Insight from the Field: Rising Overdose Deaths in Cuyahoga County

We are on track to suffer a record number of overdose deaths in 2023. A projected 770 neighbors, friends, and family members will lose their lives to an overdose in Cuyahoga County this year. This is up from the previous record of over 720 overdose deaths in 2017.

We are on track to suffer a record number of overdose deaths in 2023.

One clear reason for the dramatic increase in overdose deaths is the proliferation of Fentanyl (a synthetic opioid roughly fifty to one hundred times more potent than heroin) in all kinds of street drugs, including heroin, cocaine, methamphetamine, marijuana, and fake pills pressed to look like commonly abused prescriptions.

Fentanyl was involved in four out of five overdose deaths in Ohio in 2020, typically in combination with other drugs. As the presence of fentanyl has increased so have rates of death by overdose of Black people. Overdose deaths of Black people have recently and dramatically begun to outpace deaths of white people in Ohio. Trends that were observed in Summit County and Cuyahoga County alike and explored by Director of Public Policy Tara Britton in her August 2022 blog.

Prior to my work with Community Solutions, I spent six years working in the research department of a large community corrections non-profit that specialized in substance use disorder treatment, providing services across Ohio. While in this line of work I had the opportunity to learn from countless professionals, partners, and clients. These folks are a wealth of knowledge, and when I read about the recent horrifying overdose numbers in Cuyahoga County, I immediately wanted to tap into their insights.

Three professionals at recovery focused agencies within the region were gracious enough to give me some time this month to offer their expertise.


Reba McCray
Executive Director
ARC Recovery Services

Allyse Hawkins
Clinical Director
Oriana House, Inc.

Erin Kray
Associate Director of Housing and Shelter
Lutheran Metropolitan Ministry

All conversations were transcribed, and the following passages have been paraphrased, being slightly edited for clarity and conciseness.

1. How have the increases in overdose deaths been felt in your work?

 Reba McCray

  • It makes the work much more critical, much more like a dire need. We can’t be taking our time trying to get somebody
  • We have to be really precise with our work and our judgements, because just one use can be fatal. There’s always going to be errors, but it just feels heavier right now.

Erin Kray

  • We haven’t noticed a particular increase in overdoses. Of course, people do overdose at the shelter, but we always have staff on site. If someone is found unresponsive, they always get Narcan. It’s not like when you’re alone in your home. The shelter is actually a much safer place to be.

Allyse Hawkins

  • We’ve noticed that, when working with folks who have recently overdosed, they are surprised to discover they overdosed on fentanyl. It turns out there was fentanyl in their cocaine, or methamphetamine, or even their weed!
  • On a positive note, in response to the rise in overdoses, we’ve seen a greater acceptance of medication assisted treatments, specifically like buprenorphine. Not so long ago we’d have partner agencies or recovery houses that wouldn’t work with individuals using MATs.

2. How has this crisis intersected with other important issues?

 Reba McCray

  • Almost all of the people we work with are struggling with housing. Very few people come to us with stable housing. And trying to help them find employment that can cover the rising costs of housing, it almost seems impossible without some kind of help.
  • There is a strong intersection between addiction and mental health issues, specifically trauma. We’re working with individuals who’ve lost their best friends, their mom, their kids… you have to address it.
  • The highest overdose rates right now are young African American men, and we need to continue to do all we can to reach that population and offer them hope and support.

There is a strong intersection between addiction and mental health issues, specifically trauma.

Allyse Hawkins 

  • Unfortunately, substance use is largely criminalized, which puts so many stressors on our systems. It costs a lot of money and resources to incarcerate someone in jail or prison, often after they’ve overdosed. And at that point often the police, EMS, children’s services, and the criminal justice system are all involved. A more treatment centered approach to substance use, an approach that prioritized helping a person get well, would alleviate so many of those stressors in the long term.
  • We don’t know for sure if African Americans are actively seeking out fentanyl more frequently, or if fentanyl is just more frequently being found in the substances they’re using. But the overdose numbers have definitely shifted, and African Americans are overdosing at higher rates. And while some people are starting to say the right words, I don’t think we’ve shifted enough focus yet onto addressing this issue.

3. What should elected officials, policymakers, and local leaders know about this crisis?

 Erin Kray

  • I know this feels radical, but safe use spaces. If people are worried about going to jail for holding and using, they’re going to use as quietly and as isolated from others as possible, which is so dangerous because when you’re alone, there’s no one around to revive you.
  • Decriminalize drugs as much as possible. Victims of addiction need help, just like how someone should go to the doctor if they’re suffering from depression. If we want to help people, it needs to be destigmatized, and that’s impossible if it’s criminalized. It will always be stigmatized if it’s illegal.
  • I think medication assisted treatment should be available over the counter. You shouldn’t have to go to a doctor before having access to MAT.

Allyse Hawkins 

  • Thankfully there’s a good deal of money allocated towards behavioral health in Ohio. But I think where the challenges frequently come in is that the dollars come with stipulations that aren’t necessarily evidence based related to behavioral health. They give the sort of stipulations that help them maybe feel comfortable, like, ‘we’ll give you the money, but we’re not quite sold that these criminals aren’t actually criminals. So, we still want you to have these rules.’ And so, it does create some challenges in implementation. So I guess I say all that to say to policy writers and leaders, that when you’re doing these things, have behavioral health experts and evidence-based information like from SAMSA, or OMHAS, incorporated into rules, laws and dollars.

To incarcerate somebody can cost up to $48,000 a year, but recovery housing can cost only $8,000 a year.

Reba McCray

  • To incarcerate somebody can cost up to $48,000 a year, but recovery housing can cost only $8,000 a year. We need funding for recovery housing, either after incarceration or after treatment. It’s way more profitable for the county and the state, a win-win as far as tax dollars go. They need to add recovery housing into the budget. Otherwise, we’re going to just continue to see people with addiction put back in jail or prison, and continue with the stigma, the criminalization of addiction. Without housing, it’s just making everything worse and not better.
  • There needs to be more quality recovery housing, and there should be a certification standard that meets best practices.
  • I want people to know that people do I think there’s even a stigma with what we actually look like as people with substance use disorders or alcoholism. And then I’d want them to know what we are capable of doing after we get into recovery.


In the early days of the opioid crisis the issue received more attention and resources than previous substance use crises; a change that happened because the face of addiction had changed from Black people in cities (crack epidemic), to white people in the suburbs (opiate epidemic). Traditionally our systems have been less comfortable criminalizing white substance users and more comfortable criminalizing Black and Brown users. And these overtly racist behaviors around white versus Black substance users persist when it comes to harm reduction tactics as well, something that is untenable as the opioid crisis continues to shift to a fentanyl crisis, and the population impacted shifts to have more deadly outcomes for Black non-Hispanic males. It is important for policy makers to keep the following three points in mind:

  • The criminalization of substance use disorders has disastrous effects for individuals in need of treatment. It overburdens our systems and stigmatizes the very people in need of help.
  • Stigma is still hard to overcome when it comes to seeking help with addiction. This fear of seeking help is dangerous and leads to more overdoses.
  • There needs to be more funding opportunities for evidence based and treatment centered approaches to care, written with the consideration of treatment professionals.

For the time being, see the ADAMHS Board’s information on free fentanyl test strips, free Narcan and other local harm reduction efforts.