The stimulant deaths are mostly opioid deaths

Overdose deaths involving cocaine and psychostimulants — methamphetamine
and similar — kept rising. Between 2015 and 2016 the age-adjusted rates rose
52.4% and 33.3% respectively.

From 2016 to 2017 they increased again, across every dimension measured:

Age groups · racial and ethnic groups · county urbanisation levels ·
multiple states

An increase that appears everywhere at once is not a local phenomenon or a
demographic one. It is a change in the drug supply.

What is actually killing people

**Synthetic opioids appear to be the primary driver of cocaine-involved death
rate increases, and recent data point to increasing synthetic opioid
involvement in psychostimulant-involved deaths.**

Rates rose both with and without opioids — but the driver identified is
fentanyl, present in the cocaine and increasingly in the stimulants.

That reframes the whole category. A rise in "cocaine deaths" reads as a return
of cocaine. What the data shows is largely fentanyl arriving in the cocaine
supply, killing people who were not seeking an opioid, may never have used one,
and have no tolerance to it.

It also explains why prevention aimed at opioid users misses them. Somebody
buying cocaine does not think of themselves as at risk of an opioid overdose,
has no reason to carry naloxone, and will not be reached by messaging addressed
to people who use opioids.

Why a stimulant overdose is a different problem

There is no naloxone for stimulants and no equivalent of methadone or
buprenorphine — the medications that make opioid use disorder treatable. When
fentanyl is also present, naloxone helps with half of what is happening, and
a bystander watching an incomplete recovery may conclude it did not work.

So a supply where the two are mixed produces deaths that neither the opioid
response nor the stimulant response fully covers.

Source: Centers for Disease Control and Prevention, MMWR.