For several years now, indicators have pointed to an increase in cocaine use, regardless of its form (powder or cocaine base: cakes, crack), accompanied by a “democratization”^¹ of its use, driven by a diversification of user profiles².

Furthermore, the number of cases treated for cocaine use at Centers for Addiction Care, Support, and Prevention (CSAPA) also rose between 2015 and 2019. This trend is linked to an increase in global cocaine production and a rise in imports into Europe.

A sharp and sustained increase in emergency department visits related to cocaine use

Results from emergency department visit data (OSCOUR®) related to cocaine use highlight a sharp and continuous increase over the 2010–2022 period, regardless of region. After a period of relative stabilization between 2018 and 2021, the data show a particularly sharp rise between 2021 and 2022.

Between 2010 and 2022, 23,335 emergency department visits related to cocaine were identified. The visits primarily involved men (75%), and the median age was 32 years, which corresponds to the profiles typically associated with the highest levels of consumption within the general population. Discharge diagnoses were mainly related to intoxication (65%), dependence (13%), or withdrawal (7.5%). Over 12 years, the rate of visits rose from 8.6 to 21.2 per 100,000 visits, representing a more than threefold increase. This translates to an average of 72 emergency department visits related to cocaine use per week in France in 2022.

Significant regional disparities were observed, with very high rates in French Guiana (44.1 per 100,000 visits), Provence-Alpes-Côte d’Azur (40.8), and Occitanie (27). Furthermore, a very sharp increase was observed in Auvergne-Rhône-Alpes (from 1.2 to 22.9 per 100,000 visits), Brittany (from 4.3 to 34.4), Nouvelle-Aquitaine (3 to 20.6), Grand Est (8.7 to 19.9), and Bourgogne-Franche-Comté (2.9 to 13.1).

The identified visits predominantly involved associated diagnoses related to alcohol intoxication (33%), benzodiazepines (9.6%), cannabis (9.5%), or opioids (4.8%), reflecting a pattern of poly-substance use. Other associated diagnoses were related to cardiac symptoms (chest pain, palpitations, tachycardia) and psychiatric symptoms (agitation, depression, anxiety, schizophrenia), the most common complications of cocaine use.

The increase in overdoses could be explained in particular by the circulation over the past decade of cocaine with an increasing active ingredient content⁶ or the emergence of new synthetic substances (NPS) that are more potent and toxic than the molecule whose effects they mimic^⁷. Indeed, since the names of the products in question are based solely on self-reporting, new synthetic substances (NPS) could be sold to these users as cocaine.

Furthermore, certain patterns of use can also increase the risk of poisoning: poly-substance use with alcohol, in particular, increases the duration and potency of the psychoactive effects sought by users, as well as cardiac toxicity⁸.

Santé publique France continues to monitor this trend reactively and regularly, using data from the OSCOUR® network. In addition, the EROPP 2023 survey led by the OFDT and supported by Santé publique France will provide an updated estimate of cocaine use among the adult population, along with associated profiles.

Drogues-Info-Service: Increasing Number of Inquiries

These results regarding emergency department visit rates linked to cocaine use are consistent with reports from the Drogues Info Service, which has seen a steady increase in inquiries since 2010. The number of calls, chats, and Q&As mentioning cocaine rose from 2,133 to 6,447 between 2010 and 2022.

Most inquiries from users are related to psychological and/or physical distress, often accompanied by significant anxiety about the symptoms experienced, difficulties in stopping or reducing use, requests for information on the effects and risks of cocaine, as well as requests for treatment.