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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.

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.”

People with anxiety and depression are disproportionately prescribed painkillers. That’s what new research from the Dartmouth-Hitchcock Medical Center suggests, adding a complex layer to the opioid epidemic ravaging the United States and encouraging calls from New Hampshire’s congressional delegation to not move forward with the repeal of the Affordable Care Act.

The findings, which appear in the July issue of the Journal of the American Board of Family Medicine, show that nearly 19 percent of the 38.6 million American adults with mental health disorders use prescription opioids compared to only 5 percent of those without a disorder. Adults with depression and anxiety receive 51 percent of the 115 million opioid prescriptions distributed each year in the U.S., the study found.

“Because of the vulnerable nature of patients with mental illness, such as their susceptibility for opioid dependency and abuse, this finding warrants urgent attention to determine if the risks associated with such prescribing are balanced with therapeutic benefits,” said Brian Sites, an anesthesiologist at Dartmouth-Hitchcock and one of the co-authors of the study.

Image Credit: Dartmouth-Hitchcock

Opioid prescribing in the U.S. quadrupled between 1999 and 2015, and during that time more than 183,000 people died from overdoses related to prescription opioids, according to the Centers for Disease Control and Prevention.

Sites also notes that because pain is subjective, “the presence of mental illness may influence the complex dynamic between patient, provider, and health system that results in the decision to write an opioid prescription.”

The study does not give a specific reason why people with mental disorders are more frequently prescribed opiates. The study encourages more research on this population to understand opiate addiction.

Those patients may have some form of physical pain, but their mental condition may cause them to feel that pain more acutely or be less able to cope with it, leading to increased requests for something to dull the pain. As a result, doctors trying to be empathetic to their patients’ complaints may tend to overprescribe opioid painkillers, Stiles said.

Research also shows that patients are more likely to take opioids when there aren’t specialists nearby. A study published earlier this year found that the number of seniors in rural America who take at least three prescribed psychotropic drugs ― including opioids and antidepressants ― tripled over a nine-year period. The study found that many of these prescriptions were given without a proper diagnosis.

Being able to identify a subset of the population that could be more likely to use opioids could help providers and policymakers address opioid use. It “suggests that there may be additional patient- and provider-related factors specific to those with mental illness that increase the likelihood of receiving prescription opioids,” the authors wrote.

U.S. Rep. Annie Kuster, D-N.H., was present for a press conference about the study on Monday. She said repealing Obamacare could be disastrous for New Hampshire’s opioid epidemic.

“This is critically important in New Hampshire, as we have gone from second in the nation in deaths from the opioid crisis and heroin to first for fentanyl,” she said. “That’s not what we want to be known as first in the nation for.”

The U.S. Congress is currently in a heated healthcare battle. The Senate is working on legislation to repeal the healthcare law, but a vote on the bill has been delayed due to opposition from Republicans. New Hampshire Democratic Sens. Jeanne Shaheen and Maggie Hassan have both stated their opposition to the healthcare overhaul and have sent many press releases condemning “Trumpcare.”

“This new study is yet another reminder that, to combat the devastating opioid crisis, we must make mental health treatment affordable and accessible,” Shaheen said in a statement.

Hassan said she opposes proposed cuts to Medicaid that would affect coverage of mental health and substance abuse services.

“As we work to combat the horrific substance misuse crisis that is devastating our communities and taking a major toll on our economy in New Hampshire, this study highlights how dangerous Trumpcare, which includes massive cuts to Medicaid, would be for our state,” Hassan said in a statement. “We need a comprehensive, holistic approach to combating this epidemic that addresses the underlying causes of addiction, including mental health issues.”

To address the overprescription problem within the mental health community, Sites has suggested physicians need more access to alternative medicine besides opioids, including acupuncture, massage therapy, physical therapy, and non-opioid pharmaceuticals.

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