Trends in opioid overdose fatalities in Cuyahoga County, Ohio: Multi-drug mixtures, the African-American community and carfentanil

•3 or more cause of death drugs were identified in nearly two-thirds of opiate/opioid decedents.•Cocaine/opioid mixtures led to 4 times as many African American decedents than 2 years prior.•Fentanyl and its analogs were present in 90% of decedents, and carfentanil was present in 35%.•Carfentanil was more common in people with prior illicit drug use, but no relevant medical history.