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Why does New Hampshire lead in synthetic opioid death rate? - CNN

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Why does New Hampshire lead in synthetic opioid death rate? - CNN

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Few states know the epidemic as viscerally as New Hampshire, which President Trump previously said he won because it was a "drug-infested den."

"It's a terrible combination of factors," including the types of drugs that permeate the state, geography and limited addiction resources, said Lisa Marsch, a professor at Dartmouth's Geisel School of Medicine.

"My hope is that we can think of a more coordinated and multifaceted approach where we can reduce barriers" to treatment, instead of the "siloed responses that we're seeing."

New Hampshire ranks second in overdose death rates across the country, behind West Virginia. But looking only at synthetic opioids like fentanyl, New Hampshire has twice West Virginia's overdose death rate.

The prevalence of fentanyl versus other opioids is one factor that makes New Hampshire's crisis different from some other states, said Marsch. She leads a study that is trying to get to the bottom of what's behind the state's epidemic. Because fentanyl is more potent, the risk of overdose is much higher, she said. The high is shorter than other opioids, so users tend to inject it more often, putting themselves at greater risk of life-threatening infections, too.

Unlike heroin, illicit fentanyl and its ingredients are largely manufactured in labs overseas, particularly in China. It can be up to 100 times more potent than morphine, and the fentanyl molecule can be tinkered with to create even more powerful drugs and subvert regulation. "We have these highly potent drugs in a context that has very little resources," Marsch said.

'An everyday battle'

"I want my kids back," said Caitlyn, a 31-year-old mother of two living under a bridge near the New Hampshire-Massachusetts border who prefers not to use her last name. "I want to get up and go to work every day like every normal human being and not be out chasing the high."

She lost custody of her kids because of her addiction, but she is determined to get them back. "I don't need a detox," she said. "I'm looking for a treatment facility, like a residential, where I can go and live at and get my treatment."

When CNN spoke to Caitlyn, she was calling long-term rehab facilities, hoping to be admitted. But she was turned down because she was on too high a dose of methadone -- an opioid medication that doctors prescribe for people to wean off street drugs like heroin.

Marsch said that New Hampshire residents are suffering while too little is spent on addiction treatment and prevention. The state also lags behind on needle exchange programs and low prescribing rates of an addiction treatment called buprenorphine.

Unlike long-term residential treatment, short-term detoxification doesn't necessarily confront the social and behavioral issues surrounding addiction.

"And then you leave and you're right back out on the streets," Caitlyn said. "It's still an everyday battle."

Location, location, location

"Back when I started this business, if you did CPR once a month, that was a lot. Now it's every single day," said Daniel Goonan, fire chief of Manchester, New Hampshire.

When CNN spoke with Goonan, there had been a dozen calls related to opioids the night before.

"This isn't your father's fire department anymore."

Manchester is at the intersection of several major roads and highways, a 30-minute drive from the Massachusetts border. This is one reason why Manchester has more opioid deaths than anywhere else in the state, said Marsch.

"Particularly in the southern part of the state, we're right along a main trafficking route" for fentanyl, said Marsch, adding that the nearby city of Lawrence, Massachusetts is a key hub of activity.

"There's a really strong business model that incentivizes sales across the border into New Hampshire," she said. "The price that they can get for these drugs in New Hampshire is much higher than it is in Massachusetts."

This is presumably because there are reportedly more fentanyl distributors and manufacturers in Massachusetts, Marsch said, and those who transport the drug across state lines can charge more.

Opioid use has surged in rural communities like those in New Hampshire. Rates of drug overdose deaths in rural areas surpassed urban areas by 2015, having converged in 2004, according to a report released Thursday by the US Centers for Disease Control and Prevention.

Rural areas present many other transportation and economic challenges for people battling addiction, Marsch added. Even if they're lucky enough to get placement in a treatment program, they might deal with a potentially long commute or harsh weather during the winter. This can discourage people who might otherwise seek help.

"Some of those who were interested in treatment, they've just kind of given up," Marsch said.

A way forward

"It's hit us like a ton of bricks in Manchester," Goonan said.

Responding to a community in need, last year the Manchester Fire Department opened every one of its fire stations to people struggling with addiction. The 24-hour program allows people to seek help without fear of being arrested.

"We were sick and tired of sitting in meetings," Goonan said. "So with the 'Safe Station' program, we just jumped in with both feet."

More than 65% of the nearly 2,500 visits they've had have come from outside Manchester, according to Goonan.

"The best part about it is they pass no (judgment)," said Benjamin, 27, who arrived at Goonan's station one night, looking for help. He has struggled with addiction for 12 years.

"I came back in tonight because I had relapsed, and it was going to be a problem if I didn't do something about it," he said.

On Tuesday, the program secured another $150,000 from Governor Chris Sununu. Manchester Mayor Ted Gastas said in a statement that he expects more funding will follow in the future.

Like police units and even libraries around the country, the Manchester Fire Department also carries naloxone, commonly known as Narcan, which can quickly reverse a deadly overdose when sprayed into the nose.

That gives the drug a "route right to the brain," said Christopher Hickey, the fire department's EMS officer.

There are other initiatives popping up around the state, Marsch said, including one program that connects patients in emergency rooms with addiction resources. Another program provides integrated care for pregnant women with addiction, as well as their partners and even their babies after birth.

Programs like these, Marsch said, aim to lower barriers to treatment for entire communities in need.

"The opioid epidemic is something that could strike anybody, anytime, anywhere," said Hickey. "And no one can ever say, it's not going to be my children because no one knows."

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why does new hampshire lead in synthetic opioid death rate? - cnn

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This fire department responds to more ODs than fires

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Few states know the epidemic as viscerally as New Hampshire, which President Trump previously said he won because it was a "drug-infested den." "It's a terrible combination of factors," including the types of drugs that permeate the state, geography and limited addiction resources, said Lisa Marsch, a professor at Dartmouth's Geisel School of Medicine.

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Babies born exposed to drugs in New Hampshire has skyrocketed over past decade, researcher says - The Boston Globe

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Babies born exposed to drugs in New Hampshire has skyrocketed over past decade, researcher says - The Boston Globe

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Over the course of a decade, the number of babies born already exposed to drugs in New Hampshire quintupled, according to a researcher at the University of New Hampshire.

In 2005, 52 babies were born with neonatal abstinence syndrome, which occurs when a baby is exposed to drugs in the womb, the university said. By 2015, that number had risen to 269.

The syndrome appears most often in babies whose mothers were taking opioids during pregnancy, said Kristin Smith, a family demographer at UNH and the author of the recent report.

"Both alcohol and tobacco use during pregnancy have proven negative health consequences for children, and the adverse effects are magnified when combined with opiates," she said in the statement.

The research comes as states around the country are working to stem an opioid epidemic. Government figures released this month said 63,600 people died from drug overdoses in 2016, up from about 52,000 in 2015. Two-thirds of last year's drug deaths - about 42,000 - involved opioids, a category that includes heroin, methadone, prescription pain pills like OxyContin, and fentanyl.

In New Hampshire, the babies born with neonatal abstinence syndrome in 2015 account for 2.4 percent of births in the state, and that number is projected to rise, she said. Smith found, based on anecdotal evidence, that a recent change to the state's Child Protection Act designed to encourage the Department of Children and Families to provide treatment actually had a "chilling effect" on women seeking care during pregnancy.

"One thing that came up enough for me to want to draw attention to it was this concern they have about unintended consequence of policies," Smith said in a telephone interview Wednesday. "They have a fear that if the [Department of Children and Families] is contacting them, their child will be taken away."

The act does not require that the department become involved in the family or mandate the child's removal, but oftentimes when women are contacted by the department, they assume the worst, she said.

Women who use opioids while pregnant are also likely to be using other drugs, suffering from mental health issues, and experiencing poverty, homelessness, and domestic violence, the university said. Smith said in order to address the numerous issues at play, recovery programs must be comprehensive.

Alyssa Meyers can be reached at alyssa.meyers@globe.com. Follow her on Twitter @ameyers_.

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department of children and families (nj)

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Babies born exposed to drugs in New Hampshire has skyrocketed over past decade, researcher says - The Boston Globe

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Over the course of a decade, the number of babies born already exposed to drugs in New Hampshire quintupled, according to a researcher at the University of New Hampshire. In 2005, 52 babies were born with neonatal abstinence syndrome, which occurs when a baby is exposed to drugs in the womb, the university said.

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Rodricks: Baltimore should call off the war on drugs - Baltimore Sun

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Rodricks: Baltimore should call off the war on drugs - Baltimore Sun

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Would Baltimore be better off if we called off the war on drugs? Yes. There would almost certainly be less violence here. The downside: Barring a sudden and significant change in the city's economic base that could lead to more jobs for men who have been involved in the illegal narcotics trade, we would still have too many neighborhoods with open-air drug markets.

But first things first. Let's deal with the violence.

The violence remains Baltimore's most immediate and pressing problem; we are internationally known for it.

Fortunately, Baltimore is also internationally known for Johns Hopkins - the university and the medical institution.

And, within Johns Hopkins, there is the Center for Gun Policy and Research, perhaps the leading program of its kind. Its scholars and associates dive deeply into data about gun violence, providing reliable analysis of trends and highlighting best practices for preventing more death and injury. They study gun violence in its various forms: Mass shootings, domestic-partner assault, street killings like those we're so sick of seeing in Baltimore.

One of a zillion noteworthy points in the center's most recent study on Baltimore jumped off the page: General police crackdowns on drug possession and sales tend to lead to more gun violence, not less. Looking at month-to-month trends in specific police posts across the city over several years, the researchers found that a higher number of shootings followed an increase in drug arrests.

"Although surges in arrests for illegal drug distribution may have a very short-term, violence-reducing effect in an area," the report says, "there appear to be violence-generating effects up to a year after these drug arrest surges."

Daniel Webster, the center's director and the study's lead author, says general efforts to make arrests on drug charges might clear corners for a time, but the disruption in a given drug market causes a push-and-shove among dealers as they vie for customers.

"You are not going to remove the drug trade," he says. "The idea that you can lower violence by curtailing the drug trade is foolhardy."

Webster's report adds this: "The powerful market forces at play - a high demand for illegal drugs in a city where addiction is highly prevalent and a large supply of labor exists, with many individuals willing to engage in very dangerous work due to the lack of legal employment opportunities for individuals with criminal histories - and available research evidence suggest that drug law enforcement efforts rarely have lasting positive impacts on violence."

This does not mean the police should stop making drug arrests altogether. (Baltimore police have been making fewer arrests for several years now.)

But it means they must make better arrests, with the heavy focus on violent repeat offenders. We've heard this before - "bad guys with guns" - but the Johns Hopkins report makes the point convincingly with data.

"It means you're not going to allow people engaged in violence to be in the drug trade," Webster says. "You don't need drug laws to go after violent offenders."

The Johns Hopkins team studied various initiatives that have been employed to stem violence in Baltimore. The report concluded that, between 2007 and 2012, the BPD's Violent Crime Impact Section, or VCIS, had the most success. It was a "hot spots" program that sent plainclothes detectives into violent neighborhoods to focus on illegal firearms and people with a history of gun offenses.

Some members of the VCIS generated several abuse complaints and lawsuits against the city, and the Johns Hopkins report addresses that. Webster, mindful of public reaction to the horrors of another special unit - the notorious and now-disbanded Gun Trace Task Force - made clear that, if the strategy is to be used again, it must be done by the book.

"Our research presents good evidence that VCIS contributed to reductions in nonfatal shootings and homicides," Webster wrote in an email. "Our report notes the harms that VCIS officers caused and states strongly that these units, or proactive gun law enforcement generally, must be carried out in ways that are legal and acceptable to the communities they serve. Otherwise the harms they bring are far greater than any benefits."

It might seem crazy to even talk about reviving something that many Baltimoreans have come to despise. But many Baltimoreans are eager to see the surge in violence end.

If you go by the data, as Webster and his staff have done, then you would conclude that a focus on violent offenders - mostly men, and men most likely to use a gun - should be the BPD's prime strategy. And the approach should be holistic. Getting guys to put down their guns should involve probation agents, social workers, health workers and re-entry counselors.

Given Baltimore's condition, this focus on violence makes more sense than having police chase low-level drug dealers. If we needed further proof of the futility of the war on drugs, the GTTF revelations provided it in a visceral way. The Johns Hopkins report provides hard evidence.
drodricks@baltsun.com twitter.com/DanRodricks

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Rodricks: Baltimore should call off the war on drugs

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Would Baltimore be better off if we called off the war on drugs? Yes. There would almost certainly be less violence here. The downside: Barring a sudden and significant change in the city's economic base that could lead to more jobs for men who have been involved in the illegal narcotics trade, we would still have too many neighborhoods with open-air drug markets.

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Part I: Baltimore Is the U.S. Heroin Capital - ABC News

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Part I: Baltimore Is the U.S. Heroin Capital - ABC News

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Baltimore is the heroin capital of the United States.

Government agencies estimate that as many as one in 10 of the city's residents are addicted to the drug. Wanda, 42, was one of them.

"I did tricks, I stole, I robbed, I did whatever I had to do to get it," she says of her $50-a-day heroin habit. "The drug was taking control of my life."

Wanda, who asked that her last name not be used, says she began using heroin at the age of 18. Now she is in a treatment program at the Center for Addiction Medicine in downtown Baltimore. She has been drug-free for more than two months.

'I Wanted to Die'

A 27-year-old woman who asked to be identified only as "T" is also undergoing treatment. She says her heroin addiction turned her from a ballet student into an exotic dancer.

"I went from dancing at the Peabody [Institute] to dancing in a strip club - that's how I paid for that habit," she says. "[Heroin] will make you do things you wouldn't expect yourself to do."

Jonathan, 18, says he contemplated suicide before he quit using the drug only last Friday.

"I wanted to die," he explains. "I just wanted to shoot up until it killed me because I'd lost my feeling of self-worth."

Jonathan, who says he spent as much as $140 per day on the drug, is being treated with buprenorphine - a prescribed "substitute drug."

The U.S. Drug Enforcement Agency says the city has the highest per capita heroin addiction rate in the country. Estimates of the total number of addicts in the city vary, but experts agree it's staggering.

In a city of 645,000, the Baltimore Department of Health estimates there are 60,000 drug addicts, with as many as 48,000 of them hooked on heroin. A federal report released last month puts the number of heroin addicts alone at 60,000.

The problem in the city is so acute that the federal government has designated Baltimore part of what it calls a High Intensity Drug Trafficking Area, making it eligible for special federal assistance to local police.

Tom Carr, the director of the Washington/Baltimore HIDTA program - a joint federal, state and local effort - says the heroin epidemic in Baltimore dates back to the 1950s and is now an engrained part of the city's culture.

"It's an old 'heroin town,'" says Carr. "There is an appetite for heroin in Baltimore ... It's accepted by all too many people down there as something that's normal behavior."

"It's almost a rite of passage for some," he adds, noting that heroin habits are often passed down from generation to generation.

Purer, Stronger, More Deadly

The narcotic white powder that, according to a February report by the HIDTA, one in every 10 residents of the city snorts, smokes or, more commonly, heats and then injects with needles is significantly more potent than the heroin sold in many other areas of the country.

In the mid-1990s, Baltimore became a key East Coast distribution point for high purity South American heroin. Smuggled into the United States from Colombia, South American heroin is substantially more potent than its East Asian and Mexican counterparts, making it more addictive and more deadly. Last year, there were 304 fatal heroin-related overdoses in Baltimore and a similar number of heroin-related hospital emergencies.

The higher potency, combined with an increased availability and a reduced street price - now pegged at $100 to $120 per gram - is fueling the city's scourge of addiction by helping to draw in new users.

"People think because it's pure, you can smoke it, snort it - that it's safer," explains Drug Enforcement Agency Special Agent Bill Hocker.

Recovering addicts say anyone thinking about trying heroin should think again.

"They might as well put a gun to their head and kill themselves," says Wanda, forming the shape of a gun with her fingers and pointing it at her forehead. "It's suicide."

"I wouldn't let my worst enemy do it," adds "T." "Once you learn how it feels, you're on that track and there's not much that's gonna help you."

The Washington/Baltimore HIDTA predicted in its February situation report, "The number of heroin addicts in [Baltimore] will continue to rise."

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heroin; baltimore; drug treatment; addiction

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Part I: Baltimore Is the U.S. Heroin Capital

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Baltimore is the heroin capital of the United States. Government agencies estimate that as many as one in 10 of the city's residents are addicted to the drug. Wanda, 42, was one of them. "I did tricks, I stole, I robbed, I did whatever I had to do to get it," she says of her $50-a-day heroin...

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Scourge of heroin addiction revealed as Baltimore drug trial goes to jury - Baltimore Sun

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Scourge of heroin addiction revealed as Baltimore drug trial goes to jury - Baltimore Sun

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A street lieutenant in a crack cocaine gang, a police officer turned masked robber, a widow who spent her husband's death payments on heroin. All are admitted criminals who have testified against five men accused of operating a million-dollar heroin ring in Northeast Baltimore.

A jury heard closing arguments Friday in the two-week federal trial and will decide whether it can trust the word of drug dealers, heroin addicts and rogue cops who testified as government witnesses.

"Have you ever seen a cast of characters like this?" defense attorney Robert Bonsib asked jurors. "Talk about a topsy-turvy world. It's like being in 'Alice in Wonderland.' "

At stake are decades in federal prison for the five men from Baltimore. Police say the drug crew led by Antonio "Brill" Shropshire, 31, emerged as the largest supplier of heroin to suburban Baltimore and Harford counties.

During the trial in U.S. District Court, prosecutors called 35 witnesses - including heroin buyers and wholesalers - who described a sophisticated drug ring that operated with impunity for years around The Alameda.

Assistant U.S. Attorney Derek Hines said the dealers earned more than $2 million and sold nearly 18,000 grams of heroin.

"They had a seven-year run, and how were they able to do it?" Hines asked jurors. "They were protected by a corrupt Baltimore City police officer."

Former police Detective Momodu Gondo, 34, admitted to tipping off the alleged drug dealers to police whereabouts. He wanted to protect them from honest police who would arrest them and rogue officers who would rob them, Gondo said. He pleaded guilty to his crimes and is now facing up to 60 years in prison.

Prosecutors say Shropshire sold heroin with Antoine Washington, 27, Alexander Campbell, 29, Omari Thomas, 25, and Glen Kyle Wells, 31. The men all declined to testify.

The defendants are all charged with conspiracy to distribute heroin and face maximum sentences of 40 years or more.

The Baltimore trial provided jurors and spectators a look at the breadth of the opioid epidemic, which President Donald Trump declared a national public health emergency.

More than 60 people overdosed and 15 of them died from heroin traced back to the alleged drug dealers, police say.

Leon Koger told jurors he helped sell Shropshire as much as 500 grams of heroin at a time - a supply worth more than $30,000. Koger pleaded guilty to selling cocaine in another case. He awaits sentencing and testified, he said, in hopes of leniency.

Kenneth Diggins, 41, told jurors how he texted a 19-year-old woman and recovering addict, tempting her with the heroin she craved. He told jurors he bought six grams of heroin from the defendant Washington. He binged on the heroin and had sex with the teenager before she died in his basement. He was sentenced to a decade in federal prison and testified hoping for an early release.

The trial also revealed how a wiretap investigation into Gondo led investigators to a rogue unit within the Baltimore Police Department. Prosecutors said officers in the elite Gun Trace Task Force robbed drug dealers and innocent civilians for years. Four officers, including Gondo and his former police partner, Jemell Rayam, pleaded guilty to the racketeering conspiracy. Four more officers head to trial next year.

Rayam testified in the drug case too, telling jurors he helped Gondo and the defendant Wells rob a rival heroin dealer. Rayam pleaded guilty to his crimes and faces as many as 20 years in prison.

The trial brought jurors deeper and deeper into the underworld of Baltimore's heroin trade - an urban business that relied on suburban customers from Towson, Perry Hall and Bel Air. Recovering addicts told how their use of prescription painkillers such as Percocet and Oxycontin led to the cheaper substitute of heroin. Some shopped each day for a $120 gram of heroin. They worked two jobs, borrowed money from parents and maxed out credit cards with cash advances to pay for the drugs.

There was the widow who cleaned houses and broke down in court, telling how she spent her husband's death payments on heroin. There was the gymnast who became hooked on prescription painkillers after an injury and then resorted to heroin. One young man said his path to addiction began by taking his parents' cancer pills; he turned to heroin when they died. There came others: an auto-parts dealer, the girlfriend of a dairy farmer, a man with multiple sclerosis - all testified to buying heroin from the defendants.

"Are they scared and embellishing? Maybe," said Alfred Guillaume, the defense attorney for Shropshire. "If you're caught red-handed as these people were, you don't have a whole lot of options."

One more recovering heroin addict testified and told of an afternoon six years ago when she injected heroin at Diggins' home - the day her teenage friend died there.

Washington was charged with selling the heroin that caused the young woman's death. But his attorney, Bonsib, said Diggins alone was to blame.

In court, Bonsib showed one photo of the teen, smiling on a beach. He wanted to know how much heroin she used, and how, and when exactly.

Later, he showed another photo: The teen slumped on a sofa, her head turned aside, as she overdosed.

The witness squeezed her eyes shut.

"Do I have to keep looking at this?"
tprudente@baltsun.com twitter.com/Tim_Prudente

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Scourge of heroin addiction revealed as Baltimore drug trial goes to jury

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A street lieutenant in a crack cocaine gang, a police officer turned masked robber, a widow who spent her husband's death payments on heroin. All are admitted criminals who have testified against five men accused of operating a million-dollar heroin ring in Northeast Baltimore.

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How a ‘Perfect Storm’ in New Hampshire Has Fueled an Opioid Crisis - The New York Times

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How a ‘Perfect Storm’ in New Hampshire Has Fueled an Opioid Crisis - The New York Times

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Unlike West Virginia, New Hampshire is relatively prosperous, which makes an opioid crisis here seem all the more jarring. This state has the highest median household income in the country, ranks low in unemployment and crime, and often lands at or near the top of lists of the best states in which to live.

Researchers at Dartmouth College in Hanover, N.H., have been studying the issue to try to understand why the state's opioid problem is so dire.

One big reason, they say, is the proximity to an abundant drug supply in neighboring Massachusetts, the center of drug distribution networks that traffic opioids throughout New England.

Another, they say, is New Hampshire's low per capita spending on services to help drug users break free from addiction. Nationally, the state, which has no income or sales tax, ranks at the bottom in availability of treatment programs. The fire departments' safe stations are one effort to fill that void.

The researchers also noted that the state has pockets of "economic degradation," especially in rural areas where jobs are few, and that may contribute to the problem.

Beyond that, the researchers say, doctors here have long prescribed "significantly higher rates" of opioid pain relievers, almost twice the national average. When the government cracked down on legal painkillers, New Hampshire residents were primed to seek out illegal street drugs.

"This is a kind of perfect storm," says Lisa A. Marsch, a professor of psychiatry and health policy at Dartmouth's Geisel School of Medicine and the study's principal investigator.

"We have highly available, highly potent opioids in New Hampshire," she says. "And highly limited resources to reduce the risk."

The researchers noted other factors, too:

* A shortage of workers in addiction and recovery. Northeast states have an average of 15.5 doctors per 100,000 residents who can prescribe Suboxone and other medication-assisted treatments; New Hampshire has seven.

* No needle exchanges, which can reduce the transmission of diseases like hepatitis C and save health care costs. New Hampshire finally legalized needle exchanges in June, long after many other states had done so, but did not fund them. Dartmouth medical students, using donations and grants, opened the first needle exchange last summer in a Claremont, N.H., soup kitchen, but it was shut down in October because it was too close to a school.

* "Live Free or Die." The researchers said the New Hampshire ethos of "self-sufficiency and individualism" could inhibit some residents from seeking help. And for some, they said, the state's "Live Free or Die" motto might justify risky behaviors. The state does not require drivers to wear seatbelts. It allows motorcyclists to ride without helmets. And state liquor stores are right on the major highways.

For one New Hampshire family, the opioid plays out every day, an unending cycle of worry, hope and chaos. Read their story here. Help shape our opioid coverage by taking a survey here.

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How a 'Perfect Storm' in New Hampshire Has Fueled an Opioid Crisis

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Unlike West Virginia, New Hampshire is relatively prosperous, which makes an opioid crisis here seem all the more jarring. This state has the highest median household income in the country, ranks low in unemployment and crime, and often lands at or near the top of lists of the best states in which to live.

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Drug Free New Hampshire - Most commonly abused drugs by New Hampshire youth

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Drug Free New Hampshire - Most commonly abused drugs by New Hampshire youth

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Do you know the facts about adolescent alcohol and other drug abuse? Understanding what drugs kids are abusing, the signs of abuse and the risks they take when they do is an important step to protecting your child from danger.

These are the most commonly abused drugs by New Hampshire youth:

Alcohol - Almost 30% of teens had alcohol in the past month and 27.2% of high school seniors report binge drinking in the last month.

Inhalants - Almost 6% of high school freshmen in New Hampshire have sniffed glue, aerosols, or sprays at least once.

Tobacco - Almost 30% of teens report smoking or using other forms of tobacco in the last month.i

Marijuana - About 22% of teens report using marijuana in the last month.

Prescription drugs - About 7% of teens report using prescription drugs illegally in the past month and 13.4% have tried it during their lifetime.

Other facts:

Almost 4.5% of New Hampshire teens have used Ecstasy at least once.

About 2.4% of New Hampshire teens have tried heroin.

Almost 2.5% of high school students in New Hampshire have tried meth.

Almost 30% of teens in New Hampshire have smoked cigarettes or used tobacco in the past month.

Data Source: Youth Risk Behavior Survey (YRBS 2015)

See more NH Stats on CheckthestatsNH.org
NH Youth Risk Survey Behavior Findings 2014 National Survey on Drug Use and Health Results

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Drug Free New Hampshire - Most commonly abused drugs by New Hampshire youth

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Do you know the facts about adolescent alcohol and other drug abuse? Understanding what drugs kids are abusing, the signs of abuse and the risks they take when they do is an important step to protecting your child from danger.

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Opioid crisis weighs on New Hampshire’s chief medical examiner - The Boston Globe

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Opioid crisis weighs on New Hampshire’s chief medical examiner - The Boston Globe

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CONCORD, N.H. - On some days, Dr. Jennie Duval calls as many as six families after fatal overdoses - some of the families stunned and heartbroken, some of them resigned to a death they saw coming.

This, Duval said, is the most difficult part of her job as the only full-time medical examiner in New Hampshire, which leads the nation in per-capita deaths caused by fentanyl and other synthetic opioids.

"It's not like I can rush the call," said Duval, the state's chief medical examiner, as she described a heart-wrenching notification. "It takes a lot of time. But sometimes I feel like a broken record."

The crush of fatal overdoses has forced the office to abandon its practice of conducting an autopsy on each suspected overdose victim. Still, Duval has no alternative but to work a grueling schedule of 10- to 12-hour days that drains her physically and emotionally.

"If this epidemic is cresting, I'm not feeling it," Duval said in a conference room at Concord Hospital, the strain of another long day visible on her face. "There are many more autopsies that I'm not doing."

A Chelsea physician writes of the importance - and rewards - of treating opioid addiction in primary care.

Duval's only assistance comes from two contractors who each work five days a month. Among them, they conducted 548 autopsies last year - about one-third for overdoses in a state where 476 people are confirmed or suspected to have died from drugs in 2017. Duval conducted nearly 300 autopsies, far above the profession's suggested limit of 250.

The state Legislature has approved funding for two physicians to join the office. But in the ultra-competitive field of forensic pathology - a limited pool of doctors to fill many openings in the country, coupled with the challenge of recruiting in a rural state with long winters - Duval is crossing her fingers that help arrives soon.

"It takes a certain kind of person to do this job," she said. "It's not pleasant. You're dealing with death every day."

The state's former chief medical examiner, Dr. Thomas Andrew, said the opioid epidemic was part of the reason he retired last year to pursue a calling for the ministry.

The office's overall caseload has more than doubled since 1997, the year Andrew became chief medical examiner, and reached 1,820 in 2017. Twenty years ago, opioids were linked to less than 10 percent of deaths referred to the office, Andrew estimated.

"It was simply a slowly unfolding catastrophe that, even in seeing it coming, we didn't have the surge capacity to account for it," Andrew said. "The casework was getting done, don't get me wrong, but the numbers became so overwhelming."

The medical examiner's office investigates fewer than 20 percent of the approximately 12,000 people who die in New Hampshire each year. They include victims of suicide, accidents, and sudden, unexpected deaths of people under 60.

The number of cases that include an autopsy makes up about one-third of all referrals, although they are mandatory for some cases, such as homicides.

Choosing which overdose victims to autopsy "is a gamble," Duval said.

Some cases seem obvious - a syringe in the arm, opioids near the body, and a documented history of drug abuse, she said. But even cases that appear straightforward can involve factors that are discovered only through an autopsy, Duval said. Perhaps a pulmonary embolism will be found. Perhaps other damage might have caused or contributed to the death.

And as the opioid crisis continues, autopsies can yield valuable information about the effects of synthetic drugs such as fentanyl.

"It's the right thing to do," Duval said. "You want to have every piece of the puzzle."

New Hampshire is not alone in its staffing struggles.

Dr. Kim Collins, a South Carolina physician who is president of the National Association of Medical Examiners, said the profession is finding it hard to fill vacancies as fewer students choose the field and more forensic pathologists are retiring.

Each year, only about 30 to 40 young doctors in the United States become certified in forensic pathology, Collins said. Medical schools are devoting less attention to the subject - "some medical students will never even see an autopsy,'' Collins said - and the field pays far less than many other specialities.

Massachusetts, for example, is working to add three or four more doctors to a staff that already has hired two others since the beginning of the fiscal year, said Daniel Bennett, the state secretary of public safety, who oversees the medical examiner's office.

The state's nine full-time medical examiners average more than 300 autopsies a year, Bennett said. Massachusetts also has three part-time forensic pathologists, nine contracted examiners, and three young physicians who work for the office on a fellowship program.

Still, Massachusetts must improve to be fully accredited by the national association that Collins leads. Bennett said the opioid epidemic, mirroring its impact elsewhere, has created a backlog in completed autopsy reports that the office hopes to shrink to industry guidelines this year.

The national association requires that 90 percent of autopsy reports be completed in 90 days. In Massachusetts, 58.3 percent of autopsy reports met that standard between October 2015 and September 2017.

To help address the lag, Governor Charlie Baker wants to boost funding for the office by $1.7 million in fiscal 2019, to a total of $11.9 million.

In Maine, two full-time forensic pathologists handle nearly all the autopsies. Two others work on a per-diem basis and handle about 10 percent of the cases.

"We did have trouble with turnover in this office, and it was difficult. Once you get an employee trained, they leave, usually for more money," said Mark Belserene, administrator of the state's medical examiner's office.

"We were successful in reclassifying positions to better reflect the actual tasks and also to bring the salaries up to a more competitive level," Belserene said.

Despite the physical and mental stress, Duval plans to stay put as New Hampshire's chief medical examiner.

"I'm not going anywhere," she said with a small smile.

Although the caseload continues to climb, the addition of two doctors should make the work more manageable. Still, Duval said she does not expect the yearly number of autopsies to fall below 250 for any examiner.

The opioid crisis should ensure that.

Brian MacQuarrie can be reached at brian.macquarrie@globe.com.

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Opioid crisis weighs on New Hampshire's chief medical examiner - The Boston Globe

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CONCORD, N.H. - On some days, Dr. Jennie Duval calls as many as six families after fatal overdoses - some of the families stunned and heartbroken, some of them resigned to a death they saw coming.