What changed
Cocaine was linked to 1,233 drug-poisoning deaths registered in England and Wales in 2025, overtaking heroin or morphine at 1,210. Cocaine-related deaths remain roughly four times higher than in 2015, while ketamine-linked deaths reached a record 115.
Why it matters
The overall death rate fell slightly, from 93.9 to 92.4 per million, but the total remained severe: 5,519 people died from drug poisoning. A single year’s decline should not be mistaken for a settled improvement, especially because registrations lag behind the dates of deaths.
The shift also says something important about the changing risk landscape. Cocaine deaths include people who snorted, injected or smoked crack cocaine, including combinations with opioids or counterfeit medicines. Higher purity and wider availability may be increasing danger, while highly potent synthetic opioids such as nitazenes add another risk.
The burden is not evenly spread. Drug-poisoning mortality was more than twice as high in the North East as in London, with the steepest increases reported in several areas marked by longstanding poverty and unemployment. That makes this more than a story about one drug becoming more prominent. It is also a warning about unequal access to safety, support and recovery.
Ketamine’s rise deserves attention too. Its 115 linked deaths were almost double the previous year’s figure and far above the seven recorded a decade earlier. Lower prices and more normalised use were cited alongside reports of dependence and serious health problems, including bladder damage.
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