https://www.cleveland.com/news/2019/03/why-cocaine-is-setting-off-alarm-bells-for-federal-and-state-drug-enforcers-in-northeast-ohio.html

Comment; dang those unlicensed purveyors of unlicensed molecules. Caveat emptor; buyer beware, you just don’t know what you’re getting-no scruples among drug dealers!

Posted Mar 27, 2019

Cocaine was detected in 45 percent of all fatal drug overdoses last year in Cuyahoga County, according to medical examiner's office statistics. (Getty Images)
Cocaine was detected in 45 percent of all fatal drug overdoses last year in Cuyahoga County, according to medical examiner’s office statistics. (Getty Images)

Comment1.4kshares

By Evan MacDonald, cleveland.com

CLEVELAND, Ohio — Last year, Cuyahoga County saw a decrease in drug overdose deaths for the first time in nearly a decade, creating a sense of cautious optimism among authorities working to curtail the opioid epidemic.

Deaths attributed to fentanyl, the opioid that served as the primary driver of fatal overdoses, declined by 18 percent. Heroin-related deaths dropped even more significantly, by 36 percent, officials said earlier this year. But last year’s total 560 overdose deaths still notably outpaced the years preceding the current opioid epidemic.

Fentanyl remains the focal point of the opioid epidemic, but another drug has emerged as a factor in an increasing number of overdose deaths: cocaine.

Statistics from the Cuyahoga County Medical Examiner’s Office show the drug was a factor in 45 percent of all fatal overdoses last year, the highest percentage in more than a decade.

Experts believe drug dealers mix fentanyl and cocaine to expand the fentanyl market beyond opioid users. Cocaine users, though, are at a substantial risk for overdose death if they’re unaware the drug is being mixed with the powerful opioid, U.S. Attorney Justin Herdman said.

“I can’t say this enough: You think you’re buying cocaine, but you’re not. You’re buying fentanyl,” Herdman said in a meeting with cleveland.comeditors and reporters. “You don’t know what you’re getting, and that’s the point. When you talk about hundreds of people dying from cocaine that’s mixed with fentanyl, there’s clearly a problem that’s not just traced to one particular supplier. It’s across the board.”

Most heroin users assume that some amount of fentanyl has been mixed with their drugs to make it seem more potent, but that level of awareness doesn’t exist among cocaine users, Herdman added.

Cuyahoga County Medical Examiner Thomas Gilson said drug mixtures, such as a fentanyl-cocaine combination, are more common than they were 10 years ago. He also attributed their pervasiveness to drug dealers trying to increase their customer base.

“It’s a mistake to think that people who distribute drugs are dumb people. They’re very much attuned to business. It’s just a bad business,” Gilson said. “But they’re very much aware of trends.”

Fentanyl is now being added to “everything,” said Carole Negus, the nursing director at Stella Maris, a Cleveland mental health and addiction treatment center. She said drug mixtures increase the level of danger for the average drug user buying on the street.

“It’s really kind of a crapshoot when they’re out there, what they’re getting,” she said.

The combining of fentanyl and cocaine has shifted the demographics of cocaine-related overdose deaths in Cuyahoga County, statistics show.
The combining of fentanyl and cocaine has shifted the demographics of cocaine-related overdose deaths in Cuyahoga County, statistics show.

Cocaine becoming more prevalent in Cuyahoga County overdose deaths

In the five-year period from 2011 to 2015, cocaine was a factor in 30 to 35 percent of Cuyahoga County’s drug overdose deaths. But its prevalence grew to 39 percent in 2016, 41 percent in 2017 and 45 percent last year, according to statistics from the medical examiner’s office.

“This is a trend that is starting to get more play nationally, but we’ve seen this in our county for a couple of years,” Gilson said.

Preliminary 2018 statistics from other Northern Ohio counties with large cities show a wide range in the percentage of overdose deaths involving cocaine.

In Mahoning County, which includes Youngstown, the drug was a factor in half of all fatal overdoses in 2018. That represented an increase over 2017, when cocaine was a factor in 44 percent of Mahoning County’s overdose deaths.

But deaths attributed to cocaine or a mixture of cocaine and fentanyl were not as prevalent elsewhere. In Stark County, which includes Canton, it factored into 21 percent of overdose deaths last year; in Summit County, which includes Akron, it was a factor in 19 percent.

In Lorain County, which has been described as an epicenter for Northeast Ohio’s opioid epidemic, cocaine was detected in 54 percent of overdose deaths in 2018, preliminary statistics show. Cocaine was detected in half of Lorain County’s overdose deaths in 2017.

“The state isn’t homogenous,” Gilson said. “The southern part of the state has had different phases of things, and in some ways, their [drug] trends have set the precedent for what we’ve seen. They saw fentanyl before we did.”

In fact, Columbus’ Franklin County and Cincinnati’s Hamilton County have struggled more with methamphetamine than cocaine in recent years, said Beth Zietlow-DeJesus, the director of external affairs for the Alcohol, Drug Addiction and Mental Health Services Board of Cuyahoga County.

Cocaine-fentanyl mixtures killed more people last year in Cuyahoga County than heroin-fentanyl mixtures, statistics show.
Cocaine-fentanyl mixtures killed more people last year in Cuyahoga County than heroin-fentanyl mixtures, statistics show.

Fentanyl mixtures are changing the demographics of overdose deaths

Historically in Cuyahoga County, opioid deaths have had the most severe impact among white people, and in suburban communities, Gilson said. Cocaine, on the other hand, has largely been linked to overdose deaths among African-Americans, and in urban communities.

But cocaine-fentanyl mixtures have caused a massive shift in the demographic data, the medical examiner’s office statistics show.

“We’re starting to see a rise in fentanyl deaths among African-Americans, but we’re also seeing more cocaine in the fentanyl deaths among the white, suburban residents,” Gilson said. “Now, as those two interface, we start to see more deaths, period.”

In each year from 2006 to 2012, African-Americans accounted for more than half of all cocaine-related overdose deaths, including a peak of 66 percent in 2007. That percentage has dropped precipitously in the years since, falling to just 30 percent last year.

African-Americans accounted for 21 percent of all fentanyl deaths last year; the percentage had ranged from 15 percent to 27 percent in the four prior years. Even so, Gilson said he thinks the drug’s impact on the African-American community is the most significant demographic shift in recent years, because fentanyl is more lethal than cocaine.

Fentanyl test strips, like the one shown here, have helped people identify if heroin is being mixed with fentanyl. Cuyahoga County officials are hopeful they can also be used to identify fentanyl mixed with cocaine. (AP Photo/Bebeto Matthews)
APFentanyl test strips, like the one shown here, have helped people identify if heroin is being mixed with fentanyl. Cuyahoga County officials are hopeful they can also be used to identify fentanyl mixed with cocaine. (AP Photo/Bebeto Matthews)

Detecting cocaine-fentanyl mixtures before they kill

Officials said there are two major components to preventing more cocaine-related deaths: Informing people of the risk, and giving them the means of detecting fentanyl.

“We’re at least trying to make people aware that the fentanyl could be in the cocaine, so they can test it,” ADAMHS Board CEO Scott Osiecki said.

The ADAMHS Board’s 2019 budget included $15,000 for the Care Alliance Health Center to buy and distribute fentanyl test strips, which can be used to detect the drug when it is mixed with cocaine, heroin and other substances. Care Alliance, a nonprofit community health center, has four locations in Cleveland.

The agency is also planning a grassroots effort to get the fentanyl test strips into the community. Details of the plan have not been released, but officials will likely try to get the strips into places like bus stations, public libraries, recreation centers and bar bathrooms, Zietlow-DeJesus said.

Herdman said his office is also on board with the effort to get the fentanyl test strips into the community. But getting people to test their cocaine could be a challenge, because the strips are designed to test liquids; a person would need to add water to their cocaine to test it.

“It’s easier for someone to use a fentanyl test strip if they’re going to shoot something in a syringe, because it’s already liquified,” Herdman said. “We have a harder sales job to do with a powdered cocaine user.”

Officials are optimistic that public awareness campaigns, fentanyl test strips, and other initiatives will make a difference, similar to the way they helped to decrease heroin overdose deaths in 2018. But Negus said there could be another deterrent: the carnage dangerous drug mixtures are causing every day on the streets.

“I have people that come into my unit and say ‘I had to come in. All my friends have died,’” she said. “I think that’s probably the biggest deterrent.”