Connecticut opioid-related deaths declined for the second year in a row, down 14% from their 2021 high of 1431 opioid deaths, according to the latest statistics from the Connecticut Office of the Medical Examiner (OCME). Opioid deaths represented 92% of all overdose deaths in Connecticut. Fentanyl was present in 92% of opioid deaths and 85% of all overdose deaths.
While the decline is good news, the number of people in our state (1217) succumbing to opioid deaths is still achingly high. EMS has a pivotal role in helping to combat these deaths, both but providing resuscitation with naloxone, but also in helping steer those resuscitated patients toward treatment and harm reduction resources. Empathy is the hallmark of an EMS provider and this ability to see life through their patient’s eyes and treat them with respect and dignity can go along way toward helping them get the aid they need to help them stay alive as they battle the terrible disease of addiction and the perils of drug use.
Fentanyl represents the third and most deadly wave of the opioid epidemic, following wave one of prescription pills and wave two – heroin. Fentanyl is deadly because it is difficult for drug dealers to mix the potent drug in a manner that ensures all product contains a consistent dose. The inability of users to thus safely judge how much active ingredient they are exposing themselves to makes overdose random, and if a person used fentanyl alone, they can easily be poisoned and die without anyone to witness the overdose and provide naloxone.
There is discussion of the country entering a fourth wave of the epidemic which combines fentanyl use with stimulants such as cocaine and methamphetamine. Cocaine present in any death has risen each of the last ten years. In 2023, cocaine was present in 54% of all overdose deaths and 55% of all fentanyl deaths. It is unknown to what extend the cocaine contributed to these deaths. Presence of cocaine does not mean that the cocaine caused the death, nor does it mean that the cocaine and fentanyl were mixed together, only that the person who died had cocaine in their system. Many people who use fentanyl, also routinely use cocaine. Fentanyl remains the most likely cause of these deaths due to causing sudden respiratory depression and arrest.
Xylazine, an animal tranquilizer, has received much attention in Connecticut in the last two years for its increasing presence in overdose deaths, going from 0 in 2018 to a high of 351 in 2022. In 2023, xylazine presence in fatal overdoses decreased by 8% to 286. As with cocaine, it is hard to determine the extent to which the presence of xylazine contributed to the actual death or whether it is simply a reflection of the percentage of xylazine in the drug supply. In 2022, while xylazine’s presence went up, deaths with xylazine present went down. It has been speculated that if dealers are adding the far cheaper xylazine so they can use less expensive fentanyl in the mix, then xylazine, which also prolongs an opioid stupor, may lead to people using a less powerful mix and using fewer times a day, thus helping reduce deaths. An unfortunate side effect of xylazine is skin necrosis.
While we can be hearted by the decrease in fatal overdoses, we must recognize the number is still terribly high and we must continue to do all we can to provide life-saving treatment, report quality data, and use our position as EMS responders to encourage people who use drugs to seek treatment and utilize harm reduction resources, as well as to advocate for compassionate policies that treat the opioid epidemic as a public health not a criminal problem.