The cocaine comeback, explained

Key Points:

• Stimulant overdose deaths, particularly from cocaine and methamphetamine, have surged in the U.S. over recent years, with cocaine deaths rising from 10,375 in 2016 to 29,449 in 2023, and meth deaths increasing from 9,438 in 2017 to 33,283 in 2023.
• Unlike the opioid crisis, there are currently no approved medications to treat cocaine or methamphetamine addiction, and existing behavioral treatments are limited and not widely accessible in primary care settings.
• The simultaneous use of opioids (especially fentanyl) and stimulants is increasing, with users either unintentionally consuming fentanyl-laced stimulants, intentionally combining drugs for recreational effects, or using stimulants to manage opioid withdrawal symptoms, which poses heightened health risks.
• Contingency management, a behavioral treatment offering incentives for drug-free urine tests, has shown promise in treating stimulant addiction but faces funding challenges and political resistance; experts also advocate for broader measures of treatment success beyond complete abstinence.
• Public health efforts are urged to adopt lessons from the opioid crisis by expanding education on stimulant overdose symptoms, improving treatment access, and developing new interventions to prevent a worsening stimulant overdose crisis.