During the last several years, a clearer understanding of cocaine's effects on the body has emerged. Metabolism and tissue distribution are better understood. A diverse group of cocaine-related illnesses have been reported, but many appear to share the underlying mechanism of catecholamine toxicity. Knowledge of cocaine's metabolism makes possible certain conclusions about route of ingestion, time of use, and patterns of abuse in general. Knowledge of the histologic alterations known to be associated with cocaine use can pinpoint cocaine as the cause of death, even in cases where there are negligible blood levels. What follows is a brief review of recent observations that bear on the forensic aspects of cocaine abuse.