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
9 Cuyahoga County Overdose Deaths 26-217* Most Common Drugs (*projected by ruled as of Dec. 31, 217) 8 7 6 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 218. 666 822 5 477 4 3 2 25 226 251 269 267 31 31 34 353 194 198 184 161 114 17 117 13 113 111 116 124 115 127 17 81 92 87 87 13 91 91 98 85 11 87 49 4 8 64 64 37 23 11 9 7 13 8 1 5 26-25 27-226 28-251 29-269 21-267 211-31 212-31 213-34 214-353 37 215-37 32 99 399 26 56 216-666 349 25 192 96 217*-822 Heroin Cocaine Carfentanil Fentanyl All Opioids (not inc. Fentanyl) TOTAL DRUG OD DEATHS
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 24 8 24 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 216. 217 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).
13 12 1 9 8 7 Cuyahoga County Heroin/Fentanyl Related Overdose Deaths 27-217* Projected deaths with DAWN Saves as overdose Deaths (* based on preliminary data thru December 31) 921 139 6 5 445 56 522 4 3 2 194 197 23 198 223 329 184 228 32 25 213 213 plus Fentanyl 213 w/o DAWN 214 214 plus fentanyl 214 w/o DAWN 215 215 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).
% 9% 8% 2.5 3.5 1.5 3 1.5 3 2.25 3.5 5 13.67 Cuyahoga County Fentanyl Deaths 26-217 67 7% 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, 215 - 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
12 CCMEO Fentanyl-related fatalities among African Americans 214-217* (* Based on preliminary data as of December 31, 217) 99 8 6 58 4 25 2 7 214 215 216 217
4 217 CCMEO Overdose Deaths, Most Common Drugs Involved (Fentanyl analogues will be counted under Fentanyl Columns). 36 35 33 31 3 25 2 15 1 5 1 18 28 19 JAN- 55 26 7 7 2 27 9 3 3 3 2 FEB- 68 9 MAR- 38 28 14 13 12 APR- 54 27 21 2 2 2 4 MAY-51 3 8 JUNE- 66 8 9 28 1 JULY- 81 13 11 6 2 24 AUG- 5 8 18 14 14 14 13 11 1 SEP- 47 4 21 OCT- 52 7 14 9 22 12 NOV- 52 Heroin Fentanyl Heroin/Fentanyl Combined Cocaine alone Cocaine/Fentanyl Combined 16 15 2 19 19 DEC- 52
CCMEO, Proliferation of Fentanyl and Cocaine/Fentanyl mixtures in fatalities 213-217 (as of Dec. 31) 217 2 25 477 216 161 213 399 215 24 47 92 214 12 22 37 213 2 5 212 4 1 211 1 8 21 1 13 29 1 7 28 1 9 27 2 11 26 7 1 23 2 3 4 5 6 Cocaine + Fentanyl Heroin + Fentanyl Fentanyl
CCMEO/CCRFSL Drug Chemistry testing # Items or powder with both cocaine and fentanyl (includes fentanyl analogs) 35 3 299 25 2 15 134 5 9 215 216 217 (thru June 3, 217) Examiner s Office revised 9-25-17
9 8 7 CCMEO/CCRFSL Drug Chemistry Testing, Monthly Positive Results for Fentanyl Analogs 217 (Jan. 1 - June 3) 77 83 6 5 53 4 3 29 3 2 1 11 8 14 January February March April May June 3-Methylfentanyl 4-ANPP Acetylfentanyl Acrylfentanyl Butyrylfentanyl Carfentanil Cyclopropylfentanyl FIBF Furanyl Fentanyl Methoxyacetylfentanyl U-477 U-51754 Examiner s Office revised 9-25-17
CCMEO/CCRFSL Fentanyl and It's Most Common Analogs, Overdose Deaths in Cuyahoga County 213-217 (*projected based on ruled through June 3, 217) 45 4 399 35 3 273 25 2 192 176 15 5 134 116 112 119 92 17 96 91 56 37 43 39 25 5 7 25 12 14 3 213-34 214-353 215-37 216-666 217 Actual MidYear Non-fentanyl associated Heroin deaths Non-fentanyl associated Cocaine deaths Carfentanil Acetyl-fentanyl Fentanyl Acryl-fentanyl Furanyl-fentanyl
7 CCMEO/CCRFSL Fentanyl and Carfentanil Future Trajectories for Overdose Deaths in Cuyahoga County 213-219** 6 625 525 5 477 4 399 3 2 192 5 37 92 213-34 214-353 215-37 216-666 217*-822 218**- 1, 56 219** - 1,2 Carfentanil Fentanyl