Health Advisory: Increase in Overdoses Involving Fentanyl and Cocaine in Snohomish County

7/3/2025

 Action Requested:

• Be Aware that the number of fatal overdoses involving both fentanyl and cocaine in Snohomish County increased to their highest levels on record in the first months of 2025. The illicit drug supply is unregulated and therefore constantly changing, and rocks and powders containing fentanyl are visually identical to similar rock and powder substances such as cocaine. Individuals are not able to see, taste, or smell the difference – the only way to know if a drug contains fentanyl is to test.
• Provide guidance when engaging with individuals who use stimulants, particularly cocaine, on the use of fentanyl test trips and/or community drug-checking programs. 
  • Fentanyl test strips are for people not intending to use fentanyl. 
• Promote the following recommended harm reduction strategies to individuals who use drugs, including stimulants such as cocaine.
  1. Test non-fentanyl drugs before using with fentanyl test strips or by visiting a community drug-checking program. 
  2. Attend Naloxone training and distribution
  3. Avoid mixing different types of drugs
  4. Go slow and use less
  5. Never use alone. Call the Never Use Alone Hotline at 800-484-3731 or 877-696-1996, 24/7/365.
  6. Please see below for locations with fentanyl test strip and naloxone availability.

Background:

The number of fatal overdoses involving both fentanyl and cocaine in Snohomish County increased to their highest levels on record in the first months of 2025.

In the first quarter of 2025, the Snohomish County Medical Examiner’s Office Expedited Drug Analysis Program reported 17 overdose deaths involving both fentanyl and cocaine.

Additionally, narrative reports from EMS agencies throughout the county have mentioned increased incidents of responding to fentanyl overdoses, including a triple overdose (where three people overdosed at the same time using the same supply), among people believing to have used cocaine. 

Snohomish County Health Department receives these reports in partnership with several EMS agencies as part of a naloxone leave-behind program. A data report is received for each overdose incident in which a kit is left behind by EMS. Upon receiving these reports, health department staff began to engage with additional community partners and review additional data sources. Thank you to our EMS agencies and community partners who helped alert us to this emerging trend.

Fentanyl Test Strips (FTS) are a harm reduction tool that offer a low-cost way to provide people who use drugs with information about fentanyl in the illicit drug supply. These paper test strips can detect the presence of fentanyl in different types of drugs, including cocaine, methamphetamine, heroin, or in opioid pills. While fentanyl test strips are highly accurate, they are not perfect and can produce false positives or false negatives. However, when used in combination with having naloxone on hand, FTS are a valuable harm reduction tool to reduce the risk of overdose.

For individuals living in Snohomish County, there are several locations providing fentanyl test strips and naloxone at no cost to community members:

• Snohomish County Health Department STI Clinic, 3020 Rucker Avenue, Suite 106, Everett, WA Phone: 425-339-5261 
• Carnegie Resource Center, 3001 Oakes Avenue, Everett, WA 98201 Phone: 425-434-4680
• Sound Pathways | Harm Reduction Center, 1625 East Marine View Drive Suite #4, Everett, WA Phone: 425-258-2977 The Harm Reduction Center also operates Snohomish County’s only community drug checking program with funding from the University of Washington.

Visit https://stopoverdose.org/find-naloxone-near-me-washington-state/ for a list of additional locations with naloxone.

Community drug checking is another harm reduction intervention that offers people who use drugs with information on the illicit drug supply. These programs are typically operated by local harm reduction service providers (often an SSP, or Syringe Services Program). People who use drugs can bring in small amounts of drugs/residue to be tested by trained technicians. Participants receive preliminary results on site, and secondary testing may be sent out to a laboratory and reported back to the participant. 

Drug testing enables individuals to make informed choices about their drug use and is an important tool to reduce the risk of overdose. Both FTS and community drug-checking programs can never determine whether a drug is "safe" to use or not, therefore individuals should be counseled on the limitations of these strategies and encouraged to use additional harm reduction practices.

Snohomish County Health Department staff will continue to monitor overdose data and incident reports and will provide relevant updates related to this emerging trend. If you have information related to problems or patterns regarding substance use in the community, please consider completing our Substance Use: Gathering Anecdotal Reports (SUGAR) survey.

 For further guidance or questions, please contact Snohomish County Health Department at shd-opioids@co.snohomish.wa.us.

Resources:

• CDC What You Can Do to Test for Fentanyl: Information on Fentanyl test strips.
• Washington State Naloxone Finder: Find locations with Naloxone.
• University of Washington-Washington State Community Drug Checking Network: Information on Washington State Community Drug Checking Network.
• Snohomish County Health Department Substance Use Gathering Anecdotal Reports (SUGAR): A survey for those that have information related to problems or patterns regarding substance use in the community.