Access to OD data sought

State has no real-time info on overdoses

NORWALK — When someone seeks medical care for food poisoning in Connecticut, it triggers a series of actions designed to protect public health.

A health professional follows up with an interview about what that person ate, and the incident is reported to the state in a system that local health departments can access in real time. And if another person falls ill after eating at the same place, the Department of Health is called and an investigation is opened into the restaurant.

Similar processes are in place for chicken pox, carbon monoxide poisoning, syphilis and 79 other conditions. That’s because they’re on the state’s list of reportable diseases, emergency illnesses and health conditions, which mandates which conditions must be reported by health professionals. Cases of West Nile virus, which killed three people in Connecticut between 2000 and 2016, must be reported.

But opioid overdoses, which claimed more than 1,000 lives in Connecticut last year?

Not on the list.

“There is no mechanism for reporting overdoses. None at all.” David Knauf, Darien Health Department

This is in spite of efforts by a local health official and nonprofits to have overdoses added to the list of reportable conditions.

Every year, the Department of Public Health Advisory Committee meets to review proposed changes to the list of reportable diseases. At the meeting for the 2018 list, David Knauf of the Darien Health Department, Jeff Holland and Ingrid Gillespie of the Connecticut Prevention Network based out of Stamford and Shane Lockwood of the Plainville-Southington Health District traveled to Hartford in an attempt to sway the committee. The local health professionals believed overdoses should be added to the list.

“There is no mechanism for reporting overdoses. None at all,” Knauf said.

This means that, even as an opioid pandemic sweeps Connecticut, the state has very little data on how many overdoses actually occur. At the end of the year, the medical examiner issues a report on how many people died from opioid overdoses. But that report does not include people who survive. Instead, health departments are forced to grapple with a problem that is largely unseen until it’s too late.

“Because the opioid epidemic is rapidly evolving, it would help if departments could monitor overdoses,” Norwalk Director of Public Health Deanna D’Amore said. If overdoses were labeled a reportable disease, the information would come in directly to the departments. “We have a system called Maven — so we could easily pull that information from the health department side.”

Every letter written to the commissioner on the subject supported adding overdoses to the list. The level of attention was unusual for the committee, which usually proceeds without controversy. “The state epidemiologist at the meeting said it was the first time he’s had people testify ever for a request,” Knauf said.

But when the updated list of reportable conditions was emailed out in January, the only condition that was added was ventilatorassociated events, which can lead to pneumonia. The Department of Health did not respond to a request to comment on why opioid overdoses were not added to the list, but minutes from the meeting showed concerns over the best way to capture overdose information. Michael Parry, a Stamford Hospital doctor and infectious disease expert who was at the meeting, said he believed that further discussions were probably needed about the optimal ways to gather data.

Now Knauf, Holland and Gillespie are lobbying state lawmakers to create legislation requiring that overdose poisonings be added to the list.

State Rep. Terrie Wood, R-Darien, said the public health committee planned to raise a bill within the next three weeks. “It’s important to have the number of overdoses that do not result in death,” she said. “Because that number is unknown.”

“For years, legislators came up with a list of responsibilities for local health departments,” Knauf said. “And number one in the 10 essential services is to monitor the health status of the community to identify and solve local health problems. And to me, this screams for having data on local overdoses, in real time. Without that information, we cannot do the number-one defined responsibility that we have.”

Congress is currently allocating $6 billion from the two-year federal budget for addiction recovery and mental health. It has yet to be determined what types of programs will receive that money, and when U.S. Sen. Chris Murphy and Rep. Jim Himes sat down with advocates from Fairfield County to hear their thoughts on how the funds should be used, some frustration was expressed at the lack of data.

“We have great difficulty in getting real-time data on the magnitude of the issue because of the way overdoses are recorded or not recorded,” noted Darien’s first selectman, Jayme Stevenson.

However, some medical professionals believe that reporting opioid overdoses would not be enough.

Patrick Broderick, a doctor at Danbury Hospital who has worked in emergency medicine for three decades, said that he saw many patients with substance abuse disorders who had not overdosed.

“The people who take Narcan for an overdose are really a fraction of the problem,” Broderick said. He believed somewhere between 20 and 30 percent of the patients he saw in the emergency room suffered from a substance abuse disorder, which includes opiate abuse but could also refer to misuse of other drugs.

But he and Knauf agreed on one thing. “What we can kind of generalize is deaths due to overdoses are just the tip of the iceberg,” Knauf said.