Among all the drug and alcohol overdose deaths reported recently by Maryland health officials for the first half of the year, there were 325 deaths linked to cocaine.
To be sure, opioids, particularly heroin and its more powerful synthetic relative fentanyl, kill far more people. And alcohol is still a bigger killer. But cocaine, an old foe of drug treatment professionals, remains a problem despite diminished attention from the media and policymakers.
The deaths mean that 27.7 percent of people who’ve died of an overdose in the state between January and June had cocaine in their system, according to the latest data available.
The deaths are up from 207 during the same period in 2016, and 104 in the first half of 2015. That’s more than three times the deaths in three years.
The lab results show that cocaine is linked heavily to the opioid epidemic, as most of those who fatally overdosed also tested positive for opioids including heroin, fentanyl and prescription painkillers. Among those who fatally overdosed on cocaine, 276, or about 85 percent, also had opioids in their system.
Cocaine is considered an upper, enhancing activity in the central and peripheral nervous system, and opioids are downers, suppressing respiration.
Injecting cocaine and heroin together is known as a “speedball” and was popular in the 1970s and ’80s, said Dr. Michael Fingerhood, who treats substance use disorders at Johns Hopkins Bayview Medical Center and is an associate professor of medicine and public health at Johns Hopkins University.
He said cocaine use never really ended, particularly in Baltimore. But as purity improved, powder cocaine was more likely to be snorted than injected and less likely to be cut with anything. Crack cocaine would be smoked.
He called the return of the speedball mix “pretty scary.”
One explanation for its resurgence, Fingerhood said, may be that as opioid use grew into an epidemic in Maryland and nationally, and began killing record numbers of people, users accepted the false premise that the cocaine would somehow prevent an overdose by stopping the opioids from suppressing breathing.
Cocaine does not stop opioid overdoses, he said.
Others also may be told, perhaps by dealers or even other users, that the mix would give them “the best of both worlds” — a good high without the drowsiness. Some people just may not know what is in the powder they buy on a street corner.
Fingerhood believes it’s the opioids that are most responsible for the deaths among people who mix opioids with cocaine. Heroin increasingly is being replaced by dealers with cheaper and far more powerful fentanyl, often unbeknownst to users. That’s a big reason opioids are now a bigger killer in Baltimore City than murders.
That said, cocaine alone does kill people, particularly those who have underlying health issues such as heart disease, he said.
Countering the bad information, and bad drugs, won’t be simple, Fingerhood and others say.
"In evaluating the second-quarter data from the Maryland Department of Health, it is clear that fentanyl is being mixed in with other illicit drugs, including cocaine,” said Clay Stamp, executive director of the state’s Opioid Operational Command Center. “This sets up a very dangerous situation -- users cannot be sure what exactly is in the drugs they are taking."