Using Surveillance With Near–Real-Time Alerts During a Cluster of Overdoses From Fentanyl-Contaminated Crack Cocaine, Connecticut, June 2019

Abstract

In 2019, Connecticut launched an opioid overdose–monitoring program to provide rapid intervention and limit opioid overdose–related harms. The Connecticut Statewide Opioid Response Directive (SWORD)—a collaboration among the Connecticut State Department of Public Health, Connecticut Poison Control Center (CPCC), emergency medical services (EMS), New England High Intensity Drug Trafficking Area (HIDTA), and local harm reduction groups—required EMS providers to call in all suspected opioid overdoses to the CPCC. A centralized data collection system and the HIDTA overdose mapping tool were used to identify outbreaks and direct interventions. We describe the successful identification of a cluster of fentanyl-contaminated crack cocaine overdoses leading to a rapid public health response. On June 1, 2019, paramedics called in to the CPCC 2 people with suspected opioid overdose who reported exclusive use of crack cocaine after being resuscitated with naloxone. When CPCC specialists in poison information followed up on the patients’ status with the emergency department, they learned of 2 similar cases, raising suspicion that a batch of crack cocaine was mixed with an opioid, possibly fentanyl. The overdose mapping tool pinpointed the overdose nexus to a neighborhood in Hartford, Connecticut; the CPCC supervisor alerted the Connecticut State Department of Public Health, which in turn notified local health departments, public safety officials, and harm reduction groups. Harm reduction groups distributed fentanyl test strips and naloxone to crack cocaine users and warned them of the dangers of using alone. The outbreak lasted 5 days and tallied at least 22 overdoses, including 6 deaths. SWORD’s near–real-time EMS reporting combined with the overdose mapping tool enabled rapid recognition of this overdose cluster, and the public health response likely prevented additional overdoses and loss of life.

Overdose Detection Mapping Application Program expansion evaluation—A qualitative study

“…One study reported ODMAP's successful use in an outbreak of cocaine‐related deaths associated with fentanyl in Connecticut (one of the sites we were unable to interview). ODMAP's geocoding and pinpoint mapping functionality helped target a specific neighborhood leading to a full epidemiologic investigation once an outbreak was suspected (Canning et al., 2021). That study was consistent with our findings that ODMAP is considered a valuable tool for geocoding and mapping.…”

“They say it’s fentanyl, but they honestly look like Perc 30s”: Initiation and use of counterfeit fentanyl pills

“…From a research standpoint, it is imperative to continue examining the confounding influence of the COVID-19 pandemic on individuals who are at risks resulting from NPF as the combined crisis could lead to increased health disparities over time [ 46 ] especially for ethnic minority populations [ 47 ] and those experiencing homelessness [ 48 ]. Lastly, research efforts that seek to develop and test new means of community-wide surveillance will become critical [ 49 ] for the development of a more timely and geographically targeted delivery of harm reduction services and interventions.…”

Between Care and Control: Examining Surveillance Practices in Harm Reduction

“…In addition to potential data breaches, the sharing of information about PWUD between public health, law enforcement, and the criminal legal system represents another troubling example of surveillance health data being used in problematic ways. Take, for example, the Connecticut Statewide Opioid Response Directive (or “SWORD”) where near-real-time localized overdose surveillance data gathered by Emergency Medical Services and shared with public health was subsequently made accessible to local police who used the information to target and arrest people who use and sell drugs ( Canning et al, 2021 ; see also Michaud et al, 2022 ). This example illustrates how information collected for “health” reasons becomes repurposed in service of prohibition and interdiction efforts.…”

“…Data collection can be primarily benign, motivated by establishing reach of services, managing inventory of resources, or other operational concerns. In other instances, however, public health officials have provided bio-behavioral overdose “hot spot” surveillance data to police services which use the information to target and arrest PWUD ( Canning et al, 2021 ). In this way, surveillance in harm reduction can actuate both “care” and “control” ( Moore, 2011 ).…”