Fentanyl-Laced Cocaine: Cocaine Laced With Fentanyl Causing Death

The opioid epidemic has been sweeping across the country for more than a decade, and one of the most potent opioids has been turning up in cocaine, with dangerous results.

Cocaine-involved overdose deaths climbed steadily for years, reaching 29,449 in 2023, an 85% increase from 2019. Fentanyl has become the primary driver of these deaths. Cocaine-involved fatalities with fentanyl co-involvement have increased sharply since 2015 and now account for the majority of cocaine-related overdoses.

There is some encouraging news, though. Provisional CDC data show overdose deaths of all types dropped sharply in 2024, when they fell to approximately 79,384. That’s a 26% decline from 2023. Deaths involving cocaine and other stimulants also declined from 2023 to 2024, though they remain far above pre-2015 levels.

In 2023, approximately 73,000 overdose deaths involved synthetic opioids other than methadone. They were primarily attributed to illegally manufactured fentanyl (IMF) and accounted for nearly 69% of all drug overdose deaths that year.

Fentanyl is no longer a regional threat, either. It’s now present in the illicit drug supply across all 50 states.

Dangers of Fentanyl-Laced Cocaine

One issue with cocaine being laced with fentanyl is the potency of the fentanyl itself. Fatal at 2 mg doses, fentanyl is not intended for individuals who are not already dependent on an opioid.

The 2 mg fatal dose only applies to prescription-grade fentanyl. However, illegally made fentanyl is not regulated and can be unstable and fatal in smaller amounts. If a non-opioid dependent person ingests small amounts of illegal fentanyl, it can be fatal.

It’s also important to note that illegally manufactured fentanyl varies wildly in potency and is not produced under any quality controls. A person using cocaine who unknowingly ingests contaminated product has no way of knowing whether they’re getting a trace amount or a potentially lethal dose.

Another danger of fentanyl-laced cocaine is that the person using the cocaine often has no idea that there is fentanyl in the cocaine. If a person has a high tolerance for cocaine, they may use more cocaine than what is considered an “average” dose and ingest a fatal dose of fentanyl.

Why Lace Cocaine With Fentanyl?

There are many theories as to why fentanyl-laced cocaine is becoming more prevalent, including:

• accidental cross-contamination (poor packaging, etc.)
• increase profits
• fentanyl is a cheap way to increase cocaine weight
• fentanyl-laced cocaine may be appealing to some buyers

No matter the reason, cocaine laced with fentanyl is dangerous and is a key contributing factor to cocaine overdoses in recent years.

Xylazine: Another Adulterant In The Drug Supply

Fentanyl is not the only dangerous additive appearing in cocaine and other illicit drugs. Xylazine is an animal sedative also known as “tranq,” and it has been detected in the illicit supply of fentanyl, heroin, cocaine, and other drugs. People who use drugs may have no idea xylazine is present.

Xylazine causes dangerous respiratory depression, slows the heart rate, and lowers blood pressure to potentially life-threatening levels. It’s important to know that naloxone (Narcan) does not reverse xylazine’s effects because xylazine is not an opioid.

If fentanyl and xylazine are both present, naloxone should still be administered because it will address the fentanyl. However, you should contact emergency services immediately, as xylazine’s effects will continue even after naloxone is given.

Chronic xylazine exposure, particularly through injection, is also associated with severe, disfiguring skin wounds and ulcers that can lead to tissue death or amputation if untreated.

The DEA reported in 2023 that xylazine had been seized alongside fentanyl in 48 of 50 states.

Cocaine And Fentanyl: A New Age Speedball

Speedballs from the 1970s typically combined cocaine and heroin, although any opioid/cocaine combination could be referred to as a speedball. A speedball is usually an intentional combination that works to dull the negative effects of both drugs.

This combination results in an intense rush from the cocaine (a stimulant) and the relaxation and euphoria of an opioid (a depressant). Speedballs have ended the lives of many famous people, such as River Phoenix, John Belushi, and Chris Farley.

However, the current combination of fentanyl and cocaine is often done without the buyer’s knowledge or consent, and the rise in cocaine overdoses reveals how deadly this combo can be, especially when the person is unaware.

Reversing A Fentanyl-Laced Cocaine Overdose

Narcan is the name brand of a drug called naloxone. This drug reverses the effects of opioids and saves lives.

When an overdose from fentanyl-laced cocaine occurs, if the overdose is directly caused by the fentanyl, Narcan can be effective. However, due to the potency of fentanyl, more than one dose may be necessary.

If the overdose is primarily due to cocaine, it is important to get the person emergency services as soon as possible. Typically, the fastest way to do this is to call 9-1-1.

How To Tell If Cocaine Is Laced With Fentanyl

It is difficult to tell if cocaine has been laced with fentanyl, especially by looking at the drug. To help combat this growing problem, there are fentanyl test strips that can determine if fentanyl has been combined with cocaine.

Fentanyl test strips are small, inexpensive devices that can detect the presence of fentanyl in cocaine and other drugs. A small amount of the substance is dissolved in water, and the strip is inserted. Then, a result line indicates whether fentanyl is detected. Research shows that people who receive a positive result are significantly more likely to change their behavior, including using a smaller amount, using more slowly, or having naloxone nearby.

As of 2025, the majority of U.S. states have decriminalized the possession, distribution, or sale of fentanyl test strips, removing them from drug paraphernalia laws. However, a small number of states still restrict or prohibit their possession or sale.

Legal status can also vary at the local level. Check current laws in your state before purchasing or distributing strips, or contact a local harm reduction organization for guidance.

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Written by the Addiction Resource Editorial Staff