Thomas P. Gilson, M.D.

11001 Cedar Avenue, Cleveland, Ohio 44106

A National Association of Medical Examiner’s (N.A.M.E.) accredited office

CUYAHOGA COUNTY

MEDICAL EXAMINER’S OFFICE

Heroin/Fentanyl/Cocaine Related Deaths in Cuyahoga County

2019 FEBRUARY UPDATE

March 6, 2019

Source: Cuyahoga County Medical Examiner’s Office revised 3-6-19

CURRENT PUBLIC HEALTH EMERGENCY – At least 17 fatalities since Mar. 1

Fatal Cases due to heroin/fentanyl/analogs in FEBRUARY– at least 44 (30 cases pending testing)

24 - City of Cleveland Residents

19 - Suburban Residents- Bay Village, Brooklyn, East Cleveland, Euclid, Fairview Park Highland Hts.,

Lakewood (2), Lyndhurst, Mayfield Hts., Oakwood, Richmond Hts., Solon, South Euclid, Valley View and

Westlake (2) and,

3- Out of County- Barberton (Summit),Valley City (Medina)

VICTIMS

Victims’ ages range from 25 - 70

33 Male victims; 21 Female victims

10 African American victims; 1 Asian American victim; 33 Caucasian victims (3 hispanic victims)

TRENDS

At least 97 victims have died from heroin/fentanyl/analog or in combination through February 2019. This

compares to 69 in 2018 and 112 in 2017. 2019 total is at least 107 fatalities when including cocaine as well.

Carfentanil: 191 FATAL CASES in 2017; 24 confirmed cases in 2018; 6 confirmed in 2019 as of 2/1/19

Rate of African American deaths involving fentanyl is 26.3% of all victims so far in 2019, a rate above 2016

(14.5%), and higher than the 20.33% in 2017 and 21.11 in 2018. As many as 24 cocaine related deaths

occurred in February 2019 with as many as 18 being mixed with Fentanyl, Heroin or both.

Source: Cuyahoga County Medical Examiner’s Office revised 3-6-19

1

4

31

17

21

23

4

7

28

18

0 00

5

10

15

20

25

30

35

JAN - 57 total FEB- 51 total

2019 CCMEO Overdose Deaths, Most Common Drugs InvolvedCombined is heroin and fentanyl or cocaine and fentanyl in some combination

(Fentanyl analogues will be counted under Fentanyl Columns).

Heroin Fentanyl

Heroin/Fentanyl Combined Cocaine alone

Cocaine/Fentanyl Combined Opioid ODs (awaiting confirmation tests)

Source: Cuyahoga County Medical Examiner’s Office revised 3-1-19

10

1 1 10 0

3

1 1

3

0

27

21

23

16

20

15

20

2322

23

29

24

9

1112

7 7

1615

17

8

10

16

13

32

7

9

6

10

5

7

5

8

10

1615

1213

8

13

9

14

18

8 8

30

19

0

5

10

15

20

25

30

35

JAN- 40total

FEB- 34total

MAR- 43total

APR- 33total

MAY- 34total

JUNE- 41total

JULY- 40total

AUG- 50total

SEP- 36total

OCT- 42total

NOV-58total

DEC- 53total

2018 CCMEO Overdose Deaths, Most Common Drugs InvolvedCombined is heroin and fentanyl in some combination (Fentanyl analogues will be counted under

Fentanyl Columns).

Heroin Fentanyl Heroin/Fentanyl Combined Cocaine alone Cocaine/Fentanyl Combined

Source: Cuyahoga County Medical Examiner’s Office revised 2-1-19

DAWN includes all documented naloxone saves through DAWN including

police reversals. Does not include EMS administrations:

(1,903 doses in 2015, 5,156 in 2016 and 7,745 in 2017 and 3,789 dose

administrations in 2018).

194 197 231 198223

331

184228

451

320

508

931

240

542

1439

153

416

1130

0

100

200

300

400

500

600

700

800

900

1000

1100

1200

1300

1400

2013 2013 plusFentanyl

2013 w/oDAWN

2014 2014 plusfentanyl

2014 w/oDAWN

2015 2015w/fentanyl

2015 projw/o

DAWN

2016 2016w/fentanyl

2016 projw/o

DAWN

2017 2017w/fentanyl

2017 w/oDAWN

2018 proj 2018 projw/fent

2018 projw/o

DAWN

Cuyahoga County Heroin/Fentanyl Related Overdose Deaths 2013-2018*Projected deaths with DAWN Saves as overdose Deaths

(* 2018 based on preliminary data thru February 1, 2019)

Source: Cuyahoga County Medical Examiner’s Office revised 2-1-19

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

3101

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Months Deaths

Cuyahoga County Fentanyl Deaths 2006-2019

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 1201 more

fentanyl related

deaths in the past 38

months than the

entire decade prior.

Source: Cuyahoga County Medical Examiner’s Office revised 3-1-19

25

0

22

6 25

1 26

9

26

7 30

1

31

0 34

0

35

3 37

0

66

6

72

7

56

0

11

7

10

8 13

6 15

4 17

2 20

4 22

4 26

2

25

5 27

8

55

7

55

6

44

0

46.80% 47.79%

54.18%57.25%

64.42%67.77%

72.26%

77.06%

72.24%75.14%

83.63%

76.48%78.57%

0.00%

25.00%

50.00%

75.00%

100.00%

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*-560cases

Opioid related overdose deaths as Percentage* of All Drug related Deaths

*(2006-2010 54%; 2011-2018 77%)

TOTAL DRUG OD DEATHS All Opiate/opioid % opioid deaths to all drug deaths

Source: Cuyahoga County Medical Examiner’s Office revised 2-1-19

7

25

58

100

86

25

125

0

20

40

60

80

100

120

140

160

2014 2015 2016 2017 2018 2019

CCMEO Fentanyl-related fatalities among African Americans 2014-2019*

*(Red - Projected for remainder of year, as of March 1, 2019)

Fentanyl (YTD) Fentanyl (Projected)

Source: Cuyahoga County Medical Examiner’s Office revised 3-1-19

5

37

92

399

492

404

89

2

22

47

213

217

141

43

2

12

24

161

190

167

46

0 100 200 300 400 500 600

2013

2014

2015

2016

2017

2018

2019

CCMEO, Proliferation of Fentanyl and Cocaine/Fentanyl mixtures in fatalities2013-2019* (* thru February)

Cocaine + Fentanyl Heroin + Fentanyl Fentanyl

Source: Cuyahoga County Medical Examiner’s Office revised 3-1-19

76 75

56

75

58

50

5854

58

49

79

120

76

59.84%

65.79%

52.34%

64.10%

56.31%

51.02%

52.25%

46.96%46.77%

42.61%

30.38%

40.00%

29.92%

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 2006-2018*Demographic Shift in Cocaine Deaths

(Includes cocaine/fentanyl mixed cases) *2018 from 3rd Qtr data and projected from remainder of 2018 as of 12/31/18

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

Source: Cuyahoga County Medical Examiner’s Office revised 2-1-19

Source: Cuyahoga County Medical Examiner’s Office revised 10-4-18

0

1000

2000

3000

4000

5000

EPIDEMICS OF UNINTENTIONAL DRUG OVERDOSE DEATHS IN OHIO 1979 - 2017

Heroin

Crack Cocaine

Fentanyl Analogs &

CocaineSources: WONDER (NCHS Compressed Mortality File, 1979-1998 & 1999-2005) 2006-2017 ODH

Office of Vital Statistics, Change from ICD-9 to ICD-10 coding in 1999 (caution in comparing before

and after 1998 and 1999.