On Saturday, an uptick in drug overdoses in Hartford raised alarm bells for state health officials, who have been tracking opioid overdoses in the region since April.
But first responders in Hartford and its suburbs weren’t the only ones calling the Connecticut Department of Health. June 1 marked the first day of a new program to track opioid overdoses statewide, requiring all ambulance companies throughout Connecticut to call the Poison Control Center in Farmington every time they catch a case.
“That’s when the floodgates opened,” said Ralf Coler, director of the state’s EMS system.
Seventy-eight suspected opioid overdoses were called in between Saturday and Wednesday morning through the new Statewide Opioid Reporting Directive, or SWORD, according to Peter Canning, an EMS coordinator at UConn Health’s John Dempsey Hospital.
EMTs, firefighters and bystanders administered naloxone, the life-saving opioid antidote, in 65 of those cases, Canning said.
The timing of the program’s launch was opportune. It coincided with a spike in drug deaths that killed seven people in the city of Hartford between Monday and Wednesday, including five cases possibly caused by fentanyl-laced crack cocaine.
But the rash of crack and cocaine overdoses also points out a weakness in the fledgling tracking system—not all EMTs and firefighters are reporting those cases, because those substances are not opioids.
And while police suspect those drugs have been laced or contaminated with fentanyl, a synthetic opioid 50 to 100 times stronger than heroin, it’s not possible to confirm its presence in the field.
So this week, when crack deaths surfaced for the first time in recent memory in Hartford, some EMTs reported them to the state and some did not.
Of Hartford’s five crack deaths this week, only one was reported to the new opioid tracking program, which public health officials hope to use to alert communities in real-time if they’re experiencing a spike in incidents.
Some also went unreported to the state because there were no obvious sign of drug use at the scene, like a crack pipe or heroin needle. EMTs had no reason to think the victims—ages 50 to 61—had overdosed.
Coler says the system still worked this week, and information from the state helped mobilize Hartford police, health officials and harm reduction workers to respond to the crisis.
With a heads up, communities can quickly alert vulnerable residents about a bad batch of drugs or a new risk, like the possible presence of fentanyl in Hartford’s crack supply. That’s what the city did, along with handing out extra fentanyl test strips and naloxone, and urging people to cut back on their doses and not to use alone.
“A lot of them refuse to believe that it’s really happening, a lot of them have a hard time just knowing what’s going on — their stuff gets stolen a lot, they don’t have access to the Internet," said Alixe Dittmore, a programs manager with AIDS Connecticut, which runs a needle exchange van in Hartford.
Dittmore spent Wednesday counseling her clients to test their drugs, demonstrating how they could test crack by emptying their baggy, swirling it with a bit of water and immersing a fentanyl test strip. She said it’s hard to see so many users unaware of new risks.
“It’s heartwrenching because they’re the people who are most affected by it. We can tell them till we’re blue in the face, which we do every day when we do the exchanges," Dittmore said. “But it’s hard for them to believe that the person they’ve been copping from for years would get that,” referring to a fentanyl-laced product.
Given the appearance of fentanyl in non-opioids, from cocaine to ecstasy to potentially marijuana, Coler said the state may have to re-think its instructions to towns and cities. She says all state partners should know that opioids could be the cause of an overdose, even if the person thought they were using something else.
“It’s a fluid system,” she said. “We just started in April, so this is the kind of stuff we’ll look at. Our goal is to catch the opioids, so it’s important to know about this, that there’s bad crack going out there too.”
As of Thursday afternoon, the Statewide Opioid Reporting Directive had received 103 calls, including 10 fatal overdoses, Canning said. Twenty calls came from New Haven County, 21 from Fairfield County, and 45 came from Hartford County, where more EMTs and firefighters may be following the new directive.
The North Central region of the state kicked off the program in April. And some EMTs have been reporting overdoses to Poison Control since last spring as part of an initial pilot that covered two-thirds of the city of Hartford, stopping north of Park Street.
Launched in May 2018, the pilot included American Medical Response ambulance company, Saint Francis Hospital and Medical Center, and Poison Control—part of UConn Health’s Emergency Medicine Department.
Even with shaky compliance, the tracking pilot counted 98 overdoses in the first two months—and showed promise as a model the state could adopt as an opioid overdose early-warning system.
Now, Connecticut is getting closer to understanding the scope of the epidemic.
“The long-term hope is to reduce the deaths that are occurring,” Coler said. “To make the public aware that this is what’s going on and give them the awareness that they should be much more careful.”