State health officials flagged a new, worrisome potential trend last month.
Between July and October, first responders in Connecticut saved 39 people with the opioid overdose-reversing drug naloxone who, once revived, denied using any opioids. They said they’d only smoked marijuana.
“Well, Narcan only works on one drug,” Glenn Arremony, a 30-year veteran with American Ambulance in Norwich, said, using the common brand name for naloxone.
At least 10 of those cases were in Norwich and surrounding areas.
In early October, police in Plymouth secured a sample of marijuana linked to a suspected incident. The state’s forensics lab confirmed it tested positive for fentanyl along with marijuana and the psychoactive ingredient found in cannabis, Delta-9-Tetrahydrocannabinol.
“This is the first lab-confirmed case of marijuana with fentanyl in Connecticut and possibly the first confirmed case in the United States,” said Department of Public Health Commissioner Dr. Manisha Juthani in the press statement.
Fentanyl is a dangerous and potent synthetic opioid that has been linked to increased overdoses in recent years. It is often found in heroin doses.
At least 10 of the 11 July incidents were non-fatal and occurred in the greater Norwich area, defined as stretching south from Groton to as far north as Willimantic, according to Department of Public Health Communications Director Chris Boyle, who added, “less than six” happened within Norwich city limits.
The chemical makeup of the substances on which those individuals overdosed, including whether or not they contained fentanyl, was not lab-tested.
What Norwich police are seeing
The Norwich Police Department received notification about the Plymouth case but Lt. Anthony Gomes said members of the Norwich police narcotics unit were not aware of the local cases reported by state health officials.
“[There is] nothing from the detective division indicating that there is a bad batch of marijuana out there,” he said.
Norwich police are not required to carry naloxone on duty but roughly 10 officers are trained to do so.
A 2011 “Good Samaritan Law” means individuals who report an overdose are protected from arrest for possession of drugs. As a result, Gomes said police would only investigate an overdose incident if there is a fatality or if a cooperative victim is willing to work with the police. In those cases, police attempt to use a victim’s cellphone to help identify “the drug dealer and potentially charge that person with causing the death of another person.”
The Norwich lieutenant wondered if those claiming they only used cannabis were being truthful and speculated on the “variables” behind marijuana production for the illegal market, noting police find traces of opioids on other items they seize, including money.
“That is very common for money to test positive for fentanyl,” said Gomes.
“My guess is if you are a drug dealer and you sell weed and fentanyl, and you keep your fentanyl and weed in the same container and always are reaching for the same items to sell then everything is going to test positive for fentanyl.”
Narcan and the fight to stop overdoses
Arremony said he and his colleagues have used Narcan, the most common brand of naloxone, over 200 times so far in 2021.
Showing a reporter how the drug is used, either intravenously or sprayed through a victim’s nostril, he explained how paramedics collect information on the variety of opioid overdose incidents they encounter.
“Routinely people will, when they are under the influence of an opioid and when they are resuscitated or revived with Narcan administration, they will come up and we will ask them questions,” Arremony said last week. “They become alert pretty quickly, and we will say ‘did you do any opioid’ and they will either say ‘yeah, this is what I did,’ or they will say ‘no, I didn’t do it.’”
When it works, the revival happens “within a couple of minutes,” and Arremony said.
While he or another EMT might offer resources for the victim to get help, “we don’t spend a lot of time with them to really get into the social aspect of it.”
When it comes to the marijuana-related overdoses that happened locally, he doubted they were deliberate, and suggested most could be attributed to “cross-contamination.”
“Some have said that ‘all I did was smoke marijuana tonight but I did some cocaine but I don’t do opioids’ — that has been relayed to us,” Arremony explained. “We just know that they are not breathing, so we are going to breathe for them, and we are going to give them Narcan.”
Whatever the circumstances of the 39 incidents reported by the state’s Department of Public Health last month, they come with an alarming and devastating rise in overdose deaths in the state and nationwide, particularly those linked to fentanyl.
According to data recently released by the U.S. Centers for Disease Control, there were an estimated 100,306 drug overdose deaths in the United States during the 12-month period ending in April 2021 – a record high for the country and an increase of 28.5% from the 78,056 deaths during the same period the year before.
In Connecticut, the Department of Public Health reported 1,378 fatal drug overdoses in the calendar year 2020 – a 14.6% increase from 2019 – with 91% of those deaths involving fentanyl.
A growing problem?
As a professor and the Department Chair of Public Health at Yale University, Jason Hockenberry’s wide-ranging research includes studying the interplay between cannabis liberalization policies and the opioid epidemic.
On the Plymouth case, he pointed out this was the first-ever documented overdose incident in the U.S. where marijuana was seized, collected, tested and found to be positive for fentanyl.
“This is a sentinel moment and that is probably why the police didn’t have a lot of information because [they] and the U.S. Drug Enforcement Administration is still trying to digest this,” Hockenberry said.
Like local first responders, the public health expert suspected most of the overdose cases related to marijuana came inadvertently.
“At some point, I would expect to see a seizure in the region where there are large quantities of things already cut [with fentanyl],” he added. “Otherwise it’s a cross-contamination story.”
Though marijuana possession is legal in Connecticut, Hockenberry said it could be more than 18 months before the state sees its first recreational use sale, as public health officials, policy experts, lawmakers and members of law enforcement work together to set parameters and hammer out details over how the industry will operate.
“My sense is that when we get to a point where there are dispensaries in Connecticut and things are fully legal, most [marijuana] users are going to go to the dispensaries,” Hockenberry said.
That will cut down on unintentional substances in marijuana used by Connecticut residents.
“I would say it’s still going to be feasible and possible that you are still going to find these cases, but I can’t imagine it will be a big issue,” he added.