Heroin/Fentanyl/Cocaine Related Deaths in Cuyahoga County

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1 Thomas P. Gilson, M.D. 11 Cedar Avenue, Cleveland, Ohio 4416 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 218 DECEMBER UPDATE January 11, 218

2 8 7 Cuyahoga County Overdose Deaths * Most Common Drugs (*projected based upon ruled through Sept,218 and estimated as of Dec.1, 218) NOTE: Projections have been based on initial ELISA screens and not from ruled. This may cause statistical deviations in overprojecting some drugs (especially cocaine) that do not end up in the official cause of death and underprojecting fentanyls (especially analogs and carfentanil) because the confirmations require additional time. Due to heavy caseloads, this process is 6-75 days. CCMEO is providing this very preliminary data in the interest of public safety but final statistical results will not be fully accurate or available until at least the end of the following quarter of the date below *-56 Heroin Cocaine Carfentanil Fentanyl All Opioids (not inc. Fentanyl after 21) TOTAL DRUG OD DEATHS All Opiate/opioid

3 CURRENT PUBLIC HEALTH EMERGENCY At least 12 fatalities since Jan. 1 Fatal Cases due to heroin/fentanyl/analogs in NOVEMBER at least 9 ( pending testing) 16 - City of Cleveland Residents 18 - Suburban Residents- Brook Park, Chagrin Falls, Cleveland Hts.(2), East Cleveland (2), Euclid, Fairview Park (2), Lakewood (), Parma (), Parma Hts. and University Hts., and, 5 - Out of County Brunswick (Medina), Lagrange (Lorain), Los Angeles (CA), North Ridgeville (Lorain) and Wooster (Wayne) VICTIMS Victims ages range from Male victims; 9 Female victims 9 African American victims; Caucasian victims (2 hispanic victims) TRENDS At least 416 victims have died from heroin/fentanyl/analog or in combination through December in 218. This compares to 542 through November of 217 and 56 in is at least 54 fatalities when including cocaine as well. Carfentanil: 56 FATAL CASES in 216; 191 in 217; 24 confirmed fatal in 218 as of 12/1/18 Rate of African American deaths involving fentanyl is 22.11% of all victims so far in 218, a rate above 216 (14.5%), and higher than the 2.% in 217. As many as 21 cocaine related deaths occurred in December 218 (as many as 254 for 218), with as many as 12 being mixed with Fentanyl, Heroin or both (as many as 166 for 218).

4 218 CCMEO Overdose Deaths, Most Common Drugs Involved Combined is heroin and fentanyl in some combination (Fentanyl analogues will be counted under Fentanyl Columns) JAN FEB MAR APR- 1 MAY JUNE JULY AUG SEP OCT NOV DEC- 5 Heroin Fentanyl Heroin/Fentanyl Combined Cocaine alone Cocaine/Fentanyl Combined

5 14 1 Cuyahoga County Heroin/Fentanyl Related Overdose Deaths * Projected deaths with DAWN Saves as overdose Deaths 149 (* 218 based on preliminary data thru October 1) plus Fentanyl 21 w/o DAWN plus fentanyl 214 w/o DAWN proj w/fentanyl w/o DAWN proj w/fentanyl w/o DAWN w/o w/fentanyl DAWN 218 proj 218 proj w/fent 218 proj w/o DAWN Examiner s Office revised DAWN includes all documented naloxone saves through DAWN including police reversals. Does not include EMS administrations: (1,9 doses in 215, 5,156 in 216 and 7,745 dose administrations in 217).

6 % 9% 8% 7% 6% 5% 4% Cuyahoga County Fentanyl Deaths Cuyahoga County has seen 1184 more fentanyl related deaths in the past 4 months than the entire decade prior. % 15 2% 1% % Months Deaths 26-Sept. 214 Oct. 214-Nov.21, 215 Nov. 21, Apr. 7, 216 Apr. 8 - July 2, 216 July 21 - Sept, 216 Oct. 1 - Dec 1, 216 Jan 1 - Feb 15, 217 Feb 16 - May 15, 217 May 15- June, 217 July 1 - Oct 15, 217 Oct. 16- Dec. 1, 217 Jan 1 - Apr 4, 218 April 5 - July 1, 218 July 14-Sep 1, 218 Sep 1 - Nov 28, 218 Nov 29 - Dec 1, 218

7 12 CCMEO Fentanyl-related fatalities among African Americans * *(as of December 1, 218) Fentanyl (YTD)

8 CCMEO, Proliferation of Fentanyl and Cocaine/Fentanyl mixtures in fatalities * (* through December 1, 218) Cocaine + Fentanyl Heroin + Fentanyl Fentanyl

9 CCMEO Cocaine related Overdose Deaths * Demographic Shift in Cocaine Deaths (Includes cocaine/fentanyl mixed ) *218 from rd Qtr data and projected from remainder of 218 as of 12/1/ % 59.84% 52.4% % 56.1% 51.2% 52.25% 46.96% 46.77% 42.61% % 76 7.% 6.% 5.% 4.% %.% 29.92% 2.% 2 1.% *.% African American Cocaine Deaths African American Cocaine Deaths as Percentage of Total

10 5 4 EPIDEMICS OF UNINTENTIONAL DRUG OVERDOSE DEATHS IN OHIO Sources: WONDER (NCHS Compressed Mortality File, & ) ODH Office of Vital Statistics, Change from ICD-9 to ICD-1 coding in 1999 (caution in comparing before and after 1998 and Fentanyl Analogs & Cocaine 2 Heroin Crack Cocaine Examiner s Office revised