{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T23:28:18Z","timestamp":1791588498681,"version":"4.3.4"},"reference-count":16,"publisher":"SAGE Publications","issue":"1_suppl","license":[{"start":{"date-parts":[[2021,11,1]],"date-time":"2021-11-01T00:00:00Z","timestamp":1635724800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Public Health Rep"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:p>In 2019, Connecticut launched an opioid overdose\u2013monitoring program to provide rapid intervention and limit opioid overdose\u2013related harms. The Connecticut Statewide Opioid Response Directive (SWORD)\u2014a collaboration among the Connecticut State Department of Public Health, Connecticut Poison Control Center (CPCC), emergency medical services (EMS), New England High Intensity Drug Trafficking Area (HIDTA), and local harm reduction groups\u2014required EMS providers to call in all suspected opioid overdoses to the CPCC. A centralized data collection system and the HIDTA overdose mapping tool were used to identify outbreaks and direct interventions. We describe the successful identification of a cluster of fentanyl-contaminated crack cocaine overdoses leading to a rapid public health response. On June 1, 2019, paramedics called in to the CPCC 2 people with suspected opioid overdose who reported exclusive use of crack cocaine after being resuscitated with naloxone. When CPCC specialists in poison information followed up on the patients\u2019 status with the emergency department, they learned of 2 similar cases, raising suspicion that a batch of crack cocaine was mixed with an opioid, possibly fentanyl. The overdose mapping tool pinpointed the overdose nexus to a neighborhood in Hartford, Connecticut; the CPCC supervisor alerted the Connecticut State Department of Public Health, which in turn notified local health departments, public safety officials, and harm reduction groups. Harm reduction groups distributed fentanyl test strips and naloxone to crack cocaine users and warned them of the dangers of using alone. The outbreak lasted 5 days and tallied at least 22 overdoses, including 6 deaths. SWORD\u2019s near\u2013real-time EMS reporting combined with the overdose mapping tool enabled rapid recognition of this overdose cluster, and the public health response likely prevented additional overdoses and loss of life.<\/jats:p>","DOI":"10.1177\/00333549211015662","type":"journal-article","created":{"date-parts":[[2021,11,2]],"date-time":"2021-11-02T16:23:32Z","timestamp":1635870212000},"page":"18S-23S","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":30,"title":["Using Surveillance With Near\u2013Real-Time Alerts During a Cluster of Overdoses From Fentanyl-Contaminated Crack Cocaine, Connecticut, June 2019"],"prefix":"10.1177","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5929-9997","authenticated-orcid":false,"given":"Peter","family":"Canning","sequence":"first","affiliation":[{"name":"Emergency Department, UConn John Dempsey Hospital, Farmington, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Doyon","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Connecticut Poison Control Center, UConn Health, Farmington, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Ali","sequence":"additional","affiliation":[{"name":"Overdose Response Strategy, New England High Intensity Drug Trafficking Area, Methuen, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan B.","family":"Logan","sequence":"additional","affiliation":[{"name":"Injury and Violence Surveillance Unit, Community, Family Health and Prevention Section, Connecticut State Department of Public Health, Hartford, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aliese","family":"Alter","sequence":"additional","affiliation":[{"name":"Washington\/Baltimore High Intensity Drug Trafficking Area, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Hart","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Connecticut Poison Control Center, UConn Health, Farmington, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaella","family":"Coler","sequence":"additional","affiliation":[{"name":"Office of Emergency Medical Services, Connecticut State Department of Public Health, Hartford, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Kamin","sequence":"additional","affiliation":[{"name":"Office of Emergency Medical Services, Connecticut State Department of Public Health, Hartford, CT, USA"},{"name":"Department of Emergency Medicine, UConn Health, Farmington, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven C.","family":"Wolf","sequence":"additional","affiliation":[{"name":"UConn School of Medicine, Farmington, CT, USA"},{"name":"Frank H. Netter MD School of Medicine, Quinnipiac University, Hamden, CT, USA"},{"name":"Saint Francis Hospital and Medical Center, Hartford, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Soto","sequence":"additional","affiliation":[{"name":"Infectious Disease Section, Connecticut State Department of Public Health, Hartford, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Whiteman","sequence":"additional","affiliation":[{"name":"Washington\/Baltimore High Intensity Drug Trafficking Area, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Greater Hartford Harm Reduction Coalition, Inc, Hartford, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,11,2]]},"reference":[{"key":"bibr1-00333549211015662","unstructured":"US Census Bureau. QuickFacts: Connecticut. Accessed October 19, 2020. https:\/\/www.census.gov\/quickfacts\/CT"},{"key":"#cr-split#-bibr2-00333549211015662.1","unstructured":"US Census Bureau. United States Summary: 2010-Population and Housing Unit Counts: 2010 Census of Population and Housing. US Department of Commerce, Economics and Statistics Administration"},{"key":"#cr-split#-bibr2-00333549211015662.2","unstructured":"2012. Accessed October 19, 2020. https:\/\/www.census.gov\/prod\/cen2010\/cph-2-1.pdf"},{"key":"#cr-split#-bibr3-00333549211015662.1","unstructured":"US Department of Justice, Drug Enforcement Administration. 2018 National Drug Threat Assessment. DEA-DCT-DIR-032-18. US Department of Justice"},{"key":"#cr-split#-bibr3-00333549211015662.2","unstructured":"October 2018. Accessed October 19, 2020. https:\/\/www.dea.gov\/sites\/default\/files\/2018-11\/DIR-032-18 2018 NDTA %5Bfinal%5D low resolution11-20.pdf"},{"key":"bibr4-00333549211015662","unstructured":"Centers for Disease Control and Prevention. Opioid overdose: Enhanced State Opioid Overdose Surveillance (ESOOS). Accessed May 27, 2020. https:\/\/www.cdc.gov\/drugoverdose\/foa\/state-opioid-mm.html"},{"key":"bibr5-00333549211015662","unstructured":"Conn Gen Stat Volume 6, Title 19a, Ch 368a, \u00a7 19a-127q."},{"issue":"6","key":"bibr6-00333549211015662","first-page":"293","volume":"83","author":"Canning P.","year":"2019","journal-title":"Connecticut Med"},{"key":"bibr7-00333549211015662","unstructured":"Standards for privacy of individually identifiable health information.\n                      Fed Reg\n                      . 2001;65(250):16. Accessed October 19, 2020. https:\/\/aspe.hhs.gov\/system\/files\/pdf\/133026\/PvcFR04_1.pdf"},{"key":"bibr8-00333549211015662","doi-asserted-by":"publisher","DOI":"10.1111\/ajad.12384"},{"key":"bibr9-00333549211015662","unstructured":"Legislative Analysis and Public Policy Association. ODMAP and protected health information under HIPAA: guidance document. 2020. Accessed October 19, 2020. http:\/\/www.odmap.org\/Content\/docs\/training\/featured\/ODMAP-Data-Privacy-Guidance-Document.pdf"},{"key":"bibr10-00333549211015662","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6537a6"},{"key":"bibr11-00333549211015662","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1809521"},{"key":"bibr12-00333549211015662","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2017.1387628"},{"key":"bibr13-00333549211015662","unstructured":"Hanoian A. Hartford Opioid Project Marketing Analysis Report. Connecticut Poison Control Center; January 2019."},{"key":"bibr14-00333549211015662","unstructured":"Connecticut Department of Public Health, Office of Emergency Medical Services.\n                      Statewide Opioid Reporting Directive (SWORD) 2020 Annual Report\n                      . Connecticut Department of Public Health; 2020. Accessed October 19, 2020. https:\/\/portal.ct.gov\/-\/media\/Departments-and-Agencies\/DPH\/dph\/ems\/pdf\/SWORD\/SWORD-newsletters\/2020\/20200812-SWORD-Annual-ReportFINAL.pdf"}],"container-title":["Public Health Reports\u00ae"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00333549211015662","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00333549211015662","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00333549211015662","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T09:37:06Z","timestamp":1777628226000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00333549211015662"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11]]},"references-count":16,"journal-issue":{"issue":"1_suppl","published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1177\/00333549211015662"],"URL":"https:\/\/doi.org\/10.1177\/00333549211015662","relation":{},"ISSN":["0033-3549","1468-2877"],"issn-type":[{"value":"0033-3549","type":"print"},{"value":"1468-2877","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11]]}}}