Earlier this month, the Department of Health and Human Services announced drug overdose deaths in New Hampshire have dropped 11 percent since 2018. But there’s actually been no decrease in the last three of those years – except if you look at just opioid deaths.
The rest of the country saw drug deaths spike during the pandemic. New Hampshire was one of the few that didn’t.
The commission leading the state’s drug overdose response hit some of its three-year goals but fell short of others. The latter, it says, were intentionally shoot-for-the stars aspirational.
There is no question the state has made progress fighting the drug overdose epidemic. But evaluating that success – and deciding where to invest resources – requires looking at the details, not a single metric.
And the state has done that well, according to those who’ve been part of the effort. In Manchester and Nashua, for example, AMR, which provides medical transport in those cities, tracks where the opioid overdoses and deaths happen, such as home, hotel, or vehicle and whether they’ve seen the person before to better understand what’s needed.
“New Hampshire has been very purposeful in implementing evidence-based strategies around the opioid epidemic in a really comprehensive way, and not every state has done that,” said Amy Daniels, director of the New Hampshire Center for Excellence in Addressing Alcohol and Drug Misuse at JSI. “What the evidence shows is that it takes a lot of different strategies to get your arms around this problem, and that’s what New Hampshire is doing.”
Emergency drives response
The state earned a ranking it didn’t want in 2015, when the Centers for Disease Control and Prevention put it second in the nation, behind only West Virginia, in drug overdose deaths. The next year, New Hampshire dropped, but just to third. By 2017, the state had hit its peak with 490 overdose deaths in a single year.
A focus on prevention, treatment, and recovery programs – and increased access to Narcan – had a near-immediate impact. In 2019, drug overdose deaths dropped to 415, and they’ve stayed there. (Chief Medical Examiner Dr. Jennie Duval said her office is still finalizing the 2021 numbers, but she expects a similar count.)
It’s possible the record-setting drug death numbers that put New Hampshire in the headlines has also contributed to its achievements, said Dr. Jonathan Ballard, chief medical officer at the Department of Health and Human Services.
“We had an early start, so we’ve worked at it for a long time and we’ve improved a lot of our services and prevention,” he said.
So well, Ballard said, that New Hampshire is leading the country on another drug death marker: It is alone in seeing its deaths due to opioid overdoses – versus those from other drugs – drop year after year, from 424 in 2016 to 357 in 2020.
Though, even that success has an asterisk: In 2021, suspected opioid overdose deaths climbed 31 percent in Manchester and 36 percent in Nashua, according to AMR’s Chris Stawasz, the company’s Northeast director of government affairs.
This summer, Ballard co-authored an article published in the journal Public Health Reports analyzing how New Hampshire and three other states that also brought opioid deaths down – Massachusetts, New Mexico, and Utah – did it. The authors found the four had adopted a number of the same strategies.
Their stakeholders work collaboratively, not from silos, and opted for comprehensive statewide strategies, not discrete projects. They collected and shared data to guide and evaluate investments. Reducing barriers to accessing treatment and recovery were priorities.
Collaboration is key
In New Hampshire, that effort has been led by the Governor’s Commission on Alcohol and Other Drugs.
Its members include lawmakers, state agency heads, medical providers, emergency responders, and staff from the many nonprofits working on substance misuse. Its eight task forces address not only prevention, treatment, and recovery, but also perinatal substance exposure, access for members of the military, and data collection and analysis.
The commission recently released a summary of its progress reaching goals laid out in its three-year action plan spanning 2019 to 2021. What it could not have anticipated when writing the plan was a health epidemic that would isolate people from their support systems.
The commission aimed to reduce EMS cases for alcohol misuse by 10 percent. It did, according to its report. It didn’t see an increase in residents age 12 and older reporting drug use other than marijuana.
It believes it has increased access to screening, assessment, and referrals through the Doorway, a state-run program that has nine sites across the state for people seeking help for mental illness and substance misuse. The availability of telehealth and medication for addiction treatment (MAT) has expanded dramatically, it said. There are now more than 300 “recovery friendly” employers in the state who are committed to supporting employees through their struggles with substance misuse.
The Department of Health and Human Services also just unveiled a new website tracking trends associated with opioid use and the outcomes of treatment.
The commission fell far short of its primary goals. It wanted to see drug deaths drop by 25 percent. They dropped by 11 percent. But that’s still a win, especially given the pandemic, said Patrick Tufts, chairman and president and CEO of Granite United Way.
“We’re really happy to be at 11 (percent), and I think it’s a testament to all the different strategies that we put in place,” he said. “When we picked 25 percent, that was really, really ambitious. It would have been unprecedented for us to have that kind of turnaround in three years. But we weren’t going to shy away from being bold, and we’re really happy with the progress that we have made.”
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