Opioid OD figures possibly stabilizing

State health officials ‘guardedly optimistic’

Data from 38 Connecticut emergency departments show the state’s opioid overdose crisis may be stabilizing, the state Department of Public Health said this week.

In a news release, DPH said there were about 1,200 opioid overdose-related hospital visits in the fourth quarter of 2018, compared to about 1,300 in the third.

“It is too early to determine if the current data is reflective of a trend, but we are guardedly optimistic that some of our state prevention efforts could be showing some initial results,” DPH Commissioner Raul Pino said.

Public awareness effort

The state’s public awareness campaign, Change the Script, has been at work since last March. State money also has funded medication-assisted treatment — or the combination of therapy and medications that reduce withdrawal symptoms — and recovery coaches, who help people navigate the complex process of getting and staying sober.

The data are from a DPH system that provides almost real-time information about what’s happening in state emergency departments. DPH began publicly releasing the overdose-related information last March and has been improving the data quality since.

The local situation

New London County, with 41.6 visits per 100,000 population, had the highest rate of opioid overdose-related visits in the fourth quarter of 2018. In the third quarter, when New London had 39 visits per 100,000 population, both Hartford and New Haven counties had higher rates.

Dr. Oliver Mayorga, chief medical officer at Lawrence + Memorial Hospital, said he wasn’t surprised New London County landed in the top three for suspected overdose visits.

He said he’s heard a couple possible explanations. First, the county sits on a main artery between New York City and Boston. Second, many people come here for treatment facilities, such as Stonington Institute, but because addiction is a chronic and relapsing brain disease, some of them end up using drugs again after treatment.

“But those are just theories,” Mayorga said. “It’s hard to put a finger on why (the rate) is high here.”

Reflecting on his 10 years at L+M, he said it was shocking how quickly the frequency and severity of overdose cases worsened.

While opioid overdoses slow or stop respiration, the overdose-reversal drug naloxone can reverse that effect. But patients who received a dose of naloxone from emergency responders began requiring more doses at the hospital — a phenomenon that continues today, Mayorga said.

“It’s not every case,” he said. “But there are very powerful formulations of opioids that can require multiple doses (of naloxone) ... such as fentanyl and carfentanil,” the latter of which is intended to tranquilize large animals.

Mayorga said people who overdose on long-acting prescription narcotics also are closely monitored. “They can require repeated doses because (the opioid) stays in their system but (naloxone) wears off in 45 minutes to an hour,” he said.

Anecdotally, Mayorga agreed the number of cases seems to be leveling off. “We do feel we are getting some traction with all of the efforts we have been implementing,” he said.

Mayorga said while people deemed OK for release used to get a brochure with numbers to call, now they can connect with a recovery coach.

“The (coaches) are coming in 24/7 and making a connection during that teachable moment with a peer, because the (coaches) have gone through it, too,” he said.

“They work in concert with physicians to provide a treatment plan, and they keep (their clients) accountable, too,” Mayorga said. “That’s something that didn’t happen years ago.”

Mayorga said Yale New Haven Health officials will spend this year analyzing data and incentivizing physicians to prescribe even fewer opioids.

“We believe if we can decrease the amount of excessive opioids prescribed on an outpatient basis, maybe we can have an effect on the front end,” he said.

DPH officials noted that the state’s suspected opioid overdose hospital visit rate, while steadying, still is 1.7 times higher than the national rate.

The rate also doesn’t include people who overdose and are given naloxone at home, unless they go to the hospital. That scenario is becoming more common, as nonprofits and medical professionals saturate communities with naloxone in an effort to save lives.

Overdoses claimed 1,038 lives in 2017 and were on track to claim about 1,030 more in 2018, data from the state Office of the Chief Medical Examiner show.

“Even though there are signs that the opioid crisis in Connecticut may be stabilizing, the total number of overdoses and deaths are a sobering reminder of the human and fiscal impact, and magnitude of this epidemic,” Pino said.