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Heroin vs. Cocaine

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Over the past two decades, rates of heroin abuse, addiction, and overdose have climbed throughout the United States. Men and women of all ages, demographics, and personal backgrounds have been deeply affected by what is now known as a nationwide opioid epidemic.

In 2021, 1.1 million people aged 12 and older reported using heroin in the past 12 months.

Additionally, cocaine is similar to heroin as it is a powerful drug that can lead to dependency, overdose, and death. Because people feel an intense high immediately, it creates a desire to have more. In 2020, 5.2 million people aged 12 and older reported using cocaine in the past 12 months.

Guardian Recovery will examine the similarities and differences between heroin and cocaine, the effects both drugs have on the body, and how you can seek treatment for yourself or someone you love with a substance use disorder.

If you or someone you love has a substance use disorder, Guardian Recovery is available to help. We are dedicated to providing the most comprehensive and individualized medically monitored detox program. To learn more about our programs, contact us today.

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Side Effects Caused by Heroin & Other Depressants

Central nervous system depressants act on the brain by increasing the activity of GABA, a neurotransmitter that slows brain activity. People who use depressants such as alcohol, heroin, and benzodiazepines feel sleepy and uncoordinated at first. They can also have poor concentration, confusion, lowered blood pressure, and slowed breathing.

After the initial effects, users will usually be drowsy for several hours; mental function is clouded; heart function slows; and breathing is slowed, sometimes enough to be life-threatening. Slowed breathing can also lead to coma and permanent brain damage.

Stimulant Effects of Cocaine on the Body

Short-term effects of cocaine use include restricted blood vessels, dilated pupils, increased body temperature, heart rate, and blood pressure. Large amounts of cocaine can lead to erratic or even violent behavior. Additionally, a person may experience tremors and muscle twitching.

Severe medical complications can occur with stimulant use. Examples include cardiovascular effects, headaches, seizures, strokes, and coma. In rare instances, sudden or unexpected death can occur.

Stimulants have substantial effects on the heart and cardiovascular system. Specifically, cocaine use is linked with an increased risk of stroke.

The brain also is negatively impacted by long-term stimulant use. Examples include Parkinson’s disease and cognitive impairments of memory, judgment, impulse, and motor functioning.

Long-Term Risks & Potential Damage to the Body

Both drugs take a significant toll on the body, and there are serious risks if a person uses heroin or cocaine. See below for specific medical issues related to both long-term heroin and cocaine.

Heroin’s Long-Term Risks & Damage to the Body

Long-term effects related to heroin can impact various body parts based on how a person uses heroin. The three main ways of using heroin include smoking, snorting, or injection. There are multiple risks associated with each modality.

Risks specific to smoking heroin include chronic bronchitis, bacterial bronchitis, and inflammation in the airway, leading to chronic coughing, wheezing, and shortness of breath. Additionally, there is a risk of early-onset emphysema, hypersensitivity pneumonitis, and barotrauma. These conditions cause swelling, inflammation, and trapped air in the lungs.

Some injection heroin users report snorting or smoking heroin first eased their transition to needle drug use. It is also increasingly common for heroin to be cut with other dangerous, potent opioids like illicitly manufactured fentanyl, a significant risk factor for overdose no matter how heroin is taken.

The side effects of snorting heroin include chronic runny nose, constant sniffing, nosebleeds, sores on the nostrils, holes in the septum, problems swallowing, and damage to the hard or soft palate in the mouth.

Long-term side effects of chronic needle use for heroin may develop collapsed veins, infection of the heart lining and valves, abscesses, and liver or kidney disease. Additionally, heroin creates unique risks because of the transmission of HIV and other diseases from sharing needles or unsafe injection tools.

Cocaine’s Long-Term Risks & Damage to the Body

Severe medical complications can occur with cocaine use. Examples include cardiovascular effects, headaches, seizures, strokes, and coma. In rare instances, sudden or unexpected death can occur.

Regularly snorting cocaine can lead to long-term nose damage, including nosebleeds, problems with swallowing, hoarseness, and chronic runny nose. Smoking crack cocaine damages the lungs and can worsen asthma. People who inject cocaine have puncture marks called tracks and are at risk of contracting infectious diseases like HIV and hepatitis C. They also may experience allergic reactions, either to the drug itself or to additives in cocaine, which can result in death in severe cases.

Cocaine has substantial effects on the heart and cardiovascular system. Cocaine use is linked with an increased risk of stroke.

As mentioned, the brain also is negatively impacted by long-term cocaine use. Examples include Parkinson’s disease and cognitive impairments of memory, judgment, impulse, and motor functioning.

How Do Cutting Agents Differ?

There is not much difference when comparing cutting agents to cocaine and heroin. Both drugs use similar substances to cut the drug, and both have serious effects such as overdose and instant death.

Cocaine is cut or laced with other substances to sell more, extend the product, enhance the high, increase addiction, and reduce the bulk of cocaine. More than 60% of street cocaine is cut with other substances. This is dangerous because it leads to overdose, sudden death, and toxicity of unknown substances or interactions.

Common Substances When Cutting Cocaine:

  • Laundry detergent.
  • Laxatives.
  • Caffeine.
  • Boric acid.
  • Local anesthetics.
  • Creatine.
  • Marijuana.
  • Fentanyl.
  • Heroin.
  • LSD.
  • PCP.

Heroin is hardly ever found as a pure substance when buying on the street. This leads to a significantly increased risk of overdose and death.

Common Substances That Heroin Can Be Cut With Include:

  • Baking soda.
  • Sugar.
  • Starch.
  • Crushed over-the-counter painkillers.
  • Talcum powder.
  • Powdered milk.
  • Laundry detergent.
  • Caffeine.
  • Rat poison.

None of these substances are safe to be snorted or injected directly into one’s bloodstream, but some are safer than others. Stimulants are dangerous because they can mask the signs of overdose, leading to a lack of treatment and a much higher risk of brain damage or death.

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How Do Heroin & Cocaine Affect Neurotransmitters in the Brain?

Central nervous system depressants act on the brain by increasing the activity of GABA, a neurotransmitter that slows brain activity. People who use depressants such as alcohol, heroin, and benzodiazepines feel sleepy and uncoordinated at first. They can also have poor concentration, confusion, lowered blood pressure, and slowed breathing.

Like many substances, cocaine has long-term effects on the brain. Studies show that cocaine creates glutamate, an excitatory neurotransmitter. This type of neurotransmitter stimulates a nerve cell, making the chemical message move from nerve cell to nerve cell, not stopping. Glutamate is essential for proper brain function.

Glutamate is also necessary for producing GABA, another neurotransmitter responsible for sleep, deep relaxation, anxiety regulation, and muscle function.

Can Heroin & Cocaine Both Be Taken the Same Way?

Heroin Use

One of the most common ways a person uses heroin is by injecting heroin with a needle. There are various ways a person may use heroin, such as by injecting, smoking, or snorting.

Injection

Needles are used with heroin by injecting the drug directly into a user’s vein. Users often use discreet injection sites. Most users start by injecting in their forearms but may move to other areas such as the neck, groin, hands, feet, or face when scarring or inflammation occurs.

Inhalation

One way a person may smoke heroin is through something called foil smoking. Foil smoking is generally heroin consumption by inhalation. By heating an aluminum foil with a lighter, the heroin on top of the foil starts melting, and the smoke is then inhaled using a straw. Foil smoking is the second most common form of heroin consumption after intravenous use.

Sniffing/Snorting

People may have the misconception that snorting heroin is safer than injecting heroin. However, it has been reported that heroin users who begin heroin use by snorting or smoking heroin first eased their transition to needle drug use. It is also increasingly common for heroin to be cut with other dangerous, potent opioids like illicitly manufactured fentanyl, a significant risk factor for overdose no matter how heroin is taken.

Cocaine Use

Cocaine can be snorted, gummed, injected, or smoked. If using crack cocaine, it can only be smoked.

Injection

Cocaine is injected by dissolving it in water and injecting it into the bloodstream. This is one of the quickest ways to feel the immediate effects of cocaine.

Inhalation

Inhalation takes place by smoking or inhaling the vapor of cocaine. This is the same as injecting cocaine, as the drug enters the bloodstream immediately.

Sniffing & Snorting

Snorting is the most common way people use cocaine. It is snorted and absorbed into the bloodstream through the nasal passage.

A Heroin High Compared to Cocaine

The following highs are detailed below for heroin and cocaine.

Heroin

Heroin is a powerful opioid drug made from the opium poppy plant. No matter how it is taken, when heroin enters the body, it moves to the brain quickly and changes how the central nervous system functions. In the brain, heroin binds to specific receptors responsible for sensations of pain and pleasure.

While heroin dulls pain and delivers a euphoric rush of pleasure, it also sends signals to parts of the brain responsible for regulating heart and breathing rates, memory, motor control, alertness, and emotional control. The limbic system, in particular, and the reward-response reactions that occur there play a significant role in the development of addiction. Heroin causes this system to release dopamine, leaving the individual with feelings of satisfaction and well-being for a short time. However, drowsiness and mental impairment follow for hours afterward.

Cocaine

A euphoria and a sudden rush instantly take over. This excitement and jolt of energy are what drive people to want more hits of cocaine. Because this intense feeling only lasts for a short period, for some people only a matter of minutes, it makes people want to experience that extreme cocaine high over and over again.

In addition to the sensations of euphoria and increased energy, physiological effects also occur when a person uses cocaine. Short-term physiological effects from cocaine include constricted blood vessels, dilated pupils, increased body temperature, heart rate, and blood pressure. Unfortunately, because of a person’s desire to use more cocaine to chase the sensations one may experience can lead to dangerous results.

Is Heroin or Cocaine More Addictive?

Heroin and cocaine are identified as among the 5 most addictive substances in the world. However, according to NIDA, heroin was the most addictive substance out of any other substance in the world. In addition to the dangerous level of addiction, the amount of heroin that can kill someone is only 5x greater than the amount used to achieve a high.

A Cause of Death Comparison

Heroin is a powerful drug that can lead to dependency, overdose, and death. Because people feel an intense high immediately, it creates a desire to have more. In 2020, more than 13,000 people died from an overdose involving heroin in the United States. This equals more than four deaths for every 100,000 Americans. The number of heroin overdose deaths was seven times higher in 2020 than in 1999.

Cocaine is also a drug that has deadly effects. Drug dealers may cut cocaine with other drugs such as marijuana, heroin, fentanyl, LSD, and PCP. This can heighten cocaine’s effects or increase the likelihood of an overdose. According to the CDC, cocaine was involved in nearly 1 in 5 overdose deaths in 2019. Additionally, 16,000 Americans died from overdoses involving cocaine.

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At Guardian Recovery, we remain dedicated to providing our clients with a comprehensive program of heroin and cocaine detox — one that focuses on much more than physical stabilization. In addition to emphasizing physical recovery, we tackle mental, emotional, and spiritual well-being. While we prioritize a safe and pain-free withdrawal, we offer individualgroup, and family therapy sessions, case management services, relapse prevention training, and aftercare planning.

Contact us today if you or your loved one is ready to begin an entirely new way of life and commit to long-term recovery. As soon as you call, we start developing a plan of action that begins with an initial pre-assessment. This assessment helps us determine which level of care is the most appropriate for each unique case. We identify potential coverage options if our medically monitored detox program is a good fit. We work closely with most major regional and national insurance providers. Contact us today for a free, no-obligation insurance benefit check.

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Disclaimer: Does not guarantee specific treatment outcomes, as individual results may vary. Our services are not a substitute for professional medical advice or diagnosis; please consult a qualified healthcare provider for such matters.

  1. https://nida.nih.gov/publications/research-reports/heroin/scope-heroin-use-in-united-states
  2. https://nida.nih.gov/publications/research-reports/cocaine/what-scope-cocaine-use-in-united-states
  3. https://www.dea.gov/drug-information/drug-scheduling
  4. https://www.dea.gov/sites/default/files/2020-06/Heroin-2020.pdf
  5. https://www.dea.gov/sites/default/files/2020-06/Cocaine-2020_1.pdf
  6. https://nida.nih.gov/publications/drugfacts/prescription-cns-depressants#:~:text=Prescription%20CNS%20depressants%20act%20on,blood%20pressure%2C%20and%20slowed%20breathing.
  7. https://nida.nih.gov/publications/research-reports/cocaine/what-are-short-term-effects-cocaine-use
  8. https://www.justice.gov/archive/ndic/pubs3/3843/3843p.pdf
  9. https://nida.nih.gov/publications/research-reports/cocaine/what-are-long-term-effects-cocaine-use
  10. https://nida.nih.gov/publications/drugfacts/prescription-cns-depressants#:~:text=Prescription%20CNS%20depressants%20act%20on,blood%20pressure%2C%20and%20slowed%20breathing.
  11. https://nida.nih.gov/publications/research-reports/cocaine/what-are-some-ways-cocaine-changes-brain
  12. https://www.health.state.mn.us/communities/opioids/basics/intravenous.html
  13. https://pubmed.ncbi.nlm.nih.gov/31166873/
  14. https://www.justice.gov/archive/ndic/pubs3/3843/3843p.pdf
  15. https://nida.nih.gov/publications/drugfacts/heroin
  16. https://www.cdc.gov/drugoverdose/deaths/heroin/index.html#:~:text=In%202020%2C%20heroin%2Dinvolved%20overdose,deaths%20for%20every%20100%2C000%20Americans.
  17. https://www.cdc.gov/drugoverdose/deaths/other-drugs.html

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Reviewed professionally for accuracy by:

Ryan Soave

L.M.H.C.

Ryan Soave brings deep experience as a Licensed Mental Health Counselor, certified trauma therapist, program developer, and research consultant for Huberman Lab at Stanford University Department of Neurobiology. Post-graduation from Wake Forest University, Ryan quickly discovered his acumen for the business world. After almost a decade of successful entrepreneurship and world traveling, he encountered a wave of personal and spiritual challenges; he felt a calling for something more. Ryan returned to school and completed his Master’s Degree in Mental Health Counseling. When he started working with those suffering from addiction and PTSD, he found his passion. He has never looked back.

Written by:

Cayla Clark

Cayla Clark

Cayla Clark grew up in Santa Barbara, CA and graduated from UCLA with a degree in playwriting. Since then she has been writing on addiction recovery and psychology full-time, and has found a home as part of the Guardian Recovery team.

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