The World Has More Cocaine Than Ever, and Still Nothing to Prescribe For It

Two men, 21 and 25, tried to run when Australian police pulled the lids off plastic tubs buried under three shipping containers on a property outside Sydney on June 19. Inside: 2.7 metric tons of cocaine, the largest seizure in the country’s history, worth an estimated street value in the hundreds of millions. It barely dented the supply. A week later, the United Nations released the number that explains why: global cocaine production hit roughly 4,000 tonnes of pure product in 2024, more than quadruple what it was a decade ago, according to the UNODC World Drug Report 2026. An estimated 25 million people used cocaine in 2024, part of a record 331 million people who used any drug that year — about 1 in 16 people on the planet, according to UN News.

THE TAKE: You cannot arrest, seize, or interdict your way out of a drug that has never had an approved medication to treat the disorder it causes — and every dollar spent proving that again is a dollar not spent on the one thing that actually works.

Sit with that math. Cocaine use disorder has no buprenorphine, no methadone, no naltrexone-bupropion combo — no pill that’s cleared FDA approval, and not for lack of trying. Researchers have tested modafinil, topiramate, disulfiram, and dozens more since the 1990s. None made it through. Meanwhile supply is producing four times what it did a decade ago, and the response is still, overwhelmingly, more of the same: seize the product, arrest the people moving it, repeat.

If you’ve used cocaine or meth, or you’re in recovery from either, you already know this asymmetry. There’s a methadone clinic on every corner of the opioid response. Nothing structurally equivalent exists for stimulants — not because the science gave up, but because blocking dopamine reuptake (the brain’s cleanup process for its reward chemical) has turned out to be a far harder target than the opioid receptor. What exists instead is behavioral: contingency management, therapy, peer support. That’s not nothing. It’s just not what the opioid crisis trained us to expect “treatment” to look like.

The Supply Side Is Winning, and It Isn’t Close

The DEA’s own numbers make the imbalance plain. One thirty-day nationwide operation this year pulled in 147,797 pounds of cocaine, nearly 21,000 pounds of methamphetamine, and more than 26 million meth pills — enormous, until you set it against UNODC’s estimate that global cocaine production alone now runs to roughly 8.8 million pounds a year. Cartels have pushed cultivation and cocaine sales into markets across Africa and Asia that barely touched it a decade ago, per the World Drug Report’s findings. North America remains the largest cocaine market on Earth: 6.5 million people, nearly 2% of the population age 15-64.

This isn’t about the DEA’s operation being poorly run. Seizures, even record ones, are a rounding error against production that’s quadrupled. UNODC’s lead researcher Chloé Carpentier named the deeper problem: “We don’t always know what we are taking, and first responders don’t know what they are responding to.” That’s a public health gap wearing a policing uniform, treated as the former for fifty years.

The historical echo isn’t subtle. The 1980s crack epidemic produced the same reflex — flood the DEA and courts with resources, punish crack at 100 times the rate of powder cocaine, and let treatment lag decades behind. That 100-to-1 sentencing disparity wasn’t cut to 18-to-1 until the Fair Sentencing Act of 2010, by which point it had already reshaped a generation’s relationship to the justice system. Forty years later, we’re still building the enforcement wing first and the treatment wing second, if at all.

What Cocaine Does to a Body, and Why There’s No Pill

Cocaine blocks that dopamine cleanup process, so the reward chemical pools in the brain and floods you with a high that clears in under an hour — which is exactly why the crash-and-craving cycle is so brutal. Chase that repeatedly and the same circuits that respond to a paycheck or a hug start needing more just to register anything. That’s tolerance, and it’s why euphoric in month one becomes maintenance by month twelve.

That’s tolerance, and it’s why euphoric in month one becomes maintenance by month twelve.

The cardiac data is arriving in real time, and it’s grim. A Northern California study led by cardiologist Dr. Susan Zhao, published in the Journal of the American Heart Association in April, found methamphetamine use behind roughly 1 in 6 heart attacks at one safety-net hospital over a decade. Those patients were younger — median age 52 versus 57 — and less likely to have traditional risk factors like high cholesterol. Both meth and cocaine flood the body with stress hormones that spike heart rate and blood pressure on demand; over years that damages blood vessels and ages the heart faster. People who use either drug get diagnosed with heart disease roughly eight years earlier than people who don’t, and Zhao’s team found meth-using patients were less likely to get standard cardiac procedures and more likely to die from a heart attack a non-user would survive.

There’s a mechanical reason cocaine has resisted medication where opioids didn’t. Opioid receptors are a single, well-mapped lock; buprenorphine and methadone are keys built to fit it. Dopamine transporter blockade is messier — block it hard enough to stop cocaine’s effect and you risk blunting the reward circuitry a person needs for ordinary life. That’s the wall pharmacology hasn’t cleared.

Cocaine Is a Contaminant Now Too, Not Just a Contaminated Drug

The fentanyl story usually gets told as opioids poisoning stimulants — and it does happen: drug-checking data has repeatedly found fentanyl in cocaine and meth samples nobody selling them intended to include. The newer twist is xylazine, the veterinary sedative known as “tranq.” DEA sampling now finds it in cocaine at meaningful volume — 723 cocaine samples tested positive in one federal analysis, mostly carried over from fentanyl rather than deliberately added. Xylazine doesn’t respond to naloxone, the opioid overdose reversal drug. If you use cocaine and aren’t testing it, you’re likely also using an unlabeled sedative that first responders can’t reverse with the tool they carry for everything else.

This is where harm reduction earns its keep, and where the tools are still thin. Fentanyl test strips are now legal and distributed in most states; xylazine test strips are newer and far less available. Testing your supply isn’t paranoia anymore — it’s closer to reading a label. Rize’s harm reduction coverage tracks where drug-checking access is expanding and where it isn’t.

What Actually Helps, and Who’s Doing It

With no prescription to write, the strongest evidence-based treatment for cocaine use disorder is behavioral: contingency management, where people get small incentives for verified drug-negative screens, backed by more than 200 randomized trials across four decades. It works. It’s also chronically underfunded and, until recently, barely covered by Medicaid.

What’s newer is programs built around lived experience instead of arrest. In Roanoke, Virginia, the Hope Initiative just marked ten years of police treating drug use as a health call first. Cynthia Haley, now a peer recovery specialist with nearly six years sober, moved through marijuana, then cocaine during a television career, then crack in her thirties, then heroin and meth — the cross-substance path a clean “stimulant use disorder” label rarely captures. “I had pretty much lost who I was as a person,” she said of where it took her. The program served 45 people its first year; it now serves nearly 1,000 annually, partly funded through Virginia’s opioid settlement dollars. Former police chief Chris Perkins put it plainly: “We can’t arrest our way out of this.” If you’re calling a program like this for the first time, no badge attached to the intake call is not small — for many, that’s the difference between calling and not.

If you’re in recovery from cocaine or meth and the production numbers above make it feel like the tide is against you, you’re reading it right — supply is up, and the system’s first reflex is still enforcement over care. But contingency management is real, backed by data as strong as anything in addiction medicine, and peer-staffed, non-punitive entry points like Roanoke’s are spreading. That’s within reach even when the global numbers aren’t. More on stimulant treatment access lives at Rize’s stimulants substance page and our ongoing policy and funding coverage.

More on stimulant treatment access lives at Rize’s stimulants substance page and our ongoing policy and funding coverage.

None of this resolves with a headline about a bigger bust. It resolves in the gap between how much cocaine and meth the world produces and how much treatment infrastructure it builds to match — a gap open since the 1980s, now with a fresh set of numbers attached. Test your supply if you’re using it. Ask about contingency management if you’re seeking stimulant treatment; it’s the closest thing to a proven medicine this drug class has. The record supply numbers aren’t proof nothing changes — the response to them is a policy choice, not a law of nature, and that’s the one part of this still up for grabs.