Cocaine kills. Especially in Butler County.

This year, 24 people in Butler have died seeking the ultimate high - more than in any previous year here, and more than in five surrounding Greater Cincinnati counties combined. It's also one of the largest cocaine death tolls in Ohio.

If cocaine kills one more time this year, Butler's 2003 toll will hit 25 - equaling the county's total cocaine deaths during the entire decade of the 1990s.

Older users, ages 35-50, have been dying much more frequently than younger ones, largely because of health problems that come with age, authorities said. For example, the much-publicized recent death of Nathaniel Jones, during a struggle with Cincinnati police, was complicated by the 41-year-old man's obesity, enlarged heart and use of drugs like cocaine, the Hamilton County coroner said.

But the glut of cocaine now on Ohio streets is also cheaper - $30 to $50 for a one-gram dose - and purer than even one year ago, state authorities say.

The number of cocaine casualties in Butler County is sad and shocking, "and it's just by the grace of God that I'm not one of them," said Shawn Francis, a 39-year-old mother of three who is in drug counseling at Sojourner Recovery Services in Butler County.

A crack cocaine user for 14 years, Francis said she sought help earlier this year after she finally realized: "I was slowly killing myself every day."

Cocaine is a powerful, addictive stimulant that creates an intense, immediate "high." Powder cocaine, which is snorted, is still viewed as a "glamour" drug and remains more commonly used in higher socioeconomic groups; rock-like "crack," which is smoked, tends to be used in poorer areas.

The drug is blamed for thefts, violence and rising health-care costs, among other social ills.

Tracking cocaine deaths is difficult, however, because many users often abused other drugs that may have contributed to their deaths - and because coroners' offices and state agencies have different ways of categorizing drug-related deaths. The Ohio Department of Health says it is now trying to craft a database that would show how many deaths are attributed to specific drugs.

Even so, based on available data, Butler County's cocaine death rate stands out as unusually high, considering its 334,000 population.

The Butler County coroner, Dr. Richard P. Burkhardt, is frustrated that efforts to educate people about the dangers of cocaine and other drugs aren't working.

"(People) continue to abuse drugs as if they are no more harmful than a roller-coaster ride at Americana," Burkhardt said in his 2002 annual report, lamenting last year's 19 cocaine deaths. "Until people come to realize that drugs are dangerous and that no thrill can compensate for the early loss of life, we will continue to experience tragedy after tragedy."

Burkhardt said he was disturbed that, when he returned from a vacation in September, he learned that the county had six cocaine deaths that month alone. Drug treatment professionals agree that's a large single-month toll for a county Butler's size - and they wondered whether the users were getting a "bad batch."

Burkhardt, however, said finding any such link in illicit drug supplies is unlikely. "It's not like there are lot numbers you can trace," he said.

Among the 24 who succumbed to cocaine in Butler this year, 23 were white males and one was a 27-year-old white female. The men's ages spanned 22 to 53 - and half were at least 35.

"These aren't teenagers," Burkhardt said. "But they're continuing to use a drug they may have used in their 20s - and the older people's bodies can't take it."

The age factor

When someone is older and has developed coronary artery disease, taking cocaine is "a recipe for disaster," Burkhardt said. "With cocaine use, the coronary arteries completely shut down, it causes cardiac arrhythmia (irregular heartbeat) - and they die."

Burkhardt's theory - that the victims' older ages help explain the rise in deaths - could be on target, said Sanford Starr, chief of treatment and planning for the Ohio Department of Alcohol and Drug Addiction Services.

Last year, some treatment agencies were seeing "increasing numbers of adults over the age of 40 seeking treatment for crack cocaine abuse," including many with no prior drug history, a statewide drug-monitoring network reported. Some older males who used crack cocaine reportedly were turned onto it by younger women who trade sex for crack, the network said.

Drug abuse trends are cyclical, "and right now, cocaine is on the upswing," Starr said. "The streets seem to be flooded with it."

This glut in the market has driven down street-level prices of powder cocaine, he said. A one-gram dose, which cost $60 to $100 two years ago, now can be bought for about half that, Starr said.

Tests on street-level coke reveal the supply is very potent.

Dealers seem to be pushing the drug into new territory to make more sales, he said.

While the number of cocaine-related arrests has remained about the same for Butler County's two largest police agencies, there are signs that dealers are handling larger amounts of the drug.

Hamilton police have been accustomed to seizing smaller amounts of cocaine. But in both 2001 and 2002, police had two separate big busts of a kilogram (about 2.2 pounds) - and "that's highly unusual for us," said Sgt. Carl Sigmon, Hamilton drug investigations supervisor.

Meanwhile, Butler County Sheriff's drug investigators say cocaine trafficking "is definitely not declining," said Capt. Greg Blankenship.

No more seeking help

So far, Butler drug treatment centers report no significant spike in cocaine abusers seeking help, said John Bohley, executive director of the county Alcohol and Drug Addiction Services board. That may be because there may be a time lag between a drug's rise in popularity and a rise in users seeking treatment, he acknowledged, adding, "If we can get people there (into treatment), we often can reach them."

But users often are in denial about their problem and they therefore resist getting treatment, said Andy Willis, an investigator for the Butler County Coroner's Office.

"Why would you get treated when you're doing something you enjoy doing?" Willis said. "I think they have to wind up near death, in the ER (emergency room) to come to their senses."

Willis, who began his job in 1996 when Butler had just two cocaine deaths, said the escalating toll gives only a hint of the problem.

"We only see the ones who die," he said. "There are hundreds and hundreds and hundreds that go to the ER and survive it."

Drug counselors say the cocaine problem is pervasive; a large percentage of their clients admit to some cocaine use, even if it wasn't their preferred drug.

Users' relatives usually know their loved ones have drug habits, Willis said, but they may not know what to do.

Even after loved ones die, relatives may be reluctant to acknowledge cocaine or other illegal drugs as the cause of death, treatment professionals say, because they want to avoid public humiliation - or because they blame themselves.

All of the families of Butler County cocaine victims who were contacted by the Enquirer for this story declined to be interviewed.

Users or their families may be unaware of the treatment options that are available - and that some agencies offer low- or no-cost services, said Amy Erhardt, executive director of Sojourner Recovery Services. "We don't turn anybody away for inability to pay," said Erhardt, whose agency has offices in Hamilton and Middletown.

Researchers who monitor drug-abuse patterns are to meet later this month to share data and come up with strategies to combat current trends, said Starr, the Ohio Department of Alcohol and Drug Addiction Services' chief of treatment and planning.

Often, drug-treatment professionals function like firefighters trying to douse a grass fire: once they extinguish the flame in one area, a new hot spot flares up.

"As we get better able to prevent one drug, getting the right message out, there's always something that seems to take its place," Starr said. "We'll have to see whether this (cocaine trend) is a blip on the radar - or whether we'll see this continuing."