Cocaine is a very fast-acting central nervous system stimulant that produces an intense but short-lived euphoric high, lasting for only a few minutes to an hour, depending on how it is used.1
The speed of onset of cocaine’s effects, as well as the total duration of action, is influenced by the method of use:1,2
Injecting or smoking cocaine can cause a rush, which is then followed by a high, whereas other modes of use only cause a high.4 It is common for individuals to use cocaine over and over again in a short time period to stay high, also known as a binge.5 Binge use is often followed by an unpleasant crash.6 The crash may lead them to seek more of the drug to counter the crash. Repeated cocaine use can easily lead to an increased tolerance and even addiction.5 According to the National Survey on Drug Use and Health, about 966,000 people in the United States age 12 and older met the criteria for a cocaine use disorder—more commonly referred to as a cocaine addiction—in 2017.3
Cocaine’s half-life is roughly one hour.4 This means that it takes about an hour for the body to eliminate half of the cocaine currently in the bloodstream.7 However, long-term use may lead to longer elimination times, allowing certain tests to detect the drug in the system for an extended period.8
Detection timeframes for different types of tests are listed below:
Despite the different testing methods available, urine toxicology screening remains the most commonly used method of testing.9
Anyone who is concerned about testing positive for cocaine should review the dangers of cocaine use and consider stopping use. If they find they are unable to stop using, they may have a cocaine use disorder.
Those who struggle with cocaine addiction should seek substance use treatment as soon as possible.
Factors that may affect how long cocaine stays in your system include:11
As mentioned above, the method of use affects how quickly the drug reaches the brain. But it does not affect how long cocaine stays in a person’s system. Regardless of how it is used, cocaine and cocaine’s metabolites will show up in urine 3 to 6 hours after last use.4
Cocaine is metabolized by enzymes in the liver and blood. Its main metabolite present in urine is benzoylecgonine, followed by ecgonine methyl ester.12
Benzoylecgonine can be detected in urine for up to 4 days, depending on how often someone uses, their metabolism, and the dose.12
Benzoylecgonine is the main cocaine metabolite used in drug testing because it has a urine concentration 50 to 100 times greater than the concentration of cocaine.4
Cocaine appears to be eliminated slower when it is combined with alcohol.
Using cocaine with alcohol can cause a number of problems for users:13
Cocaine appears to be eliminated slower when it is combined with alcohol, and cocaethylene appears to be eliminated slower than cocaine:
False positives with cocaine immunoassay urine drug screens are rare. But they can happen, and the result can cause issues for the person. In one case study, a false positive for cocaine negatively affected a patient’s pain therapy.17
If you believe you have a false positive test, follow up with the doctor or whoever ordered the test and see if they can verify the result with another type of test, such as gas chromatography/mass spectrometry or liquid chromatography/tandem mass spectrometry.14
Over time, cocaine can cause a number of harms to users. Possible long-term health effects of cocaine can be affected by route of administration and include:18
. National Institute on Drug Abuse. (2016). What are the short-term effects of cocaine use?
. Substance Abuse and Mental Health Services Administration. (1999). Treatment for Stimulant Use Disorders.
. Substance Abuse and Mental Health Services Administration. (2018). Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.
. The University of Arizona MethOIDE. Cocaine: Pharmacology.
. National Institute on Drug Abuse. (2018). DrugFacts: Cocaine.
. Redwood Toxicology Laboratory. (2014). Laboratory Testing Reference Guide.
. Boston University School of Medicine. (2004). Glossary of Terms and Symbols Used in Pharmacology.
. Australian Government Department of Health. (2004). Pharmacology of cocaine.
. University of Rochester Medical Center. Cocaine Screen.
. Warner, T. D., Behnke, M., Eyler, F. D., and Szabo, N. J. (2011). Early adolescent cocaine use as determined by hair analysis in a prenatal cocaine exposure cohort. Neurotoxicology and teratology, 33(1), 88-99.
. Moeller, K., Kissack, J., Atayee, R., and Lee, K. (2017). Clinical Interpretation of Urine Drug Tests: What Clinicians Need to Know About Urine Drug Screens. Mayo Clinic Proceedings.
. Redwood Toxicology Laboratory. Cocaine Drug Information.
. Pennings, E., Leccese, A., and Wolff, F. (2002). Effects of concurrent use of alcohol and cocaine. Addiction, 97(7), 773-783.
. McCance-Katz, E. et al. (1993). Concurrent cocaine-ethanol ingestion in humans: pharmacology, physiology, behavior, and the role of cocaethylene. Psychopharmacology, 111(1), 39-46.
. Laizure, S.C., Mandrell, T., Gades, N., and Parker, R. (2003). Cocaethylene Metabolism and Interaction with Cocaine and Ethanol: Role of Carboxylesterases. Drug Metabolism and Disposition, 31(1), 16-20.
. Hedaya, M. and Pan, W.J. (1996). Cocaine and alcohol interactions in naïve and alcohol-pretreated rats. Drug Metabolism and Disposition, 24(7), 807-812.
. Kim, J. et al. (2015). The Clinical Impact of a False-Positive Urine Cocaine Screening Result on a Patient’s Pain Management. Pain Medicine, 16(6), 1073-1076.
. National Institute on Drug Abuse. (2016). What are the long-term effects of cocaine use?