CINCINNATI (AP) — New surges in use of meth and cocaine in mixes with a powerful synthetic opioid are contributing to rising drug overdose death tolls in already hard-hit Ohio.

As county coroners have begun releasing their 2017 tallies, a trend has emerged of more deaths involving meth or cocaine mixed with fentanyl. That’s the powerful painkiller blamed on increasing deaths in recent years as U.S. authorities focused on reducing heroin overdoses.

U.S. authorities say fentanyl made in China has flooded in while there is increased availability of meth and a rebound in cocaine.

Authorities say many drug users may be unaware they are taking fentanyl or have any idea how much is in what they’re taking

Butler County coroner Dr. Lisa Mannix in Ohio says an already bad situation is becoming "something far worse."