Cocaine overdoses are on the rise across America, even while the rate of overall drug deaths has shown promising signs of declining.
Fatalities linked to cocaine rose nearly five percent from 2022 to 2023, new CDC data shows, and are up roughly risen 60 percent since 2015.
Doctors say the rise is linked to the co-use of cocaine and fentanyl, which can including using both of them together intentionally, or using cocaine that has been laced with fentanyl, unbeknownst to the user.
Overall, the rate of deaths due to cocaine – in crack or powdered form – in 2023 was 8.6 per 100,000 people. The rate for synthetic opioids such as fentanyl, by comparison, was 22.2 per 100,000 and for psychostimulants such as methamphetamine, the rate was 10.6.
The CDC has said that increases in cocaine deaths have coincided with the rise in fentanyl in the illicit drug supply in the mid-2010s, with trends showing a rise that ‘began around 2011 have continued through 2023.’
The list of places with the most cocaine overdose deaths in 2023 starts with Washington, DC, with 31.9 deaths per 100,000 people, then Delaware, with 26.5; Rhode Island, with 20.5; Vermont, with 21.4; and Maryland, with 16.7.
The total cocaine-related overdose deaths rose nearly five percent from 2022 to 2023, which doctors blame on co-use of cocaine and fentanyl , an insidious synthetic opioid 50 times stronger than heroin
But several states saw significant increases, including Alabama, California, Delaware, New York, Oregon, Tennessee, Texas, Washington, and others.
Dr Joseph Palamar, a drug epidemiologist at the New York University School of Medicine, said: ‘We call it the fourth wave of the opioid crisis.
‘The third wave is fentanyl. The fourth wave, which is kind of unofficial, but we all refer to it, is fentanyl plus a stimulant.
‘The increase in cocaine deaths is totally driven by co-use with fentanyl. The increase without fentanyl, it appears, would have remained level.’
Rounding out the top ten states with the most cocaine overdose deaths was Maine, Connecticut, Ohio, New Jersey, and Michigan.
Maine had an overdose rate of 17.6. Connecticut followed closely with a rate of 16.8. Ohio, another key state, recorded an overdose rate of 15.1. New Jersey’s rate was slightly higher at 12.5, and Michigan came in at 11.6.
The states showing the starkest increases in cocaine overdose deaths – Texas (+75.0 percent), Virginia (+61.4 percent), Alaska (+41.4 percent), Ohio (+36.4 percent) – have large swathes of rural regions where access to drug treatment resources can be scarce and education about the dangers of drug use more limited.
Border states like Texas may also see an influx of illicit street drugs that more inland states do not do to their proximity to the cartels pushing these drugs across the border.
Dr Akshaya Bhagavathula, an epidemiologist at North Dakota State University, told DailyMail.com: ‘Recent toxicology data from overdose deaths shows an increasing presence of multiple substances, suggesting that “cocaine deaths” are often more complex than single-substance overdoses.’
Cocaine, unlike heroin and fentanyl, is a stimulant that induces feelings of intense euphoria and alertness.
Cocaine overdose deaths have fluctuated since the 1980s, peaking in 2006 at 2.5 deaths per 100,000, before dropping to 1.3 in 2010. Starting in 2015, deaths surged, mainly due to the combination of cocaine and fentanyl, while deaths solely from cocaine have remained stable. Data came from the CDC
It affects the brain’s reward center, which is dominated by the neurotransmitter dopamine, which motivates people to seek pleasurable experiences even if they prove fatal.
An overdose causes a sharp increase in blood pressure, heart rate, body temperature, and seizures. The primary cause of death during a cocaine overdose is stroke or cardiac arrest.
Much of the public attention has been on fentanyl and other opioids, but the US saw a glimmer of hope last year when the CDC reported that drug overdose deaths overall had fallen from 32.6 deaths per 100,000 people in 2022 to 31.3 per 100,000 people in 2023, a four percent drop.
Since its heyday in the 1980s, the rate of cocaine overdose deaths nationwide has varied widely over the years. In 2003, there were 1.8 deaths per 100,000 people. This rose to 2.5 in 2006, then fell to 1.3 in 2010.
But around 2015, the year in which Dr Palamar and his colleagues say the fourth wave of the drug crisis kicked off, cocaine deaths rose precipitously. The vast majority of deaths, when autopsy results were further analyzed, were driven by cocaine and fentanyl together.
Rates of cocaine deaths alone, meanwhile, have remained relatively stagnant in that time.
And while much of the nation’s illicit cocaine supply has been contaminated with fentanyl, and many people overdose without having known their cocaine was laced, that is not to say that people are not willingly and knowingly using cocaine.
Brian Townsend, retired Supervisory Special Agent with the US Drug Enforcement Administration, told DailyMail.com: ‘What we are witnessing with cocaine aligns with a broader stimulant crisis that has been building in parallel with increasing prescription stimulant use.’
Over the past decade, prescriptions for stimulants such as Adderall and Ritalin have surged by 58 percent since 2012.
He added: ‘Many people now recognize the dangers of opioids, but there is far less caution around stimulants. Cocaine, as a widely available illicit stimulant, is filling that gap.’
Dr Palamar, who specializes in following trends in co-use studying people who survive their overdoses, said collecting more complete data about what led to the overdose and what the person thought they were taking is problematic because ‘and I know sounds common sense, but you can’t interview dead people.’
‘When someone passes away, the only thing you can look at is toxicology, which can tell you what substances they had in their system,’ he said.
‘Just because it’s in somebody’s blood sample, it doesn’t mean that they used it, that was a cause of death. Did the cocaine contribute? The cocaine could have actually helped reverse the fentanyl a little bit.’