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 Related Deaths in Cuyahoga County MARCH 31, 2016
Heroin Risk Continuum Risk of Fatality Not using heroin Being in an Auto accident Previous legal prescription for opioids Using heroin Using IV heroin Using alone Mixing with alcohol or other drugs Using after period of abstinance (jail or treatment) Using without DAWN naloxone kit Using Heroin tainted with or replaced by fentanyl Persons in Cuyahoga County Annually Misusing or Abusing Persons in Cuyahoga County who Annually Switch to Heroin Opioid Prescriptions (Based on estimates from SAHMSA Drug Survey results and known local data) Examiner s Office revised 3-31-15
Persons in Cuyahoga County Dying Annually From Heroin-related Overdoses Persons in Cuyahoga County Dying Annually From Fentanyl-related Overdoses Persons in Cuyahoga County Anticipated to Die in 2016 from Heroin Examiner s Office revised 3-31-15 Persons in Cuyahoga County Anticipated to Die in 2016 from Fentanyl
CURRENT PUBLIC HEALTH EMERGENCY No. of Fatal Cases due to heroin/fentanyl in March 50 19 - City of Cleveland Residents 31 - Suburban Residents- Brecksville, Brook Park (3), Chardon, Cleveland Heights (2), Columbia Station (2), Euclid (2), Lakewood (4), Middleburgh Heights, North Olmsted, North Royalton, Olmsted Township, Parma (4), Parma Heights, Peninsula, South Euclid (2), Strongsville, Westlake (2), One out of State resident - PA VICTIMS Victims ages range from 20 69 35 Male victims; 15 Female victims 6 African American victims; 4 Hispanic victims; 40 Caucasian victims EXPONENTIAL RATE OF INCREASE In 2015, one person died every day in Cuyahoga County from a drug overdose. In 2016, during January and February, one person died every day in Cuyahoga County from a heroin or fentanyl overdose. January was a record for fentanyl deaths, broken again in February. In March 2016, two people have died every day in Cuyahoga County from a heroin or fentanyl overdose. March will set a new record for fentanyl deaths. At least 107 victims already for 2016.
2.25 Cuyahoga County Deaths per Day due to Heroin and Fentanyl 2 Represents a projected 712 heroin/fentanyl deaths 1.75 1.5 1.25 1 Represents a projected 438 heroin/fentanyl deaths 0.75 0.5 0.25 228 dead from heroin and fentanyl out of 365 total drug Represents OD deaths 228 heroin/fentanyl deaths out of 370 total OD deaths Represents a projected 346 heroin/fentanyl deaths 0 2011 2012 2013 2014 2015 Jan-Feb 2016 3/1 to 3/9/16 3/10 to 3/31/16
40 CCMEO 2016 Fentanyl & Heroin Related Deaths, By Month (For monthly total, combined cases are subtracted from the sum of other columns ) 35 35 31 30 25 22 24 20 19 16 15 10 11 9 6 5 0 JAN FEB MAR Heroin Fentanyl Combined
2014-15 Fentanyl Residence Locations
2014-15 Fentanyl Incidence Locations
250 Cuyahoga County Overdose Deaths 2006-2015 Most Common Drugs 200 194 198 184 150 100 50 0 13 49 127 114 81 87 23 2006-250 cases 40 16 107 22 64 64 117 11 9 7 2007-226 cases 87 2008-251 cases 103 2009-269 cases 103 91 91 40 39 13 2010-267 cases 113 107 98 36 161 111 116 85 33 101 45 8 10 5 2011-301 cases 2012-310 cases 2013-340 cases 124 87 48 37 2014-353 cases 115 92 80 39 2015-370 cases Heroin Cocaine Oxycodone Fentanyl All Opioids (Inc. Oxycodone & but not Fentanyl)
CCMEO Heroin Related Deaths, Comparisions 2011-2015 250 200 194 198 184* 150 100 50 31 37 52 65 78 107 41 52 161 126 111 79 47 151 143 133 134 97 92 61 59 57 41 44 83 133 122 0 2011 2012 2013 2014 2015 1st Q 1st Tri MidYear 2nd Tri 3rd Q FINAL
450 Cuyahoga County Heroin Related Overdose Deaths 2007-2015 Projected with DAWN Saves and Fentanyl as Heroin OD Deaths 399 375 315 300 225 161 194 197 229 198 223 184 229 150 91 107 75 40 64 64 0 2007 2008 2009 2010 2011 2012 2013 2013 plus Fentanyl 2013 w/o DAWN 2014 2014 plus fentanyl 2014 w/o DAWN 2015 proj 2015 proj 2015 proj w/fentanyl w/o DAWN
CCMEO Fentanyl Related Deaths, Comparisions 2013-2015 100 90 80 81 92* 70 60 66 68 50 40 37 36 42 30 26 24 20 10 0 2 3 3 14 14 10 11 8 5 5 3 3 2013 2014 2015 1st Quarter 1st Trimester 1st Half 2nd Trimester 3rd Quarter Thru Nov Final
Cuyahoga County, Heroin and Fentanyl Deaths 2011-2015 21 47 Heroin + Fentanyl 1 2 1 44 16 Fentanyl (no Heroin) 4 8 7 137 177 Heroin (no Fentanyl) 106 159 193 0 50 100 150 200 250 2015 2014 2013 2012 2011
35 CCMEO Monthly Fentanyl Deaths October 2014 to March 2016 (January - March 2016 cases based upon preliminary toxicology) 31 30 25 24 20 19 15 14 10 5 9 11 5 6 11 6 5 6 9 5 3 7 10 0 NOV DEC JAN FEB MAR APR MAY JUNE JULY AUG SEP OCT NOV DEC JAN FEB MAR 2014 2015 2016
100% 5 Cuyahoga County Fentanyl Deaths 2006-2016 90% 13.67 80% 93 70% 60% 50% 97 40% 105 30% 20% 100 10% 0% Months Deaths 2006-Sept. 2014 Oct. 2014-Oct.31, 2015 Nov. 1, 2015 - Mar. 30, 2016
Figure 1: Gender of Fentanyl-related Overdose Decedents in Cuyahoga County, 2014-15 (126 cases) 30.16% 100% 90% 80% 70% 60% 50% 85% 73.40% 75% 81.30% 76.60% 75.80% 73.71% 79.08% 74.86% HEROIN DEATHS BY GENDER Male 69.84% 40% 30% 20% 10% 26.60% 15% 25% 18.70% 26.29% 23.40% 24.20% 20.92% 25.14% Female Male Female 0% 2007 2008 2009 2010 2011 2012 2013 2014 2015 Figure 2: Race of Fentanyl-Related Overdose Decedents in Cuyahoga County, 2014-15 (126 cases) 23.02% 0.79% 76.19% White Black Asian 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 75% 90.60% 82.80% 82.40% 82.20% 86.30% 85.57% 86.22% 83.06% 25% 17.20% 17.60% 17.80% 9.40% 13.70% 14.43% 13.78% 15.85% 7.70% 0% 3.10% 3.10% 3.70% 4.40% 4.64% 6.12% 5.46% 0% 1.09% 0% 0% 0% 0% 0% 1.24% 0.51% 2007 2008 2009 2010 2011 2012 2013 2014 2015 HEROIN DEATHS BY RACE White Black Hispanic Other Examiner s Office revised 3-21-16
Figure 3: Age of Fentanyl-related Overdose Decedents in Cuyahoga County, 2014-15 (126 cases) 29.37% 4.76% 38.89% 26.19% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% 50.00% 46.94% 45.31% 40.19% 40.44% 40.63% 39.13% 40.21% 37.50% 35.16% 36.68% 37.50% 32.65% 31.68% 31.44% 29.67% 28.04% 32.66% 26.56% 26.56% 28.57% 25.23% 25.47% 24.23% 20.41% 23.62% 26.78% 24.59% 17.19% 7.50% 7.04% 8.20% 6.59% 6.54% 4.69% 5.00% 1.56% 3.73% 4.12% 0.00% 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 19-29 30-44 45-60 60+ HEROIN DEATHS BY AGE Age 18-29 Age 30-44 Age 45-60 Age 60+ 2014-15 Fentanyl Deaths by Residence (126 cases) 2015 2014 44.26% 50.00% 43.72% 36.87% 12.02% 13.13% 13.49% 2013 2012 50.00% 44.10% 38.66% 41.61% 11.34% 14.29% 44.44% 2011 2010 43.93% 43.96% 50.47% 42.86% 5.61% 13.19% 2009 50.00% 40.63% 9.38% 42.06% 2008 42.19% 43.75% 14.06% 2007 42.50% 45.00% 12.50% 2006 55.10% 40.82% 4.08% Residence Cleveland Suburbs Out of County Examiner s Office revised 3-21-16 0% 20% 40% 60% 80% 100% City of Cleveland Suburb Out of County HEROIN DEATHS BY RESIDENCE
2014-15 Fentanyl Deaths by Incidence Location (126 cases) 2015 2014 42.08% 36.36% 31.82% 44.26% 2.53% 1.64% 12.02% 28.28% 2013 45.36% 32.99% 5.15% 16.49% 2012 40.99% 35.40% 2.48% 21.12% 27.78% 32.54% 2011 2010 46.73% 45.05% 38.32% 38.46% 0.00% 14.95% 3.30% 13.19% 2009 46.88% 31.25% 3.13% 18.75% 3.17% 2008 2007 48.44% 55.00% 37.50% 37.50% 1.56% 12.50% 0.00% 7.50% 2006 61.22% 32.65% 0.00% 6.12% 36.51% Cleveland Suburbs Out of County Unknown 0% 20% 40% 60% 80% 100% City of Cleveland Suburb Out of County Un-known HEROIN DEATHS BY INCIDENCE Examiner s Office revised 3-21-16
Examiner s Office revised 3-21-16
Examiner s Office revised 3-21-16 *82 in City of Cleveland, 39 Unknown
Bay Beachwood Bedford Bedford Hts. Berea Brecksville Broadview Hts. Brooklyn Brook Park Chagrin Falls Cleveland Hts. Cuyahoga Hts East Cleveland Euclid Fairview Park Garfield Hts. Gates Mills Highland Hts. Independence Lakewood Lyndhurst Maple Hts Mayfield Mayfield Hts Middleburgh Hts Newburgh Hts North Olmsted North Royalton Oakwood Olmsted Falls Olmsted Twp Orange Parma Parma Hts. Pepper Pike Richmond Hts Rocky River Seven Hills Shaker Hts South Euclid Solon Strongsville Valley View Warrensville Hts Walton Hills Westlake Woodmere Bentleyville Bratenahl Brooklyn Hts. Glenwillow Highland Hills Hunting Valley Linndale Moreland Hills North Randall University Hts Akron Ashtabula Avon Avon Lake Bainbridge Brunswick Camden Twp Chesterland Twp. Columbia Station Cortland Creston Delaware Eastlake Elyria Freedom Twp Litchfield Lorain Medina Mentor North Ridgeville Northfield Painesville Russell Twp Saybrook Twp Twinsburg Valley City Warren Wickliffe Windham Willoughby 80 TOTAL SUBURBAN HEROIN DEATHS (By community of residence) 2006-2015 70 60 62 67 50 40 30 29 20 10 0 15 15 10 12 11 8 7 5 5 2 2 3 1 11 16 2 5 3 15 12 11 1 6 1 18 15 2 7 6 2 18 1 2 12 7 8 4 2 16 4 1 1 12 7 6 6 4 4 4 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 3 4 5 3 4 1 1 1 3 4 1 1 1 1 1 1 2 TOTAL 2006-2015 Examiner s Office revised 3-21-16
Bay Beachwood Bedford Bedford Hts. Berea Brecksville Broadview Hts. Brooklyn Brook Park Chagrin Falls Cleveland Hts. Cuyahoga Hts East Cleveland Euclid Fairview Park Garfield Hts. Gates Mills Highland Hts. Independence Lakewood Lyndhurst Maple Hts Mayfield Mayfield Hts Middleburgh Hts Newburgh Hts North Olmsted North Royalton Oakwood Olmsted Falls Olmsted Twp Orange Parma Parma Hts. Pepper Pike Richmond Hts Rocky River Seven Hills Shaker Hts Solon South Euclid Strongsville Valley View Warrensville Hts Westlake Bentleyville Bratenahl Brooklyn Hts. Glenwillow Highland Hills Hunting Valley Linndale Moreland Hills North Randall University Hts Walton Hills Woodmere Ashtabula Avon Avon Lake Brunswick Chesterland Twp. Columbia Station Eastlake Elyria Lorain Medina Mentor North Ridgeville Painesville Wickliffe Willoughby Other 60 50 TOTAL SUBURBAN HEROIN DEATHS (By community of incidence*) 2006-15 49 * City of Cleveland 507; Unknown location 199 45 40 30 32 33 20 10 0 9 9 1 11 14 7 5 3 1 1 1 2 1 8 16 0 9 3 8 6 0 17 8 0 15 11 1 4 3 4 17 1 4 6 6 2 1 4 12 1 4 11 0 0 0 0 0 0 0 0 0 0 0 0 3 2 2 0 1 2 0 1 1 2 2 5 2 2 2 Total 2006-2015 Examiner s Office revised 3-21-16