This Week’s Focus: Cocaine

This week’s NDEWS Weekly Briefing focuses on cocaine, a euphoria‑producing stimulant with a high potential for addiction. A recent update to the CDC’s Provisional Drug Overdose Death Counts dashboard prompted our NDEWS team to take a deeper look at emerging trends in cocaine overdoses.

Our latest NDEWS Special Report examines nonfatal cocaine overdoses and identifies the Top 10 counties across four U.S. regions. Additionally, the NDEWS Web Monitoring Team has released an updated report on trends in cocaine‑related discussions among Reddit users.

The Weekly Briefing concludes with several new studies and reports relevant to cocaine use, as well as the announcement of the next Our Community, Our Health – NDEWS webinar, scheduled for March 19 at 2 p.m. ET. Shabbir Imber Safdar, CFE, Executive Director of the Partnership for Safe Medicines, will present on the broad threat that medical fraud poses to patients within the GLP‑1 space.

As always, we welcome your input.

Nationally, 52,176 nonfatal EMS encounters involving cocaine overdoses were recorded from January 1, 2023 to February 28, 2026. Of these 9,110 (17.5%) occurred in Western states, 9,074 (17.4%) in Midwestern states, 23,587 (45.2%) in Southern states, and 10,405 (19.9%) in Northeastern states. Counties with ≥ 10 encounters are presented below as encounters per 10,000 population; counties with fewer than 10 encounters have been suppressed. View the entire Special Report from the weekly briefing, click here.

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Why are we reporting on this? Cocaine remains a frequent topic of discussion on Reddit, with recent threads highlighting its continued prevalence in recreational settings and a growing concern over high-potency alternatives and dangerous combinations. Reddit discussions reveal concerning patterns including the transition from cocaine to more potent stimulants like methamphetamine, the co-use of emerging novel substances like 7-hydroxymitragynine (7-OH), and the severe physical toll of chronic use. Discussants also frequently mention the high potential for addiction and the severe impact the substance has on financial stability and family relationships.

What is Cocaine? Cocaine is a powerful stimulant drug derived from the leaves of the coca plant that is most commonly found as a white powder or in a solid rock form known as crack. It is typically consumed through insufflation, smoking, or injection, and it is widely discussed across various online communities dedicated to drug use and recovery.

Public Health Impacts: Reddit discussants report significant adverse physical and mental health effects from cocaine use, including cardiovascular strain, respiratory distress, and severe nasal damage such as septal perforations or "craters." Multiple commenters describe experiences of cocaine-induced psychosis, extreme paranoia, and overwhelming anxiety following heavy use. There are also reports of overdose symptoms such as limb tremors, difficulty breathing, and dissociation, often requiring emergency medical intervention.

How is it Being Discussed? Reddit commenters believe that cocaine provides a short-lived but intense euphoric rush that often leads to compulsive redosing and difficulty controlling consumption, frequently leading to "binge" behavior. There is frequent discussion of cocaine being used in combination with other substances, including alcohol, benzodiazepines, and 7-hydroxymitragynine (7-OH), to manage "comedowns" or to create a "nodding" effect. Discussants often compare the effects of cocaine to methamphetamine, with some noting that the latter provides a superior high and is more cost-effective, leading to shifts in preference toward more potent stimulants. Additionally, commenters sharing advice on testing for fentanyl, managing physical health complications like "coke nose," and the necessity of maintaining secrecy to avoid professional or familial consequences.

Previous NDEWS Web Monitoring Reports on Cocaine:
- NDEWS Weekly Briefing Issue Issue 245: Cocaine -  August 22, 2025

The CDC’s Provisional Drug Overdose Death Counts dashboard provides timely, rolling 12‑month estimates of overdose deaths using both reported and predicted data to account for investigation delays. The dashboard highlights trends nationally and by state, allowing users to track changes over time. Cocaine is one of the specific drug categories monitored, identified by ICD‑10 code T40.5. To visualize data for cocaine, select it in the drug‑specific trend charts to view how cocaine‑involved overdose deaths are shifting in different jurisdictions. Access the full dashboard here.

The 2025 Monitoring the Future Study Annual Report was recently published by the University of Michigan. This study tracks alcohol, tobacco, and drug use trends among US 8th‑, 10th‑, and 12th‑grade students, providing annual insights into prevalence, attitudes, and long‑term patterns of youth substance use. In the report, cocaine is noted as a to have shown a small decrease since 2019. Read the full report here.

A recently published study in PLOS One by McCulloch et al. assessed the feasibility and validity of using wastewater-based epidemiology (WBE) to estimate current cocaine use among university students at a residential campus. Wastewater samples from four locations at a residential university campus during the spring semester of 2021 were tested for cocaine metabolites. A self-reported survey was also conducted, and the results indicated that 0.13% of respondents regularly used cocaine. The reports from the self-report survey were nearly equivalent to the estimate of 0.12% of the students who use cocaine as measured through WBE. The authors concluded that WBE shows promise as a complementary approach for estimating current cocaine use among students on a residential campus. Read the full study here.

A recently published study in Drug and Alcohol Dependence Reports by Latkin et al. examined patterns of injection drug use and cocaine use frequency among people who use opioids. Cross-sectional data collected between December 2022, and January 2025, were collected from 777 community-recruited adults who use opioids in Baltimore, Maryland. The results indicated that 29.2% reported past-month injection drug use, with daily/almost daily use of crack cocaine reported by 43.2% and powder cocaine by 9.3%. The authors concluded that nearly one-fifth of people who use opioids reported both injection drug use and high-frequency cocaine use, and greater frequency of cocaine use was associated with higher overdose risk. Read the full study here.

A recently published study in JAMA Network Open by Post et al. looked to determine when US drug overdose deaths (DODs) began to decelerate and to examine patterns by census region, drug type, and demographic. A repeated cross-sectional study of DOD rates was conducted from January 2015 to October 2024, using data from the National Center for Health Statistics and the US Census Bureau. US DOD rates entered a new sustained deceleration in 2023, after two decades of increases, but the authors noted that although the decline is encouraging there is still a need for targeted interventions and improved understanding of the underlying drivers. Read the full study here.