New York City nightlife is coming back as the boroughs move to fully reopen by the end of the month. Check social media, and you’ll find people sharing flicks of their first foray back inside the bar and flyers for upcoming dance parties—some only for those who are fully vaccinated.

But last week, sinister warnings began to creep into these feeds. The posts said fentanyl, a highly potent opioid, is hiding in the cocaine supply—and that multiple people had overdosed from the concoction.

One Instagram account, hilovenewyork, posted a screenshot of a text from an acquaintance that read, “My friends died last night, multiple people, please please stop partying if you can, I can’t handle this. Eat mushrooms, smoke weed, please let people know [there is] very bad coke going around Bushwick, Williamsburg.” As hilovenewyork acknowledged in a comment on the post, such reports arise occasionally and can be difficult to vet—but city data back their suspicions.

The amount of cocaine in New York City that’s laced with fentanyl has spiked in recent years. New NYPD data from April shows that 8% of the city’s coke supply now contains fentanyl—nearly one out of every 10 bags sold on the street. In 2017, only about 2% of the cocaine seized by the NYPD contained this synthetic opioid that is about 50 to 100 times more potent than morphine.

“For someone who’s opioid-naive, a really small amount of fentanyl, given its potency, really does carry a higher overdose risk,” said Michelle Nolan, an epidemiologist at the city Health Department who serves as the real-time surveillance manager for the Bureau of Alcohol & Drug Use, Prevention, Care and Treatment. WNYC/Gothamist received the NYPD’s drug-testing statistics through the city Health Department. However, when asked for more data on the prevalence of fentanyl in various drugs and how that has changed over time, the NYPD refused to provide the public health information and directed WNYC/Gothamist to file a formal request through the Freedom Of Information Law.

A Growing Problem—And Not Just for Heroin Users

Fentanyl first entered the New York scene in 2015, primarily as a supplement combined with its opioid cousin, heroin. Today, it appears in 80% of the heroin tested by the NYPD, far outpacing its presence in cocaine. Fentanyl was involved in more than two-thirds of the 1,463 unintentional drug overdose deaths recorded in New York City in 2019, according to city data.

But Nolan explains that cocaine users are more vulnerable to overdosing on fentanyl because they are less likely to be aware of how to prevent opioid overdoses and have not built up the same tolerance for opioids as heroin users. People who use heroin often get access to the overdose reversal medication naloxone and drug safety education at syringe exchanges, but people who use cocaine don’t necessarily come into contact with that harm reduction messaging.

“When fentanyl emerged, it was so closely tied to heroin that for people who used cocaine it wasn’t at the forefront of their minds,” Nolan said.

Overdose data compiled by the city and the Centers for Disease Control and Prevention reflect a rising risk faced by people who do coke. Both convey that overdose deaths from cocaine had been flat in New York City since 2016—but then began to mount in 2019. For example, the CDC’s provisional data show that cocaine-involved overdoses in New York City increased 30% from October 2019 to October 2020. Likewise, deaths from synthetic opioids ballooned twice as much, 60%.

From 2018 to 2019, New York City health officials measured a 17% rise in overdoses involving a combination of cocaine and fentanyl without heroin, from 157 to 183 deaths, respectively.

While cocaine overdoses are rising in five boroughs, nationwide rates are flat, according to the CDC numbers. However, total opioid and synthetic opioid overdoses are rising in New York City and nationwide.

Preaching The Gospel Of Harm Reduction In Bars And Clubs

WNYC/Gothamist spoke to a friend of one of the people mentioned in hilovenewyork’s post. They said after doing cocaine, the person had been found dead by his partner in their home early last Sunday morning. Provided with the decedent's name, the city’s Office of Chief Medical Examiner said the cause and manner of the person’s death have not yet been determined.

Lauren Flax, a DJ based in Brooklyn, said coke and ketamine are popular among those in the nightlife scene she inhabits. Her concern about the drugs being laced with fentanyl led her to begin offering training on how to use naloxone in 2019 at the Lot Radio, an internet radio station based in Williamsburg. She later moved the sessions to the Ridgewood club Nowadays so that more people could attend. To provide the training, Flax partners with the local chapter of the Black Nurses Association, which is registered as an Opioid Overdose Prevention Program and gets free naloxone kits from the Health Department to hand out to participants. The pandemic slowed down the effort, but Flax said she is reviving the cause in light of recent reports of overdoses.

People just dont think it’s going to happen to them and their group

Lauren Flax, a DJ based in Brooklyn

“People just dont think it’s going to happen to them and their group,” Flax said. She said she is also hoping to get test strips to hand out that people can use to see if their drugs contain fentanyl. Asked if she would give them to bars to distribute to patrons, she noted, “It’s such a tricky situation because obviously it’s illegal to do drugs in these venues, and they don’t want to be held accountable by allowing you to test your drugs.”

City health officials have tried in recent years to spread the word about fentanyl among those who use cocaine. In 2018, they began distributing informational posters and other harm reduction materials to bars on the Lower East Side and later expanded to Williamsburg and Bushwick. The idea is to reach people from different parts of the city who flock to these nightlife hubs, said Nolan.

But 42% of the overdose deaths involving cocaine and fentanyl without heroin in 2019 took place in the Bronx. Manhattan came in second place at 25%, while Queens and Brooklyn accounted for 17% and 14%, respectively. Staten Island ranked last, with just 3% of overdoses from that combination of drugs.

Likewise, the top five neighborhoods for overdose deaths involving cocaine were all in the Bronx, except for central Harlem. Black and Latino New Yorkers had the highest rates of overdose deaths involving cocaine in 2019.

How to Prevent Overdose Deaths

Michelle Nolan of the city Health Department offered general tips for drug users on how to prevent overdoses, other than simply taking a break altogether:

  • Don’t use drugs alone, and try to stagger the consumption among the people you are with, so that there’s always someone who can react if there’s an overdose. If you are by yourself, call the NeverUseAlone hotline at 1-800-484-3731, and someone will stay on the line while you do the drugs to make sure you’re OK.
  • ”Start low and go slow.” It’s better to do a tiny amount first and see how you react.
  • Test your drugs using fentanyl test strips, especially if you’re doing cocaine. These can be obtained at syringe exchanges and harm reduction centers throughout the city. They can also be ordered online.
  • Avoid mixing drugs or using drugs with alcohol, which can increase the risk of overdose.

Carry naloxone, the overdose reversal medication. The city offers information on where to obtain the antidote at, including a list of pharmacies that hand it out for free without requesting insurance information. If you’re not near one of those locations, all major pharmacies, including CVS, Walgreens and Rite Aid, now offer naloxone without a prescription, though there may be some out-of-pocket cost. The city is also hosting some upcoming training on how to administer naloxone.

Editor's note, June 7th, 2021: After publication, the New York City Department of Health and Mental Hygiene corrected an earlier statement, saying that only about 2% of the cocaine seized by the NYPD contained fentanyl in 2017, not 2016.