Cocaine Production Just Hit a Record High. It’s Not Coming Alone Anymore.

Cocaine’s comeback isn’t a relapse of the 1980s. It’s fentanyl wearing a different drug’s name.

Cocaine never went away, but for a decade it lived in the shadow of the opioid crisis’s bigger numbers. That’s no longer true. Between 2019 and 2023, cocaine-involved overdose deaths in the U.S. rose 85%, climbing to roughly 29,449 deaths — now close to 28% of all U.S. overdose deaths. The supply side explains why: the United Nations Office on Drugs and Crime’s 2025 World Drug Report found global cocaine production at an all-time high, the peak of a decade-long climb in coca cultivation and processing efficiency across South America. More product, cheaper to move, is reaching more markets than at any point on record.

Here’s the part that turns a stimulant trend into an opioid-crisis problem: cocaine is a stimulant, meaning it speeds the body up, while fentanyl is an opioid that slows breathing down — two drugs with opposite effects on the body, increasingly showing up in the same bag. DEA laboratory analysis has found fentanyl in roughly one in four seized cocaine samples nationwide, and toxicology data shows nearly 80% of recent cocaine-involved deaths also involved an opioid, primarily illicit fentanyl. Almost none of that contamination is intentional on the buyer’s end. Cocaine and fentanyl are typically cut and packaged in the same facilities, on the same equipment, by the same supply chains that have spent a decade optimizing for fentanyl’s profit margin — a few dollars of raw fentanyl stretches further than the cocaine it’s mixed into, which means residue crossover happens even when nobody’s deliberately spiking a batch.

The practical result: a person who has used cocaine for years, who has never touched an opioid, who has no fentanyl tolerance at all, can now overdose on a drug they weren’t using. That is a different risk profile than the one most cocaine users, or the harm reduction programs built around them, were designed for a decade ago. Naloxone still works here — it reverses the opioid component of a mixed overdose even in someone who has no opioid tolerance, which is exactly the population least likely to be carrying it. If you use cocaine, or you’re around someone who does, that’s the one sentence worth remembering: carry naloxone even if opioids were never part of the plan, and consider a fentanyl test strip before a first use of a new supply, because “I don’t use opioids” no longer means what it used to.