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    Crack and Cocaine Use: Warning Signs, Legal Risks, and How to Help a Loved One

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    Harm Reduction Strategies: Stimulants

    Stimulants, which include cocaine and amphetamines, speed up the body’s system, which increases blood pressure and heart rate. This can result in serious health issues, and they are often involved in overdoses.
    What is Pink Cocaine (Tusi), and Why is it Dangerous?

    You’ve likely seen a new substance called “pink cocaine” in the news recently. But what really is it?

    If you’re a parent or other caregiver worried that your teen, adult child, or another loved one is using crack or cocaine, you’re not alone—and you’re not powerless. Substance use can tear through families with confusion, fear, and heartbreak. But with the right information and support, there is hope. This guide will help you understand what crack and cocaine are, the warning signs of use, the legal risks, health dangers, treatment options, and where families can turn for help.

    Key Takeaways

    1. Crack and cocaine are powerful, addictive, and dangerous.
    2. Warning signs include mood swings, physical symptoms, and secretive behavior.
    3. Legal penalties are severe—even for small amounts.
    4. Fentanyl-laced cocaine is increasing overdose deaths.
    5. Treatment works, and families play a key role in recovery.

    What Is Cocaine? What Is Crack Cocaine?

    Cocaine is a powerful stimulant drug made from the coca plant. It appears as a fine white powder and is typically snorted, rubbed on the gums, or dissolved and injected. It creates a short, intense high marked by energy, focus, and feeling uplifted.

    Crack cocaine is a form of cocaine that has been processed into hard, crystal-like “rocks” using baking soda or ammonia. It’s usually smoked, delivering a faster and more intense high than powder cocaine—but the effects wear off quickly. As a result, this can often lead to more frequent use.

    What Do Cocaine and Crack Look Like?

    Powdered cocaine: Fine white powder, typically in small baggies or vials. It’s often used with rolled paper, straws, or razor blades.

    Crack cocaine: Off-white or yellowish “rocks” that are smoked using glass or metal pipes. People who use crack may have burn marks on their fingers or lips.

    Cocaine and crack affect people from all walks of life, but usage patterns differ:

    Powder cocaine is more commonly found in party or club settings. It is often associated with younger adults from middle- or upper-income backgrounds.

    Crack cocaine has historically been more common in urban areas and communities facing economic hard times. It has had a far greater impact on Black and Latino families due to past differences in criminal justice penalties.

    Regardless of which substance is used, it’s a health issue that requires compassion and care.

    Why Do People Use These Drugs?

    Crack and cocaine create a rush of pleasure, energy, and confidence, especially in social settings. People have reported that they need less sleep and can stay awake longer, boosting work performance. Some people enjoy using cocaine or crack to improve sex. Others say it helps them escape emotional pain and cope with trauma. And some use them as a way to self-medicate mental health struggles like depression or anxiety.While they make “work” in the beginning, all aspects of a person’s life can become much worse.

    Signs Your Loved One Might Be Using Crack or Cocaine

    There are both physical and behavioral signs to watch for when it comes to concern about crack or cocaine.1

    Physical Signs:

    • Dilated pupils
    • Nosebleeds or frequent sniffing
    • Problems swallowing
    • Burn marks on lips or fingers
    • Increased energy or restlessness
    • Weight loss and loss of appetite
    • Insomnia or staying up for days

    Behavioral Signs:

    • Mood swings, paranoia, or irritability
    • Avoiding family or disappearing for long periods
    • Secretive behavior or sudden changes in friend groups
    • Risk-taking behaviors or brushes with the law

    The Risks of Using Cocaine and Crack

    Short-term risks include:  

    • Heart problems: Higher heart rate and pressure, chest pain, and even sudden heart attack or stroke. 
    • Mental health effects: Panic attacks, anxiety, paranoia, or aggression. 
    • Risky behavior: Poor judgment that can lead to accidents, fights, or unsafe sex. 
    • Sleep and eating disruption: Many people who use these substances go days without rest or food. 
    • Cocaine laced with fentanyl: One of the most serious risks today is fentanyl-laced cocaine. Fentanyl is a lab-made opioid 50 to 100 times more powerful than morphine. Just a tiny amount can cause a fatal overdose—and people often don’t know it’s in the drug they’re taking. Even people who don’t typically use opioids can die from a single exposure. This makes carrying naloxone (Narcan) more important than ever. Narcan reverses opioid overdoses and is available without a prescription in many states. 
    • Mixing substances: People may choose to use crack or cocaine with other substances which can increase the risk of use. For example, speedballs are typically a combination of heroin and cocaine. Heroin slows the body’s nervous system down while cocaine speeds it up resulting in a great deal of strain on the heart.

    Longer-term risks include: 

    • Addiction (also referred to as a Stimulant Use Disorder): Both crack and cocaine are highly addictive—especially crack, which has a faster and more intense high. 
    • Mental health issues: Long-term use can cause anxiety, depression, paranoia (intense fear), and even hallucinations (seeing or hearing things that aren’t real) or psychosis. 
    • Heart and lung damage: Chronic use increases the risk of stroke, heart disease, and (for crack) lung problems. 
    • Thinking and memory problems: Memory issues, difficulty concentrating, and poor decision-making. 
    • Damage to the nose (for powdered cocaine): Snorting over time can erode nasal tissue. 
    • Relationship difficulties: Ongoing use often leads to broken trust, job loss, and family conflict 
    • Legal consequences: There are huge differences in sentencing under federal law depending upon whether a person is using cocaine or crack.22  The sentence is referred to as “18 to 1” meaning that the sentencing for a person with 500 grams of powder cocaine is the same as that for a person with 28 grams of crack cocaine. This means that a person using crack is likely to receive a greater punishment than a person using cocaine even though they are both stimulants. 

    Research highlights the many sentencing problems that exist when it comes to crack, especially for Black people.3

    • From 2015 to 2023, Black people made up on average 80% of convictions for crack cocaine, while white and Latino people made up on average 6% and 13%, respectively.
    • The vast majority of people convicted and sentenced for crack cocaine offenses had no college education; 46% had a high school degree or equivalent, and 40% had less than a high school degree. Only 15% had at least some college.
    • 97% of crack cocaine sentencing resulted from a plea deal, with only 3% resulting from a trial.
    • Once convicted, 94% of people faced prison time, with only 3% to 6% receiving an alternative to incarceration, such as probation.
    • The vast majority of people convicted for crack trafficking – more than 92% – did not hold a supervisory or leadership role at work.

    A Bill called the EQUAL Act has been introduced to end the differences in sentencing for crack cocaine and powder cocaine.4 As of this writing, it has been passed in the House but not in the Senate.

    Many state laws don’t have these kinds of sentencing differences. Nevertheless, even for first-time possession, a criminal record can affect education, employment, housing, and immigration status.

    Is Treatment Available for Cocaine or Crack Addiction?

    Yes—effective treatment is available, and recovery is possible.5 There are several research-backed forms of therapy that are effective, including:

    • Contingency Management (CM): Offers rewards (like gift cards or vouchers) for staying drug-free. 
    • Cognitive Behavioral Therapy (CBT): Helps people identify and change unhelpful thoughts and behaviors. 
    • Community Reinforcement Approach (CRA): Rebuilds positive routines and relationships while supporting sobriety. 

    There are no FDA-approved medications to help with cravings specifically for cocaine or crack use, but doctors may prescribe medications to address related mental health conditions, like anxiety or depression. Learn more about what to look for in a treatment and use SafeLocator to find programs.  Note that you will still have to call the programs to make sure they are a good fit and can take new patients.

    Harm Reduction

    Your loved one may not be ready or able to participate in formal treatment. If that is the case, consider ways to reduce the risks associated with their substance use.  Safer smoking supplies, fentanyl test strips, naloxone (e.g., Narcan) and other tools may be helpful.   

    Sometimes loved ones are willing to cut back as opposed to quitting outright.  Any step in this direction is positive. Learn more about ways to suggest harm reduction for stimulants and specific actions you can suggest to your loved one here. Also, this is a helpful guide on ways to reduce the risks around consuming crack or cocaine that you may wish to give to your loved one.

    Support for Families: You’re Not Alone

    Support Groups and Resources: 

    What Parents and Other Caregivers Can Do

    • Start the conversation: Express concern without judgment. “I’m worried about you. Can we talk?” Or, “I know how important crack is to you and I’m wondering if you would consider cutting back or using more safely.” 
    • Stay connected: Isolation can make things worse. Let them know you’re there. 
    • Set healthy boundaries: This may mean no substance use in your home or not covering up for a person who is calling out of work because of their substance use.
    • Encourage treatment: Offer to help them find care when they’re ready. 
    • Take care of yourself: Your well-being matters too.