Quick answer
Stimulant-involved deaths rose in St. Louis City in 2024 even as opioid deaths fell, and cocaine is usually mixed with fentanyl. There is no FDA-approved medication for cocaine use disorder, but contingency management and CBT work. Hopewell Center runs treatment in north St. Louis. Here is how to start.
Cocaine has no medication the way opioid use disorder does, which is why so many people feel stuck after a first attempt to stop. The honest answer is that behavioral treatment works for stimulant use disorder — and St. Louis has a provider that delivers it. In a city where cocaine is usually mixed with fentanyl, getting help for both matters.
What St. Louis City's numbers show
The UMSL-MIMH Addiction Science team reports that overall drug-involved deaths in St. Louis City fell sharply in 2024 — down 36% for the year. But the trend split by drug: its first-half 2024 report found that in the city:
- Stimulant-involved deaths rose even as opioid-involved deaths fell
- Deaths involving both opioids and stimulants increased
- Xylazine was involved in 31% of city drug-involved deaths, up from 20% in 2023
Statewide, Missouri's 2024 overdose report found stimulant-involved deaths not involving opioids fell 19%, even as combined opioid-and-stimulant deaths rose in some regions. In St. Louis, cocaine rarely travels alone.
What treatment for cocaine actually looks like
The National Institute on Drug Abuse is direct: there is no FDA-approved medication for cocaine use disorder, but behavioral treatments work.
- Contingency management — tangible rewards (vouchers, prizes, or gift cards) for verified drug-free tests. This is the strongest-performing approach for stimulant use disorder in clinical trials.
- Cognitive behavioral therapy — recognizing the situations, moods, and thoughts that trigger use, and building practical ways through them.
- Structured outpatient programs — a regular schedule, groups, and case management.
One honest caveat: program listings do not flag contingency management, so ask the question directly when you call — does this program offer contingency management for stimulant use, and how quickly can it start?
Where to get help in St. Louis
Hopewell Center, part of Betty Jean Kerr People's Health Centers, is a Certified Community Behavioral Health Clinic that has served north and central St. Louis City for more than 40 years. Its behavioral health services include:
- Substance use treatment for adults and teens, with counseling and case support
- Crisis intervention — walk-in or by phone
- Medication services, therapy, and community support
The main behavioral health locations are on Delmar Boulevard and Dr. Martin Luther King Drive in north St. Louis (314-367-7848).
The polysubstance reality
Cocaine in St. Louis is usually mixed with fentanyl, and xylazine is increasingly present too. Two practical consequences:
- Tell any program everything you use, not just cocaine. A plan that ignores the opioid part misses the most dangerous part.
- If opioids are anywhere in the picture, carry naloxone. Missouri's statewide standing order lets pharmacists dispense naloxone without a separate prescription, and free naloxone is available through GetMissouriNaloxone.com. Remember that naloxone does not reverse xylazine — call 911 and keep the person breathing.
Paying for treatment
MO HealthNet (Missouri Medicaid) covers medically necessary behavioral health treatment for substance use disorders for eligible members, including outpatient and residential care. Many members enroll through managed care plans such as Healthy Blue, Home State Health, and UnitedHealthcare Community Plan. Hopewell also serves people who are uninsured.
How to start today
- If someone shows chest pain, a seizure, or severe agitation after using, call 911 now. For a crisis, call or text 988.
- Call or text (800) 653-9376 to talk through options with a person — no pressure, no commitment:
Calling is free; the referral service is paid for by treatment providers.
- Call Hopewell Center at 314-367-7848 and ask for a substance use assessment, or walk in for crisis intervention.
- When you call a program, ask specifically about contingency management, and mention everything you use so the plan fits reality.
Stimulant use disorder is treatable, and St. Louis has providers who treat it. The first call is the hard part.
Emergency and crisis lines
Call 911 first if someone is unresponsive, seizing, overheated, or having chest pain after using. For a mental health or substance use crisis that is not a medical emergency, call or text 988, the national Suicide and Crisis Lifeline.
This page is general health information, not medical advice. It is not affiliated with or endorsed by any facility named above.
Last updated: Mon Oct 19 2026 00:00:00 GMT+0000 (Coordinated Universal Time)
Frequently asked questions
Is there a medication for cocaine addiction?
No FDA-approved medication exists for cocaine or other stimulant use disorder. Per the National Institute on Drug Abuse, treatment is behavioral: contingency management, cognitive behavioral therapy, and structured outpatient programs.
How common are stimulants in St. Louis City overdoses?
The UMSL-MIMH Addiction Science team reports that in St. Louis City, stimulant-involved deaths rose in the first half of 2024 even as opioid-involved deaths fell, and deaths involving both opioids and stimulants also increased. Cocaine and fentanyl are commonly found together.
What is contingency management and does it work?
Contingency management gives concrete rewards - vouchers, prizes, or gift cards - when drug tests come back negative. It has the strongest evidence base for stimulant use disorder. Programs do not always advertise it, so ask directly when you call.
Where can I get help with cocaine use in St. Louis?
Hopewell Center, part of Betty Jean Kerr People's Health Centers, is a Certified Community Behavioral Health Clinic serving north and central St. Louis City, with substance use treatment for adults and teens, counseling, case support, and walk-in or phone crisis intervention.
What should I do in a stimulant emergency?
Call 911 if someone has chest pain, a seizure, very high body temperature, severe agitation, or is unresponsive. For a mental health or substance use crisis, call or text 988, or call or text (800) 653-9376.