What Does Cocaine Do to Your Nose?

Most people have heard of cocaine because of its mind-altering effects. People typically inhale cocaine through the nose, which is sometimes referred to as “snorting cocaine.” 

Cocaine is absorbed into the body through the blood vessels inside the nose. But the direct contact between cocaine and the inside of the nose can lead to serious nose damage. Injury to the inside of the nose starts the first time someone uses cocaine. In the long term, cocaine can damage deeper structures like cartilage and bone. This can lead to severe defects that can’t always be repaired with surgery. 

Here’s how cocaine can affect the nose. 

How does cocaine affect your nose?

Cocaine affects the nose in a number of ways. It’s important to have a sense of what the inside of your nose looks like in order to understand how cocaine affects the nose.

The inside of the nose is covered with tissue called the nasal mucosa. The nasal mucosa moistens and cleans air that you breathe in as it goes to your lungs. It makes mucus to keep your nasal passages lubricated. It also contains specialized cells that help you smell (olfactory epithelium). Directly underneath the mucosa are blood vessels as well as cartilage and bone that give your nose its shape. 

The nasal mucosa is very thin, which makes it fragile. It can be easily damaged and injured. Structures underneath the nasal mucosa become vulnerable to injury anytime the nasal mucosa gets injured or disrupted. So any injury or damage to the nasal mucosa can lead to injury of deeper nasal structures.  

When cocaine touches the nasal mucosa, it does two things right away. First, it binds to nerve endings inside the nasal mucosa. This stops the nerve endings from working and leads to numbness inside the nose. Second, it blocks a chemical called norepinephrine, which causes the blood vessels inside the nose to clamp down (constrict). 

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• Is it safe to mix cocaine and alcohol? No, mixing the two can be toxic to your liver and other parts of the body.

What are the short-term effects of cocaine use on your nose?

Nasal damage can develop within a few uses of cocaine. In the short term this can lead to the following symptoms.

Nosebleeds (epistaxis)

While a one-time dose of medical cocaine helps stop bleeding, repeated cocaine use can actually trigger nosebleeds. This can happen because cocaine directly damages the nasal mucosa, leaving the blood vessels underneath exposed. This makes them more prone to injury and breakage. 

Cocaine also causes blood vessels in the nose to clamp down. This means less blood gets to the nasal mucosa. The nasal mucosa needs nutrients carried by blood to repair itself. If it’s not able to repair itself, the nasal mucosa continues to break down each time it gets exposed to cocaine. This can lead to more blood vessel injury. 

Sometimes cocaine is altered (mixed or cut) with other chemicals. These chemicals can also damage the nasal mucosa and trigger bleeding. 

Loss of smell (anosmia)

Olfactory cells are specialized cells that detect odors and pass signals to your brain so that you can interpret different smells. These cells are part of your nasal mucosa and can be damaged when exposed to cocaine. 

Damaged olfactory cells can lead to a medical condition called anosmia. This is a condition where you can’t smell as well as you normally would. Some people lose their sense of smell altogether. Some people are able to regain their sense of smell if they stop taking cocaine. But the data around recovery isn’t very clear. 

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Pain

Cocaine is naturally acidic, which means it can easily irritate and damage the nasal mucosa. This irritation leads to inflammation of the nasal mucosa, which can be very painful. Since cocaine also temporarily numbs the nasal mucosa, people miss out real-time pain feedback. This means they may continue doing actions that are causing more nasal injury — like putting an apparatus too far into their nose to inhale cocaine.  

Inflamed nasal mucosa isn’t able to keep out bacteria and viruses as well as healthy nasal mucosa. This means that people who take cocaine are more likely to develop nasal and sinus infections. These infections can cause nose, sinus, and facial pain. 

What are the long-term effects of cocaine use on your nose?

Over time, inflammation leads to permanent damage of the nasal mucosa. When this happens, nasal symptoms become more severe and constant. Structures underneath the nasal mucosa also become prone to injury now that they no longer have the mucosa to protect them. This can lead to the following symptoms.

Chronic nasal congestion

A severely damaged nasal mucosa isn’t able to regulate itself. This means it can’t control mucus production or blood flow to its structures. The result is a chronic runny nose and chronic stuffiness. Medication that treats other causes of nasal congestion will not help in this situation. People can have trouble finding even temporary relief from their nasal symptoms. 

Ulcers

Over time, injury to the nasal mucosa can lead to nasal ulcers. Nasal ulcers are a painful breakdown of tissue inside the nose. They don’t heal easily because of lack of blood flow from cocaine-induced vasoconstriction. Ulcers can reach deeper structures inside the nose and make it easier for people to develop infections.

Septal perforation 

Septal perforation is one of several severe complications that can develop from cocaine use. Over time, cocaine starts to damage the cartilage and bony structures in the nose. A septal perforation is a hole that develops inside the nasal cartilage. This hole cannot close on its own. People can also develop other types of nasal septum damage, which can lead to very noticeable nasal deformities and even nasal collapse. You may have heard the term “cocaine nose,” known colloquially as “coke nose,” to describe these deformities. These defects must be repaired with surgery. But surgery may not be able to fully restore the original appearance of your nose. 

Infection

The nasal turbinates (bones inside the nasal cavity) can also start to erode because of cocaine use. These bones separate the sinuses and the orbit from the inside of the nose. When the nasal turbinates start to break down, bacteria and viruses that get into the nose can pass into the sinuses and orbit. This can lead to serious facial and eye infections that need to be treated in a hospital.  

Where can you find help for substance use disorder?

Call the National Helpline from the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-HELP (4357). It’s free, confidential, and open 24 hours a day, 365 days a year. They can help you find a treatment center that’s right for you.  

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Written by:

Ronald W. Dworkin, MD, PhD

Ronald W. Dworkin, MD, is a board-certified anesthesiologist who has been practicing anesthesiology in a community hospital for 30 years. He has taught in the honors program at George Washington University for over 10 years and works as a senior fellow at the Hudson Institute.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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