© Mark Mirko/Hartford Courant/TNS Hartford police officers investigate the scene of a suspected drug overdose in Hartford on Wednesday, Feb. 19, 2020. Mark Jenkins, of the Greater Hartford Harm Reduction Coalition, is at right.

HARTFORD, Conn. — Those on the front lines of Connecticut’s opioid epidemic all but expected the latest news that drug deaths have increased to devastating, record heights.

Users, recovering addicts, and those who love and treat them say they read the signs all through 2019 that the scourge of fentanyl — a potent, synthetic opioid now ubiquitous in the illegal drug market — is increasing, not waning as many in Connecticut hoped when 2018 brought a slight dip in fatal overdoses. According to a new report from the state’s Chief State Medical Examiner, there were 1,200 accidental drug deaths across the state in 2019, an 18% spike experts say reflects both a lack of education about addiction and a comprehensive, statewide strategy to turn the tide. Hartford, with 133 deaths, led all communities.

“What it is is unacceptable,” said Dr. Peter Rostenberg, an addiction medicine doctor in western Connecticut and member of the Connecticut State Medical Society’s opioid committee.

He’s among a group of Connecticut physicians that recently began developing a standard of care to treat addiction, a tool they hope the state government will use to address the epidemic.

Their plan would establish a single best practice for the state — combining medication-assisted treatment with counseling and psychoeducation — and explain how different health care providers and agencies should work together to coordinate the care of all patients with opioid-use disorder. It would also establish how to get the latest science on addiction and treatment to health care providers.

“Our job is to make sure the working physicians out there have the expertise, the training and the tools to basically deal with this like every other disease,” said committee chairman Dr. Mark Kraus of Waterbury.

For a model, Rostenberg and Kraus point to Rhode Island, where an overdose action plan has been implemented and enforced by executive order of the governor. Fatal overdoses have declined in Rhode Island for three consecutive years, for a 14% drop since 2016.

Kraus is optimistic that the Lamont administration supports the medical society’s work, but Rostenberg wants to see a more immediate commitment.

“I fear what will happen if we don’t come up with a statewide program that will simply force changes that are to the benefit of the patients that we see,” Rostenberg said. “We need a leader. Truck tolls have their place. The loss of some of our most promising young residents? That has to take precedence.”

Others also pointed to a lack of support at the federal level. Meeting with state and local health officials at a mental health and substance abuse clinic in Hartford, U.S. Sen. Richard Blumenthal, D-Conn., lambasted the Trump administration’s latest budget proposal, which would cut about $1 trillion over 10 years from Medicaid payments to states and the Affordable Care Act’s premium subsidies.

“They feel like not even real numbers anymore, because it feels like people who are making these decisions do not know what is going on in the real world here,” Kimberly Beauregard, president and CEO of InterCommunity Health Care, said during Blumenthal’s news conference.

Education for patients and physicians is an important piece of the puzzle, Jacqueline McDermott-Selman, a licensed alcohol and drug counselor and grief counselor at Connecticut Addiction Medicine, said last week after learning of the uptick in overdoses.

The news did not surprise staff at the Hartford clinic. They experienced far more losses last year than ever before.

Sometimes staff learn about the overdoses from the news, or from other clients. Sometimes a spouse or partner will call. When a client doesn’t show up for a while, clinical operations manager Molly Camara says she starts checking obituaries.

“I think a lot of people, not believing it’s a brain disease, they still think they have some control over the situation and they’re making the proper decisions and the reality is, addiction is a piece of the brain that’s making decisions for them,” McDermott-Selman said. “Like, ‘I can use this one time,’ and with the fentanyl, the ‘Oh I’m not gonna get that, I know what I’m getting.’ There’s cognitive distortions.”

McDermott-Selman says misunderstanding of the medical condition of addiction also stretches to many physicians and smaller communities that have resisted offering in-town addiction services or practicing harm reduction, like providing clean needle exchanges and overdose prevention kits.

Some of Connecticut’s tiniest towns reported a fatal overdose last year. Chaplin, a town of about 2,000 people, had five drug deaths, all involving fentanyl, in 2019.

“Denial is a wonderful place,” McDermott-Selman said. “I’m sure we all go there once in a while, you know I’ve lived in denial for a little bit. But staying there, harboring in that area, doesn’t help anybody.”

Jean Karlo Conquistador, nearly two years sober and one week out of prison, said there also seems to be resistance in the Lamont administration to addressing the problems that aggravate addiction, like a lack of family support for incarcerated individuals and housing insecurity.

It appears at least 69 of last year’s overdose victims were homeless, as there is no residence listed for them by the medical examiner.

Conquistador himself struggled with addiction and homelessness prior to his 20-month incarceration. It’s always harder to fight cravings when you’re turned away from a full shelter and left to pass the hours until morning, he said.

“If I were the governor, I’d be seeing a lot of funds spent on new shelters,” Conquistador, 31, of Hartford said. “Homelessness leads to relapse.”

While the opioid epidemic touches every corner of the state, it is concentrated in the biggest cities, where rates of homelessness are also highest.

Hartford had the most deaths with 133. So far this year, Hartford police have responded to 17 fatal overdoses, up from 12 this time in 2019, according to Lt. Paul Cicero.

The latest overdose came Wednesday afternoon, when a man reported finding an acquaintance unconscious and already cold near a wooded encampment in Frog Hollow, a known area of frequent drug activity, Cicero said. The victim, a 40-year-old homeless man, appeared to have used heroin.

Mark Jenkins, founder and executive director of the Greater Hartford Harm Reduction Coalition, got to the scene off Park Terrace and Russ Street soon after police. He’d been prepared to administer an injection of Naloxone, the overdose-reversal drug. When Jenkins learned who’d died, he shared that he revived the same man just a month ago. The coalition also recently opened Frog Hollow’s first harm reduction center at 28 Grand St., in the epicenter of the city’s epidemic.

Experts agree that fentanyl is behind the increase in overdoses. Hartford police last year seized nearly 50,000 bags of heroin mixed with fentanyl, and have also found cocaine, crack and pressed pills laced with the opioid.

“We’re trying to make the biggest dent possible,” Cicero said. “Coupled with education and the new harm reduction center, those are pretty crucial ingredients for success.”

An older Hartford resident who asked to go by “Justice” said it’s time for older people with opioid-use disorder to open up about their experiences, particularly with achieving sobriety, to push prevention and spread the message that addiction is treatable and recovery is possible.

Sixty-three people under the age of 25 died of drug overdoses in 2019, nearly all of them involving fentanyl.

People like “Justice” can help prevent the next generation of teens and young adults from repeating their elders’ mistakes, he said. In Hartford, that means convincing youth not to try habit-forming pills like Percocet that have catapulted so many into heroin use.

That’s how it started for a younger man chatting with “Justice” outside Connecticut Addiction Medicine, a Suboxone and Vivitrol clinic on Main Street. The 25-year-old said he had his first close call a month ago when he overdosed in a hospital.

“That’s the only time I’ve ever been Narcan-ed,” the man said. “I’m lucky to be standing here.”

The young man explained that he went to the emergency room for asthma, but felt the need to get high while he was still waiting to be seen. He went into a bathroom to use and came to in a hospital bed.

“I had two friends die in one month,” another man said as he walked by the clinic, stopping to greet “Justice.”

“I hate to say it, but it becomes like the norm, it happens so much,” said the passerby, who also declined to give his name.

Sober for several years now, “Justice” said he doesn’t feel much temptation anymore thanks to the treatment he’s been receiving for about five years. But heroin blocks are all around, from the dealer-heavy Barnard Park in South Green to his own spot on the sidewalk outside Connecticut Addiction Medicine.

With most heroin contaminated with fentanyl these days, addiction has become so dangerous that many people simply don’t survive long enough to get clean, even if they’re trying, “Justice” said: “Their time to stop is when they’re six feet under in a coffin.”

Recovery is going better now, Conquistador said. The other day, he was walking down a street in the South End of Hartford when he passed a couple of dealers and felt the anxiety in the pit of his stomach that meant he could use, if he wanted to. He kept on going.

Addiction is like a magnet, Conquistador says. Addicts have to find ways to repel themselves away from drugs, so that’s what he does.

“I kept walking and I made it home safe,” he said. “No relapse.”

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