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Two weeks ago, two New Haven community members were found dead — possibly due to a drug overdose — in a storage space behind Jack’s Bar and Steakhouse. The incident comes amid a significant statewide increase in fatal drug overdoses and New Haven’s status as one of the top Connecticut cities for drug fatalities, according to Connecticut State Department of Health data. And it is one reason why the city is taking action to prevent such incidents in the future.

Local government authorities, nonprofit organizations and care providers have actively sought to address community drug use issues for decades. For example, in the 1990s, New Haven pioneered harm reduction methods such as needle exchanges, according to the New Haven Independent. However, the COVID-19 pandemic has created new barriers in the city’s efforts in overdose prevention and addiction treatment — such as decreased access to in-person treatment and growing financial concerns for residents.

A CT Mirror review of state Department of Health data found that overdose deaths in Connecticut increased by 13 percent from 2019 to 2020 and that New Haven County had the highest drug overdose mortality rate in the state.

“Essentially we have two epidemics colliding: a fentanyl-driven overdose epidemic and a COVID pandemic that has left many of our patients with problematic drug supplies and limited access to the most effective treatments,” said David Fiellin, director of the Yale School of Medicine’s Program in Addiction Medicine.

The Connecticut Department of Health’s Drug Overdose Monthly Report for January 2021 shows that the drug overdose mortality rate in New Haven County increased from 36.9 deaths per 100,000 residents in 2019 to 44.2 deaths per 100,000 residents in 2020.

Community organizers, addiction experts and city officials told the News that, based on their experiences working within the community, New Haven has likely seen an increase in fatal and non-fatal overdose incidents overall during the pandemic.

“Behind every fatal overdose, there’s probably a dozen or more non-fatal overdose events,” said New Haven Community Services Administrator Mehul Dalal MED ’09. “And that’s the data we can see from our dispatch and EMS system. Thus far that’s indicating that there’s likely an increase in 2020 over 2019, in New Haven.”

Beatrice Codianni, executive director of New Haven’s Sex Workers and Allies Network, or SWAN, said that individuals often overdose and do not report the incident. She said that as she and her colleagues worked in harm reduction, they had “definitely” witnessed an increase in overdoses in the city during the pandemic.

Why are overdoses increasing?

Dalal pointed to a variety of factors, including the social isolation, economic woes and increased day-to-day stress wrought by the coronavirus, that have contributed to the pandemic’s exacerbation of existing overdose problems in New Haven.

Additionally, reduced capacity in health care centers has created new obstacles to seeking and receiving addiction treatment and overdose reversal drugs, said Christine Rodriguez, a leader of the New Haven Harm Reduction Task Force. Shifts to remote communication in medicine have left behind marginalized communities that may not have immediate access to a computer or cell phone. And social distancing recommendations are at odds with the typical advice of many harm reduction advocates: Do not use alone, so that in the case of an overdose, someone will be there to administer naloxone or call for help.

More dangerous substances like fentanyl are further infiltrating the illicit drug market — and not just among opioids. According to Rodriguez, about a third of New Haven overdoses last year involved cocaine.

“We’ve seen fentanyl contaminating drugs that we wouldn’t necessarily expect: stimulants like cocaine and methamphetamine,” Rodriguez said. “And so these are folks that may not have received the same harm reduction messaging as opioid users, for example … learning how to recognize an opioid overdose and respond to it quickly and appropriately.”

Dalal agreed, saying that he and his colleagues in the Community Services Administration had discussed the importance of communicating the danger of impure substances to New Haven residents using stimulants such as cocaine.

“We have to make sure that we’re very proactive in terms of getting the message out, and what specifically [drug users] can do about it … Even folks who are saying ‘I don’t use opioids, so it’s not an issue for me’ — we want to dispel that,” said Dalal.

City efforts

Last November, the city responded to an increase in drug-related deaths across the state by creating the New Haven Harm Reduction Task Force. Led by Rodriguez in collaboration with global health consultant firm Vital Strategies, the task force has begun work on several projects it hopes will help reduce the rate of overdoses.

According to Rodriguez, the task force is preparing to launch a data dashboard to monitor overdose incidents and pinpoint city areas facing higher numbers of overdoses in real time. The purpose of this data collection is to help the city’s partners provide more targeted harm reduction services, such as syringe exchanges and health vans, to hotspots that need it most — “down to about the [street] intersection level”, Rodriguez said.

Rodriguez and Dalal emphasized that the project would provide secure data only for the task force and its partners to protect the privacy of individuals. Dalal said the project has now entered a beta phase — but the timeline for the project’s implementation depends on ongoing work on data-sharing agreements with partner organizations across the Elm City.

“One of the things the COVID pandemic has told us is the value of real-time detailed data in fighting an epidemic,” said Fiellin. “We’ve worked with the state and other entities to try to link datasets. But there are still a large number of silos that prevent effective collection, linking and merging of real-time data to help target efforts in places like New Haven and around the state.”

One organization on track to partner with the city in its targeted data-sharing dashboard is New Haven’s Sex Workers and Allies Network, led by Codianni. SWAN established a mobile health unit last November to better reach its clients.

Often the first responders to local overdose incidents, Codianni said she and her colleagues are excited to get more targeted information to provide harm reduction services to the area. But she emphasized that a big step in preventing overdose fatalities is increasing immediate access to naloxone, a drug that can temporarily reverse an opioid overdose long enough for an individual to receive medical attention.

“We want to saturate the city with naloxone,” Codianni said. “What’s Yale’s part in this? They could certainly promote [naloxone use]. They could have naloxone kits throughout the University. And if they don’t, shame on them — and you can quote me.”

The city is also designing a separate program that will reach out to overdose survivors 24 to 48 hours after an incident and provide them with harm reduction resources, including treatment options. According to Dalal, this program is set to launch within the next two months.

The Harm Reduction Task Force is also working to increase access to naloxone. Rodriguez said they were specifically focused on making the drug available to New Haveners reentering society after incarceration.

Other projects the task force and the Community Services Administration are working on include potential solutions to local syringe litter and a survey for overdose survivors to better inform the overdose outreach program.

Future steps

Although New Haven has implemented multiple programs in overdose prevention and harm reduction, there are still many measures that have not been used in the city yet, Rodriguez pointed out.

Though Rodriguez said she wasn’t endorsing any specific policies, she highlighted other possible methods of harm reduction the city could implement — including safe consumption sites, less restricted access to methadone and the elimination of waivers for doctors to prescribe buprenorphine.

“There’s so many evidence-based interventions that we could try, many of which are extremely controversial in some parts of the country,” said Rodriguez. “And they haven’t been discussed yet in New Haven, so I’m not sure how they would be received here.”

As for measures that shouldn’t be explored, Michael Lawlor — a member of the New Haven Board of Police Commissioners and a criminal justice professor at University of New Haven — was adamant about one.

“I do have a long history involved with criminal justice policy. And I’m pretty confident in saying that a criminal justice response to this problem is not going to be successful. And might even make it worse,” he said. “Arresting people and putting people in jail, and seizing all the drugs you can think of doesn’t seem like it has any impact on the availability of drugs on the street. So I’m always saying: to expect the police to solve this problem is a fool’s errand.”

In addition to the concrete programs they and other community members are working on, both Rodriguez and Dalal emphasized the need for compassion in addressing the city’s overdoses and drug use.

“We have to accept at some level that drug use is happening in our community, and that neighbors and friends and family are often involved,” said Dalal. “And one of the things that holds us back the most is the stigmatization, and in many cases, the criminalization of the activity that results in more harm than not. So my sense is that if we can change the conversation, reduce the stigma around it and reduce the kind of the criminal-oriented approach with it, we’re gonna get a much better handle on this.”

The New Haven Harm Reduction Task Force convened for a regular monthly meeting last Friday.

Clay Jamieson | clay.jamieson@yale.edu