What Causes ‘Coke Bloat’? The Science of Drugs and Face Swelling

Frequenting the slopes can cause your face to expand like a balloon. Why?

We often imagine cokeheads as sickly sprigs, having not eaten for days at a time while dripping calories on the dance floor (or just talking really, really fast). And while that may be true to some degree, many who frequent the slopes eventually develop “coke bloat,” a considerable ballooning of the cheeks that contributes to the general appearance of weight gain. Examples include pretty much every celeb ever.

Coke bloat could result from several common complications of sustained cocaine use, such as hormonal disturbances or fluid retention. Perhaps the most likely cause, however, is simply straying from the pure stuff. “Though there may be a great deal of factors at play, perhaps one reason why those with sustained cocaine use often appear with a face that looks ‘puffy’ or ‘swollen’ could be the adulterant present in most cocaine samples,” says Lawrence Weinstein, chief medical officer of the American Addiction Centers. “Levamisole is used primarily as an anthelmintic drug, which is used to get rid of worms and other internal parasites. Its use was previously approved by the FDA in the treatment for colon cancer, but it’s no longer used in the U.S. and Canada because of reports that it caused a condition called agranulocytosis, which causes a severe reduction of white cells in the blood.”

“Levamisole is a common cutting agent in cocaine,” Weinstein continues. “It’s estimated to be present in approximately 80 percent of the cocaine seized in the U.S., so it’s exceedingly prevalent. Levamisole, when metabolized, creates a compound called aminorex that has psychostimulatory properties of its own. As a result, levamisole prolongs the stimulatory effects from cocaine use. This, in addition to its physical similarity to cocaine, is likely why it’s a frequent additive.”

Good at extending your high, sure, but levamisole can also extend your face. “In addition to many, many side effects, levamisole causes glands to swell, and one of the glands that can possibly explain a ‘puffy’ face is the parotid gland,” Weinstein explains. “The parotid glands are the largest salivary glands and are right in front of the ear. When met with an irritant such as levamisole, swelling is a great possibility. Additionally, the combination of cocaine, the nasal inflammation that occurs through the act of insufflation [snorting] and the vasoconstriction of blood vessels that can cause a backup of lymphatic fluid around the face are all factors that may explain the change in appearance.”

For anyone suffering from coke bloat, there is a cure: giving up the goods. “Cocaine is a highly addictive drug, and the most effective — and healthiest — way of preventing unwanted side effects is ceasing use of the drug through the help of addiction specialists,” Weinstein says. “In addition to the appearance of a ‘puffy’ face, cocaine can induce heart failure, cause inflammation of the heart, an aortic rupture, kidney failure or brain damage, among many adverse effects. Long-term use is also associated with cognitive deficits and impaired decision-making.”

Well, crap. Better retire those skis.