Monroe County Medical Examiner Releases 2023 Overdose Death Data: Fentanyl And Cocaine Involved In Majority Of Cases

November 26th, 2024

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View Full ME Report (PDF)

The Monroe County Medical Examiner reports 512 overdose deaths in 2023, largely driven by a rise in fatalities involving a combination of fentanyl and cocaine.

"These numbers aren't just statistics-they represent lives lost, families grieving, and communities struggling with the devastating impact of substance use disorder," said Dr. Marielena Vélez de Brown, Monroe County Commissioner of Public Health. "Each death is a tragedy and every one of these lives mattered. This crisis requires both compassion and action. By providing tools like fentanyl and xylazine test strips and naloxone, supporting treatment and recovery, expanding partnerships that target prevention efforts aimed at young people and disproportionately affected communities, and fostering understanding rather than stigma, we can save lives and give people the chance to recover."

Adulterated Drugs and Mixing Substances: A Hidden and Deadly Risk

Most overdose deaths in Monroe County in 2023 involved a combination of substances, including opioids, cocaine and alcohol.

• 72.9% of victims had at least two of these substances in their system.

• 23.6% had all three of these substances present.

Combining drugs can amplify their effects, suppress vital functions like breathing, and create dangerous or unpredictable interactions. The combination of fentanyl-a synthetic opioid up to 100 times stronger than morphine-and cocaine is a major factor in overdose deaths, both here and nationally. While some users may be aware of this mixture, the contents of illicitly obtained drugs are never certain and they may contain unexpected combinations of substances.

"Fentanyl's presence in cocaine is endangering more lives every day," said Dr. Vélez de Brown. "While the safest choice is to stop using, we know some people will continue to use. There are steps you can take to stay safer. Testing your drugs for fentanyl and xylazine, never using alone and carrying naloxone can help save lives."

Key Findings from the Medical Examiner's 2023 Overdose Report

The report outlines the following trends:

• Fentanyl or its analogs were present in approximately 83% of all opioid and cocaine overdose deaths.

• Alcohol was present in approximately 31% of opioid and cocaine overdose deaths.

• Xylazine, a non-opioid veterinary sedative not approved for human use was present in approximately 14% of opioid and cocaine overdose deaths.

• 335 overdose deaths involved both opioids and cocaine-a 32% increase from 253 in 2022.

• 114 overdose deaths involved opioids independent of cocaine.

• 63 overdose deaths involved cocaine independent of opioids.

Overdose deaths involving heroin/morphine continued to decline, and only 5 deaths (1%) were attributed to these substances in the absence of fentanyl. Additionally, 16 deaths involved prescription opioids instead of fentanyl or heroin/morphine.

Disparities in Overdose Deaths

The report also reveals significant disparities in how the overdose crisis affects different populations:

• Black or African American residents: Despite making up only 17% of the county's population, they accounted for 40% of overdose deaths.

• Men: Nearly three times as many males as females died from overdoses.

• Older adults: Overdoses among individuals over the age of 60 are on the rise, with the median age of overdose victims now at 50 years old.

Free Naloxone and Fentanyl/Xylazine Test Strips

To help prevent overdose deaths, the Monroe County Department of Public Health Addiction Services Division offers free naloxone and test strips for fentanyl and xylazine. Naloxone can reverse the effects of an opioid overdose and test strips can detect the presence of deadly fentanyl or xylazine in street drugs. To make a confidential request for supplies or to learn more, call (585) 753-5300 or visit monroecounty.gov/health-impact for a map of NaloxBox locations and resources.

Steps Taken by County Executive Adam Bello to Combat the Crisis

"These trends show the critical need for continued action," said Monroe County Executive Adam Bello. "We are working to provide life-saving tools, educate the public and remove the stigma around substance use disorder. Together, we can save lives and make our community healthier and stronger."

Since taking office, County Executive Bello has implemented several initiatives to address the overdose crisis:

• 24/7 IMPACT Team: Conducts daily community outreach, visits individuals and sites of overdoses to provide immediate support and resources.

• Opioid Command Center: Coordinates emergency response efforts to address the ongoing public health crisis.

• NaloxBox Installations: Over 500 naloxone cabinets installed in high-risk locations, paired with training resources for the public.

• 24-Hour Opioid Hotline: Connects residents to crisis services, naloxone deliveries, and family support at (585) 753-5300.

• Fentanyl Awareness Campaigns: Launched through PSA's, billboards and street-level outreach to educate the public about the dangers of fentanyl, with a particular focus on populations disproportionately represented in overdose deaths, such as older African American men who use cocaine.

• Opioid Settlement Lockbox: Ensures that every dollar from settlement funds is used exclusively for lifesaving efforts.

• Call to Action Campaign: Focused on reducing stigma, increasing public awareness of naloxone availability and sharing personal stories to foster understanding and compassion.

"We're taking a strategic approach to the overdose crisis by using tools like naloxone and test strips, peer outreach and deploying our 24/7 IMPACT team to connect people with the resources they need," said Dr. Tisha Smith, Director of Addiction Services. "By listening to the community and using data to guide our efforts, we're working to save lives and support recovery and healing."

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