Blog - Beach House Rehab Center
A young man holding bag of white powder late at night.
May 8, 2019

How to Tell if Someone is Sniffing Coke

Cocaine is an illicit, widely abused psychostimulant that was originally considered a glamour drug in the 1970s. Unlike synthetic stimulants, cocaine was derived from the Coca plant native to South America, where it was used in folk medicine prior to its discovery by westerners. Contemporary forms of the drug are increasingly polluted by impure ingredients and chemical poisonswhich help maximize dealer profits while imposing significant danger on users. Although cocaine is frequently smoked or injected, sniffing is also a popular method of ingestion that proves particularly deadly and is almost always accompanied by visible indicators. 


Although cocaine is still romanticized, thanks in part to pop culture and decades of Hollywood hype, it is implicated in one out of every three—or approximately 40 percent—of emergency room (ER) visits. Other revealing statistics include:

  • The age group deemed most likely to abuse cocaine is young adults ages 18-25.
  • According to the National Survey on Drug Use and Health (NSDUH), approximately 915,000 Americans were cocaine-dependent in 2014.
  • In 2017, approximately 15,000 cocaine overdose deaths were reported.
  • Approximately one-quarter of all drug-related emergency room (ER) admissions are caused by cocaine addiction or abuse.
  • According to the National Survey on Drug Use and Health (NSDUH), approximately 915,000 Americans were cocaine-dependent in 2014.
  • Although cocaine-related deaths temporarily declined between 2007 and 2010, they are once again on the rise, presenting a problem of overwhelming magnitude.


Cocaine’s highly addictive charms are enhanced by inhalation through the nose, a process which results in quicker absorption into the bloodstream and a more immediate, intense high. Additionally, inhalation produces extended euphoria relative to other methods of ingestion—frequently lasting between 15 and 30 minutes—longer than smoking or injection. Although many users are willing to pay top dollar to enjoy this fleeting high, it has numerous drawbacks and is considered extremely dangerous. In fact, snorting (sniffing) cocaine even once can result in a fatal overdose. Among the many complications and dangers associated with snorting cocaine are the following:

  • Violent, unpredictable behavior
  • Stomach pain
  • Angina/chest pain
  • Cardiac arrest/heart attack
  • Paranoia and delusions
  • Accelerated heartrate
  • Elevated blood pressure
  • Increased body temperature
  • Suicidal ideation (SI)


Cocaine addiction and abuse via sniffing is almost always evident through external signs which therapists and clinicians can help use for diagnostic and treatment purposes. The first, most obvious sign to look for is a white, powdery residue on or around a person’s nose and/or face. Other common indicators include:

  • White, powdery residue on the person’s clothes or atop flat furniture surfaces
  • Bloodshot, dilated, red or watery eyes; cocaine is a powerful stimulant and also causes sleep loss that reddens the eyes—especially upon waking. Cocaine addicts frequently wear sunglasses to shield their eyes from the sun and elude detection
  • Look for cocaine-specific paraphernalia: pipes, spoons, small scales, foil, sandwich bags, mirrors, CD cases, rolled up dollar bills, or paper and straws.
  • People using cocaine frequently exhibit signs of twitching, shaking, twerking, and other fast movements for no apparent reason.
  • Financial problems and criminal or delinquent behavior
  • Unkempt appearance and neglected personal hygiene
  • Erratic or unstable moods (mental health problems) and other uncharacteristic personality changes
  • Deceased appetite and unexplained weight loss


Cocaine is particularly damaging to the human nose—which is lined with delicate tissue, sensitive to toxins, and fed by a temperamental blood supply. This blood supply automatically ceases during cocaine inhalation, in turn narrowing blood vessels and limiting the oxygen supply to septal tissues. Consequently, the sensitive septal lining begins to die, followed by the underlying cartilage, a process that punctures the septum—the very structural foundation of the nose. Users who develop one or more punctures (or holes) are left with a nose that no longer properly functions. At this point, only a surgeon specializing in treating this condition can help restore the nose to general health. Without prompt, emergency treatment the septum is unable to heal and resulting damage is frequently irreversible.       


Cocaine, a psychostimulant, has powerful excitatory properties capable of increasing heart-rate, elevating blood pressure, accelerating breathing, and raising body temperature. These combined effects send the body into overdrive, making one feel extremely energetic and alive.  However, this highly desirable state is followed by an investable crash, eventually giving way to profuse sweating, labored breathing, abnormal heartbeat, and chest pains. In the worst case scenario, it can also lead to heart attack, seizures, strokes, coma, and/or death.

Sexual dysfunction and infertility are also known complications associated with cocaine addiction. Unsuspecting users may at first only experience typical symptoms such as a chronically stuffy or runny nose, sinus infections, or impaired sense of smell, only to be surprised when they later have difficulty performing in the bedroom or getting pregnant. In any event, the deleterious effects of cocaine—especially when sniffed—are far-reaching and sometimes permanent. 


People who snort cocaine are frequently polysubstance addicts who are hooked on the stimulus provided by mixing multiple drugs simultaneously. Although cocaine is deadly when combined with other hard-core, illicit drugs, it is particularly deadly when mixed with alcohol—a practice that has been gradually decreasing over the years.  Even when used separately, alcohol and cocaine are potent intoxicants that cause major cognitive distortion and physiological chaos. When taken together, however, these effects are exponentially increased.

One of the lesser-known dangers associated with combining cocaine and alcohol is the formation of cocaethylene—a toxic chemical known to produce the following deadly effects:

  • Intracranial hemorrhage
  • Cardiac arrhythmia
  • Myocardial infarction—painful heart attack
  • Cerebral infarction—the death of the blood vessels and brain tissue


Although extremely difficult and somewhat unpredictable, cocaine addiction is a highly treatable condition that responds well to early, aggressive intervention. Like other chronic, relapsing diseases, the longer it is allowed to fester, the greater the likelihood of irreparable damage. Still, at any stage of cocaine addiction, favorable outcomes may be obtained by pursuing professional treatment options.

Under no circumstances should cocaine addiction be treated in a self-guided, at home context. Clients who choose to do so in an attempt to save time and/or money place themselves at incredible risk for relapse and unnecessary—potentially deadly—complications. Only licensed clinicians and qualified medical practitioners possess the training and acquired the skill set necessary to safely guide treatment using one or more of the following options:

  • Hospitalization—cocaine-addicted clients may require short-term hospitalization in order to monitor vital signs, administer necessary IV fluids, and recover from the debilitating effects of a recent overdose (if applicable).
  • Inpatient Treatment—clients may choose to enroll in a residential treatment program featuring round-the-clock medical monitoring and clinical supervision. This short-term option, which generally lasts between 30 and 90 days, is considered extremely effective in providing cocaine addiction treatment and premium behavioral healthcare.
  • Outpatient Treatment—clients may choose to enroll in a non-residential program that offers greater flexibility based upon their personal and/or professional schedules. While less intensive in nature when compared to inpatient treatment, outpatient facilities offer many of the same medical and clinical benefits.
  • Medication-Assisted Treatment (MAT)—at all levels of cocaine addiction treatment (with the exception of hospitalization) clients have prescribed a combination of evidence-based medications and appropriate psychotherapy aimed at identifying and resolving the underlying causes of addiction and related—or co-occurring—mental health disorders.
  • Contingency Management—a therapeutic modality that utilizes the reward system when desired behaviors are exhibited such as attending 12-Step programs, passing drug tests, participating in all therapy sessions, etc.
  • The Matrix Model—this stimulant-specific therapeutic modality uses an integrative approach focusing on relapse prevention. The matrix model is extremely structured, incorporating group, individual therapy, and a variety of 12-Step programs.
  • Cognitive Behavioral Therapy (CBT)—a popular, evidence-based therapeutic modality that teaches clients to identify their particular triggers for cocaine use, examining the thoughts, feelings, and behaviors associated with those triggers. After the identification and examination stage, clients are encouraged to then to modify their thoughts, feelings, and behaviors so that they don’t perpetuate their addiction.

Cocaine addiction is not a disease affecting only those with known substance use disorders (SUDs), a family history of abuse, or genetic susceptibility. Anyone, at any time, regardless of race, age, gender, socioeconomic status, or religion can find themselves addicted to cocaine. If you or someone you love is addicted to cocaine and in need of treatment, call a substance abuse professional today.  

Also remember, in the event of an overdose seek immediate medical attention by calling 911 or visiting your nearest hospital emergency room (ER). A cocaine overdose is considered a serious, potentially life-threatening situation.

For more about cocaine addiction and recovery, check out these related articles:


Addiction Science and Clinical Practice. The Neurobiology of Cocaine Addiction. Dec, 2005.

American Heart Association Journals (AHA). Cardiovascular Effects of Cocaine. Dec, 2010.

Journal of Forensic and Legal Medicine. The pathophysiology of cocaine abuse. March, 2003

Journal of the American College of Cardiology (JACC). The Cardiovascular Effects of Cocaine. July, 2017.

Blood Journal. Cocaine and the blood-brain-barrier. Oct, 2011.