David Petkiewicz, cleveland.com

Drug overdose deaths reached record levels last year in Cuyahoga County

CLEVELAND, Ohio –The prevalence of fentanyl and an increased number of cases involving cocaine resulted in the Cuyahoga County Medical Examiner's Office confirming Wednesday a distressing bottom line expected for months: Opioids killed more people in 2016 than any year in the county's history.

The heroin and fentanyl epidemic that has claimed thousands of lives in Cuyahoga County reached a record level with 666 drug overdose deaths being reported in 2016. Officials said throughout the year that the county was on pace to exceed previous years' totals; a Wednesday news release provided final tallies for the year.

Officials also see no end in sight and are projecting another spike to approximately 775 deaths in 2017.

"What we've seen over the beginning of 2017 is it's getting off to a start that's worse than 2016," Cuyahoga County Medical Examiner Dr. Thomas Gilson said last week in a news release.

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The prevalence of fentanyl and cocaine was a key reason drug overdose deaths reached records levels last year in Cuyahoga County. The 666 people who died of drug overdoses marked the highest annual fatality rate in the county's history, officials said.

Cuyahoga County Medical Examiner's Office

Fentanyl, cocaine drive drug overdoses to record levels in 2016

Fentanyl was a factor in 399 of the 666 overdose deaths reported in 2016, according to statistics released by the Cuyahoga County Medical Examiner’s Office. The drug’s pervasiveness has risen dramatically in the past three years; fentanyl was involved in five deaths in 2013, 37 in 2014 and 92 in 2015.

The drug, a powerful opioid analgesic, is the primary reason that drug overdose deaths have nearly doubled in the past three years.

"This has been a substantially significant public health crisis," Gilson said this week in a statement.

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Fentanyl was involved in 399 of the 666 drug overdose deaths reported last year in Cuyahoga County, statistics show.

Cuyahoga County Medical Examiner's Office

Fentanyl present in nearly two-third of overdose deaths

The spike in overdose deaths is largely because fentanyl is sometimes mixed with other drugs, such as heroin or cocaine, officials said.

The 399 fentanyl deaths reported last year included 117 deaths caused by fentanyl alone and 141 caused by a mix of fentanyl and heroin. Sixty-eight deaths were caused by a mix of fentanyl and cocaine, and 73 were caused by a mix of fentanyl, heroin and cocaine.

Even more powerful drugs, such as carfentanil and acetyl fentanyl, have also been detected in Cuyahoga County. Carfentanil, an animal sedative, is not safe for human use and presents a "clear and present danger to the community," Cuyahoga County Medical Examiner Dr. Thomas Gilson said last summer in a statement.

Carfentanil was involved in 54 deaths last year and acetyl fentanyl was involved in 43, statistics show.

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Fentanyl-related deaths involving black persons more than doubled last year in Cuyahoga County, statistics show.

Cuyahoga County Medical Examiner's Office

Fentanyl increasingly affecting black community

Fentanyl, which in recent years was largely linked to deaths involving white persons, has increasingly been affecting the black community, the medical examiner’s office said.

Fentanyl contributed to the deaths of 58 black people last year in Cuyahoga County, up from 25 in 2015. Just five black people were died from fentanyl use in 2014, statistics show.

"We saw a lot more African-American citizens of our county starting to show up in our overdose numbers," Gilson said. "Traditionally, we had seen predominantly whites."

Still, 85 percent of the people killed by fentanyl last year were white, statistics show. In 2016, fentanyl was involved in the deaths of 341 white persons in Cuyahoga County.

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There were approximately 100 more overdose deaths involving cocaine last year in Cuyahoga County than any other year in the past decade, statistics show.

Cuyahoga County Medical Examiner's Office

Cocaine overdose deaths more prevalent in 2016

Cocaine-related deaths also rose sharply in 2016. There were 260 people who died after overdosing on the drug, or on cocaine mixed with other drugs, statistics show.

Cocaine resulted in 115 deaths in 2015; in fact, cocaine-related deaths have not risen higher than roughly 125 at any point in the past decade, the medical examiner’s office said.

"The driver of mortality in Cuyahoga County is going to be fentanyl, but what we've really started to notice at the end of 2016 and beginning of 2017 is a higher representation of cocaine," Gilson said last week in a statement. "Cocaine stayed relatively stable, in terms of mortality, for about 10 years up to 2016. And then it really took off in 2016."

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Deaths involving heroin and other opioids, such as painkillers, also spiked in 2016, statistics show.

Cuyahoga County Medical Examiner's Office

Deaths involving heroin, other opioids also spiked

Heroin and other opioids, such as painkillers, were also linked to a higher number of overdose deaths last year. Heroin was involved in 320 deaths, an increase from 184 in 2015.

Opioids, which include heroin and fentanyl, were linked to 557 of the 666 overdose deaths last year in Cuyahoga County.

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Overdose deaths rose during each four-month trimester of 2016, statistics show.

Cuyahoga County Medical Examiner's Office

Overdose deaths worsened each trimester of 2016

Overdose deaths worsened in each four-month trimester of 2016, the medical examiner's office said.

The county reported 140 deaths from January through April and 181 from May through August. The upward trend continued through the final months of the year; 196 overdose deaths were reported from September through December.

The deadliest month was August, with 56 deaths. The lowest total was reported in the year's shortest month -- February saw just 27 deaths, statistics show.

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Cuyahoga County saw more overdose deaths than violent deaths last year, statistics show. Violent deaths include homicides, suicides and traffic crashes.

Cuyahoga County Medical Examiner's Office

Overdose deaths outpaced violent deaths in 2016

Heroin and fentanyl killed more people last year than homicides, suicides and car crashes, statistics show.

In 2016, the county reported 475 violent deaths; that included 184 homicides, 172 suicides and 119 fatal crashes. Heroin and fentanyl, by contrast, killed 506.

Those figures were a dramatic departure from 2014 and 2015 statistics. In 2014, there were 371 violent deaths and 214 heroin/fentanyl deaths. In 2015, the county reported 423 violent deaths and 228 heroin/fentanyl deaths.

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Statistics from the first four months of 2017 have led officials to predict even more overdose deaths this year in Cuyahoga County.

Cuyahoga County Medical Examiner's Office

Officials project more overdose deaths in 2017

Officials who are grappling with the epidemic see no end in sight. In fact, drug overdose deaths are projected to increase from 666 in 2016 to 775 in 2017, the medical examiner’s office said.

Heroin deaths are projected to drop, but officials are projecting an additional 200 cases involving fentanyl or cocaine.

"We are seeing epidemic levels of drug overdose deaths in this country," Gilson said this week in a statement. "It's a big issue."

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File photo

Where do we go from here?

Gilson is scheduled to discuss the country's growing issue with synthetic opiates Thursday in front of a U.S. Senate committee. Ohio Senator Rob Portman, a Republican, and Delaware Senator Tom Carper, a Democrat, are hosting the public hearing in front of the Permanent Subcommittee on Investigations.

The medical examiner's office is also concerned that the increased number of overdose deaths will adversely affect the office. Last year, the office saw a 16 percent increase in post-mortem examinations and an 8.6 percent increase in toxicology tests; officials recently requested a $200,000 budget increase to support the increased workload.

Gilson said he hopes his appearance before the Senate subcommittee will raise awareness.

"I really think the support needs to come from our state, needs to come from our federal government," he said in a news release. "We didn't ask the crisis to land on our doorstep. But it's here."

The county is also taking steps to address the epidemic. Last month, Cuyahoga County officials kicked off the "Know the Risks" campaign to address prescription opioid abuse, which was touted as a critical component in the fight against heroin and fentanyl.

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