CLEVELAND, Ohio — For the first time in decades, cocaine is killing more people in Cuyahoga County than opioids, including fentanyl.

The news marks a historic shift that Medical Examiner Dr. Thomas Gilson says should spark an urgent change in prevention strategies.

“This is earth-shattering,” Gilson told cleveland.com and The Plain Dealer. “I don’t think that’s been true in the entire 21st century.”

His office has only certified overdose deaths for the first half of the year, representing about 169 cases, but early numbers show that cocaine was involved in 63% of them, compared with 46% involving opioids – including some overlap from drug mixtures.

Projected out for the year, Gilson’s office expects total overdose deaths will top around 415, which would be another slight drop from the

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