New surges in use of methamphetamine and cocaine mixed with a powerful synthetic opioid are contributing to rising drug overdose death tolls in already hard-hit Ohio.
As county coroners have begun releasing their 2017 tallies, a trend has emerged of more deaths involving meth or cocaine mixed with fentanyl, the painkiller blamed for increasing U.S. fatalities in recent years as authorities focused on reducing heroin overdoses.
U.S. authorities say illicit fentanyl made in China has flooded in while there is increased availability of meth and a rebound in cocaine. All have been contributing to the national rises in overdose deaths and are increasingly being seen in lethal mixes. Authorities say many drug users may be unaware they are taking fentanyl or have any idea how much is in what they're taking.
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States as different as New Hampshire, West Virginia and Florida have seen rising overdose death rates in recent years. The problem is particularly acute in Ohio, where overdose death rates have been climbing steadily this decade.
Spreading fentanyl and increased meth use "have turned an already bad situation into something far worse," Butler County coroner Dr. Lisa Mannix said recently while announcing a fifth straight record overdose toll in the southwest Ohio county just north of Cincinnati. At 232 deaths, it was up 21 percent over 2016, and Mannix said meth-related deaths quadrupled last year and have soared from one in 2014 to 46 last year. Cocaine-related deaths have doubled in Butler over five years from 28 to 56 in 2017.
Mannix said the cocaine and meth deaths predominantly involved fentanyl mixes.
"It shows the ebb and flow of drugs," said Newtown Police Chief Tom Synan, who's on the Hamilton County Heroin Coalition. "They fade out and come back with dealers always trying to find ways to make it more potent, more addictive ... more money."
Hamilton County's coroner recently reported seeing more cases of cocaine mixed with illegally manufactured fentanyl as the Cincinnati-based county's toll jumped 31 percent over 2016 to 529 overdose deaths overall.
The Franklin County coroner, based in the capital of Columbus, earlier said overdose deaths for the first nine months of 2017 had already topped full-year totals for 2016, with increases in cocaine- and meth-related deaths.
Preliminary numbers from Cuyahoga County showed 349 cocaine-related deaths in 2017, up from 115 in 2015, with most involving fentanyl mixes. The overall estimate for the year was 822 overdose deaths, up from 666 in 2016 in the Cleveland-based county.
Combining opioids and stimulants isn't anything new: The comedian John Belushi died in 1982 from a cocaine-heroin "speedball" mixture. But using fentanyl, which authorities say can be 50 times or more stronger than heroin, has heightened the danger.
"Today it is more lethal than it ever was, because now many times it does have this fentanyl mixed in, so it's really a new concoction," Ohio Attorney General Mike DeWine said about increased cocaine and meth. "People don't really know how potent it is."
The U.S. Centers for Disease Control and Prevention said Ohio's 4,329 drug overdose deaths in 2016 gave it the second-highest age-adjusted death rate after West Virginia, among 63,600 people dying nationwide from overdose. The Ohio health department reported last year that cocaine-related deaths rose 62 percent to 1,109 in 2016, with the majority involving fentanyl and related opioids. West Virginia health authorities say preliminary figures show meth-related deaths jumped to 187 last year from 107 in 2016, with a smaller increase in cocaine-related deaths, and that most involved multiple drugs.
Ohio's statewide numbers for 2017 haven't been released yet, but preliminary CDC estimates showed a 36 percent rise in Ohio deaths in the 12-month period ending August 2017.
Coping with the emerging mixes of fentanyl with meth or cocaine adds to the frustration for those on the front lines of the drug crisis.
"As soon as we come up with a program and we try to work on one drug, then another drug comes up," said Butler County Sheriff Richard Jones.