Cocaine-Related Overdose Deaths in Cuyahoga County, Ohio, 2014 to 2024: The Impact of Fentanyl on Cocaine Related Overdose Deaths.

Polysubstance drug overdoses are the most common type of overdose leading to death in the United States, yet the ability to disaggregate polysubstance overdoses is limited with national data. In addition, national data are not always timely for public health intervention and lack regional specificity. This study analyzes all cocaine-related unintentional overdose deaths (n=1150) from 2014 to 2024 in Cuyahoga County, Ohio, to understand the impact of fentanyl on cocaine overdose deaths. Cocaine overdose deaths were divided into 2 overdose categories: cocaine with fentanyl (n=858) and cocaine without fentanyl (n=292). Of all qualifying cases, 74.61% involved fentanyl. Cocaine with fentanyl decedents were younger, White non-Hispanic males who resided in Cleveland, similar to overall fentanyl decedents. Cocaine without fentanyl overdose deaths were more common in older (>45) Black men living in Cleveland. This study demonstrates the utility of an accredited medical examiner's office data in disaggregating polysubstance overdose death data by (a) identifying important subpopulations within the overdose crisis; (b) informing targeted public health education and interventions.