For the second year in a row, the number of overdose deaths in Monroe County decreased, continuing a trend that started after the deadliest year on record in 2023.
But while the numbers are falling, the substances causing those deaths are changing.
The county medical examiners office reported that 243 people died from overdoses in 2025. That's a 17% decrease from the 292 deaths reported in 2024, and a 53% decrease from the 2023 peak of 512.
Generally, the fatal overdoses involve multiple drugs, and in 2024, cocaine surpassed opioids as the most common drug present in fatal overdoses within Monroe County. That trend continued in 2025, where cocaine was present in 81% of all overdose deaths. In 38% of the fatal overdoses, cocaine was present, but opioids were not.
“This report tells us overdose prevention can no longer focus on opioids alone,” public health Commissioner Dr. Marielena Vélez de Brown said in a news release.
“Cocaine can be deadly, especially when it is combined with alcohol or other drugs," she added. "If you use street drugs, test your supply, avoid using alone and keep naloxone nearby. And if you are ready for treatment, we are ready to help.”
Opioids were present in 135 overdose deaths, or roughly 55% of the total. Fentanyl is by far the most common opioid found in overdose deaths. Heroin was listed in only seven, all of which also involved fentanyl, according to the report.
Overdose deaths are declining across the country. But county officials attributed the local decrease in part to community efforts, such as increasing access to the opioid overdose reversal drug naloxone and to test strips for fentanyl and the potent veterinary tranquilizer xylazine. The county's Addiction Services IMPACT team also performs outreach, crisis response services, and follows up with people who had an overdose.
County officials also announced the launch of a new overdose surveillance dashboard to replace the previous opioid-focused one.
