Deadly doses

Samples of the dosage of pure drugs that could kill the average human — heroin, fentanyl and carfentanil, a synthetic opioid 100 times more powerful than fentanyl — are displayed at the New Hampshire State Police Forensic Laboratory in Concord.

The eyes of the nation are on New Hampshire and how it’s using millions of dollars from the federal government to fight the deadly opioid epidemic.

“Tracking Federal Funding to Combat the Opioid Crisis,” a new report from the Bipartisan Policy Center, looks at New Hampshire and four other states with high rates of opioid-related deaths. The Washington, D.C.-based think tank calls for more flexible funding and better coordination at the federal level as states grapple with the ongoing drug epidemic.

According to the state Office of Chief Medical Examiner, 488 people died of drug overdoses here in 2017 and pending final toxicology results, 470 more are projected to have died last year. More than 80 percent of those deaths involved opioids, particularly fentanyl.

A recent conference to unveil the BPC report featured remarks by U.S. Sen. Jeanne Shaheen, D-NH, and Patrick Tufts, who chairs the Governor’s Commission on Alcohol and Drug Abuse Prevention, Intervention, and Treatment.

Shaheen said the federal funding to combat the drug epidemic has certainly been critical for New Hampshire, increasing from $3 million in 2017 to nearly $24 million each for 2018 and 2019. That allowed the state to build its hub-and-spoke system, designed so that no one has to travel more than an hour to get treatment for substance use disorder. Medicaid expansion has also helped more people get into treatment, she said.

When she meets people on the front lines of the opioid battle, Shaheen said, she asks them what would happen if the federal funding went away. And the answer is always the same, she said: “If we don’t continue to provide these resources to communities, to states, to families who need help, people will die.”

The Doorway, New Hampshire new hub-and-spoke program, opened in January. In the first two months of the new program, 916 clients were served, including individuals seeking direct services and relatives or friends seeking information on how to help a loved one, according to the state Department of Health and Human Services.

The boost in federal funding allowed New Hampshire to “stand up a system that didn’t exist before,” Tufts said. “Without this federal money, it just wouldn’t have happened.”

It also gave the commission Tufts chairs the flexibility to spend some of the $10 million it gets each year from alcohol sales on priorities such as prevention and resilience programs, sober housing and recovery programs, Tufts said. “A lot of our success, and a lot of the success that’s yet to come, is very, very dependent on this federal funding,” he said.

“In a state like New Hampshire, with no income tax, no sales tax, without this funding, these solutions just don’t take place.”

Overdose statistics “don’t really explain the human tragedies that are involved in the opioid epidemic,” Shaheen said. “It’s had such a devastating effect on the lives of so many people.”

Some mistakenly believe that the drug epidemic is only severe in economically depressed regions of the country, Shaheen said. But New Hampshire, with its prospering economy and high average annual income, puts the lie to that, she said.

The state has one of the highest opioid death rates in the nation, 34 per 100,000 population, more than twice the national rate, according to the BPC report.

“We’re a wealthy, healthy state,” Tufts said. “This shouldn’t have happened — but it did.”

The epidemic is personal here, Shaheen said; her own family knows someone who is raising three grandchildren. “I won’t forget what he said to me,” she said: “I hope I can live to be 80 so I can get the youngest one out of high school.”

“That’s what families are struggling with in New Hampshire," she said.

In the BPC report, researchers identified 57 different federal grant programs that target the opioid epidemic, through research, criminal justice, law enforcement and prevention, treatment and recovery programs, amounting to $3.3 billion in fiscal year 2017 and $7.4 billion in fiscal year 2018.

Tufts echoed the report's call for more flexibility in how the federal dollars can be spent as New Hampshire's hub-and-spoke system continues to expand. “We don’t turn anybody away,” he said. "And while we’ve had a terrible opioid crisis in our state, we still have issues with alcohol and we have growing issues with meth and cocaine.”

Tufts said the new program has multiple entry points, including the 2-1-1 helpline, Safe Station firehouses in Nashua and Manchester, and the nine hubs around the state. But he said, “What we’re finding is the lack of support services in our rural communities means our more metropolitan areas like Nashua and Manchester who have Safe Station programs are still having people referred to them because of the excellent service they’ve been able to provide over the last couple years.”

With an ongoing workforce shortage in addiction and recovery fields, Tufts said New Hampshire may have to explore tele-medicine to provide services in some areas. “Where we can’t get the bodies, we still have to get the service," he said.

The BPC report links the origin of the current epidemic to the introduction of OxyContin and its generic form oxycodone in 1996. “The combination of a highly addictive drug’s introduction to the market, an emphasis on addressing pain, aggressive marketing, and over prescribing — as well as a lack of evidence-based treatment availability and training in addiction — laid the groundwork for the opioid epidemic,” it states.

That was the first wave of the epidemic. As federal and state authorities began monitoring prescription drugs, people who were addicted to prescription painkillers began turning to heroin, the report states.

The current “third wave” of the epidemic is marked by abuse of illicit synthetic opioids, notably fentanyl, the report notes. The Northeast has been hit particularly hard and New Hampshire’s opioid death rate is one of the highest in the entire country.

Shaheen said there is cause for hope as New Hampshire continues to respond to the crisis. “There are lots of reasons to believe that we can get ahead of this epidemic, that we can make progress, but it’s going to take working together,” she said. “It’s going to take concerted effort, and it’s going to take … not stopping until we make real progress.”

To read the Bipartian Policy Center report, visit: bipartisanpolicy.org.

Beyond the Stigma, a series exploring solutions to the state’s addiction and mental health challenges, is sponsored by the New Hampshire Solutions Journalism Lab at the Nackey S. Loeb School of Communications and funded by the New Hampshire Charitable Foundation, Dartmouth-Hitchcock Medical Center, NAMI New Hampshire, and private individuals. Contact reporter Shawne K. Wickham at swickham@unionleader.com. To read previous stories in this series, visit: unionleader.com/stigma.