Every election year, New Hampshire captures the national spotlight when it hosts the first in a series of nationwide primaries. Recently, however, the state has found itself in the spotlight for a different — and deadly — reason: In 2015, reports showed that drug deaths in New Hampshire have surpassed the number of traffic deaths in the state.
Heroin and other opioids were involved in more than 400 fatal overdoses in 2015 — up from about 300 in 2014 and nearly 200 in 2013, according to the Office of the Chief Medical Examiner of New Hampshire. The CDC also named New Hampshire one of five states nationwide with the highest rates of such overdose deaths, along with West Virginia, New Mexico, Kentucky and Ohio.
The rise in heroin use and overdose deaths has been linked to the rise in prescription opioid abuse. A 2014 JAMA Psychiatry study showed that opioids have helped change the face of heroin addiction from young men in urban settings to white men and women in suburban settings.
“Respondents who began using heroin in the 1960s were predominantly young men … whose first opioid of abuse was heroin … However, more recent users were older … men and women living in less urban areas … who were introduced to opioids through prescription drugs,” the JAMA study showed.
The study concluded “that the demographic composition of heroin users entering treatment has shifted over the last 50 years such that heroin use has changed from an inner-city, minority-centered problem to one that has a more widespread geographical distribution, involving primarily white men and women in their late 20s living outside of large urban areas.”
The change in demographics has shifted how policy makers — and many ordinary Americans — view the epidemic.
“This is not something that’s just restricted to a small set of communities. This is affecting everybody — young, old, men, women, children, rural, urban, suburban,” President Obama said at a March 2016 summit on heroin.
U.S. Sen. Jeanne Shaheen of New Hampshire has been vocal about the depth of the problem.
“The crisis of heroin and opioid abuse is the most urgent public health challenge facing Nashua and the rest of New Hampshire. This is an all-hands-on-deck moment,” Shaheen posted in a public message on her Facebook page, urging diverse New Hampshire communities to unite to reverse what she called the “pandemic.”
The crisis of heroin and opioid abuse is the most urgent public health challenge facing Nashua and the rest of New Hampshire. This is an all-hands-on-deck moment.
In the fight against the state’s heroin crisis, law enforcement officials are often on the front lines. Nick Willard is chief of police in Manchester, New Hampshire’s largest city; he has called the crisis in his state “an apocalypse.” The heroin crisis is taking its toll on law enforcement officers who see it as an additional stressor.
“It’s taxing on us … not only do we have to deal with what’s going on, with the regular calls we have to go to, now we have to go to these [heroin related] calls,” Manchester Police Officer Casey Finn told Rare. “It’s another report that’s adding to the workload that we have to do. “
Police are “doing the best that we can,” Finn said, noting additional paperwork for drug-related arrests that can consume an officer’s valuable time. “A lot of the stuff that we do in New Hampshire … it’s a lot of red tape that the state government … they don’t make it easy for us.”
The issue of access is profound in New Hampshire, where the rates of heroin use and overdose deaths continue to rise.
Other people in the equation — addicts, their families and treatment providers — express their own frustrations with the state. Kristy Letendre directs the Friendship House, the only comprehensive “substance-use disorder” facility serving the northern part of New Hampshire — 45 percent of the state. Friendship House only has 18 licensed beds, which means many people seeking help cannot get it. Ensuring that those who seek treatment can find it quickly is imperative, as withdrawal symptoms are so severe that they often send an addict back to the drug.
“There is a small window of opportunity when somebody reaches out and asks for help,” Letendre told Rare. “It could be five minutes, it could be an hour … when they want help, they need that help available to them.”
Letendre recalled a recent incident in which a man seeking help died before he could find a treatment facility to take him in.
“When the police found him, there was a list of all the treatment centers in the state and each one of those treatment centers was checked off. He had called them. That’s not a person who wants to continue using. That’s someone who wants those services. And we lost the life. He doesn’t have his opportunity to today because of that,” Letendre said.
There is a small window of opportunity when somebody reaches out and asks for help.
For many users, the typical wait time — four to six weeks — to get into a residential treatment facility could mean the difference between life and death.
As the rates of heroin use and overdose deaths continue to rise, the access issue has become critical. New Hampshire has the second lowest level of access to substance abuse treatment in the country, right above Texas, according to the Substance Abuse and Mental Health Services Administration.
The Obama administration this year put in a $1.1 billion request to Congress to fight the epidemic of heroin use and prescription opioid abuse. Of the $1.1 billion, New Hampshire would be eligible for up to $5 million over two years to help expand treatment for opioid use disorders, the White House said.
Rare politics reporter Yasmeen Alamiri and videographers Tolleah Price and Dan Yar spent months researching and reporting this series — traveling to Maryland, New Hampshire and other heroin-torn places while talking and listening to users, police officers, public figures and devastated families all affected by the epidemic. See the full series at on.rare.us/HeroinInAmerica.