Aside from creating an addiction, snorting cocaine can kill a person through heart attack, stroke, kidney failure – and an underappreciated condition called penumomediastinum, a condition in which air leaks into the space in the chest between the lungs.

Brian Kloss DO, an instructor in emergency medicine at Upstate, wrote in the International Journal of Emergency Medicine about a man in his 20s who came to Upstate University Hospital‘s Emergency Department complaining of constant chest pain behind his breastbone that worsened when he moved or inhaled. The man admitted drinking a pint of gin and snorting 7 grams of cocaine prior to his arrival.

Pneumomediastinum can occur when a person smokes cocaine. Only a few cases, including the one at Upstate, have been reported from snorting the drug forcefully while bearing down to maximize the drug‘s absorption. Kloss wrote about the case to alert emergency physicians to consider pneumomediastinum in patients similar to his patient, who was treated successfully with pain medicine and bed rest after undergoing tests to make sure his respiratory tract and esophagus were not perforated.

Kloss says people using cocaine should also be aware that the drug is often cut with levamisole, a chemotherapy agent that wipes out the body‘s immune system and leads to death of skin tissue. The effects can be reversed if a person discontinues cocaine, he says, but that can be difficult since the drug is so addictive.