Harm reduction
If you're going to use, use safer.
Not using is the safest option. We won't pretend otherwise. But people use anyway, and pretending they don't has never reduced harm. So here's the practical reality — clearly, without lecture, and based on what frontline workers actually see.
Don't use alone
If something goes wrong — heart, breathing, mental state — you need someone who'll call 999 without hesitating.
Don't mix with alcohol
Cocaethylene is real and it's dangerous. If you're drinking, don't use. If you're using, don't drink.
Smaller. Slower. Spaced.
Smaller test amounts. Slower between lines. Wait longer than feels necessary. Repeated use in short windows is where most harm happens.
Watch your tolerance
Needing more to feel the same is the signal — not just that tolerance is rising, but that use is shifting. Notice it.
Look after the basics
Hydrate with water (not alcohol). Eat before and after. Sleep matters more than you think. The crash is bigger when the body's already running empty.
Know when to stop the night
If your heart's racing, your chest feels tight, you're paranoid, or your body's not right — that's the night ending. Tell someone. If symptoms persist, call 111 or 999.
Don't use in unfamiliar places
You should know who's around, where the exits are, and how to get home. Risk multiplies when the environment is unknown.
Mental health matters
Cocaine and existing anxiety, depression, or trauma is a hard mix. If you're already struggling, use will usually make it worse — not better.
The rest depends on how you use. Open only what applies to you.
Crack carries different risks from powder. It comes on faster. The high is shorter. The pull to re-dose is stronger. And the pipe and the heat bring their own damage. These aren't warnings to stop you. They're the things that matter if you're using.
Use your own pipe
Sharing pipes shares blood — cracked lips, mouth sores, and cold sores are common in people who smoke crack. Hepatitis C transmits this way. Your own pipe, every time.
Protect your lips and fingers
Hot pipes cause burns to lips and fingers that get infected. Pipe mouthpiece covers (available from needle exchanges) significantly reduce this. Burn wounds on the hands or mouth are a sign. Worth mentioning to HaRRT or a GP. You don't have to explain why.
Know what crack lung looks like
Fever, chest pain, struggling to breathe, and coughing up blood after smoking — that's crack lung, which is bleeding inside the lungs. It can look like pneumonia. It needs emergency treatment. Call 999. Be straight about what was smoked — it changes how they treat it.
The re-dose pull is physiological
The high from crack lasts 5–10 minutes. The compulsion to redose immediately after isn't weakness — it's the drug. Knowing this doesn't stop it, but it helps to name it. Longer gaps between hits reduce total exposure and the speed of dependence development.
Slow down, don't stop, on a new batch
Purity varies sharply between batches. The same weight of crack from a different source can be significantly stronger. Start smaller than you think you need to on anything new.
Ventilate
Smoking in a closed space with no airflow concentrates crack vapour and carbon monoxide. Open a window. The lung damage compounds fast in enclosed environments.
Injecting is the riskiest way to take cocaine. An overdose hits almost instantly, the pull to go again is intense, and the damage to your body stacks up fast. This is practical information, not a lecture. If you inject, you need it.
Never share any equipment
Not just the needle. The spoon, the water, the filter, the tourniquet — all of it. Hepatitis C, HIV, and other blood-borne viruses transmit on everything that touches blood. One shared filter is enough.
Use sterile water only
Tap water carries bacteria that cause abscesses and sepsis when injected. Use sterile water for injection (available free from needle exchanges) or water that has been boiled and cooled. Never use fizzy drinks or flavoured liquids.
Go smaller on a new batch
Cocaine purity varies significantly between batches. Injecting a dose that felt normal from the last batch can cause an overdose from a stronger one. Always test a smaller amount first when the source or appearance has changed.
Rotate your sites
Using the same vein repeatedly causes collapse, scarring, and chronic damage. Rotate injection sites systematically. Avoid the groin and neck — both carry serious risks of life-threatening bleeding or infection that is very hard to treat.
Cocaine overdose is different from heroin
Injecting cocaine can tip someone into overdose within seconds — heart going out of rhythm, fitting, blacking out. Naloxone won't reverse a cocaine overdose the way it does an opioid one. Give it anyway. There are often opioids in the supply. Call 999 straight away. Put them in the recovery position if they're out cold. Start CPR if they stop breathing. If you inject, carry naloxone — HaRRT will give you a kit and show you how to use it, no questions asked.
Never inject alone
This matters more for cocaine than almost any other drug. The window between injection and overdose can be under 60 seconds. If no one is with you, no one can call 999. Have someone present, or at minimum tell someone where you are before you use.
Know the signs of an abscess or infection
Redness, heat, swelling, or pus around an injection site means infection. Left untreated it becomes an abscess; left longer it becomes sepsis. HaRRT offers wound care with no questions asked. A GP can treat an abscess without involving police. Don't wait until it's serious.
Get free kit in Renfrewshire
The needle exchange in Paisley gives out free sterile needles, syringes, citric acid, sterile water, filters and sharps bins. No charge. No referral needed. HaRRT can also provide equipment and BBV (blood-borne virus) testing. Contact details below.
Let's start with the bit nobody puts in a leaflet: cocaine makes a lot of people extremely horny. Not a side effect — for plenty of folk it's one of the main reasons they use. That's not shameful and it's not unusual. But it drives everything else on this page. So it's worth knowing what it does to your judgement, to your body, and to what you end up agreeing to. Using cocaine during sex — what people often call chemsex — changes what your body does and what your judgement does, at the same time.
Wanting it more, thinking about it less
That combination is what does the damage. Wanting goes up, judgement goes down, at the same time. So it's harder to know what you want. Harder to read whether they're up for it. Harder to say no to something you'd normally knock back. It works both ways — you can end up doing things you wouldn't, and so can they. If you're not sure they're into it, they're not into it. Leave it.
You probably won't finish, and that causes its own problems
Sex on coke goes on longer because climaxing is harder. Sounds like a selling point. In practice that means more friction, more tearing, and small splits you might not notice. Torn skin is an open door for HIV and hepatitis. Anything rougher than usual, including anal, makes that more likely. Use lube, more than you think you need, and use condoms.
Trouble getting hard? That's the coke, not you
Cocaine narrows your blood vessels, including the ones you need for an erection. Plenty of men can't get hard on it. They feel humiliated, so they take more to shake the mood off. That makes it worse. If it happens every time you use, that's the coke, not you. It settles when use does. And taking Viagra to force it is a genuinely dangerous mix for your heart.
Alone, wired, and three hours into porn
You want sex badly. You can't finish. You're wide awake anyway. That's how a lot of people end up spending half the night on porn. It's one of the most common things men tell us about and one of the least talked about. A lot of people end up watching things they wouldn't normally go near. That's the drug pushing for more, the same way it does with everything else. Then the shame lands with the comedown, and shame is what sends people back for another line. If it's bothering you, it's worth saying out loud to somebody. It's far more ordinary than you think.
Locked in for the weekend
Most cocaine and sex doesn't happen at a party. It happens behind a locked door with the curtains shut.
Couples do it. A Friday that becomes Monday. Enough gear in that nobody has to leave. People on their own do it too. A hotel room. Porn running for hours. Escorts at 4am. Money going out that isn't there.
Nobody talks about it because of how it feels on the Tuesday. That silence is what keeps it going.
- Three days, no sleep, no food. Your heart works flat out the whole time.
- Paranoia lands about day two. Arguments then aren't really arguments.
- Consent gets muddy even between people who love each other. Going along with it at 4am on day three isn't the same as wanting it.
- The money. Hundreds gone. The damage lands later.
- If other people were involved, get tested. Free postal kits.
- The crash is brutal — and the shame is worse than the comedown. That's what sends people back.
Recognise your own weekend in that? It's far more common than you think. Nobody here is going to be shocked.
Get tested. It's easier than you think
Sexual health clinics don't ask what you were on, don't judge, and don't tell anyone. You can order free home testing kits online in Scotland and post them back — nobody has to see you walk in. If you inject or share pipes, ask about hepatitis C too. It's curable now.
Periods, fertility and pregnancy
Long-term use can stop your periods, so "I can't be pregnant, my periods stopped" isn't safe to rely on. Cocaine in pregnancy raises the risk of miscarriage, the placenta tearing away, and the baby coming early. If you're pregnant and using, talk to somebody — asking for help is not what puts your baby at risk.
If something happened that you didn't agree to
Being on cocaine does not make it your fault, and it does not make it less serious. It changes nothing about what you're entitled to.
You can get a forensic medical examination without going to the police. It's called self-referral, it's free, and the service is SARCS on 0800 148 88 88, open 24 hours. They'll store the evidence so you can decide about reporting later, or never. Being on drugs at the time doesn't stop you using it.
To talk to somebody first, Rape Crisis Scotland is free on 08088 01 03 02, every day 5pm to midnight, for anyone 13 or over, any gender. Calls don't show on your phone bill. You can also text 07537 410 027.
This sounds like the boring bit. It's one of the few things fully in your control. And it makes a real difference to how rough the next three days are. Cocaine kills your appetite, keeps you awake and burns through you — so the tank is empty before you notice.
Eat before, because you won't during
If you know a session's coming, get a proper meal in you beforehand. Once you've started you won't feel like eating, and by then it's too late. Something with protein and slow carbs in it — a proper dinner, not a bag of crisps.
Water, and something with salts in it
Coke pushes your temperature and heart rate up, and drink dehydrates you on top. You lose fluid and you lose the salts your heart and muscles run on. Keep water beside you and take sips even when you don't want it. A bottle of isotonic sports drink does more than water on its own, because it puts the salts back too.
The comedown is when it counts
Not eating and not drinking makes the low mood, the anxiety and the shakes worse. And a worse comedown is what sends people back for more. Getting food and fluid in you is doing something about the comedown, even when it feels like it isn't.
Losing weight isn't the drug working
Cocaine killing your appetite isn't a bonus, it's the start of your body running short. Missing vitamins and minerals makes anxiety worse and sleep worse. It slows down how you heal. And it leaves you picking up every infection going. If you're dropping weight without meaning to, that's worth mentioning to a GP.
HaRRT — Harm Reduction Response Team
Change Grow Live's Harm Reduction Response Team (HaRRT) operates across Renfrewshire — offering practical, non-judgemental support for people who are currently using. That means safer use information, naloxone supply, wound care, and a way in to further support when you're ready. No waiting list pressure. No requirement to be in recovery.
Find out how to reach HaRRT →