Deaths (68) associated with the recreational use of illicit cocaine were investigated by the Medical Examiner''s Office of Dade County, Florida [USA]. Most fatalities occurred since 1975. Although 29 involved the use of other drugs (usually heroin), 24 persons died directly of the toxic effects of cocaine. Respiratory collapse and death occurred rapidly after the i.v. injection of cocaine. Oral or nasal ingestion resulted in a symptom-free interval lasting as long as an hour followed suddenly by generalized seizures and death. Toxicological analysis could not causally relate lidocaine HCl or other adulterants to the untoward reactions. The rate of absorption, the peak blood concentration and the prior use of cocaine all apparently contribute to the possibility of a fatal reaction. Despite current belief, cocaine cannot be considered a safe recreational drug.