Cuyahoga County Fentanyl Deaths Plunge 70% as Cocaine Overtakes Opioids

Fentanyl overdose deaths in Cuyahoga County, Ohio, have plummeted by 70% since 2023, marking one of the most dramatic turnarounds in the nation's ongoing battle against synthetic opioid mortality. The decline has been so steep that cocaine has now overtaken fentanyl as the leading cause of drug-related deaths in the Cleveland metropolitan area—a shift that would have seemed unimaginable just two years ago.

According to the Cuyahoga County Medical Examiner's Office, fentanyl-involved fatalities dropped from 276 deaths in 2024 to just 140 in 2025. The trend represents a continuation of improvements that began in 2023, when the county was still reeling from the peak of the fentanyl crisis that devastated communities across Ohio and the Midwest.

A shifting landscape

Dr. Thomas Gilson, the county's medical examiner, has witnessed the transformation firsthand. "Fentanyl is on the decline. The opioid crisis is declining, thankfully," he told Spectrum News. "But what we're seeing now is cocaine."

The shift in mortality patterns reflects broader changes in the illicit drug supply and, perhaps more significantly, the growing effectiveness of harm reduction strategies that have taken root in the region. While cocaine deaths have risen to become the leading cause of overdose fatalities, even those numbers have begun to decline, suggesting that interventions developed during the fentanyl crisis may be having spillover effects across substance categories.

The changing dynamics present new challenges for public health officials. Unlike fentanyl, which can kill within minutes through respiratory depression, cocaine overdoses typically manifest differently—often involving cardiac symptoms that develop over a longer window. This difference, Gilson notes, creates opportunities for intervention that weren't available during the height of the fentanyl epidemic.

The human face of recovery

Jasmine Kochheiser knows the terrain of addiction intimately. Now a medication-assisted recovery counselor at Stella Maris, a medical detox center in Cleveland, she spent years navigating her own substance use disorder before finding stability through treatment.

"I didn't want anybody to see me, to know that I was using," she recalls of her years in active addiction. The stigma attached to injection drug use kept her away from needle exchange programs, even when she knew they could reduce her risk of infectious disease.

Today, Kochheiser leads group sessions for people in early recovery, bringing the credibility of lived experience to her clinical work. She emphasizes a distinction that public health officials are increasingly embracing: the difference between enabling drug use and maintaining connection with people who use drugs.

"Just because someone is using doesn't mean you have to give them money, right? You can still answer the phone and you can still talk to them," she says. "There's a difference between enabling and being a loving and sympathetic individual."

This philosophy—meeting people where they are rather than demanding abstinence as a precondition for support—has become central to Cuyahoga County's approach. The medical examiner's office has launched a multimedia campaign encouraging drug users to adopt harm reduction practices, including the "buddy system" for using drugs and recognizing overdose warning signs.

Lessons from the fentanyl era

The county's public health campaign, which includes messaging on buses, billboards, radio, and television, focuses on a critical insight from the fentanyl crisis: naloxone, while life-saving for opioid overdoses, does not reverse cocaine toxicity. However, fentanyl test strips remain relevant because cocaine supplies continue to be adulterated with synthetic opioids.

Gilson explains the crucial difference between the two drug categories. "With fentanyl, we didn't really have the same window of opportunity. And unfortunately, that's why we would see people who overdosed on fentanyl and they would have the naloxone kit right beside them. When you're in trouble like that, you can't give yourself the Narcan."

Cocaine overdoses, by contrast, often present with warning signs—racing heart, shortness of breath, sweating, chest pain, or tingling sensations—that create time for the user to seek help. "That's the time to call for help, even if you're by yourself," Gilson emphasizes.

Context and caution

The dramatic improvement in Cuyahoga County comes amid broader national trends. The United States has recorded three consecutive years of declining overdose deaths, with synthetic opioid fatalities dropping 22% between 2024 and 2025 according to White House figures. States including Oregon, North Carolina, New York, and Alabama have reported significant proportional declines.

Yet public health officials caution against complacency. The drug supply continues to evolve, with new threats like medetomidine—a veterinary tranquilizer 100 to 200 times more potent than xylazine—emerging in markets across the Midwest. The same adaptive capacity that allowed traffickers to shift from heroin to fentanyl now drives the proliferation of novel synthetic compounds that evade existing regulatory frameworks.

Moreover, the racial disparities that have characterized the overdose crisis persist. In Cleveland, as in many American cities, Black residents continue to experience disproportionate mortality from drug overdoses despite the overall decline in fatalities.

Sustaining the gains

For Kochheiser, the statistics represent individual lives saved or lost—people who, like her, might find their way to recovery if given the chance. "Everyone deserves a shot to be alive and stay alive until they decide that they want something different," she says.

The challenge for Cuyahoga County, and for communities across the country that have begun to see similar improvements, is to sustain these gains amid evolving threats and persistent resource constraints. The medical examiner's office continues to emphasize that naloxone distribution and fentanyl test strips remain essential tools, even as the dominant drug in overdose deaths has shifted.

The 70% decline in fentanyl deaths demonstrates that coordinated public health interventions—expanded access to medication-assisted treatment, harm reduction infrastructure, and community-based outreach—can bend the mortality curve even amid a dangerous and adaptive illicit drug supply. Whether those gains can be maintained, and extended to address emerging challenges, will depend on continued investment in the systems that made them possible.