Tuberculosis (TB) remains a significant global health burden, with substance abuse being a common comorbidity. Cocaine-derived drugs, particularly crack and cocaine hydrochloride, have been associated with poor TB treatment outcomes. Objective: This systematic review aimed to synthesize the evidence on the relationship between crack or cocaine hydrochloride use and TB treatment outcomes. Materials and methods: A comprehensive search was conducted across multiple databases (PubMed, Ovid, EBSCOhost, Lilacs, and Google Scholar) using structured search terms. Eligible studies were included in a meta-analysis performed using STATA 16. Results: Five studies were included in the analysis. Overall, crack or cocaine use was associated with a higher risk of loss to follow-up or non-completion of TB treatment (OR = 2.73; 95% CI: 1.33-5.61). In the subgroup of individuals with active TB, this associ...