Around 22 million people worldwide use cocaine in any given year, making it one of the most widely used illicit stimulants on the planet. In the United States alone, roughly 5.5 million people reported using cocaine in the past year based on national survey data, with young adults between 18 and 25 accounting for the largest share of users.
Cocaine Use in the United States
About 1 in 20 young adults in the U.S. (roughly 5 percent) use cocaine in a given year. That age group, 18 to 25, makes up a disproportionate share of users. Among new cocaine users aged 12 and older, about 68 percent are young adults, while adults 26 and older account for 20 percent and adolescents aged 12 to 17 make up around 12 percent.
These numbers come from self-reported surveys, which means they almost certainly undercount actual use. People underreport illegal drug use for obvious reasons. Workplace drug testing offers another lens: Quest Diagnostics, which processes millions of employer-ordered drug tests each year, found that 0.24 percent of general workforce urine tests came back positive for cocaine in 2024. That rate has held steady, even as positive results for amphetamines have climbed. Among federally mandated safety-sensitive workers (truck drivers, airline employees, pipeline operators), the cocaine positivity rate was slightly lower at 0.20 percent.
Cocaine Use in Europe
In the European Union, an estimated 2.5 million people aged 15 to 34 used cocaine in the past year, representing about 2.5 percent of that age group. Use is concentrated in western and southern Europe. Belgium, Spain, and the Netherlands are the primary entry points for cocaine trafficked into the continent, and seizure volumes reflect that: EU member states seized a record 323 tonnes of cocaine in 2022, with Belgium alone accounting for 111 tonnes. Those record seizures have been climbing for six consecutive years, suggesting supply (and likely demand) continues to grow.
Who Uses Cocaine Most
Cocaine use skews young, male, and urban. Men use cocaine at roughly twice the rate of women across most national surveys. Use peaks in the late teens through mid-twenties and drops off significantly after 35. Urban areas consistently report higher rates than rural ones, partly because cocaine distribution networks concentrate in cities and partly because nightlife culture drives casual use.
Income plays a less straightforward role than many people assume. Cocaine is expensive compared to other stimulants, so it has historically been more common among higher-income users. But crack cocaine, a cheaper smokeable form, expanded use across income levels starting in the 1980s. Reliable data comparing powder and crack users is surprisingly thin. One older study of adolescent offenders in Miami found that about 30 percent used crack regularly and a nearly identical 30 percent used powder cocaine regularly, but that population was far from representative of general use patterns.
The Overdose Picture
Cocaine contributed to 21,945 overdose deaths in the United States in 2024. That number has risen sharply over the past decade, and the primary reason isn’t cocaine itself becoming more dangerous. It’s fentanyl contamination. A large and growing share of cocaine-involved deaths also involve synthetic opioids. Many users don’t know their cocaine contains fentanyl, and even a tiny amount of the opioid can be lethal for someone without opioid tolerance.
This makes cocaine riskier today than it was a generation ago, even for occasional users. The drug’s direct risks (heart attack, stroke, seizure) haven’t changed, but the odds of encountering a contaminated supply have increased dramatically. Fentanyl test strips, which cost a few dollars and take minutes to use, can detect contamination before use.
How These Numbers Are Tracked
Most cocaine prevalence data comes from two types of sources: household surveys and drug testing programs. In the U.S., the National Survey on Drug Use and Health (run by SAMHSA) asks a representative sample of people aged 12 and older about their drug use. In Europe, individual countries conduct similar surveys, and the European Union Drugs Agency compiles the results. Both approaches depend on honest self-reporting, so they tend to produce conservative estimates.
Wastewater analysis offers a newer, arguably more objective method. Researchers measure cocaine metabolites in sewage to estimate community-wide consumption. These studies consistently suggest that actual use is higher than survey data indicates, sometimes by a significant margin. Cities like London, Barcelona, and Amsterdam regularly show some of the highest cocaine concentrations in European wastewater monitoring.