Post on 24-Mar-2020
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.