Tuesday, March 29, 2016
Before the New Hampshire medical examiner’s office had even finished counting the number of drug deaths in 2015, the 2016 numbers were already rolling in.
The latest numbers released this year show 10 deaths confirmed so far in 2016 with 86 more pending. Last year, 428 people died from drug overdoses, with eight cases still pending.
Behind that startling statistic is this one: New Hampshire ranks third-highest for per-capita drug deaths nationwide, falling behind only West Virginia and New Mexico. Its per-capita drug death toll has eclipsed that of other New England states, also dealing with similar heroin and opioid crises.
“The stage was set with the prescription opiate problem,” said New Hampshire Medical Examiner Thomas Andrew. “It cut such a wide swath through our population that when those folks switched over . . . to use heroin and ultimately fentanyl, with its increased potency came an increased death rate.”
At the same time, the state is racing to improve its ability to treat drug users. An oft-repeated statistic is that New Hampshire is the 49th-worst state when it comes to accessing treatment. A bipartisan group of legislators and treatment advocates is trying to improve access, but health officials in the state say continued funding and staff are needed to stem the tide of addiction.
‘Dramatic spike in fentanyl’
Law enforcement officials report synthetic fentanyl flowing over the Massachusetts border into New Hampshire towns and cities. The drug is anywhere from 50 to 100 times stronger than heroin.
Law enforcement experts in the state say that while many drug users are unaware they are buying fentanyl, some are seeking out the drug for a more powerful high. But as the numbers show, chasing that feeling comes with a powerful price.
The drugs are manufactured by Mexico’s Sinaloa cartel and transported up to the northeastern United States.
“What we have seen is a dramatic spike in fentanyl in New Hampshire,” said Assistant Special Agent Jon DeLena of the DEA, pointing to the spike in fentanyl-related fatalities.
DeLena and his fellow agents used to see batches of heroin laced with fentanyl in the Granite State. Now, “we’ve seen the shift to fentanyl laced with heroin, to most recently fentanyl laced with some sort of cutting agent, and that’s deadly.”
Much of New Hampshire’s heroin and fentanyl is mixed and packaged in northern Massachusetts, and law enforcement officials say there’s little precision to how the drugs are cut and packaged.
“These aren’t rocket scientists,” said Lt. Brian O’Keefe of the Manchester Police Department.
The end product is usually a haphazard mix of heroin, fentanyl and cutting agents, crudely mixed with blenders. In one drug raid in Lawrence, Mass., law enforcement officials found 10 to 12 blenders used to cut up the product.
Law enforcement officials say these are hitting the streets being marketed as China White, a cleaner, more pure heroin. But by the time drugs get to users, there’s no telling whether they’re getting the part of the batch that’s heroin or the part that’s fentanyl.
If it’s the latter, “there’s no coming back from that, no opiate antagonist like Narcan is bringing you back from that,” O’Keefe said.
The drugs flowing into some neighboring states are different.
New York City traffickers mostly supply Vermont and Maine, and are largely still bringing heroin into those states, DeLena said.
“The majority (of opiates) in those states still remains as heroin, although we have seen somewhat of an increase in the presence of fentanyl,” he said.
Andrew’s office came across its first case of heroin laced with the potent synthetic drug fentanyl in December 2013.
“As winter melted into the spring, that’s when the heroin-fentanyl combination became less prominent and the fentanyl alone came to dominate,” Andrew said. “That’s when the real fentanyl impact has hit us.”
Center stage in Legislature
Addiction has come to dominate the political conversation in New Hampshire. It was often discussed during the presidential primary and has become a bipartisan issue in the Legislature.
Some of the bills in front of the Legislature this session include ones to increase access to overdose reversal drug Narcan and trying to decrease barriers to getting insurance coverage for substance abuse issues.
Treatment providers and advocates say expanded Medicaid and its substance abuse benefits are some of the most important tools in the fight against heroin and opioids.
So far, expanding Medicaid has not been much of a fight in the Republican-led Legislature. The state House overwhelmingly reauthorized Medicaid expansion last week and the bill is on its way to the Senate.
Members in both parties have touted the reauthorization as a way to deal with the drug problem and get 48,000 Granite Staters health care.
“I feel like we’re on an upward trajectory,” said Michelle Michele Merritt, policy director at New Futures, a drug and alcohol treatment advocacy organization. “Reauthorization of the Health Protection Plan is the single most important step that our senators and legislators can take.”
Even with the action that’s being taken at the state level and in many local communities, law enforcement and health experts don’t see this problem going away soon.
Another issue health officials are trying to address is the lack of counselors and staff at New Hampshire treatment facilities.
“We also don’t have the workforce we need to deliver those services,” said Jaime Powers, a clinical administrator at the Department of Health and Human Services Bureau of Drug and Alcohol Services.
Still, Powers says expanded Medicaid in the state has been pushing things in the right direction and that setting up treatment capacity takes time and manpower. The state currently has a request for proposals for more treatment facilities and is expected to announce the results of that in the coming weeks.
“I do see it growing,” Powers said.
With deaths on their current trajectory, Andrew said he also needs another staff person in the medical examiner’s office to keep up.
“It’s changed the entire face of the practice of forensic pathology,” Andrew said. “It’s on everyone’s lips all the time.”
(Ella Nilsen can be reached at 369-3322, firstname.lastname@example.org or on Twitter @ella_nilsen.)