Cocaine and Seizures: Why They Happen and Who's at Risk

The people who ask me about cocaine and seizures are almost never the person it happened to. They are the friend who was standing there. The partner who came into the kitchen and found him on the floor. The brother who did not know whether to hold him down or ring an ambulance, and who has not been able to sleep properly since.

And the person who actually had the seizure? Very often they remember almost nothing about it. They come round confused, sore, embarrassed, and by the following afternoon the whole thing has been quietly filed under a bad one. That gap — between how terrifying it was to watch and how little it registered with the person it happened to — is the reason I wanted to write this page properly.

Why cocaine causes seizures

Your brain has what doctors call a seizure threshold — a level of electrical stability that normally holds, no matter how tired, stressed or wound up you are. A seizure happens when that stability breaks down and a burst of disordered electrical activity sweeps through the brain.

Cocaine lowers that threshold. It is a powerful stimulant acting directly on the central nervous system, flooding it with activity while stripping out the braking systems that would usually damp things down. Push a brain hard enough in that direction and the threshold can be crossed. That is the whole mechanism, and it is worth understanding because it explains something people find hard to accept: a cocaine seizure is not a sign that there was something already wrong with you. The drug itself is enough.

Most cocaine-related seizures are what people picture when they hear the word — the person loses consciousness, goes stiff, then convulses, and afterwards is drowsy and disorientated for a while. They typically happen soon after use, within minutes to an hour, though not always. Some people describe a strange few seconds beforehand that they cannot put into words. Many describe nothing at all, because the memory of it simply is not laid down.

The same nervous-system overdrive is behind other things I write about here — the racing heart in what cocaine does to your heart, the chest tightness in chest pain after cocaine. A seizure sits at the far end of that same spectrum.

Who is most at risk

There is no safe user profile here, and I will not pretend there is. But some things genuinely stack the odds:

• Larger amounts and long binges. The more that goes in, and the longer the session runs, the further the threshold gets pushed.
• Mixing. Cocaine with alcohol, with other stimulants, or with anything else on top changes the picture in ways nobody can predict in a kitchen at three in the morning. There is more on the alcohol side in cocaine and alcohol.
• Crack and injecting. Anything that gets a large amount into the brain very fast raises the risk compared with the same amount arriving slowly.
• Existing epilepsy or a previous seizure. If your threshold is already lower, there is less margin. If you have ever had a seizure before, from any cause, that matters.
• Days without proper sleep. Sleep deprivation lowers the seizure threshold on its own, and heavy cocaine use almost guarantees it — see cocaine and sleep.
• Withdrawal from alcohol or benzodiazepines. Coming off either of those abruptly can itself cause seizures, and plenty of people are doing exactly that while still using cocaine.
• Not knowing what is in it. Street cocaine is cut with things you never agreed to and nobody can identify by looking at it.

What is not on that list, and I want to be direct about this, is any promise that being young, being fit, or being a moderate weekend user protects you. It does not. Some people have their first seizure on a night no different from a hundred others.

What to do if someone has a seizure in front of you

This is the section to read now rather than later, because if you ever need it you will not have time to look it up. It is also the section that friends tell me they got wrong, and then carried guilt about for months afterwards.

1. Call 112 or 999. With a drug-related seizure, ring straight away. Do not wait to see how it goes.
2. Move the danger away from them, not them away from the danger. Push back furniture, glasses, anything hard or sharp.
3. Cushion their head with something soft — a folded jacket will do.
4. Do not restrain them and do not try to stop the movements. You cannot, and you can injure them or yourself trying.
5. Never put anything in their mouth. Not your fingers, not a spoon, nothing. People cannot swallow their tongue, and this is how carers and paramedics get bitten and how teeth get broken.
6. Note the time it starts. The crew will ask, and how long it lasted genuinely matters.
7. When the convulsing stops, roll them onto their side into the recovery position, so their airway stays clear if they are sick.
8. Stay with them and keep them warm and calm. Coming round from a seizure is frightening and confusing; a familiar voice saying what has happened helps.

And tell the ambulance crew that cocaine was taken, along with anything else — alcohol, tablets, whatever it was. I know how much that costs some people to say. It genuinely changes how the medical team assess and treat the person on the floor, because the causes are managed differently. They have seen this many times before. They are not there to judge anybody, and holding it back only makes their job harder at the worst possible moment.

Afterwards — the part everyone skips

The seizure ends. Someone is embarrassed. There is a shaky cigarette outside the hospital, or a taxi home, and an unspoken agreement not to make a fuss about it.

Please do not leave it there. Go to hospital, or go to your GP within days if you did not go on the night. A seizure needs to be looked at properly — not because anyone wants to lecture you, but because there may be things worth checking, injuries you have not noticed, and a real question about whether it is likely to happen again.

There are practical things too that people are never told. Do not drive until you have had medical advice about it — the rules on driving after a seizure exist for a reason and they apply to you. Avoid swimming or baths alone for now. Tell one person you live or work near what happened, so you are not the only one who knows.

If you are going to stop using, do not do it blind either. Read coming off cocaine safely first, especially if alcohol or tablets are in the picture as well, because that is exactly the combination where stopping without advice can cause its own problems.

What a seizure is actually telling you

Here is the honest version, and it is the conversation I have for a living rather than a medical one.

A seizure is the body running out of ways to be subtle. Most people get years of quieter signals first — the sleepless nights, the dread on a Monday, the money, the lies, the flat grey afternoons. Those are easy to talk yourself past, and everyone does. A seizure is the same message arriving in a form that cannot be talked past, and that is a brutal way to receive information, but it is still information.

What I see in my work is that the moment does not stay open for long. Within a fortnight the fear has faded, the story has been reshaped into something manageable, and the person is back where they were, only now with something new to carry. That is not stupidity or weakness. It is what minds do with things too frightening to hold in full view. But it means the window for doing something with it is measured in days, not months.

If someone you love had the seizure and you are the one reading this at midnight, you are allowed to say plainly what you saw and what it did to you. That is not nagging. That is often the single most useful thing anyone says to them. And if it is your own name in this article, the question underneath it is not whether you are a bad person — it never is. It is simply whether this has stopped being something you are choosing. Am I addicted to cocaine is the honest place to start, and if you are worried about what stopping would do to a demanding job, quitting without derailing your career is the realistic version of how that works.

Related reading

• Chest Pain After Cocaine: What It Means and When It's an Emergency
• Cocaine and Psychosis: When the Paranoia Goes Further
• Coming Off Cocaine Safely: What to Know Before You Stop

Gary Clinton

Ireland's cocaine addiction specialist — CBT-qualified therapist, bestselling author of Never Give Up, and in long-term recovery himself. Private one-to-one help for professionals, online and worldwide.