Over the past decade, the prevalence of cocaine use has remained relatively stable in some countries of South America while increasing in others. However, the most recent data from countries where available show signs of stabilization.

• A wide variety of cocaine products are used in the region, contributing to differing patterns of use and harm. As in other parts of the world, men have a higher prevalence of cocaine use than women, though the divide varies across countries.
• Among youth, sex differences are more pronounced for cocaine hydrochloride use compared to other cocaine products.
• Chile is the only country with data showing a sharp decrease in the prevalence of use in 2020, likely related to COVID-19 related restrictions. Brazil has recorded a considerable increase in deaths attributed to cocaine use disorders since 2020, with another sharp increase in 2024. Although this trend may be influenced by reporting practices, and hence needs to be interpreted with caution, it aligns with increasing amounts of cocaine detected in wastewater in several cities of the country. A rise in harms could reflect developments in use patterns or higher-purity products.