Co­caine-re­lated deaths in­crease in Mary­land

Baltimore Sun Sunday - - NEWS - — Mered­ith Cohn

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.

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