Cocaine has played a role in a rising number of fatal overdoses in New Hampshire, an alarming trend in a state with the highest rate of cocaine use among young adults in the U.S.
Cocaine turned up in toxicology reports on at least 63 drug deaths last year, according to the latest data from the Office of the Chief Medical Examiner - a 70 percent increase since 2012.
The majority of those cases - 44, or seven in 10 - also involved illicit fentanyl, an extremely potent opioid that has been linked to more than 800 fatal overdoses in New Hampshire. Cocaine was the sole drug identified in 14 fatal overdoses last year.
Whether fentanyl is being sold as cocaine or mixed with it is unknown. The Drug Enforcement Administration has reported that fentanyl is turning up in seized shipments of counterfeit prescription drugs and other substances; and nationally there have been a number of reports of people overdosing on fentanyl after ingesting what they thought was cocaine.
Meghan Shea, clinical director at Family Willows Substance Use Treatment Center, which provides intensive outpatient care for women, says crack cocaine is a "strong secondary substance" with the center's clients.
"When we drug screen folks they are often aware that they used cocaine but are shocked that it is also positive with fentanyl," Shea says.
Nationally, cocaine-related overdoses have increased 60 percent since 2010, despite a continuing decline in the drug's use, according to a study published last month in the American Journal of Public Health. The study’s lead author, Christopher M. Jones, an associate deputy assistant secretary at the U.S. Department of Health and Human Services, says the primary reason is the growing supply of heroin and illicit fentanyl.
Jones says combining cocaine with heroin - known as “speedballs” - has long been popular among intravenous drug users. But the increase may also be driven by “growing poly-substance use” among people who need treatment but aren’t getting it.
“As people are moving along in their addiction and the addiction is not being treated, they’re using multiple substances, which also increased their risk of overdose,” Jones says.
The threat of fentanyl-contaminated cocaine raises the stakes in New Hampshire’s struggle to contain an epidemic of drug abuse. The state has the second-highest rate of overdose deaths in the country, and despite millions of dollars in new spending on treatment, there are still waiting lists for most levels of care.
Moreover, according to federal estimates, one in 10 young adults aged 18 to 25 in New Hampshire used cocaine in 2014 and 2015 - the highest percentage in the U.S.
Jones says state health officials and law enforcement agencies need to keep close tabs on the illicit drug supply and act quickly if more potent fentanyl analogues like carfentanil start turning up in seizures and autopsy reports.
They also need to spread the message that recreational drug users - commonly thought to be at lower risk for overdose - are more vulnerable. Jones says making the overdose reversal drug naloxone even more widely available should be considered.
“This research shows that messages to individuals who are using illicit drugs, whether or not they are opioids, is very important in understanding that your cocaine might be adulterated with a high-powered opioid,” he says.