HARTFORD, Conn. — Fentanyl, 50 times more potent than heroin, kills no matter what age its victim may be.
Since 2020, at least eight Connecticut children under 2 1/2 years old have died of fentanyl exposure, six in 2021 alone, according to the Child Advocate’s Office. One was less than a month old, an infant girl from Fairfield County.
There also have been eight accidental deaths from fentanyl overdoses in older teenagers since 2019, according to the child advocate.
Of the young children, there was one fentanyl-related death in 2020 and one so far in 2022, but the Office of the Chief State Medical Examiner has not completed its analysis of all deaths this year.
“Six kids in a calendar year is way too many,” said Brendan Burke, the state’s assistant child advocate. “And the systems have to adjust to it and respond differently in terms of how adult services are geared towards substance-abusing clients and people that are using illicit substances and the precautions they’re taking in the home and understanding the lethality of fentanyl. It’s a game changer.”
Of the eight deaths, three each occurred in Fairfield and Hartford counties and one each in New Haven and New London counties.
“The important thing to know [for 2022] is that that data is delayed based on some medical examiner toxicological reports being pending,” Burke said. “We expect that 2022 number to grow.”
He said fentanyl deaths of such young children were almost unknown before 2020.
“It’s a new phenomenon,” Burke said. “Prior to 2020 this wasn’t an issue. So this is very much in line with the fentanyl epidemic being found in illicit substances, children dying from it. … This is a new development in child welfare.”
Money from opioid settlements should be used by the state to put more programs in place to educate parents about the dangers of drugs in the home, Burke said.
He said other opioids, such as heroin, can be laced with trace amounts of fentanyl, “like grains of sand.” “And those trace amounts are enough to kill an adult. You can only imagine how little is needed to be in contact with a child for that to have a terminal impact,” he said.
Burke said “rainbow fentanyl,” pills that look like candy, has not been seen in Connecticut.
It is not clear how all eight young children came into contact with fentanyl.
“Some scene investigations have determined that fentanyl was in the home,” Burke said. “Others have not been that clear. And there’s still mystery around how the child came in contact with it. A majority of these children were in the care of individuals that have had known substance-abuse history.”
Lenin Rodriguez of Enfield was charged Nov. 16 with the fentanyl-related death of his 1-year-old son in November 2021. But in many cases, there’s a danger in assuming the child found the fentanyl at home.
“That’s part of the challenge here is that you know investigation of this is going to incriminate whoever the caregiver was if they know how the child got it,” Burke said.
“I’m a parent caring for a kid and my child dies from fentanyl intoxication. I as the parent have to come forward and say, hey, I had fentanyl in the home, which is going to incriminate me and leads to potential criminal charges,” he said.
In addition to the eight deaths, since 2021 the child advocate’s office received more than 24 notifications from the Department of Children and Families about children under 5 suspected to have ingested opioids, including fentanyl, who survived. And eight adolescents have died since 2019 from fentanyl overdoses.
In January 2022, a 13-year-old student at Sport and Medical Sciences Academy who was initially in grave condition at Connecticut Children’s hospital and later died, had ingested a drug that tests confirmed to be fentanyl, according to police.
‘Kids are naturally curious’
Fentanyl, a synthetic opioid, is used legitimately as a painkiller, but its illicit use has grown in recent years to become a national epidemic.
According to the Centers for Disease Control and Prevention, deaths from fentanyl and similar drugs increased more than 56% from 2019 to 2020, to more than 56,000, and were more than 18 times the number in 2013.
Dr. Gregory Vincent, associate medical examiner, said of the fentanyl deaths, “We hadn’t quite seen this before.” It could be because it’s new on the illicit market or because of more exposures. But his office is seeing a rise in fentanyl deaths over heroin, for example.
“If you look at 2015 here in Connecticut, about 54% of the overdose deaths involved heroin, whereas only 26% involve fentanyl, and then we’ll go forward to 2021,” he said. “Eight percent of the cases involved heroin and 86% of the cases involved fentanyl.”
However, it doesn’t mean there is less heroin on the street. “I think that the real reason we’re seeing this bump-up is that fentanyl is more present out there in the community, and I think that these kids are getting exposed to it,” Vincent said.
Besides its potency, reasons for exposure may be that more people have been working from home during the COVID-19 pandemic, or not working, and more day-care facilities have been closed.
“So there’s a potential rise in people doing the recreational activities maybe more often or at different times than previous to the pandemic,” Vincent said. “And they also have the stress of the pandemic, which I think has led to more exacerbations of mental health issues and exacerbation of various addictions and addictive behavior.”
One of Vincent’s concerns is that all seven of the infants and young children his office examined (one was brought to Massachusetts for examination) looked like sleep-related deaths and were found after the child was put to bed.
The medical examiner’s office “made the Department of Health aware and information has been released to the hospitals to keep an eye out for this,” Vincent said.
Dr. Deepa Camenga, associate professor of emergency medicine, pediatrics and public health at the Yale School of Medicine, said, besides the increased supply, “kids are naturally curious when they’re young. And if it’s available, not locked in the home or secured … there is a potential for a child to get their hands on it and it’s very natural for them to try it by seeing what happens when they place it in their mouth.”
With teenagers, it’s more often “mixed with other substances in the illicit drug supply,” Camenga said. “So teens are unknowingly being exposed, meaning they’re not trying to use opioids but it’s contaminated in whatever other substance they are trying. And unfortunately, they’re experiencing overdose as a result of that.”
She said, though, that while there are anecdotal stories about fentanyl-laced cannabis, “I haven’t seen the toxicology confirmation of that being the case.”
Saving lives
Commissioner Vannessa Dorantes of the Department of Children and Families said 70% of the cases the department handles are related to substance use. “So the department has really always taken a really affirmative stance as it relates to how we assess and investigate as it relates to substance use,” she said.
“This fentanyl thing is different, the lethality of it and the ability for kids to get hold of it and have a really bad outcome,” she said. “We had to add another layer of our already robust substance-use assessment to really tackle this issue with fentanyl.”
Not only are children being exposed to fentanyl, but “you have a child that has been left parentless because of overdoses” by adults, Dorantes said.
If found quickly, opioid overdoses can be reversed with naloxone, known as Narcan, which Dorantes said has saved a number of children’s lives.
“The first responders who use Narcan when they come upon a child that they suspect may have ingested, or they might come upon a child that is either having seizure activity or are lethargic, and that could be a host of things. So the fact that they’re thinking quickly and using Narcan in situations that they’re not really sure [about] is a testament to how good their training is,” she said.
“Usually when they come upon a child in that condition, the adult caregivers are not going to give up immediately that oh, this child may have been exposed to an opioid,” Dorantes said. “That’s probably the last thing that the person will admit to in the crisis situation. So the fact that they are responding in that way so quickly really has saved lives.”
Another response has been an app on state cell phones, called NORA for naloxone overdose response app, that gives information on the signs of fentanyl exposure and how to treat it, Dorantes said. It is available to anyone on the web.
There is also a media campaign to raise awareness of the dangers of fentanyl. Anyone who suspects child abuse or neglect can call DCF at 800-842-2288.
The Department of Public Health is another state agency concerned about fentanyl. Colleen Violette, health program supervisor for the Office of Injury and Violence Prevention, said a CDC grant, Overdose Data to Action, is helping the department track unintentional overdoses up to age 17.
“We focus on a whole array of the substances, but mainly the deaths are fatalities due to fentanyl,” Violette said. “So we presented on emergency room visits and also unintentional overdoses of youth 17 to zero.”
The health department would not be involved in the youngest deaths because those will be ruled homicides, Violette said, but they are focusing on 16 teenage deaths, the youngest being 13, between 2015 and 2022.
Violette pointed out that the most fentanyl-related deaths by far are of adults. “Obviously, those parents who have passed away are impacting children, but the number of children who are dying is a very small number in the large scope of the amount of deaths that are occurring every single year,” she said.
DPH also uses the NORA app and has information on it including harm-reduction strategies such as “using slow,” said Violette, which means “making sure that if you are [using], you’re not using all of it at the same time.”
The department, also concerned about stigma, has messaging that promotes safe storage and having Narcan in the home, because it also can be used on small children.
“We don’t want to have the public place more of a stigma on people who are using substances with this notion that they’re using substances around their kids and potentially putting their children in harm’s way,” Violette said.
“We’re just trying to be cautious about what type of messaging we’re going to continue to put out when it comes to children,” she said.
At the Department of Mental Health and Addiction Services, along with DCF and Wheeler Clinic, the Substance Exposed Pregnancy Initiative “is really looking to address the needs of substance-exposed infants and their families,” said Kimberly Karanda, director of DMHAS’s State Services Division.
Like the other agencies, DMHAS attends the monthly meeting of the Child Fatality Review Panel, led by Burke at the child advocate’s office, which examines any unnatural childhood deaths. “Where we come in, I think, is ensuring that there’s a recovery lens to any type of training and education that the state decides to message out,” Karanda said.
DMHAS wants “to make sure that the messaging makes sense, make sure it’s non-stigmatizing, and to make sure that the message is really coming across in a way that would be understandable for folks,” Karanda said.
Another program, REACH (Recovery, Engagement, Access, Coaching and Healing), is “staffed by women with lived experience of substance use and many of them with child welfare,” she said.
“We have currently 20 REACH navigators located statewide and their job is to really engage with women and families who might be in need of treatment but who are not yet connected to the system and then to do follow-up and aftercare with those same families,” she said.
Safe storage of drugs and naloxone are also focuses of the department, Karanda said.
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