Lessons From the Field: King County, Washington OFR

Free Virtual Event!

1:00-2:00 p.m. CDT | Wednesday, June 24, 2026

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From Powder Confusion to Prevention: Identifying Fatal Fentanyl Overdoses Among Cocaine Users

This presentation explores a growing overdose trend identified through King County’s Overdose Fatality Review (OFR) and real-time overdose surveillance systems in which individuals unintentionally consume fentanyl while believing they are using cocaine in powder or base form. King County OFR refers to this phenomenon as “powder confusion” or “rock confusion.”

These cases are not examples of “fentanyl-laced” cocaine, but rather fatal visual misidentification of fentanyl as cocaine, revealing a previously overlooked opioid overdose risk pathway among stimulant-using populations.

Drawing on fatal overdose investigations in King County, this presentation focuses on how OFRs can translate emerging overdose trends into action through targeted prevention efforts.

Attendees will learn how these findings informed the creation and distribution of cocaine-focused fentanyl testing kits, tailored overdose prevention messaging for stimulant users, and targeted outreach to populations that may not perceive themselves to be at risk for opioid overdose.

The presentation highlights how multidisciplinary overdose review can strengthen collaboration between medical examiners, public health agencies, clinicians, harm reduction organizations, and frontline responders to rapidly respond to evolving overdose trends.

Emily Dalgo

Overdose Fatality Review Coordinator King County Medical Examiner's Office

Emily Dalgo is the Overdose Fatality Review (OFR) Coordinator for King County, Washington, based in the Medical Examiner’s Office. She convenes and facilitates a multidisciplinary committee of more than 40 agencies—including public health, behavioral health, law enforcement, housing, and healthcare partners—to review overdose deaths, identify system-level interventions, and advance strategies that prevent future fatalities.

Under her coordination, the OFR has implemented several impactful recommendations, including training and equipping all Sound Transit safety staff with naloxone and overdose response education.

She is also the Founder and Executive Director of the Overdose Prevention Collective, a Seattle-based 501(c)(3) nonprofit dedicated to overdose prevention through naloxone distribution and substance use education.

Previously, Emily served as Associate Director of Regulatory Policy for a national healthcare association and as Executive Director of a patient safety advocacy coalition in Washington, D.C. She holds a master’s degree in Sociology from the University of Washington.

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