Cocaine
powder cocaine · coke · charlie
What does current UK evidence show?
ONS recorded 1,233 England and Wales registrations mentioning cocaine in 2025, down 3.6% from 1,279 in 2024. Cocaine nevertheless overtook heroin/morphine as the most frequently mentioned specific substance; opioids remained the largest group. Scotland separately recorded 589 cocaine-implicated drug use deaths in 2025 (52%, up 23%). Mortality data do not split powder from crack, and a mention does not establish sole causation.
Overview
Identity, legal classification, form and pharmacological context
- Drug category
- Stimulants
- Common names
- powder cocaine, coke, charlie
- Typical forms
- Usually a fine white or off-white powder in the UK illicit retail market. Appearance alone cannot establish purity or contents
- Routes
- Most commonly snorted. Powder cocaine may also be rubbed on the gums, swallowed or injected. Smoking is primarily associated with crack or freebase cocaine rather than ordinary powder cocaine
- UK legal classification
- Class ACocaine is a Class A controlled drug.Check government source ↗
- Concise pharmacology
- Increases central nervous system activity through substance-specific effects on monoamine signalling.
Main harms
Concise clinical and polydrug picture
Agitation, anxiety, overheating, chest pain, seizures and cardiovascular strain.
Sleep disruption, mood problems, cardiovascular harm and stimulant-related psychosis may develop.
Fatigue, low mood, sleep disturbance and craving can follow sustained use.
Alcohol and cocaine together form cocaethylene; some evidence suggests added cardiotoxicity. Other stimulants can increase cardiovascular strain, while sedatives do not cancel cocaine-related risk.
Snorting can damage nasal tissue; injecting adds infection and blood-borne virus risks. Smoking risks relate primarily to crack or freebase cocaine.
Current intelligence status
Assessment, confidence and direction
ONS recorded 1,233 England and Wales registrations mentioning cocaine in 2025, down 3.6% from 1,279 in 2024. Cocaine nevertheless overtook heroin/morphine as the most frequently mentioned specific substance; opioids remained the largest group. Scotland separately recorded 589 cocaine-implicated drug use deaths in 2025 (52%, up 23%). Mortality data do not split powder from crack, and a mention does not establish sole causation.
Reason: Direct official statistics or confirmed analytical evidence support the defined signal. Interpretation remains limited to each source’s geography, period and method.
Principal source limits: NRS calls this series drug use deaths. Substance implication overlaps and does not prove sole causation. Nitazene testing expanded, including etonitazene in May 2025; 2025 versus 2024 rate difference is not statistically significant. Deaths are counted by registration year; 62.7% of the 2025 registrations concern earlier deaths. Substance mentions overlap and do not prove sole causation.
Geography and reference periods are given in each linked source card below. The rating is an editorial evidence judgement, not a probability, clinical risk score or TD priority.The assessment reflects the latest linked evidence and is not a universal severity rating.
Operational implications
Evidence-supported prompts for professional response
Strengthen stimulant pathways across cardiovascular, mental-health, alcohol and emergency-care services and keep powder cocaine separate from crack indicators.
Record substance, sold identity, route, frequency and combinations; review physical, mental-health and dependence needs.
Use symptom-led assessment and escalate reduced consciousness, seizures, overheating, chest pain or severe agitation.
Link early identification with safeguarding and age-appropriate treatment without presenting population use as individual risk.
Related intelligence
Continue into connected platform evidence
Sources & limitations
Direct evidence links, reference periods and status
Drug-related deaths in Scotland, 2025
Published23 Sep 2026Reference period2025 registrations
NRS calls this series drug use deaths. Substance implication overlaps and does not prove sole causation. Nitazene testing expanded, including etonitazene in May 2025; 2025 versus 2024 rate difference is not statistically significant.Deaths related to drug poisoning in England and Wales: 2025 registrations
Published4 Nov 2026Reference period2025 registrations; 2024 occurrences
Deaths are counted by registration year; 62.7% of the 2025 registrations concern earlier deaths. Substance mentions overlap and do not prove sole causation.WAND wastewater analysis
Published13 Apr 2026; revised 8 Oct 2026Reference periodEngland annual estimates · Aug 2024–Jul 2025; 16-site trend · Jan–Apr 2021–2025
The 8 October revision changed methodology and reporting, including uncertainty presentation and trend descriptions. Table 1 national ranges and Table 2 standard errors describe different estimates. The 16-site series is not a national annual total; wastewater cannot count people using drugs. Heroin estimates have particular biomarker limitations.Drug misuse in England and Wales
Published11 Dec 2025Reference periodYear ending March 2025
Household survey for England and Wales; it under-represents some high-risk populations and does not cover the whole UK.National Strategic Assessment 2026
Published17 Mar 2026Reference periodLatest national assessment
An intelligence assessment rather than a population survey or a complete count of incidents.Clinical guidelines for alcohol treatment: harm reduction
Published28 Nov 2025; updated 17 Apr 2026Reference periodClinical guidance
Withdrawal risk and care depend on individual assessment.Cocaine and crack drug profile
PublishedSource page undatedReference periodPharmacology, forms and routes
European clinical and product context; UK mortality data do not distinguish powder from crack.