Connecticut Post (Sunday)

‘We have to do something different’

As fatal drug overdoses climb, harm reduction is one way to save lives

- By Liz Hardaway STAFF WRITER The state Department of Mental Health and Addiction Services also offers a helpline that can link individual­s to residentia­l detox and other services at 800-563-4086.

The evening started with a delivery.

Chris Ortiz and Rodger Clark drove to one of the many motels lining the Berlin Turnpike, a busy divided road in Newington, on a recent Friday. In the parking lot, a woman in fishnet tights handed the two outreach workers a bin containing 200 used syringes as she excitedly told them about an upcoming visit with her family.

It was a regular twice-aweek transactio­n. Ortiz grabbed his clipboard, noting the exchange as they caught up. Clark grabbed 200 new clean syringes from a large storage container in the van’s back seat and gave them to her.

Providing clean needles is just one form of harm reduction for people struggling with drug use. State officials and nonprofit organizati­ons employ this public health response to keep people who use drugs safe and alive as Connecticu­t sees deadlier drugs in the mainstream supply and hundreds of overdose fatalities a year.

Harm reduction is meeting people who use drugs where they are and providing sterile equipment – such as clean syringes and pipes – as well as fentanyl test strips, methadone, wound care kits and naloxone, the generic form of Narcan that instantly reverses an opioid overdose, to help those who use drugs stay safe.

The practice also comes with a stigma; there are complaints that harm reduction techniques enable or promote drug use, state Public Health Commission­er Manisha Juthani said. However, the reality is that someone who uses harmful substances will shoot up regardless of whether they have a clean or a dirty needle, she said.

Also, they can’t recover or receive treatment if they’re dead.

“Death is final,” said Mark Jenkins, founder and executive director of the Connecticu­t Harm Reduction Alliance. “We have to do something different.”

The Hartford-based nonprofit strives to keep what it calls its participan­ts, many of whom may have a physical or psychologi­cal dependence on drugs, safe and relates with them in whatever they’re going through, Jenkins said.

The organizati­on has five vans, each sporting two erect, bright orange flags on each side, letting passersby know they’re open for business. The silver van Ortiz and Clark drove had large white letters on the windows, explaining their mission exactly: “This van saves lives.”

In the van’s back seat, Ortiz and Clark keep a bulky container, dubbed the “Rover,” that holds all of their supplies. A separate container holds up to 1,000 of the used needles; it typically fills up at least once a night.

For anyone who interacts with the outreach workers, “they’re going to be treated in a nonjudgmen­tal fashion,” Jenkins said. “And, when they are ready for things like treatment, whether it be inpatient or medication-assisted treatment, that they know they’re going to be able to come to us.”

Harm reduction specialist­s also serve as familiar, friendly faces to those who may otherwise see nothing but chaos in their lives.

Ortiz and Clark, who are employees of the alliance, know most of their participan­ts well, coming across only one unfamiliar face on that particular Friday evening.

They also typically know exactly what that person needs – usually either a handful of clean syringes or a sterile pipe.

The outreach workers said they have known the woman at the motel for two years, but the organizati­on first started working with her when she was living in a tent in Bristol.

Though they know she’s using drugs, they also know the woman is in a much better place than before. She has a roof over her head and is rebuilding relationsh­ips with her family. Ortiz and Clark ensure she uses drugs in a safe manner and will be there for her if she’s ever ready to get treatment.

What is Connecticu­t doing?

State officials have pushed various forms of treatment and recovery for those with a substance use disorder for years. Meanwhile, the opioid epidemic dug its claws into the nation, taking more than 80,411 lives in 2021 – with 1,405 of those deaths in Connecticu­t, according to state data.

More recently, though, the messaging has shifted and health officials have been promoting harm reduction techniques, which include handing out sterile parapherna­lia or providing informatio­n to minimize the potentiall­y harmful effects of drug use.

“All of these harm reduction modalities actually save lives,” said Juthani, Connecticu­t’s health commission­er. “It’s reducing harm, meeting people where they’re at and potentiall­y giving people that opportunit­y to think about buprenorph­ine, methadone, trying to get out of the cycle.”

Jenkins formed the Connecticu­t Harm Reduction Alliance, originally the Greater Hartford Harm Reduction Coalition, in 2014. After doing outreach for years, he was frustrated with other organizati­ons, feeling as though they were doing the bare minimum.

“There is such a demonstrat­ed need, and such an evident need,” he said. “There’s no mistaking it.”

One of the most important harm reduction initiative­s is making naloxone abundant statewide. The life-saving medication, which can reverse the effects of a drug overdose, has been available by prescripti­on and, recently the U.S. Food and Drug Administra­tion approved it for overthe-counter sales. But health officials said the over-the-counter product won’t be be available anywhere until the summer.

But health officials remain focused on blanketing the state with as much free naloxone as possible to help keep people alive.

The number of deaths by unintentio­nal overdose doubled from 728 in 2015 to 1,459 in 2022, Connecticu­t Department of Public Health data shows. And while some people intentiona­lly use fentanyl, the increase in fatalities is partly due to an influx of the potent synthetic opioid mixed into the illicit drug supply.

Only 2 milligrams of fentanyl – the equivalent of a few grains of sand – is considered a lethal dose. And though fentanyl has been around since the 1960s, it has made a recent resurgence. State data shows fentanyl was present in about a quarter of the fatal drug overdoses in 2015. By 2022, it was found in 85 percent of deadly overdoses.

Fentanyl has been found in heroin, cocaine and methamphet­amine, as well as in fake prescripti­on pills. It is sometimes added to these drugs because of its potency, which makes drugs “cheaper, more powerful, more addictive, and more dangerous,” according to the federal Centers for Disease Control and Prevention.

Simple cases of crossconta­mination also taint the drug supply, Ortiz said, who works with the Connecticu­t Harm Reduction Alliance.

“Drug dealers don’t have a hygienic code,” Ortiz added.

Fentanyl is present in most of the state’s illicit drug supply, according to Luiza Barnat, the Opioid Services Director for DMHAS.

In response, harm reduction efforts now include distributi­on of fentanyl test strips. However, this tool has its limits: The strips only detect the presence of fentanyl in another drug, not its potency.

Also, since most test only a portion of their drugs, a negative result “doesn’t necessaril­y mean all of your drug supply is free of fentanyl,” Barnat warned.

Demand for test strips also decreased because drug users have come to expect fentanyl to be in their drugs, Juthani said. And it’s unlikely that someone who uses drugs frequently will throw them out, even if they test positive for fentanyl.

“If somebody has spent all their money on purchasing a certain drug – unfortunat­ely this is a disease we’re talking about, opioid use disorder is a disorder,” Juthani said. “And the chances that somebody’s not going to use it is probably low.”

The health department is also encouragin­g people to have someone with them when they are using drugs. And when using drugs suspected of containing fentanyl, have naloxone available in case of an overdose.

Those struggling with mental health or substance use issues can call the Substance Abuse and Mental Health Services Administra­tion national helpline at 800-662-HELP (4357) for informatio­n or for a free and confidenti­al treatment referral.

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