Cocaine Addiction Statistics 2026: National Numbers, the Fentanyl Factor, and New England Data

Cocaine statistics are easy to find and surprisingly hard to trust. Many widely shared pages still quote user counts from 2015, emergency room data from a surveillance system that stopped collecting in 2011, or relapse figures with no source at all. This page takes the opposite approach: every number below comes from a primary source, carries the year its data were collected or published, and links directly to that source so you can check it yourself.

Two stories define the current data. First, the fentanyl factor: the large majority of cocaine-involved overdose deaths now also involve opioids, which changes what "cocaine risk" means for every person who uses it. Second, a turn in the trend: after peaking in 2023, cocaine-involved deaths are falling in provisional data, though far less evenly in New England than nationally.

Key numbers at a glance

• 4.3 million Americans aged 12 or older (1.5 percent) used cocaine in the past year in 2024, a statistically significant decline from 5.0 million (1.8 percent) in 2023 (SAMHSA, 2024 NSDUH Detailed Tables, published 2025).
• 1.7 million people (0.6 percent) used cocaine in the past month, and 42.4 million (14.7 percent) have used it in their lifetime, per the same 2024 survey (SAMHSA, 2024).
• 749,000 people used crack cocaine in the past year in 2024, down from 997,000 in 2023 (SAMHSA, 2024 NSDUH Detailed Tables).
• About 1.2 million people aged 12 or older (0.4 percent) had a past-year cocaine use disorder in 2024 (SAMHSA, 2024 NSDUH Detailed Tables).
• 29,449 overdose deaths involved cocaine in 2023, an 85 percent increase from 2019 and the highest annual total on record (NIDA, citing final CDC data, 2025).
• Roughly 19,600 cocaine-involved deaths are predicted for the 12 months ending January 2026 (19,195 reported), a provisional figure about one third below the 2023 peak (CDC provisional data, accessed July 2026).
• 79.1 percent of cocaine-involved overdose deaths from January 2021 through June 2024 also involved opioids (Tanz et al., CDC MMWR, 2025).
• Among Black Americans, the cocaine-involved overdose death rate rose from 9.1 to 24.3 per 100,000 between 2018 and 2023, versus 4.5 to 8.6 per 100,000 for the population overall (Tanz et al., CDC MMWR, 2025).
• 89,763 treatment admissions in 2023, 6.8 percent of all U.S. admissions, listed cocaine as the primary substance (SAMHSA, TEDS 2023 Annual Report, published 2025).
• 354,512 cocaine-related emergency department visits occurred in 2023, down 15.1 percent from 2022 (SAMHSA, DAWN 2023 National Estimates, published 2024).
• Contingency management was the only treatment significantly associated with cocaine abstinence across 157 clinical trials, roughly doubling the odds of a cocaine-negative test (OR 2.13) (Bentzley et al., JAMA Network Open, 2021).
• Past-year cocaine use exceeds the national average of 1.62 percent in four of six New England states, led by Vermont at 2.43 percent (SAMHSA, 2023-2024 NSDUH State Estimates, published December 2025).

How many Americans use cocaine?

The most current national picture comes from the 2024 National Survey on Drug Use and Health, published by SAMHSA in July 2025. Among Americans aged 12 or older in 2024:

• Lifetime use: 42.4 million people (14.7 percent) have used cocaine at least once.
• Past-year use: 4.3 million people (1.5 percent), down significantly from 5.0 million (1.8 percent) in 2023.
• Past-month use: 1.7 million people (0.6 percent).
• Crack cocaine: 749,000 people (0.3 percent) used crack in the past year, and 10.6 million (3.7 percent) have used it in their lifetime.
• Cocaine use disorder: about 1.2 million people (0.4 percent) met DSM-5 criteria in the past year. Cocaine sits within the broader category of central nervous system stimulant use disorder, which affected 4.3 million people in 2024 (SAMHSA, 2024 NSDUH Detailed Tables).

The decline is clearest among young adults: past-year use among 18-to-25-year-olds fell from 3.1 percent in 2023 to 2.3 percent in 2024, a statistically significant drop (SAMHSA, 2024 NSDUH Detailed Tables).

A note on older figures you may still see online: pages citing "1.5 million current users" trace to 2015 data, and "1.9 million" traces to the 2019 survey. NSDUH was redesigned in 2021, so estimates from 2019 and earlier are not directly comparable to current numbers. When a statistics page does not date its figures, assume they are old.

Cocaine-involved overdose deaths: the full trend

Overdose deaths are where the cocaine data turned darkest over the past decade. According to NIDA's compilation of final CDC death data (2025), cocaine-involved deaths rose 85 percent between 2019 and 2023, reaching 29,449 deaths in 2023, the highest total ever recorded. For context, more than 105,000 Americans died of drug overdoses overall in 2023, so cocaine was involved in roughly 3 of every 10 overdose deaths that year. CDC's separate SUDORS surveillance found the same share: 30.0 percent of overdose deaths from January 2021 through June 2024 involved cocaine (Tanz et al., MMWR, 2025).

Since the peak, the curve has bent. CDC provisional data predict roughly 19,600 cocaine-involved deaths for the 12 months ending January 2026 (19,195 reported as of July 2026), about one third below the 2023 peak. These counts are provisional: they can be revised as death investigations close, and they should always be labeled with their 12-month window.

If you have seen much lower death counts on other statistics pages, check the vintage. A commonly copied figure of 13,942 deaths describes 2017, and 27,569 describes 2022. Both are years out of date, and both understate the 2023 peak.

The fentanyl factor: why cocaine deaths look different now

The single most important change in cocaine risk over the past decade is not about cocaine itself. It is about what else is in the death toxicology.

• 79.1 percent of cocaine-involved overdose deaths co-involved opioids between January 2021 and June 2024, according to CDC's State Unintentional Drug Overdose Reporting System covering 49 states and DC (Tanz et al., MMWR, 2025).
• NIDA reports that nearly 70 percent of stimulant-involved overdose deaths in 2023 involved illegally made fentanyl, which it identifies as the main driver of cocaine-involved overdose deaths (NIDA, 2025).
• Among people who died in cocaine-involved overdoses, only 12.5 percent were receiving treatment for a mental health or substance use disorder at the time of death (Tanz et al., MMWR, 2025).

Two pathways drive this overlap, and honesty requires naming both. Some people knowingly use both drugs. But the same CDC report notes that drug-checking programs rarely detect opioids in recent stimulant samples, meaning intentional co-use of separate products explains much of the overlap, while contamination of the stimulant supply remains a real and unpredictable danger documented in seizures like the California fentanyl bust we covered previously. For the person using cocaine, the practical risk is the same either way: opioid-level overdose danger without opioid tolerance.

This is why harm-reduction guidance has shifted. A person who thinks of themselves as "only" a stimulant user, and who would never touch fentanyl on purpose, now carries meaningful opioid overdose risk. Fentanyl education, naloxone access, and never using alone are now standard safety advice for cocaine use, and structured fentanyl-aware treatment matters even when cocaine is the primary drug.

"Most of the people I see who use cocaine do not think of fentanyl as their problem, and that assumption is exactly what we have to address first. The drug supply no longer respects the line between stimulant use and opioid risk. That is why fentanyl education and naloxone counseling are now part of standard care for every patient who uses stimulants."

Dr. Richard Marasa, Medical Director, Clear Steps Recovery

Who uses cocaine: age, sex, and race

The 2024 NSDUH detailed tables break past-year cocaine use down by demographics (all figures are 2024, ages 12 and older):

Source: SAMHSA, 2024 NSDUH Detailed Tables, published 2025.

The most important demographic story, however, is not about who uses cocaine. It is about who dies. While past-year use rates are similar across White, Black, and Hispanic Americans, the cocaine-involved overdose death rate among Black Americans nearly tripled from 9.1 to 24.3 per 100,000 between 2018 and 2023, roughly three times the overall national rate of 8.6 (Tanz et al., MMWR, 2025). Emergency department data show the same imbalance: Black individuals accounted for 46.4 percent of cocaine-related ED visits in 2023 (SAMHSA, DAWN 2023). Similar use, wildly unequal harm, largely tracking the fentanyl-contaminated supply and unequal access to treatment and naloxone.

Teens and young adults

Teen cocaine use remains near the lowest levels ever measured, with one number worth watching. In the 2025 Monitoring the Future survey, 1.4 percent of 12th graders reported past-year cocaine use, up from 0.9 percent in 2024, a statistically significant increase, though still far below the rates of earlier decades (NIDA news release on the 2025 Monitoring the Future results, December 2025). The survey collected responses from 23,726 students across 270 schools.

Among adolescents aged 12 to 17 in the household survey, past-year cocaine use was 0.3 percent in 2024, and young-adult use (ages 18 to 25) declined significantly to 2.3 percent (SAMHSA, 2024 NSDUH). The teen uptick and the young-adult decline point the same direction for families: the highest-risk years for starting cocaine use remain the late teens and early twenties.

New England cocaine statistics: the data nobody compiles

National statistics hide how uneven the cocaine problem is. New England stands out on both use and deaths, and the two tables below, compiled for this article from federal survey and death data, do not appear together anywhere else in the ranking cocaine-statistics pages.

Past-year cocaine use and cocaine-involved deaths, all six states

Sources: use estimates from SAMHSA, 2023-2024 NSDUH State Prevalence Estimates (published December 2025); death counts from CDC provisional drug overdose data, accessed July 2026. Provisional counts may be revised.

Four of the six states exceed the national past-year use rate, and the gap widens dramatically among young adults: 18-to-25-year-old past-year use is 6.44 percent in Vermont, 4.73 percent in Rhode Island, and 4.51 percent in New Hampshire, versus 2.69 percent nationally (SAMHSA, 2023-2024 state estimates, published December 2025).

The New Hampshire and Massachusetts fentanyl-cocaine synthesis

The fentanyl factor is more extreme in the two states Clear Steps Recovery serves than nationally, and it shows up in opposite directions in the data:

• Massachusetts: cocaine was present in 54 percent of opioid-related overdose deaths with an available toxicology screen in 2023, and fentanyl was present in 90 percent of those same deaths; the state health department reports cocaine presence in opioid deaths has grown about 6 percent per quarter on average since 2016 (Massachusetts DPH, 2024; ongoing series at MA DPH Current Opioid Statistics). In other words, in Massachusetts the typical fatal "opioid overdose" now involves cocaine more often than not, and almost always involves fentanyl.
• New Hampshire: as fentanyl deaths fall, cocaine is claiming a larger share of a shrinking total. Total NH overdose deaths dropped from 430 (12 months ending December 2023) to a provisional 268 (December 2025), yet cocaine-involved deaths held essentially flat, 62 to 63, over the same windows (CDC provisional data, accessed July 2026). By our calculation from those CDC counts, cocaine's share of New Hampshire overdose deaths rose from about 14 percent to about 24 percent in two years. The state's own Drug Monitoring Initiative tracks the same shift in its monthly surveillance reports.
• Nationally, cocaine was involved in about 28 percent of overdose deaths in both windows, so Massachusetts sits far above the national share while New Hampshire is converging toward it from below (CDC provisional data).

DAWN emergency department data reinforce the regional picture: the Northeast had the nation's highest rate of cocaine-related ED visits in 2023, 235 per 100,000 people (SAMHSA, DAWN 2023). For readers in the region, our New Hampshire cocaine treatment program and Massachusetts cocaine treatment program pages explain what evidence-based outpatient care looks like locally.

Cocaine and mental health: the dual diagnosis numbers

Cocaine use disorder rarely travels alone.

• In 2024, 21.2 million U.S. adults had both a mental illness and a substance use disorder in the past year (SAMHSA, 2024 NSDUH).
• In the national NESARC-III study, drug use disorder was significantly associated with major depressive disorder (odds ratio 1.3), dysthymia (1.5), bipolar I disorder (1.5), and posttraumatic stress disorder (1.6), as well as borderline (1.8) and antisocial (1.4) personality disorders (Grant et al., JAMA Psychiatry, 2016).
• The same study found only 13.5 percent of people with a past-year drug use disorder received any treatment (Grant et al., 2016).

For someone using cocaine to manage depression, anxiety, or trauma symptoms, the stimulant crash amplifies the underlying condition, which in turn drives more use. Treating the two together is the evidence-based standard, a topic we cover in depth in our guide to dual diagnosis treatment for depression, anxiety, and addiction.

"When someone is using cocaine and also living with depression, anxiety, or PTSD, treating one condition and ignoring the other rarely holds. The two feed each other. We design care so both are addressed together from the start, because in my experience that is when recovery begins to stick."

Dr. Richard Marasa, Medical Director, Clear Steps Recovery

Veterans and stimulant use

Veteran-specific cocaine data are scarce on most statistics pages, but the research that exists points to a growing stimulant problem inside the veteran population:

• In Veterans Health Administration records covering roughly 6 million patients per year, diagnoses for alcohol, cannabis, and stimulant use disorders grew 4 to 18 percent annually between fiscal years 2016 and 2019, with stimulant and cannabis use disorders increasing most rapidly, while cocaine-specific diagnoses changed by 1 percent or less per year (Hoggatt et al., The American Journal on Addictions, 2023).
• More than 1 in 10 veterans have been diagnosed with a substance use disorder, slightly higher than the general population (NIDA, Substance Use and Military Life, 2019).
• Pooled 2022-2024 survey data show past-year substance use disorder in 17.5 percent of veterans who served in a combat zone and 15.4 percent of other veterans (SAMHSA NSDUH veterans spotlight, published 2025).

Notably, the strongest recent evidence for cocaine treatment also comes from the veteran system: the VA's contingency management program, discussed in the next section, is the largest real-world deployment of the treatment in the country. Veterans in New Hampshire and Massachusetts can access outpatient stimulant treatment through our VA Community Care rehab program.

Treatment: admissions, completion, and what actually works

Who enters treatment for cocaine

In 2023, 89,763 treatment admissions, 6.8 percent of all U.S. admissions, listed cocaine as the primary substance, making it the sixth most common primary substance after alcohol, methamphetamine, heroin, other opioids, and marijuana (SAMHSA, TEDS 2023 Annual Report, published 2025).

Completion rates by level of care

Federal discharge data show how outcomes vary by treatment setting. Among 2023 discharges, here is how the standard outpatient and residential settings compare; the all-settings row also includes discharges from detoxification and medication-assisted opioid therapy services (SAMHSA, TEDS 2023 Annual Detailed Tables, published 2025):

Read the IOP row carefully before concluding anything: the largest single outcome for IOP discharges is transfer to further treatment, which usually means a planned step to another level of care, not a failure. Completion and transfer together account for about 6 in 10 IOP discharges. Level of care should match clinical need, and for many people a structured intensive outpatient program provides treatment while they keep working and living at home.

No medication, but not no treatment

There is no FDA-approved medication for cocaine use disorder (NIDA, cocaine research topic). That fact is often quoted as if it ends the conversation. The outcome data say otherwise:

• A meta-analysis of 157 clinical trials with 15,842 participants found contingency management, a structured program of tangible rewards for verified abstinence, was the only treatment significantly associated with cocaine-negative urine tests, roughly doubling the odds (OR 2.13, 95 percent CI 1.62-2.80), an association that held in every sensitivity analysis (Bentzley et al., JAMA Network Open, 2021).
• In a 2025 cohort study of 2,962 VA patients with stimulant use disorder, those who received contingency management were 41 percent less likely to die within one year than matched patients who did not (Coughlin et al., American Journal of Psychiatry, 2025).
• Cognitive behavioral therapy builds the skills that support long-term abstinence, and NIDA also cites evidence for computer-delivered CBT and therapeutic communities (NIDA, cocaine research topic).

"People hear there is no medication for cocaine use disorder and assume nothing works. That is not what I see in practice. Structured outpatient care built around contingency management and cognitive behavioral therapy gives people concrete, repeatable tools, and patients who stay engaged genuinely change their lives. It is not a consolation prize. It is the evidence-based path."

Dr. Richard Marasa, Medical Director, Clear Steps Recovery

Relapse and recovery: what the evidence does and does not show

Cocaine relapse statistics are where unsourced numbers circulate most freely. Figures like "24 percent relapse," "18 percent return to treatment," and "44 percent readmission" appear on multiple treatment-industry pages with no primary source, and we could not trace any of them to a study. Rather than repeat them, here is what peer-reviewed research actually shows.

The strongest long-term evidence is a national 5-year follow-up of 708 people treated for cocaine dependence across 45 programs (Simpson et al., Archives of General Psychiatry, 2002):

• 21 percent reported weekly cocaine use one year after treatment, and 25 percent at five years. Self-reports agreed with urine and hair toxicology about 80 percent of the time.
• The large reductions in cocaine use achieved in the first year after treatment were sustained across the full five years.
• Outcomes were consistently better for people with more treatment exposure, and worse for those who entered treatment with more severe problems and received little care.

In other words, roughly three quarters of treated patients were not using cocaine weekly years later, and staying connected to care was the strongest lever. That pattern, front-loaded risk that falls with continued support, matches the broader relapse literature we cover in our relapse statistics guide, including the finding that ongoing participation in treatment or self-help after discharge dramatically lowers relapse hazard for stimulants.

Emergency departments and health harms

Emergency department data illustrate both the scale of cocaine's medical harm and the danger of quoting dead surveillance systems. The original Drug Abuse Warning Network stopped collecting data in 2011, so the "505,224 cocaine ER visits" figure still circulating online describes a system that no longer exists. SAMHSA relaunched a redesigned DAWN, and its current estimates are not comparable to the old ones.

The current numbers (SAMHSA, DAWN 2023 National Estimates, published 2024):

• An estimated 354,512 cocaine-related ED visits occurred in 2023, down 15.1 percent from 2022. Cocaine was mentioned in 4.7 percent of all drug-related visits.
• 72.5 percent of cocaine-related visits involved additional substances, most commonly alcohol, cannabis, or fentanyl, mirroring the polysubstance pattern in the death data.
• Adults aged 26 to 64 accounted for 83.8 percent of cocaine-related visits.

On the clinical side, cocaine's cardiovascular danger is precisely quantified. In the landmark Determinants of Myocardial Infarction Onset Study, the risk of a heart attack was elevated 23.7 times above baseline in the 60 minutes after cocaine use, in patients who were otherwise at relatively low cardiac risk (Mittleman et al., Circulation, 1999). NIDA's clinical overview adds documented risks of heart rhythm disturbances, stroke, seizures, lung damage from smoked crack, and gastrointestinal injury from reduced blood flow (NIDA, cocaine research topic).

If you or someone you love is in crisis right now, call or text 988 for the Suicide and Crisis Lifeline.

The bottom line

The 2026 cocaine data tell a story with two honest halves. Use is edging down, deaths are falling from their 2023 peak, and treatment, especially contingency management and CBT delivered in structured outpatient settings, has stronger evidence behind it than most people realize. At the same time, fentanyl has permanently changed the risk calculus for every person who uses cocaine, the harm falls with brutal unevenness on Black Americans, and in New England cocaine now shadows the opioid crisis so closely that in Massachusetts most fatal opioid overdoses involve it. Every number on this page is dated and linked because decisions this important deserve current facts, not recycled ones.

If cocaine has become a problem for you or someone you care about in New Hampshire or Massachusetts, our admissions team can explain what evidence-based outpatient treatment looks like, confidentially and without judgment.

Methodology and sourcing notes

Every statistic on this page comes from a primary source: federal surveys and surveillance systems (NSDUH 2024, CDC WONDER-based final death data as compiled by NIDA, CDC provisional VSRR counts, CDC SUDORS via MMWR, TEDS 2023, DAWN 2023, Monitoring the Future 2025), state health departments (Massachusetts DPH, New Hampshire DHHS Drug Monitoring Initiative), or peer-reviewed journals. No figure was drawn from treatment-industry blogs, commercial statistics aggregators, or undated sources. Prevalence figures reflect the 2024 NSDUH, published July 2025; because NSDUH was redesigned in 2021, estimates from 2019 and earlier are not trend-comparable and are flagged as historical where mentioned. CDC provisional overdose counts are 12-month rolling totals accessed in July 2026 and may be revised; they are labeled provisional throughout. The New England tables were compiled for this article from the 2023-2024 NSDUH state estimates and CDC provisional state counts, and the New Hampshire share-of-deaths calculation is our own arithmetic from those published CDC figures. Every citation URL was verified live before publication. This page was medically reviewed by Dr. Richard Marasa and last reviewed on July 6, 2026.