Cocaine shortage: What providers and prescribers need to know in 2026

Cocaine Hydrochloride Shortage: What Providers Need to Know in 2026

Healthcare providers who rely on Cocaine Hydrochloride topical nasal solution for diagnostic and surgical procedures continue to face supply challenges in 2026. This guide provides a comprehensive overview of the current shortage, its root causes, clinical alternatives, and practical sourcing strategies for ENT surgeons, ophthalmologists, anesthesiologists, and other specialists.

Current Supply Status

As of early 2026, Cocaine Hydrochloride topical solution remains in limited and inconsistent supply across the United States. The two FDA-approved products — Goprelto (4% solution, Genus Lifesciences / Noden Pharma) and Numbrino (4% and 10% solutions, Omnivium Pharmaceuticals) — are the sole legal sources of this medication.

Supply disruptions have been a persistent challenge since 2019, and the structural factors driving the shortage show no signs of quick resolution. Providers should plan for ongoing supply variability and maintain familiarity with alternative protocols.

Root Causes of the Shortage

The Cocaine Hydrochloride shortage is driven by a convergence of regulatory and market factors:

1. Limited Manufacturer Base

With only two FDA-approved manufacturers, the market has virtually no buffer capacity. Any production disruption at either facility can cascade into widespread shortages. Unlike most pharmaceutical markets, new entrants face extraordinary barriers due to the controlled substance designation.

2. DEA Schedule II Manufacturing Quotas

The DEA sets annual aggregate production quotas (APQ) and individual manufacturing quotas (IMQ) for Schedule II substances, including Cocaine. These quotas are designed to prevent diversion but can constrain medical supply. Manufacturers must apply for quota adjustments, a process that can lag behind actual clinical demand.

3. 2019 FDA Enforcement Action

In 2019, the FDA directed companies marketing unapproved cocaine hydrochloride solution products to cease distribution. While this enforcement action improved product quality and safety, it eliminated several supply sources that the medical community had relied upon for decades. The previously marketed product C-Topical (Lannett Company) was among those affected.

4. Raw Material Constraints

The number of approved suppliers of pharmaceutical-grade cocaine as a raw ingredient is extremely limited. This creates an additional bottleneck in the supply chain that is difficult for manufacturers to work around.

Clinical Impact

Cocaine Hydrochloride remains the only local anesthetic with intrinsic vasoconstrictive properties. Its dual mechanism — sodium channel blockade for anesthesia and norepinephrine reuptake inhibition for vasoconstriction — makes it particularly valued in:

• Septoplasty and rhinoplasty
• Functional endoscopic sinus surgery (FESS)
• Nasal polypectomy
• Nasal packing procedures
• Diagnostic nasal endoscopy
• Dacryocystorhinostomy (DCR) in ophthalmology

When Cocaine Hydrochloride is unavailable, providers must use combination agents that separately address anesthesia and vasoconstriction, which may alter procedural workflow and timing.

Evidence-Based Alternatives

When Cocaine Hydrochloride is unavailable, the following alternatives have clinical evidence supporting their use in nasal procedures:

Lidocaine + Oxymetazoline

This is the most widely used alternative combination. Topical Lidocaine (4%) provides mucosal anesthesia while Oxymetazoline (0.05%) delivers vasoconstriction. A study comparing Lidocaine/Oxymetazoline to Cocaine found comparable operative field quality, though preparation requires two separate agents.

Tetracaine + Oxymetazoline

Research published in Anesthesia & Analgesia demonstrated that Tetracaine combined with Oxymetazoline provided superior pain reduction compared to both Cocaine and Lidocaine at 10 and 30 minutes post-application. This combination may be preferred when maximal mucosal anesthesia is desired.

Co-Phenylcaine (Lidocaine + Phenylephrine)

Widely used in ENT practice internationally, this combination spray provides concurrent anesthesia and vasoconstriction. Availability in the US may be limited, but the individual components can be prepared.

Xylometazoline + Lidocaine

Clinical studies have demonstrated comparable vasoconstriction and anesthetic efficacy to Cocaine when these agents are combined. Alternative analgesics may take preference over Cocaine due to decreased risk of cardiovascular adverse events.

Sourcing Strategies

To maximize your chances of obtaining Cocaine Hydrochloride for your practice or facility:

1. Check Both Branded Products

Always inquire about both Goprelto and Numbrino with your distributors. Availability may differ between the two products at any given time.

2. Engage Your GPO

Group purchasing organizations may have contracted supply arrangements that provide priority access during shortages. Contact your GPO representative to understand your facility's position.

3. Use MedFinder for Providers

Visit medfinder.com/providers to access provider-specific tools for tracking medication availability. MedFinder can help you identify supply sources and connect with facilities that may have product available.

4. Contact Manufacturers Directly

In some cases, reaching out to Genus Lifesciences (Goprelto) or Omnivium Pharmaceuticals (Numbrino) directly may provide information about expected shipment timelines or allocation programs.

5. Establish Alternative Protocols

Develop and maintain standing protocols for alternative anesthetic combinations so your team can pivot quickly when Cocaine Hydrochloride is unavailable. Ensure all surgical team members are familiar with preparation and administration of alternative agents.

Regulatory Considerations

Providers should be aware of the following regulatory points:

• DEA registration: Facilities must maintain appropriate DEA registration to order, store, and administer Schedule II controlled substances
• Documentation: Strict record-keeping requirements apply to all Cocaine Hydrochloride inventory, including administration logs and waste documentation
• No compounding of cocaine: Compounding pharmacies may not compound cocaine hydrochloride products; only FDA-approved products should be used
• Maximum dosing: The recommended maximum dose is 3 mg/kg per procedure for both Goprelto and Numbrino

Patient Communication

When discussing the shortage with patients, consider sharing these resources:

• Cocaine shortage update: What patients need to know in 2026
• Alternatives to Cocaine if you can't fill your prescription
• How to find Cocaine in stock near you

For a comprehensive guide on helping patients navigate this shortage, see our article: How to help your patients find Cocaine in stock.

Looking Ahead

The Cocaine Hydrochloride shortage is unlikely to resolve quickly given the structural barriers to new market entry. Providers should:

• Maintain proficiency with alternative anesthetic protocols
• Monitor ASHP and FDA shortage databases for updates
• Advocate for regulatory adjustments that could improve supply without compromising safety
• Use tools like MedFinder for Providers to stay ahead of supply fluctuations

Additional Resources

• How to help patients save money on Cocaine: A provider's guide
• Cocaine drug interactions: What to avoid
• What is Cocaine? Uses, dosage, and what you need to know
• ASHP Current Drug Shortages