008 Cocaine exposures reported to United States poison control centers, 2000–2020

Abstract

<h3>Statement of Purpose</h3> To explore the characteristics of cocaine exposure in the U.S. from 2000–2020. <h3>Methods/Approach</h3> Descriptive and analytical statistics were used to evaluate a National Poison Control Center (NPCC) database of cocaine exposures in the U.S. from 2000–2020. <h3>Results</h3> The National Poison Data System (NPDS) managed 59,466 cases in which cocaine was the first-ranked substance between January 1, 2020 and December 31, 2020. Among multiple-substance exposures, co-exposure to ethanol beverages was the most common in both fatal (n = 164, 7.0%) and fatal and non-fatal exposures combined (n = 6534, 6.7%), followed by benzodiazepines in both fatal (n = 152, 6.5%) and fatal and non-fatal exposures combined (n = 4658, 4.8%). 41.1% of first-ranked cases involved a serious medical outcome, and 1.8% of exposures lead to death. Exposures involving multiple substance were more likely to lead to both a serious medical outcome (p &lt;.0001) and admission (p &lt;.0001). From 2000 to 2020, the rate of exposure to cocaine per 100,000 US population decreased significantly overall (from 1.66 to 1.33; p = 0.0027). From 2000 to 2019, the rate of exposures in males decreased significantly (from 2.20 to 2.09; p = 0.0033), and from 2007 to 2019, the rate of exposures in males decreased significantly (from 3.13 to 2.09; p = 0.0056). From 2000 to 2019, the rate of exposures in females decreased significantly (from 1.14 to 1.14; p = 0.0051), and from 2007 to 2019, the rate of exposures in females decreased significantly (from 1.83 to 1.14; p = 0.0047). Males were more likely to experience a serious medical outcome than females (OR 1.12, 95% CI 1.01–1.16, P &lt; .0001), but less likely to be admitted (OR 0.94, 95% CI 0.90–0.97, P = 0.0004). From 2000 to 2019, the rate of exposures to cocaine per 100,000 US population decreased significantly in individuals age 13–19 years (from 2.0 to 0.99; p = &lt;.0001), in individuals age 20–29 years (from 3.95 to 3.29; p = 0.0008), and in individuals age 30–39 years (from 3.30 to 3.22; p = 0.0024). From 2007 to 2019, exposures decreased significantly in individuals age 13–19 years (from 2.51 to 0.99; p = 0.0037), in individuals age 20–29 years (from 5.60 to 3.29; p = 0.0047), and in individuals age 30–39 years (from 4.81 to 3.22; p = 0.0053). From 2000 to 2020, exposures decreased significantly due to intentional misuse or abuse (from 0.94 to 0.68; p = 0.0038), due to unintentional – general decreased (from 0.13 to 0.04; p = &lt; .0001), due to other reasons (from 0.04 to 0.04; p = 0.0038), and due to unknown reasons (from 0.03 to 0.07; p = 0.0284). From 2007 to 2020, exposures decreased significantly due to intentional-suspected suicide (from 0.88 to 0.52; p = 0.0039) and due to intentional misuse or abuse (from 1.2 to 0.68; p = 0.0038). From 2000 to 2020, the rate of exposures decreased significantly in the South (from 2.14 to 1.48; p = &lt;.0001) and in the West (from 1.11 to 0.85; p = &lt;.0001). From 2007 to 2020, the rate of exposures per 100,000 US regional population decreased significantly in the Northeast (from 2.84 to 2.05; p = 0.0079), in the South (from 3.24 to 1.48; p = 0.0001), and in the West (from 1.21 to 0.85; p = 0.0064). The annual number of reported cocaine-associated fatalities varied during the study period varied between 41 deaths (2012) and 111 deaths (2005). <h3>Conclusions</h3> Although the rate of cocaine exposures in the US has declined between 2000 and 2020, continued prevention efforts are warranted to prevent cocaine-involved overdose deaths, especially deaths due to cocaine and opioid co-exposure. <h3>Significance</h3> Understanding the characteristics of cocaine exposures in the US allows for more targeted prevention efforts, which will reduce serious and/or fatal outcomes across all age groups.