Lethal fentanyl now reaches recreational cocaine users in opioid scourge

The scourge of opioid deaths has made its way to recreational cocaine users.

That's because the highly toxic fentanyl, the synthetic opiate, and its analogs, are seeping into cocaine in the Cincinnati area and beyond. Just grains of fentanyl can kill.

So far, incidents of the cocaine-fentanyl combination appear to be relatively spotty. Ohio, New York City, San Francisco and locations in Canada are among places it has appeared.

Dr. Lakshimi Sammarco, Hamilton County coroner, said she's starting to see deaths from the drug mix, but she had already cautioned that any street drug can be more dangerous than ever, because the drugs are being cut with synthetic opiates.

“It’s like playing Russian roulette,” Sammarco said.

In Cleveland, the Cuyahoga County medical examiner is convinced a specific demographic is being targeted by the new mixture – black, urban residents.

National data shows the opioid and heroin epidemic has hit hardest in the white population. But Dr. Thomas Gilson believes the concoction of opiates in cocaine is victimizing black people deliberately.

“With seemingly purposeful intent, cocaine is now being mixed with fentanyl and its analogs in an effort to introduce these drugs into the African American population. Cocaine had been the only drug that victims were predominately African American," Gilson testified Thursday at a U.S. Senate hearing on opioids. "The covert introduction of fentanyl into the cocaine supply has caused a rapid rise in fatalities and in 2017, (in Cuyahoga County) the rate of African American fentanyl-related deaths has doubled from 2016.”

The U.S. Drug Enforcement Administration doesn't see it the same way.

Russell Baer, a DEA spokesman, confirmed that fentanyl is being mixed with cocaine in locations across the country. But he said it's "incorrect" that black people are being specifically targeted by the illegal drug trade. In response to the Cuyahoga County medical examiner's statements, Baer said, "Fentanyl does not discriminate and kills without regard to who maybe the consumer."

In February, Sammarco called the cocaine-overdose death uptick in Hamilton County “huge.” There were 31 overdose deaths attributed to cocaine in 2016, and 60 attributed to a combination of drugs that included fentanyl.

The coroner said Thursday that she is not seeing great numbers of the deaths, and she is not having the population death shift that Gilson is facing.

“We are not aware of any groups specifically being targeted,” Sammarco said. “We have not seen any one particular ethnic group represented in the cocaine-related deaths.”

So far this year, final reports of cocaine-fentanyl related overdose deaths in Hamilton County are available only from January and February. Seven men and three women, ages 23-63, five black and five white, died. 

Sammarco said that more than 220 people have died from suspected overdose so far in 2017, and about 25 percent of the cases could be from cocaine and fentanyl. She cautioned that is an estimate and that not all death reports are final. Early in May,  four people overdosed in a car in Over-the-Rhine. Two died and the other two were hospitalized. The coroner said it appears they were using the cocaine-fentanyl cocktail. 

In Cuyahoga County, 19 people died in February after overdosing on cocaine mixed with fentanyl, putting the county on pace to nearly double the previous year’s total.

In January, 24 of 60 overdose deaths there were from a cocaine-fentanyl mix. In February, the ratio was 26 of 70 overdose deaths. In March, 10 of 47 overdose deaths were from the dangerous mix, according to the medical examiner. 

The Cuyahoga medical examiner's report from 2016 shows 260 cocaine-related overdose deaths. Of those, 68 were fentanyl-plus-cocaine deaths, and 73 were fentanyl, heroin and cocaine-related. The report shows that 30.38 percent, or 79, black people died from all cocaine-related overdose deaths. Overdose deaths in Cuyahoga County last year totaled 666.

Gilson, like law enforcement and public health officials elsewhere facing the overdose epidemic, is frustrated.

"Cuyahoga County will see approximately 800 drug-related deaths in 2017," Gilson said. If so, the toll would be up from 666 in 2016, which the medical examiner described as "the most devastating year we have ever had."

"Our estimates are that there are enough people in our county dependent on opioids to fill our football stadium (First Energy, which has 68,000 seats) every year," Gilson told the Senate committee. "And that our basketball arena (Quicken Loans, which seats 20,000) could be filled for the number who switch over to heroin or fentanyl every year."

Cocaine-fentanyl rarely seen in many locations

Kentucky has seen only "a handful" of seized cocaine with fentanyl in it, mainly from the Lexington area, said Kentucky Drug Control Policy Executive Director Van Ingram. And Chris Conners, director of the Northern Kentucky Drug Strike Force, said his narcotics officers have seen "some cocaine with other drugs" in it, but he added, "it's rare."

"We're hearing indications of some cocaine-fentanyl overdose deaths not involving heroin in New York City as well, suggestive of fentanyl directly mixed with cocaine," said Daniel Raymond, policy director for the national Harm Reduction Coalition. "It's not clear that any specific demographics are being targeted or even the market rationale."

The coalition, which works to reduce stigma and protect people from harm or death, recommended recently that drug users be alerted that the drug supply is "inconsistent and unpredictable," and that people should carry naloxone, the non-narcotic that can turn around an opioid or heroin overdose. Naloxone can be purchased at pharmacies without a prescription in Ohio and Kentucky, among other states, and several public advocacy groups are providing it free.

Still, Sammarco said – and public health and safety officials across the country have agreed – any drug could be tainted, and many who overdose are the unwitting victims of dealers who do not sell "pure anything."

“If you’re using drugs and if you’re not obtaining them from a physician’s prescription at a pharmacy, then you are using street drugs,” the coroner said. She said she does not distinguish from the casual or recreational user and those who are addicted.

Neither the cost of the drug nor whether a user is addicted to heroin makes a difference, she said.

“I don’t care if you’re paying $5,000 … or $10," Sammarco said. "You are still using street drugs and you are at risk."