Last year, Concord emergency responders noticed that drug overdose numbers were leveling off and even going down slightly.
Then, at the beginning of 2017, they noticed a significant increase, which they attributed to fentanyl, a synthetic drug up to 100 times as strong as morphine. Fentanyl was deemed responsible for more than two-thirds of the state’s 478 drug deaths in 2016.
Now, emergency responders are bracing for even more calls because of carfentanil, a new drug that is 100 times as strong as fentanyl, meaning carfentanil has 10,000 times the potency of morphine.
Gov. Chris Sununu and state officials announced on Tuesday that they had confirmed the first carfentanil deaths in New Hampshire – two in Manchester and one in Meredith.
“We were not surprised,” Concord fire Chief Dan Andrus said on Wednesday. “If it’s out in Manchester, I’m sure we will be seeing it here very soon. If there’s any kind of surprise, it’s that it took that long to get to us.”
In recent years, carfentanil has been making its way into batches of heroin as drug manufacturers cut it in to make higher quantities of drugs and boost profit margins. The drug is so potent that an amount smaller than a poppy seed can be lethal to humans. The drug has been linked to spates of fatal overdoses in states including Ohio and Maryland; however, state officials said they believe the New Hampshire deaths are the first confirmed cases in New England.
Andrus said street drugs’ increasing potency means his department is dealing with a 40- to 45-percent rise in overdose calls over last year.
The Concord Fire Department recorded 42 drug overdoses, plus another six intentional overdoses by the end of March. There have been 20 overdoses so far this April, Andrus said; at times Andrus’s crews have responded to three in one day.
He calls it a “noticeable and prominent increase” from last year.
“It’s alarming,” Andrus said. “Just the first quarter, we’ve seemed much busier. It’s very noticeable even if you’re casually listening to our dispatch channel.”
Most of those who overdose are revived, but some aren’t so lucky.
Concord police Lt. Sean Ford said the city has had one overdose death so far this year and that opioids are likely to blame, although final toxicology reports are still pending. He said the agency is not aware of carfentanil in the city. He noted, however, that toxicology tests typically take six to 12 weeks to return from the lab, so it’s not out of the question that the drug could show up in the near future.
“Given the news (out of the governor’s office), we were thinking back to a recent spike we had in overdose calls between April 10 and April 12,” Ford said, noting that eight people overdosed during that time. “But no one died.”
Responders are needing to use more Narcan to revive people because of how potent carfentanil is.
EMTs can now administer up to 10 milligrams of Narcan to an overdose victim – the maximum dose used to be 2 milligrams.
In nearby Franklin, Deputy fire Chief Robert Goodearl said he has not noticed an uptick in overdoses. However, his crews have said there are often bad months where there are more overdoses followed by quiet periods.
With more Narcan available in the community to help reverse overdoses, Goodearl said Franklin firefighters have encountered people who ask friends to give them just enough Narcan to keep them breathing – but not enough to take away their high.
“That’s pretty sad,” he said. “Narcan works, but it’s not always the answer.”
Franklin police Chief David Goldstein said his biggest concern about carfentanil extends beyond drug users to innocent victims, including young children, family members and first responders who may come into contact with the drug. The department has a dog that works on narcotics cases, and Goldstein said he is increasingly worried about the animal’s safety, especially given that carfentanil could soon make its way to Franklin.
Goldstein said the arrival of carfentanil in New Hampshire “came a little bit out of left field,” as the department’s focus has most recently been on the resurgence of methamphetamine and other drugs that could one day replace opioids.
“Shame on me as a police chief for not thinking about that, but we were really looking for other substances that people would be going to as we began to solve the opioid problem,” he said. “Now, we realize we need to take a step back and reassess.”
State officials also warned emergency responders and police to exercise extreme caution when called to the scene of an overdose.
The New Hampshire Bureau of Emergency Medical Services released an officer safety alert to communities across the state, warning of the dangers of carfentanil and telling responders to look for signs of accidental overdose in their peers if they happen to come in contact with even a tiny grain of carfentanil.
Concord and Franklin crews already take precautions by wearing rubber gloves and carrying face masks on their trucks to avoid accidentally inhaling the drug.
Concord police are constantly taking steps to reinforce safety protocols with officers, who are told to operate under the assumption that fentanyl can be instantly fatal, Ford said.
Andrus said his crews know to be very wary of any powdery substance; carfentanil can look like powdered heroin or cocaine.
“We have been preparing for this, even before carfentanil,” he said. Crews watch to make sure drugs don’t get on their clothes, and get isolated until they can be disposed of safely.
“I wish we had something that’s a magic bullet to protect our responders,” Andrus said. “It’s underscores how hazardous this profession has become. It’s a nightmare what people are facing and how quickly one of our people, in doing their duty, could be dropped by this.”
(Staff writer Alyssa Dandrea contributed to this report. Ella Nilsen can be reached at 369-3322, enilsen@cmonitor.com or on Twitter @ella_nilsen.)