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We studied the 2016 fentanyl and heroin overdose deaths and compared them to previously studied heroin\u2010associated fatalities from 2012 over a wide range of demographic and investigative variables, including overdose scene findings, toxicology results, and prescription drug history. We observed a significant increase in fentanyl\u2010related deaths (<jats:italic>n<\/jats:italic>\u00a0=\u00a0421, 2016) versus heroin deaths (<jats:italic>n<\/jats:italic>\u00a0=\u00a0160, 2012) but the baseline demographics between both cohorts remained similar. Victims were predominantly of ages 35\u201364\u00a0years (60%\u201364%), White (83%\u201385%), and male (73%\u201376%). 2016 fentanyl decedents were more likely to have naloxone administered upon overdose, and the majority still had a positive prescription history for a controlled substance. Toxicology data showed a decrease in mean morphine and 6\u2010monoacetylmorphine concentrations when cointoxication with fentanyl occurred. Our study emphasizes the medical examiner's role as a public health data source and bridge between different stakeholders combating the opioid epidemic.<\/jats:p>","DOI":"10.1111\/1556-4029.14665","type":"journal-article","created":{"date-parts":[[2021,1,4]],"date-time":"2021-01-04T19:09:22Z","timestamp":1609787362000},"page":"926-933","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["The fentanyl phase of the opioid epidemic in Cuyahoga County, Ohio, United States"],"prefix":"10.1111","volume":"66","author":[{"given":"Vaishali S.","family":"Deo","sequence":"first","affiliation":[{"name":"Department of Population and Quantitative Health Sciences Case Western Reserve University Cleveland OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas P.","family":"Gilson","sequence":"additional","affiliation":[{"name":"Chief Medical Examiner and Executive Director of Regional Forensic Science Laboratory Cuyahoga County OH USA"},{"name":"Cuyahoga County Medical Examiner\u2019s Office Cleveland OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claire","family":"Kaspar","sequence":"additional","affiliation":[{"name":"Cuyahoga County Medical Examiner\u2019s Office Cleveland OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mendel E.","family":"Singer","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences Case Western Reserve University Cleveland OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,1,4]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"MuhuriP GfroererJ DaviesC.Associations of non\u2010medical pain reliever use and initiation of heroin in the United States. 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