PRELIMINARY DRUG DEATHS REPORTmedicalexaminer.cuyahogacounty.us/pdf_medicalexaminer/en... ·...

PRELIMINARY DRUG DEATHS REPORT

2017

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

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

370

328

281

152

92

184

11591

134

0

80

0 0

666

591557

506

399

320

260

119 107 99 99

54 43

727

604

553

515492

240

290

100

23

292

103

191

60

0

100

200

300

400

500

600

700

800

CCMEO 2015-17 Opioid involved deathsNotes: All analogues are included in total fentanyl-involved deaths

and there is overlap between categories

2015 2016 2017

Source: Cuyahoga County Medical Examiner’s Office revised 6-1-18


48

57

33

39

47

4949

28

3834

37

33

45

3

16

30

39

34

11

14

1815

2

57

69

40

53 53

60

56

41

4845

4948

69

79

52

65 6568 69

4852 51

57

52

0

10

20

30

40

50

60

70

80

90

JAN FEB MAR APR MAY JUNE JULY AUG SEP OCT NOV DEC

CCMEO All Drug Related Deaths 2017, By Type and Combinations, By Month

Heroin All Fentanyls Combined all fentanyls w/heroin

Combined all fentanyls w/cocaine Carfentanil Other Analogs

Combined heroin-carfentanil Combined heroin-analog All Cocaine

Fentanyl (no cocaine, heroin or analog) TOTAL Opioid/Cocaine Deaths All Drug Deaths


49 40 64 6491

107

161194 198 184

320

240

127114 107 117 103

98

111 116 124 115

260

290

00 0 0 0 0 0 0 0 0

56

191

23 11 9 7 13 8 10 537

92

399

492

81 87 87 10391

113

85 101 87 80 99102

250226

251269 267

301 310340 353 370

666

727

0

100

200

300

400

500

600

700

800

900

2006 - 250cases

2007 - 226cases

2008 - 251cases

2009 - 269cases

2010 - 267cases

2011 - 301cases

2012 - 310cases

2013 -340cases

2014- 353cases

2015 - 370cases

2016- 666cases

2017*-727cases

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

Cuyahoga County Overdose Deaths 2006-2017 Most Common Drugs

138 158184 182 177

137107

23

151151

172 162

1644

186

275

82

114

119 126

21 47

213 217

0

100

200

300

400

500

600

2014 2015 2016 2017 2014 2015 2016 2017

CCMEO Comparison Violent Deaths vs. Heroin/Fentanyl 2014-2017

Homicide Suicide Traffic accident Heroin Combined Fentanyl

371

423

475

214 228

506

457

515


194 198 184

320

240

192176

134

107

23

116 124 115

260 290

116112

91

119

100

537

92

399

492

340 353370

666

727

0

50

100

150

200

250

300

350

400

450

500

550

600

650

700

750

800

850

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

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

Cuyahoga County Overdose Deaths 2013-2017 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%

50.80%50.44%

42.63%43.49%

38.58%

32.56%35.81%

34.12% 35.13% 31.59%

39.04%39.89%

5.60%

7.08%8.76%

14.87% 14.61%11.96% 10.65% 13.24% 13.60%

10.71%8.81%

5.78%

9.20%

4.87%3.59% 2.60%

4.87%2.66% 3.23%

1.47%

10.48%

24.86%

59.91%

67.68%

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

8.41%

26.27%

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

Heroin Cocaine Oxycodone Fentanyl Carfentanil

Cuyahoga County Overdose Deaths 2006-2017% 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

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Months Deaths

Cuyahoga County Fentanyl Deaths 2006-2018

2006-Sept. 2014 Oct. 2014-Nov.21, 2015 Nov. 21, 2015 - Apr. 7, 2016 Apr. 8 - July 20, 2016

July 21 - Sept 30, 2016 Oct. 1 - Dec 31, 2016 Jan 1 - Feb 15, 2017 Feb 16 - May 15, 2017

May 15- June 30, 2017 July 1 - Oct 15, 2017 Oct. 16- Dec. 31, 2017 Jan 1 - Apr 4, 2018

Cuyahoga County

has seen 800 more

fentanyl related

deaths in the past 2

years than the

previous decade.



127114

107

117

10398

111 115124

115

260

290

0

50

100

150

200

250

300

350

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

CCMEO Overdose Deaths involving Cocaine 2006-2017The Explosion of Cocaine

Cocaine

76 75

56

75

58

50

5854

58

49

79

115

59.84%

65.79%

52.34%

64.10%

56.31%

51.02%

52.25%

46.96%46.77%

42.61%

30.38%

39.66%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

0

20

40

60

80

100

120

140

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

CCMEO Cocaine related Overdose Deaths 2006-2017Demographic 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

18.92%

27.17%

14.54%

20.33%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

0

20

40

60

80

100

120

2014 2015 2016 2017

CCMEO Fentanyl-related fatalities among African Americans 2014-2017



49 40 64 6491

107

161194 198 184

320

240

176

127114 107 117 103

98

111 116 124 115

260

290309

00 0 0 0 0 0 0 0 0

56

191

84

23 11 9 7 13 8 10 537

92

399

492

365

81 87 87 10391

113

85 101 87 80 99103

250226

251269 267

301 310340 353 370

666

727

680

0

100

200

300

400

500

600

700

800

900

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*- 680cases

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

Cuyahoga County Overdose Deaths 2006-2018* Most Common Drugs (*projected based upon estimated cases as of May 31, 2018)

4064 64

91 107161

194 197230 198 223

328

184228

439

320

508

903

240

542

1417

176

411

595

0

100

200

300

400

500

600

700

800

900

1000

1100

1200

1300

1400

Cuyahoga County Heroin/Fentanyl Related Overdose Deaths 2013-2017Projected deaths with DAWN Saves as overdose Deaths


2017 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%


2017 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%


2017 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%


2017 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%


2017 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%


2017 AGENCY IMPACTS –

CASE INVESTIGATIONS

DRUG CHEMISTRY

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total

31.7 27 30.1 26.1 30.4 33.1 21.1 16.4 18.7 25.4 27.3 13.3 300.6

25 24 14.1 22 7.6 0.3 0 0 0 0 0 0 93

0 0 0 0 0 0 0 7 15 0 11 15 48

33 24.4 36.9 24 30 32.6 15 16.4 18.1 32.9 23.3 20.4 307

27.9 13.6 12.9 15.9 20.4 17.3 13.4 17.4 15.4 8.1 7.1 27.4 196.8

28.1 33.3 28.9 26 5.6 39.3 27.1 23.3 23.3 32.1 28.7 25.3 321

18.7 9 14.9 8 16.7 19.7 9.3 5.3 11.3 14.1 4 11.9 142.9

0 0 0 0 0 0 0 0 0 0 7 6 13

0 0 0 0 0 0 28 25 16 25 24 27 145

35.7 27.6 18.9 19.9 34.9 30.3 21.3 22.9 23 22.9 28 20.4 305.8

0 23.9 35.4 31.1 27.6 29.3 21.9 19.7 17.6 0 0 0 206.5

0 0 0 0 0 0 23 25 18 24 27 17 134

200.1 182.8 192.1 173 173.2 201.9 179.1 177.7 176.4 181.5 183.4 174.7 2214

McCollom M.D., Andrea

Mooney D.O., Elizabeth

Spencer D.O., Amanda

Total # Cases:

Felo D.O., Joseph A.

Galita M.D., Dan A.

Gilson M.D., Thomas P.

Keep M.D., David

Magguilli M.D., Michael

Armstrong M.D., Erica J.

Barr M.D., Todd

Catanese M.D., Charles

Dolinak M.D., David

Pathologist


2017 AGENCY IMPACTS –

TOXICOLOGY

HOMICIDES


2014 JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC TOTAL

Armstrong 21.6 21.9 21.9 15.6 17.3 20.9 29 10.9 25 18.6 21 15.9 239.6

Dolinak 0 0 0 0 0 0 0 6 29 29 29.3 31.6 124.9

Felo 27.1 12 18.6 17 27.4 18.3 7.3 24.7 13.7 14.4 17.3 16.9 214.7

Galita 24.4 33 17 20.1 12.6 25.4 27.1 17.7 19.7 14.9 13.4 19.4 244.7

Gilson 6.7 14.9 8.3 10.4 17 7.7 24.9 15.4 13.3 11 10.3 18.1 158

Keep 0 0 0 0 0 0 0 27 18 21 19 22 107

McCollom 21.7 11 15.1 27.7 29.7 18.1 25.1 18.6 26.3 16 15.7 18 243

Niblo 26 25 18.3 22.3 20 2.3 0 0 0 0 0 0 113.9

Timm 26.3 20.9 19.6 20.4 18.6 20.4 29 16 10.6 27.1 14.9 13.1 236.9

TOTAL 153.8 138.7 118.8 133.5 142.6 113.1 142.4 136.3 155.6 152 140.9 155 1682.7


Armstrong 28.3 10.3 25.3 15.1 18.4 17 33.4 23.6 18.6 28.3 22.4 14.9 255.6

Dolinak 26.3 21.1 23.6 27.4 34 31.3 29.1 25.4 20 23.7 19.7 18.6 300.2

Felo 18.9 11.4 19.3 13.7 24.3 16.1 19.1 22.7 19.6 8.1 18.4 25.3 216.9

Galita 26.4 24.1 20.7 10.9 25 31 22.3 28.6 22.3 27.4 20.7 18.7 278.1

Gilson 12.1 8.6 13.9 19.9 10.4 17.9 9.6 5 15.7 12.9 9 24.4 159.4

Hansma 0 0 0 0 0 0 17 23 20 22 21 20 123

Keep 24 20 21 26.1 22.6 17.7 0.9 0 0 0 0 0 132.3

Maskovyak 0 0 0 0 0 0 25 23 14 19 21 24 126

McCollom 16.7 22.6 18.4 26.1 19.3 28.4 18.4 19.4 25.6 25 24 11.3 255.2

Timm 22.4 20.9 12.7 11.3 0 0 0 0 0 0 0 0 67.3

TOTAL 175.1 139 154.9 150.5 154 159.4 174.8 170.7 155.8 166.4 156.2 157.2 1914


Armstrong 23.4 11 26.6 18.9 22.7 35.1 33.9 32 28.1 29.7 35.3 29.1 325.8

Barr 23 27 22 31 21 26 150

Dolinak 22.4 26.3 22.1 20.6 32.3 31.3 27.4 37.9 26.1 29 23.7 36 335.1

Felo 26.4 8 22.9 14.9 37.6 25.4 0 37.6 20.1 18.9 22.7 18.3 252.8

Galita 16.1 29 29.3 19 9.3 38.1 40.6 39.6 33.4 30.7 32.9 19.4 337.4

Gilson 9.3 11.3 12.9 17.1 24 11.6 29.1 21.4 13 25 15.4 37 227.1

Hansma 26 26 32.3 29.4 15.6 0 0 0 0 0 0 0 129.3

Maskovyak 24.4 29.9 28.9 22.7 22.1 0.9 0 0 0 0 0 0 128.9

McCollom 17 26.3 16.3 17.9 28.3 31.9 34.3 25 36.3 31.4 31.6 22 318.3

TOTAL 165 167.8 191.3 160.5 191.9 174.3 188.3 220.5 179 195.7 182.6 187.8 2204.7

AGENCY IMPACTS – CASE INVESTIGATIONS (By month and doctor)

Note: 2016 caseload increased 16.196%


MEDICAL EXAMINER / CCFRSL

Drug Chemistry 2016 JAN FEB MAR APR MAY JUNE JUL AUG SEP OCT NOV DEC TOTAL

Submissions 424 483 495 524 562 493 299 514 570 502 476 431 5773

Submissions Completed 420 400 546 397 687 494 303 518 441 595 469 414 5684

Completed from Previous Month/s 83 92 166 93 228 116 109 111 77 205 107 124 1511

Submissions Pending (Backlog) 69 69 66 220 110 57 112 119 158 119 115 106 1320

10 day Completion (%) 95.7 95.5 84.4 85.8 74.2 91.8 75.2 82.2 91.6 80.6 89.3 88.4 86.23

5 day Completion (%) 83.1 70.5 69.9 69 56.9 80 72.6 74.7 82.7 70.5 71.6 78.9 73.37

Average TAT 3.6 3.9 5.9 5.9 8 7.5 7.2 5.1 4.3 7.4 5.9 6.6 5.94

Items Processed 1412 665 1321 1056 1438 1176 988 1289 1085 1623 1228 1296 14577

MEDICAL EXAMINER / CCFRSL 2015

Drug Chemistry JAN FEB MAR APR MAY JUNE JUL AUG SEP OCT NOV DEC TOTAL

Submissions 436 377 489 495 373 392 400 396 467 475 415 425 5140

Submissions Completed 450 366 501 462 400 400 372 400 393 419 344 618 5125

Completed from Previous Month/s 53 42 52 38 69 46 39 67 63 137 193 273 1072

Submissions Pending (Backlog) 23 31 3 58 34 3 0 0 71 93 214 27 557

10 day Completion (%) 97 93 94 97 95 97 80 98 94 81 65 71 1063

5 day Completion (%) 82 79 87 89 85 88 36 93 69 48 43 41 840.2

Average TAT 3 4 3 3 3 3 5 3 5 6 7 9 53.9

Items Processed 863 655 968 1063 931 946 825 884 680 1164 769 1124 10872

AGENCY IMPACTS - DRUG CHEMISTRY

Note: 2016 caseload increased 10.96% & items processed in those cases has increased by 34.07%.


Drug Chemistry JAN FEB MAR APR MAY JUNE JUL AUG SEP OCT NOV DEC TOTAL

Cases Submitted 487 489 555 600 590 578 585 609 636 548 344 478 6499 Cases Completed 436 488 593 616 577 539 639 549 503 666 453 451 6510 Cases Pending (Backlog) 71 74 0 5 6 29 11 93 188 32 21 31 10 day Completion (%) 98 98 98 99 98 98 98 96 73 36 83 90 88.75 5 day Completion (%) 90 82 92 96 92 92 88 72 40 6 46 70 72.17 Average TAT 2.4 3.4 2.5 1.9 2.3 2.3 2.9 5.5 7.5 12.9 6.1 4 4.48 Items Processed 857 1135 1282 1485 1008 800 1334 1014 882 1270 975 941 12983



Toxicology JAN FEB MAR APR MAY JUNE JUL AUG SEP OCT NOV DEC TOTAL

Cases Submitted 291 292 308 260 292 289 289 349 305 313 304 273 3565

Cases Completed 329 260 257 246 337 271 268 348 296 275 265 261 3413

Cases Pending (Backlog) 258 300 357 378 337 358 383 388 398 448 493 511

Avg TAT (Days) - ALL 32 31 34 37 38 34 40 41 35 43 45 43 37.75

90% Completion (Days) 59 55 55 57 60 59 59 59 59 59 59 64 58.67

Avg TAT (Days) - POS 51 44 46 49 47 48 50 51 45 54 57 56 49.83

Avg TAT (Days) - NEG 7 4 7 8 12 6 10 12 7 7 12 15 8.917

AGENCY IMPACTS - TOXICOLOGY

Note: 2016 Caseload increased 8.6%



Cases Submitted 292 255 249 279 280 270 282 292 272 276 278 258 3283

Cases Completed 289 271 222 362 255 269 249 324 355 301 280 310 3487

Cases Pending (Backlog) 302 328 280 317 395 367 441 434 366 344 350 308

Avg TAT (Days) - ALL 27 42 23 39 45 59 35 50 52 41 35 41 40.75

90% Completion (Days) 58 86 58 104 118 113 82 102 90 76 62 65 84.5

Avg TAT (Days) - POS 45 61 46 57 65 65 56 68 63 56 55 56 57.75

Avg TAT (Days) - NEG 9 8 9 8 12 28 11 17 10 8 8 9 11.417



Cases Submitted 256 241 238 260 253 229 255 232 273 246 223 319 3025

Cases Completed 303 221 363 288 199 232 212 219 382 308 338 258 3323

Cases Pending (Backlog) 281 311 201 195 260 273 316 344 259 239 161 273 Avg TAT (Days) - ALL 35 42 36 31 33 35 38 50 48 41 29 29 37

90% Completion (Days) 58 63 58 57 51 63 70 89 78 74 50 58 66

Avg TAT (Days) - POS 45 54 53 40 42 49 52 70 59 48 39 39 49

Avg TAT (Days) - NEG 19 15 12 7 8 16 14 13 14 10 8 7 12



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

City of Cleveland 5 8 9 10 8 14 17 12 21 12 9 125

Suburban Cuyahoga County 5 4 2 3 0 1 2 0 0 2 3 22

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

Unknown 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL 10 13 11 14 9 15 19 12 21 15 13 152

2014

City of Cleveland 8 8 6 8 14 9 6 5 12 12 15 5 108

Suburban Cuyahoga County 3 1 3 3 0 4 1 0 1 4 0 2 22

Out of County 1 1 0 0 0 0 0 1 0 0 0 1 4

Unknown 0 0 0 1 1 0 1 0 0 0 0 1 4

TOTAL 12 10 9 12 15 13 8 6 13 16 15 9 138

AGENCY IMPACTS - HOMICIDES

Note: Represents increase of 25 homicides (+15 in Cleveland, +7 in suburbs and -2 Out of County, +5 unknown incident origin) in 2016


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

Homicides

City of Cleveland 5 8 9 10 8 14 18 12 21 13 8 3 129

Suburban Cuyahoga County 5 4 2 3 0 1 2 0 0 2 3 3 25

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

Unknown 0 0 0 0 0 0 0 0 0 0 1 0 1

TOTAL 10 13 11 14 9 15 20 12 21 16 13 6 160


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


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Nalxone in Cuyahoga County

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


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CCMEO/CCRFSL Drug Chemistry testing# Items or powder with both cocaine and fentanyl (includes fentanyl analogs)


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JAN FEB MAR APR MAY JUNE JULY AUG SEP OCT NOV DEC

CCMEO All Drug Related Deaths 2017, By Type and Combinations, By Month, Focus Analogs and Carfentanil

All Fentanyls Carfentanil Other Analogs Combined heroin-carfentanil

Combined heroin-analog TOTAL Opioid/Cocaine Deaths All Drug Deaths


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CCMEO Comparing Fentanyl and Carfentanil Relationship between Lab Submissions and Fatalities, Monthly Totals, 2014-2018* (*through April)

Carfentanil lab submissions Fentanyl lab submissions Fentanyl fatalities Carfentanil fatalities

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