Expert Commentary

Cocaine use is on the rise: Research highlights troubling trends

National rates of cocaine use have climbed in recent years, and the ubiquity of the highly potent synthetic opioid fentanyl has made the resurgence particularly deadly. We’ve summarized some of the latest research.

cocaine bricks
(Cocaine bricks / DEA)

Amid the United States’ heavily documented opioid crisis, the nation is dealing with another, lesser known rise in substance use. In recent years, national rates of cocaine use have steadily climbed.

Cocaine-related overdose deaths are on the rise, too, and opioids are largely to blame. The ubiquity of the highly potent synthetic opioid fentanyl has made the resurgence of cocaine particularly deadly.

The U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics finds that the number of overdose deaths involving cocaine almost doubled in two years — jumping from 5,892 in 2014 to 11,316 in 2016, the most recent year for which data was available. Of these 11,316 cocaine overdose deaths, 2 out of 5 also involved fentanyl. (The CDC reported that in 2016, 42,249 overdose deaths involved opioids.)

According to the Drug Enforcement Administration’s 2018 National Drug Threat Assessment, the rise in cocaine use can be attributed to increases in availability. The assessment further pinpoints increases in supply to heightened Colombian cultivation of coca and production of cocaine.

“Record levels of coca cultivation and cocaine production in Colombia, the primary source for cocaine seized and tested in the United States, has widened the cocaine market, leading to increased domestic abuse,” the report states. “Increased availability levels and concurrent lowered domestic prices will likely propel this trend through the near-term.”

The presence of fentanyl-contaminated cocaine is also rising. “Fentanyl/cocaine mixtures often target a user-base that is typically unaware it is consuming fentanyl and thus more likely to have an adverse reaction than one who intentionally sought out the opioid,” the report notes. In 2016, 4,184 of the 7,263 deaths involving cocaine and an opioid involved “synthetic opioids other than methadone;” fentanyl makes up the vast majority of this category.

“Previously, the threat was primarily concentrated in traditional cocaine markets, such as Florida, New York, Massachusetts, and Maryland; however, it has now moved beyond cocaine-dominated areas into states with high opiate proliferation, such as Ohio and West Virginia,” the report adds. “Additionally, examples of cocaine and fentanyl mixtures have been analyzed in states with neither a high synthetic opioid presence nor a high cocaine presence, such as Arkansas, Washington, and Missouri, extending the reach of both drugs outside of their traditional markets.”

For journalists looking to learn more about cocaine’s rise, we’ve summarized some of the latest academic research. Featured studies analyze demographic trends in cocaine use, rates of overdose deaths and federal interventions aimed at reducing cocaine availability and use.

Increased Presence of Fentanyl in Cocaine-Involved Fatal Overdoses: Implications for Prevention
Nolan, Michelle L.; et al. Journal of Urban Health, February 2019.

In New York City, the rate of cocaine-involved overdose deaths doubled from 5.2 deaths per 100,000 residents in the first half of 2015 to 10.4 deaths per 100,000 in the second half of 2016, after a period of stability from 2010 to 2014.

“This study aims to determine the contribution of opioids, and fentanyl in particular, to the increase in cocaine-involved overdose death from 2015 to 2016,” the authors explain.  They analyzed death certificate data and toxicology results from the New York City Office of the Chief Medical Examiner. For all overdose deaths involving cocaine, they looked to see if other substances were involved, too. They found that opioids, and particularly fentanyl, accounted for 90% of the increase in cocaine-involved overdose death rates from 2015 to 2016.

“While the presence of fentanyl in heroin confers additional risk to people using opioids, the presence of fentanyl in cocaine poses a dramatically heightened risk of overdose among individuals who use only cocaine and lack opioid tolerance,” the authors conclude. “Therefore, harm reduction efforts should be expanded to include targeted outreach, education, and overdose prevention messages for people who use cocaine but are opioid naïve.”

Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2011-2016
Hedegaard, Holly; et al. National Vital Statistics Reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, December 2018.

The CDC’s National Center for Health Statistics tracks the number of drug overdose deaths that occur each year (deaths involving multiple drugs include each in the relevant categories). The most recent statistics available, summarized here, were published in December 2018. The top-line finding is that the age-adjusted rate of drug overdose deaths more than tripled from 1999 to 2016. In 2016, the rate was 19.8 deaths per 100,000. While various opioids, including heroin, fentanyl and oxycodone, were typically the drug involved in the most overdose deaths each year, “cocaine consistently ranked second or third.” In 2016, the number of overdose deaths involving cocaine almost doubled from two years prior, jumping from 5,892 to 11,316. Forty percent of these deaths also involved fentanyl. Between 2011 and 2016, the age-adjusted rate of overdose deaths involving cocaine increased by about 18% each year, on average. In 2016, cocaine ranked third among the top 10 drugs involved in unintentional overdose deaths; it was not among the top 10 drugs involved in suicides.

Trends and Correlates of Cocaine Use and Cocaine Use Disorder in the United States from 2011 to 2015
John, William S.; Wu, Li-Tzy. Drug and Alcohol Dependence, November 2017.

As cocaine use increases in the U.S., researchers have begun to examine associated demographic trends. Using nationally representative survey data encompassing responses about substance use collected from 281,242 people between 2011 and 2015, the researchers find that cocaine use had increased in the past year among the following groups:

  • Women; people between the ages of 18 and 25; people over age 50; black people; people reporting a family income of less than $20,000 a year; people who reported using tobacco or alcohol during the past year; and people who in the past year reported binge or heavy drinking.

Weekly cocaine use increased among the following groups:

  • People over age 50; and people who reported heavy drinking in the past month.

Sociodemographic, Neighborhood, Psychosocial, and Substance Use Correlates of Cocaine Use Among Black Adults: Findings from a Pooled Analysis of National Data
Nicholson, Harvey L.; Ford, Jason A. Addictive Behaviors, January 2019.

This study looks at factors related to cocaine use in a national sample of 9,281 black adults. The survey data was collected in 2015 and 2016. The researchers found that overall, 2.4% of respondents had used cocaine in the past year, which is higher than rates of use among other racial groups (per data collected through the same survey). Factors associated with cocaine use in black adults included opioid use, encounters with drug dealers, easier access to the drug, unemployment and being over the age of 35. Black adults who were less likely to use cocaine included those who felt cocaine posed a greater risk of physical and other harms and those who reported that their religious beliefs influence their decisions.

Past 15-Year Trends in Lifetime Cocaine Use Among US High School Students
Schneider, Kristin E.; et al. Drug and Alcohol Dependence, February 2018.

This study looks at nationally representative survey data on substance use collected between 1999 and 2015 from U.S. high school students. The key finding from this study is that while the proportion of high school students who had tried cocaine dropped from 9.5% to 5.2% during the study period, there was an upswing between 2009 and 2015, when the percentage of students who had ever tried it went from 2.8% to 5.2%. Similar patterns were evident for repeated use of cocaine. “The decrease over time reflects more general public health success in reducing substance use among adolescents across drugs,” the authors write. “Despite the general decrease over time, rates of cocaine use have risen since 2009 among adolescents, though not to the peak of previous decades.” The authors suggest further research is required to determine the reasons behind this resurgence.

Boys were more likely than girls to have ever used cocaine and to have used cocaine repeatedly. The racial and ethnic groups with the highest rates of adolescents having ever tried cocaine were American Indian/Alaskan Native, Native Hawaiian/Pacific Islander and Hispanic. As the study period went on, black boys became more likely to have tried cocaine than at the outset, but prevalence rates among black girls stayed low throughout.

Mandatory Minimum Sentencing Policies and Cocaine Use in the U.S., 1985-2013
Walker, Lauryn Saxe; Mezuk, Briana. BMC International Health and Human Rights, December 2018.

Prior to the passage of the federal Fair Sentencing Act of 2010 (FSA), a disparity in mandatory minimum sentencing for powder and crack cocaine existed at a 100:1 ratio – that is, the criminal penalties for offenses involving one ounce of crack were equal to the penalties for possessing 100 ounces of powder cocaine. The FSA reduced the sentencing disparity to 18:1.

The authors of this study explain the justification for the prior 100:1 sentencing disparity, writing, “Despite [a] lack of scientific evidence, crack cocaine, in particular, was seen as a highly addictive drug that led to unpredictable, often violent behavior, included increased gang-related violence in urban areas.”

This study aims to examine how sentencing disparities affected crack and powder cocaine use from 1985 to 2013. Through an analysis of nationally representative survey data, the authors find that crack use did not decrease after the initial 100:1 sentencing policy was implemented. Additionally, crack use did not change after the FSA was passed. “Despite harsher penalties for crack versus power cocaine, crack use declined less than powder cocaine and even less than drugs not included in sentencing policies,” the authors write. “These findings suggest that mandatory minimum sentencing may not be an effective method of deterring cocaine use.”

Supply-Side Disruption in Cocaine Production Associated with Cocaine-Related Maternal and Child Health Outcomes in the United States
Delcher, Chris; et al. American Journal of Public Health, May 2017.

A federal regulation passed in December 2006 targeted sodium permanganate, a chemical needed to produce cocaine. Did this impact health outcomes related to the drug as it became less available? This study analyzes cocaine-related maternal and newborn hospital stays in the U.S. in an attempt to answer that question. The researchers found that after the regulation was enacted, the number of monthly cocaine-related maternal hospital stays decreased by 221 nationwide; neonatal stays decreased by 128. Rates of cocaine-related hospital stays for mothers and newborns continued to decline through 2010. The authors conclude that “results support findings that federal precursor regulation can positively reduce cocaine availability in the United States.”

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