Cocaine Comedown (Crash or Hangover): Symptoms, Risks & How to Recover

According to Yale Medicine (2022), cocaine can cause a dopamine flood — the neurotransmitter responsible for feelings of pleasure and euphoria — up to 10 times stronger than natural rewards such as socialising, food, or even sex.

It hits hard and fast, causing feelings of intense excitement, energy, and confidence as dopamine production is pushed into overdrive. At the same time, it also shuts down the brain’s natural dopamine cleanup crew, typically leaving the user in a temporary state of euphoria.

Temporary being the operative word here, eventually, the cleanup crew arrives on the scene, shutting down dopamine production and clearing out the excess. While we’ll get into more details below, in a nutshell, restoring natural dopamine levels after a wild night out is uncomfortable, tiring, and anxiety-inducing.

A cocaine comedown, also called a cocaine hangover or cocaine crash, won’t kill you, but understanding how it works, how to treat it, and, importantly, how it fits into the broader picture of addiction and risky behaviour, may help some individuals avoid repeated use, recognise the early signs of addiction, and make informed decisions on seeking professional help.

A cocaine comedown is, in essence, the rebound effect seen with all forms of substance abuse. The rebound effect states that as a drug wears off, the individual experiences the opposite effects of the drug*. For example, a substance that causes feelings of relaxation may cause anxiety as it wears off, stimulants may cause fatigue, sleeping aids may cause insomnia, and so forth.

As a powerful Central Nervous System (CNS) stimulant, cocaine causes feelings of intense energy and excitement, confidence, and euphoria through both increasing dopamine production and restricting the brain’s ability to readily absorb it. As the drug wears off, dopamine levels spike below the usual sober levels and the rebound effect kicks in, leaving the individual feeling fatigued, lethargic, anxious, and seeking relief.

*The intensity of the effects may vary significantly between individuals based on several factors.

A cocaine hangover is not the same thing as a cocaine withdrawal. Although there are symptoms that overlap, such as fatigue, anxiety, and irritability, these two conditions are typically seen in different contexts.

A cocaine comedown is the brain’s attempt to restore normal neurochemistry only after the last cocaine use, similar to the hangover someone who drank too much may experience. Even a first-time cocaine user might develop a cocaine comedown a few hours after the last use; however, it’s unlikely that they will experience any further side effects or symptoms more than 48 hours later.

Cocaine withdrawal deals with the longer-term symptoms of prolonged cocaine abuse. Regular cocaine use suppresses the body’s natural dopamine levels in response to regular and toxic dopamine floods, and as the body slowly removes all traces of cocaine and its metabolites during detox, most individuals experience a range of uncomfortable and anxiety-inducing withdrawal symptoms over a period of 8 to 14 days.

Similar to an alcohol hangover, an individual may experience a cocaine hangover anywhere on a scale from 1 to 10. A healthy, young individual who didn’t drink alcohol and only tried ‘a little bit to see what it’s like’ might feel next to nothing (not necessarily a good thing in the long run), while those who used excessively, took cocaine alongside other drugs or alcohol, or are in general poor health, might experience a significantly more intense crash. As a potent stimulant, it is fair to say that nearly all cocaine users can expect some degree of crash.

The crash typically starts anywhere between 3 and 6 hours after last use, peaks after around 9 to 12 hours, and wears off after around 24 to 48 hours. At this point, depending on the individual and whether or not they have used cocaine since then, withdrawal might set in.

While the euphoric effects of cocaine wear off within an hour of last use, fully eliminating it from the system happens over a longer period. As the drug wears off, physical fatigue sets in; however, the residual and still-active cocaine in the system prevents the user from sleeping.

In contrast to its immediate effect of heightened alertness, a cocaine crash can cause mental fog, poor concentration, and a feeling of mental sluggishness. Depending on the severity of the crash, the individual might not be able to perform simple tasks or safely operate certain types of machinery.

As dopamine levels temporarily drop below normal, comfortable levels, the user may experience the opposite of euphoria: sadness, anxiety, irritability, and depressive symptoms. These may be exacerbated by (potentially undiagnosed) mental health disorders and polydrug use.

Similar to other stimulant party drugs such as Ecstasy or MDMA, cocaine may cause the user to flex their muscles without realising, with a clenched coke jaw being the most common example. As the coke wears off, those muscles may start to ache.

Cocaine suppresses the appetite, and as it wears off, users often experience a ravenous hunger.

Realistically, the overwhelming number of first-time users won’t experience any serious, potentially dangerous, or otherwise too scary side effects of cocaine. If you’ve tried it once, enjoyed yourself and came out unscathed, the odds are pretty good that you’ll do it again.

Cocaine crashes become dangerous when you don’t have to learn about them from the internet anymore. It’s dangerous when you’ve experienced the various shades of comedown first-hand, when you plan your time around using cocaine, knowing that it’ll take you out of commission for a day or two, or when the idea of not taking cocaine is scarier than the crash.

One cocaine crash won’t kill, but repeated crashes are a very clear and unambiguous warning of a broader substance abuse problem.

Strictly dealing with an individual crash and ignoring the broader context above, treating the physical symptoms of a cocaine comedown again resembles treating a conventional hangover — staying hydrated, eating nutritious foods, getting lots of rest, and taking it easy. Having a non-judgemental support system in place to help deal with the physical demands and provide emotional support also goes a long way. While simple, these steps form the basis of recovering from cocaine abuse, even in residential treatment centres.

Although non-prescription analgesics or muscle relaxants can be taken in moderation to deal with physical pain, headaches, or other discomfort, it’s worth mentioning that many of these common medications place an additional load on an already-strained liver, even more so in cases of polydrug use.

Prescription medications should only ever be taken as prescribed by an informed physician and used under medical supervision. Self-medicating greatly increases the risk of an overdose and dependence.

• Do not treat a cocaine comedown with more cocaine. It can be tempting to taper yourself off after a binge to avoid the crash; however, situations like these can lead to an overdose and only further reinforce a growing dependency.
• Do not treat a cocaine crash with any other drugs, alcohol, or prescription medications, including anti-anxiety medications and benzodiazepine-based sleeping aids. In addition to, again, strengthening a substance dependency, certain drug interactions create toxic byproducts that raise the risk of organ failure and death (American Addiction Centers, 2024).