‘It’s an everywhere problem’
All but 10 state towns record a death in 4 years; Stamford has 44 in crisis
The nationwide opioid epidemic has hit hard in Connecticut, where accidental overdoses increased almost 40 percent from 2015 to 2018.
Fentanyl, 100 times more potent than morphine and 50 times stronger than heroin, has become the drug of choice for those addicted to opioids, outstripping heroin and other drugs. In 2018, 760 of the 1,017 opioid-related deaths involved one or more forms of fentanyl. In 2015, only 189 of 729 deaths were fentanyl-related.
Hearst Connecticut Media obtained the detailed data about the 3,701 opioid-related deaths over four years, from the chief state medical examiner’s office. They paint a picture, in numbers, of a tragedy that is exploding by the year.
The individual cases were analyzed according to the city or town where the deceased lived, not where they died. What they reveal destroys the stereotypes that the opioid scourge is an urban problem or one that primarily afflicts the African-American community.
“It clearly is not an inner-city problem,” said Dr. Michael Werdmann, an emergency physician at Bridgeport Hospital, where 53 percent of those who come to the emergency department with narcotic overdose as their chief complaint live in Bridgeport. “They still have that kind of image, that it’s an urban or an inner-city problem, and what this suggests is that it’s an everywhere problem.”
Overall, 60 percent of the hospital’s emergency patients are from the city, suggesting that opioid overdoses are more likely to be from the suburbs than other emergency department cases are.
Dr. Gail D’Onofrio, physician in chief of emergency medicine at Yale New Haven Hospital, called the beginning of the epidemic “a perfect storm” between “Purdue Pharma and physicians telling us that patients should not have pain (and) that these medications were safe. … It was not evidence-based information.”
“Pain became like the fifth vital sign,” D’Onofrio said, along with heart rate, blood pressure, respiration rate and oxygen saturation. “If it was more than 4 on a scale of 10, we had to treat pain.”
As people who developed substance abuse disorder turned from prescription drugs to less expensive street drugs, such as heroin, accidental deaths mounted. Fentanyl and its analogs multiplied the problem. According to the chief medical examiner’s reports, other drugs often were found in the system of the deceased, including heroin, cocaine, methadone and alcohol.
The largest group of victims are white men, although the number of black men and women who die of opioids is increasing, D’Onofrio said. She said there’s not “a simple answer to this,” but the problem largely started in the Appalachian Valley among miners and other white men who perform manual labor and were prescribed opioids for their pain.
“There was also a lot going on there . ... Companies were sending in massive amounts of oxycodone and people were selling it and doing it illegally,” she said. However, she added, the cost of illicit prescription drugs drove those who had become addicted to heroin.
“The epicenter of the epidemic was primarily in a white area,” D’Onofrio said, unlike the spread of cocaine in the 1980s, which “perhaps ... was not treated as aggressively from a policy point of view because it was in our black communities; it was not in our white communities.”
Stamford ranks in at 142
residents. Bridgeport, at 31, ranked below both West Haven and Middletown with an average of more than 46 per year and 3.16 per capita, and New Haven was No. 40, with an average 38.5 deaths per year and 2.94 per capita.
West Haven had an 18-death average, while Middletown had more than 15, but both rank higher on the list of opioid deaths than New Haven because of their smaller population sizes.
Fairfield County ranks as the county with the fewest opioid deaths per 10,000 residents, with an average of 1.47 from 2015 to 2018. Bridgeport accounted for 185 of the county’s 560 deaths over those four years. Without the state’s largest city, the average rate would fall to less than 1.
Stamford, despite its large size, only had 44 overdose deaths putting it at 0.84 per capita and at 142 on the list.
The challenge in Fairfield County towns that had few opioid overdoses is “not to be complacent — that’s the problem,” said Alan Barry, Greenwich’s human services commissioner. He said three years ago a survey of youth in town was conducted, and vaping turned out to be a much larger issue than opioid use.
However, “it did bring this coalition together and now we’re putting together some strategies overall,” Barry said. “If the parents are lackadaisical or giving out mixed messages, it certainly has an impact on their kids,” Barry said.
According to Lauretta Grau, a clinical psychologist and research scientist at the Yale School of Public Health, Connecticut is “a little bit behind” the rest of the country in the rise of opioid deaths. “We’re not often the leading edge of a problem,” she said. Fentanyl hit the state in about 2015, about a year after other regions. Once it arrived, however, fentanyl as a street drug spread quickly across the state, she said.
Grau said she used to classify fentanyl as a pharmaceutical opioid, like methadone, because of its use as an anesthetic, for acute pain caused by cancer or surgery or for chronic pain. Now, however, “it is an illicit opioid,” she said.
Town data ‘not granular enough’
While the chief state medical examiner provided a breakdown of opioid deaths by town, Robert Heimer, professor of epidemiology and pharmacology at the Yale School of Public Health, said that doesn’t go far enough to determine what populations are using which drugs.
“The towns themselves are not homogeneous, so what we’re trying to do right now is define it down to the census tract,” he said. “To look at the level of the town is not granular enough.”
In a study published in 2014 in the journal AIDS and Behavior, he and Russell Barbour, a research scientist in biostatistics at the School of Public Health, as well as Grau, focused on the suburbs of New Haven and Fairfield counties, using a tool known as the community disadvantage index.
The index uses a number of socioeconomic variables, rather than race, to identify who is most at risk of becoming a drug injector. They include whether the person is a single head of household or a renter vs. an owner.
“Drug users were found most often in the poorer census tracts,” Heimer said. “This problem remains economically distributed. Race doesn’t matter as much. … Part of the reason for that is a history of drug addiction tends to compromise one’s ability to earn money and tends to move you down the socioeconomic ladder. … Drug use is downwardly mobile.”