take care of your cardiovascular health, so ask your doctor to test your blood pressure, circulation and whatever else she recommends. Again, if you have early warning signs of heart damage or cardiovascular disease, you should strongly consider stopping or at least reducing your cocaine use. Studies show that seemingly healthy young adult recreational cocaine users often display multiple cardiovascular risk factors, such as higher blood pressure, aortic thickening and heart scarring.5
  • Cocaine overdose is not always dose-dependent; sometimes a small amount can cause dangerous symptoms. Variables which increase your likelihood of experiencing an overdose include your state of mind (feeling anxious), your state of sleep deprivation, your state of food deprivation or dehydration and/or using other substances with cocaine.
  • When using new cocaine, always try a small amount first as a potency tester, especially if injecting.
  • Avoid mixing cocaine with opiates for a speedball. Mixing cocaine with alcohol or other sedatives also increases fatal overdose risks.
  • Cocaine overdose is often cardiovascular in nature (heart attack, stroke or serious arrhythmia). Naloxone injection will not reverse cocaine overdose so emergency medical attention is required. To avoid fatal overdose, you should avoid using cocaine alone, so you have someone on hand to call 911, if needed.
  • Do not wait before calling 911. If you wait until the situation becomes critical, it may be too late.

Signs of Overdose

Anyone who uses cocaine or loves a cocaine user should know the warning signs of overdose:

Signs of cocaine overdose include:

  • Nausea and throwing up.
  • Passing out.
  • An elevated body temperature and heavy sweating.
  • Racing heart beat.
  • Any signs of heart attack, such as chest pain (tightening in the chest).
  • Intense headache.
  • Muscle cramps.
  • Being unable to urinate.
  • Feeling short of breath or breathing irregularly.
  • Experiencing tremors or convulsions or signs of seizure, like drooling or frothing or limb spasms or rigidity.
  • Grinding teeth.
  • Signs of stroke, such as: a sudden inability to talk coherently or understand what other people are saying, sudden weakness or loss of feeling in the face, arms or legs (usually on one side of the body), sudden loss of balance or coordination and or sudden vision difficulties.

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