Cocaine addiction signs and boufa: risks to the heart and mind, and treatment

Cocaine addiction signs: what might a family notice at home?

Cocaine addiction signs often show up as clear swings: nights of staying awake, talking a lot and being overactive, then days of exhaustion, sluggishness, irritability and sadness, with a strong urge to use again. Cleveland Clinic's list of signs of use and addiction includes loss of appetite and weight, a constant runny nose, frequent respiratory infections, changes in hygiene and sleep, pulling away from family and friends, anger and impatience, and severe depression or paranoia.

Cocaine is a powerful stimulant made from the leaves of the coca plant, native to South America. The US National Institute on Drug Abuse (NIDA) explains that its effects appear almost immediately and usually fade within a few minutes to an hour, and that some people use it in repeated binges. If you are a parent or a wife reading this with worry, here is what you may notice at home:

• Mood and energy swings: unusual enthusiasm and fast talking, then a crash, sluggishness and snapping at small things.
• Sleep and eating: staying up until morning, eating little and losing weight, then deep tiredness.
• Physical signs: wide pupils, a frequent runny nose or nosebleeds, a racing heart and sweating.
• Money: repeated requests for cash with changing excuses, debts, or things going missing from home.
• Behavior: secrecy around the phone, new friends, missing work or school, and lies to cover time or money.

One sign alone proves nothing, but several together, with a clear change in the person, are worth acting on calmly. When suspicion is strong, a drug test can help confirm it, as part of a conversation, not a punishment.

From use to addiction: when does it become dependence?

NIDA explains that cocaine strongly activates the brain's reward system. With repeated use the brain adapts: it responds less to natural pleasures, the person may need more to get the same effect, and stress circuits grow more sensitive, so they feel uneasy and low when not using. The UK's FRANK drug advice service says cocaine mostly causes psychological dependence, and that some people keep using just to escape the after-effects once the high fades, which can lead to non-stop binges. Signs of dependence include:

• Carrying on despite repeated promises to stop and failed attempts to cut down.
• Constant thoughts about the drug and the money for it.
• Dropping activities, duties and relationships that used to matter.
• Continuing despite clear harm to health, work or marriage.
• Strong cravings and a low crash in mood and energy when stopping.

Cocaine health risks: what it does to the heart and brain

Cocaine raises heart rate, blood pressure and body temperature, and narrows blood vessels. According to NIDA, heart rhythm disturbances and heart attacks are among its most common serious complications, chest pain that feels like a heart attack often sends people who use it to the emergency room, and use is linked to a higher risk of stroke, bleeding inside the brain and seizures. Over time it can also inflame the heart muscle and weaken its ability to contract.

MedlinePlus (US National Library of Medicine) adds that cocaine poisoning can cause permanent damage, including stroke and paralysis, heart rhythm problems and weaker heart function, kidney failure, and chronic anxiety and psychosis.

Effects on the mind: agitation and suspicion, then depression

Under the influence, a person may become anxious, agitated, restless and irritable, or violent and reckless. NIDA notes that binges can lead to panic, paranoia and even psychosis with hallucinations; the family may notice he thinks someone is watching him or plotting against him. Cleveland Clinic lists hallucinations, delirium and violent behavior among the signs of overdose, so if they appear suddenly, call an ambulance on 123 straight away and keep yourself and others at home safe.

Then comes the crash. FRANK says some people feel down, anxious and paranoid the next day or longer. MedlinePlus lists withdrawal symptoms such as tiredness, low mood, restlessness and agitation, slowed activity, increased appetite and vivid, unpleasant dreams, adding that cravings and depression can last months after long-term heavy use, and that some people have suicidal thoughts during withdrawal. So do not brush off your son's or husband's sadness now: ask him gently and directly how he is, and watch for the warning signs in the emergency section below. If he also has depression, anxiety or another mental health condition, both are best treated together, an approach known as dual diagnosis treatment.

What is boufa, the drug called "poor man's cocaine"?

Boufa is a name that has spread in Morocco in recent years for a cheap smoked drug, often called "poor man's cocaine" for its low price. What is known comes mostly from press reports and Moroccan security statements, not medical research, and they disagree on what it is: some say cocaine turned into a smokable form like crack, others a mix of cocaine residues or other drugs with harmful chemicals. So nobody can know exactly what any batch sold on the street contains. Crack itself, as NIDA explains, is cocaine processed into solid crystals that are smoked.

NIDA explains that the faster cocaine reaches the brain, the shorter its effect, and that the high from smoking may last only a few minutes. Crack cocaine effects are almost instant, FRANK notes. A short high means a quick crash, making it easy to slip into the binges described above. NIDA adds that smoking crack damages the lungs and can worsen asthma.

Street drugs of unknown make-up may also contain harmful cutting agents. A 2021 report by the United Nations Office on Drugs and Crime (UNODC) cites a Moroccan study that found levamisole, a deworming medicine now almost never used to treat people, in 63% of 154 cocaine powder samples seized in Morocco between 2007 and 2016. The report notes that it can harm white blood cells and may increase cocaine's damage to the heart and blood vessels.

A 2026 study in BMC Public Health analyzed twenty years of school surveys in Morocco. In the 2021 survey, 1.6% of students aged 15 to 17 said they had tried crack at least once (2.9% of boys, 0.6% of girls), and the rise over the years was clearer in boys than in girls. The study does not name boufa, but it shows that smoked cocaine has reached some teenagers.

Is cocaine spreading in North Africa and the Gulf, and why?

UNODC's World Drug Report 2025 says cocaine production, seizures and use all hit records in 2023: illicit production reached about 3,708 tons, nearly 34% more than in 2022, and the number of people using cocaine worldwide rose from 17 million in 2013 to 25 million in 2023. Against this backdrop, the report notes, traffickers are breaking into new markets in Asia and Africa. For the Arab region specifically, the data show:

• North Africa: the World Drug Report 2026 says cocaine seizures in Africa rose more than 20-fold between 2015 and 2024, and in 2023 seizures of cocaine en route to Africa were 278% higher than in 2015, with the largest increase in shipments heading to North Africa and to West and Central Africa.
• The Middle East and the Gulf: the picture is less clear. The same report suggests that trafficking to the Near and Middle East may be a somewhat "latent" phenomenon, as more is seized on the way there than inside the region, though such seizures are limited in number. It estimates that past-year cocaine use across Asia doubled from 0.05% of people in 2014 to 0.10% in 2024.
• Smokable forms: the 2021 UNODC report warns that some stages of cocaine processing spreading to countries in Africa and Europe could expand the market for smokable forms there.

These are seizure figures and broad estimates, not proof that cocaine is equally common in every Arab country, but they are reason enough for families to watch for the signs early.

Emergency signs: when should you call an ambulance right away?

If your son or husband talks about death or wanting to end his life, especially in the crash days after stopping, take it seriously. Other warning signs include saying he is a burden or sees no way out, sudden withdrawal, saying goodbye to people or giving away things he values, and a sudden calm after deep sadness. Ask him directly and calmly whether he is thinking of harming himself: asking does not plant the idea, it opens the door to talking. Listen without blame or argument. If he is in danger now, call an ambulance on 123 straight away or take him to the nearest emergency department (elsewhere, your local emergency number), stay with him, and move away anything he could hurt himself with. Our article on suicide warning signs explains how to help step by step. If the danger is not immediate, you can get support in Egypt from the Ministry of Health's 24/7 mental-health line on 16328 or Oxygen Center's 24/7 emergencies and complaints line on +20 100 006 6752. These moments are hard, but they pass, and help is available.

What can the family do now, and when should you get help?

1. Choose a calm moment when he is not under the influence, and describe what you have seen yourself, without accusing or insulting him.
2. Share your worry about his health, his heart and his future; it reaches him better than threats.
3. Don't fund the drug use by accident: stop giving money without knowing where it goes, without cutting off love and contact. Our article on supporting without enabling addiction explains this balance.
4. Ask for help early: don't wait for a heart attack, legal trouble, or for work and marriage to collapse.
5. Come alone if he refuses: the family can start with a session with specialists to learn how to persuade him, as explained in how to convince someone to get addiction treatment.

Ask for a specialist assessment if several of these signs come together, use continues despite promises, paranoia, depression or suicidal thoughts appear, or he has heart disease or high blood pressure. In Egypt, the Fund for Drug Control and Treatment of Addiction offers confidential treatment through partner centers, paid for by the state, via its 24/7 hotline 16023.

Cocaine addiction treatment: how does it work?

NIDA explains that no medicine is currently approved by the US Food and Drug Administration (FDA) to treat cocaine use disorder, and MedlinePlus says that, for now, there is no medicine to reduce cravings for it, though research continues. Cleveland Clinic adds that researchers are still evaluating medicines that may help people stop using cocaine, so their benefit is not yet established. Whether any medicine suits a particular person is a decision for a specialist doctor alone. So treatment rests mainly on behavioral therapy, with medical and psychiatric care for related problems. MedlinePlus adds that withdrawal symptoms usually fade with time, that outpatient care works as well as inpatient care for most people, and that a live-in program may be advised when symptoms are severe, to monitor health and safety during recovery.

• Medical and psychological assessment: checking the heart, blood pressure and general health, and looking for depression, anxiety or psychosis that needs treatment.
• Cognitive behavioral therapy: learning to recognize the situations that trigger use and to handle them differently.
• Contingency management: rewards linked to negative drug tests, which NIDA says may be especially useful early in abstinence and for staying in treatment.
• Psychiatric care: a doctor may prescribe medicines for accompanying depression, anxiety or sleep problems; only the doctor decides on this and monitors it.
• Family involvement and relapse prevention: a clear plan for coping with cravings and pressure, and follow-up after the program ends.

At Oxygen Center, the first step is a doctor's appointment and an assessment, then the right path is chosen: the outpatient clinic and therapy sessions for men and women, or the inpatient rehabilitation program for males only, which includes family counseling and aftercare. The center's services are for people aged 15 and over, and anyone under 18 needs a guardian's consent. A relapse, if it happens, is not failure but a sign to adjust the plan with the treatment team.