Dr. Thomas Gibson, Medical Examiner of Cuyahoga County (Ohio), reviews the history of opioid abuse and related fatalities in his state and county, along with state and county efforts to address the crisis, followed by his description of how the medical examiner's office in Cuyahoga County has been a focal point for cooperation between public health and criminal justice agencies.
Ohio has more opioid overdose deaths than any state in the country, and it has the second highest per capita drug overdose fatality rate. This crisis can be traced back to the late 1990s and early 2000s, when pharmaceutical companies targeted Ohio and other Appalachian states with aggressive marketing campaigns. "Pill mills" introduced huge quantities of prescription opioids into the state, and the overdose deaths increased. State regulations have since brought "pill mills" under state control; however, from 2010, prescription overdoses have remained stable, but deaths from illegal heroin use began to rise, producing a fivefold increase in heroin deaths from 2008 to 2013 in Cuyahoga County. Cuyahoga County has had various task forces to address public health and criminal justice issues in this drug crisis. The medical examiner's office, which has links to both criminal justice and public health agencies, became the logical focal point for collaboration among these agencies. The medical examiner's toxicology lab, which tests for the drugs that kill people, communicates with the medical drug chemistry lab, which examines drugs seized on the street. The data from these labs inform the nature and impact of drug abuse in the county. Partnerships with the Cleveland Police Department and County Sheriff's Office led to the creation of overdose scene-processing protocols, which produced improved prosecution.