Cocaine was linked to more registered drug poisoning deaths than heroin or morphine in England and Wales for the first time in 2025, despite a small annual fall in cocaine-related fatalities.

Office for National Statistics figures recorded 1,233 deaths mentioning cocaine, against 1,210 involving heroin or morphine, also down on the previous year. Cocaine featured in more than one in five drug poisoning deaths, more than any other single substance. Opiates and opioids combined, however, remained linked to more deaths. The figures cover registrations, which can lag behind the deaths themselves.

Overall, 5,519 drug poisoning deaths were registered. The mortality rate fell from 93.9 to 92.4 per million people, its first annual decline since 2012. Yet total deaths have roughly doubled since then, while cocaine-linked deaths remain nearly four times their 2015 level.

Dr James Morgan, an addiction and mental health specialist at London Metropolitan University, cautioned against over-interpreting the cocaine decline. The figures include people who snort cocaine, inject it or smoke crack alongside opioids or counterfeit pharmaceuticals.

The national fall also conceals widening geographical inequalities. Mortality in the North East was more than twice London’s rate. The steepest increases were in formerly industrial areas marked by poverty and unemployment dating to the 1980s, including Wales, Yorkshire and the Humber, the North West and East Midlands.

Morgan said poorer regions were falling further behind more affluent areas.

Ketamine was mentioned in a record 115 deaths, almost twice the 2024 figure and up from seven a decade earlier. Morgan attributed this to lower prices and increasingly normalised use, citing reports of young people developing dependence and acute health problems, including bladder damage.

Charities blamed cocaine’s increasing purity and availability. Mike Trace, chief executive of Forward Trust, also highlighted nitazenes, synthetic opioids that can be many times more potent than heroin and have been linked to hundreds of UK deaths.

Elsewhere, National Records of Scotland said in September that drug deaths rose 11% in 2025, leaving Scotland with Europe’s worst mortality rate. Northern Ireland’s statistics agency reported in May a 7.1% rise between 2021–23 and 2022–24.

For bereaved families, the substances involved can remain uncertain. Anthony Irvin died from drug poisoning in Ramsgate in September 2025, aged 52. His siblings, Tom Powell and Nyk Irvin, believe synthetic opioids contaminated his drugs, but say blood-testing delays mean they will never know for sure.

“We are fighting to wake people up to the scale of the problem,” Powell said.