The cocaine comeback, explained |
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The cocaine comeback, explained
The next phase of America’s drug crisis is here.
We’ve been bringing the 1980s back — including, unfortunately, the cocaine.
While opioid overdose deaths are mercifully on the decline, more Americans are now using and dying from stimulants, particularly cocaine and methamphetamine. A decade ago, in 2016, there were 10,375 deaths from cocaine overdoses; in 2023, there were 29,449. Meth has seen a similar spike in fatalities, from 9,438 deaths in 2017 to 33,283 in 2023. The drug of choice varies depending on where in the US you are: Cocaine is still king in some parts of the Northeast, while methamphetamines are more commonly used elsewhere.
The surge in stimulant use at the same time the opioid overdose crisis has started to ebb is a warning that drug use doesn’t simply end — it evolves. And the image of somebody being solely a heroin user or a cocaine user is outdated: People use multiple drugs, and they choose different ones for different reasons — which can also increase their risk of death. The drugs themselves are now more complex and likely to be synthetic, adding to the risk that you could be taking something without fully understanding what’s in it.
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These shifts present real challenges to the public health system and public health messaging. The United States spent a generation building treatment and recovery programs to address the opioid crisis. The focus was on prescription painkillers, heroin, and later fentanyl; dependence was managed through proven medications like methadone and buprenorphine, and overdoses could be stopped with a spray of naloxone. There was a dedicated effort to get treatment into the hands of primary care doctors, first responders, and ultimately, people in need.
We have none of the same interventions for cocaine or methamphetamine addiction, or for preventing death once an overdose has started.
“There is no medication for cocaine or methamphetamine,” said Keith Humphreys, professor of psychiatry and behavioral sciences at Stanford University. “Everything under the sun has been tested and nothing has worked.”
The behavioral treatments that do exist are still largely reserved for specialty clinics and aren’t available in the primary care offices that are often........