What happens if you take cocaine while drinking

Cocaine use is on the rise in New Zealand and we know that people often take it while also drinking alcohol. Mixing these two drugs doesn’t just add their individual effects together—it produces a third chemical in the body, cocaethylene, which has its own risks and can stay in the system longer than either substance alone.

Make sure you understand the potential harms of mixing cocaine and alcohol so you can take steps to reduce the risks and keep yourself safer.

What are the risks of taking cocaine and alcohol together?

When alcohol and cocaine are consumed at the same time, the liver processes them and produces cocaethylene. This compound is known to be more toxic than either cocaine or alcohol on their own.

Some of the key risks of cocaethylene include:

• Increased heart strain: Cocaethylene puts significant stress on the heart, increasing the risk of high blood pressure, irregular heart rhythms, and even heart attacks. Research suggests that cocaethylene stays in the body longer than cocaine, meaning the heart is exposed to strain for a longer period.
• Overconsumption: Cocaine can mask the effects of alcohol, making it easier to drink more without realising how much you’ve had. This can increase the risk of alcohol poisoning and blackouts, on top of the usual impact of drinking too much.
• Overdose: Because cocaethylene stays in your body almost twice as long as cocaine does, you can end up with a large amount of the active drug in your system if you take more after your first initial dose. This seriously increases your risk of overdose.
• Increased liver toxicity: Cocaethylene is more toxic to the liver than alcohol alone, increasing the risk of liver damage over time.
• More unpleasant effects: Cocaethylene has stronger effects than just cocaine alone. You may be more likely to experience anxiety, agitation, jitters, nausea, dizziness and a racing heart. It also increases your risk of experiencing more serious side effects such as seizures, psychological distress and overheating.
• Greater risk of accidents: Studies have linked the combination of cocaine and alcohol to an increased likelihood of risky decision-making and accidents, due to impairment. There’s also a chance of increased aggressive behaviour, which could potentially lead to violence.

How to stay safer using cocaine and alcohol 

While avoiding this combination entirely is the safest choice, if you choose to use cocaine and alcohol together, here are some ways to reduce harm:

• Pace yourself: To avoid cocaethylene forming, leave as much time as possible between drinking alcohol and using cocaine. A standard drink takes at least an hour to be processed by your body. So, if you have had 4 drinks, wait at least four hours before using cocaine. Be aware that these drugs will still be in your body, even after you no longer feel their effects - so you may need to wait longer than you think. Keep in mind cocaine can make you feel less intoxicated by alcohol than you are, so keep track of how much you’re drinking and take breaks between drinks. If you notice a racing heartbeat, chest pain, or dizziness, take a break from both substances. These could be signs of stress on your heart.
• Avoid re-dosing: Cocaethylene stays in your body more than twice as long as cocaine alone does. This means that if you re-dose (take more after your first dose) frequently, you’re essentially creating a back log of it in your body. This increases the risk of overdose and other harmful effects.
• Lower doses are less risky: To reduce the risks of unexpected or harmful effects, stick to lower doses of cocaine and drinking lower alcohol beverages.
• Avoid mixing with other substances: Combining alcohol and cocaine is already risky—adding other drugs, especially depressants like benzodiazepines or opioids, can significantly increase the chance of overdose or severe health complications.
• Avoid using alone: Like with all drug use, it’s best to be with people you trust and who can call for help if something goes wrong. Use a buddy system if needed - where someone is on the phone or calls you to check you are ok. If you’re having a big night, make sure you have a plan for getting home safely, and avoid engaging in risky activities like driving or swimming.
• Know the signs of overdose: Symptoms such as difficulty breathing, chest pain, extreme confusion, or unconsciousness require immediate medical attention. Call 111 and ask for an ambulance if you think someone might be overdosing – tell paramedics what the person has taken, you won’t get in trouble, and it could save their life.

Remember to get any substances checked before taking them. You can't tell what something is by sight and smell alone, and there have been instances of cocaine being misrepresented as something else in New Zealand (including heroin and fentanyl). Drug checking is free, legal and confidential. KnowYourStuffNZ, the New Zealand Drug Foundation and the New Zealand Needle Exchange Programme's DISC Trust run regular drug checking clinics across the country, and a drop off service is now available in Auckland. A calendar of upcoming clinics can be found on The Level.

Are you concerned about your own drinking or drug taking? Reach out to the Alcohol Drug Helpline on 0800 787 797, or text 8681. You'll be able to speak with a trained counsellor who can provide you with helpful information, insight and support. They’re available 24/7, all calls are free and confidential.