North American investigators systematically reviewed and meta-analysed the RCTs of acupuncture for the treatment of cocaine addiction. Two reviewers independently searched 10 databases. Unpublished studies were sought using the http://www.clinicaltrials.gov, the UK National Research Register and contacting content experts. Eligible studies enrolled patients with the diagnosis of cocaine dependence of any duration or severity randomly allocated to either acupuncture or sham or other control. Studies of acupuncture methods and trials enrolling patients with polysubstance use or dependence were excluded. Nine studies enrolling 1747 participants met inclusion criteria; seven provided details for biochemical confirmation of cocaine abstinence. On average, trials lost 50% of enrolled participants (range 0–63%). The pooled OR estimating the effect of acupuncture on cocaine abstinence at the last reported time-point was 0.76 (95% CI 0.45–1.27).