Youngeun Armbuster Geisinger Commonwealth School of Medicine Scranton, Pennsylvania

Declines, But State-Level Differences, in Medical Cocaine Yse Interview with:

Youngeun Armbuster Geisinger Commonwealth School of Medicine Scranton, Pennsylvania

Youngeun Armbuster

Youngeun Armbuster
Geisinger Commonwealth School of Medicine
Scranton, Pennsylvania What is the background for this study?

Response: Cocaine is classified by the U.S. Drug Enforcement Administration (DEA) as a Schedule II drug that can be used as an anesthetic in various types of surgery by otorhinolaryngologists, as well as in diagnosing Horner syndrome. Although controlled doses of cocaine used in topical anesthetics does not cause myocardial infarction as can occur with recreational dosages, intranasal administration of cocaine is absorbed systemically and it results in vasoconstriction of the coronary arteries via stimulation of adrenergic receptors. These potential adverse effects may disincentivize health care providers from medical cocaine use. Our objective was to quantify the trends in licit cocaine distribution in the United States using DEA data and to determine the usage of medical cocaine in Medicaid and Medicare, as well as based on electronic medical records [1]. What are the main findings?

Response: There was a major decrease in licit cocaine use in the United States from 2002 to 2017: −62.5%. The number of pharmacies carrying cocaine dropped by −69.4%. Hospitals were the largest distributor of licit cocaine in 2017 (38.4%), followed by practitioners (2.3%) and pharmacies (0.3%). There was a 7-fold difference in 2002 between the state reporting the highest values (South Dakota, 76.1 mg/100 persons) and the lowest values (Delaware, 10.1 mg/100 persons). A 10.2-fold difference between the highest (North Dakota, 24.1 mg/100 persons) and the lowest (South Carolina, 2.4 mg/100 persons) reporting states was observed for 2017. Cocaine use within the Medicare and Medicaid programs was negligible. Interestingly, cocaine use within the Geisinger system was rare from 2002 to 2007 (<4 orders/100 000 patients per year) but increased over 12-fold to 48.7 in 2018. What should readers take away from your report?

Response: Cocaine is becoming extremely uncommon for use in outpatient and inpatient procedures. Continuation of this trend could result in medical use of this stimulant becoming an obscure pharmacological relic, of interest only to analytical chemists, veterinarians and medical historians. The pharmacology and pharmacotherapeutics education of health care providers may need to be adjusted accordingly. Is there anything else you would like to add?

Response: The pharmacoepidemiological patterns indicate that cocaine may soon reach the point where, at a practical level, it no longer functions nationally as a Schedule II substance. This report may prompt some states and institutions to reconsider whether additional efforts to identify other replacement agents is warranted.

We also continue to be surprised regarding the limited use of the DEA’s ARCOS database. This is a wonderful publicly-available resource for pharmacoepidemiology, public health, or journalism projects [2].


  1. Armbuster Youngeun et al. Decline and pronounced regional disparities in medical cocaine usage in the United States. Journal of Pharmacy Technology, 2021;
  2. ARCOS Retail Drug Summary Reports.

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Last Updated on August 18, 2021 by Marie Benz MD FAAD