Renee Matthews Jackson
Although cocaine is one of the leading causes of drug overdose deaths in Cuyahoga County in 2026, fentanyl continues to claim lives at an alarming rate. According to the Recovery Institute of Ohio there was a significant decline in fentanyl deaths in 2023.
The national data from the Centers for Disease Control and Prevention (CDC) show an increase in cocaine overdoses. In 2023 more than 107,500 overdose deaths nationwide were linked to synthetic opioids, including fentanyl.
According to overdose data compiled by the Cuyahoga County Medical Examiner’s Office, there were 333 suspected overdose deaths in Cuyahoga County in 2025 through December, based on toxicology reports that include fentanyl, cocaine, and other substances. The specific report separates substances and does not list a simple total for fentanyl alone in the summary chart. This total of 333 is for all suspected overdose deaths through 2025, not just fentanyl.
This monthly report confirmed the trend continued through the end of the year, showing that while fentanyl (and analogs) remains highly dangerous and present in mixtures, the total count of deaths primarily attributed to cocaine (including mixtures) exceeded those attributed solely to Opioids/Fentanyl for the 2025 calendar year. Even with the number of fentanyl related overdoses on the decline and seemingly replaced by cocaine, there is still reason for concern in Cleveland communitues because fentanyl contamination could be in street drugs.
Medical origins, illicit consequences
After originally being developed for medical use by Dr. Paul Janssen in Belgium in 1959 in 1968, fentanyl was approved by the U.S. Food Drug Administration (FDA) to treat severe pain, typically after surgery or serious injury. Public health officials say the drug’s presence in the illicit market has dramatically altered overdose risk.
Fentanyl is frequently mixed into other substances, including heroin, cocaine, and counterfeit pills, often without the user’s knowledge. Because the drug is extremely potent, even trace amounts can be fatal. According to the Health Policy Institute of Ohio, “Statewide, overdose deaths are declining. Ohio has not reported 2024 numbers yet, but the state recorded 4,452 unintentional drug overdose deaths in 2023, down 9% from the year prior.”
Emergency departments see continued impact
Emergency departments across Northeast Ohio continue to see thousands of substance-related visits each year, reflecting both fatal and nonfatal overdoses. In October, 2025 Dr. Thomas Gilson, the Cuyahoga County Medical Examiner, delivered remarks during budget hearings before the Cuyahoga County Council. Gilson said, “for the first time in the 21st century, cocaine is more prevalent in overdose deaths than opioids. In early 2025, cocaine was involved in approximately 63% of certified overdose deaths, compared to 46% for opioids.” 
Community questions drug contamination
Community members are increasingly questioning how and why fentanyl is appearing in the local drug supply. One Cleveland resident, who requested anonymity for professional career reasons, said the drug’s potency raises troubling concerns about intent. “Putting fentanyl into drugs, if deliberate, is used to stretch the drug and bring in more money,” he said. “It only takes a tiny amount to be life threatening for someone, so why would anyone risk doing that to a paying customer?”
No strong evidence exists that states, fentanyl contamination is typically intentional. However, the resident’s statement raises the issue of contamination by accident or through unsafe illicit drug manufacturing practices. Health expert, Dr. Joan Papp, MD from Metro Health (video – 4:04) stated that illicit drug production is unpredictable, increasing the likelihood of uneven mixing and unintended overdoses. She said, “even if you are a recreational cocaine user and use it on weekends or once a month, that cocaine may be contaminated with fentanyl.”
The Executive Summary says: a lack of product transparency” as a primary driver of the crisis. It explains that the illicit supply is marked by “inconsistent drug purity and quality.” This validates that users are not just “making mistakes”, they are facing a supply where it is impossible to know the ingredients (transparency) or the strength (purity) of what they are buying.”
Risk remains despite national decline
Although overdose deaths declined nationally from 2023 to 2025, according to provisional federal data, fentanyl’s continued presence means overdose risk remains high, particularly for people who use drugs alone or lack access to treatment.
Local agencies, like the Cuyahoga County Board of Health, are expanding access to Naloxone, a medicine that quickly reverses and prevents an opioid overdose by attaching to opioid receptors and blocks the effects of other opioids. Residents are encouraged to seek treatment, referrals, and public education.
Local and national support is available
Residents seeking help can contact local providers or call the 988 Suicide and Crisis Lifeline for mental health or substance-related crises and 24-hour support. Additional data and resources are available from the Centers for Disease Control and Prevention, the National Institute on Drug Abuse, and the Alcohol Drug Addiction Mental Health Services Board’s website, which provide updated statistics, prevention guidance, and treatment information.
Renee Matthews Jackson is a contributing writer. She is a 2025 graduate from Full Sail University with a master’s degree in new media journalism.
