Monroe County Overdose Deaths Fall 53% in Two Years — 243 Deaths in 2025

Monroe County recorded 243 fatal overdose deaths in 2025. Two years earlier, the number was 512. The county released the full 2025 data on September 15, and the 53% two-year decline — the second consecutive year of sharp improvement — is worth understanding: both for what changed, and for what hasn't.

Monroe County Overdose Deaths Dropped by Half in Two Years

Monroe County Overdose Deaths Dropped by Half in Two Years

The 53% drop — from 512 deaths in 2023 to 243 in 2025 — stands out against national trends. WXXI News reported that fatal overdoses dropped 26.9% nationwide between 2023 and 2024. Monroe County's two-year trajectory cleared that benchmark by a significant margin.

The starting point was steep. The Rochester Beacon reported that fentanyl-cocaine combination deaths reached 335 in 2023, accounting for 65% of all fatalities that year — up 32% from 2022. The county has reversed that trajectory in two years.

Cocaine Is Now the Drug Behind Four of Every Five Deaths

Cocaine Is Now the Drug Behind Four of Every Five Deaths

According to the county's September 2026 data, cocaine appeared in 80.7% of 2025 overdose deaths. In 37.9% of cases, cocaine was the only drug present — no opioids — up from 22.6% in 2024.

The explanation is not that cocaine changed. The supply did. DEA Special Agent Frank Tarentino told the Rochester Beacon: "The cocaine and the fentanyl are already mixed together in the same glassine bag. They think they're buying cocaine, but they're really buying cocaine mixed with fentanyl, and that's what's killing people often."

Xylazine — a veterinary sedative that can blunt naloxone's effect — appeared in 30.9% of 2025 deaths, up from 26% in 2024. Standard Narcan response is no longer sufficient for every case.

What the County Built to Turn the Numbers

What the County Built to Turn the Numbers

The Monroe County IMPACT team grew from 7 people in 2020 to 24 staff. More than 35,000 packages of Narcan have been distributed since the program launched. The county now has 637 public naloxone boxes installed — at the airport, the University of Rochester, Innovative Field, barbershops, and restaurants across Monroe County.

A new Overdose Surveillance Dashboard launched in 2026 to give public health officials real-time pattern data for faster outreach targeting. The Overdose Fatality Review program — funded by a $1.6 million Department of Justice grant — fields a 24-member multidisciplinary team that analyzes every death and issues prevention recommendations.

243 Deaths Are Still Too Many

243 Deaths Are Still Too Many

Monroe County's own data names the disparity directly: Black residents account for 26.7% of 2025 overdose deaths. The Rochester Beacon reported that Black residents comprise 16.5% of the county's population. The median age of someone who died of an overdose in Monroe County in 2025 was 54. Seventy-one percent were male.

County Executive Adam Bello said at the September 15 release: "Fewer overdose deaths means fewer families receiving devastating news. That is progress, but 243 deaths are still far too many."

The 24-hour Monroe County treatment and crisis hotline is (585) 753-5300.