Lessons from the Field: Cuyahoga County, Ohio Overdose Fatality Review
- Melissa Heinen
- Oct 28, 2025
- 3 min read
Updated: Oct 31, 2025
This September, I had the privilege of attending the annual Cuyahoga County Overdose Fatality Review (OFR) Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP) planning meeting.
Discovering Cleveland
On a golden September afternoon, I landed in Cleveland, Ohio overlooking the shimmering waters of Lake Erie. On my ride on the rail to my hotel, I was struck by all the bridges. (Note: I google searched “Number of bridges in Cleveland” and found out there are more than 330 bridges in the immediate Cleveland area!)
Since this was the first time I had been in Cleveland, I made the most of my visit. I walked everywhere and was able to take in the impressive Case Western University campus, Cleveland Hospital, Little Italy (with great pasta, gelato, and pastries!), historic Lake View Cemetery (where John D Rockefeller and several other famous persons are laid to rest), and walk in the evenings past Cleveland Clinic, Museum of Art, Botanical Garden, and many more grand sites.
After soaking in Cleveland’s history and charm, I was ready to dive into the work that brought me here.
Inside the Cuyahoga County Medical Examiner’s Office
We began our day with a tour of the medicolegal death investigation training lab, complete with mock death scenes that challenge us to interpret causes of death, including the all-too-common overdose scenario.
With an overdose rate nearly 50% higher than the national average (41.3 per 100,000 versus 27.1 per 100,000 for years 2020-2024) Cuyahoga County has invested deeply in data-driven prevention. The Cuyahoga County Medical Examiner's Office (CCMEO) co-leads the county OFR with Cuyahoga County Board of Health (CCBH) and has an in-house toxicology laboratory, forensic epidemiologists, and data dashboards:
Leadership in OFR
Cuyahoga County has a rich history of implementing overdose fatality review (OFR). They were one of the original Bureau of Justice Assistant OFR Mentor Sites and pilot sites for Version 1.0 of the OFR Data System.
Cuyahoga’s OFR is COSSUP funded. They work closely with their county health department and Alcohol, Drug Addiction, and Mental Health Services (ADAMHS); their evaluator; The Begun Center for Violence Prevention Research and Education at Case Western Reserve University; and many partner organizations.
Lessons from the Field: Annual Reflection in Action
Annually, the Cuyahoga County OFR hosts a meeting with program partners and community stakeholders to review grant deliverables, highlight activities accomplished, present data findings (for example, in-depth detailed cohort analyses), and plan next year’s grant activities.
The meeting was a great example of OFR sharing findings and informing community partners and community partners interpreting findings and informing the OFR. All participants contributed and learned from each other. There were difficult and respectful conversations. Different perspectives shared. Business cards were swapped.
Several recommendations came from the meeting. Some suggested next steps in already implemented recommendations. Some highlighted partners to engage, possible interpretations of data presented, and prevention messages to consider.
The meeting revealed that the OFR’s ripple effects extend far beyond what early summaries captured.
Because of this meeting there will be better data, better understanding, better partnership, and most importantly, better prevention!
Key Takeaways for Other Fatality Reviews
I encourage OFRs to:
Share data and findings beyond your core team
Convene partners and invite feedback
Collaborate with an external evaluator
Engage continuously – many want to help, they just need good data
Reflect annually – Allow time to process, plan, and celebrate! Cuyahoga met for two days – not two hours! This allowed for time to share, discuss, process, reflect, and plan!
Cuyahoga County OFR Contact
Manreet K. Bhullar, MPH (she/her) Senior Forensic Epidemiologist Cuyahoga County Medical Examiner’s Office phone: 216-721-5610 ext. 6233
Manreet was named to De Beaumont Foundation's Class of 40 under 40 Class of 2025 in Public Health. Learn more here.