Cocaine Is Back!

"Upon the recent death of the luminous Diane Keaton, forever "Annie Hall," I found myself reflecting on the cocaine epidemic epitomized by that movie, because, now, cocaine is back, but more lethal, and often mixed with fentanyl. Although most overdose deaths involve opioids, 182,502 persons died of overdoses involving stimulants (with or without other drugs) in the United States during January 2021-June 2024, accounting for 59% of all overdose deaths. Cocaine is a top 3 cause of overdose death today."

"Cocaine in the United States today is cheaper, purer, and more widespread than in decades. According to Millennium Health, cocaine consumption between 2019-2025 increased by 154%. Regional stimulant patterns are striking: In the West, fentanyl is often mixed with methamphetamine; in the Northeast, fentanyl is more often found alongside cocaine. By early 2025, although fentanyl detections fell from their 2022 peak, fentanyl-associated polysubstance use remained high, with cocaine a commonly co-detected drug."

"During the late 1970s and early 1980s, I was a cocaine researcher among other scientists who demonstrated cocaine was profoundly addictive, not the harmless "champagne of drugs" as marketed. That time frame was perfectly captured in Woody Allen's movie, "Annie Hall" (1977), with the supremely talented late Diane Keaton. It was initially entitled " Anhedonia," - the inability to feel pleasure. Opportunities for pleasure surrounded Alvy Singer (Allen's character), but he was consistently anhedonia-trapped and over-intellectualizing. It was a parody of too-hip city life."

Stimulant-involved overdoses claimed 182,502 lives in the United States from January 2021 to June 2024, representing 59% of overdose deaths and placing cocaine among the top three causes. Cocaine availability rose markedly, with Millennium Health reporting a 154% increase in consumption between 2019 and 2025. Regional patterns show fentanyl commonly co-detected with methamphetamine in the West and with cocaine in the Northeast. By early 2025 fentanyl detections declined from 2022 peaks, yet polysubstance use involving fentanyl remained high. The perception of cocaine as a "safer" stimulant benefits drug cartels despite increased lethality.

Read at Psychology Today