U.S. deaths from overdoses of cocaine totaled 14,666 in 2018, according to a new report from the Centers for Disease Control and Prevention. The rate of overdose deaths remained stable from 2009 through 2013, the report found, but then headed upward at about 27 percent each year from 2013 through 2018. Approximately 80% of overdose deaths involved opioids, and three of four opioid overdose deaths involved illicitly manufactured fentanyls (IMFs). The supply of fentanyl and overdose deaths involving synthetic opioids are projected to have increased for the seventh straight year in 2019. Fentanyl, heroin, cocaine, or methamphetamine (alone or in combination) were involved in nearly 85% of overdose deaths. The CDC report suggests the combination of drugs complicates intervention and treatment efforts; one-half of these deaths involved two or more of these four drugs.

That rate increase represents about 2½ times more cocaine-related deaths in 2018 than in 2014. A Washington Post report indicates that the Drug Enforcement Administration has said increased availability of the drug is “in large part due to record levels of coca cultivation and cocaine production in Colombia.”


The CDC report says that the rate of overdose deaths from cocaine was higher among men than women and more common among middle-aged people (35 to 44 years old), those living in urban rather than rural areas, and people residing in the Northeast region. In addition, the rate of overdose deaths attributed to cocaine laced with a synthetic opioid such as fentanyl increased faster in recent years than did overdose deaths from purely cocaine.


The CDC research indicates that more than three in five overdose deaths (62.7%) had evidence of at least one potential opportunity for intervention. Approximately one in ten opioid overdose deaths had evidence of past-month institutional release (10.7% with stimulants; 10.8% without stimulants) or previous overdose (10.9%; 12.1%). Mental health diagnoses were documented for one quarter (25.8%) of overdose deaths. Evidence of current or past substance use disorder treatment was more common among opioid overdose deaths (18.6% with stimulants; 19.1% without stimulants) than nonopioid overdose deaths (<10%). Among overdose deaths, 37% occurred with a bystander present.


A 2018 report by the Assistant Secretary for Planning and Evaluation (ASPE) examined the impact of increased opioid use on foster care.  Substance Use, the Opioid Epidemic, and the Child Welfare System: Key Findings from a Mixed Methods Study found a 10 percent increase in overdose death rates corresponded to a 4.4 percent increase in the foster care entry rate and a ten percent increase in the hospitalization rate due to drug use corresponded to a 3.3 percent increase in the foster care entry rate. At the time, the report indicated that more research was needed to understand better how economic opportunity and substance use interact at the community level, but they also conclude that action to address the risks and consequences of the opioid epidemic in communities simultaneously facing economic challenges need not wait. This new CDC research was based on data before the outbreak of the COVID-19 pandemic.


In 2017, CWLA expressed to Congress the critical impact of the drug treatment provided through the ACA, telling Congress, “The Affordable Care Act has provided more than $5.5 billion in substance use and mental health services…foster care numbers released by HHS indicated that in 2015, 427,910 children were in foster care, an eight-percent increase since 2012. New data suggests that drug abuse by the parent was the primary reason for the child’s removal in 32 percent of cases, and a parent’s inability to cope was a factor in a child’s removal in 14 percent of cases. The reduction or elimination of this expanded behavioral health coverage would no doubt increase these numbers…”