Ohio study reveals high risk of overdose deaths among those using drugs when they're alone

In Cuyahoga County, the stark reality of the opioid crisis is that most drug overdose victims die alone, with no one nearby to help. A recent study, done in partnership with Case Western Reserve University and Cuyahoga County, highlights the critical need for "targeted harm-reduction strategies" in Northeast Ohio, where the opioid epidemic continues to claim lives at nearly twice the national average. The paper is published in the journal Substance Use & Misuse.

Those strategies include the distribution of Naloxone (an opioid antagonist that can reverse the effects of an overdose), and increasing the availability of medication-assisted treatment options and fentanyl test strips.

The research, using data from the Cuyahoga County Medical Examiner's Office, examined overdose deaths between 2016 and 2020, focusing on people using drugs when they were alone.

The study revealed that a staggering 75% of overdose victims were using drugs alone, a behavior strongly associated with increased mortality. Key findings indicate that individuals using drugs alone were more likely to be at home and less likely to receive life-saving interventions like naloxone, said Daniel Flannery, the Dr. Semi J. and Ruth Begun Professor and director of the Begun Center for Violence Prevention Research and Education at CWRU's Jack, Joseph and Morton Mandel School of Applied Social Sciences.

"Being informed is crucial—knowledge equips you to take action," Flannery said. "It's about reviving someone in need, and if that's not possible, contacting emergency services immediately. The chances of a fatal outcome significantly increase when there's no one around to help."

New policies and community efforts must prioritize reaching individuals at risk of using alone to curb the devastating impact of the opioid crisis, said Vaishali Deo, research associate at the Begun Center and co-principal investigator in the research.

"Our findings underscore the urgent need for innovative harm-reduction strategies aimed at those most vulnerable—those using drugs alone," Deo said. "Interventions must focus on reducing isolation and improving access to emergency medical care to prevent further loss of life."

Additional insights include:

• In Cuyahoga County, from 2016 through 2020, there were 2,944 unintentional overdose deaths for those over 18 years old. That's 54 deaths per 100,000 residents. The national average is 28 overdose deaths per 100,000 residents.
• The study further details the demographics and circumstances surrounding overdose deaths in Cuyahoga County from 2016 to 2020. Most were non-Hispanic (94.9%), white (72.2%) and male (71.3%), with a significant portion 35 to 64 years old. Most lived in the City of Cleveland. Over half attained at least a high school diploma.
• Toxicology reports revealed that synthetic opioids, specifically illicitly manufactured fentanyl, was present in 72.7% of the deaths. Cocaine and heroin were also significant contributors, found in 41.6% and 29.6% of cases, respectively. Nearly 80% of overdose deaths involved the use of multiple substances.
• Despite the presence of bystanders in more than half the cases, most victims (74.9%) were using drugs alone at the time of their fatal overdose, mainly at home. Emergency medical services responded to most of the incidents, yet over 60% of victims were pronounced dead at the scene—highlighting the critical timing needed for interventions like naloxone, which was administered in just 28.6% of the cases.

Deo and Flannery were joined in the research by Sarah Fulton, a research associate at the Begun Center, and Manreet K. Bhullar, a senior forensic epidemiologist at the Cuyahoga County Medical Examiner's Office, and Thomas P. Gilson, chief medical examiner of Cuyahoga County.

"These findings paint a stark picture of the opioid crisis in our community," Gilson said. "The tragic reality is that too many people are dying alone, and we must act swiftly to implement lifesaving measures that can prevent these unnecessary deaths."