A group of 11 towns in the northwest corner of Connecticut are combining the money they received from a nationwide opioid settlement to jointly address the crisis in their area.
In July, four of the largest drug companies agreed to pay a total of $26 billion to 46 states. Connecticut received $300 million, of which about 85 percent remains with the state and 15 percent will be distributed to individual towns over multiple years.
According to a report to the state’s Opioid Task Force, most towns are using their funding for educating young people about the dangers of opioid use, often by diverting the funds to the local Youth Services Bureau. Others are using the money to purchase Narcan, or to support nonprofits or substance abuse clinics.
The northwest corner, however, is unique in seeking a regional solution.
Leonardo Ghio, project manager for the Council of Governments, said the decision made sense because of the towns’ size. Nine of the 11 communities who agreed to pool their funds have a population of under 4,000 people, and the largest — Litchfield — has a population of about 12,300.
Gregory LaCava, the first selectman of Warren, which has a population of about 1,300, said the small amount of money the town received — about $4,700 — is best used by combining it with neighboring towns.
“A lot of our area towns in our [Council of Governments] share the same responsibilities and concerns with everyone facing the epidemic,” LaCava said.
Litchfield First Selectman Denise Raap said the town decided to give a portion of their funding — about $21,300 — to the council because it had received more money than they could effectively spend. She said she hoped these funds could assist other towns that didn’t receive as much money.
The additional funding, about $18,000, will be split between the Litchfield Preventative Council, an organization that works with young people, and the Greenwoods Counseling Center.
“Sometimes you think it’s just people who are inexperienced and naive,” said Raap, adding she was surprised by the number of people in their 50s and 60s who experienced non-fatal opioid overdoses. “So I think it’s important that we have better education out there, so people realize what they might be taking is not exactly what they think it is.”
Department of Mental Health and Addiction Services Commissioner Nancy Navaretta told CT Examiner that she supported the northwest corner’s plan to pool together their money.
“They have some good leadership in that part of the state. They’ve really brought people together and early on made a difference in their numbers,” she said.
Combating the stigma
Litchfield County Opioid Task Force coordinator Lauren Presto said although the total number of overdoses in the towns is low, the county had one of the highest rates of overdoses per capita a few years ago.
“You might have one fatal overdose, but if you look at the population rates, it’s actually a pretty significant and heartbreaking proportion of the population in a rural area that’s been impacted,” she said.
That number has since decreased, she said, thanks to increased access to naloxone and coordinated care.
Data shows the number of opioid overdoses in Litchfield County rose from 52 in 2015 to 76 in 2019, where it peaked. Last year, the number dropped to 44.
But Presto said she was still worried, mainly because the type of drug available on the street was changing. Fentanyl remains the opioid currently responsible for the majority of overdoses, but the horse tranquilizer Xylazine is becoming more prevalent. According to data from the Western CT Coalition, one of five regional oversight bodies under the Department of Mental Health and Addiction Services, about 14 percent of fatal overdoses in the area involved Xylazine.
Ghio believes one of the biggest barriers for rural areas is the misconception that smaller towns aren’t impacted by the opioid crisis, which hinders people from learning more about it.
“If the stigma is there and they’re saying, ‘Well, we don’t really have that problem,’ then it’s hard to reach people who are in fact having that problem in that town,” Ghio said. “If we can create awareness and education of the signs and the symptoms and how it even comes about — like with fake pills and the increased fentanyl that are being found and being laced in things … the first tier is combating that stigma.”
So far, the task force has agreed to put a portion of the funding toward “leave-behind kits,” or kits that contain two doses of naloxone, a pair of gloves, contact information of a treatment provider and instructions on how to administer Narcan and perform CPR.
Emergency medical personnel responding to an overdose incident can provide the kits to family members or loved ones, ensuring they have them on hand in case of a recurrence. According to Ghio, 90 percent of overdoses happen in the home.
Presto said this is especially important in rural towns like those in the northwest corner, where people may live far from a hospital.
“It’s absolutely critical as soon as possible to help somebody restore their breathing,” Presto said. “And naloxone helps do that by blocking the [neural] receptors [that opioids bind to in the brain].”
LaCava, who is also an EMT, agreed about the importance of bringing helpful materials to residents.
“We’re going to be able to leave this stuff behind at a local level where a lot of our residents may not be in the big cities or in these high-traffic areas where there’s campaigns, and there’s advertising, and there’s media and marketing to affect change,” LaCava said. “We’re going to actually bring the help to the community and to the houses.”
Maria Skinner, CEO of McCall Behavioral Health Network in Torrington and co-chair of the Opioid Task Force, said solving the opioid crisis meant going beyond teaching people about opioids — it means changing everything from insurance to how children are supported in school and how families understand addiction.
“What are the barriers to access once somebody is starting to first show signs of trauma or mental health or addiction issues, and what do we have in place to do early intervention to change the trajectory?” asked Skinner. “What do we have in place and what are we lacking in terms of when somebody is really suffering and struggling? And are we just going to keep putting money into the exact same systems that, quite frankly, have failed people in spite of our best efforts over and over again for … several generations?”
Too little, too late
Despite the recent stream of funding, Presto said it’s coming too late.
“With the opioid settlement dollars, it’s a little bit of funding a lot too late for a crisis that has been raging on for many, many years,” she said, adding that many towns already had strong initiatives aimed at preventing young people from trying opioids.
Emma Hollis, behavioral health director for the Western CT Coalition, which is responsible for coordinating services for mental health and substance abuse in the region, said pills like Xanax and Oxycontin sold on the street are sometimes contaminated with fentanyl, making them especially dangerous.
“One portion of the pill may have a really high concentration of fentanyl, and then the other portion may not. So it’s very hard for us to distinguish who might be getting a lethal dose of these pressed pills,” she explained.
Hollis added that prevention efforts for the youth don’t necessarily focus on teaching about drugs themselves, particularly for very young children. Instead, she said, children are taught to seek a trusted adult to help them with difficult emotions.
“That’s really the root of the prevention work, is to foster healthy kids, healthy young people, so that when they’re older they feel OK and they’re not going to necessarily need to go to a maladaptive coping skill like substance use,” Hollis said.
But young people, Presto said, represented a very small portion of people suffering from opioid addiction. Many, she said, were adults who had suffered from trauma.
“It could have started with prescriptions. It could have started with something else. It could have started straight with the drug,” Presto said. “They’re folks who have experienced a lot of trauma in their life, a lot of negative things that have really hurt them deeply. They’re deeply wounded people. And that’s the one thing that they’re finding that is making them feel OK in their skin.”
While prevention was important, Navarretta said, she and state researchers agreed that the opioid settlement funds needed to go toward treating people in immediate danger.
“We’re in agreement that this money is really there to prevent overdoses, and what is going to give us the biggest return on investment in terms of people’s lives. And to that end, that’s why naloxone and [medications for opioid treatment] really hit the top of the list,” Navaretta said. “The first dollars out the door will be the dollars that stop people from dying immediately.”
Making a difference
In 2022, the state legislature established the Opioid Settlement Advisory Council, which was tasked with deciding how the settlement funds would be spent throughout the state. Navarretta, who co-chairs the council, said they started working with Yale researchers to canvas the current landscape and explore strategies implemented by other states.
According to CDC data, Connecticut ranked 14th in the number of opioid overdoses in 2021 when adjusted for population. In the last few years, the number of overdoses has decreased across the state — Navaretta said the number of opioid deaths dropped 4.3 percent between 2021 and 2022, and are trending toward a drop of 4.5 percent from 2022 to 2023, the biggest reduction across New England.
“We feel that we are making a difference, and the numbers are starting to show,” she said.
Ghio said Connecticut should fund harm reduction services, including programs that provide access to and safe disposal of syringes, overdose prevention centers that allow people to inject drugs in a safe space, access to naloxone, and drug checking to ensure they are not contaminated.
Another promising practice, he said, is diverting people who commit low-level crimes related to substance use — like loitering or shoplifting — to social services rather than sending them to jail. In Torrington, Winstead and Watertown, he said, people who overdose are introduced to a team that connects them to housing, food and harm reduction.
“A lot of times you see they have an addiction, they have no food, their children have been taken away by DCF, they’re getting kicked out of their house. There’s so many complicating factors that, at that moment, they’re not like, ‘Oh yeah, let me just stop doing the one thing that makes me feel well,’” Ghio said.
So far, the council has approved one use for the funds: supplies for syringe exchange programs. According to Navarretta, the funding for these programs has remained flat, but the need has doubled. She said she hopes to bring more recommendations to the council at its next meeting.
Many programs are often concentrated in the state’s urban centers, but Navarretta said they may focus specific outreach on the hardest-hit populations — Black men between the ages of 45 and 54.
Federal rules prevent Connecticut from using the funds to support overdose prevention sites, where people can actively use drugs. But she said the state would support creating other spaces where people could come together in recovery.
“We know connection is really important in the process of recovery. So whether that takes the form of a self-help meeting or a drop-in center of sorts or a recovery center, those are all things that we would support right now,” she said.