Cocaine in medicine: A historical perspective on its medical uses

Few substances in medical history have undergone such a dramatic transformation as cocaine. It used to be available at pharmacies without a prescription, promoted as a cure for various ailments, including sore throats. Today, it’s viewed as a controversial and dangerous drug, but did you know it’s still medically legal in some countries like the USA?

Join us as we explore the ups and downs of cocaine’s medical journey, uncovering the factors that have shaped its evolving role in medicine, from science and regulations to societal attitudes.

The coca leaf

Coca use has a long history in South and Central America, dating back to at least 1000 BC.
Under Incan rule, coca played a significant role in the culture and daily life of the Inca civilisation. It was believed to have healing properties and was used to alleviate various ailments, including altitude sickness, fatigue, and digestive issues. Coca leaves also served as a perceived source of essential nutrients and energy for the Inca people, especially in high-altitude regions where other crops were less abundant.

When the Spanish conquered the Incas in 1532, they initially tried to eliminate its use. However, this proved unsuccessful, and instead, the Spanish began to exploit coca cultivation. It became a common practice to provide agricultural workers with coca leaves as part of their daily wages. This tradition continued in the Andean region.

Cocaine’s medical history

In the 16th and 17th centuries, coca leaves gained some interest in Europe for their potential medicinal properties, particularly as stimulants and anaesthetics. However, the active alkaloid in coca, cocaine, was not isolated or widely studied.

It wasn’t until the 19th Century that cocaine was first isolated from coca leaves.

In 1860, a German chemist named Albert Niemann successfully isolated the pure alkaloid cocaine from coca leaves. This meant powder cocaine could be used rather than chewing the whole coca leaf. Niemann’s work paved the way for a deeper understanding of the substance’s properties and potential applications.


Cocaine medical bottle

Source: BBC

In 1880, Basil von Anrep presented his research findings after administering cocaine to humans. He found that cocaine was a useful anaesthetic in surgical procedures. However, it wasn’t until 1884 that Carl Koller conducted experiments that demonstrated the medical advantages of employing cocaine, particularly in the field of ophthalmology.

He conducted his first public demonstration of cocaine’s effectiveness in April 1884 during a meeting of the German Ophthalmological Society in Heidelberg. Koller applied a cocaine solution to a patient’s eye, allowing the patient to undergo painless eye surgery while fully conscious.

Koller’s groundbreaking work shed light on the effectiveness of cocaine as a medical tool, highlighting its remarkable utility in various eye-related procedures. This discovery sparked a rapid and widespread interest among the medical community. Within a mere couple of months, after Koller’s findings were made public, the medical world enthusiastically embraced the use of cocaine to provide localised anaesthesia in various medical contexts. The acceptance idea marked a significant turning point in the history of medical practice and anaesthesia.

But it wasn’t just praised for its surgical benefits. In the British Medical Journal, editorials explored the potential therapeutic attributes of whole coca, while the works of Sigmund Freud hinted at the possibility that complete coca could serve as a versatile psychological remedy.

As the 1900s dawned, troubling reports began to emerge regarding the addictive nature of cocaine. Physicians and researchers observed that patients who were exposed to cocaine for anaesthesia purposes often developed a strong craving for the drug, leading to addiction and its associated health problems. In the USA alone, there were thought to be approximately 200,000 people addicted to cocaine in 1902, highlighting the high potential for addiction.

The medical community faced a moral dilemma. On one hand, cocaine was an excellent anaesthetic, relieving pain during procedures. On the other hand, its potential for addiction and harm to patients’ well-being posed a grave ethical concern for healthcare providers.

Due to these issues, medical usage of cocaine plummeted during the early 20th Century. Advancements in medical science led to the development of alternative anaesthetic agents, such as synthetic compounds like novocaine and lidocaine. These substances were found to be less addictive and safer for patients.

Cocaine in over-the-counter medicine

Cocaine pastilles

Source: BBC

Did you know that cocaine was once an ingredient in products readily available over the counter in pharmacies? While many know its presence in Coca-Cola, few may realise it was also included in throat lozenges and wine. Due to unregulated advertising and no laws on selling cocaine, numerous products containing the drug were sold freely, promising healing properties and mood-enhancing effects.

The image above displays throat pastilles, which contained menthol and cocaine. The recommended usage was once every two hours or ‘as directed by the physician.’ Surprisingly, these pastilles were available over the counter and entirely legal to purchase.

The addition of cocaine wasn’t the only eyebrow-raising ingredient. These pastilles also contained formaldehyde, known for its cancer-promoting properties, and borax, a toxic food additive. Despite these questionable ingredients, they were advertised to be ‘very efficacious.’

Even high street stores were involved in selling questionable products. In London during 1916, Harrods sold a ‘kit’ named ‘A Welcome Present for Friends at the Front,’ which contained cocaine, morphine, syringes, and needles. It’s presumed that these kits were marketed to soldiers returning from WW1.

Cocaine Toothache drops
Source: Pharmacy Times

Here, we encounter another intriguing chapter in the history of advertising and cocaine use: cocaine toothache drops! It’s proposed that these drops were effective in numbing toothache pain, adding to the allure of this product.

Vin Mariani was a popular tonic wine that gained fame in the late 19th and early 20th centuries. It was created by Angelo Mariani, a French chemist, in the 1860s. Vin Mariani was essentially a combination of red Bordeaux wine and coca leaves containing the stimulant cocaine.

The coca leaves in Vin Mariani provided a stimulating effect, and the wine was marketed as a medicinal and energising drink. It gained popularity for its supposed health benefits and because various public figures, including Pope Leo XIII and Thomas Edison, endorsed it. In fact, Pope Leo XIII awarded a Vatican gold medal to Vin Mariani, and Thomas Edison even created an advertising jingle for it.

However, as the harmful and addictive nature of cocaine became more widely recognised, Vin Mariani’s popularity declined.

Cocaine prohibition

In the early 20th Century, many countries began regulating and eventually banning the sale of cocaine-containing products, which led to the discontinuation of Vin Mariani and other ‘medicinal’ products.

Below is a table of when cocaine was banned for sale in different countries.
*We have approximate dates due to the difficulty in confirming the exact date different countries banned cocaine.*

Country Approximate Date of Cocaine Prohibition
United States Early 20th Century (e.g., 1914)
United Kingdom 1920s
Canada 1908 (initial regulations)
Australia 1905 (initial regulations)
Brazil 1938 (initial regulations)
Argentina Early 20th Century
Colombia 1923 (initial regulations)
Mexico Early 20th Century (e.g., 1931)
Peru 1949 (initial regulations)
Chile 1920s
France 1916 (initial regulations)
Germany 1929 (initial regulations)
Russia 1924 (initial regulations)
China 1914 (initial regulations)
Japan 1951 (initial regulations)

Cocaine uses in modern day medical practices

Despite cocaine’s negative effects if recreationally abused, some countries still legally allow the drug to be used for medical use only.

The following countries are:

  • Australia
  • Canada
  • Germany
  • Greece
  • USA

It must be noted that the use of cocaine in medical procedures is rare nowadays, but it is usually used in the following:

Medical Application Description
Local Anaesthetic Cocaine hydrochloride topical solution, containing 4% cocaine, is employed by healthcare professionals as a local anaesthetic. Due to its numbing properties, it is particularly effective for surgical procedures involving the nose, throat, and upper airways.
Vasoconstrictor Cocaine hydrochloride functions as a vasoconstrictor, meaning it narrows blood vessels. Healthcare professionals can utilise it in specific medical procedures to manage bleeding by reducing blood flow to the site.
Diagnostic Aid Historically, healthcare professionals have used cocaine hydrochloride as a diagnostic aid for specific medical conditions. It can be applied topically to the nasal passages to assist in diagnosing and treating certain bleeding disorders. Constricting blood vessels helps identify the source of bleeding by reducing blood flow.

Data sourced from:

Are you suffering from issues with cocaine?

If you or someone you know is struggling with cocaine addiction, UKAT is here to help. Our in-house rehab programmes offer comprehensive support, including safe and supervised detoxification to manage withdrawal symptoms. Our dedicated team of experts provides tailored rehabilitation, addressing the physical and psychological aspects of addiction. At UKAT, we are committed to helping you or your loved one regain control and lead a healthier, drug-free life. Don’t wait; reach out to Sanctuary Lodge for compassionate and effective care. Your journey to a cocaine-free life starts here.

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