Believe it or not, heroin is no longer the leading cause of overdose death in New Hampshire. In fact, law enforcement rarely sees heroin anymore. Fentanyl, and not heroin, is the leading contributor to overdose death in New Hampshire.
Fentanyl is a synthetic opioid that is easily manufactured and readily available. It is increasingly showing up in cocaine, methamphetamine and other drugs in New Hampshire.
An evidence-based strategy to combat this problem is the provision of on-site drug-checking programs that allow people who use drugs the ability to test their substances for the presence of fentanyl and other unwanted adulterants. Point-of-use test strips rapidly indicate if a drug sample contains fentanyl or another adulterant. When informed of the presence of these contaminants, a person can be deterred from using the substance, or use less of the substance and thereby reduce harm and overdose risk. Routine use of these test strips, or another drug-testing method, could help reduce overdoses that require the provision of more costly naloxone and emergency medical care.
In November, after a rise in local overdose deaths, I piloted a point-of-use drug-checking program at Safe Harbor Recovery Center. Using fentanyl test strips that I bought with my own money, I invited people into the recovery center for drug-checking materials, no questions asked. I have since found a small private funding mechanism to continue this program, which is cost-free for the consumer. I have distributed over 200 fentanyl test strips and intend to distribute 200 more. If it saves one life, it was all worth it.
In an illegal drug market there are no protections for consumers, and my friends are dying preventable deaths because of it. Without a change to legislation and funding, these programs will not exist to save lives. Just like consumers of food, drug users have the right to know what they are ingesting.
As a recovery support worker, I can tell you first-hand that dead people do not enter recovery. But with harm reduction all drug-related death and disease is preventable. The goal of harm reduction is to reduce drug-related death and disease and improve public health. With these very large goals comes pragmatic strategies that are proven to work.
Another harm-reduction strategy is the provision of low-barrier cost-free naloxone on request. Naloxone is an opioid antagonist medication used to reverse an overdose, with no potential for misuse. New Hampshire has one of the best naloxone distribution models in the country. Limited supplies and the prohibition of state-purchased intramuscular naloxone delivery products represent barriers to getting naloxone out to those who need it most.
Syringe services programs are highly effective at distributing naloxone to the highest risk drug users. But SSP’s receive no public funding. New Hampshire has some of the best laws for syringe services programs in the country, but lack funding. With the hopeful passage of Senate Bill 87, New Hampshire will have the ability to use state and federal funds to support these life-saving programs.
More than 25 years of research shows that syringe services programs save lives and money, and improve public health. There must be a lift on the state and federal ban on the funding of SSPs. To rein in this public health crisis, every person who uses drugs must have access to an SSP in their community.
The addiction treatment world is shifting toward an evidence-based approach, offering low-barrier access to medication-assisted treatments, like buprenorphine and methadone. When implemented correctly, opioid agonist therapies will reduce overdose rates in a community by around 50 percent. This is an example of state and federal funding being used to implement harm reduction strategies. But more must be done. Our federal delegation must protect and improve medication-assisted treatment coverage under Medicare. The State Opioid Response funding is being used to implement new MAT programs, and that must continue when the SOR funding ends in 2020.
Every day, citizens are donating time, resources and money to implement harm-reduction strategies. What we need now is help from lawmakers. Citizens can’t do this work forever without funding to support these life-saving endeavors. We are out here on the front lines waiting for our lawmakers to allow these programs to be funded. We all pay the price for this uncontrolled public health crisis.
We need a public health response, not more failed Drug War policy. I implore our federal delegation to sign on in support of legislation filed in Congress known as the CARE Act. This is a comprehensive 10-year funding mechanism to scale up addiction treatment, recovery and harm reduction in all 50 states. It is modeled after the Ryan White CARE Act and treats substance use disorders as chronic lifelong conditions. Our elected officials all spoke about addiction on the campaign trail. Now I am asking for follow through, and funding for harm reduction, so my friends stop dying preventable deaths.
This is a cry for help to our elected officials at the state and federal level. Harm reduction, in the long term, will move New Hampshire toward a public health model for managing drug use. Syringe services programs, naloxone, medication-assisted treatment and on-site drug-checking programs must be funded if we ever want to gain traction in this crisis.
(Ryan Fowler is a certified recovery support worker with Granite Pathways.)