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/Cocaine Related Deaths in Cuyahoga County

SEPTEMBER UPDATE

OCTOBER 5, 2017

Source: Cuyahoga County Medical Examiner’s Office revised 10-5-17

49 40 64 6491

107

161194 198 184

320

273

192 176 134

107

65

127114 107 117 103

98

111 116 124 115

260

377

116 112 91

119

167

23 11 9 7 13 8 10 537

92

399

445

81 87 87 10391

113

85 101 8780

99

124

250226

251269 267

301 310340 353 370

666

783

0

100

200

300

400

500

600

700

800

900

2006 - 250cases

2007 - 226cases

2008 - 251cases

2009 - 269cases

2010 - 267cases

2011 - 301cases

2012 - 310cases

2013 -340cases

2014- 353cases

2015 - 370cases

2016- 666cases

2017*-783cases

Heroin Non-fentanyl associated Heroin deaths Cocaine

Non-fentanyl associated Cocaine deaths Fentanyl All Opioids (not inc. Fentanyl)

Cuyahoga County Overdose Deaths 2006-2017* Most Common Drugs (*projected based on ruled cases as of Oct. 5)

CURRENT PUBLIC HEALTH CRISIS – 11 fatalities since Oct. 1

Fatal Cases due to heroin/fentanyl/analogs in SEPTEMBER–at least 35 (41 cases pending additional testing)

21 - City of Cleveland Residents

12 - Suburban Residents- Broadview Hts., East Cleveland, Euclid, Garfield Hts., (3) North Olmsted,

North Royalton, Olmsted Falls, Parma, and (2) Out of County – Chicago, IL and Geneva (Ashtabula).

1 UNKNOWN

VICTIMS

Victims’ ages range from 21 – 68

27 Male victims; 8 Female victims

4 African American victims; 1 Asian American; 30 Caucasian victims (3 Hispanic victims)

TRENDS

At least 396 victims have died from heroin/fentanyl/analog or in combination in 2017. This

compares to 366 through end of September 2016. Drug deaths in 2017 total at least 521 fatalities

when including cocaine as well.

Carfentanil: 58 CONFIRMED FATAL CASES in 2016; 64 CONFIRMED as of 10/5 in 2017

Rate of African American deaths involving fentanyl is 23.07% of all victims, a significantly higher rate

than 2016 (14.5%). At least 25 cocaine related deaths occurred in September (at least 286 for 2017),

with at least 14 being mixed with Fentanyl, Heroin or both (at least 159 for the year).

Source: Cuyahoga County Medical Examiner’s Office revised 10-5-17

144

100 92

49

7

38

120179

7 33

116

158

0

50

100

150

200

250

300

350

400

450

3rd Q 2014 3rd Q 2015 3rd Q 2016 3rd Q 2017*

CCMEO Heroin, Fentanyl and Heroin/Fentanyl Combination Deaths (*2017 through Oct. 5, 2017)

Heroin only Fentanyl only Combined

Source: Cuyahoga County Medical Examiner’s Office revised 10-5-17

DAWN includes all documented naloxone saves through

DAWN including police reversals. Does not include EMS

administration (nearly 1,000 in 2015, and over 2,000

thru October 2016). No 2017 EMS data yet.

4064 64

91 107

161194 197

230 198223

329

184 228

444

320

506

916

273

522

1037

0

100

200

300

400

500

600

700

800

900

1000

1100

1200

Cuyahoga County Heroin Related Overdose Deaths 2007-2017*Projected deaths with DAWN Saves and Fentanyl as overdose Deaths

(* 2017 projected based on preliminary data thru Oct. 5)

Source: Cuyahoga County Medical Examiner’s Office revised 10-5-17

105

100

13.67

100

5

100

3.5

100

2.25

100

3

100

1.5

100

3

100

1.5

100

3.25

90

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Months Deaths

Cuyahoga County Fentanyl Deaths 2006-2017

2006-Sept. 2014 Oct. 2014-Nov.21, 2015 Nov. 21, 2015 - Apr. 7, 2016 Apr. 8 - July 20, 2016 July 21 - Sept 30, 2016

Oct. 1 - Dec 31, 2016 Jan 1 - Feb 15, 2017 Feb 16 - May 15, 2017 May 15- June 30, 2017 July 1 - Oct 5, 2017

Source: Cuyahoga County Medical Examiner’s Office revised 10-5-17

Cuyahoga County has

seen 590 more

fentanyl related

deaths in the past 23

months than the

previous 10 years.

43

4

6

2

8

10

5

7

22

2625

21

25

18

14

9

18

23

33

9

16

14

18

15

20

1011

10

12

20

9

17

20

13

11

24

27

16

14

8

18

14

24

14

0

5

10

15

20

25

30

35

JAN- 60 total FEB- 72 total MAR- 50 total APR- 63 total MAY-50 total JUNE- 61 total JULY- 59 total AUG- 47 total SEP- 46 total

2017 CCMEO Overdose Deaths, Most Common Drugs InvolvedCombined is heroin and fentanyl in some combination (Fentanyl analogues will be counted under

Fentanyl Columns).

Heroin Fentanyl Heroin/Fentanyl Combined Cocaine Cocaine/Fentanyl Combined

Source: Cuyahoga County Medical Examiner’s Office revised 10-5-17

5

37

92

399

338

2

22

47

213

158

2

12

24

161

159

0 50 100 150 200 250 300 350 400 450

2013

2014

2015

2016

2017

CCMEO, Proliferation of Fentanyl and Cocaine/Fentanyl mixtures in fatalities2013-2017* (through Sept. 25)

Cocaine + Fentanyl Heroin + Fentanyl Fentanyl

Source: Cuyahoga County Medical Examiner’s Office revised 10-5-17

9

134

299

0

50

100

150

200

250

300

350

2015 2016 2017 (thru June 30, 2017)

CCMEO/CCRFSL Drug Chemistry testing# Items or powder with both cocaine and fentanyl (includes fentanyl analogs)

Source: Cuyahoga County Medical Examiner’s Office revised 9-25-17

267

25

58

78

0

10

20

30

40

50

60

70

80

90

100

2014 2015 2016 2017

CCMEO Fentanyl-related fatalities among African Americans 2014-2017*

(Blue - Projected for remainder of year, as of October 5, 2017)

Source: Cuyahoga County Medical Examiner’s Office revised 10-5-17

29

77

11 8 14

30

53

83

0

10

20

30

40

50

60

70

80

90

January February March April May June

CCMEO/CCRFSL Drug Chemistry Testing, Monthly Positive Results for Fentanyl Analogs 2017 (Jan. 1 - June 30)

3-Methylfentanyl 4-ANPP Acetylfentanyl Acrylfentanyl

Butyrylfentanyl Carfentanil Cyclopropylfentanyl FIBF

Furanyl Fentanyl Methoxyacetylfentanyl U-47700 U-51754

Source: Cuyahoga County Medical Examiner’s Office revised 9-25-17

192 176

134

107

65

116 112

91

119

167

55

112

405

37

92

399

445

3

45

00 0 7 28

0

50

100

150

200

250

300

350

400

450

500

2013 -340 cases 2014- 353 cases 2015 - 370 cases 2016- 666 cases 2017*-780 cases

CCMEO/CCRFSL Fentanyl and It's Most Common Analogs, Overdose Deaths in Cuyahoga County 2013 - 2017 (*projected based on ruled cases through June 30, 2017)

Non-fentanyl associated Heroin deaths Non-fentanyl associated Cocaine deaths Carfentanil

Acetyl-fentanyl Fentanyl Acryl-fentanyl

Furanyl-fentanyl

Source: Cuyahoga County Medical Examiner’s Office revised 9-25-17