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Connecticut Department of Public Health

Drug Overdose Monthly Report Fatal Unintentional and Undetermined Overdose Report Key Findings of Drug Overdose Decedents, 2019 – March 2021 • Current monthly report is based on confirmed fatal drug overdose cases for 2019, 2020 and January through March 2021. Statistics may change for 2021 as confirmation of cases occurs periodically. Period of analysis includes January 2019 through the middle of March 2021. • The final and total number of fatal drug overdoses for 2020 was 1372, with an increase of 14.3% from the previous year, 2019. • There were 250 confirmed and 255 pending cases for 2021, as of the middle of March. • In 2019, there were 1,202 unintentional and undetermined drug overdose related . • New and emerging substances: Lethal combinations of xylazine, an animal tranquilizer, with were identified in 2019 and continued in 2020. The same combination trends for 2021 also. In 2020, new emerging substances, Flualprazolam, a designer , in combination with fentanyl resulted in 10 overdose deaths and Eutylone, a synthetic , resulted in 3 overdose deaths. Para-fluorofentanyl, a fentanyl analog was present in 13 overdose deaths in 2020 and 20 in 2021 as of the middle of March.

Comparative Overview of Unintentional and Undetermined Drug Overdose Deaths (January 2019 – March 2021) 2020 and 2021 2019 There were 1,372 confirmed drug overdose There were 1,202 unintentional and deaths for 2020, with an increase of 14.3% undetermined drug overdose deaths in 2019, compared to 2019. As of the middle of March, with an increase of 16.7% compared to 2018. there were 250 confirmed drug overdose deaths for 2021 with 255 pending cases. The lethal combination of xylazine and fentanyl For the first time in 2019, xylazine/fentanyl resulted in 141 deaths in 2020 with a median combinations were involved in 71 drug overdose number of 11 and continues to be a problem in deaths. The median number for xylazine-involved 2021. Between January and the middle of March deaths was 7. 2021, there were 37 deaths involving a fentanyl+ xylazine combination. The average percentage of fentanyl-involved On average, fentanyl or fentanyl analogs were deaths was at 85% for 2020 and 80% as of the involved in 82% of the overdose deaths in 2019. middle of March 2021. Updated on 4-9-2021; Data Source: Connecticut Office of the Chief Medical Examiner (OCME), per CDC-SUDORS grant guidelines For information visit: https://www.drugfreect.org. For information on the CT DPH and Prescription Drug Overdose Prevention Program in the Office of Injury and Violence Prevention, visit: https://www.ct.gov/dph/injuryprevention

Unintentional and undetermined drug overdose deaths, by month, Connecticut, 2019 – February 2021*: There was a 14.6% increase in unintentional and undetermined drug overdose deaths in 2020 in Connecticut, compared to 2019. In 2021, January had 128 and February had 96 confirmed drug overdose deaths and this number may increase as there are 71 cases pending for confirmation for these two months. The chart below represents the monthly count of confirmed drug overdose deaths. Number of Drug Overdose Deaths, by Month, Connecticut, 2019 - February 2021* 133 137 134 140 128 121 121 122 123 127 106 106 114 110 114 120 96 105 101 103 98 90 94 89 100 80 81 85 86 80 60 40

NumberofDeaths 20 0 Jan Feb March April May June July Aug Sept Oct Nov Dec

2019 2020 2021* *Data subject to change

The percentage of fentanyl-involved overdose deaths continued to be a problem in 2021: Fentanyl-involved overdose deaths increased significantly in 2019 to 82%, compared to the previous years of 2015 to 2018. In 2020, the average percentage of fentanyl- involved deaths further increased to 85%. As of the middle of March 2021, the percentage of fentanyl involved deaths was 80% and it may change due to pending cases. The chart below represents the percentage of fentanyl-involved deaths by month.

Percentage of Fentanyl Involved Overdose Deaths, by Month, Connecticut, 2019 - February 2021* 120 91.2 87.6 90.1 84.1 88.5 86.6 88.3 82.7 83.5 86.2 84.7 87.4 80.2 80 85.4 86.1 78.1 84.3 81.2 80.9 83.1 79.7 76.5 75.6 74.3 76.4 62.5

Percentage 40

0 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec *Data subject to change 2019 2020 2021*

Xylazine, a veterinary tranquilizer, identified as an emerging novel substance in drug intoxication deaths in Connecticut since 2019 – February 2021*: To enhance drug effects, recreational are often adulterated with other pharmacological agents such as xylazine, a veterinary not intended for human use. In Connecticut, in March 2019, xylazine was identified as a novel and emerging in fatal drug intoxications when combined with fentanyl; it continues to be a problem in 2021. There were 71 xylazine-involved deaths in 2019 and 141 in 2020. In 2021, January had 19 and February had 16 xylazine + fentanyl combination deaths and these numbers may change because of pending cases. The below chart represents the number of xylazine-involved deaths by month.

Number of Xylazine Involved Overdose Deaths, By Month, Connecticut, 2019 - February 2021*

25 21 19 18 20 16 15 14 15 12 13 10 11 9 9 8

10 6 7 Number 9 8 10 5 7 0 0 1 7 6 5 5 0 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

*Data subject to change 2019 2020 2021*

Drug overdose rates were higher in males compared to females in 2019 – 2020: Rates of unintentional and undetermined drug overdose-related death were consistently higher among males when compared to females. The graph below represents rates of unintentional and undetermined drug overdose death by gender (rate per 100,000 gender-specific population) for 2019 and 2020.

Drug Overdose Mortality Rates, by Gender, Connecticut, 2019 - 2020 (Rate/100,000 gender-specific population)

58.1 51.4 60.0

40.0 15.3 18.6

20.0

0.0

2019 2020 Rate per 100,000 population 100,000 per Rate Male Female

Drug overdose death rates were higher among the non-Hispanic White and non- Hispanic Black populations compared to the Hispanic population in Connecticut, 2019 – 2020: Drug overdose death rates were highest among non-Hispanic White and non- Hispanic Black populations compared to the Hispanic population during 2019 and 2020. However, in 2020, the drug overdose mortality rate substantially increased in the non-Hispanic Black population compared to the previous year. The graph below represents the unintentional and undetermined drug overdose mortality rate in Connecticut, by race/ethnicity for years 2019 and 2020.

Drug Overdose Mortality Rates, by Race/Ethnicity, Connecticut, 2019-2020 (Rate/100,000 Race-specific population)

51.9 60.0 39.7 36.4 34.0 36.5 40.0 31.0

11.2

20.0 9.2 Rateper 100,000 0.0 Non Hispanic Non Hispanic Hispanic Other* White Black 2019 2020 *Other includes American Indian or Alaska Native, Asian or Pacific Islander or Unknown Drug overdose death rates were highest in the 35-44 year old age group in Connecticut, 2019 – 2020: Drug overdose death rates were calculated per 100,000 age specific population and they were highest among the 35-44 year age group followed by 25-34 and 45-54 year age groups. The graph below represents the unintentional and undetermined drug overdose mortality rate in Connecticut, by age, by year.

Drug Overdose Mortality Rates, by Age, Connecticut, 2019 - 2020 (Rate/100,000 Age-specific population)

100.0 82.2 68.1 75.2 62.5 62.5 54.3 54.1 45.6 50.0 10.1 6.0 7.8 7.1

Rateper 100,000 0.0 <25 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 65+ 2019 2020

Drug overdose death rates in Connecticut, by County, 2019 – 2020: The graph below represents the unintentional and undetermined drug overdose mortality rate in Connecticut, by county, by year. During this period, New Haven County (44.8) had the highest rate followed by New London County (41.9), Windham County (40.2), Litchfield County (38.8), Hartford County (37.3), and Middlesex County (39.4). In 2020, the lowest overdose death rate was seen in Fairfield County (22.0) followed by Tolland County (25.2). Overall, except Litchfield County, all other counties had an increase in drug overdose death rate in 2020, when compared to 2019.

Drug Overdose Mortality Rates, by Resident County, Connecticut, 2019 - 2020 (Rate/100,000 county-specific population) 44.8 42.6 41.1 45.0 40.5 38.8 40.2 37.5 35.1 36.9 38.1 40.0 34.3 35.0 30.0 22.3 23.4 25.2 25.0 17.6 19.2 20.0 15.0

Rateper 100,000 10.0 5.0 0.0 Fairfield Hartford Litchfield Middlesex New New Tolland Windham Haven London

2019 2020