Overdoses in the state from fentanyl-laced heroin may be on the decline, but the state is increasingly facing a new problem: fentanyl-laced cocaine.

According to a report issued in August by the Department of Public Health, the first three months of 2018 was the second quarter in a row that cocaine surpassed heroin in the toxicology for opioid-related deaths. Meanwhile, the rate of overdoses related to heroin has decreased from 2014 to 2018.

Alongside both of those trends has been an alarming increase in the rate of overdoses that have tested positive for fentanyl, with a staggering 90 percent of all overdose deaths in 2018 through March testing positive for the drug.

The state said the figures illustrate "the changing nature of the epidemic," with providers concerned that overdose deaths are occurring because of fentanyl-laced cocaine.

“This quarterly report provides a new level of data revealing an unsettling correlation between high levels of synthetic fentanyl present in toxicology reports and overdose death rates,” said Governor Baker in a statement that went out with the report. “It is critically important that the commonwealth understand and study this information so we can better respond to this disease.”

The state re-issued a June clinical advisory to physicians as a result, informing providers that those needing treatment for substance use disorder may have a problem with any number of drugs, and asked providers "to educate clients and staff regarding the presence of fentanyl in cocaine, as well as other illicit substances.”

Massachusetts is following national trends in fentanyl-laced cocaine deaths over taking those of fentanyl-laced heroin. According to the Center for Disease Control and Prevention, there was a sharp increase in the estimated number of overdose deaths involving cocaine nationally from 2016 to 2017, from approximately 10,000 deaths in 2016 to 14,556 in 2017.

In Connecticut, WBUR reported that the number of deaths involving cocaine and fentanyl together had increased 420 percent in the last three years, though heroin laced with fentanyl still killed more people in that time period.

According to Vox, the reasons could be numerous, but drug users have mixed heroin and cocaine purposefully in the past in what is known as a “speedball.” Dealers may also be purposefully mixing fentanyl with cocaine without the buyer’s knowledge, because it’s a cheap way to give a product more kick.

This story originally appeared on Boston Business Journal.