There have been growing concerns about the health risks of cocaine use, particularly because of the trend of increasing recreational use observed in some countries, especially in settings (discos, clubs) frequented by youth groups. Despite the difficulties in estimating the number of cocaine-related deaths, this measure may act as a valuable indicator of increased risk or help to identify risky patterns of use. Although acute deaths in which cocaine is present without opiates seem to be infrequent in Europe, it is likely that current statistics are inadequate in recording cocaine-related deaths. The information that is available about cocaine deaths at the European level is limited and is reported in different forms. Cocaine use is frequent among opiate users, and it is common to find cocaine in toxicological analyses of cases of opiate overdoses, in addition to other substances such as alcohol and benzodiazepines.
Several countries reported information about cocaine deaths in 2003 (Reitox national reports): Germany (25 cases involving cocaine alone and 93 involving cocaine in combination with other drugs; in 2002, the corresponding figures were 47 and 84), France (10 deaths due to cocaine alone and one associated with a medicine), Greece (two cases due to cocaine), Hungary (four deaths due to cocaine overdose), the Netherlands (17 deaths due to cocaine in 2003, with an increasing trend between 1994, two cases, and 2002, 37 cases), Austria (cocaine was found in 30 % of drug-related deaths, but alone in only three cases and in one case in association with gas), Portugal (cocaine was found in 37 % of drug-related deaths) and the United Kingdom (‘mentions’ of cocaine in death certificates increased from 85 in 2000, to 115 in 2001 and 171 in 2002, with an eightfold increase over the period 1993–2001). In its 2003 Reitox national report, Spain reported that, in 2001, cocaine was present in 54 % of all drug-related deaths; in 39 cases (8 % of all drug-related deaths) death occurred in the absence of opiates, of which 21 were caused by cocaine only and five were caused by cocaine and alcohol.
Despite the limitations of the available information, cocaine seems to have played a determinant role in between 1 % and 15 % of drug-related deaths in countries that were able to make the differentiation between drug types causing death, with several countries (Germany, Spain, France and Hungary) reporting figures of around 8–12 % of drug-related deaths. Although it is very difficult to extrapolate these results to the whole of Europe, this could mean several hundreds of cocaine-related deaths per year at EU level. Although the numbers are much lower than deaths caused by opiates, cocaine-related death is a serious and possibly increasing problem; in the few countries where trends can be estimated, they tend to show an increase.
In addition, cocaine may be a contributing factor in deaths due to cardiovascular problems (arrhythmias, myocardial infarction and cerebral haemorrhages; see Ghuran and Nolan, 2000), particularly in users with predisposing conditions, and many of these deaths may pass unreported.