The Cuyahoga County Heroin Epidemic

Abstract

Cuyahoga County, Ohio has recently seen a dramatic rise in the number of deaths associated with heroin (DAH). DAH rose from 40 in 2007 to 161 in 2012 with heroin now identified in half of all overdose deaths. One third of DAH involve heroin alone; the remainder, in combination with other drugs. Over this period, opioid pain reliever (OPR) deaths appear to have plateaued. Along with this rise have been shifts in overdose victim demographics. These data most notably include a rise in the number of women (from 15% to 24%), overdoses between the ages 19 and 29 (8% to 25%), and a generally equal number of urban and suburban fatalities. The Medical Examiner's Office conducted a retrospective analysis of 2012 fatalities to identify potential risk factors and intervention points. This review indicates that most victims (81%) were known to abuse drugs. Half were found with drug paraphernalia at the scene. Approximately 12% were using heroin with other addicts, while 60% were using drugs or succumbed to them in proximity to other non-using people. Emergency medical services were only able to administer naloxone in 22% of cases. Histories of recent abstinence (29%), incarceration (18%), and detoxification (31%) were noted and may reflect times of increased risk secondary to decreased tolerance. A prescription for legal controlled substances was noted in 64% of DAH (the most common medications being OPRs and benzodiazepines). This suggests a need to address prescribing practices. Public health interventions, implemented or planned, based on these data are discussed.