Presence of fentanyl, heroin, cocaine and meth detailed
Fentanyl’s presence in Ohio’s illegal drug supply remains high and near record levels, although slightly lower so far this year than in 2022. The presence of fentanyl closely tracks the frequency of overdose death in Ohio, so analyzing trends in fentanyl’s presence in the illegal drug supply as reported in crime lab tests will provide a good approximation of the number of people who died from drug overdoses.
This article provides a detailed look at how the composition of Ohio’s illicit drug supply has changed — and become more dangerous — over the last decade. The increased deadliness of Ohio’s drug supply followed the state’s crackdown on prescription opioids, a policy that drove consumers and drug markets from prescription opioids to heroin first and then to fentanyl. Fentanyl then became an all-purpose adulterant, sometime found in cocaine and meth. Today, in Ohio, about half of overdose deaths involve cocaine-fentanyl and meth fentanyl.
For this article, Harm Reduction Ohio analyzed data from drugs seized by law enforcement across Ohio and tested on gas chromatography–mass spectrometry (GC-MS) machines at the Ohio Bureau of Criminal Investigation crime labs through August 19, 2023. Marijuana is not tested at the crime labs, so “Ohio Drug Supply” equals all controlled substances except cannabis. Except when noted, the term “fentanyl” also incudes fentanyl analogs.
The data set consists of 314,000 GC-MS lab tests done on drugs confiscated by law enforcement in Ohio since 2013. The state crime labs test about half of all drugs seized in Ohio. The other half of seized drugs are analyzed at local crime labs in Ohio; those results are not included in this analysis.
After the crackdown in prescription drugs began around 2010, heroin’s presence in Ohio’s drug supply increased. It peaked in 2015, then was displaced by fentanyl, a more potent, compact, easy-to-smuggle drug that is a superior option in criminalized drug markets.
Today, not much heroin is found in Ohio and nearly all of it also contains fentanyl.
A relatively small amount of meth contains fentanyl…but it kills a lot of people. Meth-related overdoses increased from 49 in 2013 to 1,350 in 2022. Eighty percent of meth overdoses also involve fentanyl. An academic study found that the entire increase in Ohio meth overdoses can be attributed to meth used with fentanyl.
Unlike fentanyl, heroin and meth, cocaine has changed little over the decade as a share of seized drugs.
What has changed, though, is the share of tested drugs in which cocaine has been found with fentanyl.
Just as with meth-fentanyl, cocaine-fentanyl is highly correlated with cocaine overdose deaths. As with meth, 80% of cocaine overdose deaths also involve fentanyl. In other words, fentanyl is killing a lot of cocaine users, who don’t have the opioid tolerance that regular opioids users build.
The number of cocaine overdoses in Ohio increased from 405 in 2013 to 1,628 in 2022.
The increase in cocaine deaths also has driven the increase in overdose deaths of Black Ohioans. For decades, Ohio’s White residents died of heroin overdoses at higher rates than Black residents while Black residents died of cocaine overdoses at higher rates than White residents. When fentanyl moved into the cocaine supply, starting in the second half of 2016 and growing to a record 18.7% this year, the racial makeup of overdose death started change, too. In 2018, for the first time, Black Ohioans had a higher overdose death rate than White Ohioans. Today, the gap is enormous.
In 2022, overdose deaths declined 8.8% for White Ohioans but rose 6.8% for Black Ohioans. Overdose deaths among Black residents increased from 227 in 2013 to 1,045 in 2022. The racial disparity in overdose death between White and Black Ohioans is on track in 2023 to be the worst ever. The expansion of fentanyl into the cocaine supply is the primary reason.
Fentanyl – Detailed
Carfentanil is the most powerful and deadly fentanyl analog. For reasons unknown, Ohio had more carfentanil deaths by far than any other state. From 2016 to 2020, all significant increases and decreases in overdose deaths were linked to the increased and decreased presence of carfentanil.
The chart shows how carfentanil comes and goes quickly.
In 2017. when Ohio had a surge in overdose death and Dayton attracted international attention as the “heroin capital of the world,” the primary cause of Dayton’s overdose surge was carfentanil, especially in cocaine. Even today, few realize that heroin had little to do with Dayton’s “heroin crisis.”
To get a better sense of how quickly carfentanil comes and goes in Ohio, look at carfentanil’s fast-changing presence on a quarterly basis.
Fortunately, also for reasons unknown, carfentanil has been nearly non-existent in Ohio since 2020. This makes the covid pandemic period — roughly defined as from February 2020 to December 2022 — the first in many years in which fentanyl itself drove an increase in overdose death (and a historic increase).
The record months of death in early 2017 were driven by carfentanil. The record months of overdose death during the pandemic (2020-2022) were driven by a decline in the availability of bulky drugs (cocaine, meth, heroin) and their replacement by easy-to-smuggle fentanyl.
One interesting measure of fentanyl’s ubiquity is how often only fentanyl is found when a seized drug is tested. This chart shows how often “only fentanyl” — no analogs, heroin cocaine, meth or other drugs — are found among seized drugs.