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Once the epicenter of New Hampshire’s opioid crisis, Manchester continues to show signs of recovery, with a record-low number of overdoses reported in November.

According to Mayor Jay Ruais, the numbers show city efforts to address the crisis are working — and saving lives.

“Manchester’s continued decline in suspected opioid overdoses and overdose deaths shows that our coordinated, evidence-based approach is making a real difference,” Ruais said. “Being 28 percent below last year in total suspected overdoses and nearly 20 percent lower in suspected overdose deaths puts us on track for a potential record low in 2025. This progress reflects the tireless work of our first responders, public health partners and recovery organizations, and it reinforces the importance of staying focused on prevention, treatment and long-term recovery.”

Statistics reported last week by Chris Stawasz, Northeast regional director of government affairs for private ambulance service Global Medical Response Inc., show overdoses in Manchester and Nashua continue to decline.

“November’s opioid overdose response numbers were notable once again by setting another record low for the second month in a row,” Stawasz said. “That virtually assures that 2025 will have the lowest annual number of suspected opioid overdoses in a decade in both Nashua and Manchester.”

Manchester experienced 24 reported overdoses in November, slightly up from October’s 17, but still in line for a dramatic year-over-year decrease. The city is on track for the lowest overdose and overdose fatality numbers in more than a decade, according to Stawasz.

“Manchester is continuing to trend toward ending 2025 with a record-low number of annual suspected opioid overdoses and is currently 28 percent below last year in total annual suspected opioid overdoses,” Stawasz said.

Manchester recorded 345 total overdoses through the end of November and is expected to reach 377 by the end of December. Compared to 2024’s 527 total overdoses, that represents a significant decrease. Overdose-related fatalities are also down, with two reported in November. The current total of 35 overdose fatalities for the year is far below the peak of the epidemic.

When Stawasz began tracking the opioid crisis in 2015, Manchester recorded 728 overdoses and 88 deaths. It is anticipated that 2025 will end with fewer than 40 overdose fatalities.

Nashua’s opioid numbers are on a similar trajectory. The city reported seven overdoses and two overdose fatalities in November, putting it on track for 161 total overdoses by the end of the year and 25 overdose fatalities.

While Nashua’s overdose fatality total is higher than 2024’s 20 deaths, the numbers still represent a major improvement. In 2016, the city recorded 361 overdoses and 44 overdose fatalities.

Efforts such as the state’s Doorway program and the ready availability of over-the-counter Narcan have contributed to the steady decline, according to Stawasz.

Welcome to Nashua, where you can make any political statement you want — so long as city officials approve. Just as the Founding Fathers intended.

The Gate City’s attorney, Steve Bolton, stood before a three-judge panel of the 1st Circuit Court of Appeals in Boston on Tuesday and acknowledged that the city is discriminating against symbols it doesn’t like. That includes Steve and Beth Scaer’s Pine Tree flag.

Nashua found itself in federal court this week thanks to its 2024 rejection of the Scaers’ application to fly the Revolutionary War-era flag on the so-called citizens’ flagpole in front of City Hall.

“We agree that there is viewpoint discrimination,” Bolton told the court. “When a flag is raised under the new policy, it’s right in front of City Hall. It’s right on Main Street. Passersby will say, ‘There’s City Hall, look! What kind of a place is Nashua if they’re flying this symbol, or that symbol, or some other symbol that is generally not regarded as savory?”

But Bolton’s argument is precisely the reason Nashua is in court, according to Judge Sandra Lynch, who sat on Tuesday’s panel. Lynch called Nashua’s flag policy the “essence of viewpoint discrimination.”

“Here’s the problem, counselor. Nashua has chosen to fly, on what are known as the citizens’ flagpoles, flags that are brought to it by private speakers who own the flags, who design the flags, and who come up with a message that the flags display. And then the government is using the force of government to choose among those viewpoints, and that is what government cannot do,” Lynch said to Bolton.

The Scaers, well-known conservative activists, wanted to fly the Pine Tree flag in the summer of 2024 to commemorate New Hampshire citizens who fought at the Battle of Bunker Hill. But the city rejected their application on the grounds that the banner — which has been embraced by some far-right activists — “is not in harmony with the message that the City wishes to express and endorse.”

Nashua’s government is under no legal obligation to allow speech it does not approve of on the citizens’ flagpole, Bolton said, since anything displayed at City Hall is considered government speech and not free speech.

“If this is government speech, which we say it is, the government is not required to give air time to opposing views,” Bolton said.

Nathan Ristuccia, the Institute for Free Speech attorney representing the Scaers, told the justices that Nashua is effectively killing a message it dislikes under the guise of government speech.

“A government cannot turn private speech into government speech simply by exercising final approval authority over that speech,” Ristuccia said.

Ristuccia and the Scaers want the 1st Circuit to overturn the March decision by U.S. District Court Judge Landya McCafferty that allowed Nashua to label any displays flown on the citizens’ flagpole as government speech subject to government control. McCafferty’s decision relied on the flagpole policy games Nashua played, Ristuccia argued.

“This demonstrates that Nashua’s attempt was to do exactly what the Supreme Court warned against — attempting to expand government speech in such a way as to cover all limited public forums,” Ristuccia said.

From 2017 through 2022, Nashua allowed residents to fly flags at the City Hall Plaza with no written policy for oversight or content restriction. Nashua created a written policy in 2022 to give officials veto power over the public flagpole in response to a U.S. Supreme Court ruling against the city of Boston for its refusal to fly a Christian flag. Nashua used that policy to reject the Pine Tree flag.

But when the Scaers challenged the rejection with their lawsuit last year, Nashua changed its policy yet again. The new 2024 policy states that flagpoles “shall henceforth be exclusively controlled by city government” and that Nashua “does not seek input from other sources” about what to fly. The 2024 policy still allows people to apply to fly their flags on city property — so long as the government approves of the message.

The 1772 Pine Tree Riot took place in Weare and is considered a preview of the conflict that led to the American Revolution. The flag was flown during the war by members of the Continental Army and has long been associated with patriotic movements and resistance to authoritarianism.

After nearly a decade of grim statistics, New Hampshire’s getting some very good news in the fight against opioid death and addiction.

The latest data show opioid deaths and overdoses have dropped dramatically, with overdose deaths and emergency responses falling to their lowest levels in a decade in the state’s two largest cities.

No one died from opioid-related overdoses in Nashua last month, and Manchester saw three overdose deaths, continuing a trend that health officials say could mark a genuine shift in the long-running epidemic.

“October suspected opioid ODs were well below recent averages and continue to trend in a very encouraging direction,” said Chris Stawasz, Northeast regional director of government affairs for Global Medical Response, Inc.

Stawasz, who began tracking opioid overdose statistics in Manchester and Nashua for a decade, said 2025 is shaping up to be the best year yet in the fight against opioids. AMR medics responded to just 35 suspected opioid overdoses in the two cities in October — 17 in Manchester and 18 in Nashua.

“The combined (two) city total of 35 was the lowest total number of suspected opioid ODs in one month since AMR began tracking them 10 years ago,” Stawasz said. “The 17 suspected opioid ODs in Manchester were by far the lowest one-month total since AMR began tracking them 10 years ago.”

Gov. Kelly Ayotte said the drop in overdoses shows progress, but warned the fight is not over.

“I am encouraged to see a decline in opioid overdoses, but there is more work to do to fight the drug crisis in our state. We’ll continue to give a hand up to Granite Staters recovering from addiction by funding our Doorways and Recovery Friendly Workplace programs and strengthen our efforts to fight trafficking of deadly poison like fentanyl into our communities.”

Manchester Mayor Jay Ruais, who was just reelected to a second term in part based on his work confronting the city’s drug problems, credited a community effort for the success.

“Manchester’s progress shows that when we come together with focus and determination, we can make real, lasting change. These numbers represent more than just data points; they represent lives being changed and saved. I want to thank our ROAR Team, Health Department, AMR, and all our community partners and outreach workers for their efforts to make a difference in the lives of others.”

Manchester is currently at 321 overdoses for the year and is projected to finish 2025 with about 385, nearly 27 percent below last year’s total. The city has recorded 33 opioid-related deaths so far this year and is on pace for about 40, down from 47 in 2024.

“Manchester is continuing to trend toward ending 2025 with a record-low number of annual suspected opioid ODs and is currently 27 percent below last year in total annual suspected opioid ODs. Suspected opioid OD deaths in Manchester are currently 16 percent lower than in 2024 and very close to a record low,” Stawasz said.

In 2015, at the height of the crisis, Manchester saw 728 overdoses and 88 deaths.

Nashua is also improving, though more gradually; zero overdose deaths in October, 18 overdoses, and 140 for the year so far. The city is projected to finish 2025 with 168 overdoses and 25 deaths. Nashua had 184 overdoses and 20 deaths in 2024, meaning fatalities have already surpassed last year despite a 9 percent decline in total overdoses.

In 2015, Nashua recorded 256 overdoses and 26 deaths.

Experts say one major factor behind falling death rates is widespread access to Narcan, the overdose-reversing medication. Narcan is available without a prescription at most New Hampshire pharmacies and distributed at no cost through public health programs and harm-reduction agencies.

“With Narcan now widely available, it is likely that some opioid overdoses are now occurring without 911 intervention, and are not being reported due to rapid reversal,” Stawasz said.

People can also get Narcan at the state’s nine Doorway locations, which provide addiction treatment referrals, medical support, peer counseling, housing help, and job training. Anyone seeking help can visit a Doorway site or call 2-1-1.