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Cuyahoga County Overdose Fatality Review Counteractive Initiative

Award Information

Award #
Funding Category
Competitive Discretionary
Awardee County
Congressional District
Funding First Awarded
Total funding (to date)

Description of original award (Fiscal Year 2023, $1,600,000)

The Cuyahoga County Medical Examiner’s Office (CCMEO) proposes to
implement the Cuyahoga County Overdose Fatality Review Counteractive Initiative
(CCOFRCI). The purpose of this effort is to enhance Cuyahoga County’s Overdose Fatality
Review (OFR) to promote cross-system coordination within the criminal justice and behavioral
health systems for the identification and implementation of preventable risk factors and missed
opportunities for intervention in order to reduce overdose deaths in Cuyahoga County,
particularly for those historically marginalized, underserved, and adversely affected by inequality
in Cuyahoga County, Ohio (metropolitan Cleveland). The OFR is a 20+ member,
multidisciplinary body established in 2013 that shares identified cross-agency data to conduct
intensive case reviews of exemplar overdose deaths, to identify systems gaps, and create
recommendations, all with the purpose of learning from fatal overdose deaths and working
towards decreasing deaths. This process and access to cross-agency information is uniquely
distinctive to OFRs. The OFR is under the purview of the CCMEO and co-led by The Cuyahoga
County Board of Health. Project activities include enhancing the OFR, with the addition of desk
reviews and increasing the number of reviews from 18 to 54. Subrecipient activities include (1)
54 Next-of-Kin interviews conducted by the Alcohol, Drug Addiction and Mental Health
Services Board; (2) The University of Kentucky Institute for Pharmaceutical Outcomes and
Policy will pilot and develop a Natural Language Processing (NLP) plug-in for the COSSAP
OFR Data System (COSSAP – DS) for use by all OFRs who utilize this data system; and (3) The
Case Western Reserve University (CWRU) Begun Center for Violence Prevention Research and
Education will conduct survey and focus group/interviews with OFR stakeholders to evaluate the
utility of OFR recommendations and apply risk terrain modeling to findings from the OFR to
inform a county-wide educational outreach program in Year Three. Expected outcomes include:
(1) increasing the pool of OFR cases to substantiate findings from previous reviews; (2)
oversampling of populations of interest to understand variability of characteristics not captured
due to the limited sample (Priority 1A); (3) implementation of a county-wide community
outreach education campaign to share emerging overdose trends and promote public health
strategies to reduce overdoses; and (4) create a resource guide that describes the OFR model of
Cuyahoga County and its application of the COSSAP – DS that can benefit and assist other

Date Created: September 25, 2023