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Overdose deaths surged in Connecticut during pandemic

Even as the COVID-19 pandemic recedes, continued disruptions to recovery programs and a deadly, fentanyl-laced drug supply continue to drive increasing opioid overdose deaths in Connecticut, medical experts and harm reduction advocates say.

In 2020, opioid overdose deaths in Connecticut increased by 14.6% over the previous year — and have largely continued to rise in the first half of this year, according to data from the state Department of Public Health.

“Is it going to get worse? Yes,” said Mark Jenkins, director of the Greater Hartford Harm Reduction Coalition, which distributes the opioid overdose-reversing drug naloxone, and offers education, syringe exchanges and other resources.

Advocates and experts say it’s clear what’s driving the increase in overdoses: fentanyl, a synthetic opioid 80 to 100 times stronger than morphine, pervades the drug supply in Connecticut, and — unbeknownst to buyers and consumers — is often combined with other drugs. Less than a decade ago, fentanyl appeared in a small fraction of opioid deaths. Last year, the average percentage of fentanyl-involved overdose deaths was 85%.

“The reason we’re going to see more fatalities is because fentanyl is not going anywhere,” Jenkins said.

Recovery disrupted

Last year, Peter Canning, a paramedic who also serves as the EMS Coordinator at UConn Health, responded to a “lot more fatals” and reviewed a “continually heartbreaking” stream of overdose reports from the Statewide Opioid Reporting Directive, a program that tracks opioid overdoses in the state.

“COVID increased people’s isolation, so we had more people using alone — and we had more deaths,” he said.

In January of this year, there were 131 overdose deaths in the state, compared to 106 in January 2020 and 80 in January 2019. The number of overdose deaths in February and March was also higher this year than in the previous two years, and while there was a dip in April, advocates say that they do not expect the fatal overdose trend to drop significantly. (Data from 2021 is not final and subject to change, according to the state Department of Public Health.)

From March to May 2021, the statewide three-month rolling average rate of emergency department visits for suspected drug overdoses rose from 28.13 to 29.76, out of 100,000 people. In New Haven County alone, that rate increased from 35.68 to 38.61.

Another contributor to the increase in overdose deaths, providers and advocates say, was that last year, some recovery programs stopped offering treatment or in-person support groups, which many residents rely on.

“Disrupting the recovery community led to more relapse, more use, more overdoses,” said Dr. J. Craig Allen, the medical director at Rushford, a Hartford HealthCare center in Meriden dedicated to substance use prevention and treatment.

Some programs switched over to telehealth, but for many people in recovery, it is harder to provide care from afar, he said, and some patients did not have the technology they needed for virtual appointments.

“Until someone is fairly stable, it’s really important to be seeing them in person, face to face,” he said.

While in-person care is beginning to return at Rushford, there are still limitations, including a 3-foot spacing restriction for group sessions. And the center has also struggled with a more significant problem, Allen said, which is replicated in hospitals across the state and country: inadequate staffing levels.

“With the lessening of COVID, we are having a huge challenge in the workforce, being able to get frontline clinicians, being able to get enough nurses for our withdrawal management detox program, for our residential treatment program, being able to get clinicians to see our patients,” he said.

Mark Jenkins, of the Greater Hartford Harm Reduction Coalition, often reminds people that “the opposite of addiction is connection.” But he’s worried that those crucial in-person programs that unite people in recovery are not returning quickly enough.

“Many hospitals, churches, that at one time opened their doors to 12-step groups, they still haven’t come back in the numbers that we had prior to COVID,” he said.

A ‘volatile and dangerous’ drug market

Even if recovery programs do begin to return, advocates and experts warn that fatal overdoses will likely continue to rise in the state due to the pervasion of fentanyl in the drug supply.

In 2012, fentanyl appeared in just 4% of “accidental intoxication” deaths in Connecticut. By 2015, it showed up in more than half of such deaths. Last year, it was found in the vast majority of all fatal overdoses, according to data from the Office of the Chief Medical Examiner.

“It’s not that more people are using, it’s that the drug supply is far more dangerous,” Canning said.

Robert Lawlor, Jr., drug intelligence officer for Connecticut with the New England High Intensity Drug Trafficking Areas, said that for drug trafficking organizations, it’s far more profitable to manufacture fentanyl than it is to grow opium poppies to produce heroin.

“It’s just all about profit,” he said.

In Connecticut, fentanyl not only appears mixed into the heroin supply, but also shows up in cocaine and is pressed into pills made to resemble prescription medications. Increasingly, xylazine, an animal tranquilizer, has appeared in the toxicology reports of fentanyl-involved overdose deaths. Xylazine is “extremely dangerous” because it slows down the respiratory system and is resistant to naloxone, Lawlor said.

In 2019, the combination of fentanyl and xylazine was linked to 71 overdose deaths. Last year, that number rose to 141 deaths. So far this year, there have been 80.

Lawlor cautioned against blaming clusters of overdoses on a “bad batch” or on a new strain of drugs.

“We have to get away from that and understand that the drug market is so volatile and dangerous that every single dosage could potentially be a deadly dosage,” he said.

He advised those with substance use disorders to follow harm reduction guidelines: “If you’re going to use, you need to not use by yourself, have naloxone on hand and use slowly.”

Lessons from the pandemic

As the pandemic abates in Connecticut, many advocates hope to see the state tackle the opioid crisis with the same commitment it brought to combating COVID-19.

“The response that we had to COVID should serve as a model for our response to opioids,” Canning said, noting the Department of Public Health’s comprehensive, frequently-updated data tracking methods, which in turn informed public health interventions.

Many advocates say that overdose deaths won’t slow without a significant expansion of treatment programs, including those that offer medication-assisted treatment (MAT) like methadone. Others want to see the creation of supervised injection sites, where those with substance use disorders can consume drugs in a safe, clean space where staff can administer naloxone in the case of an overdose.

Connecticut is also on the receiving end of a massive influx in federal relief funds, billions of which are earmarked for mental health and substance use disorder efforts. Advocates and physicians say that the money is most needed for community-based programs that support overdose prevention and addiction recovery efforts.

At Rushford, Allen wants to see an expanded program where the center could send nurses out into the field, bringing treatment directly to people who want it. For instance, a team could help a patient go through withdrawal management without leaving their house.

“That would greatly expand our ability to reach citizens, whereas the current model is, ‘Everyone has to come to us.’ I think that COVID exposed that to the Nth degree, because people were afraid to go to [the] center,” he said.

On the ground in Hartford, Jenkins has committed his life’s work to saving lives, person by person. In addition to distributing naloxone, his 25-person team began handing out fresh food in the early days of the pandemic and still delivers more than 500 sandwiches per week to people in need.

“You can’t just give someone a phone number,” he said. “You have to be able to show compassion and commit someone to a resource that has value to them.”




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