Cuyahoga County medical examiner reports declines in homicides and overdoses, flags suicides and gun-access concerns

CLEVELAND — The Cuyahoga County medical examiner briefed the county's Public Safety and Justice Affairs Committee on April 15, saying overall homicide and drug-overdose totals have fallen from recent peaks even as suicide-by-firearm and questions about gun access pose continuing concerns.

The medical examiner, in a roughly hourlong presentation to the committee, said the county saw a four-year run above 200 homicides from 2020 through 2023 but reported that 2024's total was ‘‘a 181'' and that preliminary first-quarter figures show a decline early in 2025 (36 through Q1 2025 compared with 46 in the same period in 2024). ‘‘I think this number, a 181, is pretty close to what we'll finish the year out, and we're not anywhere near 200,’' he said.

On drug deaths, the medical examiner told the committee that certified 2024 overdose deaths dropped below 500 for the first time in nearly a decade and that fentanyl-related deaths and seizures have fallen dramatically. ‘‘Fentanyl has just fallen dramatically. We're seeing less fentanyl seizures, we're seeing less fentanyl overdoses, period,’' he said, while cautioning that multiple factors — from prescribing changes and litigation to possible shifts in supply from drug cartels — may be at work.

The medical examiner also described results from the office's child fatality reviews and toxicology findings: of teenage traumatic deaths examined before marijuana legalization, roughly one-quarter to one-third tested positive for cannabinoids. He noted the office has a staff epidemiologist, Manreet Bohler, and a second epidemiologist funded through a Department of Health partnership to support more detailed, longitudinal analysis.

Suicide and firearms were a central concern. The medical examiner said about half to 60 percent of suicides involve a firearm and that while older white men historically accounted for most firearm suicides, the gap has narrowed among younger, nonwhite people. He recommended investigation into whether guns used in those deaths were owned by the decedent or entered communities through other means, saying that different prevention strategies follow from different ownership patterns. ‘‘Our prevention strategy for that individual isn't ... some[thing] to get guns off the street. It's to treat the individual's underlying mental health illness,’' he said, adding that where guns are circulating in the community, interdiction strategies become relevant.

On in-custody deaths, the medical examiner said he has discussed convening law enforcement and medical partners to review natural, suicide and overdose deaths in jail settings, citing a recent case of an inmate who collapsed while playing basketball as an example for deeper review.

Committee members asked about technical and forensic procedures. The medical examiner explained that local departments test-fire seized guns and submit shell casings to the county lab for NIBIN entry and that the county lab conducts ballistics comparisons. He said suicide firearms are sometimes brought into the medical examiner's office and may be destroyed after testing, but ownership records generally require police access.

The committee accepted the April 1 meeting minutes by voice vote at the close of the session; Speaker 1 moved to approve and Speaker 4 seconded, with both recorded as voting "Aye." The meeting included no substantive formal actions beyond the minutes vote and focused on information gathering and next steps for interagency review.

What's next: the medical examiner urged continued collaboration with police, public health partners and jail medical staff to trace ownership patterns, monitor changing drug trends and study in-custody deaths; he flagged upcoming follow-up work on potential post-legalization effects of cannabinoids and further forensic analysis of guns used in suicides.