Big killer: Cocaine with fentanyl and carfentanil

The racial make-up of Ohio’s drug overdose deaths is changing.

For years, drug overdose deaths have been a predominantly white phenomenon, disproportionately killing high school-educated, working-class whites. But that has changed with the emergence of fentanyl-laced cocaine in Ohio.

In 2017, for the first time in the overdose epidemic, African Americans will die in proportion to their percentage of Ohio’s population: 12.7%. If this trend continues (which is far from certain), African Americans will account for a disproportionate share of Ohioans dying from drug overdoses.

The changing racial composition of overdoses raises an uncomfortable question: Why have our state and local governments ignored the emergence of fentanyl-laced cocaine over the last two years? Contrary to the evidence, health authorities have remained singularly focused on (white) opioid users while (black) cocaine users have started to die in numbers large enough to reshape the racial dynamics of the drug overdose epidemic.

If hundreds of suburban white kids suddenly died from fentanyl-laced LSD, would the state’s response be so lackadaisical and indifferent?

I think we all know the answer to that question.

To know is to love

Robert, an Akron resident, died in February 2017, from carfentanil in cocaine. “To know Robert was to love him,” his obituary said.

For many years, whites have accounted for a disproportionate share of heroin overdoses, while African Americans have been disproportionately represented in cocaine deaths.

Fentanyl and its variants carry the same danger in both drugs, whether snorted, smoked or injected, and whether consumed as powder cocaine, crack cocaine or in heroin. Cocaine users are more vulnerable to overdose, though, because they lack the tolerance to opioids (such as fentanyl) that regular heroin users possess.

So while a greater share of heroin is mixed with a fentanyl, more cocaine users actually die from the combination In other words, a little fentanyl in Ohio’s cocaine is killing a lot more users, many of whom are African American.

A Harm Reduction Ohio study published this month found that 11.2% of cocaine was mixed with fentanyl or a fentanyl analog in 2017 (based on 6,300 cocaine samples tested at state crime labs after being confiscated by law enforcement). Even scarier, 4.5% of cocaine was mixed with carfentanil, an ultra-potent and more dangerous variant.

Ohio health officials: Silence is deadly 

Despite being fully aware of the increase in cocaine-related deaths, the Ohio Department of Health has remained publicly silent about how the overdose epidemic has changed. It has avoided acknowledging that overdoses deaths have spread far beyond heroin users and has failed to warn cocaine (and meth) users of fentanyl risk, a seeming dereliction of its public health duty.

The Ohio Department of Health issued a private advisory on the issue to county health departments in February but has refused to release the health warning to the public, to share it on social media or its web site,  or to warn at-risk communities of the overdose risk. (Harm Reduction Ohio published the internal warning here.)

On April 5, the Ohio Department of Mental Health and Addiction Services (a separate state agency from the Ohio Department of Health) issued a one-page report warning of “Fentanyl-laced Drugs,” including cocaine.

Compounding the silence, the state has done nothing to prevent overdose death in cocaine users, black or white. No effort has been made to get Narcan, the overdose-reversing drug, to people who use cocaine or into settings where it is used — unlike the extensive and worthy effort to get Narcan into settings where heroin is used. (Read here about Project DAWN (Deaths Avoided With Naloxone.)

Even the inexpensive intervention of distributing fentanyl test strips — which allow cocaine users to test easily and quickly for the presence of a fentanyl — has not been tried.

Instead, cocaine-fentanyl deaths continue to soar while heroin-fentanyl deaths decline.

State policy: Blame heroin users

Rather than adjust to how overdose death has changed, Ohio has stuck to its long-standing belief that drug overdoses are a function of doctors prescribing too many pain pills, which triggers an increase in opiate addiction and heroin use.

However accurate this story was in 2010, it does not explain what’s happening in 2018. Ohio’s understanding of and response to drug overdose deaths is stuck in a time warp.

The state’s annual conference on the problem illustrates how the state looking left when it should be looking right.

On June 11-12, more than 1,200 professionals — doctors, cops, treatment providers — will convene in Columbus for the giant, “Ohio’s 2018 Opiate Conference: Strengthening Ohio’s Communities.” Amazingly, no conference speaker or any of the 55 panels — not one — will discuss fentanyl-cocaine deaths, much less its racial implications, according to the conference’s 18-page program.

Ohio’s response to the drug overdose epidemic rolls on as if the years 2016 and 2017 had never happened, as if the actual chemicals — contaminants, adulterants and drugs — being ingested don’t matter.

Black deaths matter

RIP: Alfred Jr.

Talk to African Americans about opiate overdoses and you’ll often hear: “Why did the government respond with treatment when whites had an opioid epidemic but responded with arrests and imprisonment when blacks had a crack epidemic?”

To most African Americans, the reason is obvious:  Race.

Whites get compassion; blacks get prison.

The unequal response to overdose deaths is today expressing itself as indifference.

Opiate overdose deaths in Ohio have always skewed white. Although no group has been immune, overdose deaths have hit white, high school educated working class Ohioans hardest. Since 2010, blacks have accounted for 8.7% of heroin overdose deaths, less than their 12.7% share of the state’s population.

Cocaine is the drug that most often puts African Americans at overdose risk. 

Because of fentanyl in cocaine, black overdose deaths are rising faster than among whites. In 2017, overdose deaths claimed the lives of 587 black Ohioans, up 37% from a year earlier and 94% higher than in 2015.

Every life matters. So does every death, black and white. So does every drug user, black and white, cocaine smokers and heroin injectors, in cities and in small towns.

Today, Ohio is neglecting cocaine users, especially black ones, and the result of this neglect is deaths than can be prevented.