There have been increased numbers of cocaine-related deaths reported in some European countries since the early 1990s and there are indications that cocaine deaths are more difficult to define, detect and record as such in mortality registries, and more particularly in some countries’ General Mortality Registries due to coding practices. This project aimed to describe the trend in numbers of cocaine-related deaths reported to mortality registries over 15 years in some European countries. In addition, it aimed to provide information on the demographic and drug-use characteristics of recent cases. Nineteen countries responded to a survey on cocaine- related deaths. The identification and coding of cocaine-related deaths varies across registers and across countries. The study shows that during the 2000s there was an increasing upward trend in the numbers of these deaths, followed by a decline in most countries. By far, most deaths were reported in the UK and Spain. Most victims were males (7–9 in 10), in their late 20s or early 30s, having often used cocaine with opioids and sometimes with more drugs. Most of the reported cases died of an overdose. The report also calls for further examination of deaths indirectly related to cocaine use.