Opioid Epidemic Through the Lens of Prehospital Emergency Care: A 5-Year Descriptive Analysis of the Statewide Opioid Response Directive (SWORD) Surveillance Program.

Abstract

Objectives: The Connecticut Statewide Opioid Response Directive (SWORD), a surveillance program utilizing emergency medical services (EMS) clinician reporting to the Connecticut Poison Control Center (CPCC) on suspected opioid overdose cases, was created to collect data on the opioid overdose epidemic, monitor revealing trends, and provide early warning alerts to overdose outbreaks. This study provides a description of patient characteristics, overdose location, opioid type, disposition, and use of opioid antagonist treatment for the first five years of surveillance.

Methods: This was a retrospective review of data collected from the SWORD surveillance program between June 2019 and May 2024. For each suspected opioid overdose encounter, data related to patient demographics, descriptions of the overdose event, prehospital treatments, disposition and fatality were obtained from the database. Descriptive statistics were completed for outcomes of interest.

Results: Over the five-year period, EMS clinicians reported 21,281 opioid overdoses. Fentanyl or heroin was suspected in 7,208 (83.4%) cases when the drug of exposure was known (n = 8,641). There were 17,597 (82.7%) patients who received naloxone, and 1,151 (5.4%) patients who suffered fatal overdoses. Males represented 73.6% (n = 15,559) of all overdose cases. The median patient age increased from 38 in year one to 43 in year five. Patients 60 years of age and older accounted for 13.3% (n = 2,771) of all overdoses. Bystanders first administered naloxone in 18.9% (n = 2,926) of the cases where naloxone was given. The data produced 1,489 early warning notifications to local community partners to alert them to high overdose activity in their community.

Conclusions: This five-year descriptive study highlights the ongoing severity of the opioid epidemic as reflected in the SWORD surveillance program. Over the years, a rising median age and an increasing percentage of overdose cases among those aged 60 and older were noted, indicating a shift in the demographic profile of affected individuals. These findings underscore the complex and evolving nature of the opioid crisis, emphasizing the need for continued monitoring, targeted interventions, and community involvement in opioid overdose response.