This Week’s Focus: Cocaine

This week’s NDEWS Weekly Briefing focuses on cocaine, a euphoria-producing stimulant drug with strong addictive potential. A June 2025 report from the United Nations highlights the fact that the production, seizures, and use of cocaine reached all-time highs in 2023. 

NDEWS is monitoring the national scope of cocaine use and related harms through its biospatial and web monitoring reports, as well as through our Early Warning Network. 

Out of 68,790 EMS encounters for nonfatal cocaine-related overdoses from January 1, 2024 to July 31, 2025, 12,989 (18.9%) occurred in Western states, 11,337 (16.5%) in Midwestern states, 29,543 (42.9%) in Southern states and 14,921 (21.7%) in Northeastern states. The data shows a statistically significant increase in EMS encounters for nonfatal cocaine-related overdoses across Western and Southern states, and nationally overall, while a statistically significant decrease was observed across the Midwestern and Northeastern states.

To view the entire Special Report from our Weekly Briefing, click here.

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Search Methodology: 240 separate searches on Reddit were conducted to analyze discussions about cocaine use in the powder form and experiences. Our search methodology identified posts mentioning cocaine in its powder form by searching for terms including "powder," "powdered," "snort," and "snorting" alongside cocaine references, while excluding crack-related terminology.

What was Found? According to Reddit discussions analyzed from recent months, powder cocaine remains a frequently discussed substance across multiple drug-related subreddits. Posts indicate ongoing concerns about purity, with users reporting cocaine cut with various adulterants including benzocaine, talcum powder, and other substances.

Public Health Concerns: Reddit discussants express significant concern about widespread adulteration of cocaine with unknown cutting agents, including potential fentanyl contamination. Posts sometimes report severe nasal damage including septal perforations from regular use but frequently describe multi-day binges and rapid tolerance development.

How is it Being Discussed? People who report commonly write that cocaine's effects last 30-90 minutes, leading to frequent redosing and multi-day binges. Discussions about nasal damage are prevalent, including detailed accounts of septal perforations with DIY solutions for managing symptoms. Comparisons to other stimulants suggest many people find cocaine overpriced relative to its effects, with some preferring amphetamines or research chemicals like 4-MMC. Reddit posts expressing concern about addiction describe the rapid tolerance buildup and diminishing returns with continued use. Discussions frequently mention combining cocaine with alcohol despite acknowledged risks.

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A recently published study in Neuroscience & Biobehavioral Reviews by Medigue et al. analyzed 19 studies (12 human, 7 animal) to understand how cocaine use disorder (CUD) and withdrawal affect sleep efficiency. Active cocaine use significantly disrupts sleep architecture; however, sleep efficiency can be restored through time depending on early or late withdrawal. The authors suggest a deeper understanding of sleep disturbances related to CUD could lead the way for therapeutic interventions designed to improve sleep quality. Read the full study here.

A recently published study in Drug and Alcohol Dependence by Frøyland et al. examined the variation in cocaine use among adolescents in Oslo, Norway, based on neighborhood and high school affiliation. Data from the Young in Oslo 2023 survey collected information from 9,741 senior high school students living in 95 neighborhoods and 25 schools. A total of 9.3% of all adolescents reported cocaine use the previous year. Read the full study here.

A recently published study in Diagnostics by Palumbo et al. examined the histological and immunohistochemical cardiac alterations associated with cocaine use. Post-mortem tissue samples from 60 cadavers (30 cocaine-related deaths, 30 controls) were analyzed. The findings from the study revealed that 87% of the deaths from individuals who used cocaine had visible heart damage, while only 20% of the control group showed any heart issues. The authors emphasize the importance of combining toxicology, histology, and autopsy data to accurately diagnose cocaine-related deaths. Read the full study here.

A recently published review in the Substance Use & Addiction Journal by Sinatora et al. evaluated attrition rates among randomized controlled trials (RCTs) for cocaine use disorder (CUD). 106 RCTs that spanned over two decades were included, with 82 explicitly being evaluated for attrition. 80.1% of the articles presented high attrition rates, while 19.2% had a medium attrition rate. The interventions that led to lower attrition rates included, in order, medication, psychotherapy, contingency management, treatment as usual, counseling, and intensive treatment programs. Read the full review here.

A recently published review in the Journal of Addictive Diseases by van Amsterdam et al. analyzed why individuals who co-use opioids and cocaine face significantly higher mortality rates than those who use opioids alone. A systematic literature review addressing the question of why people who use drugs combine opioids and stimulants was performed. 39 studies were selected, and the main findings revealed motives for co-use, pharmacokinetic interactions, pharmacodynamic interactions, accidental overdosing, impulsivity, and the adulteration of cocaine. Read the full review here.

A recently published review in Trends in Pharmacological Sciences by Allen and Nader discussed two possible reasons why no efficacious treatments have been approved for cocaine use: the low number of studies incorporating social variables and overlooking the clinical reality of polysubstance use. Read the full review here.

A recent article in Psychology Today's Addiction Outlook, by NDEWS SAG member Dr. Mark Gold, discusses research concerning the problematic cardiac changes in patients with cocaine and alcohol use disorders. Two recent studies from Yale and the University of Pennsylvania were highlighted and both contributed complementary insights into the cardiovascular effects of cocaine, methamphetamine, and other stimulants. Read the full article here.

A recently published article in The New York Times discusses why the global production of cocaine reached a new high in 2023. According to a recent United Nations report, global seizures of cocaine reached a record high 2,275 tons – a 68% rise from 2019 to 2023. Use of cocaine has also grown from 17 million users in 2013 to 25 million users in 2023. Read the full article here.

A recently released report by the United States Navy detailed the seizure of 1,300 pounds of cocaine in the Eastern Pacific. A US Coast Guard Law Enforcement Detachment traveled with the USS Sampson and identified a suspicious vessel operating in a known drug trafficking corridor in international waters. The vessel was disabled, and 12 bales of suspected narcotics that tested positive for cocaine were found. Read the full release here.

National Fentanyl Prevention and Awareness Day occurred Wednesday, August 21. The day was established in 2022 to remember and honor the lives lost to overdoses involving illegally made fentanyl. The theme for this year focused on hope and mental health, which emphasized the importance of healing, reducing stigma around seeking treatment for substance use, and sharing lifesaving information about prevention.
Learn more here.

📅 Date: Wednesday, September 3, 2025

🕑 Time: 2:00 pm - 3:00 pm ET

📍 Location: Online 

The NDEWS Weekly Briefing curates emerging data and findings from across the Early Warning Network, which includes three core components: our Scientific Advisory Group (SAG), comprised of national experts and federal partners; our Sentinel Site Directors (SSDs), who lead local surveillance in key geographic regions; and our Community-Based Health Experts, who provide on-the-ground insights from populations most impacted by drug trends. Together, these contributors generate timely, multidisciplinary and impactful information, ranging from peer-reviewed research findings to local surveillance data. These contributions inform public health and research communities.

More about The NDEWS Early Warning Network
- Issue 230: Early Warning in Action — Insights from the NDEWS Early Warning Network
- Issue 234: Early Warning in Action — Insights from the NDEWS Early Warning Network

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If you miss or want to learn more about NDEWS Original Content, you can find our archived content on the NDEWS website:

     • NDEWS Hotspot Alerts using substance-related EMS data
     • NDEWS Rapid Street Reporting (RSR) survey data reports
     • NDEWS Web Monitoring Team Reddit Alerts
     • NDEWS Sentinel Site Reports
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The Weekly Briefing is a newsletter published each week by the National Drug Early Warning System (NDEWS) Coordinating Center, which is funded by the National Institute on Drug Abuse (U01DA051126) to the University of Florida (MPI: Cottler (contact), Co-Is: Goldberger, Nixon, Striley), NYU Langone Health (MPI: Palamar), and Florida Atlantic University (Co-I: Barenholtz). Any item may be reproduced provided the source is acknowledged.