Thomas P. Gilson, M.D. 111 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 219 FEBRUARY UPDATE March 6, 219
Examiner s Office revised -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 ( 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, - Out of County- Barberton (Summit),Valley City (Medina) VICTIMS Victims ages range from 25-7 Male victims; 21 Female victims 1 African American victims; 1 Asian American victim; Caucasian victims ( hispanic victims) TRENDS At least 97 victims have died from heroin/fentanyl/analog or in combination through February 219. This compares to 69 in 218 and 112 in 217. 219 is at least 17 fatalities when including cocaine as well. Carfentanil: 191 FATAL CASES in 217; 24 confirmed in 218; 6 confirmed in 219 as of 2/1/19 Rate of African American deaths involving fentanyl is 26.% of all victims so far in 219, a rate above 216 (14.5%), and higher than the 2.% in 217 and 21.11 in 218. As many as 24 cocaine related deaths occurred in February 219 with as many as 18 being mixed with Fentanyl, Heroin or both. Examiner s Office revised -6-19
5 219 CCMEO Overdose Deaths, Most Common Drugs Involved Combined is heroin and fentanyl or cocaine and fentanyl in some combination 1 (Fentanyl analogues will be counted under Fentanyl Columns). 28 25 2 15 21 17 2 18 1 5 4 1 JAN - 57 Heroin Heroin/Fentanyl Combined Cocaine/Fentanyl Combined 7 4 FEB- 51 Fentanyl Cocaine alone Opioid ODs (awaiting confirmation tests) Examiner s Office revised -1-19
218 CCMEO Overdose Deaths, Most Common Drugs Involved Combined is heroin and fentanyl in some combination (Fentanyl analogues will be counted under Fentanyl Columns). 5 27 29 25 2 15 1 5 1 9 15 JAN- 4 21 12 11 2 FEB- 4 2 1 12 7 16 1 1 1 MAR- 4 2 9 8 7 7 6 APR- 1 MAY- 4 16 15 1 9 JUNE- 41 2 15 14 5 JULY- 4 2 18 17 7 AUG- 5 22 8 5 1 1 SEP- 6 2 1 8 8 8 OCT- 42 16 1 NOV-58 24 1 16 19 DEC- 5 Heroin Fentanyl Heroin/Fentanyl Combined Cocaine alone Cocaine/Fentanyl Combined Examiner s Office revised 2-1-19
14 Cuyahoga County Heroin/Fentanyl Related Overdose Deaths 21-218* Projected deaths with DAWN Saves as overdose Deaths 149 (* 218 based on preliminary data thru February 1, 219) 1 12 11 11 1 9 91 8 7 6 5 4 2 1 194 197 21 198 22 1 184 228 451 2 58 24 542 15 416 21 21 plus Fentanyl 21 w/o DAWN 214 214 plus fentanyl 214 w/o DAWN 215 215 215 proj w/fentanyl w/o DAWN 216 216 216 proj w/fentanyl w/o DAWN 217 217 217 w/o w/fentanyl DAWN 218 proj 218 proj w/fent 218 proj w/o DAWN Examiner s Office revised 2-1-19 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 in 217 and,789 dose administrations in 218).
1% 9% 8% 7% 2.25 2.25 2.75.5 1.5 1.5 2.25.5 5 1.67 Cuyahoga County Fentanyl Deaths 26-219 11 1 1 1 1 6% 5% 4% 1 1 1 1 1 Cuyahoga County has seen 121 more fentanyl related deaths in the past 8 months than the entire decade prior. % 2% 1% 15 1 1 1 1 1 % Months 26-Sept., 214 Oct. 1, 214-Nov.21, 215 Nov. 21, 215 - 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 Nov 29 -Feb 28, 219 1 Deaths Examiner s Office revised -1-19
117 18 16 154 172 24 226 224 25 251 269 267 262 255 278 1 1 4 5 7 44 557 556 56 666 727 8 7 6 Opioid related overdose deaths as Percentage* of All Drug related Deaths *(26-21 54%; 211-218 77%) 64.42% 67.77% 72.26% 77.6% 72.24% 75.14% 8.6% 76.48% 78.57% 1.% 75.% 5 54.18% 57.25% 4 46.8% 47.79% 5.% 2 25.% 1 26-25 27-226 28-251 29-269 21-267 211-1 212-1 21-4 214-5 215-7 216-666 217-727 218*-56.% TOTAL DRUG OD DEATHS All Opiate/opioid % opioid deaths to all drug deaths Examiner s Office revised 2-1-19
16 CCMEO Fentanyl-related fatalities among African Americans 214-219* *(Red - Projected for remainder of year, as of March 1, 219) 14 12 1 8 125 6 4 1 86 2 58 25 25 7 214 215 216 217 218 219 Fentanyl (YTD) Fentanyl (Projected) Examiner s Office revised -1-19
CCMEO, Proliferation of Fentanyl and Cocaine/Fentanyl mixtures in fatalities 21-219* (* thru February) 219 46 4 89 218 141 167 44 217 19 217 492 216 161 21 99 215 24 47 92 214 12 22 7 21 2 2 5 1 2 4 5 6 Cocaine + Fentanyl Heroin + Fentanyl Fentanyl Examiner s Office revised -1-19
CCMEO Cocaine related Overdose Deaths 26-218* Demographic Shift in Cocaine Deaths (Includes cocaine/fentanyl mixed ) *218 from rd Qtr data and projected from remainder of 218 as of 12/1/18 12 65.79% 59.84% 1 52.4% 8 76 75 75 64.1% 56.1% 51.2% 52.25% 46.96% 46.77% 42.61% 79 12 4.% 76 7.% 6.% 5.% 4.% 6 4 56 58 5 58 54 58 49.8%.% 29.92% 2.% 2 1.% 26 27 28 29 21 211 212 21 214 215 216 217 218*.% African American Cocaine Deaths African American Cocaine Deaths as Percentage of Total Examiner s Office revised 2-1-19
5 4 EPIDEMICS OF UNINTENTIONAL DRUG OVERDOSE DEATHS IN OHIO 1979-217 Sources: WONDER (NCHS Compressed Mortality File, 1979-1998 & 1999-25) 26-217 ODH Office of Vital Statistics, Change from ICD-9 to ICD-1 coding in 1999 (caution in comparing before and after 1998 and 1999. Fentanyl Analogs & Cocaine 2 1 Heroin Crack Cocaine Examiner s Office revised 1-4-18