Ohio continues to be among the U.S. states with the highest number of overdose fatalities, and this trend can be framed in waves. The initial wave of deaths associated with prescription opioid pain relievers (OPR) appeared prior to 2010 and then began to plateau. Soon after, a second wave began, characterized by a rise in heroin fatalities. This likely reflected interdiction efforts to address overprescribing and diversion of OPR.2 Wave three began in 2014, with an increase in illicitly manufactured fentanyl (IMF), often present in mixtures with heroin and cocaine. Overdose deaths rose dramatically, as fentanyl is a substantially stronger drug (50–100 times more potent that morphine). In 2016, the first overdose deaths due to carfentanil (CF) were observed in northeast Ohio; this powerful fentanyl analogue was historically used as an elephant tranquilizer and is 10,000 times more potent than morphine. Through 2017, CF and many other fentanyl analogues appeared in the illicit drug market. These drugs are attractive because of their high-profit margin as a result of their increased potency and the fact that they can be synthesized in a laboratory (unlike heroin which is derived from the poppy plant and, thus, dependent on growing seasons and other environmental factors). A significant concern is the recent reappearance of CF-related overdose deaths in Cuyahoga County, Ohio (metropolitan Cleveland). This may represent a new fourth wave of synthetic opioid-related deaths.
The purpose of this research was twofold: (1) to describe and document the changing nature of overdose fatalities, and (2) to examine how the increase in CF overdose fatalities affects law enforcement investigations and, ultimately, prosecutions of major drug traffickers.
