Decline in Fentanyl-Related Overdose Deaths and Subsequent Change in Decedent Demographic Characteristics: Trends in Cuyahoga County, Ohio, 2023-2025.

Overdose deaths have steadily decreased in the United States from 105 000 deaths in 2023 to 79 384 deaths in 2024. To better understand emerging trends in overdose deaths, we conducted a pilot epidemiological study of fatal drug overdose data from the Cuyahoga County Medical Examiner's Office (Cleveland, Ohio) from 2023 through mid-2025 (all accidental drug overdose deaths from January through June). During the study period, all fentanyl-related accidental drug overdose deaths decreased from 75.8% to 45.6% (P < .001). During the same period, all cocaine deaths that included fentanyl decreased from 69.8% to 40.7% (P = .004), and all cocaine deaths that excluded fentanyl increased from 17.6% to 39.2% (P < .001). Drug overdose deaths decreased among White males but increased by 9% among Black males, largely driven by Black men aged ≥55 years. Percentages of overdoses among Black men aged ≥55 years in the all-fentanyl group (P < .001) decreased from 53.4% (47 of 88) to 34.1% (15 of 44) but remained steady in the all-cocaine group (P < .001) from 85.2% (75 of 88) to 84.1% (37 of 44). Overdoses increased in the cocaine-without-fentanyl group (P < .001) from 46.6% (41 of 88) to 63.6% (28 of 44) but decreased in the cocaine-only group (P < .001) from 31.8% (28 of 88) to 27.3% (12 of 44). Our results showed a shift in demographic characteristics with regard to decreases in fentanyl-related overdose deaths and increases in cocaine-related overdose deaths. Because no stimulant antidote analogous to naloxone for opioids is available, public health policy will need to pivot in response to the increase in stimulant-involved overdose deaths.