Background: Cocaine is a stimulant and Schedule II drug used as a local anesthetic and vasoconstrictor. Objective: This descriptive study characterized medical cocaine use in the United States. Methods: Retail drug distribution data from 2002 to 2017 were extracted for each state from the Drug Enforcement Administration, which reports on medical, research, and analytical chemistry use. The percentage of buyers (pharmacies, hospitals, and providers) was obtained. Use per state, corrected for population, was determined. Available cross-sectional data on cocaine use as reported by the Medicare and Medicaid programs for 2013-2017 and electronic medical records were examined. Results: Medical cocaine use decreased by −62.5% from 2002 to 2017. Hospitals accounted for 84.9% and practitioners for 9.9% of cocaine distribution in 2017. The number of pharmacies carrying cocaine dropped by −69.4%. The percentages of hospitals, practitioners, and pharmacies that carried cocaine in 2017 were 38.4%, 2.3%, and 0.3%, respectively. There was a 7-fold difference in 2002 (South Dakota, 76.1 mg/100 persons; Delaware, 10.1 mg/100 persons). Relative to the average state in 2017, those reporting the highest values (Montana, 20.1; North Dakota, 24.1 mg/100 persons) were significantly elevated. Cocaine use within the Medicare and Medicaid programs was negligible. Cocaine use within the Geisinger system was rare from 2002 to 2007 (<4 orders/100 000 patients per year) but increased to 48.7 in 2018. Conclusion and Relevance: If these pharmacoepidemiological patterns continue, licit cocaine may soon become a historical relic. The pharmacology and pharmacotherapeutics education of health care providers may need to be adjusted accordingly.

Purpose: Cocaine is a stimulant with a complex history that is used in otorhinolaryngological surgeries as a local anesthetic and vasodilator. There is extensive regulation in the United States for the storage and disposal of this Schedule II drug, potentially incentivizing health care professionals to avoid use. This descriptive study characterized medical cocaine use in the United States. Methods: Retail drug distribution from 2002-2017 in units of grams of weight was extracted for each state from the Drug Enforcement Administrations Automation of Reports and Consolidated Orders System database, which reports on medical, research, and analytical-chemistry use. The percent of buyers (hospitals, pharmacies, providers) was obtained. Use per state, corrected for population, was determined. Available data on cocaine use, as reported by the Medicare and Medicaid programs for 2013 to 2017, also were examined. Results: Medical cocaine use in the US, measured on the basis of mass, decreased 62.5% from 2002 to 2017. Hospitals accounted for 84.9% and practitioners for 9.9% of cocaine distribution in 2017. The number of pharmacies nationwide carrying cocaine dropped by 69.4% to 206. The percent of all US hospitals, practitioners, and pharmacies that carried cocaine in 2017 was 38.4%, 2.3%, and 0.3%, respectively. There was a seven-fold difference in distribution per state in 2002 (South Dakota = 76.1 mg/100 persons, Delaware = 10.1 mg/100 persons). Similarly, there was a ten-fold regional disparity observed for 2017. Relative to the average state, those reporting the highest values (Montana = 20.1 and North Dakota = 24.1 mg/100 persons), were significantly elevated. Cocaine use within the Medicare and Medicaid programs was negligible. Conclusion: Medical cocaine use across the United States exhibited a pronounced decline over a fifteen-year period. If this pattern continues, licit cocaine will soon become an obscure pharmacological relic of interest only to analytical chemists and medical historians.