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Global cocaine production hit an all-time high, followed by record cocaine seizures, consequences, and deaths

Cocaine accounts for nearly one-third of U.S. overdose deaths.

Cocaine enforcement has intensified, targeting maritime routes and cartel leadership to reduce access and use.

With cocaine, the overdose bedside reflects decisions made thousands of miles away. Cocaine is clearly a major threat worldwide.

A decade ago, it would have seemed highly implausible that cocaine would account for nearly one-third (28%) of U.S. overdose deaths. Yet by 2023, approximately 30,000 overdose deaths in the U.S. involved cocaine. Synthetic opioids, particularly fentanyl, remain the principal driver of death, followed by cocaine.

Acute cocaine toxicity may cause arrhythmia, seizure, ischemic and hemorrhagic stroke, and sudden cardiac death. Chronic use contributes to cardiomyopathy, accelerated atherosclerosis, neurocognitive impairment, mood disorders, and psychosis. The drug’s effects generate immediate and cumulative cardiovascular risks.

The question is not just why an excessive flow of cocaine is happening, but how we react to this threat.

To understand the cocaine resurgence, let’s start with Colombia, where coca is grown. I have visited indigenous people and coca farmers, most recently in 2021 (see picture). Roughly up to 92% of cocaine seized on the streets of the U.S. originates in Colombia.

Beginning in 2016 and especially accelerating between 2020 and 2023, record amounts of coca were cultivated and record amounts of cocaine were produced, as documented by the United Nations Office on Drugs and Crime. By 2022, the estimated potential production in Colombia had more than tripled from 2015.

Improved, more resilient coca plant varieties, combined with better techniques, led to exploding production, with potential yields increasing by more than 50% in the last reported period. Colombia produced an estimated 3,000 metric tons of cocaine in 2024. In fiscal 2025, the U.S. Coast Guard reported a record-setting seizure of nearly 510,000 pounds of cocaine in the eastern Pacific and Caribbean.

Expanded cocaine production in Colombia has translated into greater availability in North America and Europe and more deaths. The Drug Abuse Warning Network (DAWN) estimates that roughly 354,000 cocaine-related emergency department visits occurred in the U.S. in 2023 and 393,000 in 2024. As with most items,greater supply brought lower prices—and lowered barriers to first use. Cocaine’s addictive pharmacology itself sustains repeated use.........

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