Roughly 5.7 million Americans aged 12 or older used cocaine in the past year, based on the most recent national survey data. That figure includes all forms of the drug and captures everyone from one-time experimenters to daily users.
Who Uses Cocaine in the U.S.
Young adults between 18 and 25 account for a disproportionate share of cocaine use. Combined 2014-2015 data from the National Survey on Drug Use and Health (NSDUH) estimated 1.7 million young adults in that age range used cocaine in the past year, or about 1 in 20. That 5 percent rate is significantly higher than the rate for any other age group.
Young adults also dominate the pool of first-time users. Of the roughly 968,000 people who tried cocaine for the first time in 2015, about 68 percent were 18 to 25 years old. Adults 26 and older made up only 20 percent of new users, with the remainder being adolescents under 18. This pattern suggests most people who try cocaine do so in their late teens or early twenties.
Occasional Use vs. Frequent Use
Most people who report cocaine use describe themselves as occasional or recreational users. But those self-reports can be misleading. The Office of National Drug Control Policy defines “hardcore” cocaine use as using more than 10 days in the past month or weekly use over the past year. When researchers compared self-reported frequency against other measures, they found that about 22 percent of people who called themselves occasional cocaine users were actually using at frequencies that met the hardcore threshold. In other words, roughly 1 in 5 people who say they use cocaine casually are using it far more often than they admit, sometimes even to themselves.
This gap between reported and actual frequency matters because it means national estimates of heavy cocaine use are likely undercounts. The true number of frequent users is higher than surveys suggest.
How Many Develop a Cocaine Use Disorder
Not everyone who uses cocaine develops a dependency, but a meaningful fraction does. The estimated prevalence of cocaine use disorder (the clinical term for problematic, compulsive use) peaked at about 0.71 percent of the adult population in 2006-2007. By 2018-2019, that figure had dropped to 0.37 percent, translating to roughly 1 million adults meeting the diagnostic criteria in a given year.
The decline likely reflects shifts in the overall drug landscape rather than better treatment access. During the same period, opioid use surged and reshaped patterns of substance use across the country. Some of the drop may also reflect changes in how people report their drug use on surveys.
Cocaine and Overdose Deaths
While cocaine use rates have fluctuated, cocaine-involved deaths have climbed sharply. In 2023, 29,449 people in the United States died from overdoses involving cocaine. That number has risen steeply since around 2015, and the main reason is not cocaine itself but what’s mixed into it.
Illicitly manufactured fentanyl, a synthetic opioid that is 50 to 100 times more potent than morphine, now contaminates a large share of the cocaine supply. Nearly 70 percent of stimulant-involved overdose deaths in 2023 also involved fentanyl. Many of these deaths happen to people who did not know fentanyl was in what they purchased. Someone who has used cocaine dozens of times without incident can die from a single dose that has been cut with even a tiny amount of fentanyl.
This means the risk profile of cocaine use has changed dramatically over the past decade. The drug itself carries cardiovascular risks, including heart attack and stroke, but the addition of fentanyl to the supply has made overdose a far more immediate and common danger than it was even ten years ago.
Regional Variation
Cocaine use is not evenly distributed across the country. SAMHSA’s state-level estimates show that past-year cocaine use among young adults ranges from under 3 percent in some states to over 7 percent in others. States in the Northeast and parts of the West Coast consistently report higher rates, while states in the South and Midwest tend to fall below the national average. Urban areas also have higher prevalence than rural ones, though the gap has narrowed as drug distribution networks have expanded.