How a ‘perfect storm’ in New Hampshire has fueled an opioid crisis

FILE -- Justin Lerra and his girlfriend, Sarah, as he turned himself in to the fire station to get treatment for his opioid addiction in Manchester, N.H., July 20, 2017. New Hampshire is relatively prosperous, with low crime and unemployment. But the state is short on treatment centers, and drugs are readily available in nearby Massachusetts.
Justin Lerra and his girlfriend, Sarah, as he turned himself in to the fire station to get treatment for his opioid addiction in Manchester, N.H. –odd Heisler/The New York Times

MANCHESTER, N.H. — They sat on plastic chairs in a corner of the Manchester fire station, clutching each other in a desperate farewell.

Justin Lerra was 26 when he turned himself in last summer to the fire department’s “safe station” program, which helps get drug users into treatment. He had been using drugs for seven years. His girlfriend, Sarah, who asked that her last name not be published, was pregnant and had told him that if he didn’t stop using, she would leave him.

Emotional scenes like this play out daily at firehouses in Manchester and Nashua, a measure of how deeply the opioid scourge has ravaged New Hampshire. The state leads the nation in overdose deaths per capita from fentanyl, a powerful synthetic opioid that has virtually replaced heroin across New England. Because fentanyl is so potent, the risk of overdose is high.


In New Hampshire, which President Donald Trump has called a “drug-infested den,” the opioid crisis is almost a statewide obsession.

An astonishing 53 percent of adults said in a Granite State poll last year that drugs were the biggest problem facing the state — the first time in the poll’s history that a majority named a single issue as the most important. (Jobs and the economy lagged a distant second.)

While West Virginia leads the nation in overall drug overdose deaths per capita, New Hampshire is essentially tied with Ohio for second place.

Unlike West Virginia, New Hampshire is relatively prosperous, which makes an opioid crisis here seem all the more jarring. This state has the highest median household income in the country, ranks low in unemployment and crime, and often lands at or near the top of lists of the best states in which to live.

Researchers at Dartmouth College in Hanover, New Hampshire, have been studying the issue to try to understand why the state’s opioid problem is so dire.

One big reason, they say, is the proximity to an abundant drug supply in neighboring Massachusetts, the center of drug distribution networks that traffic opioids throughout New England.


Another, they say, is New Hampshire’s low per capita spending on services to help drug users break free from addiction. Nationally, the state, which has no income or sales tax, ranks at the bottom in availability of treatment programs. The fire departments’ safe stations are one effort to fill that void.

The researchers also noted that the state has pockets of “economic degradation,” especially in rural areas where jobs are few, and that may contribute to the problem.

Beyond that, the researchers say, doctors here have long prescribed “significantly higher rates” of opioid pain relievers, almost twice the national average. When the government cracked down on legal painkillers, New Hampshire residents were primed to seek out illegal street drugs.

“This is a kind of perfect storm,” says Lisa A. Marsch, a professor of psychiatry and health policy at Dartmouth’s Geisel School of Medicine and the study’s principal investigator.

“We have highly available, highly potent opioids in New Hampshire,” she says. “And highly limited resources to reduce the risk.”

The researchers noted other factors, too:

— A shortage of workers in addiction and recovery. Northeast states have an average of 15.5 doctors per 100,000 residents who can prescribe Suboxone and other medication-assisted treatments; New Hampshire has seven.

— No needle exchanges, which can reduce the transmission of diseases like hepatitis C and save health care costs. New Hampshire finally legalized needle exchanges in June, long after many other states had done so, but did not fund them. Dartmouth medical students, using donations and grants, opened the first needle exchange last summer in a Claremont, New Hampshire, soup kitchen, but it was shut down in October because it was too close to a school.


— “Live Free or Die.” The researchers said the New Hampshire ethos of “self-sufficiency and individualism” could inhibit some residents from seeking help. And for some, they said, the state’s “Live Free or Die” motto might justify risky behaviors. The state does not require drivers to wear seat belts. It allows motorcyclists to ride without helmets. And state liquor stores are right on the major highways.


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