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

• Published in: Public health reports (1974) Vol. 136; no. 1_suppl; pp. 18S - 23S
• Main Authors: Canning, Peter, Doyon, Suzanne, Ali, Sarah, Logan, Susan B., Alter, Aliese, Hart, Katherine, Coler, Raffaella, Kamin, Richard, Wolf, Steven C., Soto, Kristin, Whiteman, Lauren, Jenkins, Mark
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.11.2021; SAGE PUBLICATIONS, INC
• Subjects: Adult; Case Study; Clusters; Cocaine; Computer Systems - standards; Computer Systems - trends; Connecticut - epidemiology; Crack cocaine; Crack Cocaine - administration & dosage; Crack Cocaine - therapeutic use; Data collection; Drug abuse; Drug overdose; Drug trafficking; Emergency medical services; Emergency services; Female; Fentanyl; Fentanyl - adverse effects; Fentanyl - therapeutic use; Government agencies; Harm reduction; Health services; Humans; Intervention; Male; Mapping; Middle Aged; Naloxone; Narcotics; Neighborhoods; Opiate Overdose - diagnosis; Opiate Overdose - epidemiology; Opioids; Outbreaks; Overdose; Population Surveillance - methods; Public health; Public health departments; Public safety; Real time; Reduction; Risk reduction; Specialists; Surveillance; Connecticut; United States > US; opioid overdose; public health surveillance
• ISSN: 0033-3549; 1468-2877
• DOI: 10.1177/00333549211015662

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.