Is dobutamine stress safe in someone with cocaine chest pain?

Probably: As long as the patient did not have an actual infarct and was not having serious arrhythmias, i wouldn't necessarily have a problem using dobutamine. Exercise or Adenosine (or regadenoson) would be my preferred choices, however.

Generally safe: It has its risks of causing arrhythmias, chest pain in any individual. Whether Cocaine induced or atherosclerosis.

Stress tests : If chest pain is active further evaluation & blood tests for myocardial damage is indicated as well. But tell doctor Cocaine has been used because beta blockers can lead to unopposed Alpha adrenergic activity with potential disastrous consequences.