Risks of Snorting Drugs And Nasal Perforation

Why do people snort drugs?

People snort drugs to get a more immediate, intense high, and because it’s more convenient than injecting.

When you ingest a substance, you have to wait until it’s absorbed through the digestive system, metabolized by the liver, and then enters the bloodstream—a process than can take 30 minutes to an hour, or longer if you have a full stomach. 

On the other hand, if you inhale a substance through your nose, it’s absorbed through the nasal membrane and enters the bloodstream quickly. It also enters the bloodstream close to the brain so it produces effects immediately. This results in a fast, powerful high, taking effect in as little as five to ten minutes.

Traditionally cocaine is the drug most commonly snorted but drug users also snort opioids, crushing up prescription pills into a fine powder that can be inhaled. Heroin, meth, ketamine, MDMA, benzodiazepines, ADHD medication, and synthetic cathinones (also known as bath salts) are also sometimes snorted. Any drug that can be dissolved in water can be snorted. 

Risk of snorting drugs

Nasal damage from snorting drugs

Snorting cocaine has been known to cause damage to the nasal septum (the cartilage between the nostrils), including its complete perforation, for decades.^[5] In extreme cases, the septum can collapse, leading to a collapse of the outside of the nose and a deformity known as “saddle nose.”^[4] Additionally, a hole can develop in the palate separating the mouth and nose.^[3]

Cocaine is so destructive to the nose because it’s a powerful vasoconstrictor, which reduces blood flow into an area (hence its continued occasional use to reduce bleeding during oral, nasal, and throat surgeries). In chronic cocaine use, there’s a persistent lack of oxygen in nasal issues, causing cell death and necrosis.^[3] 

Related: How is cocaine used?

The nose and its mucous membranes are further damaged by chemical and mechanical irritation from the drug and cutting agents such as talcum powder. Finally, the patient may try to scrape away intranasal crusts with their fingers or other instruments. The anesthetic effect of the cocaine allows them to be rough and cause further damage to the nose.^[6]

Nasal damage has also occasionally been linked to snorting methamphetamine, heroin, and opioids, especially oxycodone (OxyContin and Percocet).^{[7][8][9][10]}

Can nasal damage from snorting drugs be fixed?

Reconstructive surgery can correct some cases of drug-induced nasal damage to reduce symptoms and restore a normal appearance. However, surgeons will typically only undertake these reconstructive surgeries on patients who are abstinent from drugs.

In some cases, the nasal damage is permanent and can only be ameliorated and not fixed.