Background: Increased cocaine supply has coincided with increased global cocaine use. In 2019 Ireland had one of the highest last-year rates of cocaine use in Europe. However, there is a lack of data on the health-related impacts of cocaine use in European countries over time.

Methods: This retrospective, multi-source database study utilised data from national databases to evaluate the following time trends: (1) prevalence of cocaine use; (2) number of cocaine-related hospital discharges; (3) number of cocaine-related psychiatric hospital admissions; (4) treatment demand for problem cocaine use; and (5) cocaine-related deaths. Joinpoint regression was used to examine change points over time and average annual percentage changes (AAPCs).

Results: Last-year cocaine use among 15–64-year-olds increased from 1·1% in 2002/03 to 2·4% in 2022/23. The number of cocaine-related acute hospital discharges per 100,000 population increased from 1·4 in 2000 to 24·3 in 2023 (AAPC: 13·0%; 95% CI: 11·95, 14·84), and psychiatric hospitalisations increased from 0·2 in 2000 to 2·4 in 2022 (AAPC: 11·1%; 95% CI: 9·41, 15·48). Treatment entrants reporting cocaine as a main problem drug increased from 1·5 per 100,000 population in 2000 to 93·2 in 2023 (AAPC: 17·6%; 95% CI: 15·89, 20·74), while cocaine-related deaths increased from 0·3 in 2000 to 5·6 in 2020 (AAPC: 16·9%; 95% CI: 14·71, 21·70). In general, rates of harm increased from 2000 to 2007, decreased until 2011–2013, and since 2013 have increased significantly and consistently.

Conclusions: Multiple databases show significant increases in cocaine-related harm since 2000. Responding to cocaine-related health problems and prevention efforts focused on cocaine constitute a public health priority.