The cocktail of death: opioids and cocaine are driving more overdose deaths

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Drug overdose deaths involving cocaine and psychostimulants such as methamphetamine have been rising rapidly in the United States in recent years, and a new report from the US Centers for Disease Control and Prevention shows that opioids are also involved in most of those deaths.

In 2021, opioids were present in about 79% of overdose deaths involving cocaine and about 66% of those involving psychostimulants, according to CDC data. And these multi-drug combinations have become increasingly common.
Overdose deaths involving both cocaine and opioids have become more than seven times more frequent over the past decade, growing from less than 1 death for every 100,000 people in 2011 to nearly 6 in 2021. And those involving both psychostimulants and opioids became 22 time it’s more common , jumping from 0.3 deaths for every 100,000 people in 2011 to nearly 7 in 2021.

Deaths from cocaine or psychostimulants that did not also involve opioids also increased, but they grew at significantly slower rates.

“The epidemic is showing us that it is quite dynamic and it can change quite rapidly,” said Katherine Keyes, an associate professor at the Columbia University Mailman School of Public Health, who was not involved in the new report but whose research focuses on psychiatric and substance use epidemiology. “This data is a stark reminder of how much more we need to be doing to combat these very preventable deaths.”

Although the new CDC report does not specify the type of opioids involved, experts say that these trends highlight the dangers of illicit fentanyl, a powerful synthetic opioid.

“Cocaine combined with fentanyl is much more toxic and lethal. Methamphetamine can kill more than cocaine by itself, but having said that, it’s much more dangerous when you combine it with fentanyl,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse, who also was not involved in the new research . “This accounts for why we’re seeing firsthand a high rise in mortality from these two drugs.”