There have been many reported cases of complications such as hypertensive emergencies, strokes, myocardial infarctions and deaths arising from cocaine use. In this case report, we present a rare complication arising from chronic cocaine use. A 58 year old male with past medical history of hypertension, chronic obstructive pulmonary disease (COPD) and cocaine abuse, presented to the emergency department because of acute onset difficulty in breathing. Review of systems was positive for chronic right knee pain. His blood pressure was found to be elevated and his urine toxicology screen was positive for cocaine and amphetamines. Cocaine induced bronchospasm with COPD exacerbation was diagnosed and the patient was admitted to the pulmonology floor and was started on nebulization treatments, steroids and doxycycline. A right knee X-ray was obtained to evaluate patient’s chronic knee pain which showed multiple areas of necrosis in femur and fibula, suggestive of cocaine induced osteonecrosis.