Topical cocaine can be used as a local
numbing agent to help with painful procedures in the mouth or nose.
TAC is one such formulation used for pediatrics.
Cocaine was historically useful as a topical anesthetic in eye and nasal surgery, although it is now predominantly used for nasal and
lacrimal duct surgery. The major disadvantages of this use are cocaine's intense
vasoconstrictor activity and the potential for
cardiovascular toxicity. Cocaine has since been largely replaced in Western medicine by synthetic local anesthetics such as
tetracaine though it remains available for use if specified. If vasoconstriction is desired for a procedure (as it reduces bleeding), the anesthetic is combined with a vasoconstrictor such as
epinephrine. In Australia it is currently prescribed for use as a local anesthetic for conditions such as mouth and lung ulcers. Some
ENT specialists occasionally use cocaine within the practice when performing procedures such as nasal
cauterization. In this scenario dissolved cocaine is soaked into a ball of cotton wool, which is placed in the nostril for the 10–15 minutes immediately before the procedure, thus performing the dual role of both numbing the area to be cauterized, and vasoconstriction. Even when used this way, some of the used cocaine may be absorbed through oral or nasal mucosa and give systemic effects. An alternative method of administration for ENT surgery is mixed with
sodium bicarbonate, as
Cocaine is a powerful nervous system stimulant.
 Its effects can last from fifteen or thirty minutes to an hour. The duration of cocaine's effects depends on the amount taken and the route of administration.
 Cocaine can be in the form of fine white powder, bitter to the taste. When inhaled or injected, it causes a numbing effect. Crack cocaine is a smokeable form of cocaine made into small "rocks" by processing cocaine with sodium bicarbonate (baking soda) and water.
Cocaine increases alertness, feelings of well-being and
euphoria, energy and motor activity, feelings of competence and sexuality. Cocaine's stimulant effects are similar to that of
amphetamine, however, these effects tend to be much shorter lasting and more prominent.
A spoon containing baking soda, cocaine, and a small amount of water. Used in a "poor-man's" crack-cocaine production
Many users rub the powder along the gum line, or onto a cigarette filter which is then smoked, which numbs the gums and teeth – hence the colloquial names of "numbies", "gummers", or "cocoa puffs" for this type of administration. This is mostly done with the small amounts of cocaine remaining on a surface after insufflation (snorting). Another oral method is to wrap up some cocaine in rolling paper and swallow (
parachute) it. This is sometimes called a "snow bomb."
Coca leaves are typically mixed with an alkaline substance (such as
lime) and chewed into a wad that is retained in the mouth between gum and cheek (much the same as
chewing tobacco is chewed) and sucked of its juices. The juices are absorbed slowly by the mucous membrane of the inner cheek and by the gastrointestinal tract when swallowed. Alternatively, coca leaves can be infused in liquid and consumed like tea. Ingesting coca leaves generally is an inefficient means of administering cocaine. Advocates of the consumption of the coca leaf state that coca leaf consumption should not be criminalized as it is not actual cocaine, and consequently it is not properly the illicit drug.
Because cocaine is
hydrolyzed and rendered inactive in the acidic stomach, it is not readily absorbed when ingested alone. Only when mixed with a highly alkaline substance (such as lime) can it be absorbed into the bloodstream through the stomach. The efficiency of absorption of orally administered cocaine is limited by two additional factors. First, the drug is partly catabolized by the liver. Second, capillaries in the mouth and esophagus constrict after contact with the drug, reducing the surface area over which the drug can be absorbed. Nevertheless, cocaine metabolites can be detected in the urine of subjects that have sipped even one cup of coca leaf infusion. Therefore, this is an actual additional form of administration of cocaine, albeit an inefficient one.
Orally administered cocaine takes approximately 30 minutes to enter the bloodstream. Typically, only a third of an oral dose is absorbed, although absorption has been shown to reach 60% in controlled settings. Given the slow rate of absorption, maximum
psychotropic effects are attained approximately 60 minutes after cocaine is administered by ingestion. While the onset of these effects is slow, the effects are sustained for approximately 60 minutes after their peak is attained.
Contrary to popular belief, both ingestion and
insufflation result in approximately the same proportion of the drug being absorbed: 30 to 60%. Compared to ingestion, the faster absorption of insufflated cocaine results in quicker attainment of maximum drug effects. Snorting cocaine produces maximum physiological effects within 40 minutes and maximum psychotropic effects within 20 minutes, however, a more realistic activation period is closer to 5 to 10 minutes. Physiological and psychotropic effects from nasally insufflated cocaine are sustained for approximately 40–60 minutes after the peak effects are attained.
Coca tea, an infusion of coca leaves, is also a traditional method of consumption. The tea has often been recommended for travelers in the Andes to prevent
 However, its actual effectiveness has never been systematically studied.
 This method of consumption has been practised for many centuries by the indigenous tribes of South America. One specific purpose of ancient coca leaf consumption was to increase energy and reduce fatigue in messengers who made multi-day quests to other settlements.
In 1986 an article in the
Journal of the American Medical Association revealed that U.S.
health food stores were selling dried coca leaves to be prepared as an infusion as "Health Inca Tea."
 While the packaging claimed it had been "decocainized", no such process had actually taken place. The article stated that drinking two cups of the tea per day gave a mild
heart rate, and
mood elevation, and the tea was essentially harmless. Despite this, the
DEA seized several shipments in
Georgia, and several locations on the
East Coast of the United States, and the product was removed from the shelves.
Lines of cocaine prepared for insufflation
insufflation (known colloquially as "snorting", "sniffing", or "blowing") is a common method of ingestion of recreational powdered cocaine.
 The drug coats and is absorbed through the
mucous membranes lining the
nasal passages. When insufflating cocaine, absorption through the nasal membranes is approximately 30–60%, with higher doses leading to increased absorption efficiency. Any material not directly absorbed through the mucous membranes is collected in
mucus and swallowed (this "drip" is considered pleasant by some and unpleasant by others).
In a study of cocaine users, the average time taken to reach peak subjective effects was 14.6 minutes.
 Any damage to the inside of the nose is because cocaine highly constricts blood vessels – and therefore blood and oxygen/nutrient flow – to that area. Nosebleeds after cocaine insufflation are due to irritation and damage of mucus membranes by foreign particles and adulterants and not the cocaine itself; as a vasoconstrictor, cocaine acts to reduce bleeding.
straws, pointed ends of keys, specialized spoons, long
fingernails, and (clean) tampon applicators are often used to insufflate cocaine. Such devices are often called "tooters" by users. The cocaine typically is poured onto a flat, hard surface (such as a mirror, CD case or book) and divided into "bumps", "lines" or "rails", and then insufflated.
 The amount of cocaine in a line varies widely from person to person and occasion to occasion (the purity of the cocaine is also a factor), but one line is generally considered to be a single dose and is typically 35 mg (a "bump") to 100 mg (a "rail"). As tolerance builds rapidly in the short-term (hours), many lines are often snorted to produce greater effects. A 2001 study reported that the sharing of straws used to "snort" cocaine can spread blood diseases such as
Drug injection by turning the drug into a solution provides the highest blood levels of drug in the shortest amount of time. Subjective effects not commonly shared with other methods of administration include a ringing in the ears moments after injection (usually when in excess of 120 milligrams) lasting 2 to 5 minutes including
tinnitus and audio distortion. This is colloquially referred to as a "bell ringer". In a study of cocaine users, the average time taken to reach peak subjective effects was 3.1 minutes.
 The euphoria passes quickly. Aside from the toxic effects of cocaine, there is also danger of circulatory
emboli from the insoluble substances that may be used to cut the drug. As with all injected illicit substances, there is a risk of the user contracting blood-borne infections if sterile injecting equipment is not available or used. Additionally, because cocaine is a vasoconstrictor, and usage often entails multiple injections within several hours or less, subsequent injections are progressively more difficult to administer, which in turn may lead to more injection attempts and more consequences from improperly performed injection.
An injected mixture of cocaine and
heroin, known as "
speedball" is a particularly dangerous combination, as the converse effects of the drugs actually complement each other, but may also mask the symptoms of an overdose. It has been responsible for numerous deaths, including celebrities such as comedians/actors
John Belushi and
River Phoenix, grunge singer
Layne Staley and actor
Philip Seymour Hoffman. Experimentally, cocaine injections can be delivered to animals such as
fruit flies to study the mechanisms of cocaine addiction.
Inhalation by smoking cocaine is one of the several ways the drug is consumed. The two main ways cocaine is smoked are
freebasing and by using cocaine which has been converted to smokable "
crack cocaine". Cocaine is smoked by inhaling the vapor produced when solid cocaine is heated to the point that it sublimates.
 In a 2000 Brookhaven National Laboratory medical department study, based on self reports of 32 abusers who participated in the study,"peak high" was found at mean of 1.4min +/- 0.5 minutes.
Pyrolysis products of cocaine that occur only when heated/smoked have been shown to change the effect profile, i.e. anhydroecgonine methyl ester when co-administered with cocaine increases the dopamine in CPu and NAc brain regions, and has M1- and M3- receptor affinity.
Smoking freebase or crack cocaine is most often accomplished using a pipe made from a small glass tube, often taken from "
love roses", small glass tubes with a paper rose that are promoted as romantic gifts.
 These are sometimes called "stems", "horns", "blasters" and "straight shooters". A small piece of clean heavy copper or occasionally stainless steel scouring pad – often called a "brillo" (actual
Brillo Pads contain soap, and are not used) or "chore" (named for
Chore Boy brand copper scouring pads) – serves as a reduction base and flow modulator in which the "rock" can be melted and boiled to vapor. Crack smokers also sometimes smoke through a
soda can with small holes on the side or bottom. Crack is smoked by placing it at the end of the pipe; a flame held close to it produces vapor, which is then inhaled by the smoker. The effects, felt almost immediately after smoking, are very intense and do not last long – usually 2 to 10 minutes.
 When smoked, cocaine is sometimes combined with other drugs, such as
cannabis, often rolled into a joint or
blunt. Powdered cocaine is also sometimes smoked, though heat destroys much of the chemical; smokers often sprinkle it on cannabis. The language referring to paraphernalia and practices of smoking cocaine vary, as do the packaging methods in the street level sale.
Another way users consume cocaine is by making it into a
suppository which they then insert into the anus or vagina. The drug is then absorbed by the membranes of these body parts. Little research has been focused on the suppository (anal or vaginal insertion) method of administration, also known as "plugging". This method of administration is commonly administered using an
oral syringe. Cocaine can be dissolved in water and withdrawn into an oral syringe which may then be lubricated and inserted into the anus or vagina before the plunger is pushed. Anecdotal evidence of its effects is infrequently discussed, possibly due to social taboos in many cultures. The rectum and the vaginal canal is where the majority of the drug would be taken up through the membranes lining its walls.