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Increased Presence of Fentanyl in Cocaine-Involved Fatal Overdoses: Implications for Prevention


After remaining stable from 2010 to 2014, the  rate of cocaine-involved overdose death increased sharply from 2015 to 2016. This study aims to determine the contribution of opioids, and fentanyl in particular, to the increase in cocaine-involved overdose death from 2015 to 2016. Using New York City death certificate data linked to medical examiner toxicology data, we identified all overdose deaths where post-mortem toxicology results were positive for cocaine from 2010 to 2016. We analyzed cocaine-involved overdose deaths by co-occurring substances. Age-adjusted rates per 100,000 residents were calculated for 6-month intervals from 2010 to 2016. Data suggest that increased deaths involving opioids, specifically fentanyl, accounted for most of the increase in cocaine-involved deaths from 2015 to 2016.

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The authors would like to thank Bennett Allen for his editorial assistance.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This research was conducted with the support of the New York City Department of Health and Mental Hygiene. At the time the study was conducted, all authors were employees of the New York City Department of Health and Mental Hygiene. Authorization to submit and publish the enclosed manuscript was received from the institution.

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Michelle Nolan and Sindhu Shamasunder had full access to study data and take responsibility for the accuracy of the data analysis. Michelle Nolan, Denise Paone, and Hillary Kunins were responsible for study concept and design and critical revision of the manuscript. Denise Paone, Michelle Nolan, Hillary Kunins, and Sindhu Shamasunder were responsible for the analysis and interpretation of the data. Michelle Nolan, Cody Colon-Berezin, and Sindhu Shamasunder contributed to manuscript drafting. All authors approved the final article as submitted on 31 May 2018.

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Correspondence to Michelle L. Nolan.

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Nolan, M.L., Shamasunder, S., Colon-Berezin, C. et al. Increased Presence of Fentanyl in Cocaine-Involved Fatal Overdoses: Implications for Prevention. J Urban Health 96, 49–54 (2019).

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  • Overdose
  • Fentanyl
  • Opioid
  • Cocaine
  • Heroin