DOI: 10.3886/icpsr38295
title: Cuyahoga County, Ohio, Heroin and Crime Initiative: Informing the Investigation and Prosecution of Heroin-Related Overdose, 2012-2021
title: Archival Version

description: 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.
description: The purpose of this study was to evaluate the Heroin Involved Death Investigation (HIDI) protocol and other contributing factors in successfully investigating and prosecuting drug traffickers in and around Cuyahoga County, Ohio.
description: <b>Medical examiner decedent records (DS1). </b>Death certificates, toxicology reports, and elements of investigative files dated 2014 to 2019 were transferred from paper/electronic copies into a REDcap database. An MPH-level epidemiologist served as the primary coder, but over the course of the project, five master's and PhD level coders participated. In total, 3,261 cases were coded. <b>Northern District of Ohio (NDO) trafficking cases (DS2). </b> Indictments for violations in Title 21, Sections 841, 843 and 846 in the Eastern Division of the U.S. Attorney's Office (USAO)-NDO totaled 469 cases from 2015-2020. <b>Prosecution data (DS3). </b>Data on drug-related homicide cases were selected from public documents available online from the state and federal clerk of court websites (n=121). The identification of court cases for review were determined by USAO-NDO and the Office of the Cuyahoga County Prosecutor. Cases included 43 federal cases prosecuted by USAO-NDO within Cuyahoga County (n=12) and neighboring counties (n=31) for the period of 2012 through 2019. Federal cases were selected if the defendant was charged with the federal death penalty enhancement. Cases selected from state prosecutions in Cuyahoga County included all cases where the defendant was indicted for involuntary manslaughter either based on corrupting another with drugs or trafficking in drugs from the period of 2013 through 2018 (n=78). <b>Individual and focus group interviews. </b>Between April 2018 and September 2021, heroin involved death investigation (HIDI) protocol stakeholders were invited to participate in the focus groups or interviews to provide information on their part of the process and the value of the HIDI protocol as implemented in Cuyahoga County. All participants were invited to participate in person or over email. Between April 2018 and February 2020, all interviews (n=15) and focus groups (n=3) were conducted in-person, and 3 interviews were conducted via phone. The remaining interviews (March 2020 to September 2021) were conducted via phone.
description: <b>Medical examiner records (DS1):</b> Items coded from death certificates include cause of death (including "due to"), manner of death, other conditions, and drugs present. Items coded from investigation files include drug paraphernalia present at the scene, prescriptions on scene, drug use history, health history, treatment history, law enforcement/legal contact, and if naloxone/Narcan was administered. Decedent demographic items include death date (month/year), race, ethnicity, gender, age at time of death, education level, veteran status, and marital status. <b>Drug trafficking indictment case records (DS2):</b> Items include year of case filing, county/region in which the defendant was tried, and U.S. code(s) violated. <b>Drug-induced homicide cases (DS3):</b> Demographics for defendant and related decedent(s) include age, race, ethnicity, and gender. Charges indicted, date of indictment (month/year), counts in the indictment, motions filed, case result (e.g., pled out, trial, dismissed, withdrawn), and types of documents reviewed. <b>Individual interviews and focus groups:</b> Questions were grouped thematically around participant experiences in investigations that used the HIDI protocol; inter-agency collaboration; data sharing, collection, and analysis processes; facilitators and challenges to using the HIDI protocol; and the impact of opioid overdoses on day-to-day work.
description: Not applicable.
description: Response Rates: Not applicable.
description: Presence of Common Scales: Not applicable.
description: <b>Medical examiner's office data (DS1):</b> All deaths with a drug in the cause of death between 2014 and 2019 were included in the sample. <b>Review of prosecution data (DS2, DS3):</b> All trafficking cases (21:841, 843 and 846 violations) were provided with indicted violations. Cases identified as drug-induced homicide cases by the Cuyahoga County prosecutor's office and the US Attorney's Office of the Northern District of Ohio were reviewed. <b>Qualitative data:</b> The researchers initially identified a convenience sample of 25 eligible participants before using snowball sampling to identify similar participants. Fifty-four stakeholders were interviewed individually or as part of a focus group.
description: Datasets: DS0: Study-Level Files DS1: Cuyahoga County Medical Examiner's Office Data DS2: U.S. Attorney's Office, Northern District of Ohio Indictment Data DS3: Drug-Induced Homicide Case Data, Federal and State Courts
description: Fatal overdose victims in Cuyahoga County from 2014-2019 Court cases/indictments that involved drug trafficking or drug-related homicide Professionals working in Cuyahoga County on the heroin-opioid crisis, including first responders, death scene investigators and medical examiner, police detectives, parent advocates, county and federal prosecutors, and data analysts. Smallest Geographic Unit: ZIP code
description: record abstracts; face-to-face interviewPlease refer to Appendix C in the final NACJD project report (see Data-related Publications) for medical examiner record coding instructions and Appendix F for the qualitative interview guide.