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Geographic and temporal trends in fentanyl-involved deaths in Connecticut, 2009-2019

Background: Since 2012 fentanyl-involved fatal overdoses have risen from 4% of all fatal overdoses in Connecticut to 82% in 2019. We investigated the geographic and temporal trends in fentanyl-involved deaths in Connecticut during 2009-2019 and examined the relationship of fentanyl-involved deaths and overall trends of opioid overdose deaths. Methods: Data on the dates and locations of accidental/undetermined opioid-involved fatalities that occurred during 2009-2019 were obtained from Connecticut Office of the Chief Medical Examiner. Using a Bayesian space-time binomial model adjusted for demographic covariates, we estimated spatial and temporal trends in the proportion of fentanyl-involved deaths, as well as overall opioid-involved overdose deaths. Results: During 2009-2019, a total of 6,632 opioid-involved overdose deaths were identified. Among these, 3,234 (49%) were fentanyl-involved. The modeled spatial patterns suggested that opioid-involved deaths in northeastern Connecticut had higher probability of being fentanyl-involved, while New Haven and its neighboring towns and the southwestern region of Connecticut, primarily Greenwich, had a lower risk. Model estimates also suggested the geographic patterns of fentanyl-involved deaths gradually overtook the preceding non-fentanyl opioid overdose deaths. The estimated temporal trend showed the probability of fentanyl involvement increased substantially since 2014. Conclusion: Our findings suggest that geographic variation exists in the probability of fentanyl-involved deaths, and areas at heightened risk are identified. Further studies are warranted to explore the factors contributing to the geographic heterogeneity and continuing dispersion of fentanyl-involved fatal overdoses in Connecticut. Such efforts could inform overdose prevention and intervention strategies.