Hanover — Researchers, health care providers, first responders and U.S. Rep. Annie Kuster, D-N.H., gathered at Dartmouth College on Tuesday afternoon to discuss ways to reduce opioid misuse and opioid-related deaths.
The issue has come to the fore across the country in recent years and particularly in New Hampshire, where rates of opioid overdoses increased by nearly 1,600 percent from 2010 to 2015.
The problem stems from doctors’ efforts to treat pain, which led to the overprescription and misuse of opioids, said Dr. Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health.
“What went wrong with our good intention?” Volkow said during her presentation to an audience of about 100 people gathered in Dartmouth’s Collis Center for “Tackling the New Hampshire Opioid Crisis: Harnessing the Power of Science to Break the Cycle.”
Opioids are an appropriate treatment for acute pain, said Volkow, who experienced the positive effects of the opioid drug Demerol following a severe car accident.
“That’s when I actually realized how powerful these drugs were,” she said.
Overprescription is just part of the problem, however. In recent years, doctors have been prescribing fewer opioids, but the number of overdoses have continued to rise, Volkow said.
In particular, New Hampshire’s spike in overdoses from 2010 to 2015 surprised her, she said.
“What the hell is going on with New Hampshire?” she said. “Oh, my God. This is a really shocking development.”
In an effort to answer questions about the increase in overdoses in New Hampshire, Geisel School of Medicine professor Lisa Marsch presented results of a new HotSpot Report, a rapid epidemiological study of opioid overdoses in the Granite State. The study focuses on the increase of overdoses from fentanyl, a drug that is 50 to 100 times more potent than heroin and often is mixed with heroin, Marsch said.
The study was conducted by Dartmouth’s Center for Technology and Behavioral Health — which Marsch directs — in collaboration with the National Drug Early Warning System. It was funded by the National Institute on Drug Abuse.
Marsch’s team interviewed 76 opioid users, 18 first responders and 18 emergency department personnel from six counties in New Hampshire, including Grafton and Sullivan.
The resulting report provides a glimpse into the experiences of New Hampshire’s opioid users and emergency responders. The study investigated how users first began using opioids; fentanyl-seeking behavior; trafficking and supply chains; users’ experiences with overdoses, Narcan and treatment; harm reduction; prevention and laws; and policies.
The report indicates that the recent increase in fentanyl availability is because it is less expensive and faster-acting than heroin. But the associated high doesn’t last as long and requires users to use more often, which can increase the risks of both overdose and infection.
Ninety percent of the drug users interviewed for the study indicated they actively sought out drugs known to cause overdoses.
“(Overdosing is) one of the best highs you’ll ever have,” one respondent said.
The glimpse the report offers into users’ lives depicts the role family members — and early use of drugs — can play in people developing an addiction later on in life.
For example, one respondent said, “(at age 8) my brother thought it would be funny to get his little sister high,” according to a draft version of the report Marsch’s team provided to the Valley News.
Conversations with first responders highlighted some common misperceptions, including folk remedies for overdoses, such as showers or putting ice in a user’s pants.
“There’s a couple movies and some misinformation over the years that if somebody is overdosed on heroin, you stick them in the shower,” one first responder told researchers, according to the draft report. “Unfortunately, that’s not true, so we found everybody from people who’ve been brought in from the shower, we find that very commonly. We’ve seen people with ice shoved down their pants. It’s almost kind of comical at times because we try to tell these people this doesn’t work.”
Some users also seem to think that combining opioids with a stimulant might prevent an overdose, even though studies suggest the combination may worsen the negative effects for the drug user.
Due to the pervasiveness of opioid addiction in New Hampshire, some of the first responders refer to residents in the age range between 20 and 40 years old as the “lost generation.”
The report includes descriptions of loss as witnessed by health care providers.
“He was a handyman, and he and his son were in the truck one morning. He had the son in the backseat,” one emergency department physician recalled. “The son had come in the morning and said, ‘Dad, I was up late last night with my friends. I just need to lay down in the backseat and get a little rest before we get to the job.’ They got to the job and he was dead and blue, and had overdosed in the truck right behind his father driving to work ... In his honor, I am trying to give back. What a terrible thing. ... No family is ever the same with that kind of thing.”
First responders described responding to calls from children after parents had overdosed.
“I responded to a residence where a 13-year-old girl had called in because she found both her parents unresponsive in the living room. ... She’s making pancakes in the kitchen. She walks out into the living room to ask her mother a question, and they’re both unresponsive. ... Both of them had overdosed on heroin. … To find two in the same house like that, and the circumstances in how it was found, that’s probably going to stick with me for the rest of my life,” the report said.
Speakers at Tuesday’s event offered a range of solutions, but all spoke of the importance of collaboration.
Volkow emphasized the need for medical schools, such as Geisel, to teach students how to appropriately treat pain and substance abuse disorders.
“We’re not doing it,” she said.
Similarly, more needs to be done to make medicines — including methadone, buprenorphine and naltrexone — available to those suffering from addiction, she said. Nationally, some emergency departments have begun offering such treatment with good results, she said.
Manchester Fire Chief Danny Goonan told the audience of the department’s success with a safe station program, which invites members of the community who are struggling with addiction to come to the fire station. Firefighters check people’s vital signs and bring them to the hospital when necessary. They also connect those struggling with addiction to recovery programs with Serenity Place, which offers community-based behavioral health treatment.
“We think in the city that we’ve saved many, many lives with this program,” Goonan said.
Granite Staters’ “certain blend of tenacity and creativity” will help them find solutions to this epidemic, Kuster, who co-chairs a House Bipartisan Heroin Task Force, said during her remarks on Tuesday.
Kuster used the opportunity to critique President Donald Trump’s proposed budget, which includes cuts to Medicaid, a program Kuster said many of the state’s residents rely on for mental and behavioral health services.
“It’s no secret (that) our nation’s behavioral health is dependent on Medicaid,” Kuster said. “It provides the bedrock for effective evidence based treatment (and) makes crucial treatment and recovery services accessible.”
Other speakers described other Upper Valley-based efforts to address the epidemic.
Nancy Bernardy, an associate professor of psychiatry at Geisel who also works for the U.S. Department of Veterans Affairs National Center for PTSD, described efforts to move away from prescribing opioids to veterans with PTSD, help those struggling with addiction to find treatment and find other non-opioid ways to address pain, including acupuncture, mindfulness, yoga and exercise.
Dr. Julia Frew, who directs Dartmouth-Hitchcock’s Perinatal Addiction Treatment Program, described her work to help pregnant women overcome their addiction and care for their children. Pregnancy is a temporary “window of opportunity” when women often seek treatment for the sake of their baby, Frew said.
By providing treatment when women are ready for it, Frew said, she and other providers in the program aim to “break the cycle of addiction that so many of these families have faced.”
Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.