Note: This story was originally published on April 4, 2019.

Fentanyl is killing black people in Connecticut at the same rate as whites for the first time since state officials began tracking the epidemic around 2012, a CT Mirror analysis has found.

There is no clear consensus among experts in Connecticut as to what is driving up the death rate among African Americans. But some researchers and medical professionals point to the proliferation of fentanyl in inner cities and the state’s declining prison population as possible reasons for the increase.

Initially, fentanyl-related overdoses impacted whites at higher rates than blacks and Hispanics, but the most recent data from the state’s Office of the Chief Medical Examiner shows the gap between blacks and whites has vanished.

In 2018, the fentanyl-related death rate for both blacks and whites was around 23 per 100,000 residents in Connecticut, according to the Mirror’s analysis of records published by the state medical examiner. The rate among Hispanics in Connecticut was lower, around 18 per 100,000 — but still high compared with an overall rate for all groups of 6 per 100,000, according to a new report by the CDC.

The CDC report found, among other trends, that fentanyl-related death rates nationwide have risen fastest among black and Hispanic populations from 2011 through 2017.

The opioid crisis, once associated with predominantly white small towns and suburbs, has been moving to cities and claiming the lives of African Americans at unprecedented rates. A 2018 Washington Post investigation found that, unlike the white overdose victims who have been the focus of the national debate, the epidemic’s new casualties are seldom young and were not first hooked by doctors prescribing pain pills. Rather, they are veteran, urban drug users caught off guard by the sudden lethality of drugs like heroin that they once used with relative safety.

“Illicit synthetics like fentanyl have surpassed heroin as the leading killer,” said Dr. J. Craig Allen, an addiction expert and medical director of the Rushford Center in Connecticut. “Because of their inexpensiveness, their easy access and their potency, they have been adulterating other drugs and sometimes masquerading as other drugs.”

That has made it difficult for many users to know what they’re buying.

“You can’t tell what’s in it. People aren’t going out there and buying fentanyl. They’re buying whatever their local dealer happens to have available, some of which may be heroin, some of which may be fentanyl, some of which may be mixed,” said Robert Heimer, a professor of epidemiology and pharmacology at the Yale School of Public Health.

“The trafficking of these drugs is more common in urban areas where there are concentrations of African Americans and other minorities relative to the whiter parts of the state,” he added, “so it’s not surprising that both in Connecticut and nationally, after a relatively long period of stable overdose deaths among African Americans, the rates are going up.”

In addition, the state’s rapidly declining prison population — disproportionately made up of minorities — has caused many to re-enter society with untreated opioid use disorder, experts said. The number of people behind bars dwindled to 13,228 in January, down from a peak of 19,413 in July 2008.

“We have found here in Connecticut and elsewhere in the world this is a problem — that the first three weeks or so after people are released from prison, their chances of dying are extremely high if they reinitiate opioid use,” Heimer said. “They come out … they go back to using opioids and use far more than is needed considering their state of lower tolerance. And because they are ashamed of relapsing, they tend to use those drugs alone, so there’s no one there to call 911 or administer naloxone and save them.”

The state correction department has cited some of its programs, like methadone initiatives for people in different stages of recovery, as progress, but officials in the academic and medical fields have pushed for more to be done.

“The trafficking of these drugs is more common in urban areas where there are concentrations of African Americans and other minorities … so it’s not surprising that both in Connecticut and nationally, after a relatively long period of stable overdose deaths among African Americans, the rates are going up.”

Robert Heimer
Professor of epidemiology and pharmacology
Yale School of Public Health

The legislature is considering several bills that would require counseling or medication-assisted treatment for inmates with opioid use disorder.

In written testimony to lawmakers, Asadullah Awan, a doctor at Yale New Haven Hospital, said of the more than 1,000 residents who died of opioid overdoses in 2017, more than half of them were formerly incarcerated people.

Ex-offenders are eight to 11 times more likely to overdose during the first few weeks post-release, Awan wrote, yet most state prisoners have no access to medication-assisted treatment and there is little help in connecting those people with resources upon their departure.

A significant problem

The rise of fentanyl in Connecticut has been staggering, and the state sits squarely in the nation’s hardest-hit region.

New England has led the country in fentanyl-related drug overdoses. The rate of overdose deaths in New England reached 20 per 100,000 in 2017, according to the CDC report. The next-highest rate is 12 per 100,000 in a region that spans from Pennsylvania down to Virginia. Sandwiched between the two regions, New York and New Jersey have a rate of around 8 deaths per 100,000 residents.

In 2012, there were around 0.4 deaths in Connecticut per 100,000 residents of all racial and ethnic groups combined, but by 2018 that rate had ballooned to 21. Fentanyl is now involved in most drug deaths, and the number of fentanyl deaths has continued to increase even as overall drug deaths decreased for the first time in 2018.

On Monday, the Connecticut Conference of Municipalities, the chief lobbying arm for the state’s cities and towns, said the opioid crisis has forced many communities to take on additional costs for overdose-related health needs. That has included spending more money on police and fire services, addiction programs and NARCAN, a medication used to treat overdoses in emergency situations.

The group called on state leaders to direct more resources to municipalities for prevention, education and recovery efforts.

The same day, Gov. Ned Lamont unveiled a new campaign aimed at increasing awareness to opioid addiction and available treatments. At the center of the campaign is a mobile application that tells its users how to administer NARCAN and where to find it. A series of radio spots and billboards are also planned.

“We can’t allow opioid addiction to continue consuming our families and residents,” Lamont said. “There are resources available to help no matter what stage individuals find themselves in.”

Jenna is CT Mirror’s Health Reporter, focusing on health access, affordability, quality, equity and disparities, social determinants of health, health system planning, infrastructure, processes, information systems, and other health policy. Before joining CT Mirror Jenna was a reporter at The Hartford Courant for 10 years, where she consistently won statewide and regional awards. Jenna has a Master of Science degree in Interactive Media from Quinnipiac University and a Bachelor or Arts degree in Journalism from Grand Valley State University.

Jake was Data Editor at CT Mirror. He is a former managing editor of The Ridgefield Press, a Hersam Acorn newspaper. He worked for the community newspaper chain as a reporter and editor for five years before joining the Mirror staff. He studied professional writing at Western Connecticut State University and is a graduate student in software engineering at Harvard Extension School.

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