Nation Sees Troubling Rise in Fatal Cocaine Overdoses

A fraction of the cocaine seized from a ship at a Philadelphia port is displayed ahead of a news conference at the U.S. Custom House in Philadelphia, on June 21, 2019.

A fraction of the cocaine seized from a ship at a Philadelphia port is displayed ahead of a news conference at the U.S. Custom House in Philadelphia, on June 21, 2019. AP Photo/Matt Rourke)


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Many of the deaths involve cocaine mixed with the opioid fentanyl, a new analysis finds. Data shows that 2019 may have been a record year for deadly overdoses.

Cocaine overdose deaths, particularly in cases where the drug is mixed with the powerful synthetic opioid fentanyl, have been on the rise in the U.S., according to a new analysis.

The report from the Rockefeller Institute of Government says that if a national figure of 71,966 overdose deaths during 2019 holds, it will set a new annual record, surpassing a previous high mark of 70,237 for overdose fatalities set in 2017. The report says that much of the increase is attributable to deaths from cocaine and fentanyl use.

It’s a troubling trend, and one that overshadows a decline in overall drug overdose deaths in 2018. That decrease can be largely chalked up to drops in overdoses involving opioids, including heroin and prescription opioid drugs like OxyContin.

There are few signs of a positive turnaround in preliminary data for 2020. The figures show that when comparing the years ending March 2019 and March 2020, cocaine mortality is up 15% with 17,418 deaths for the more recent 2020 timeframe.

“To design effective policy to support those suffering from substance-use disorder, it is important to understand changes in substance use patterns and treatment options,” said Laura Schultz, the Rockefeller Institute’s executive director of research, in a statement.

Looking back to detailed data that’s available for earlier years, the report’s author, Rockefeller senior policy analyst Leigh Wedenoja, finds that in 2018 there were 14,666 cocaine-related deaths and that nearly 60% also involved fentanyl, a potent synthetic opioid that has been increasingly available in recent years.

That’s a sharp rise from 2014, when there were 5,415 cocaine overdose fatalities and just 11% of those also involved fentanyl. 

The report explains that cocaine overdoses are much more common for Black Americans than for people of other races or ethnicities. But it also notes that white people have been more likely to die from overdoses involving a mix of cocaine with opioids. 

Wedenoja also points out that while cocaine mortality is highest among people with lower incomes and less education, there has been a rise in cocaine use on college campuses as well.

A rate of five overdose deaths from a drug per 100,000 residents is considered problematic. From 1999 to 2014, Washington D.C. and New Mexico were the only two places that consistently had state-level cocaine overdose rates above that threshold, the report says.

But this has changed significantly over the years. By 2017, 18 states were above the five deaths per 100,000 mark. And seven saw at least 10 deaths per 100,000 people, including D.C., and several states at the center of the opioid crisis—West Virginia, Ohio and Pennsylvania.

“Much of this increase in mortality was driven by the increased lethality of mixing cocaine and opioids,” the report says.

Preliminary data for the year ending in March 2020 indicate that D.C.’s cocaine overdose rate could be up to 20 deaths per 100,000, and that in Delaware the rate could be 17 in 100,000. The data doesn’t show what role fentanyl may have played in the cocaine-related deaths.

The Rockefeller research can be found here.

Bill Lucia is a senior reporter for Route Fifty and is based in Olympia, Washington.

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