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Even with the total number of opioid-related overdoses dropping in Nashua and Manchester, the number of overdose deaths continues to rise, based on figures released Tuesday.

Nashua saw a 16 percent increase in opioid deaths in May, according to data from ambulance company American Medical Response (AMR). Manchester is holding steady at last year’s record-breaking death total.

Fentanyl fuels the crisis that is engulfing the Granite State, said Chris Stawasz with AMR.

“The high death rate per capita is attributed to synthetic fentanyl, which is now found in all types of illicit substances,” Stawasz explained. “People who are using illicit substances have no idea that what they are using contains synthetic fentanyl or how potent the synthetic fentanyl in the product is. Synthetic fentanyl can be lethal the first time you use it, knowingly or unknowingly.”

Where those drugs are coming from is not a mystery. While the bulk of the fentanyl and methamphetamines reaching New Hampshire originate in Mexico, plenty of illegal drugs are crossing the border from Canada, too.

Last month, federal agents arrested 31 people in the North County near the Canadian border who were allegedly engaged in large-scale drug trafficking. Agents seized 14 pounds of fentanyl and another two pounds of methamphetamine in the operation. 

Republican Gov. Chris Sununu has been pushing for another $1.4 million to beef up border security in New Hampshire, something Democrats have opposed. 

Sununu announced Monday that he would not run for president, but he is considering a run for an unprecedented fifth term as governor. Sununu told Drew Cline the opioid epidemic is something GOP presidential candidates who come to New Hampshire should focus on.

“I think there’s a big winning issue with mental health and opioids and drugs; we’ve made many strides here,” Sununu said.

Asked about the ongoing opioid epidemic in her city, Manchester Mayor Joyce Craig declined to respond. Craig has formed an exploratory committee for a possible run for governor next year. NHJournal also contacted her potential opponent in the Democratic primary, District 2 Executive Councilor Cinde Warmington, about the latest opioid statistics. She, too, declined to respond.

The opioid problem is serious across the state, as highlighted by AMR’s statistics from New Hampshire’s two major cities. Medics responded to 80 suspected opioid overdoses in May — 58 in Manchester and 22 in Nashua. There were 11 suspected opioid deaths in Nashua and Manchester in May;  seven deaths in Manchester and four in Nashua.

There have been 358 opioid overdoses in Nashua and Manchester through the end of May, with 53 suspected opioid overdose deaths. There were 32 in Manchester and 21 in Nashua.

In Nashua, suspected opioid overdoses are trending 17 percent lower than last year annually. However, suspected fatal opioid overdoses are trending 16 percent higher, according to AMR. Some 25 percent of all suspected opioid overdoses in Nashua this year have been fatalities.

The number of opioid-related overdoses first responders treated in Nashua rose sharply in March, up nearly 80 percent over the previous month, according to stats compiled by American Medical Resources (AMR). It is yet another sign the state’s opioid crisis continues in its two largest cities.

Chris Stawasz, the Northeast Regional Director of Government Affairs at AMR, said medics responded to 87 suspected opioid overdoses in March; 62 in Manchester – up 13 percent from February and 25 in Nashua – up 79 percent from February.

While the total number of opioid-related overdoses for the year in both cities is trending lower than last year’s record-setting high, 2023’s death count continues to rise. Last month, there were 10 suspected opioid deaths in Nashua and Manchester, with three in Manchester and seven in Nashua. 

Nashua is getting hit particularly hard this year, according to Stawasz. Suspected fatal opioid overdoses in Nashua are trending 29 percent higher than last year. Even more alarming: one in four suspected opioid overdoses (27 percent) in Nashua this year have been fatal.

AMR medics have responded to 224 suspected opioid overdoses in Nashua and Manchester through the end of Marc,h with 35 resulting in suspected opioid OD deaths; 21 in Manchester and 14 in Nashua.

Jay Ruais, who’s running for mayor of Manchester and has had his own struggles with addiction, points a finger at Mayor Joyce Craig’s management during the ongoing crisis.

“Our city needs to alter our approach to this crisis, the current trajectory is clearly unsustainable. We must grow our police department and fully empower them to go after drug dealers while building better systems for vulnerable individuals at critical intervening moments in our hospitals, jails, and schools.

“As Mayor, I will work to ensure we are coordinating with all those fighting to improve our community and save lives,” Ruais said.

Why are such a high percentage of overdoses becoming deaths? Stawasz believes fentanyl is the culprit.

“The significant increase in deaths is attributed to very potent synthetic fentanyl,l which is now found in all types of illicit substances,” Stawasz said. “People who are using illicit substances can have no idea that what they are using contains synthetic fentanyl – or how potent the synthetic fentanyl in the product is. Synthetic fentanyl can be lethal the first time you use it, knowingly or unknowingly.”

In all, there were 62 suspected opioid overdoses in Manchester during March, bringing the year-to-date first-quarter total to 173. The total number of suspected opioid overdoses in Manchester is currently trending the same as last year on an annual basis, with 12 percent of all suspected opioid overdoses responded to by first responders in Manchester this year having been fatal.

There were 25 suspected opioid overdoses in Nashua during Marc,h bringing the year-to-date first-quarter total to 51. The total annual number of suspected opioid overdoses in Nashua is currently trending 15 percent lower than last year on an annual basis, Stawasz said.

Manchester is breaking new ground in misery as the Queen City death totals from the opioid crisis keep rising. It is a crisis, Republicans say, driven by illegal fentanyl pouring over a border Democrats refuse to secure.

Manchester and Nashua experienced a record-high number of opioid-related overdose deaths last year. Manchester is on track to exceed that number in 2023 said Chris Stawasz with American Medical Response.

“There were 18 suspected opioid deaths in Nashua and Manchester in February. That is the most suspected opioid deaths in one month for Nashua and Manchester combined since tracking began in 2015.”

Nashua suffered 44 opioid-related overdoses last year, the most since 2018 when 35 people died. Manchester saw 79 people die from opioid overdoses in 2022, the highest number since 2017’s 67 deaths. More troubling, while Nashua is estimated to see a slight dip in deaths this year, Stawasz anticipates Manchester’s death toll to reach 111, the most ever.

Synthetic fentanyl, the type being smuggled over the southern border by Mexican cartels, is the most likely culprit for the increase in deaths. Fentanyl is used in counterfeit pills, and it is used to lace other illegal drugs.

“The significant increase in deaths can most likely be attributed to very potent synthetic fentanyl which is now being found in nearly all types of illicit substances,” Stawasz said. “In many cases, people who are using illicit substances have no idea that what they are using contains synthetic fentanyl – or how potent the synthetic fentanyl in the product is. Synthetic fentanyl can be lethal the first time you use it, knowingly or unknowingly.”

Fentanyl is responsible for the majority of overdose deaths in the country, according to federal government statistics. In 2021, 90 percent of all overdose deaths were connected to the drug. And most of that is coming from Mexican cartels who are producing the synthetic drug using ingredients from China, then using their control of the southern border to smuggle it into the U.S.

“The source of fentanyl is Mexico and its drug labs,” said Todd Bensmen with the Center for Immigration Studies. “I’m not seeing any evidence that the Biden administration is interested in damming up the source.”

Gov. Chris Sununu acknowledges New Hampshire is being hit hard by the opioid crisis, but he noted it is part of a national problem.

“States across the country are seeing a rise in opioid-related deaths and New Hampshire is not immune. Every death is tragic; it is someone’s son, daughter, and family member,” Sununu said. “The bottom line is that fentanyl is now in all different types of substances, whether that be cocaine, methamphetamine, fake pills, or vape cartridges – assume it is in anything and everything.

“There is no safe experience with substances, unless they are prescribed by a provider, and taken only as directed by the person they are prescribed to.”

Getting a handle on the crisis in Manchester calls for more police support, and getting cops the tools they need to do the job, said Jay Ruais, a Republican running to replace Democratic Manchester Mayor Joyce Craig.

“We must provide greater resources for our police department to go after drug dealers and fight for bail reform at the state level to keep them off our streets,” Ruais said. “Additionally, most who suffer a fatal overdose have previously overdosed, meaning we have to build better systems for individuals when they are at their most vulnerable like in hospitals, jails, and prevention programs in schools. Solving this crisis doesn’t cost more money. It requires prioritization and better coordination with existing community partners.”

Sununu announced a new PSA campaign this year, “No Safe Experience” to educate Granite Staters, especially young people, about the danger of fentanyl and other illegal drugs. Expected to run through the fall, the campaign includes video and public service announcements, social media campaigns, an informational website, billboards, and highly visible signs, posters, and materials that will be widely disseminated across the state and made available to schools, and an active media campaign to share that there is no safe experience through personal stories and data. 

Global Medical Response released its November numbers for opioid overdoses and deaths on Monday. It reported a 30 percent increase in opioid-related overdose deaths in Nashua and Manchester so far this year, and a total of 112 opioid-related overdose deaths according to GMR’s Christopher Stawasz.

Those overdoses and deaths are directly related to the flow of fentanyl across the border from Mexico and making its way to the Granite State.

But just hours after the GMR report, White House Press Secretary Karine Jean-Pierre insisted criticism of the Biden administration’s border policy is exaggerated.

“It would be wrong to think that the border is open. It is not open,” said Jean-Pierre said. 

Border security advocates and elected officials don’t agree.

Illegal border crossings have skyrocketed in recent years, jumping from 405,000 in fiscal year 2020 to 1.6 million in 2021. In fiscal year 2022, which ended in October, the figure spiked again to more than 2.2 million. 

And with that record flood of migration comes drug trafficking and other crimes, said Jessica Vaughan, director of policy studies for the conservative Center for Immigration Studies.

“The tragic spike in deaths from fentanyl and other dangerous illicit drugs is a direct result of the Biden administration’s failure to control the border and to enforce immigration laws in the interior, which makes the deadly drug trafficking business way too easy and profitable for the cartels and all their operatives and subsidiaries,” Vaughan said. “Because the Border Patrol is so tied up with processing and with care and feeding of the thousands of illegal migrants taking advantage of the catch and release policies, there are no agents on the line to prevent the drug traffickers from getting their product over the unguarded areas.”

Chinese organized crime syndicates, working with Mexican cartels, ship precursor drugs to Mexico where fentanyl and methamphetamines are manufactured. Those deadly drugs are then smuggled over the southern border and then flow freely throughout the United States.

According to the Drug Enforcement Agency, Chinese syndicates are mostly responsible for illicit drugs obtained through online markets and sent through the mail to the United States, while the Mexican cartels are manufacturing hub for drugs that get smuggled into the U.S. India is emerging as a new source for fentanyl that gets smuggled into China and then sold into America according to an unclassified DEA report.

New Hampshire Gov. Chris Sununu scoffs at the Biden administration’s claims they have got the situation under control.

“Yes, the governor believes the nationwide surge in drug deaths is a direct result of fentanyl coming across the southern border,” said his spokesperson Ben Vihstadt. “The unfettered movement of these drugs has created more of a ‘cartel driven’ market than ever before. It’s not just over-prescribing or user demand. The cartels are now putting fentanyl in a variety of other substances to drive their market of addiction.”

Even the Biden administration believes the problem is likely to get worse with the court-ordered end of the Title 42 border policies put in place by President Donald Trump during the COVID-19 pandemic. A DHS memo obtained by CNN warned the end of Title 42 will “likely increase migration flows immediately into the U.S.,” and they predict 14,000 unauthorized migrants crossing into the country each day.

On Monday, Jean-Pierre appeared to suggest the Biden administration opposed ending Title 42 and blamed the policy shift on the courts. “What I am telling you is that it was a court order that was — that we are following. And we’re going to follow the law when it comes to what the court has decided to do.”

But President Biden announced on April 1 he planned to end the policy on May 23. The courts prevented the administration from doing so until now.

U.S. Supreme Court Justice John Roberts has issued a temporary halt to ending the policy.

During their reelection bids last month, both Sen. Maggie Hassan and Rep. Chris Pappas said they opposed the Biden plan to end Title 42 and wanted the administration to continue turning away would-be migrants. Sununu agrees.

“The governor believes the Biden administration must do everything in its power to extend Title 42 and secure the border and is pleased the Supreme Court just this evening halted Title 42 from expiring,” Vihstadt said.

Vaughan said the fentanyl crisis will get worse until the Biden team gets serious about securing the border.

“There is little to inhibit the flow of this illegal poison into communities – the product and the people who distribute it are able to do so with impunity,” Vaughan said. “But if we could regain control of the border and deport the criminals who are trafficking the drugs here, authorities could begin to clean up the streets.”

Nashua and Manchester continue chasing a grim record as opioid-related overdose deaths continue to rise in the two cities. 

According to data released Thursday by ambulance company American Medical Response, there were 77 suspected opioid overdoses in Nashua and Manchester during September 2022 bringing the combined total for this year to 701.

And they warn there is no end in sight.

“Preliminary data show Nashua has experienced 33 suspected opioid-related deaths through September. That is 3 more deaths than during all of 2021,” said Chris Stawasz, Northeast Regional Director of Government Affairs for AMR. “Nashua remains on pace to have the highest number of suspected deaths from opioids in one year since the opioid epidemic began in 2015. Manchester is also still on pace to have the highest number of suspected opioid-related deaths in a one-year period since 2017.”

This year’s number of opioid-related overdose deaths is already close to last year’s totals. Manchester had more than 500 suspected overdoses in 2021, 30 percent more than the previous year, and Nashua had 250 suspected overdoses in 2021, which was 29 percent more than in 2020.

Stawasz said opioids like Fentanyl are not the only thing first responders are worried about. The growing prevalence of methamphetamines on New Hampshire streets is concerning, he said.

“Methamphetamine, which is not currently tracked and is not included in this report, continues to be seen mixed with opioids. Meth is a particularly dangerous drug for both users and first responders as it can cause extreme excited delirium and alarmingly unpredictable behavior in users,” Stawasz said.

Meth use has been linked to violent incidents in recent years, with several fatal police shootings involving people who were heavy meth users coming into conflict with police.

Both methamphetamine and fentanyl are coming over the Mexican border and making their way into New Hampshire, according to law enforcement. Mexican drug cartels are getting the necessary chemicals to make the deadly drugs from Chinese triads. The partnership extends to billions of dollars being laundered by the triads for the cartels, with the knowledge of China’s government.

The drugs continue to stream over the border, which has seen record numbers of people illegally crossing. The Border Patrol reports it apprehended 2 million people this year, the largest number of illegal crossings in history. That blows past last year’s figure of 1.7 million people coming over the border illegally, which was a record number at the time.

Democratic Sen. Maggie Hassan received testimony on the need to secure the border from national law enforcement officials during a hearing earlier this year. Jon DeLena, Deputy Special Agent in Charge of the New England Field Division for the DEA, testified regarding the danger posed by the cartels.

“The model of the drug cartels right now is simple. Relentless expansion and addiction. They simply don’t care if Americans die. They only want to reach more Americans in unprecedented ways. This is a moment in time, our moment where we have to do everything we can to reverse this deadly trend,” DeLena said.

EDITOR’S NOTE: This article has been updated to more accurately reflect the testimony offered by Mr. DeLena.

An explosive report published in ProPublica links the official policy of China’s government to the fentanyl epidemic killing Americans, including a record number of Granite Staters. And Granite State GOP opponents of President Joe Biden’s border policy are pointing to it as more proof it is time to make a change in Washington.

ProPublica released a story last weekend by reporters Sebastian Rotella and Kirsten Berg about a Chinese American gangster named Xizhi Li who came to dominate the money laundering market for Mexican drug cartels. The ruthless cartels are making billions sending fentanyl and other drugs to users in the United States and beyond through the porous Southern border.

“At no time in the history of organized crime is there an example where a revenue stream has been taken over like this, and without a shot being fired,” retired DEA agent Thomas Cindric, a veteran of the elite Special Operations Division, told ProPublica. “This has enriched the Mexican cartels beyond their wildest dreams.”

Since 2006, China has exported more than $3.8 trillion through money laundering schemes according to the report. China now leads the world as the primary financial underwriter for the cartels.

According to ProPublica, the Chinese government certainly knows that its citizens around the globe are involved in money laundering for the cartels and it approves.

With a major world power now suspected of using America’s unsecured southern border to attack the United States, Republicans like retired Gen. Don Bolduc are laying the blame at the feed of Biden and his Democratic allies, including his opponent Sen. Maggie Hassan.

“It’s no secret the drug crisis is plaguing New Hampshire communities and families, exacerbated by the open-border policies supported by Sen. Hassan,” Bolduc’s spokesperson Kate Constantini told NHJournal. “Drugs are pouring in and killing Granite Staters while Sen. Hassan is hiding in her safe and cushy D.C. office. Parents across the country now have to worry about telling their own children they can’t eat Halloween candy because Democrats like Sen. Hassan continue to stay soft on crime and drugs.

“We’ll gladly compare our vision for a secure border and strong communities over Sen. Hassan’s pathetic record any day.”

The issue is more problematic for Hassan because she sits on the powerful Homeland Security Committee which has direct oversight of border security policy.

Former senior FBI official Frank Montoya, Jr. told ProPublica China supports the money laundering business which props up the cartels as part of a policy to further weaken the United States.

“We suspected a Chinese ideological and strategic motivation behind the drug and money activity,” Montoya told ProPublica.

He offered this rationale to ProPublica for the Communist government’s policy.

“To fan the flames of hate and division. The Chinese have seen the advantages of the drug trade. If fentanyl helps them and hurts this country, why not?”

The Hassan campaign did not respond to a request for comment. But in the first U.S. Senate debate of the general election Tuesday, Hassan insisted she supports “a secure, orderly and humane border,” and that she supports additional “physical barriers,” aka “a wall.”

But as a senator, Hassan repeatedly voted against funding the border wall former President Donald Trump tried to build while he was in office. And she opposes deporting illegal immigrants who successfully make their way into the nation, also known as “interior enforcement.” 

Karoline Leavitt, in an apparent neck-and-neck race with incumbent Democrat Rep. Chris Pappas, also blames her opponent for the border problem.

“With each passing day, Chinese fentanyl continues to be smuggled across our wide-open southern border. Our families and communities are being poisoned by this dangerous drug, and we cannot afford another weak leader in D.C. who will act as if this problem isn’t occurring,” Leavitt said. “We need a representative who will work with law enforcement to secure our communities and stop this dangerous drug from pouring into our state.”

Pappas also did not respond to a request for comment.

Both Pappas and Hassan heard testimony earlier this year from national security officials who testified that Chinese triads are supplying Mexican cartels with the chemicals needed to make fentanyl. Those drugs are making their way into New Hampshire with deadly consequences.

New Hampshire’s two largest cities, Manchester and Nashua, are on target for record opioid overdose deaths this year, thanks to the fentanyl flooding the streets. According to American Medical Response, a large ambulance company that services New Hampshire, opioid deaths continue to rise.

Data for August, the most recent set available, show Nashua has seen 32 suspected opioid-related deaths, topping last year’s 30 opioid deaths.

“Nashua remains on pace to have the highest number of suspected deaths from opioids in one year since the opioid epidemic began in 2015,” AMR states in its monthly report.

Manchester is on pace to have the highest number of suspected opioid-related deaths in a year since 2017, with more than 71 opioid deaths projected for the year. As of the end of August, the Queen City has 45 suspected opioid overdose deaths on record.

The rate of overdose deaths from the opioid epidemic continues to climb in Manchester and Nashua, with both cities approaching record deaths this year. And Republicans are pointing a finger at President Joe Biden’s border crisis.

According to Chris Stawasz with American Medical Response, first responders were called to 86 suspected opioid overdoses in Nashua and Manchester during July 2022, bringing this year’s total to 539. That is 99 more incidents than the same period last year, a 23 percent increase.

Nashua is on track to have the highest number of opioid deaths in a year since the start of the pandemic. Manchester is looking to break the record it set in 2017.

“Preliminary data shows Nashua has experienced 29 suspected opioid-related deaths through July. There were 30 suspected opioid-related deaths in Nashua during all of 2021. Nashua remains on pace to have the highest number of suspected deaths from opioids in one year since the opioid epidemic began in 2015. Manchester is still on pace to have the highest number of suspected opioid-related deaths in a one-year period since 2017,” Stawasz said.

There were 10 likely opioid-related deaths in July, eight in Manchester, and two in Nashua. Their causes are still pending verification from the Office of the New Hampshire Chief Medical Examiner. 

Republicans note the surge in unlawful border crossings since Biden took office and the flood of fentanyl across the southern border.

So far this year, United States Customs and Border Patrol has seized about 133,000 pounds of methamphetamine at the border, compared to more than 8,000 pounds of fentanyl, and 50,000 pounds of cocaine.

National Republican Congressional Committee spokesperson Samantha Bullock says voters should hold elected Democrats like Reps. Annie Kuster and Chris Pappas to account.

“Chris Pappas and Annie Kuster have buried their heads in the sand to avoid addressing Democrats’ southern border crisis that’s allowing deadly drugs to destroy New Hampshire communities.”

A spokesperson for the House Republican Conference reiterated that point to the Washington Examiner.

“Joe Biden’s open-border policies have plunged our southern border into absolute chaos. It is a fact that Biden’s fentanyl crisis is directly a result of his border crisis, as the illegal drugs pour in over the wide open southern border,” the spokesperson said.

In New Hampshire’s two largest cities, Stawasz says first responders are dealing with people overdosing after they use drugs that they did not believe were opioids.

“AMR medics continue to see and listen to reports from suspected opioid OD patients who believed they were not specifically using opioids and were surprised that they overdosed on an opioid,” Stawasz said.

Stawasz told Democratic Sen. Jeanne Shaheen during a July roundtable that dealers are putting potentially deadly doses of fentanyl into other drugs and selling them to unsuspecting users.

“I personally have experienced several occasions on a call when someone we’ve woken up from an opioid overdose will insist, ‘I was not using an opioid, I’m not an opioid user. I smoke marijuana. But I bought it from a different person.’ I think that’s contributing to an increased number of deaths,” Stawasz said.

July also saw an increase in the number of patients treated who reported or were suspected of consuming methamphetamine. Methamphetamine use numbers are not currently tracked and are not included in this report. Meth is a particularly dangerous drug for both users and first responders as it can cause extremely excited delirium and alarmingly unpredictable behavior in users.

Methamphetamine is seen by federal law enforcement as a growing problem in New Hampshire. It is coming into the United States in the same way as fentanyl, largely from Mexican cartels who smuggle the drugs over the border. 

The opioid addiction crisis in New Hampshire continues to worsen as Nashua and Manchester recorded another month of increased overdoses and deaths. 

According to Chris Stawasz, Northeast Regional Director of Government Affairs with Global Medical Response, Nashua is expected to have a record number of deaths this year.

“Nashua is still on pace to have the highest number of suspected deaths from opioids since the opioid epidemic began in 2015,” Stawasz said.

Through the end of June, Nashua and Manchester have seen a 20 percent increase in opioid overdoses from the same time last year. In the two cities alone, there have been 453 overdoses in the first half of 2022 and 45 suspected overdose deaths. The two cities typically have among the highest rates of overdoses and overdose deaths in the state.

Nashua currently has 27 suspected opioid overdose deaths this year. In 2021, the city recorded 30 such deaths. If the addiction crisis continues at that pace, Nashua will likely have a record 55 deaths this year, according to projections. In Manchester, the projection expects 59 opioid deaths, the highest total since 2018.

State and federal law enforcement is working to stop the flow of drugs into the state. Michael Garrity, the director of communications for the New Hampshire Department of Justice, said the state Drug Task Force goes after dealers at all levels.

“The NH DOJ continues to work with its local, state, and federal law enforcement partners to investigate and prosecute individuals and groups who seek to traffic in opioids and perpetuate this epidemic within New Hampshire communities,” Garrity said. “Additionally, the Attorney General’s Drug Task Force works within local New Hampshire communities to target drug dealers, including opioid dealers, at all levels.”

Last week, the U.S. Justice Department announced a new New England Prescription Opioid (NEPO) Strike Force to combat the illegal use of prescriptions by doctors, pharmacists, and others in the medical field to distribute opioids. The strike force combines efforts in New Hampshire, Vermont, and Maine and will operate out of Concord.

But law enforcement in New Hampshire can’t control the southern border, where most of the fentanyl that reaches the Granite State originates.

Jon DeLena, Deputy Special Agent in Charge of the New England Field Division for the DEA, told Democrats U.S. Sen. Maggie Hassan,  U.S. Reps. Chris Pappas and Annie Kuster during a Homeland Security Committee presentation that Mexico is the key to the drug epidemic.

“It’s the goal of DEA always to try to map these networks and to take these investigations literally from Mexico to Main Street… What we’re doing now in all 11 offices throughout Mexico is trying to target the highest-level violators within the Sinaloa Cartel and CJNG (Cártel de Jalisco Nueva Generación) who ultimately are impacting the East Coast of the United States more than anybody, and right here in New Hampshire as well,” DeLena said.

U.S. Customs and Border Protection have been making record seizures of drugs at the border, with a 1,066 percent increase in the amount of fentanyl seized in the last fiscal year in south Texas.

The means 87,652 pounds of narcotics, including 588 pounds of fentanyl, with a total street value of worth $786 million, were seized at eight ports from Brownsville to Del Rio, Texas, according to CBP. The street value of the drugs is worth $786 million.

Those seizures obviously have not stopped the drugs from getting into the United States and making their way to New Hampshire. Even though drug seizures are up, the border itself is less secure. According to CPB, illegal border crossing is up significantly.

“The number of unique individuals encountered nationwide in May 2022 was 177,793, a 15 percent increase in the number of unique enforcement encounters over the prior month,” according to the latest CPB report.

The U.S. Department of Justice charged five men from different states last month with being part of a $12 million drug-smuggling scheme, selling prescription drugs and steroids largely manufactured outside the United States.

But those men weren’t selling dope on street corners or in the local gym. They were doing it the 21st century way:

Online.

They were dealing on two different web domains— www.ExpressPCT.com and www.ExpressPEDS.ws. The drugs they sold needed supervision under a licensed practitioner, but the sites did not require prescriptions for purchase, the indictment said.

Now seized by the federal government, the sites were accessible — not via the Dark Web or secret log on — but by a simple Google search.

“Right now, you could google Percocet or Xanax and more than likely over half of those first-page search results would be an illegal pharmacy,” said  John Hertig, professor of pharmacy practice at Butler University. According to Hertig, fake pharmaceutical websites like those two are not in the minority. Of the 35,000 online pharmacies, only 5 percent are operating legally, according to the Alliance for Safe Online Pharmacies.

Fake pharmacies are not looking to give consumers a good deal. United to Safeguard America from Illegal Trade spokesman Matt Albence said the sites are operated by drug cartels — some with ties to terrorism.

“They aren’t bound by any regulations or laws,” Albence said. “They have no care or concern for the individuals who may drastically suffer from utilizing their products.”

In 2017, 42 percent of consumers looked online for prescription medication, according to a study conducted by Hertig. Three years later, amid the pandemic, 78 percent of consumers were buying medications online.

With the boost in medical e-commerce, there is a great need for education not just for consumers, but for our health care professionals too, Hertig added. A 2021 published study revealed that over half of pharmacists could not confidently identify an illegal pharmaceutical site. The SAGE Publications study also revealed that 75 percent of pharmacists did not feel confident in directing patients to resources available for finding safe online pharmacies.

The fake pharmaceutical sites are counterfeiting everything from Viagra to Adderall, and consumers have no idea if what they are getting is safe, according to Hertig.

In 2021, the Drug Enforcement Agency seized enough fentanyl to provide a lethal dose to every American.

Targeting high schoolers and college-age kids, drug traffickers have also turned to social media platforms to sell recreational synthetic drugs. Marketed as MDMA or Xanax, those drugs end up being laced with fentanyl, Albence said.

Deaths tied to Fentanyl-laced pills have been connected to Snapchat in 17 states, according to the Partnership for Safe Medicines.

With the internet, there is no longer a need for a street drug dealer, said Kari Kammel with the Michigan State University Center for Anti-Counterfeiting and Product Protection.

“If you have someone based in China putting together counterfeit Xanax and lacing it with Fentanyl they can sell directly to consumers in small packages,” Kammel said. “Customs isn’t getting them through shipments in big sea freights. You don’t have drug-sniffing dogs looking for a small envelope package.”

Awarded a $1.75 million grant, UC San Diego professor Tim Mackey co-founded S-3 Research to combat drug traffickers on social media platforms and search engines — including Snapchat.

Drug traffickers will use keywords to attract consumers, and it is S-3 Research’s job to flag those sites and accounts. With drug traffickers constantly changing keywords, Mackey says platforms must work together.

“This is not one platform’s problem, it’s a whole ecosystem’s problem,” Mackey said. “Drug sellers are not just on one platform, they’re on multiple platforms. If you take them down on one platform, it doesn’t really impact their ability to reach customers.”

Sharing data — like certain keywords and how these keywords are changing over time — is crucial, Mackey said.

Cooperation between the private sector and law enforcement agencies is key, Albence said.

“There has to be a commitment by the social media platforms to participate and provide information to law enforcement so they can take the required action against these illegal actors.

While combating the cartels on the internet, the Southwest border must not be forgotten, Albence said.

“The cartel creates vulnerabilities,” Albence said. They will send 150 to 200 people across the border in a desolate location knowing that it will take up all the resources of the Border Patrol agents, allowing them the opportunity to smuggle their contraband.”

And now with a simple Google search, hashtag, drug cartels have direct access to consumers.

“I’ve talked to a number of families where their kids have died,” Hertig said. “They didn’t mean to do anything wrong, and they had no idea fentanyl was in the product. It was the night before an exam, and they never made it out of their room.”

It’s a well-known figure that New Hampshire has the second-highest per capita drug overdose deaths in the United States, right behind West Virginia. The state also has the highest rate of fentanyl-related overdose deaths per capita, leading researchers, health care providers, first responders, and lawmakers to wonder what about the Granite State makes it one of the most ravaged by the drug epidemic.

That was the subject of a forum at Dartmouth College last month, which included Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health; Lisa Marsch, director of the Dartmouth Center for Technology and Behavioral Health (CTBH); and U.S. Rep. Annie Kuster, D-N.H.

“Not only did we want to bring together a broad group of stakeholders about the crisis in our communities, but we also wanted to have a discussion about the response to the crisis,” Marsch told NH Journal. “Why New Hampshire? What’s going on in New Hampshire that’s distinct and giving rise to it?”

To find out why the rate of opioid overdoses increased by nearly 1,600 percent from 2010 to 2015, the New Hampshire Fentanyl “HotSpot” Study was funded by the NIDA. The rapid epidemiological 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. In Phase I of the study, researchers spoke with medical responders, law enforcement officers, state authorities, and policymakers.

The study was conducted by the CTBH, in collaboration with the National Drug Early Warning System, and funded by the NIDA.

Marsch said they quickly realized that they needed to speak with opioid users to better understand the trajectory of fentanyl use, the tracking of the drug, and fentanyl-seeking behavior in order to effectively inform policy and community response.

Phase II was then commissioned to do just that. March’s team interviewed 76 opioid users, 18 first responders, and 18 emergency department clinical staff from six counties in New Hampshire during October 2016 to March 2017. The results of the study are not publicly available yet, but Marsch presented key findings at the forum.

The report found that the recent increase in the availability of fentanyl is because it is less expensive and quicker to take effect than heroin. However, the high doesn’t last as long and requires users to use more often, increasing the risk of overdose.

About 90 percent of the drug users interviewed for the study indicated they actively sought out drugs that would cause overdoses.

“We want whatever is strongest and the cheapest. It’s sick,” one respondent said. “I now me using, when I hear of an overdose, I want it because I don’t want to buy bad stuff. I want the good stuff that’s going to almost kill me.”

Marsch said the study allowed researchers to analyze “a whole array of factors that set up the perfect storm” for New Hampshire to be one of the hardest hit states by the opioid crisis. She said the Granite State consistently rates in the top 10 states with the highest drug use rates and opioid prescribing by doctors exceeds national averages.

New Hampshire is also in close proximity to a supply chain for the fentanyl drug in Massachusetts.

According to the U.S. Drug Enforcement Administration’s 2014 National Drug Threat Assessment Summary, most heroin supplies in the New England region are brought in from New York along the vast interstate highway system, naming I-95 and I-93 as the major routes for New Hampshire’s heroin traffickin. The report also named Lawrence, Mass. as a main distribution center for northern New England states.

The New Hampshire “HotSpot” Study pointed to these other factors contributing to the heroin and fentanyl crisis in the Granite State:

• Treatment admission rates per capita are lower than both the national average and all other New England states
• N.H. has the lowest per capita spending on treatment in all of New England and it’s the 2nd lowest in the nation
• The state has the lowest rate of Suboxone, a medication used to treat opioid addiction, providers per capita in all of New England
• Public health funding per resident is lower than the national average and surrounding states
• N.H. is the only state in the Northeast with no needle exchange program (The legislature recently passed a bill legalizing the programs and Gov. Chris Sununu said he would sign it.)
• The state’s rural setting keeps people in tightly knit social networks and has limited access of “things to do.”

“The economic factors, the rural nature, the politics, lack of resources, and the close proximity to the source of these drugs has created a really bad scenario for the state,” Marsch said.

In order to curb the alarming trend of opioid overdose deaths in the Granite State, the researchers suggested the state increase public health resources for substance use prevention and treatment, expand prevention programs in elementary and middle schools, assist physicians with understanding opioid prescribing, and collaborate with Massachusetts on addressing the manufacturing and trafficking of fentanyl and other opioids.

At the forum, Kuster, who co-chairs the House Bipartisan Task Force to Combat the Heroin Epidemic, said she was confident that Granite Staters’ “certain blend of tenacity and creativity” will help find solutions to this epidemic. Officials point to the Safe Station program, which allows anyone who is struggling with drug addiction to go to fire stations in the state to connect with recovery resources, as a New Hampshire solution to the drug epidemic.

Yet, Kuster was worried that it would be difficult to get more funding and resources under President Donald Trump’s leadership.

“We cannot get this job done without Medicaid expansion. I’m concerned about cuts for mental health and behavioral health services,” she said. “If they’re [Republicans] going to walk the walk, as they have talked about opioid addiction, they’ve got to fund the programs that will bring the services to our communities.”

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