Granite State News Collaborative

Opioids in New Hampshire: The view from the frontlines

Health professionals, first responders provide answers, advice and perspective on the crisis

By Anthony Tone Payton

Healthcare professionals, first responders and community workers are at the forefront of dealing with the opioid epidemic, facing challenges and responsibilities as they strive to save lives, provide care and address the devastating consequences of opioid use.

One of the obstacles is the number of emergencies related to opioids — two to three a day in Nashua and Manchester alone. Responding to overdose calls has become a daily occurrence, putting pressure on their resources and emotional well-being. The dedicated individuals witness firsthand the toll that drug use takes on people's lives, often encountering patients in life-threatening situations.

Managing overdoses can be particularly difficult. Healthcare professionals and first responders must act efficiently by administering naloxone (also known as Narcan), a medication used to reverse opioid overdoses. However, naloxone's effectiveness can vary depending on the potency of the opioids involved, turning it into a race against time to save a life. Witnessing moments where life hangs in the balance emotionally affects health professionals’ resilience and mental well-being. I’ve watched countless healthcare workers, both on the street and indoors, break down in tears at the carnage Opioid misuse has left on our communities.

Known for its presidential primary and fall foliage, New Hampshire has reintroduced itself to America as a state riddled by opioid abuse, among those most hit by opioid abuse and overdose for several consecutive years. In 2017, U.S. World News and Report called New Hampshire,“Ground Zero for Opioids.”

Six years later, on Aug. 31, Gov. Chris Sununu declared it International Overdose Awareness Day in New Hampshire.

A 40-year view

The Mayor’s Task Force on Substance Misuse in the city of Nashua meets monthly. The room is filled with members of law enforcement, schoolteachers, healthcare workers and concerned community members. There are also individuals who have put

substance abuse in the rearview mirrors of their lives in attendance, both in-person as well as online.

Attending the Zoom meeting was Christopher Stawasz, director of government affairs-Northeast Region for Global Medical Response, parent company of AMR, the ambulance services provider in some of the largest cities in New Hampshire, including Nashua and Manchester. Also taking part was Lisa Vasquez, behavioral health strategist for the Nashua’s Division of Public Health and Community Service.

The room is filled with concern, ideas and fatigue. The common denominator that I felt upon entering was hope. The collaborative effect keeps everything running well.

Chris Stawasz was born and raised in New Hampshire. As a man on the frontline of the opioid war for decades, he’s seen firsthand the progression of abuse in his home state. He’s been a paramedic for over 40 years.

“I remember when this fight was all about prescription abuse. Back then, I heard whispers about my own friends addicted to opioids by way of prescriptions. Fast-forward to 2023, and this fight is heavily focused on synthetic opioids, which are much more addictive and dangerous,” he said.

The reason for New Hampshire's problem with opioids can’t be placed on a single factor. A major pipeline does exist in New Hampshire between the opioid hubs, like Lawrence and Boston. However, we’d be doing a major disservice to attribute our woes strictly to our proximity to Massachusetts. Stawasz simplifies it and adds another piece that people tend to gloss over or dismiss.

“We went from heroin to synthetic fentanyl, which is highly addictive, but there are people in society looking to escape the realities of their lives.” he said. “And that feeling of utopia is strong enough to break the bond between a mother and child. You'll never understand if you’ve never experienced the pull of that addiction.”

Through October 2023 — the latest statistics available — AMR medics have responded to a total of 802 suspected opioid overdoses in Nashua and Manchester — 614 in the Queen City, and 188 in the Gate City. Eighty-six of those calls were suspected opioid overdose deaths — 53 in Manchester, and 33 were in Nashua.

In Nashua, suspected opioid overdoses are trending 7% lower than last year on an annual basis, with suspected fatal opioid overdoses trending 10% lower than last year. In Manchester, suspected opioid overdoses are trending 5% higher than last year on an annual basis, while total suspected fatal overdoses are trending 19% lower than last year.

The continued high death rate is attributed to synthetic fentanyl, which is commonly found in all types of illicit substances in New Hampshire. It is important to note that many people who use illicit substances are unaware that what they are using contains synthetic fentanyl and are even less aware of how potent the synthetic fentanyl in the product is. The truth is that synthetic fentanyl can be lethal even when used for the first time, whether knowingly or unknowingly. This is a serious concern that highlights the need for greater awareness and education about the dangers of synthetic fentanyl. 

Language and stigma 

This public health crisis won't be solved overnight, but listening to these workers and community members can help us navigate through these times.

Lisa Vasquez believes that efforts to end opioid abuse also must include working on language and stigma. In addition, she adds that we should all embrace empathy.

“If we want to start changing the way things are, we can't continue viewing this as a criminal issue. Substance use is a brain issue, making it mental health-related. It’s a disease.” Lisa said.

Employees in the mental health and substance abuse fields will often cite indifference from those closest to the solutions. Negative language is a separate war in and of itself, whether implicit or outright. The stigma associated with the words is something that some people don’t recognize. A handful of names and phrases make people clutch their purses, scowl in disgust, or favor indifference.

Vasquez has been working that road since 2017. She developed a model trying to change the language of substance use disorders.She is someone who sees the struggle firsthand as well as being among those people behind the scenes who are bringing people together to effect change.

:”Words matter. Let’s try referring to people as having a substance use disorder as opposed to an addiction. This is also a mental health issue.” she said.

 Also within this mental health issue lies the stigma of criminality. This isn’t an issue that we can lock away. In fact, it is an issue that the criminal system should take a back seat to, since most members of law enforcement aren’t equipped to handle mental health crises. she added

“We should be training people to have more compassion for this population. We’ve been defunding mental health and substance use efforts without the proper training of police,” said Vasquez.

 Some mental health programs are pairing together police officers with mental health professionals to address someone going through a crisis. Police officers have begun to get the training needed to help someone going through a mental health crisis.

 Bobbie Bagley, director of Nashua’s Division of Public Health and Community Services, said, “We’ve seen an increase in opioid overdoses and the number of deaths in our areas. We’re back at the 2017 epidemic levels in New Hampshire. This is significant. We’ve employed strategic efforts to mitigate this, including working with community partners, some within the mayor's task force, and implementing strategies to reduce usage and overdose,” she said.

During a recent conversation, Bagley explained that her agency is dedicated to assisting vulnerable populations, including those experiencing homelessness. They have also expanded their community health worker team to increase further outreach with community partners who provide services to individuals with behavioral and health issues or substance use disorders.

Under her leadership, they have established an internal behavioral health team comprising licensed independent clinical social worker (LICSW) behavioral health specialists and behavioral nurses. The team works closely with the outreach team to assist with syringe services to reduce the spread of diseases like hepatitis and HIV. Additionally, they make referrals to organizations that provide medical assistance.

Narcan and assistance

 According to Chris Stawasz, to prevent overdose deaths, it is crucial for individuals using illegal drugs never to use them alone and always have Narcan on hand. Narcan is available throughout New Hampshire at most pharmacies. It is available free of charge from local public health departments and any New Hampshire Doorway location — there are nine of them around the state. It’s safe and easy to use. Narcan is now available over the counter, meaning it is available without a prescription.

 In addition he said, there is no safe illicit drug. People who use illicit drugs of any type should be mindful of the high chance that synthetic fentanyl is in the substance that they’re using.

Opioid and substance users aren’t some mysterious person lurking in the shadows. They are our sons and daughters. They are our store clerks and teachers. They’re politicians and authority figures.

 He also said how important the effort by Manchester firefighter Chris Hickey — who fought for creation of the “Safe Stations” program, which welcomes addicts and directs them to available drug and substance abuse treatment and recovery services — is in helping avoid overdoses. In fact, Stawasz said, it has been duplicated across the country and should be expanded on an even bigger scale.

This public health crisis won't be solved overnight, but listening to these frontline workers and community members can help us navigate these times. Let’s lead with compassion and continue the work.

Anyone can seek substance use disorder treatment in New Hampshire by accessing the NH Doorway program 24/7. To access the NH Doorway program, call 2-1-1 at any time of the day or night or visit thedoorway.nh.gov. If you believe someone is overdosing, call 9-1-1 immediately,

If you or a loved one is experiencing a mental health or substance use crisis, help is available 24/7. Call or text 833-710-6477, or visit nh988.com

Syringe service information can be obtained through the NH Harm Reduction Coalition. The Boys & Girls Club of the Souhegan Alley also has a Children’s Resiliency Retreat, which is designed for school-age children who are affected by a loved ones’ drug or alcohol use.

The action plan of the Governor’s Commission on Alcohol and Other Drugs can be found here.

Editor’s note: For the last decade, New Hampshire has found itself in the middle of an opioid crisis, one that can often seem never-ending. While there has been much press coverage, both in the state and nationally, about New Hampshire’s plight, this series aims to look at it differently, from the perspective of individuals most affected by it — users, their families, and frontline healthcare workers, all of whom live the crisis every day.

As author Anthony "Tone" Payton writes: “This series was meant to connect people with more than numbers and statistics. Few methods are more effective at humanizing than through the lens of story. I wrote this series with ‘story’ and ‘names’ in mind. I wanted to take people into the heart of this epidemic and get invested in the person and their story.”

This story, part of the series, “Opioids in New Hampshire,” was made possible by a grant from the Center for Rural Strategies and Grist. It is produced by Nashua Digital in partnership with The Granite State News Collaborative.