Erythroxylum coca, the source of cocaine, is renowned in toxicology and medicine for its ritual use by ancient cultures, traditional use by modern indigenous peoples, role as the first pharmaceutical local anesthetic, and notorious use as an illicit drug of abuse. The molecule benzoylmethylecgonine (cocaine) highlights the complex structure of a plant alkaloid. At the cellular level, cocaine is a remarkable drug that blocks the reuptake of neurotransmitters (dopamine, norepinephrine, epinephrine, and serotonin), blocks neuronal and cardiac sodium channels, and causes vasoconstriction. The cardiotoxic effects are demonstrated on the electrocardiogram, which shows a classic ST segment anterior wall myocardial infarction in a young person who recently used cocaine. Although a true antidote to cocaine toxicity has yet to be developed, the vial represents the benzodiazepines, which have become the mainstay of therapy for psychomotor agitation that results from typical cocaine overdose.