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.
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.