With Cuyahoga County on Pace to Set a Record for Overdose Deaths in 2021, Experts Warn of 'Fifth Wave' of Opioid Epidemic and Fentanyl-Laced Drugs

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Cuyahoga County Medical Examiner Dr. Thomas Gilson last week issued the second public health alert in as many months after another cluster of suspected overdose deaths.

Those eight came on Thursday, Dec. 2, with victims both Black and white and ranging in age from 31 to 60.

“Much like a month ago, [this] overdose cluster is very concerning. Again, the public needs to be aware that using street drugs in and around Cuyahoga County is deadly,” Gilson said in the alert. “Resources are available to lessen the dangers, but the simple fact is there is only one sure way to avoid these tragic ends. Get yourself into treatment before it is too late."

The public alert came less than four weeks after 12 overdose deaths in Cuyahoga County, with ten of them in Cleveland, over the course of two days in November.

"It remains to be seen what the cause is, but the public should be aware that there is a serious threat to their lives if they are using street drugs right now in Cuyahoga County," Gilson said at the time.

Cuyahoga County is now on pace for more than 750 overdose deaths in 2021, a number not seen since the height of the opioid epidemic in 2017 when 727 county residents died from overdoses.

The numbers, which had been improving in recent years, have reversed course not just in Cuyahoga County but the entire state and country. America as a whole crossed the grim six-figure overdose death toll in 2021, a 29% increase over 2020. Ohio's overdose death toll was up from 4,410 in 2020 to 5,585 this year.

Experts at Case Western Reserve University, which has worked closely with the Cuyahoga County Medical Examiner's office, say that this "fifth wave" of the opioid epidemic is different than earlier ones and primarily features deaths "due to fentanyl mixed with cocaine and methamphetamines—often present in illicit counterfeit pills—without the user necessarily being aware."

“This epidemic can be framed in waves, starting prior to 2010 that began to rise, then plateau,” said Daniel Flannery, a CWRU professor who also directs the university’s Begun Center for Violence Prevention Research and Education. “The trend was largely focused around overdose deaths from prescription opioid pain relievers. Next came heroin. Wave three began in 2014, with an increase in illicitly manufactured fentanyl, often present in mixtures with heroin and cocaine.”

Bridget Brennan, U.S. Attorney for the Northern District of Ohio, echoed the CWRU researchers in a statement this month.

“There are no safe street drugs,” she said. “Pills that look like oxycontin or percocet are often pressed fentanyl, fentanyl analogues or carfentanil. Similarly, cocaine is not just cocaine, and heroin is not just heroin. What is being bought on the streets is killing our friends and neighbors. We will continue to identify, dismantle and prosecute anyone selling these illegal narcotics. But for those who are using, know that help is available. Please get the help you need.”

Experts have tied this year's dismal stats to the pandemic, which is exacerbating a problem the state has been dealing with for years.

“[People are] dealing with the isolation they felt; they’re dealing with the loss of jobs,” Scott Osiecki, CEO of the Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board of Cuyahoga County, said recently. “They’re not looking to take fentanyl. They’re not even looking to take an opioid, and it is in there and that’s what’s causing the opioid deaths to increase.”
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