New Hampshire is in a state of crisis; in fact, all of New England is struggling. From high rates of death due to drug overdose, increased number of arrests for drug-related charges, and more and more people seeking treatment for addiction, it is clear that substance use disorders have reached epidemic proportions across the state.
Opiate drugs – heroin, prescription painkillers like OxyContin, and fentanyl – are among the most commonly cited drugs of abuse among people who enter drug addiction treatment programs in New Hampshire, according to the White House Office of National Drug Control Policy (ONDCP). Deadly from the first use, these substances can easily become overwhelming to the system, whether the user is experimenting with the drug or a “seasoned” user.
It is a problem that has struck the nation so hard that state and federal organizations are taking notice. The Obama administration pledged more than $10 billion to increasing access to treatment options and improving drug education programs across the country, according to the National Drug Control Strategy in 2013. The White House has called prescription drug abuse the most rapidly growing problem in the country, and the Centers for Disease Control (CDC) has called it an epidemic.
From the prescription drug addiction and overdose epidemic has evolved an epidemic of heroin abuse and addiction. From there, a steadily climbing rate of drug overdose deaths has occurred, not only due to heroin and prescription painkillers but also fentanyl, an opiate that is 50 times more potent than heroin.
Few places in the country have been hit as hard by painkillers, heroin, and fentanyl as the state of New Hampshire.
New Hampshire Stats and Facts
The more details we have on the how drug use and addiction is impacting New Hampshire, the better equipped we will be to provide treatment services that will have a positive impact on the problem and in the areas where it is most needed. Here is what we know.
The 2015 National Drug Threat Survey reports that New Hampshire is struggling specifically with prescription drugs, marijuana, and illicit substances. They found that:
- About 12.6 percent of people in New Hampshire reported past-month use of illicit drugs, compared to 10.1 percent nationally.
- An estimated 11.51 percent of residents of New Hampshire reported past-month use of marijuana, compared to 7.96 percent nationally.
- About 4.21 percent reported nonmedical use of prescription medications in the past year in New Hampshire, compared to 4.06 nationally.
- Rates of nonmedical use of prescription drugs were highest in New England, with Rhode Island coming in second at 4.15 percent.
According to the 2014 National Survey on Drug Use and Health, the following is true about New Hampshire’s increasing rates of drug use and abuse across the state:
- There was an increase in the use of illicit drugs in the past month among residents aged 12 and over from 2012-2013 to 2013-2014 – 11.28 percent up to 12.6 percent.
- Marijuana use increased in that same time period in the 12+ age group as well: from 15.39 percent to 16.95 percent.
- The perception of great risk associated with monthly marijuana use dropped from 19.86 percent among those aged 12 and over in New Hampshire in 2012-2013 down to 15.43 percent in 2013-2014.
- Illicit drug use in the past month excluding marijuana increased as well, from 3.54 percent to 3.69 percent in that same time period.
- Cocaine use specifically increased as well, from 1.96 percent reporting use of the drug in the past year up to 2.48 percent, one of the highest rates of use in the nation.
Compared to the rest of the country, New Hampshire rates of illicit drug use are among the highest, as are the rates of loss of life associated with use of these drugs. Unfortunately, there are also high rates of residents who required treatment for drug and alcohol abuse who did not connect with services. For example, SAMHSA reports that about 7.61 percent of residents over the age of 18 did not connect with the alcohol abuse and addiction treatment they needed.
The New Hampshire Office of the Chief Medical Examiner confirmed that there were 326 deaths in New Hampshire due to drug overdose in 2014. In 2015, they reported that 439 people lost their lives to drug overdose in New Hampshire, an increase of more than 25 percent in a single year. As of July 2016, the New Hampshire Medical Examiner reported that 161 drug overdose deaths had been confirmed across the state. The projection is that that number will reach 494 by the end of the year, outpacing the number of lives lost in 2015 to drug overdose.
The Office of the Chief Medical Examiner released statistics that found that the following substances were the cause of overdose death in 2016 up through July:
- Fentanyl alone: 62 deaths
- Fentanyl in combination with other drugs, not including heroin: 41 deaths
- Combination of fentanyl and heroin: 5 deaths
- Other opiate drugs: 27 deaths
- Other non-opiate drugs: 21 deaths
- At the time the report was released, 68 cases were still pending. It can take up to 2-3 months to receive the final toxicology results and have a pathologist review them to determine cause of death.
As of 2015, the number of overdose deaths outpaced the number of lives lost due to car accidents in New Hampshire, according to the Union Leader. Additionally, the Centers for Disease Control reports that the average of all overdose deaths in New Hampshire is 26.2, much higher than the national average.
As compared to the rest of the country, New England is struggling with higher rates of mental health issues and New Hampshire is included. According to the National Institute on Mental Health (NIMH), there were 9.8 million adults over the age of 18 in the United States who were living with a serious mental illness, or about 4.2 percent of all American adults, in 2014. They also estimated that about 43.6 million Americans over the age of 18 were living with any mental illness, or about 18.1 percent all adults.
Comparatively, the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that, between 2009 and 2013, about 45,000 adults, or 4.3 percent of the population, were living with a serious mental illness. Additionally, SAMHSA estimates that about 200,000 adults in New Hampshire were living with any mental illness in that same time period, or 19.1 percent of the population. Both of these numbers are higher than the national average.
SAMHSA also noted that only about 46.1 percent of people who needed treatment for any mental illness in New Hampshire received the treatment they needed to manage symptoms related to the problem. To address this problem, a number of statewide organizations like the New Hampshire Community Behavioral Health Association are working to increase education on the subject, remove stigma, and help people connect with mental health treatment services.
Why New Hampshire?
Why is New Hampshire, a relatively small and rural state in the Northeast, suffering so much due to serious drug use and addiction? There is no one specific cause but a number of possible factors that may be contributing to the current situation.
According to Business Insider, the perception of harm associated with use of drugs like marijuana and alcohol is problematic. That is, as compared to the national average, people living in New Hampshire are less likely to recognize the dangers associated with binge drinking, or drinking more than four or five drinks in a two-hour period, or with regular use of marijuana. This can also lead to earlier age of first use, another factor that can contribute to the development of a lifelong substance use problem.
A cold climate may also be part of the problem. According to US Climate Data, New Hampshire has low temperatures that range from 10 degrees Fahrenheit in January to 58 degrees Fahrenheit in July, on average. Short, dark days in winter and a longer winter as compared to more southern climates may keep more people indoors and bored, looking for a way to deal with issues like seasonal affective disorder and other types of depression that often strike people living in cold, dark regions during the winter months.
Additionally, New Hampshire is situated in between a number of major cities, from Montreal and New York City to Philadelphia and Boston. Because many major highways leading to these cities go through the state, residents are exposed to drug traffickers coming through and peddling their wares along the way. The US Department of Justice calls all of New England a High-Intensity Drug Trafficking Area, which means that there are high rates of arrests in the region associated with drug dealing as well as drug use and possession.
Towns in Crisis
The New Hampshire Drug Monitoring Initiative works hard to follow the trends of drug use and abuse as they occur across the state. Undoubtedly, the entire state is in crisis, but some counties are struggling with higher rates of addiction, drug overdose, and emergency room admissions due to drugs and alcohol than others. In the June 2016 report, they note that:
- Hillsborough County saw the highest numbers of emergency room admissions due to opiate use by far with 225 admissions in April, 182 in May, and 231 in June.
- A distant second was Strafford County with 77 admissions in April, 74 in May, and 79 in June.
- Rockingham County residents struggled with opiates as well, with 87 admissions to the ER for opiate drug use in April, 52 in May, and 69 in June.
- Merrimack County was not far behind with 44 admissions in April, 45 in May, and 50 in June.
- The counties with the lowest average admissions to ERs for opiate drug use were Belknap and Cheshire Counties. Belknap saw six admissions in April and May and eight in June, while Cheshire saw seven people for opiate drug use in April, six in May, and eight in June.
These admissions occurred most among those aged 20-29, followed by people aged 30-39. Patients admitted for opiate drug use at the ER were more likely to be male than female.
The rates of admission for treatment for opiate addiction, however, did not exactly match up with the clear need across counties. For example:
- Hillsborough County saw 81 people seek treatment for opiate addiction in April, 93 in May, and 76 in June, and saw the highest number of treatment admissions in the state.
- Merrimack, Strafford, and Rockingham Counties all saw similar numbers of admissions into opiate treatment programs between April and June, averaging about 20 new admissions per month each.
- Belknap County was next in line, with 12 admissions to drug rehab for opiate addiction in April, 16 people in May, and 20 in June.
- Grafton County was next, with eight admissions in April, 15 in May, and 14 in June.
The rates of admission into treatment were relatively equal between genders on average across the three-month period. Between 25 and 33 percent of admissions occurred in the 18-25 age group with the rest occurring in people over the age of 26.
The issue of drug use and abuse, especially opiate abuse, has struck towns large and small across the state. For example, CNN highlighted the problem in Laconia, New Hampshire, where a former police officer for the local police department is working to help people overcome the problem of drug addiction one by one. With a population of about 16,000 people, Laconia is one of many small towns across the state fighting the problem of opiate abuse and addiction.
But Manchester, the largest city in New Hampshire with about 110,000 residents, has been hit just as hard. According to the Union Leader, the city fielded more than 540 overdose calls in the first nine months of 2015 and lost 65 people to drug overdose in that same period. The youngest person in Manchester lost to overdose was 18 and the oldest was 51, with people being treated for opiate overdose at young ages, older ages, and everywhere in between.
Focus on Fentanyl
High numbers of prescriptions for addictive drugs like OxyContin may have triggered the downward spiral of opiate addiction that has hit New Hampshire, combining with other factors to create a “perfect storm” of epidemic proportions. When state and federal governments began to work with the medical community to tighten up prescription practices and better manage distribution, the pills became harder to come by on the black market, causing the price of these pills to go through the roof.
Many were no longer able to afford the medication, especially in the high amounts often needed to avoid withdrawal symptoms, and thus turned to a cheaper and more readily accessible source to get high: heroin. As a result, rates of heroin abuse and addiction rose considerably as prescription drug abuse rates began to fall, becoming the primary drug problem in many towns across New Hampshire – until fentanyl hit the scene.
According to The Guardian, fentanyl is a synthetic substance that is 50 times stronger than heroin and created by Mexican drug cartels and trafficked through New Hampshire. They report that of the 69 fatal overdoses in Manchester in 2015, an estimated 68 percent of those people took fentanyl.
Across the state, the issue is just as severe. As cited above, the Office of the Chief Medical Examiner reports that 62 of the 161 overdose deaths that occurred in the first six months of 2016 were caused by fentanyl alone, 41 were caused by fentanyl in combination with another substance (not including heroin), and another five were caused by fentanyl and heroin combined. That means that about 67 percent of drug overdoses in 2016 have been caused by fentanyl use, making it a very serious issue.
Unfortunately, many who take the drug believe that they are taking heroin. In some cases, fentanyl is mixed into the heroin coming out of Mexico, and because it is so much stronger than heroin, people take the dose that is “normal” for them and overdose. It is one more factor to consider when helping people to understand the risks of drug use and addiction.
Building a Brighter Tomorrow through Treatment and Resources
New Hampshire is hard at work to help families and those who are struggling with addiction to connect with the treatment services and resources that will save lives from overdose and provide healing in recovery.
According to the National Survey of Substance Abuse Treatment Services, there is a range of treatment services currently available to residents in New Hampshire, including:
- 43 private, nonprofit treatment programs
- 13 private, for-profit drug rehab programs
- 1 local or community treatment program
- 1 state-run treatment facility
- 1 federal addiction treatment program
While this is a good start toward providing those in need with the treatment services necessary to overcome addiction and avoid overdose, it is nowhere near enough. Many are looking out of state in order to find a program that has availability and the resources they need to overcome addiction.
Governor Maggie Hassan of New Hampshire is working together with governors from four other states in New England to better manage the epidemic of drug-related deaths that is sweeping the region. According to The New York Times, they will share data about prescription drug use and prescribing practices across state lines in an effort to identify patients who are crossing state lines to get similar addictive prescriptions from multiple doctors. They will also work on creating Medicaid treatment agreements that would allow low-income residents of one state to connect with an open bed in a treatment program in another state if none are available locally.
- The New Hampshire Statewide Addiction Crisis Line is accessible toll-free at 1-844-711-HELP (4357).
- The New Hampshire Bureau of Drug and Alcohol Services offers a number of resources and helpful information concerning statewide treatment resources.
- The New Hampshire Providers Association offers a range of resources to families in New Hampshire who are struggling with addiction as well as resources for the treatment programs in the state that serve them.
- The Naloxone Kit Locator is an online resource to connect concerned friends and family members with lifesaving naloxone kits that can be used to reverse an opiate overdose.