1st year of Conn. real-time overdose tracking reveals 131 spikes in cases
The Statewide Opioid Reporting Directive allows participating agencies to recognize and respond to overdose increases in their coverage area
The Hartford Courant
HARTFORD COUNTY, Conn. — In the state’s first year of tracking suspected opioid overdoses in real time, the new program registered 131 spikes in cases — more than a third of them in Hartford County — to create an early warning system that may save more lives.
The Statewide Opioid Reporting Directive, or SWORD, alerted participating agencies and community partners of these significant upticks in suspected overdoses, allowing them to react quicker than ever before to try to save lives in high-risk populations. Used as a guide for distributing limited resources, like naloxone and fentanyl testing strips, the initiative seems to be working, according to the first annual report released Wednesday by the Department of Public Health.
“For the first time, we have near real-time overdose data directly reported by first responders that enables us to act quickly to respond to overdose spikes and bad batches, resulting in lives saved,” said Peter Canning, the EMS Coordinator for UConn’s John Dempsey Hospital.
Drug overdoses have been on the rise in Connecticut, which had 1,200 drug deaths in 2019 and 531 in the first six months of 2020. That’s a 22 percent increase over the same period last year. SWORD tracks something different - all suspected opioid overdoses that EMS respond to and later report themselves to UConn Health’s Poison Control Center.
In the first year, between June 1, 2019 and May 31, 2020, EMS crews reported 4,505 suspected overdoses.
Hartford County reported the most overall overdoses, 1,590, followed by New Haven and Fairfield counties.
The zip code with the most overdoses was the section of Hartford that contains the Park Street corridor, which the Greater Hartford Harm Reduction Coalition describes as “ground zero” of Connecticut’s opioid epidemic.
Canning conceived of the tracking system two years ago, and his idea was developed into a pilot program in Hartford involving the AMR ambulance company, Saint Francis Medical Center and Connecticut Poison Control at UConn Health. The pilot then became SWORD, through which Connecticut is complying with a state law passed in 2018 to improve reporting of overdoses.
“Thanks to SWORD and its treasure trove of data, we have a much clearer and more immediate picture of the epidemic in our state and towns that is translating into improved outreach and saving more lives,” Canning said.
From the time the program was fully implemented in June 2019 through May 2020, Hartford County registered 46 spikes of at least seven to 10 cases in a 24-hour period.
Whenever a county reported two more cases than average in a 24-hour period, SWORD would alert the local agencies that it was experiencing a spike. This threshold was also adjusted over time depending on how frequently the alerts were being triggered.
For example, New London County reported 31 spikes in overdose incidents, the second highest number in the state, though each was triggered when at least three suspected overdose were reported. In Hartford County, where overdoses are more common, it took seven to 10 incidents to trigger a spike and an alert to local agencies.
The program began tracking spikes in its second month, but by chance, its first day of statewide use coincided with a cluster of cases in the Hartford region. Two people who used crack cocaine were revived with naloxone and denied using any opioid, the report found.
The cluster continued for five days, resulting in 22 overdoses and six deaths. Hartford police suspected a bad batch of crack cocaine tainted with fentanyl.
While SWORD tracked 4,505 suspected overdoses, it only recorded 337 drug deaths, far less than the number of actual drug deaths. The number of fatalities is low for several reasons. Unless there is drug paraphernalia near a patient, like a needle, baggie or pill bottle, or an eyewitness reports drug use, EMS have no reason to suspect an overdose. Only later will a medical examiner determine they died of drug use.
Patients may also die at the hospital after an EMS team has already reported that their patient survived an overdose.
SWORD also undercounts the total number of overdoses because not all EMS crews in the state are calling in every overdose. Compliance with the law was only at 74% in February and it fell during the first three months of the pandemic, to 62% in May.
Public health experts say they still glean important information from those who participate.
“The SWORD data enables us to identify overdose hotspots so we can better target our outreach, education, and naloxone training efforts,” said Dr. Richard Kamin, EMS program director at UConn Health. “The demographic information about who is overdosing provides us with actionable data on who is most at risk for overdose so we can better target our limited resources.”
About 87% of cases involved heroin or fentanyl, 11% a prescription opioid and 2% a drug used to treat opioid addiction, either methadone or the combination of buprenorphine and naloxone.
And in 15% of cases where 911 was called, a bystander delivered a dose of naloxone, the drug that reverses the effects of opioids.
Men accounted for 74% of those who overdosed, and people ages 25 to 39 were most likely to overdose.
Only 2% of incidents involved a cluster of people, and 11% occurred in a motor vehicle.
The overdose rate was also highest in Hartford County, with 179.95 incidents per 100,000 people, followed by Litchfield and New London counties, after the data was adjusted for age differences in the populations.
The 06106 area code in Hartford reported 298 overdoses over the 12-month period, twice as many as the next zip code, Torrington, which was trailed by Bristol and in a tie for fifth, Middletown and southeast New Britain.
The report also took note of some of the brands stamped on the glassine baggies that heroin and fentanyl often come in, some of which include “Pray for Death,” “Nite Nite,” and “Corona Virus.”
©2020 The Hartford Courant (Hartford, Conn.)