Statement of Purpose To explore the characteristics of cocaine exposure in the U.S. from 2000–2020.

Methods/Approach Descriptive and analytical statistics were used to evaluate a National Poison Control Center (NPCC) database of cocaine exposures in the U.S. from 2000–2020.

Results The National Poison Data System (NPDS) managed 59,466 cases in which cocaine was the first-ranked substance between January 1, 2020 and December 31, 2020. Among multiple-substance exposures, co-exposure to ethanol beverages was the most common in both fatal (n = 164, 7.0%) and fatal and non-fatal exposures combined (n = 6534, 6.7%), followed by benzodiazepines in both fatal (n = 152, 6.5%) and fatal and non-fatal exposures combined (n = 4658, 4.8%). 41.1% of first-ranked cases involved a serious medical outcome, and 1.8% of exposures lead to death. Exposures involving multiple substance were more likely to lead to both a serious medical outcome (p <.0001) and admission (p <.0001). From 2000 to 2020, the rate of exposure to cocaine per 100,000 US population decreased significantly overall (from 1.66 to 1.33; p = 0.0027). From 2000 to 2019, the rate of exposures in males decreased significantly (from 2.20 to 2.09; p = 0.0033), and from 2007 to 2019, the rate of exposures in males decreased significantly (from 3.13 to 2.09; p = 0.0056). From 2000 to 2019, the rate of exposures in females decreased significantly (from 1.14 to 1.14; p = 0.0051), and from 2007 to 2019, the rate of exposures in females decreased significantly (from 1.83 to 1.14; p = 0.0047). Males were more likely to experience a serious medical outcome than females (OR 1.12, 95% CI 1.01–1.16, P < .0001), but less likely to be admitted (OR 0.94, 95% CI 0.90–0.97, P = 0.0004). From 2000 to 2019, the rate of exposures to cocaine per 100,000 US population decreased significantly in individuals age 13–19 years (from 2.0 to 0.99; p = <.0001), in individuals age 20–29 years (from 3.95 to 3.29; p = 0.0008), and in individuals age 30–39 years (from 3.30 to 3.22; p = 0.0024). From 2007 to 2019, exposures decreased significantly in individuals age 13–19 years (from 2.51 to 0.99; p = 0.0037), in individuals age 20–29 years (from 5.60 to 3.29; p = 0.0047), and in individuals age 30–39 years (from 4.81 to 3.22; p = 0.0053). From 2000 to 2020, exposures decreased significantly due to intentional misuse or abuse (from 0.94 to 0.68; p = 0.0038), due to unintentional – general decreased (from 0.13 to 0.04; p = < .0001), due to other reasons (from 0.04 to 0.04; p = 0.0038), and due to unknown reasons (from 0.03 to 0.07; p = 0.0284). From 2007 to 2020, exposures decreased significantly due to intentional-suspected suicide (from 0.88 to 0.52; p = 0.0039) and due to intentional misuse or abuse (from 1.2 to 0.68; p = 0.0038). From 2000 to 2020, the rate of exposures decreased significantly in the South (from 2.14 to 1.48; p = <.0001) and in the West (from 1.11 to 0.85; p = <.0001). From 2007 to 2020, the rate of exposures per 100,000 US regional population decreased significantly in the Northeast (from 2.84 to 2.05; p = 0.0079), in the South (from 3.24 to 1.48; p = 0.0001), and in the West (from 1.21 to 0.85; p = 0.0064). The annual number of reported cocaine-associated fatalities varied during the study period varied between 41 deaths (2012) and 111 deaths (2005).

Conclusions Although the rate of cocaine exposures in the US has declined between 2000 and 2020, continued prevention efforts are warranted to prevent cocaine-involved overdose deaths, especially deaths due to cocaine and opioid co-exposure.

Significance Understanding the characteristics of cocaine exposures in the US allows for more targeted prevention efforts, which will reduce serious and/or fatal outcomes across all age groups.