I remember many things from my days and nights working as a junior doctor in A&E, but some are more vivid than others.
In particular, I remember seeing a young man in his twenties who came in with severe chest pain. My registrar at the time told me to go back and ask him how much cocaine he had taken.
I protested that I had already asked about drug use when taking his history, and he had denied it.
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But my registrar was firm: the question wasn't whether this patient took cocaine, it was how much.
He was right. On questioning him again, the patient admitted he was a habitual user – and a heavy one at that.
Hours later, the consultant who treated the young man confirmed the diagnosis: cocaine had caused the blood vessels in the patient's heart to constrict, a complication that can lead to a full-blown deadly heart attack.
The consultant drove the lesson home in no uncertain terms: see a young person with chest pain, always ask about cocaine. I have never forgotten it.
I am now a GP, but I still ask about drug use regularly. Most recently, a patient came to me with persistent nosebleeds that turned out to be almost certainly related to their cocaine use.
When a young person shows up to hospital with chest pain, doctors will always ask if they have been taking cocaine, says Dr Philippa Kaye.
It is one of the most widely used illegal drugs in the UK – second only to cannabis.
Despite its reputation as a 'middle class' drug, cocaine is used across every demographic, every income level and every social group. And whatever your background, it can kill you.
Cocaine is one of the leading causes of sudden cardiac death. Let that sink in. The drug dramatically increases both your blood pressure and your heart rate, while causing the coronary arteries – the vessels that carry oxygen to the heart muscle itself – to constrict.
Narrow those arteries and you raise the risk of heart attack. Narrow the vessels elsewhere, like the brain, and you raise the risk of stroke.
Regular use can also trigger abnormal heart rhythms and cardiomyopathy, a condition in which the heart muscle itself is damaged. These are not remote, theoretical dangers. My A&E patient was living them. And he was in his twenties.
Cocaine can damage other parts of the body too.
If you were around in the nineties or noughties, you will likely remember the widely reported case of EastEnders actress Danniella Westbrook, whose septum collapsed after sustained cocaine use.
Damage to the nose is one of cocaine's most visible consequences. When snorted, the drug damages the delicate mucous membranes lining the nasal passages.
Cocaine is one of the leading causes of sudden cardiac death, says Dr Philippa Kaye. This is because the drug dramatically increases both blood pressure and heart rate.
Cocaine is also directly toxic to cells, and is frequently cut with harsh fillers that compound the damage.
Because the drug acts as a local anaesthetic, numbing the tissue, users can be unaware of the harm being done until it is severe.
The results can include chronic nosebleeds, loss of smell, ulceration and, in serious cases, a hole in the septum or full structural collapse of the nose.
Then there are the sexual side effects – and for men in particular, they can be deeply embarrassing. While cocaine may initially lower inhibitions, regular use commonly causes erectile dysfunction.
The same mechanism that constricts blood vessels throughout the body restricts blood flow to the genitals, making it physically difficult to achieve or maintain an erection.
Some men find themselves dependent on cocaine to feel confident socially or sexually, only to discover the drug is actively undermining their performance. It is a cruel paradox, and one that many men are too embarrassed to discuss with their doctor.
The risks multiply dramatically when cocaine is combined with alcohol – as it very often is. When the two substances meet in the body, they produce a toxic compound called cocaethylene, which is psychoactive and places an even greater strain on the heart and liver than either substance alone.
A 2024 study found that combining cocaine and alcohol increases the risk of sudden death due to heart problems by as much as 25 times. Cocaethylene also increases the risk of erectile dysfunction by more than six times.
GP, author and broadcaster Dr Philippa Kaye
Cocaine's damage is not only physical. It is highly psychologically addictive, and tolerance builds quickly, meaning users need increasing amounts to achieve the same effect.
People often binge – taking multiple doses in quick succession – followed by a crash of exhaustion, disorientation and dark mood. Even occasional use is strongly linked to anxiety, panic attacks and paranoia.
In the longer term, cocaine increases the risk of depression, psychosis and cognitive impairment, affecting memory and concentration. It can trigger and dramatically worsen any pre-existing mental health condition.
There is a spectrum of cocaine use, but the line between recreational use and dependency blurs faster than most people expect.
Warning signs include spending more than you intended, using it alone, finding it hard to enjoy social situations without it, changes in mood, or an impact on your relationships or ability to work. Often it is those closest to you who notice the problem first. Listen to them.
You do not need to hit rock bottom before seeking help. Support is available at every stage, and drug addiction treatment is free on the NHS – your GP can refer you to local drug treatment services, or you may be able to self-refer.
Charities including FRANK, We Are With You, Narcotics Anonymous, Cocaine Anonymous UK and Smart Recovery UK all offer confidential support.
Asking for help is not weakness. If anything, it is one of the bravest things you can do.