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Home , Cocaethylene, Fentanyl, Xylazine

2020 Annual2020 Annual ReportReport DDeeaatthhss rreellaatteedd ttoo ooppiioioiddss aanndd ootthheerr ddrruuggss CCaallhhoouunn

This report is in memory of those who lost their life or a loved one to substance use. These losses must motivate us all to prevent future deaths.

A few notes... Purpose: This data was collected by the Office of the Medical Examiner in the Department of Pathology at WMed. Unless otherwise noted, data is from 2020 and includes deaths where were the immediate cause of death. This report is meant to provide up to date statistics to those involved in efforts to reduce the number of -related deaths.

Sections with the following headings are approximations and frequencies may be higher than what is reported: Health Factors, Mental Health Factors, Social Factors, Children and Substance Use History. Sources: All data was extracted from a Medical Examiner database, law enforcement (LE) and EMS reports, death certificates, obituaries, Swift Toxicology of Overdose-Related Mortalities (STORM) results, medical records, toxicology reports, MDHHS reports, and autopsy reports.

Please email Chloe Bielby for additional information or to set up a time to discuss your county's report: [email protected] Office of the Medical Examiner Annual 2020 Report

Deaths Related to OCpalhiooiudns and Other Drugs All Drug-Related Deaths Injury Age Race Sex Death Certificate: Substances Contributing to Death Zip Code 18 W F Pt. I: , , , phentermine 49014 18 W M Pt. I: , , fentanyl 49068 26 W M Pt. I: Acetyl-fentanyl, amphetamine, fentanyl, xylazine 49015 26 W F Pt. I: Fentanyl, , , 48917 28 W M Pt. I: , alprazolam, , 49014 29 W M Pt. I: Fentanyl 49014 29 W F Pt. I: Methamphetamine, fentanyl, acetyl-fentanyl 49015 30 W F Pt. II: , , , fentanyl* 49015 31 W M Pt. I: Fentanyl, , 49015 32 W M Pt. I: Fentanyl, methamphetamine 49014 32 W M Pt. I: Fentanyl, methamphetamine, diphenhydramine 49037 33 W M Pt. I: Fentanyl 49017 33 B F Pt. I: Cocaine, ethanol, cocaethylene, methamphetamine, fentanyl, 49014 Pt. I: Acetyl-fentanyl, diphenhydramine, fentanyl, methamphetamine, 35 W F morphine, , xylazine 49015 35 W F Pt. II: Amphetamine, methamphetamine, fentanyl* 49015 35 W F Pt. I: Gabapentin, 49017 36 W F Pt. I: Methamphetamine 49015 37 W M Pt. I: Methamphetamine, fentanyl 49014 37 W M Pt. I: Fentanyl, heroin, methamphetamine 49015 38 W F Pt. I: Cocaine, , tramadol, fentanyl 49014 38 W M Pt. I: Fentanyl, diphenhydramine 49015 40 W M Pt. I: Fentanyl, acetyl-fentanyl 49014 42 W M Pt. I: Fentanyl, 49224 43 W F Pt. I: Cocaine, fentanyl, bupropion, gabapentin, 49014 43 W M Pt. I: Fentanyl, cocaine 49017 44 W M Pt. I: Heroin 49016 45 W M Pt. I: , fentanyl, 49017 45 B M Pt. I: Fentanyl, heroin 49014 Office of the Medical Examiner Annual 2020 Report

Deaths Related to OCpalhiooiudns and Other Drugs All Drug-Related Deaths (cont.)

45 W M Pt. I: Fentanyl, methamphetamine 49015 47 W F Pt. I: Alprazolam, gabapentin, promethazine, tramadol 49017 50 W M Pt. I: Ethanol, clonazepam, morphine, fentanyl 49014 52 W M Pt. I: Heroin, fentanyl, mitragynine, ethanol 49017 52 B F Pt. I: Cocaine Unknown 52 W M Pt. I: Methamphetamine, fentanyl, ethanol 49068 52 W M Pt. I: Methamphetamine, fentanyl 49014 54 W M Pt. I: Heroin, fentanyl, methamphetamine 49014 54 W M Pt. I: Fentanyl, clonazepam 49017 54 W M Pt. I: Morphine, amphetamine, fentanyl Unknown 55 B F Pt. I: Cocaine, , fentanyl 49037 56 W F Pt. I: Fentanyl, heroin, 49037 56 W M Pt. I: Fentanyl, , trazodone, promethazine 49068 57 W M Pt. I: Sertraline, tramadol, gabapentin, trazodone, diphenhydramine 49015 58 W M Pt. I: Fentanyl, acetyl-fentanyl, , quetiapine, 49015 59 W F Pt. I: Fentanyl, oxycodone 49201 60 W M Pt. I: Cocaine, fentanyl, heroin, methamphetamine 49015 60 B M Pt. I: Cocaine, ethanol, fentanyl 49017 61 W M Pt. I: Fentanyl, 49017 62 W M Pt. I: Fentanyl, heroin, ethanol 49017 63 B M Pt. I: Cocaine, fentanyl, ethanol 49037 63 B M Pt. I: Cocaine 49017 65 B M Pt. I: Fentanyl, morphine, hydrocodone 49017 69 W M Pt. I: Cocaine 49015 70 W M Pt. I: Cocaine 49015 75 B M Pt. I: Methamphetamine, ethanol 49017 * Case is not included in the following report Office of the Medical Examiner Annual 2020 Report

Deaths Related to OCpalhiooiudns and Other Drugs Total deaths due to drugs: 2018, 2019, 2020 2018 2019 2020 51 deaths 43 deaths 52 deaths

13 only 8 opioid only 8 opioid only 4 non-opioid only 8 non-opioid only 8 non-opioid only 34 opioid & non-opioid 27 opioid & non-opioid 36 opioid & non-opioid

3.8 3.2 3.9 deaths per 10,000 deaths per 10,000 deaths per 10,000

Number of nonfatal overdoses among ED 568 41.7 Nonfatal overdoses discharges, 2020 per 10,000

Number of all drug-related deaths by month and year

9

8 8 8

7.5 7

6 6 6 6 6 6 y

c 5 5 n

e 5 u

q 4 4 4 4 2018 e r

F 2019 3 3 3 3 3 3 2020 2.5 2 2 2 2 2

1

0 0 l t r r r r ry ry h ri y e ly s e e e e a a rc p a n u u u u a M u J g b b b b n r A J u m to m m a b M A te c e e J e p O v c F e o e S N D

Percent decrease Percent increase from 2018 to 2019 16% 21% from 2019 to 2020 Office of the Medical Examiner Annual 2020 Report

DDeeaatthhss RReellaatteedd ttooG rOOaCpnpdaii lhoTorioiadudvnsesr saaenndd OOtthheerr DDrruuggss Demographics Decedent's Employment status Race Unemployed 31

Employed 11

Retired 4

Disability 3

Unknown 3 White (83%) African American/Black (17%) 0 5 10 15 20 25 30 Frequency County of Residence by County of Death Sex 46

25 73%

5 1 0 Decedent has residency in county of death Decedent did not have residency in county of death 27% Decedent was experiencing homelessness or insecure housing at time of death

Decedent's Highest Level of Education Age 9th-12th grade, no diploma 9 Minimum Age High school graduate/GED 31 18 years Some college credit, no degree 9 Maximum Age Associates Degree 1 75 years Bachelors Degree 1

Masters Degree 1 Average Age

0 5 10 15 20 25 30 46 years Frequency Office of the Medical Examiner Annual 2020 Report

DDeeaatthhss RReellaatteedd ttooG rOOaCpnpdaii lhoTorioiadudvnsesr saaenndd OOtthheerr DDrruuggss Health Factors Most prevalent ailments*

Hypertension (31%) *Decedents may be represented in more than one category. Only illnesses with official diagnosis Chronic (21%) are included. **Lungs includes asthma, COPD, and emphysema Lungs** (17%) ***Heart includes MI, CABH, CAD, AFib, ACD, and heart failure Heart*** (12%)

At least 9 decedents were Hepatitis C positive 7 of these decedents were known to use substances intravenously

Body Mass Index (BMI) Decedent used Underweight 2 71%+ Normal weight 13

Decedent Overweight 12 drank 54%+ Obese class 1 16

Obese class 2 8 Decedent had Obese class 3 1 a PCP 50% 0 5 10 15 Frequency Office of the Medical Examiner Annual 2020 Report

DDeeaatthhss RReellaatteedd ttooG rOOaCpnpdaii lhoTorioiadudvnsesr saaenndd OOtthheerr DDrruuggss Mental Health Factors

Most Depression (40%) prevalent

mental illnesses* Bipolar (21%)

*Decedents may be represented in more than one category. Anxiety (15%) Only mental illnesses with official diagnosis are included. PTSD (12%)

Percentage of decedents...

19% 12% ...who have ever had ...with previous suicidal ideation suicide attempts

Number Diagnosed Mental Illnesses among decedents 21 20 s t

n 16 e d e

c 15 e d

g n o m

a 10

y 8 c n e u q

e 5 4 r

F 3

0 0 1 2 3 4 Number of diagnosed mental illnesses Office of the Medical Examiner Annual 2020 Report

DDeeaatthhss RReellaatteedd ttooG rOOaCpnpdaii lhoTorioiadudvnsesr saaenndd OOtthheerr DDrruuggss Social Factors

Decedent was experiencing Decedent was 12% 10% homelessness or insecure a veteran housing at time of death

27% Decedent has ever 64% Decedents ever been incarcerated <60 incarcerated were released DAYS in past 60 days

Children decedent had.... Number of Minor biological children

Adult 1 minor 8 children 35% only 2 minors 3 At least 29% one minor 3 minors 3 child Unknown No 1 36% children 0 2 4 6 8 Frequency of decedents Employment status of those with minor children 4 decedents 27% 7% lived with Employed Disability their minor Unemployed Unknown child(ren) at time of death 67% 0% Office of the Medical Examiner Annual 2020 Report

DDeeaatthhss RReellaatteedd ttooG rOOaCpnpdaii lhoTorioiadudvnsesr saaenndd OOtthheerr DDrruuggss Substance Use History

At least 92% of At least 44% of those decedents were known decedents used to use or abuse substances substances intravenously

At least 37% of At least 68% of those decedents have had at decedents have had least one two or more prior overdose prior overdoses

At least 50% of At least 21% of decedents were decedents substance prescribed an opioid use started from the in the past two years prescribed opioid

recovery history (n=48*) Decedent's substance of choice vs. what 40% Decedent has been to a was determined to cause death substance rehabilitation 22 clinic at least one time Cocaine 13

27 Decedent was currently Heroin 8% receiving or has received 9 a form of medication- 11 assisted treatment (MAT) Methamphetamine in the past two years 15

11 Other 40% Decedent was recently 65 substance free in the past three weeks Prescriptions 5 29 Suspected reasons for relapse** Other 1 18

0 20 40 60 53% 31% 16% Left jail/rehab Life stress*** Unknown Substance of Substance determined *ONLY decedents known to use substances are choice to cause death included. **These factors were mentioned by those close *Decedent may have had more than one substance of choice to decedent for why they may have and in their toxicology. begun to use substances again after a few NOTE: 2 decedents would use any substance available and 4 months to years of living substance free. were not known to use substances. ***Life stress includes death of a friend, Prescriptions does not include opioids. depression, traumatic motor vehicle accident, Other includes cocaethylene, diphenhydramine, ethanol, and job loss. hydroxyzine, ketamine, mitragynine, and xylazine. Office of the Medical Examiner Annual 2020 Report

Allegan, Barry, Berrien, CDalehoaunt, Ghrasnd R Traevelraset, Keadlam tazooo ,O LeCpealailhnoauoi, uMdnasso na, Mnudske gOont, hOsecerol aD, Str. uJosgepsh, and Van Buren County Administration naloxone administration status How many doses (2 mg) of naloxone were administered 7

14 5 4

38 2.5 2

1

0 1 dose 2 doses 5 doses Unknown Naloxone No Naloxone administered administered 2 decedents were given extensive resuscitative efforts (CPR, epinephrine, etc.) but were not given Naloxone.

Who Administered Naloxone?

Bystander 2

Bystander; EMS 1

Bystander; EMS; ED 1

EMS 7

Hospital 1

LE 2

0 1 2 3 4 5 6 7 Frequency Office of the Medical Examiner Annual 2020 Report

Allegan, Barry, Berrien, CDalehoaunt, Ghrasnd R Traevelraset, Keadlam tazooo ,O LeCpealailhnoauoi, uMdnasso na, Mnudske gOont, hOsecerol aD, Str. uJosgepsh, and Van Buren County Death Scene Findings

27% Use7d 5the% fatal 0% Were found substance(s) Were found by family alone by a minor

Syringes and suspected illicit 10% 27% drugs were the Had Narcan on Were given most common scene and/or Narcan paraphernalia found on scene were prescribed Narcan

69% Were dead 12% 63% Died at the upon EMS Died at their hospital arrival residence

Autopsy and Toxicology Results Number of substances Manner of DeatH contributing to death Accident 48 1 substance 15 8 2 substances Decedent Suicide 2 frequency 3 substances 5 4 substances 14 Indeterminate 2 10 5+ substances 0 20 40 Office of the Medical Examiner Annual 2020 Report

Allegan, Barry, Berrien, CDalehoaunt, Ghrasnd R Traevelraset, Keadlam tazooo ,O LeCpealailhnoauoi, uMdnasso na, Mnudske gOont, hOsecerol aD, Str. uJosgepsh, and Van Buren County Substance Breakdown substances contributing to death

Fentanyl 41

Non-opioid prescription 30

Opioid prescription 16

Methamphetamine 15

Cocaine 13

Ethanol 9

Heroin 9

Acetyl-fentanyl 5

Diphenhydramine 4

Mitragynine 2

Xylazine 2

Bupropion 1

Cocaethylene 1

Ketamine 1

0 5 10 15 20 25 30 35 40 Frequency of substance Please see following graphs on the next page for a list of opioid and non-opioid prescriptions.

Heroin & Fentanyl Xylazine & Fentanyl 9 decedents had heroin in their 2 decedents had xylazine in their toxicology toxicology 8 of these decedents also had Both of these decedents also had fentanyl in their toxicology fentanyl in their toxicology

Benzodiazepines & Opioids Methamphetamine & Opioids 6 decedents had a 13 decedents had methamphetamine and an opioid in their toxicology and opioid(s) in their toxicology 5 decedents were prescribed that 3 decedents had methamphetamine opioid and benzodiazepine and heroin in their toxicology Office of the Medical Examiner Annual 2020 Report

Allegan, Barry, Berrien, CDalehoaunt, Ghrasnd R Traevelraset, Keadlam tazooo ,O LeCpealailhnoauoi, uMdnasso na, Mnudske gOont, hOsecerol aD, Str. uJosgepsh, and Van Buren County Autopsy and Toxicology Results, cont. non-opioid Prescriptions present in toxicology

4 3 y c n e u

q 1 e r

F 2 2 2 3 3 2 2 2 1 1 1 1 1 1 1 1 1 1 0 e e n n e e e e e e e e m n n o m m ti n n n n n n n n la li i i a a n i i i zi i o li o o y m p p p e p p m a p d a d z t a o ze ze p za za r h ia ri tr a a ip t r a a a a e t t e r z r r e p i b r n t e e e a lp it h u n D a it la n u sp S r A p B lo O e m Q i T m m C G M h ro R A A P P

Decedent was prescribed drug Decedent was not prescribed drug

opioid Prescriptions present in toxicology

4

3

y 3 c n e u

q 2 4 e r F

1 2 2

1 1 1 1 1

0 Buprenorphine Codeine Dihydrocode… Hydrocodone Methadone Morphine Oxycodone Tramadol Decedent was prescribed drug Decedent was not prescribed drug

Note: Of the 41 decedents with fentanyl present in their toxicology, 2 were prescribed fentanyl