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 217 DECEMBER UPDATE JANUARY 5, 218

2 9 Cuyahoga County Overdose Deaths * Most Common Drugs (*projected by ruled as of Dec. 31, 217) 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 which have now stretched to 9 days due to heavy caseloads. 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 the end of the 1 st quarter of *-822 Heroin Cocaine Carfentanil Fentanyl All Opioids (not inc. Fentanyl) TOTAL DRUG OD DEATHS

3 CURRENT PUBLIC HEALTH EMERGENCY At least 5 fatalities since JAN. 1 Fatal Cases due to heroin/fentanyl/analogs in DECEMBER at least 33 (5 pending additional testing) 15 - City of Cleveland Residents 16 - Suburban Residents- Brook Park (2), Euclid, Garfield Hts., Parma (7), Parma Hts., Pepper Pike, Richmond Hts., South Euclid and (1) Out of County Mentor (Lake). 2 Unknown (homeless) VICTIMS Victims ages range from Male victims; 9 Female victims 6 African American victims; 1 Native American; 26 Caucasian victims (1 Hispanic victim) TRENDS At least 522 victims have died from heroin/fentanyl/analog or in combination in 217. This compares to 58 through end of at least 664 fatalities when including cocaine as well. Carfentanil: 56 CONFIRMED FATAL CASES in 216; 151 CONFIRMED as of 12/31 in 217 Rate of African American deaths involving fentanyl is 2.7% of all victims, a higher rate than 216 (14.5%). At least 38 cocaine related deaths occurred in December (at least 349 for 217), with at least 14 being mixed with Fentanyl, Heroin or both (at least 195 for the year).

4 Cuyahoga County Heroin/Fentanyl Related Overdose Deaths * Projected deaths with DAWN Saves as overdose Deaths (* based on preliminary data thru December 31) plus Fentanyl 213 w/o DAWN plus fentanyl 214 w/o DAWN w/fentanyl 215 proj w/o DAWN 216 proj 216 w/fentanyl 216 proj w/o DAWN 217 proj 217 proj w/fentanyl 217 proj w/o DAWN DAWN includes all documented naloxone saves through DAWN including police reversals. Does not include EMS administrations:(829 doses in 215, over 2, doses thru October 216 and 6,589 dose administrations in 217).

5 % 9% 8% Cuyahoga County Fentanyl Deaths % 6% 5% 4% 3% 15 Cuyahoga County has seen 867 more fentanyl related deaths in the past 25 months than the previous 1 years. 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 3, 216 Oct. 1 - Dec 31, 216 Jan 1 - Feb 15, 217 Feb 16 - May 15, 217 May 15- June 3, 217 July 1 - Oct 15, 217 Oct. 16- Dec. 31

6 12 CCMEO Fentanyl-related fatalities among African Americans * (* Based on preliminary data as of December 31, 217)

7 4 217 CCMEO Overdose Deaths, Most Common Drugs Involved (Fentanyl analogues will be counted under Fentanyl Columns) JAN FEB MAR APR MAY JUNE JULY AUG SEP OCT NOV- 52 Heroin Fentanyl Heroin/Fentanyl Combined Cocaine alone Cocaine/Fentanyl Combined DEC- 52

8 CCMEO, Proliferation of Fentanyl and Cocaine/Fentanyl mixtures in fatalities (as of Dec. 31) Cocaine + Fentanyl Heroin + Fentanyl Fentanyl

9 CCMEO/CCRFSL Drug Chemistry testing # Items or powder with both cocaine and fentanyl (includes fentanyl analogs) (thru June 3, 217) Examiner s Office revised

10 9 8 7 CCMEO/CCRFSL Drug Chemistry Testing, Monthly Positive Results for Fentanyl Analogs 217 (Jan. 1 - June 3) January February March April May June 3-Methylfentanyl 4-ANPP Acetylfentanyl Acrylfentanyl Butyrylfentanyl Carfentanil Cyclopropylfentanyl FIBF Furanyl Fentanyl Methoxyacetylfentanyl U-477 U Examiner s Office revised

11 CCMEO/CCRFSL Fentanyl and It's Most Common Analogs, Overdose Deaths in Cuyahoga County (*projected based on ruled through June 3, 217) Actual MidYear Non-fentanyl associated Heroin deaths Non-fentanyl associated Cocaine deaths Carfentanil Acetyl-fentanyl Fentanyl Acryl-fentanyl Furanyl-fentanyl

12 7 CCMEO/CCRFSL Fentanyl and Carfentanil Future Trajectories for Overdose Deaths in Cuyahoga County ** * **- 1, ** - 1,2 Carfentanil Fentanyl

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