LONDON — Cocaine has overtaken heroin as the drug most often named in fatal drug poisonings in England and Wales, according to new official figures published on 4 November 2026, in a landmark shift that charities say exposes the failure of decades of drug policy. The Office for National Statistics (ONS) recorded 1,233 deaths in which cocaine was mentioned in 2025, narrowly ahead of the 1,210 deaths involving heroin or morphine, the first time cocaine has topped the list since the ONS series began in 1993.
The figures also contain a rare piece of better news: the overall drug-poisoning death rate fell for the first time since 2012. A total of 5,519 deaths related to drug poisoning were registered in England and Wales in 2025, 46 fewer than the 5,565 registered in 2024. But charities warned that the small decline should not be mistaken for a turning point, with deaths remaining roughly double the level of a decade ago and cocaine deaths more than eight times higher than in 2010.
Illustration: A stylised bar chart rising over a map of England and Wales, with one tall column standing out above the rest, representing cocaine's rise to the top of the drug-death figures.
What Happened
The ONS published its annual report on deaths related to drug poisoning in England and Wales on Wednesday, 4 November 2026, covering deaths registered in 2025. The headline finding was the changing of the guard at the top of the list of individual substances: cocaine was mentioned in 1,233 deaths, making it the most frequently mentioned specific substance for the first time in the 32-year history of the series. Heroin or morphine, which had long dominated the figures, was mentioned in 1,210 deaths, down sharply from 1,415 in 2024.
Cocaine deaths themselves actually fell slightly, from 1,279 in 2024 to 1,233 in 2025. But the longer trend is stark. Cocaine was involved in just 144 deaths in 2010, meaning the 2025 figure is more than eight times higher. Deaths linked to the drug have nearly quadrupled in a decade, and cocaine was mentioned in about 22 per cent of all drug-poisoning deaths registered in 2025. The ONS figures cover cocaine in all its forms, including powder cocaine, crack cocaine that is smoked, and cases in which the drug was injected.
The wider picture was more mixed. Opiates and opioids remained the most commonly mentioned group of substances overall, appearing in 2,324 deaths in 2025, down from 2,621 in 2024. Deaths related to drug misuse — a narrower category involving drug dependence or controlled drugs — also fell, with 3,615 deaths registered in 2025.
The report also flagged a sharp rise in deaths involving ketamine, mentioned in a record 115 deaths in 2025, almost twice as many as the year before and up from 27 in 2020 and just seven in 2015. Deaths involving nitazenes, a group of synthetic opioids far more powerful than heroin, fell from 195 to 150, although that is still almost three times the 52 deaths recorded in 2023.
People aged 40 to 49 had the highest drug-poisoning death rate of any age group, at 141.4 deaths per million. The North East of England again recorded the highest rate among English regions, at 135.2 deaths per million people, although that was down sharply from 167.6 in 2024 and was the largest decrease of any English region. London had the lowest rate, at 58.3 deaths per million. Wales recorded a rate of 141.3 deaths per million, compared with 89.5 per million in England.
The ONS also cautioned that the figures are incomplete in two important ways. Nearly a quarter of drug-poisoning deaths in 2025 — 22.5 per cent, or 1,244 deaths — had no specific substance recorded, so the figures for individual drugs may be underestimates. And almost two-thirds of the deaths registered in 2025, 62.7 per cent or 3,460 deaths, actually occurred in earlier years, reflecting delays linked to coroners' inquests.
Background
The rise of cocaine to the top of the death figures has been years in the making, and charities say it reflects a transformation in the drug itself: it has become cheaper, purer and far more widely available. Record production levels in South America have flooded the market, and the drug that was once regarded as a luxury for the wealthy is now, in the words of the treatment charity WithYou, "increasingly socially acceptable" and available in ever smaller amounts across the country.
Robin Pollard, head of policy at WithYou, said the change was visible in every area where the charity delivers services. "Across almost all areas where WithYou delivers services, we hear that cocaine has become far more prevalent," he said. "Whereas before 2020, we typically would have seen the price of a gram of cocaine being around £100, it is much more common to hear it being available for £60 a gram or less now, and available to buy in ever smaller amounts. It has also become easier to purchase in all parts of the country, has become increasingly socially acceptable and of higher purity."
Greater purity means greater potency, and greater potency means greater risk. Mike Trace, chief executive of the social justice charity Forward Trust, described the situation as a "perfect storm" of record production in South America, falling prices and rising purity. "We're facing the perfect storm of record levels of production in South America leading to falling prices combined with increasing purity, which means increasing potency and risk," he said. "We know that increasingly potent drugs like nitazenes are making their way on to the market. We know that established drugs like cocaine are growing in purity which means they come with much higher risks to users."
The figures arrive against a backdrop of long-running debate about Britain's approach to drugs. An independent review led by Professor Dame Carol Black, commissioned by Boris Johnson's government and published in 2021, recommended a major overhaul of drug treatment services. Charities say many of those recommendations remain unimplemented, and Will Haydock, chief executive of the drug treatment campaigning charity Collective Voice, warned that improvements made in earlier years were now at risk "due to government inaction".
The contrast with Scotland underlines how uneven the picture is across the United Kingdom. Figures published by National Records of Scotland in September 2026 showed that drug deaths there rose by 11 per cent in 2025, to 1,133 deaths — 116 more than in 2024 — giving Scotland the worst drug mortality rate in Europe. Nitazenes were implicated in 247 deaths in Scotland, in contrast to the fall seen in England and Wales.
Drug-checking services, which allow people to have substances tested so they know what they are taking, have spread only slowly. England's first permanent drug-checking service opened in Bristol in 2024, run by the charity The Loop, and more have since opened in community settings across London. Scotland's first drug-checking service, planned for Glasgow and due to open in October 2026, has been delayed, according to The Pharmaceutical Journal.
Illustration: A community addiction support centre in the United Kingdom, with a counsellor's desk, a cup of tea and a noticeboard, in calm blue and green tones.
Why It Matters
The headline — cocaine overtaking heroin — matters because it signals a change in who is dying and why. For decades, Britain's drug-death crisis was overwhelmingly a story of heroin and an ageing population of opioid users. The new figures show a stimulant that is used far more widely, and far more casually, now killing more people than any other single drug.
The numbers also matter because they show how little has changed despite years of warnings. The overall death rate fell for the first time since 2012, but only slightly, and it remains historically high — roughly double the level of a decade ago. Dr James Morgan, who specialises in addiction and mental health at London Metropolitan University, cautioned against overinterpreting the small decline in cocaine-linked deaths, saying that while there had been a slight decrease, "the numbers remain objectively high".
The ketamine figures are a warning of a second front opening up. Deaths mentioning ketamine have risen from seven in 2015 to 115 in 2025, and Dr Morgan attributed the rise to lower prices and the drug's use becoming normalised.
The regional pattern matters too. The North East has now recorded the highest drug-poisoning mortality rate in England for years, even after its sharp fall in 2025, while Wales records a higher rate than England as a whole. The geography of drug deaths tracks closely with deprivation, unemployment and poor mental health, and charities argue that the crisis cannot be separated from those wider problems. The Guardian also reported last week that police were recording a growing number of crimes linked to cocaine, including assaults, domestic abuse and dangerous driving — a reminder that the drug's harms extend well beyond the people who take it.
Above all, the figures matter because, as the charities stress, these are preventable deaths. Simon Phillips, chief executive of the drug and alcohol treatment provider WithYou, put it bluntly in the charity's response to the figures: "These deaths were preventable. Each number is a person, with family, friends, and a future, and their loss is felt every day. My thoughts are with them today. Any fall is welcome, but even one life lost is too many. These deaths are preventable with the right support, treatment and policy-making." This article is general information about a public health report, not medical advice, and anyone worried about their own drug use or that of someone close to them should seek help from a health professional or a support service.
What Happens Next
Charities are using the release of the figures to press the government for a new drugs strategy with clear priorities, including a target to reduce drug-related deaths. Their demands are specific. WithYou's Simon Phillips called for a dedicated drugs minister with the authority to drive action across central government, pointing out that responsibility for drugs policy is currently spread across at least six government departments with no single minister in charge. Dame Carol Black's 2021 review recommended appointing a single responsible minister to hold the government to account, a recommendation Phillips urged the government to adopt.
Phillips also called for a national drug-checking service in England, saying the government "should set one up urgently", and for naloxone — the medicine that reverses opioid overdoses — to be made easy to obtain for anyone who might need it. He further urged the government to allow overdose prevention centres "where people are injecting in public, so people can use drugs under supervision and be connected to treatment".
"There's no single quick fix for this complex problem," Phillips said. "The best way to tackle it is with a joined-up approach that focuses on saving lives now, helping people recover over time, and addressing the root causes for the future. Drug deaths don't exist in a vacuum. They're bound up with homelessness, poverty, poor mental health, unemployment, crime and the pressure on the NHS, and the government can't meet its goals on any of these without taking drug harm seriously."
Niamh Eastwood, executive director of Release, the UK's national centre of expertise on drugs and drug laws, went further, describing cocaine deaths as "a direct result of policy failures both in the UK and internationally". She said: "Cocaine production is at an all-time high; it's more available, cheaper and purer than ever, despite billions spent on trying to disrupt or eradicate the trade."
Mike Trace of the Forward Trust called the overall drug-related death rate "a national scandal" that needed urgent attention, while Clare Taylor, chief operating officer at Turning Point, said the prominence of cocaine in the statistics was "a massive cause for concern and demonstrates the urgent need for a stronger public health response". Scott Barnes, chief executive of Addictions North East, welcomed any reduction but warned that the region "continuing to record the highest rate in England shows the scale of the challenge we still face".
Whether the government responds with the strategy charities want remains to be seen. The figures will also be watched for what they say about the year ahead: the ONS cautioned that registration delays mean the 2025 figures partly reflect deaths from earlier years, so the full effect of the current drug supply — including the spread of nitazenes and the rising purity of cocaine — may not yet be visible.
Illustration: A northern English city skyline at dusk, with terraced houses and a river bridge under a single warm streetlight, in muted teal and amber tones.
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FAQ
How many cocaine deaths were recorded in England and Wales in 2025?
Cocaine was mentioned in 1,233 deaths registered in 2025, according to the Office for National Statistics. That made it the most frequently mentioned specific substance for the first time since the ONS series began in 1993, ahead of heroin or morphine at 1,210 deaths.
Did the overall number of drug deaths fall?
Yes, slightly. A total of 5,519 deaths related to drug poisoning were registered in 2025, 46 fewer than the 5,565 registered in 2024. The age-standardised rate fell from 93.9 to 92.4 deaths per million people, the first annual fall since 2012. Charities cautioned, however, that deaths remain roughly double the level of a decade ago.
Why has cocaine overtaken heroin?
Charities point to record cocaine production in South America, which has made the drug cheaper, purer and more widely available. WithYou said a gram that typically cost around £100 before 2020 is now commonly available for £60 or less. Greater purity means greater potency and greater risk for users, according to the Forward Trust.
Which region has the highest drug-death rate?
The North East of England had the highest rate among English regions, at 135.2 deaths per million people in 2025, although that was down from 167.6 in 2024. London had the lowest rate, at 58.3 deaths per million. Wales recorded 141.3 deaths per million, compared with 89.5 per million in England.
What are charities calling for?
Charities are calling for a new drugs strategy, a dedicated drugs minister, a national drug-checking service in England, easier access to the overdose-reversing medicine naloxone, and overdose prevention centres. WithYou's chief executive, Simon Phillips, said the deaths were preventable "with the right support, treatment and policy-making".
Sources
- Office for National Statistics, "Deaths related to drug poisoning in England and Wales: 2025 registrations" — annual report published 4 November 2026 (via BBC News, The Pharmaceutical Journal and WithYou, 4–5 November 2026).
- BBC News, "Cocaine overtakes heroin as leading cause of drug deaths in England and Wales" — 4 November 2026.
- The Pharmaceutical Journal, "Drug poisoning deaths fall in England and Wales for first time since 2012, ONS figures show" — 4 November 2026.
- WithYou, "WithYou responds to the ONS statistics on drug-related deaths in 2025" — 4 November 2026.
- The Guardian (via EuropeSays), "Cocaine overtakes heroin as leading cause of drug deaths in England and Wales" — 4 November 2026.
- National Records of Scotland drug-related deaths figures for 2025, published September 2026 (as reported by The Pharmaceutical Journal, 4 November 2026).
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