New Haven Register (Sunday) (New Haven, CT)
State overdose deaths down; opioid use still widespread
Data shows clearly that overdose deaths are down in Connecticut, but Nancy Navarretta is hesitant to call it a trend.
Now the commissioner of the state Department of Mental Health and Addiction Services, Navarretta has been with the agency for 11 years. She said the opioid epidemic has come in waves, and there are still 1,300 opioid deaths a year in Connecticut.
“After two years, we’re cautiously optimistic that we could start calling this a trend,” she said. “Last year, from 2022 to 2023, there was an 8.3 percent decrease and from 2021 to 2022, there was an additional 4.7 percent decrease. That is something that we’re proud of.”
Navarretta and Luiza Barnat, DMHAS director of opioid services, said it’s difficult to pinpoint one reason why deaths from opioid overdoses are down in Connecticut, but the wide availability of a rescue drug called naloxone has played a big part.
Connecticut’s goal, based on a report by Canadian researcher Michael Irvine, was to distribute 45,000 doses of naloxone. The state far exceeded that number. Last year, DMHAS distributed 60,000 naloxone kits, with pharmacies in the state handing out an additional 30,000.
Soon, treatment will be mobile. The state’s Opioid Settlement Advisory Committee approved two vans that will travel the state, methadone and naloxone in stock, to where the medication will be most beneficial.
Those doses have not only gone to first responders but they’ve gone into the hands of people who use narcotic substances. Naloxone works immediately — knocking an opioid out of the brain’s receptors, if a person gets it in time. It has been referred to as a “Lazarus drug.”
“What we know is that naloxone is best used when it’s in the hands of people who use drugs because they’re able to help each other during an active overdose,” Barnat said. “What we know is that folks often die in their home or somebody else’s home. It’s not people on the streets, it’s people in their households.”
Mark Jenkins agreed. To Jenkins, CEO of Hartford’s Connecticut Harm Reduction Alliance, first responders to a drug overdose are typically not EMS or police, but “the people who are there with the people who were using. Those are traditional first responders.”
Perhaps as valuable as naloxone has been efforts to educate people who use drugs. Xylazine, an animal tranquilizer found in about 24 percent of opioid-related deaths in Connecticut, is not an opioid itself and so will not react to naloxone.
Without xylazine in their system, a person in the midst of an overdose will sit up and start talking after naloxone has been administered. But that won’t happen if xylazine is present, so it’s important, Navarretta said, to teach people to use naloxone anyway, and to administer CPR until paramedics arrive.
“Then at least you have a strategy to make sure that the person is staying conscious and continues to breathe,” she said.
Opioid use trends
Overdose fatalities are down, yes, but Jenkins says “we’re hearing about just as many overdoses, if not more, as we ever had.”
Kevin Shuler is program manager for Connecticut Community Addiction Recovery in Hartford, which puts recovery coaches in nearly every emergency department in the state.
He said that overdose deaths are down as are the overall volume of users, though there may be many possible reasons for that.
“I don’t know if we can attribute that to people struggling less, as much as just services not being utilized to the capacity that they were,” he said.
The saturation of naloxone, though it is saving lives, may itself be hiding the extent of opioid use. A recent report from the state Department of Health showed that, “in the month of April 2024, there were 195 calls to the Connecticut Poison Control Center” for opioid use, of which 185 were non-fatal and 10 were reported as fatalities.
But that only represents events where emergency medical personnel got involved. “We know there’s a lot happening that we’re not aware of,” Navarretta said of overdoses.
Barnat believes there are closer to 400 overdoses a month in Connecticut, but that many go unreported.
“A decline in the reporting could mean many things, not necessarily that people are not overdosing. They could just not be calling” 911, she said. “We are saturating the state with naloxone. It could mean that people who use drugs will just revive one another and never involve any provider.”
The demographics have changed, too. Navarretta said that when the crisis began, there were many younger, white men and women getting addicted to opioids. Now, she said it’s predominantly impacting Black communities, which “may or may not be connected to” contaminated drug supply that mixes opioids with cocaine and fentanyl or other narcotics.
Barnat said the trend seems to be moving toward older folks, though she said 90 percent of overdoses occur in people between the ages of 25 and 65.
The future of the epidemic
Jenkins said he hopes the trend of fewer overdose deaths continues, but he’s not sure it will.
“We’ve yet to really enter the next wave of this epidemic,” he said. “The next wave will be pills.”
It’s a question of cost. “The United States makes up 5 percent of the world’s population but we ingest 80 percent of the world’s prescription opioids,” Jenkins said.
Now, what Jenkins called “closet chemists” are developing their own versions of fentanyl in pill form.
“If you can take a $5,000 investment and turn $500,000, now you see where we are,” he said. “If your product is now reduced to $2 and the frequency of administration has gone from eight hours to two hours, now take that half-million dollars, add a pill press and your money just doubled.”
But as difficult as it is to estimate the full extent of the epidemic, Navarretta said it’s more difficult yet to guess what will happen.
“This crisis started out as over prescribing. We had a lot of efforts educating prescribers and changing how people treat pain,” she said. “Then it shifted to heroin. Then it shifted to fentanyl, and that’s where we sit today. I can’t predict the future. I don’t know where we’ll go.”