A State Project to Map Overdoses in Real Time

The Statewide Opioid Reporting Directive, or SWORD, began as a pilot project in Hartford in 2018.

The Statewide Opioid Reporting Directive, or SWORD, began as a pilot project in Hartford in 2018. Shutterstock


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A statewide project in Connecticut takes reports of suspected opioid overdoses from first responders and maps them in real time, helping community partners better direct their services to high-risk areas.

First responders in Connecticut reported 4,505 suspected opioid overdoses and 131 spikes in cases during the first year of a statewide reporting program, according to an annual report from the Connecticut Department of Public Health.

The initiative—known as the Statewide Opioid Reporting Directive, or SWORD—aims to track suspected overdoses in real time, creating an early warning system that pinpoints high-risk areas to help community partners direct their services to the neighborhoods that need them most. The system, which debuted in June 2019, is so far helping agencies distribute their limited resources more effectively, said Peter Canning, EMS coordinator for the University of Connecticut’s John Dempsey Hospital.

“For the first time, we have near real-time overdose data directly reported by first responders that enables us to act quickly to respond to overdose spikes and bad batches, resulting in lives saved,” he said in a statement. “The data is not only providing near real-time actionable intelligence for our public health efforts, but detailed data to help us better understand how to fight the ever-changing opioid crisis.”

The program, created by a 2018 state law, is an expansion of a pilot that began as a way to improve surveillance of opioid overdoses in the city of Hartford. The current project, a collaboration between state and local health and safety officials, starts by having hospitals and EMS crews to report all suspected opioid overdoses to the Connecticut Poison Control Center. Specialists there plug the data onto a map via a federal web-based tracking application, which allows “local, state and federal public health and public safety agencies to rapidly respond to overdoses in their respective communities,” the report said.

In the project’s first year, from June 2019 through May 2020, Hartford County recorded 1,590 suspected overdoses, the most in the state, followed by New Haven County (1,006) and Fairfield County (831). EMS crews reported 4,505 suspected overdoses but just 337 fatalities, far less than the actual number of drug-related deaths throughout Connecticut (there were 531 overdose deaths in just the first six months of 2020, according to data from the state health department).

Underreporting of fatal overdoses is a known and expected issue, according to the report, “because without (drug) paraphernalia or eyewitness accounts, EMS has no way to determine cause of death. Additionally, patients may pass away later at the hospital after the call has already been reported as nonfatal.”

Compliance is also less than 100% among EMS agencies. Only 17 of the 27 agencies asked to participate in the project routinely submit data, and compliance among those 17 topped out at 74% in February before falling to 62% in May. 

“This lack of compliance reporting creates limitations in the representativeness of the data and knowledge gaps across the state, as well as risks associated with delayed detection of spikes,” the report said.

But any amount of data is useful in targeting resources to combat the opioid epidemic, officials said. For example, data collected by first responders showed that males accounted for 74% of overdoses in the state, and people between the ages of 25 and 39 were most likely to overdose. In cases where the “drug of exposure” was known, the vast majority of overdoses (87%) were due to heroin or fentanyl. Those details provide a crucial framework for first responders and community programs to work from, said Dr. Richard Karmin, EMS program director at UConn Health.

“The SWORD data enables us to identify overdose hotspots so we can better target our outreach, education, and naloxone training efforts,” he said in a statement. “The demographic information about who is overdosing provides us with actionable data on who is most at risk for overdose so we can better target our limited resources.”

Kate Elizabeth Queram is a staff correspondent with Route Fifty and is based in Washington, D.C.

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