Overdose deaths in Monroe County plummeted last year, falling in line with national trends and reaching the lowest numbers since 2020.
The Monroe County medical examiner's office attributed 292 deaths in 2024 to the use of opioids and cocaine, either separately or together. That's a 43% drop from 2023, when that figure stood at a record 512. At the national level, fatal overdoses dropped by 26.9% between 2023 and 2024.
"It's obviously very good news that the number of overdose deaths has decreased so significantly," said Dr. Marielena Vélez de Brown, the county's public health commissioner.
The report also noted some improvement in racial disparities around overdose deaths.
Nationally, the decrease in fatal overdoses has been attributed to increased awareness and increased availability of the overdose reversal drug naloxone.
Vélez de Brown said the work of the county health department's IMPACT team, which was formed several years ago in response to the growing opioid epidemic, has helped drive the local decrease. Among the team's efforts: installing roughly 640 publicly accessible boxes stocked with free naloxone.
The team also does street outreach to help connect people using substances with everything from clean socks to treatment, and it follows up with overdose survivors. It's also headed up campaigns to address stigma around substance use disorder, which can prevent people from seeking treatment.
"Addiction is a disease of the brain, these controlled and addictive substances change the way our brains and bodies function, and so ... a response to this type of a crisis requires multiple interventions," Vélez de Brown said.
It's not just the county doing overdose prevention work. Several organizations work throughout the Rochester area to educate people about substance use and overdose prevention.
One of them is DePaul, which is home to the National Council on Alcoholism and Drug Dependence-Rochester Area. The organization does educational outreach at events like health and community fairs, and it distributes lockboxes for medication, test strips for the opioid fentanyl and the veterinary tranquilizer xylazine, and naloxone kits.
"The good news is we're getting stuff out there so people can respond quicker," said Jennifer Faringer, the council's director. "I think the bad news is that one death is still too many, so I think we still have work to do."
A shifting dynamic
Most fatal overdoses involve multiple drugs. Until a few years ago, opioids — particularly fentanyl — showed up in overdoses most frequently. But when county officials released the 2022 numbers, they noted that cocaine-related overdose deaths were rising, and they shifted from talking about an opioid crisis to a broader substance use and overdose crisis.
In 2024, cocaine surpassed opioids as the most common drug present in fatal overdoses within Monroe County. The drug was a factor in 82.5% of last year's overdose deaths while fentanyl was present in 73%, according to the county data. Often, both cocaine and opioids were present.
In 2022, cocaine was found in 77% of overdose cases while fentanyl was found in 80%.
The shift playing out in Monroe County is in line with national trends. Cocaine-related overdoses rose by 85% nationwide from 2019 to 2023, according to the National Center for Health Statistics.
Faringer said it is still important to have naloxone — its brand name is Narcan — on hand and to use it in the event of an overdose. Often street drugs are not pure, and fentanyl is frequently part of the mix.
"It's Russian roulette," Faringer said. "You have no idea what you're buying on the street."
Vélez de Brown said that the health department's IMPACT team has, from day one, been trying to connect people with treatment regardless of the substance they are using. She added that the shifting nature of overdose deaths won't change their approach much.
"We need to get folks the mental health counseling supports that they need so that they can develop other coping mechanisms than turning to a substance at all," Vélez de Brown said.
But the department plans to have stocked all of its indoor naloxone boxes with test strips for fentanyl and xylazine by the end of this month. Vélez de Brown said that's a harm reduction measure — as is making naloxone free and easy to get —meant to help keep people using substances safer until they are ready to get treatment.
"We want folks to know what they're using, to not use alone, and to just be prepared," Vélez de Brown said.
Signals about 2025
Whether the dip in overdose deaths will be sustained is an open question. But there are two things happening that concern Vélez de Brown, and public health officials and researchers across the country.
The federal government's Medicaid cuts are one of them. An NPR story from June noted that the public health insurance program is the largest payer for mental health and substance use disorder treatment.
Current data is the other. The county now has access to the state EMS database that tracks the number of calls that first responders classify as overdoses. And in 2025, the number of calls is rising, Vélez de Brown said.
"We have reason to believe that the overdose death report for next year won't be quite as positive as this one," Vélez de Brown said.
By contrast, overdose calls decreased in 2024, coinciding with the decrease in deaths.
In the meantime, public officials and others in the addiction field are sounding a familiar refrain.
"If you don't have a Narcan kit, get one and be ready to use it," Faringer said. "They're very simple to use. Also, you've got to call 911, because with the strength of product out there, the one dose or two doses that you might have won't do it. You want to be sure that EMS is on the way."
