by Kaitlin Durbin, cleveland.com – Sep. 27, 2025
A graph from the Cuyahoga County Medical Examiner’s Officer shows that cocaine overdoses are expected to kill more residents this year than fentanyl and other opioids, marking a major shift in drug patterns that Dr. Thomas Gilson says requires new prevention and treatment strategies.(Courtesy of the Cuyahoga County Medical Examiner’s Office)
CLEVELAND, Ohio — For the first time in decades, cocaine is killing more people in Cuyahoga County than opioids, including fentanyl.
The news marks a historic shift that Medical Examiner Dr. Thomas Gilson says should spark an urgent change in prevention strategies.
“This is earth-shattering,” Gilson told cleveland.com and The Plain Dealer. “I don’t think that’s been true in the entire 21st century.”
His office has only certified overdose deaths for the first half of the year, representing about 169 cases, but early numbers show that cocaine was involved in 63% of them, compared with 46% involving opioids – including some overlap from drug mixtures.
Projected out for the year, Gilson’s office expects total overdose deaths will top around 415, which would be another slight drop from the year before, indicating numbers are heading in the right direction. Fentanyl overdoses, in particular, are expected to fall to a near 10-year low.
But that progress could largely be offset by an increase in cocaine deaths – again, some mixed with opioids – which is projected to kill 399 Cuyahogans by the end of the year.
“This is the problem that we’re living with now,” Gilson said of the moment. “Opiates aren’t going to go away, but if you define an epidemic as a disease that’s occurring at a higher incidence rate in the population than baseline, well, we’ve had two years of decline; so, it’s pretty hard to say, ‘I’m still living in the opioid epidemic.’”
The shift
Opioid-related deaths, especially involving fentanyl, have been falling sharply over the last three years. Last year, overdose deaths dropped below 500 for the first time in a decade. The reason still isn’t clear.
It could be that the fentanyl supply is shrinking, or that what is circulating on the street is less potent, with smaller amounts showing up in drug mixtures, Gilson said. It could also be intervention strategies and overdose reversal drugs are working to curb deaths. Gilson suspects younger generations have started shying away from the drug, after years of warnings about its lethal effects.
Regardless, he worried that the lull was only leaving the door open for something else. Something new. It turns out, it was actually something old – though thankfully less lethal: cocaine.
Gilson recalled the crack cocaine epidemic of the 1980s and early 1990s, which devastated many urban communities and coincided with a major crime wave. The crisis helped fuel the “tough-on-crime” era, leading to harsh sentencing laws and mass incarceration that disproportionately affected Black Americans.
Back then the drug was killing 100-150 people a year in the county – a number which pales in comparison to the 600-700 who were dying at the peak of the opioid crisis. Now, though, the numbers are ticking upward again, and faster, partly fueled by cocaine-opioid mixtures.
In August, the Centers for Disease Control and Prevention published a report noting a rise in overdose deaths involving stimulants, like cocaine and methamphetamine, since 2011. Though it primarily attributed the increase to opioid mixtures, it noted that “stimulant-involved deaths without opioid co-involvement have also increased.”
The CDC urged expanded access to evidence-based treatment for stimulant use disorder, along with outreach to people “who might be missed by opioid-focused prevention efforts.”
After seeing the shift locally, Gilson is sounding his own alarm.
“Things are changing, and the demographics of who’s affected by it is changing, too,” Gilson said.
New strategies?
In the early phases of the opioid epidemic, particularly with prescription painkillers, white communities bore the brunt of overdose deaths. Even as the crisis evolved and overall numbers leveled out, Gilson’s office continued to record higher rates of fentanyl and opioid fatalities among white residents.
Overdose data through the first half of the year shows a rise in cocaine-related deaths, especially among Black men.(Courtesy of the Cuyahoga County Medical Examiner’s Office)
However, the rise in cocaine overdoses is disproportionately affecting the Black community, echoing patterns seen in the 1980s and 1990s. In the first half of this year, overdose deaths among white residents declined compared to 2024, while the share among Black residents rose from 42% to 48%. Black men, in particular, were impacted.
“We’re reverting back to a pre-opioid phase,” Gilson said. “And that means we’re going to see another racial disparity develop like we did before.”
That makes directing prevention and treatment outreach specifically to Black communities both more urgent and more challenging, he said. He noted it was harder to reach Black communities with prevention messaging during the opioid epidemic.
And that challenge raises a bigger question: whether current prevention and treatment strategies would be adequate, given decades of opioid-focused efforts. Unlike fentanyl, which can be reversed with naloxone, there is no antidote for cocaine overdoses, which often result in sudden heart attacks or strokes.
(Earlier this year, Gilson also flagged the need for better prevention strategies to address rising suicide rates.)
One strategy Gilson said he knows can help save lives is reminding people not to use drugs alone. He reiterated a recent study by Case Western Reserve University that found that about 75% of overdose victims over a five-year period were using alone, increasing death rates.
But what other strategies may be needed to save lives remains an open question.
“The winds are changing,” Gilson said. “If we want to really be effective, we need to start pivoting to these stimulants as enemy number one.”
Source: https://abcnews.go.com/Health/wireStory/issue-drugs-showcased-general-assembly-year-125919663