Cuyahoga County, Ohio, Heroin and Crime Initiative: Informing the Investigation and Prosecution of Heroin-Related Overdose, 2012-2021

In 2013, the Cuyahoga County (Ohio) Medical Examiner's Office (CCMEO) and the Regional Forensic Science Laboratory developed the Heroin Involved Death Investigation (HIDI) alert system and protocol in response to a substantial increase in opioid-related overdose fatalities. The HIDI protocol is designed to support a safe, coordinated, and rapid response to an active, suspected opioid-overdose death scene, or suspected opioid-overdose deaths occurring at hospitals that are not considered active scenes, by alerting investigators to potential dangers and facilitating the timely protection of scene integrity and evidence collection in order to successfully investigate and prosecute drug traffickers. The primary goals of the project were to: Complete extended coding of local medical examiner decedent data--investigative reports and toxicology to identify demographic or geographic trends or patterns of overdose deaths, as well as paraphernalia and evidence present at death scenes that may be useful to prosecutions; Examine the efficiency of how cases flow through the investigative and prosecutorial stages and how these could be improved; Identify key variables that may contribute to the successful indictment of traffickers connected to fatal and non-fatal overdose cases; and Evaluate the implementation and perceived effectiveness of the Cuyahoga County HIDI protocol. This multi-method project involved three phases of data collection and analysis. First, a forensic epidemiologist coded and analyzed existing CCMEO records for decedent toxicology and death scene characteristics, focusing on drug-related fatalities. Second, county and federal cases prosecuted for drug trafficking, especially those linked to deaths, were systematically reviewed to determine what evidence was deemed important for successful indictment. Third, interviews and focus groups were conducted with key stakeholders from local and federal law enforcement, intelligence analysts, public health officials, and local and federal prosecutors to learn about the HIDI protocol. Data and documentation for interviews and focus groups will be made available in a future update.