The weekend brought 11 new overdose deaths in Hamilton County and another eight in Cuyahoga County. The spike has alarmed coroners, who suspect cocaine mixed with fentanyl has fueled a fatal overdose toll of at least 49 people across Ohio in the last two weeks.

What’s caught the eye of coroners is the bulk of the deaths are happening on weekends. Recreational cocaine and crack-cocaine users appear to be among those dying. The dead represent a different group than people who are addicted to opioids such as heroin or fentanyl and use them around the clock, officials say. 

The 11 deaths in Hamilton County occurred Friday through Wednesday morning, coroner’s reports show. On the previous weekend, there were another seven overdose deaths in the county.  

Officials gave several possible reasons for the spike.

“We had a number of cases over the weekend that seem like they have involved crack cocaine,” said Dr. Lakshmi Sammarco, Hamilton County coroner.

While it’s premature to say exact causes of death, she noted that analysts at the Hamilton County Crime Lab have found fentanyl in seized crack cocaine.

Overdoses seem to be more frequent during the summer months, officials said.

“We see spikes of a lot of things at this time of year,” Sammarco said, listing traffic crashes, boating accidents and alcohol-related deaths. “Risky behavior is risky behavior, and it includes alcohol and drugs.”

Newtown Police Chief Tom Synan, who’s with the Hamilton County Heroin Coalition, said it’s not the first time the region has experienced fentanyl mixed in the cocaine supply.

Recreational drug users may not be aware that fentanyl is in their cocaine, Synan said. As cocaine users, they’re not tolerant to opioids, especially fentanyl, which is a highly potent synthetic opiate. Finally, cocaine users aren’t likely to be carrying naloxone, the antidote for opioid overdose, he said.

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Sammarco said that some people who died during the weekend did not respond to naloxone that paramedics administered, and that indicates another drug could be in play.

Xylazine, a horse tranquilizer, has been detected in crime-lab seizures recently. It’s not an opioid, as is fentanyl. Instead, it’s a benzodiazepine, a type of sedative and therefore couldn’t be reversed with naloxone. It’s possible that xylazine caused some of the overdoses.

Sammarco cautioned that toxicology reports, which can take days or weeks to be completed, will best identify what’s happening.

Dr. Thomas Gilson, Cuyahoga County medical examiner, said he is concerned about trends he’s seeing there.

“I’m deeply concerned about the number of overdose fatalities we’ve seen within the past week,” Gilson said in a statement. “We are seeing a high percentage of African American victims –  50%.” 

Gilson issued a public health alert on Tuesday after counting eight deaths over Memorial Day weekend, in addition to 10 he reported the previous week.

In Hamilton County, Synan said, “the heroin coalition is working to get in touch directly with those using on the street.”

Synan urged people to call 911 in the case of an overdose and get naloxone. It is available at pharmacies, needle exchanges in Hamilton County and Northern Kentucky and some public health clinics. (Call first.)

The coalition is sharing information about overdose trends with Cleveland and Columbus.

Suburban Butler and Clermont counties reported no suspected overdose deaths over the Memorial Day weekend. Franklin County issued an alert last weekend, when nine people died from suspected overdoses.

More: 4 died in Butler County suspected overdose surge that killed 7 in Hamilton County

More: Cocaine-fentanyl mix triggers rising OD deaths among African Americans in Greater Cincinnati

More: Naloxone boxes to be placed in Downtown Cincinnati in new bid to stem overdose deaths

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