Upon the recent death of the luminous Diane Keaton, forever “Annie Hall,” I found myself reflecting on the cocaine epidemic epitomized by that movie, because, now, cocaine is back, but more lethal, and often mixed with fentanyl. Although most overdose deaths involve opioids, 182,502 persons died of overdoses involving stimulants (with or without other drugs) in the United States during January 2021–June 2024, accounting for 59% of all overdose deaths. Cocaine is a top 3 cause of overdose death today.
Cocaine in the United States today is cheaper, purer, and more widespread than in decades. According to Millennium Health, cocaine consumption between 2019-2025 increased by 154%. Regional stimulant patterns are striking: In the West, fentanyl is often mixed with methamphetamine; in the Northeast, fentanyl is more often found alongside cocaine. By early 2025, although fentanyl detections fell from their 2022 peak, fentanyl-associated polysubstance use remained high, with cocaine a commonly co-detected drug.
The CDC notes that as the dangers of fentanyl became widely known, cocaine was recast by some as a “safer”, less stigmatized stimulant. The only ones who benefit from this mistaken view are the drug cartels.
Annie Hall, Anhedonia, and the Illusion of Pleasure
During the late 1970s and early 1980s, I was a cocaine researcher among other scientists who demonstrated cocaine was profoundly addictive, not the harmless “champagne of drugs” as marketed. That time frame was perfectly captured in Woody Allen’s movie, “Annie Hall” (1977), with the supremely talented late Diane Keaton. It was initially entitled “Anhedonia,” — the inability to feel pleasure.
Opportunities for pleasure surrounded Alvy Singer (Allen’s character), but he was consistently anhedonia-trapped and over-intellectualizing. It was a parody of too-hip city life. A physical manifestation of his anhedonia occurred when Alvy and his friends were preparing to use cocaine. Someone opened a small cocaine-filled box. As the group leaned in, Alvy sneezed, blowing away the entire pile into the air, now useless. This scene became an iconic comedic moment, poking fun at elites endlessly seeking pleasure and the drug culture glamorized in Hollywood and New York. In contrast, Diane Keaton’s Annie Hall character embodied a spontaneous and emotionally expressive person who experienced pleasure in everyday living.
For millions during that cocaine epidemic, cocaine’s promise of pleasure, sophistication, and confidence gave way instead to anxiety, depression, overdoses, and addiction.
Moving to Now: Cocaine Déjà Vu
The World Drug Report 2025 confirms global cocaine production is at an all-time high, as are seizures, users, and related harms. According to the United Nations Office on Drugs and Crime (UNODC), coca cultivation and cocaine production has risen sharply. Colombia’s coca fields expanded 10% in one year — from 230,000 to 253,000 hectares. UNODC estimates Colombian production reached nearly 2,650 metric tons of pure cocaine in 2023 — a 53% increase. More supply means cheaper prices. Cheaper prices also mean more access for users. The cocaine supply is so high that prices in the United States have fallen by almost half, to $60–$75 per gram, compared to five years ago. The reasons for this increased cocaine surge are complex — reduced aerial eradication, shifting rural policies, and drug traffickers using new maritime routes and semi-submersible craft. U.S. authorities, including the DEA and Customs and Border Protection, reported record seizures of cocaine in 2024–2025.
By mid-2025, the DEA seized over 200,000 pounds of cocaine nationwide, and laboratory analysis showed roughly one in four cocaine samples tested by DEA labs contained fentanyl. Fentanyl’s presence in cocaine has amplified overdose deaths among accidental users who don’t regard themselves as “opioid users.”
Even as total overdose deaths plateaued, cocaine-related mortality continues to rise, a sign that cocaine’s resurgence is real and far from benign. According to the National Institute on Drug Abuse (NIDA), cocaine-involved overdose deaths reached about 29,000 in 2023 — a stark increase over previous years. Nearly 80% of those deaths involved opioids, primarily illicit fentanyl.
The Centers for Disease Control and Prevention (CDC) and National Drug Early Warning System (NDEWS) confirm fentanyl contamination of cocaine is the rule, not the exception.
Americans Fear Cocaine Much Less
Among U.S. youth, the perceived risk of cocaine use has declined. Fewer people see cocaine as a major risk. A 2024 cross-sectional study found that only about 16% of respondents mentioned “harm to health” when discussing cocaine on social media. Instead, conversations focused on status, pleasure, or nostalgia. This recalibration of risk perception may be fueling renewed interest and experimentation.
The UNODC’s Global Report on Cocaine 2023 noted a “normalization” of cocaine use as a routine part of socializing. Occasional use is often viewed as low-risk, especially in affluent or celebrity circles, for whom cocaine may retain its aura of confidence and control.
Overdose Mortality and the Fentanyl Connection
Cocaine remains a potent vasoconstrictor capable of causing arrhythmias, ischemia, and acute coronary syndromes. Yet many new users perceive cocaine as “safe.” It is not.
Cocaine overdoses present as heart attack or stroke, disrupting body temperature regulation and causing psychosis and other mental health symptoms. The Drug Abuse Warning Network (DAWN) found nearly three-quarters (72.5%) of cocaine-related emergency visits involved at least one other substance, most commonly alcohol or opioids. These patients rarely presented with straightforward cocaine intoxication; their clinical pictures were complex, often dominated by opioid overdose or cardiac complications.
Even if patients deny opioid use, fentanyl contamination should be assumed. In 2021, comedian Kate Quigley overdosed on what she believed was cocaine alone. However, the drug had been secretly mixed with fentanyl, causing three people at the party to die of overdoses. Quigley survived after being given Narcan, a medication that reverses opioid overdoses.
The UNODC World Drug Report 2024 documented a 60% increase in addiction treatment admissions for cocaine use disorders between 2011 and 2022. The 2025 report continues the trend, with rising admissions across North and South America. In the USA, Dr. Adam Scioli Caron Chief Medical Officer told me: “… we’ve observed a steady rise in patients presenting with cocaine use disorder over the past several years.. consistent with national surveillance data.. with more patients listing cocaine as a primary, secondary, or contributing drug of choice. In contrast, opioid-related admissions have declined—from approximately 14.2% of all patients in 2020 to just 6.5% in 2025.”
Cocaine Is a Suicide Risk
A meta-analysis of multiple studies reported by Bahram Armoon, PhD, found that female abusers, especially of cocaine, showed an increased risk for suicide attempts. Men are usually significantly more likely to consider or attempt suicide than women. But being a cocaine abuser doubled the risk for attempted suicide, as did a history of sexual abuse.
The Bigger Picture
Each generation rediscovers old drugs as if for the first time, confident this time, they’ll manage it better. They never do.
In the 1970s, cocaine symbolized affluence, sophistication, and pleasure on demand. In the mid-2020s, it has resurfaced amid widespread depression, disillusionment, digital overstimulation, and social fatigue. The substance is the same; the anhedonia persists.