DRAFT FINAL DRUG DEATHS REPORT - Cuyahoga County...

DRAFT FINAL DRUG DEATHS REPORT

2018

CUYAHOGA COUNTY MEDICAL EXAMINERS OFFICE DR. THOMAS P. GILSON, MD

CUYAHOGA COUNTY | 11001 Cedar Ave., Cleveland, OH 44106

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66

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90

11

67

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100

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700

800

All drug OD deaths All OD deathsincluding heroin,

fentanyl andcocaine

All Opiate/Opioidrelated OD deaths

Heroin/Fentanyldeaths

All Fentanylinvolved deaths

Heroin involveddeaths

Cocaine involveddeaths

Non fentanylcocaine deaths

Non fentanylheroin deaths

All PrescriptionOpiates (not

including illicitfentanyl)

Carfentanil

CCMEO 2015-18 Cocaine and Opioid involved deathsNotes: All analogues are included in total fentanyl-involved deaths

and there is overlap between categories

2015 2016 2017 2018

Source: Cuyahoga County Medical Examiner’s Office revised 3-25-19

Source: Cuyahoga County Medical Examiner’s Office revised 3-25-19

198 184

320

240

150124 115

260

300

246

00

56

191

2437

92

399

492

398

87

80

99 10367

353370

666

727

551

255278

557 556

439

0

100

200

300

400

500

600

700

800

900

2014- 353 cases 2015 - 370 cases 2016- 666 cases 2017-727 cases 2018-551 cases

Heroin Cocaine Carfentanil

Fentanyl All Opioids (not inc. Fentanyl after 2013) TOTAL DRUG OD DEATHS

Cuyahoga County Overdose Deaths 2006-2018 Most Common Drugs

138158

184 182 185 177137

107

23 11

151151

172 162

211

16

44

186

275

139

82

114

119 126

86

21 47

213 217

259

0

100

200

300

400

500

600

2014 2015 2016 2017 2018 2014 2015 2016 2017 2018

CCMEO Violent Deaths vs. Opioid related deaths2014-2018

Homicide Suicide Traffic accident Heroin Combined Fentanyl

Source: Cuyahoga County Medical

Examiner’s Office revised 3-25-19

194 198 184

320

240

150192 176 134

10723 11

116 124115

260300

246

116

11291

119100 90

340 353 370

666

727

551

0

100

200

300

400

500

600

700

800

900

2013 -340 cases 2014- 353 cases 2015 - 370 cases 2016- 666 cases 2017-727 cases 2018-551 cases

Heroin Non-fentanyl associated Heroin deaths Cocaine Non-fentanyl associated Cocaine deaths TOTAL DRUG OD DEATHS

Cuyahoga County Overdose Deaths 2006-2018 Impact of Fentanyl



19.60%17.70%

25.50%23.79%

34.08%35.55%

51.94%

57.06% 56.09%

50.55%

48.05%

33.01%

27.22%

50.80% 50.44%

42.63% 43.49%

38.58%

32.56%

35.81%34.12% 35.13%

31.59%

39.04%41.27%

44.65%

5.60%

7.08%

8.76%

14.87% 14.61%

11.96%10.65%

13.24% 13.60%

10.71%8.81%

5.78%

4.72%

9.20%

4.87%

3.59% 2.60%4.87%

2.66% 3.23%1.47%

10.48%

24.86%

59.91%

67.68%

72.23%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

8.41%

26.27%

4.36%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

2006 - 250cases

2007 - 226cases

2008 - 251cases

2009 - 269cases

2010 - 267cases

2011 - 301cases

2012 - 310cases

2013 - 340cases

2014- 353cases

2015 - 370cases

2016- 666cases

2017- 727cases

2018 - 551cases

Heroin Cocaine Oxycodone Fentanyl Carfentanil

Cuyahoga County Overdose Deaths 2006-2018% Impact of Fentanyl (including analogs) and other drugs



105

100

13.67

100

5

100

3.5

100

2.25

100

3

100

1.5

100

3

100

1.5

100

3.5

100

2.75

100

3

100

3.25

100

2

100

2.25

100

3102

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Months Deaths

Cuyahoga County Fentanyl Deaths 2006-2018

2006-Sept. 30, 2014 Oct. 1, 2014-Nov.21, 2015 Nov. 21, 2015 - Apr. 7, 2016 Apr. 8 - July 20, 2016July 21 - Sept 30, 2016 Oct. 1 - Dec 31, 2016 Jan 1 - Feb 15, 2017 Feb 16 - May 15, 2017May 15- June 30, 2017 July 1 - Oct 15, 2017 Oct. 16- Dec. 31, 2017 Jan 1 - Apr 4, 2018April 5 - July 13, 2018 July 14-Sep 13, 2018 Sep 13 - Nov 28 Nov 29 -Feb 28, 2019

Cuyahoga County

has seen 1202 more

fentanyl related

deaths in the past

38 months than the

entire decade prior.



127114

107117

103 98111 115

124115

260

300

246

0

50

100

150

200

250

300

350

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

CCMEO Overdose Deaths involving Cocaine 2006-2018The Explosion of Cocaine

Cocaine



76 75

56

75

58

50

5854

58

49

79

120

93

59.84%

65.79%

52.34%

64.10%

56.31%

51.02%

52.25%

46.96%46.77%

42.61%

30.38%

40.00%

37.80%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

0

20

40

60

80

100

120

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

CCMEO Cocaine related Overdose Deaths 2006-2018Demographic Shift in Cocaine Deaths

(Includes cocaine/fentanyl mixed cases)

African American Cocaine Deaths African American Cocaine Deaths as Percentage of Total



7

25

58

100

76

39

53

75

110

81

0

20

40

60

80

100

120

2014 2015 2016 2017 2018

CCMEO Fentanyl-related and all opiate/opioid related fatalities among African Americans 2014-2018

Fentanyl (YTD) All Opiate/opioid African American Deaths





49 4064 64

91

107

161

194 198184

320

240

150217

127114 107 117

103

98

111 116 124 115

260

300

246

345

0 0 0 0 0 0 0 0 0 0

56

191

244823 11 9 7 13 8 10 5

3792

399

492

398

433

8481

87 103 91

113

85

101 87

80

99 103

67

250226

251269 267

301 310340 353 370

666

727

551

634

0

100

200

300

400

500

600

700

800

2006 - 250cases

2007 - 226cases

2008 - 251cases

2009 - 269cases

2010 - 267cases

2011 - 301cases

2012 - 310cases

2013 -340cases

2014- 353cases

2015 - 370cases

2016- 666cases

2017-727cases

2018-551cases

2019* - 666cases

Cuyahoga County Overdose Deaths 2006-2019* Most Common Drugs

(* 2019 based on projections through May 8, 2019)

Heroin Cocaine Carfentanil Fentanyl All Opioids (not inc. Fentanyl after 2013) TOTAL DRUG OD DEATHS

2018 DEMOGRAPHIC ANALYSIS – SUMMARY (PENDING)

FENTANYL TOTAL Fentanyl

Fentanyl +

Heroin

Fentanyl +

Cocaine

Fentanyl +

Heroin +

Cocaine

399 117 141 68 73

29.32% 35.34% 17.04% 18.30%

Res Inc Age

Male Female White Black Other Hispanic CLE Sub OU CLE Sub OU ? <18 19-29 30-44 45-60 60+

292 107 337 61 1 11 181 172 46 187 157 9 46 3 89 150 125 32

73.18% 26.82% 84.46% 15.29% 0.25% 2.76% 45.36% 43.11% 11.53% 46.87% 39.35% 2.26% 11.53% 0.75% 22.31% 37.59% 31.33% 8.02%

HEROIN TOTAL Heroin

Heroin +

Fentanyl

Heroin +

Cocaine

Heroin +

Cocaine +

Fentanyl

320 72 141 34 73

22.50% 44.06% 10.63% 22.81%

Res Inc Age


228 92 283 36 1 8 138 145 37 136 128 6 38 3 68 116 102 31

71.25% 28.75% 88.44% 11.25% 0.31% 2.60% 44.81% 47.08% 12.01% 44.16% 41.56% 1.95% 12.34% 0.97% 22.08% 37.66% 33.12% 10.06%

COCAINE TOTAL Cocaine

Cocaine +

Heroin

Fentanyl +

Cocaine

Cocaine +

Fentanyl +

Heroin

260 85 34 68 73

32.69% 13.08% 26.15% 28.08%

Res Inc Age


184 76 181 79 0 4 145 82 33 141 79 5 35 5 42 77 104 32

70.77% 29.23% 69.62% 30.38% 0.00% 1.54% 55.77% 31.54% 12.69% 54.23% 30.38% 1.92% 13.46% 1.92% 16.15% 29.62% 40.00% 12.31%

2018 DEMOGRAPHIC ANALYSIS – FENTANYL (PENDING)

FENTANYL TOTAL Fentanyl

Fentanyl +

Heroin

Fentanyl +

Cocaine

Fentanyl +

Heroin +

Cocaine

399 117 141 68 73

29.32% 35.34% 17.04% 18.30%

Res Inc Age


292 107 341 58 0 11 177 175 47 182 160 11 46 3 89 150 125 32

73.18% 26.82% 85.46% 14.54% 0.00% 2.76% 44.36% 43.86% 11.78% 45.61% 40.10% 2.76% 11.53% 0.75% 22.31% 37.59% 31.33% 8.02%

Res Inc Age


Fentanyl 93 24 100 17 0 5 44 62 11 50 51 5 11 0 26 44 37 10

79.49% 20.51% 85.47% 14.53% 0.00% 4.27% 37.61% 52.99% 9.40% 42.74% 43.59% 4.27% 9.40% 0.00% 22.22% 37.61% 31.62% 8.55%

Fentanyl +

Heroin 101 40 128 13 0 5 54 71 16 57 65 3 16 1 32 55 44 9

71.63% 28.37% 90.78% 9.22% 0.00% 3.55% 38.30% 50.35% 11.35% 40.43% 46.10% 2.13% 11.35% 0.71% 22.70% 39.01% 31.21% 6.38%

Fentanyl +

Cocaine 49 19 53 15 0 1 42 14 12 41 17 3 7 1 10 28 20 9

72.06% 27.94% 77.94% 22.06% 0.00% 1.47% 61.76% 20.59% 17.65% 60.29% 25.00% 4.41% 10.29% 1.47% 14.71% 41.18% 29.41% 13.24%

Fentanyl +

Heroin +

Cocaine 49 24 60 13 0 0 37 28 8 34 27 0 12 1 21 23 24 4

67.12% 32.88% 82.19% 17.81% 0.00% 0.00% 50.68% 38.36% 10.96% 46.58% 36.99% 0.00% 16.44% 1.37% 28.77% 31.51% 32.88% 5.48%



2018 DEMOGRAPHIC ANALYSIS – HEROIN (PENDING)

HEROIN TOTAL Heroin

Heroin +

Fentanyl

Heroin +

Cocaine

Heroin +

Cocaine +

Fentanyl

320 72 141 34 73

22.50% 44.06% 10.63% 22.81%

Res Inc Age


228 92 283 36 1 8 138 145 37 136 128 6 38 3 68 116 102 31

71.25% 28.75% 88.44% 11.25% 0.31% 2.60% 44.81% 47.08% 12.01% 44.16% 41.56% 1.95% 12.34% 0.97% 22.08% 37.66% 33.12% 10.06%

Res Inc Age


Heroin 53 19 63 8 1 1 31 33 8 35 24 3 10 1 9 28 19 15

73.61% 26.39% 87.50% 11.11% 1.39% 1.39% 43.06% 45.83% 11.11% 48.61% 33.33% 4.17% 13.89% 1.39% 12.50% 38.89% 26.39% 20.83%

Heroin +

Fentanyl 101 40 128 13 0 5 54 71 16 57 65 3 16 1 32 55 44 9

71.63% 28.37% 90.78% 9.22% 0.00% 3.55% 38.30% 50.35% 11.35% 40.43% 46.10% 2.13% 11.35% 0.71% 22.70% 39.01% 31.21% 6.38%

Heroin +

Cocaine 25 9 32 2 0 2 16 14 4 18 14 0 2 0 6 10 15 3

73.53% 26.47% 94.12% 5.88% 0.00% 5.88% 47.06% 41.18% 11.76% 52.94% 41.18% 0.00% 5.88% 0.00% 17.65% 29.41% 44.12% 8.82%

Heroin +

Cocaine +

Fentanyl 49 24 60 13 0 0 37 28 8 34 27 0 12 1 21 23 24 4

67.12% 32.88% 82.19% 17.81% 0.00% 0.00% 50.68% 38.36% 10.96% 46.58% 36.99% 0.00% 16.44% 1.37% 28.77% 31.51% 32.88% 5.48%



2018 DEMOGRAPHIC ANALYSIS – COCAINE (PENDING)


Cocaine +

Heroin

Fentanyl +

Cocaine

Cocaine +

Fentanyl +

Heroin

260 85 34 68 73

32.69% 13.08% 26.15% 28.08%

Res Inc Age


184 76 181 79 0 4 145 82 33 141 78 4 37 5 42 77 104 32

70.77% 29.23% 69.62% 30.38% 0.00% 1.54% 55.77% 31.54% 12.69% 54.23% 30.00% 1.54% 14.23% 1.92% 16.15% 29.62% 40.00% 12.31%

Res Inc Age


Cocaine 61 24 36 49 0 1 50 26 9 48 20 1 16 2 5 16 46 16

71.76% 28.24% 42.35% 57.65% 0.00% 1.18% 58.82% 30.59% 10.59% 56.47% 23.53% 1.18% 18.82% 2.35% 5.88% 18.82% 54.12% 18.82%

Cocaine +

Heroin 25 9 32 2 0 2 16 14 4 18 14 0 2 1 6 10 14 3

73.53% 26.47% 94.12% 5.88% 0.00% 5.88% 47.06% 41.18% 11.76% 52.94% 41.18% 0.00% 5.88% 2.94% 17.65% 29.41% 41.18% 8.82%

Fentanyl +

Cocaine 49 19 53 15 0 1 42 14 12 41 17 3 7 1 10 28 20 9

72.06% 27.94% 77.94% 22.06% 0.00% 1.47% 61.76% 20.59% 17.65% 60.29% 25.00% 4.41% 10.29% 1.47% 14.71% 41.18% 29.41% 13.24%

Fentanyl +

Heroin +

Cocaine 49 24 60 13 0 0 37 28 8 34 27 0 12 1 21 23 24 4

67.12% 32.88% 82.19% 17.81% 0.00% 0.00% 50.68% 38.36% 10.96% 46.58% 36.99% 0.00% 16.44% 1.37% 28.77% 31.51% 32.88% 5.48%



2018 DEMOGRAPHIC ANALYSIS – CARFENTANIL (PENDING)


Cocaine +

Heroin

Fentanyl +

Cocaine

Cocaine +

Fentanyl +

Heroin

260 85 34 68 73

32.69% 13.08% 26.15% 28.08%

Res Inc Age


184 76 181 79 0 4 145 82 33 141 78 4 37 5 42 77 104 32

70.77% 29.23% 69.62% 30.38% 0.00% 1.54% 55.77% 31.54% 12.69% 54.23% 30.00% 1.54% 14.23% 1.92% 16.15% 29.62% 40.00% 12.31%

Res Inc Age


Cocaine 61 24 36 49 0 1 50 26 9 48 20 1 16 2 5 16 46 16

71.76% 28.24% 42.35% 57.65% 0.00% 1.18% 58.82% 30.59% 10.59% 56.47% 23.53% 1.18% 18.82% 2.35% 5.88% 18.82% 54.12% 18.82%

Cocaine +

Heroin 25 9 32 2 0 2 16 14 4 18 14 0 2 1 6 10 14 3

73.53% 26.47% 94.12% 5.88% 0.00% 5.88% 47.06% 41.18% 11.76% 52.94% 41.18% 0.00% 5.88% 2.94% 17.65% 29.41% 41.18% 8.82%

Fentanyl +

Cocaine 49 19 53 15 0 1 42 14 12 41 17 3 7 1 10 28 20 9

72.06% 27.94% 77.94% 22.06% 0.00% 1.47% 61.76% 20.59% 17.65% 60.29% 25.00% 4.41% 10.29% 1.47% 14.71% 41.18% 29.41% 13.24%

Fentanyl +

Heroin +

Cocaine 49 24 60 13 0 0 37 28 8 34 27 0 12 1 21 23 24 4

67.12% 32.88% 82.19% 17.81% 0.00% 0.00% 50.68% 38.36% 10.96% 46.58% 36.99% 0.00% 16.44% 1.37% 28.77% 31.51% 32.88% 5.48%



2018 AGENCY IMPACTS –

CASE INVESTIGATIONS - Pathologists

DRUG CHEMISTRY

2018

Case Load-Post JAN FEB MARCH APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC TOTAL

Armstrong 19 13 18 17 18 24 37 20 24 21 23 18 252

Barr 13 36 23 21 21 26 20 21 181

Catanese 0 16 18 14 0 0 0 0 0 0 0 0 48

Dolinak 11 16 22 13 23 25 26 27 18 27 16 22 246

Felo 9 5 16 13 17 1 14 16 11 13 9 13 137

Galita 16 20 15 17 3 25 30 29 21 24 22 20 242

Gilson 7 5 3 4 6 4 4 7 11 11 2 11 75

Keep 0 3 0 3 0 0 0 0 0 0 0 0 6

Magguilli 26 20 17 13 10 0 0 0 0 0 0 0 86

McCollom 7 18 19 14 17 29 27 15 22 24 24 22 238

Mooney 24 13 15 17 23 29 14 27 19 25 20 18 244

Spencer 23 18 24 12 17 0 0 0 0 0 0 0 94

TOTAL 142 147 167 137 147 173 175 162 147 171 136 145 1849



2018 AGENCY IMPACTS –

TOXICOLOGY

HOMICIDES

MEDICAL EXAMINER / CCFRSL 2018

Statistics & Records JAN FEB MAR APR MAY JUNE JUL AUG SEP OCT NOV DEC TOTAL

City of Cleveland 9 9 7 11 5 16 13 16 18 9 8 9 130

Suburban Cuyahoga County 4 4 3 0 2 4 2 4 3 7 9 7 49

Out of County 0 2 0 1 0 0 1 0 1 0 0 0 5

Unknown 0 0 0 0 0 0 0 0 0 0 0 3 3

TOTAL 13 15 10 12 7 20 16 20 22 16 17 19 187



WHAT WE KNOW

Fentanyl Substances Date 1st Encountered

Acetylfentanyl 2/10/16

Furanylfentanyl 3/7/16

Butyrylfentanyl 3/23/16

Beta-Hydroxythiofentanyl 3/23/16

U-47700 5/9/16

4-ANPP 8/2/16

Para-Fluorofentanyl 8/29/16

Meta-Flurorfentanyl 8/29/16

Carfentanil September 2016

Valeryl Fentanyl 10/25/16

Acrylfentanyl 11/7/16

para-Chloroisobutyryl Fentanyl 11/7/16

para-Fluorobutyryl Fentanyl 1/17/17

ortho-Fluorobutyryl Fentanyl 1/17/17

meta- Fluorobutyryl Fentanyl 1/17/17

Isobutyryl Fentanyl 2/16/17

Fluoroisobutyryl Fentanyl 2/16/17

Methyoxyacetylfentanyl 4/19/17

Figure 1 Fentanyl molecule

Figure 2 Carfentanil molecule

Figure 3 Acetyl fentanyl molecule



34

108

224

426

570

501

6 33 165 338 213

1903

5156

7745

4353

376

887 1509

24052719

3647

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

0

100

200

300

400

500

600

2013 2014 2015 2016 2017 2018

Nalxone in Cuyahoga County

Project DAWN saves Police DAWN saves EMS Narcan dose administrations Project DAWN kits distributed



23.45%

19.96%

8.45%

8.08%

3.32%

1.55%

1.17% 1.13% 0.89% 0.81%

2018 CCRFSL Forensic Drug Chemistry Samples Submitted

THC/Marihuana Cocaine Fentanyl Heroin Methamphetamine

4 ANPP Oxycodone Acetyl fentanyl N-ethylpentalone Tramadol





01

00

200

300

400

500

010

20

30

40

50

60

NO

V

DEC

JAN

FEB

MA

R

AP

R

MA

Y

JUN

E

JULY

AU

G

SEP

OC

T

NO

V

DEC

JAN

FEB

MA

R

AP

R

MA

Y

JUN

E

JULY

AU

G

SEP

OC

T

NO

V

DEC

JAN

FEB

MA

R

AP

R

MA

Y

JUN

E

JULY

AU

G

SEP

OC

T

NO

V

DEC

JAN

FEB

MA

R

AP

R

MA

Y

JUN

E

JULY

AU

G

SEP

OC

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NO

V

DEC

2014 2015 2016 2017 2018

CCMEO/CCRFSL Relationship of Fentanyl and Carfentanil Fatalities and Fentanyl and Carfentanil Lab Submissions 2014-2018

Fentanyl submissions Carfentanil submissions Fentanyl deaths Carfentanil deaths

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DRAFT FINAL DRUG DEATHS REPORT - Cuyahoga County...

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