NH Union Leader – November 29, 2024
By SHAWNE K. WICKHAM, Union Leader Staff
Fatal drug overdoses are down, both in New Hampshire and nationally. New Hampshire was hard hit early on in the opioid epidemic that has ravaged the nation. And while it’s too soon to declare victory, some hope that the state could lead the nation in climbing out of the crisis. You have to look back a decade to find overdose numbers as low as they are this year. As of Nov. 13, the state Office of Chief Medical Examiner confirmed 228 drug deaths this year, with 33 additional cases pending toxicology results.
In 2023, 431 New Hampshire residents died from drug overdoses. The vast majority were ruled accidental, but 19 died by suicide, according to the medical examiner’s office. The year before that, there were 487 overdose deaths, close to the record high number (490) recorded in 2017. Most overdoses are still related to fentanyl, a synthetic opioid that is exponentially more potent than heroin. But methamphetamine, cocaine, xylazine (a sedative used in veterinary medicine) and carfentanil also were detected in some overdose victims so far this year, according to the medical examiner’s office.
Dr. Jonathan Ballard, chief medical officer at the state Department of Health and Human Services, spent five years as state epidemiologist in Kentucky before moving back in 2017 to New Hampshire, where he had done his residency at Dartmouth, earned a master’s degree in public health, and met his wife. Back then, Ballard said, New Hampshire had a “hodgepodge” of treatment programs, and there were not enough of them. Naloxone, an antidote to opioid overdose, was not widely available.
“We knew that we needed to take a strategic and methodical approach to system transformation,” Ballard said. “We looked at all the other states who were doing a little bit better than us at the time and we realized we needed to have a comprehensive approach that emphasized different aspects of prevention, treatment and recovery supports.”
“So at that time, we set forth a long-range plan that would build out that system of care for substance use disorders,” he said. For the past five years, the state has received about $28 million annually to address substance use disorders. Health leaders created the Doorway program, a statewide system to link individuals with immediate evaluation and treatment. The state amended its Medicaid plan to include coverage for substance use-related treatment and support services. That’s key to saving lives, Ballard said. “Being in treatment and continuing in treatment is one of the most important factors for preventing death,” he said.
“We knew we had to cut down on stigma,” Ballard said. “We had to make it easy to access, and then — here’s the important kicker — it had to be same-day access,” he said. So the state funded training for 600 physicians in medication-assisted treatment and also allowed providers to prescribe through telemedicine. It also authorized hospital emergency departments to prescribe the treatment drug buprenorphine, and connected the Doorway locations to prescribers to start people on medication right away.
And naloxone is now widely available, at pharmacies, harm-reduction coalitions, shelters, schools and law enforcement agencies — for anyone “who may have an opportunity to save a life,” Ballard said. New Hampshire was the first state to place naloxone boxes in public places. “Yes, it did need to be in the hands of people who have opioid use disorder, but really, it needs to be in the hands of the bystanders,” Ballard said. Long-term, Ballard said, recovery supports are key to keeping people drug-free. Housing, jobs, recovery-friendly workplaces, peer support workers, drug courts and programs for individuals involved in the justice system are all part of the all-hands-on-deck approach, he said.
And finding ways to address adverse childhood experiences — ACES — could prevent the next generation of individuals from developing substance use disorders, experts say. “It’s logical, it makes sense, it’s extremely hard to do, and it takes time to get at the primary prevention of substance use disorders,” Ballard said. Ballard said he approaches the ongoing drug epidemic from a disease perspective. “This is a terrible, lifelong, chronic, relapsing and remitting disease,” he said. “That’s how I’ve been trained, and that’s my belief.” And that makes this “a generational and systematic challenge,” both for affected families and communities, he said. But he’s optimistic New Hampshire is on the right path. “We’re a small state, we’re close-knit, and we take care of each other,” Ballard said. “Your health does affect my health.”