Cocaine overdose deaths have overtaken fentanyl in Cuyahoga County, Ohio, for the second year in a row. The figures come from the Cuyahoga County Medical Examiner’s Office, and WOIO in Cleveland reported them. Opioids led the toll for a long time, so the change is a big one.

Cocaine Overdose Deaths Climb as Fentanyl Falls

For decades, opioids, including fentanyl, caused the most overdose deaths in the county. Not any more. Suspected overdose deaths recorded by the medical examiner from 2009 to 2026 show fentanyl deaths dropping from 2024. In 2025, cocaine rose above them.

The 2026 numbers are projections based on data through the end of August. On that basis, the county expects 340 overdose deaths this year. Cocaine is expected to be involved in 200 of them, almost 59 per cent. Fentanyl is projected to be involved in 130, about 38 per cent.

The two counts overlap, though. Most overdose deaths in the county involve more than one drug, the medical examiner’s office said, so the categories are not mutually exclusive.

A Cheaper Supply Behind Deadly Cocaine Overdoses

Brian McNeal of the DEA Detroit Field Division, which covers Ohio, points to price and supply. Talking to law enforcement partners, he hears of an uptick in cocaine. It is cheaper than it has been traditionally, McNeal said, at “15 to 20,000 a kilogram versus, 25, 30,000 a kilogram.”

A lower price brings a bigger supply, he said. “When you see more cocaine, there’s more opportunity to have that cocaine adulterated with a synthetic like a fentanyl,” McNeal said. So a person seeking cocaine can overdose on a fentanyl they never knew was there.

More supply can also mean more crack cocaine, which McNeal said has a big impact on communities. “With crack cocaine, a lot of times we see crime increase,” he said. “We see upticks in your robberies and things of that nature.”

Summit County Shows a Similar Pattern

Summit County shows a similar trend. Cocaine overdose deaths started rising there in 2023, according to data from the Summit County Medical Examiner’s Office and the ADAMHS Board. Even so, fentanyl has caused the most overdose deaths overall there since 2016, followed by methamphetamine and then cocaine.

McNeal said drug mixtures are more common now, and that unknown factor makes drugs today dangerous. “The times of experimentation back in the 50s and 60s, that’s over,” he said. “The experimentation can be the end.”

Across both counties, men are more likely to die of an overdose. In Cuyahoga County, deaths occur most often among people aged 55 to 64.

Help Before an Overdose Happens

The Cuyahoga County Medical Examiner’s Office and the ADAMHS Board have started an awareness campaign. It offers free, local tools to use before an overdose happens, including peer support and free naloxone. Details are available at signsofOD.org.

People can also call or text 988 and press one for the Substance Use and Mental Health hotline, available 24 hours a day.

Cocaine is involved in about six of every ten projected deaths this year. Deadly cocaine overdoses now sit at the centre of the county’s drug picture, and the local tools on offer are meant to reach people before an overdose happens.

Source: cleveland19