Cocaine (benzoylmethylecgonine) remains one of the world’s most widely abused illicit stimulants despite decades of enforcement, public‑health campaigns, and scientific research. This paper reviews the drug’s pharmacology, epidemiology, socio‑economic impact, and the current state of treatment and policy, with a focus on the question implicit in the Albanian‑English phrase “Is John using cocaine now?” – i.e., how clinicians, policymakers, and communities can identify and intervene in acute cocaine use. A narrative literature review of peer‑reviewed sources (1990‑2024) was performed. Findings indicate that cocaine’s rapid onset of central‑nervous‑system (CNS) stimulation, high addiction potential, and acute cardiovascular toxicity pose a unique challenge for rapid detection and intervention. Emerging biomarkers (e.g., salivary benzoylecgonine) and point‑of‑care testing devices show promise for real‑time identification, while integrated psychosocial‑behavioral therapies remain the most effective long‑term treatment. Recommendations for research, clinical practice, and policy are presented. 1. Introduction Cocaine is a naturally occurring alkaloid extracted from the leaves of Erythroxylon coca (L.) (World Health Organization, 2022). Historically used in South American indigenous cultures for its stimulant properties, the compound entered the global market in the late 19th century as a legal medicinal agent and recreational drug (Musto, 1999). By the mid‑20th century it had become a controlled substance in most jurisdictions (UNODC, 2021).

*Values drawn from validation studies (Kumar et al., 2021; García‑López et al., 2023).