City of Waterbury
Unified Public Safety Response
to Opioid Crisis

The opioid crisis has become the worst drug epidemic in modern American history. Connecticut's age-adjusted death rate from opioid overdoses was 27.7 deaths per 100,000 people in 2017—the ninth highest of all states. New Haven County's death rate in 2017 was even higher: 31.5 deaths per 100,000 people.

“No one and no worksite is safe from the possibility of encountering opioid overdose, and therefore preparedness is of the utmost importance.”

—Adam Rinko, Director of Emergency Management, Waterbury Fire Department

Opioids are a class of drugs that include prescription painkillers as well as the illegal drug heroin. Potent synthetic opioids, including fentanyl and carfentanil, are increasingly sold on the black market, alongside or mixed with heroin, driving the death rate still higher. 

Characteristics of overdose death victims vary in Waterbury, Greater Waterbury, and Connecticut.

Data on overdose victims between 2016 and 2018 shows several patterns in both Waterbury and Connecticut. Most are men, and most are not homeless. Naloxone, a lifesaving medication that can counter opioid overdoses, was administered in roughly a third of cases—and among those cases, most often by first responders.

Some variation exists between Waterbury residents, Waterbury occurents (Greater Waterbury visitors/nonresidents that overdose and die in Waterbury), and Connecticut as a whole—though because of the small sample sizes in the city and region, these differences should be interpreted with caution.

Demonstration of naloxone (Narcan) administration.

Choose a category of characteristics to compare:

Hover over a segment of the bar chart to see the number of deaths for that location and characteristic. (Deaths are totals for the three-year period between 2016 and 2018.)

Opioids form nearly half of suspected overdose-related emergency department visits in Connecticut.

Heroin, in turn, was suspected for roughly half of opioid-related emergency department (ED) visits. ED visits from overdoses spiked in the summer of 2018. Note that the three categories shown here are not mutually exclusive. 

Opioid prescriptions have declined since 2012. 

Health experts trace the roots of the opioid crisis to the over prescription of opioid pain relievers, beginning in the late 1990’s. It is now widely acknowledged that many prescription opioids are dangerously addictive. Doctors are now taking steps to limit their distribution. Since 2010, the amount of opioids prescribed in the United States has decreased each year. 

Prescription rate data collected and published by the CDC shows New Haven County and the state of Connecticut following national trends. The state had 48.9 opioid prescriptions per 100 people in 2017, lower than the U.S. rate. 

But legal prescription opioids are just one side of the epidemic. Even as the prescription opioid supply is constrained, the illegal supply has rapidly expanded to meet the demand. Heroin and black-market fentanyl are often cheaper and more accessible than legal prescription opioids. Studies have shown that prescription opioid use is a strong predictor of later heroin use: three out of four new heroin users have reported previously abusing prescription opioids.

How Greater Waterbury is Responding

In October 2016, Governor Dannel Malloy announced the Connecticut Opioid REsponse (CORE) Initiative, a statewide strategy to address the opioid crisis in Connecticut. In Waterbury, Mayor Neil M. O’Leary's Opioid Task Force developed an opioid response plan even prior to the State CORE program. When the City of Waterbury received a 3 year, $90,000 grant ($30,000/year) to deliver selected CORE strategies, the funding enabled the Waterbury Public Safety Departments to implement the plan developed by the Mayor’s Opioid Task Force. 

The Public Safety Departments—the Waterbury Fire Department, the Waterbury Health Department, and the Waterbury Police Department—work in close collaboration and within their individual areas of strength and jurisdiction on the Waterbury CORE Program. The Waterbury CORE program focuses on increasing Safe Use—Safe Storage—Safe Disposal of prescription opioids, and community recognition and ability to respond to opioid overdoses. In addition, the Housatonic Valley Coalition Against Substance Abuse holds trainings for the public.

Adam Rinko, Director of Emergency Services, presenting at the 2018 CT Opioid and Prescription Drug Overdose Prevention Conference.

“Our training program ensures that worksites are prepared and that employees understand and practice how easy it is to administer naloxone. During an opioid overdose, the victim’s impulse to breathe waivers and they can die because they stop breathing. Naloxone administered by a bystander helps to keep the victim alive and breathing until first responders can arrive.”

Adam Rinko, Director of Emergency Management, Waterbury Fire Department

Waterbury Mayor Neil O’Leary receiving award for his work in the community.

Rx Drug Drop Box located at Waterbury Police Community Relations.

Naloxone Training at Alpha Omega Kingdom Ministries.

Shock n’ Awe smoke shop naloxone training.

“Shirt stuffers” Waterbury first responders leave with people who have overdosed and their families to promote getting into treatment.

Naloxone training flyer for businesses, community groups and organizations.

The National Survey on Drug Use and Health shows heightened risks for Connecticut children and young adults. 

Based on data from the National Survey on Drug Use and Health, Connecticut's rate of pain reliever misuse is roughly the same as the nation's. The age breakdown in the survey show that young adults are the most at-risk population.

Misuse is defined as use in any way not directed by a doctor, including use without a prescription of one's own; use in greater amounts, more often, or longer than told; or use in any other way not directed by a doctor. 

To aid in the prevention of prescription drug misuse and abuse, the City of Waterbury takes a unified public safety approach across Waterbury Fire, Police and Health Departments in promoting safe use, safe storage and safe disposal of prescription medications. 

The survey also asks participants their views on the risks of trying heroin. Again, Connecticut's data is not significantly different from the nation as a whole, but clear differences emerge between different age groups. Children in particular show much less awareness of the risks of trying heroin. Only about 66% of Connecticut children aged 12 to 17 perceived trying heroin once or twice as a "great risk."

Waterbury Public Schools recently hosted a series of H.E.A.T. (Heroin Education Action Team) assemblies, educating children and parents about the dangers of opioid addiction.  

Prescription drop box located at a Waterbury Police Department.

Perceptions of Great Risk from Trying Heroin Once or Twice: by Age (2016-2017)

Source: National Survey on Drug Use and Health

“We all have fire extinguishers in our homes and workplaces, even though not everyone is a firefighter, but we are prepared with the fire extinguishers because we understand the importance of immediate response in an emergency. We want employers, employees and really everyone to see that preparedness for an opioid overdose is very similar.”

—Adam Rinko

Additional Resources

• City of Waterbury Public Health Department. Site for those seeking more information about opioid overdoses and resources for treatment. 

• CDC: Understanding the Epidemic. Hub for opioid information from the Centers for Disease Control and Prevention.

About the Data

Mortality data was queried from CDC WONDER based on the following combinations of ICD-10 codes:

• For opioid deaths — UCD codes: F11.0, X40-X44, X60-X64, X85, Y10-Y14; MCD codes: T40.0-T40.4, T40.6

• For heroin deaths — UCD codes: X40-X44, X60-X64, X85, Y10-Y14; MCD codes: T40.1.

• For fentanyl/synthetic opioid (excluding methadone) deaths — UCD codes: X40-X44, X60-X64, X85, Y10-Y14; MCD codes: T40.4

Prescription data was published by the CDC (link). The CDC's source for this data was IQVIA Xponent 2006–2017. "IQVIA Xponent is based on a sample of approximately 50,000 retail (non-hospital) pharmacies, which dispense nearly 90% of all retail prescriptions in the United States. For this database, a prescription is an initial or refill prescription dispensed at a retail pharmacy in the sample and paid for by commercial insurance, Medicaid, Medicare, or cash or its equivalent. This database does not include mail order pharmacy data."

NSDUH data—for both "pain reliever misuse" and "perceptions of great risk" for heroin—was reported by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Video: Adam Rinko trains Waterbury Health Department staff on how to use Narcan.

Video: Narcan Information from Lieutenant Myers