Cocaine Deaths in US 2025 | Statistics & Facts

Cocaine Deaths in America 2025

The landscape of cocaine deaths in the United States has undergone remarkable transformation throughout 2024 and into 2025, presenting both encouraging trends and persistent challenges that demand attention from public health officials, policymakers, and communities nationwide. While the nation witnessed an unprecedented 26.9% decline in overall drug overdose deaths during 2024 according to provisional data from the Centers for Disease Control and Prevention’s National Center for Health Statistics, cocaine-related fatalities tell a more complex story. The 29,449 cocaine-involved deaths recorded in 2023 represented the peak of a deadly trend that has been escalating since 2010, driven primarily by the contamination of cocaine supplies with illicitly manufactured fentanyl and the rise of polysubstance use patterns that have fundamentally altered the American drug crisis.

The most recent provisional data through December 2024 reveals that cocaine deaths declined approximately 28% from 2023 levels, dropping to an estimated 22,200 deaths for the year. This represents the first significant decrease in cocaine-related mortality after more than a decade of continuous increases, yet these numbers remain dramatically higher than pre-2015 levels when annual cocaine deaths numbered around 6,784. The decrease coincides with broader reductions in opioid-involved deaths and reflects changing drug supply dynamics, increased naloxone availability, and expanded harm reduction efforts. However, experts caution that cocaine remains implicated in over 60% of stimulant-related overdose deaths alongside methamphetamine, and the threat of fentanyl contamination continues to make cocaine use exponentially more dangerous than in previous decades.

Interesting Facts About Cocaine Deaths in the US 2025

Data Source: CDC National Center for Health Statistics, CDC WONDER Database, National Institute on Drug Abuse, State Unintentional Drug Overdose Reporting System (SUDORS), 2023-2024

The dramatic statistics surrounding cocaine deaths in America reveal several critical patterns that distinguish this crisis from previous drug epidemics. The 334% increase in cocaine-related fatalities between 2015 and 2023 far outpaces population growth and represents one of the steepest rises in substance-specific mortality in recent American history. What makes these numbers particularly alarming is the shift in the nature of cocaine deaths themselves—while cocaine has always carried cardiovascular risks, the modern epidemic is predominantly driven by respiratory depression from fentanyl co-involvement rather than traditional cocaine toxicity alone. The 14.8% fentanyl contamination rate in powder cocaine samples represents a deadly lottery for users, who may unknowingly consume lethal doses of synthetic opioids when they believe they are using pure cocaine.

The demographic patterns reveal significant disparities that underscore the need for targeted interventions. Black non-Hispanic individuals face cocaine-involved overdose death rates of 24.3 per 100,000—nearly three times the national average and substantially higher than any other racial or ethnic group. This disparity has widened dramatically since 2018, when the rate stood at 9.1 per 100,000, representing a 167% increase in just five years. Meanwhile, adults in the 35-44 age bracket continue to experience the highest absolute number of cocaine deaths, though older adults aged 45 and above now account for 66.5% of cocaine-involved deaths that do not co-involve opioids, often presenting with cardiovascular complications rather than respiratory depression. The geographical concentration of cocaine deaths in the Northeast region, where 54% of fentanyl users also test positive for cocaine, highlights how drug supply chains and regional preferences create localized epidemics within the broader national crisis.

Cocaine Death Trends in the US 2015-2024

Data Source: CDC WONDER Database, National Vital Statistics System, CDC National Center for Health Statistics Press Release May 2025

The trajectory of cocaine deaths across the United States from 2015 through 2024 illustrates a crisis that intensified dramatically before showing recent signs of improvement. The period between 2015 and 2016 marked the beginning of a deadly acceleration, with deaths jumping 52.9% in a single year as illicitly manufactured fentanyl began infiltrating cocaine supplies across major metropolitan areas. This pattern continued through 2017 with another 34.4% increase, establishing a sustained upward trend that would persist for nearly a decade. The 2020 pandemic year saw a particularly sharp 25.5% increase, as social isolation, disrupted treatment services, and an increasingly volatile drug supply created perfect conditions for overdose deaths. By 2023, annual cocaine deaths had reached 29,449—more than four times the 2015 total—before the historic decline observed in 2024.

The 2024 decline of 28% represents the first time in nearly a decade that cocaine deaths decreased year-over-year, bringing fatalities down to approximately 22,200. This reduction mirrors broader declines in opioid-involved deaths and likely reflects multiple factors: increased naloxone distribution and use, expanded medication-assisted treatment programs, potential changes in drug supply characteristics, and sustained public health interventions focused on harm reduction. Public health experts emphasize that while this decrease is encouraging, it must be viewed in context—2024 cocaine deaths remain 227% higher than 2015 levels, and the ongoing contamination of cocaine with fentanyl and other synthetic opioids means the drug remains far more dangerous today than it was a decade ago. The age-adjusted rate declining from 8.6 per 100,000 in 2023 to an estimated 6.5 per 100,000 in 2024 still represents a death rate more than triple that of 2015, underscoring that significant progress has been made but the crisis is far from over.

Cocaine Deaths by Age Group in the US 2023-2024

Data Source: National Vital Statistics System, CDC State Unintentional Drug Overdose Reporting System, 2023

Age distribution patterns in cocaine-related overdose deaths reveal critical insights about vulnerability and risk factors across different life stages. The 35-44 age group bears the heaviest burden, accounting for 30% of all cocaine deaths with 8,835 fatalities in 2023 and a death rate of 21.5 per 100,000—the highest among all age brackets. This demographic represents individuals who may have decades-long histories of substance use, accumulated health complications, limited access to treatment resources, and responsibilities that complicate recovery efforts. The 25-34 age bracket follows closely with 7,944 deaths representing 27% of the total, highlighting how cocaine fatalities concentrate among working-age adults during what should be their most productive years. Together, these two age groups account for 57% of all cocaine overdose deaths, demonstrating how the epidemic disproportionately affects individuals in early to middle adulthood.

Notably, older adults are experiencing increasing vulnerability to cocaine-involved deaths, particularly when cocaine is used without opioid co-involvement. Among deaths involving stimulants without opioids, 66.5% occur in individuals aged 45 and older, compared to only 44.2% for deaths involving both stimulants and opioids. This pattern reflects the cardiovascular risks that intensify with age—older adults using cocaine face heightened risks of heart attack, stroke, and sudden cardiac death even without fentanyl contamination. These individuals also show 38.7% prevalence of cardiovascular disease history compared to 21.2% among younger cocaine users. Meanwhile, the youngest age group (15-24) accounts for 6% of cocaine deaths, a relatively smaller proportion that nevertheless represents 1,765 young lives lost in 2023. The concentration of deaths among those aged 25-54, who account for 78% of all cocaine fatalities, underscores the need for prevention and treatment services specifically tailored to the needs, circumstances, and risk factors of working-age adults who may face barriers accessing care due to employment, family responsibilities, lack of insurance, or fear of legal consequences.

Cocaine Deaths by Race and Ethnicity in the US 2018-2023

Data Source: CDC MMWR Volume 74 Number 32, National Vital Statistics System 2018-2023, CDC Drug Overdose Deaths by Race and Ethnicity

Racial and ethnic disparities in cocaine-involved overdose mortality have widened dramatically over the past five years, reflecting structural inequities in healthcare access, drug supply contamination patterns, and social determinants of health. Black non-Hispanic individuals experience by far the highest cocaine death rate at 24.3 per 100,000 in 2023—nearly four times higher than White non-Hispanic individuals and representing a staggering 167% increase since 2018. This disparity has emerged as one of the most concerning trends in the overdose epidemic, as Black communities that were less affected by the initial prescription opioid wave now face disproportionate mortality from fentanyl-contaminated cocaine. Research indicates that cocaine markets in areas with larger Black populations show higher rates of fentanyl contamination, creating unequal exposure to the most dangerous drug combinations.

American Indian and Alaska Native populations face the second-highest cocaine death rate at 8.9 per 100,000, representing a 112% increase since 2018. These communities have experienced the fastest-growing polysubstance use crisis, with deaths involving combinations of cocaine and methamphetamine particularly prevalent. Hispanic/Latino individuals saw their cocaine death rate increase 87% to reach 7.1 per 100,000, while Native Hawaiian and Pacific Islander populations experienced a 139% increase to 7.4 per 100,000—one of the steepest relative increases among any group. Even populations with traditionally lower overdose rates have seen significant increases: White non-Hispanic individuals experienced a 54% increase to 6.3 per 100,000, while Asian non-Hispanic populations, though maintaining the lowest absolute rates, still saw a 75% increase to 1.4 per 100,000. These divergent trends highlight how the cocaine crisis has evolved from a problem affecting primarily White communities during the powder cocaine era of the 1980s and crack epidemic of the 1990s, to today’s epidemic that disproportionately devastates Black communities through fentanyl-contaminated cocaine supplies concentrated in urban areas with histories of segregation, disinvestment, and limited healthcare infrastructure.

Cocaine Deaths by Gender in the US 2023-2024

Data Source: National Center for Health Statistics Data Brief No. 522, CDC National Vital Statistics System Mortality Data 2023

Gender differences in cocaine-involved overdose deaths remain stark and consistent, with males accounting for 70% of all cocaine fatalities in 2023. The 20,614 male deaths translate to an age-adjusted rate of 12.7 per 100,000—more than twice the female rate of 5.2 per 100,000. This 2.4:1 ratio has persisted relatively unchanged over the past decade despite overall increases in absolute numbers for both genders. The gender gap in cocaine deaths reflects multiple intersecting factors: higher rates of cocaine use among men, greater likelihood of polysubstance use combining cocaine with opioids or alcohol, different patterns of drug-seeking behavior, reduced healthcare utilization among men, and possibly biological differences in cocaine metabolism and cardiovascular response.

Research from the CDC’s State Unintentional Drug Overdose Reporting System indicates that male cocaine users are more likely to die from overdoses involving multiple substances, with 75% of male cocaine deaths co-involving other drugs compared to 68% of female deaths. Men also show higher rates of cocaine use in combination with alcohol, which compounds cardiovascular risks and complicates emergency response efforts. However, female cocaine deaths have been increasing at a slightly faster rate than male deaths in recent years—female cocaine-involved deaths increased 6.2% annually from 2020-2023, compared to 5.8% for males. Women using cocaine face unique vulnerabilities: they progress more rapidly from first use to addiction (a phenomenon called “telescoping”), experience more severe withdrawal symptoms, face greater stigma seeking treatment, and often have co-occurring mental health conditions and histories of trauma that complicate recovery. Pregnant women who use cocaine face additional risks including placental abruption, preterm birth, and neonatal complications. The 8,835 female cocaine deaths in 2023 represent not just individual tragedies but ripple effects through families and communities, as women are more likely to be primary caregivers whose deaths leave children and dependents without essential support.

Cocaine Deaths by State in the US 2023-2024

Data Source: CDC Provisional Drug-Specific Mortality Counts, State-Level Drug Overdose Data 2023, CDC Wonder Database

Geographic distribution of cocaine deaths across the United States reveals striking regional variations that reflect drug trafficking patterns, harm reduction infrastructure, and local policy approaches. West Virginia maintains the highest cocaine death rate at 36.8 per 100,000—more than four times the national average—driven by its position along major drug trafficking corridors and limited treatment infrastructure in rural areas. The Northeast corridor from Massachusetts through Maryland shows consistently elevated rates, with Delaware (18.4), District of Columbia (18.1), Maryland (16.2), and Pennsylvania (15.1) all ranking among the ten highest-rate jurisdictions. This regional concentration reflects the historical predominance of powder cocaine in Eastern markets and the subsequent infiltration of these supplies with fentanyl as synthetic opioids spread eastward from Western states.

States showing the most concerning trends include Tennessee with an 11.6% increase in cocaine deaths from 2022 to 2023, Rhode Island with a 9.4% increase, and Kentucky with an 8.9% increase—all significantly exceeding the national average increase of 4.9%. These accelerating death rates suggest spreading contamination of cocaine supplies with fentanyl in areas that previously had lower exposure. Meanwhile, Michigan was one of the few states showing a decrease (-2.1%) in 2023, though this modest improvement was overwhelmed by the state’s 35% decline observed in 2024 as part of broader national trends. The three states with the highest absolute numbers of cocaine deaths—California (3,987), New York (2,243), and Pennsylvania (1,947)—together account for 28% of all national cocaine fatalities, reflecting both their large populations and the prevalence of cocaine use in major metropolitan areas like Los Angeles, New York City, and Philadelphia where drug markets are well-established and fentanyl contamination rates are high.

Fentanyl Co-Involvement in Cocaine Deaths in the US 2015-2024

Data Source: CDC WONDER Multiple Cause of Death Database, National Institute on Drug Abuse Overdose Data, CDC SUDORS 2015-2024

The infiltration of fentanyl into cocaine supplies represents the single most significant factor driving the dramatic increase in cocaine-related deaths over the past decade. In 2015, only 21% of cocaine deaths involved synthetic opioids like fentanyl, with most fatalities resulting from cocaine’s direct cardiovascular effects including heart attack, stroke, and arrhythmias. By 2023, that proportion had surged to 70%, meaning 20,614 of the 29,449 cocaine deaths involved concurrent fentanyl exposure. This transformation fundamentally changed the nature of cocaine-related mortality from primarily cardiovascular events to predominantly respiratory depression and overdose—the classic mechanism of opioid toxicity. The number of fentanyl-involved cocaine deaths increased 1,347% between 2015 and 2023, far outpacing the 334% increase in total cocaine deaths, demonstrating that fentanyl contamination is the primary driver of rising mortality.

Laboratory testing of seized cocaine samples reveals that 14.8% of powder cocaine contains detectable fentanyl nationally as of 2023, though this rate varies dramatically by region and form—crystalline crack cocaine shows less than 1% contamination while powder cocaine in Northeastern states can exceed 20% contamination rates. The mechanism of fentanyl’s entry into cocaine supplies remains debated: some contamination is clearly unintentional cross-contamination at packaging sites where multiple drugs are handled, while other instances may represent deliberate adulteration to enhance addictive properties or compensate for lower-quality cocaine. Regardless of intent, the result is deadly—cocaine users without opioid tolerance who unknowingly consume fentanyl face extreme overdose risk, and even those who intentionally seek “speedballs” (cocaine-opioid combinations) cannot reliably dose fentanyl given its extreme potency. The 70% co-involvement rate in 2023 and 2024 appears to have plateaued after years of increases, possibly reflecting market saturation or changes in trafficking patterns, but experts warn that the threat remains severe as new synthetic opioids and adulterants continue emerging in illicit drug supplies.

Polysubstance Use in Cocaine Deaths in the US 2023-2024

Data Source: CDC State Unintentional Drug Overdose Reporting System (SUDORS) January 2021-June 2024, Millennium Health Signals Report 2025

The modern cocaine overdose crisis is fundamentally a polysubstance epidemic, with 93% of cocaine-involved deaths in 2023-2024 involving at least one additional substance beyond cocaine alone. Only 7% of cocaine fatalities—approximately 2,061 deaths—involved cocaine as the sole detected drug, highlighting how rare “pure” cocaine deaths have become in the fentanyl era. The most dangerous combination remains cocaine with synthetic opioids, accounting for 70% of all cocaine deaths and representing the primary driver of mortality increases. This combination creates synergistic toxicity: cocaine’s stimulant effects mask opioid-induced sedation, potentially leading users to consume more of both substances, while the eventual opioid effect can cause sudden respiratory depression after the shorter-acting cocaine wears off. Additionally, cocaine increases heart rate and blood pressure while fentanyl decreases respiration, creating competing physiological stresses that complicate emergency response.

Alcohol co-involvement appears in 45% of cocaine deaths, making it the second most common co-involved substance after fentanyl. Alcohol and cocaine together produce cocaethylene in the liver—a metabolite that is more cardiotoxic than either substance alone and has a longer half-life than cocaine, prolonging cardiovascular stress. The combination of cocaine and methamphetamine appears in 27% of deaths, reflecting the rise of “polysubstance stimulant use” patterns where individuals mix or alternate between different stimulants. This combination places extreme stress on cardiovascular and nervous systems, causing severe hyperthermia, seizures, and heart failure. Benzodiazepines appear in 23% of cocaine deaths, often used intentionally to “come down” from cocaine’s stimulant effects, but creating dangerous respiratory depression especially when opioids are also present. Perhaps most concerning, 29% of cocaine deaths involve four or more different substances, demonstrating the chaotic and unpredictable nature of modern drug use patterns where contaminated supplies, intentional polydrug use, and medication interactions create lethal combinations that are increasingly difficult to predict or reverse even with prompt emergency intervention.

Cocaine Death Rates by US Region 2023-2024

Data Source: CDC Regional Drug Overdose Data 2023-2024, Millennium Health Regional Analysis, MMWR Morbidity and Mortality Weekly Report

Regional variation in cocaine-related overdose deaths reflects the complex interplay of drug trafficking routes, local market characteristics, and regional substance use cultures. The Northeast region bears the heaviest burden with a death rate of 14.2 per 100,000—nearly double the Western rate—and shows the highest fentanyl co-involvement at 78% of cocaine deaths. This regional concentration stems from the Northeast’s historical position as a primary destination for Colombian cocaine trafficked through Caribbean and East Coast ports, combined with the region’s high rates of prescription opioid and heroin use that created established markets for fentanyl’s introduction. Urban centers like Philadelphia, Baltimore, New York, and Boston serve as distribution hubs where fentanyl-contaminated cocaine has become the norm rather than the exception, with 54% of people using fentanyl in the Northeast also testing positive for cocaine.

The South region shows the second-highest rate at 9.8 per 100,000, with 68% fentanyl co-involvement and notable contributions from alcohol in the cocaine death toll. Southern states have seen accelerating cocaine deaths as fentanyl has spread into historically cocaine-dominant markets, with Tennessee, Kentucky, and West Virginia experiencing some of the steepest rate increases nationally. The Midwest posts a rate of 8.4 per 100,000 with 72% fentanyl co-involvement, but shows a distinctive pattern of cocaine and methamphetamine polysubstance use, reflecting the region’s position at the intersection of cocaine routes from the South and methamphetamine production and trafficking from the West and Southwest. The West region shows the lowest cocaine death rate at 7.1 per 100,000 and only 58% fentanyl co-involvement, but demonstrates the highest prevalence of methamphetamine use alongside cocaine, with 78% of fentanyl users in the West also using methamphetamine. This reflects the dominance of methamphetamine in Western drug markets, where stimulant polysubstance use patterns differ markedly from Eastern markets’ cocaine-opioid combinations.

Cocaine Death Demographics and Circumstances in the US 2021-2024

Data Source: CDC State Unintentional Drug Overdose Reporting System (SUDORS) January 2021-June 2024, CDC MMWR Volume 74

The circumstances and characteristics surrounding cocaine-involved overdose deaths vary significantly depending on whether opioids are co-involved, reflecting two distinct populations with different risk profiles and intervention needs. Cocaine deaths involving opioids affect a younger population with a median age of 41 years, compared to 52 years for cocaine deaths without opioid involvement. This eleven-year age difference is substantial and reflects how fentanyl-contaminated cocaine has drawn in younger users from opioid-using populations, while older cocaine users without opioid habits face primarily cardiovascular risks. The older population using cocaine without opioids shows dramatically higher rates of cardiovascular disease history (38.7% vs 21.2%), consistent with their longer histories of stimulant use and age-related cardiac vulnerabilities.

Mental health and substance use treatment histories are common in both groups but slightly more prevalent among those whose deaths involve opioids—38% had received mental health treatment and 42% had prior substance use treatment, compared to 33% and 35% respectively for cocaine-only deaths. This suggests that individuals using cocaine with opioids may have more severe substance use disorders and greater mental health comorbidities, though both populations show high unmet treatment needs. Criminal justice involvement is notably higher in the opioid-involved group (28% vs 22%), likely reflecting the criminalization of opioid use and possession. The naloxone administration rate reveals a stark difference—45% of cocaine deaths involving opioids received naloxone compared to only 8% without opioids—demonstrating both the greater bystander recognition of opioid overdose symptoms and naloxone’s irrelevance for pure cocaine toxicity. Homelessness rates are high in both groups but slightly elevated for cocaine-only deaths (18% vs 14%).

Disclaimer: This research report is compiled from publicly available sources. While reasonable efforts have been made to ensure accuracy, no representation or warranty, express or implied, is given as to the completeness or reliability of the information. We accept no liability for any errors, omissions, losses, or damages of any kind arising from the use of this report.

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