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Review
. 2017 Mar;7(1):41-49.
doi: 10.23907/2017.005. Epub 2017 Mar 1.

The Evolution of the Opiate/Opioid Crisis in Cuyahoga County

Thomas P Gilson  1 , Hugh Shannon  2 , Jaime Freiburger  2
Affiliations
Review

The Evolution of the Opiate/Opioid Crisis in Cuyahoga County

Thomas P Gilson et al. Acad Forensic Pathol. 2017 Mar.

Abstract

The United States continues to grapple with an epidemic of opiate/opioid drugs. This crisis initially manifested itself in the use and abuse of opioid pain relievers and has since seen an increase in illicit opiate/opioid drug use mortality. Cuyahoga County (metropolitan Cleveland) has been an area where the crisis has been particularly acute; this paper updates our previous experience. Most notable in the evolution of the drug epidemic has been an increase in mortality associated with fentanyl and an alarming rise in overall deaths, largely attributable to the emergence of fentanyl (a 64% increase in total overdose deaths from 2015 to 2016, with fentanyl increasing 324%). Fentanyl is a synthetic opioid with use in medical analgesia and anesthesia; however, most of the current supply is of clandestinely manufactured origin. Also of concern is the recent appearance of illicit fentanyl analogues, which are briefly described in this report. White males continue to be the most frequent overdose victims in the current crisis. A decrease of age appears to have taken place with the emergence of fentanyl with the most common age group being between 30 and 44 years of age. The majority of decedents are nonurban residents. Educationally, most of these decedents have a high school diploma or less schooling and a significant percentage consists of manual laborers. Medical examiners are an important source of information necessary to develop prevention and interdiction strategies. Challenges faced regarding adequate funding, instrumentation, and staffing are being felt.

Keywords: Cocaine; Epidemiology; Fentanyl; Forensic pathology; Heroin; Opioid.

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Conflict of interest statement

DISCLOSURES & DECLARATION OF CONFLICTS OF INTEREST The authors, reviewers, editors, and publication staff do not report any relevant conflicts of interest

Figures

Figure 1
Figure 1
Cuyahoga County overdose deaths 2006-2016, most common associated drugs. 2016 cases projected from 3rd quarter data based on ruled cases as of December 31.
Figure 2
Figure 2
Cuyahoga County overdose deaths by year, drug and fentanyl contribution 2006-2016, most common associated drugs. 2016 cases projected from 3rd quarter data based on ruled cases as of December 31.
See this image and copyright information in PMC

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