At least 42 people died from heroin and fentanyl overdoses in Cuyahoga County last month.
According to Cuyahoga County Medical Examiner Dr. Thomas Gilson, all 42 died from heroin, fentanyl or a combination of both.
Twenty of the people who overdosed were Cleveland residents.
This number brings the total overdoses in the county for the year to 446.
Currently 16 cases from October are pending further toxicology testing so the total could increase. Since Nov. 1, there have been 16 fatal overdoses.