The majority of the cocaine available in the US is sourced from Colombia and trafficked into the US by drug cartel networks. Most of it enters the country via the US/Mexico land border, and some is transported by air or sea. The consumption of cocaine by people in the US creates a demand that keeps cartels in business and plays a role in the violent crime epidemics in Mexico and other South American nations.
The 2019 National Drug Threat Assessment report found that cocaine ranked third behind only methamphetamine and cannabis/THC on the list of the top 25 most frequently identified drugs. In fact, it was the second most commonly-reported drug by federal laboratories, behind only methamphetamine. In total, cocaine represented 14 percent of all reports that year. The report found that cocaine production has sustained at record-high levels recently, which has increased its presence in the United States.
In 2017, almost 6 million people in the United States over the age of 12 said they used cocaine. 
About 1 million people every year report using cocaine for the first time.
The highest rate of cocaine use is in the 18–25 bracket, with more than 1.9 million people saying they abused cocaine in the last 30 days. The next highest grouping was in those aged 26–34, with 1.5 million people reporting cocaine use in the past 30 days.
Men are twice as likely as women are to abuse cocaine, with 2.5 percent of men reporting cocaine abuse compared to 1.3 percent of all women. Men were also hospitalized for cocaine abuse twice as often as women—12,500 men in 2015 compared to 6,386 women. Men also die at a much higher rate than women—7,400 compared to 2,882.
Cocaine usage occurs the most among people who identify as being white, with approximately 3.36 million users. The next closest ethnicity is Hispanic (768,000), followed by Black (612,000), Asian (101,000), Native American (31,000), and Pacific Islander/Hawaiian (18,000).
The U.S. Centers for Disease Control and Prevention said approximately 18,558 people for every 100,000 people in the country were hospitalized in 2016 because of a cocaine overdose. 
That totals almost 600,000 people in the United States who went to a hospital for a cocaine overdose in only one year. More than 10 percent of all drug overdoses that year were due to cocaine.
Part of the reason for the increase in cocaine overdoses in recent years is the emergence of the dangerous drug fentanyl. Not surprisingly, cocaine usage has been reported to be highest in regions of the country that are also experiencing surges in heroin and fentanyl usage.
Some users have begun to mix multiple drugs together. “Speedballs” are a mixture of cocaine and heroin, and “super speedballs” are cocaine, heroin, and fentanyl mixed together. By combining cocaine with the opioids, the user gets the high of the cocaine and the depressant effects of the opioids. The desired outcome is to reduce the sharp comedown after the effects of the cocaine subside.
A recent problem, however, has been that many users do not know ahead of time that multiple drugs are being mixed. This has resulted in more drug overdoses, as typical cocaine users may not have the tolerance for opioids that typical opioid users do, thereby leading to serious health consequences. Contact the hotline for more information.
According to the DEA report, laboratories from Puerto Rico, Washington, D.C., and 36 states have reported an increase of almost 15,000 percent of reports involving “speedballs” and “super speedballs” between 2013 and 2017. In 2013, there were only a total of 18 reports of these kinds. That number skyrocketed to 2,695 in 2017. 
The DEA states in its report that most of these mixtures of cocaine and fentanyl, specifically, probably occurred at the dealer level, without knowledge among the users about what they were getting. Because fentanyl is a viable adulterant, and because it is inexpensive, dealers often use it to cut the cocaine to gain more product, without weakening the drug’s effects.
Last updated: November 14, 2022
Hailey Shafir, M.Ed., LCMHCS, LCAS, CCS
Hailey Shafir is a licensed addiction specialist and mental health counselor. She graduated from North Carolina State University with a master of education in clinical mental health counseling in 2012, and has developed deep expertise in the areas of mental health, behavioral addictions and substance abuse. She is passionate about using this knowledge to raise awareness, provide clear and accurate information, and to improve the quality of treatment for these disorders.
Hailey is an LCMHCS (license number: S9539) under the North Carolina Board of Mental Health Counselors, and an LCAS (ID: LCAS-21333) and CSS (ID: CCS-20721) under the North Carolina Addictions Specialist Professional Practice Board.
|↑1||Monitoring the Future: National Survey Results on Drug Use 1975-2018. Monitoring the Future Website. http://monitoringthefuture.org/pubs/monographs/mtf-overview2018.pdf. Published January 2019. Accessed July 10, 2020.|
|↑2||2018 Annual Surveillance Report of Drug-Related Risks and Outcomes. U.S. Centers for Disease Control and Prevention Website. https://www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-surveillance-report.pdf. Published 2018. Accessed July 11, 2020.|
|↑3||2019 National Drug Threat Assessment. Drug Enforcement Agency Website. https://www.dea.gov/sites/default/files/2020-01/2019-NDTA-final-01-14-2020_Low_Web-DIR-007-20_2019.pdf|