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Where the opioid epidemic stands in New Hampshire - YouTube

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Where the opioid epidemic stands in New Hampshire - YouTube

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Where the opioid epidemic stands in New Hampshire

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Preventing Drug Abuse: The Best Strategy | National Institute on Drug Abuse (NIDA)

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Preventing Drug Abuse: The Best Strategy | National Institute on Drug Abuse (NIDA)

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Preventing Drug Abuse: The Best Strategy

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Why is adolescence a critical time for preventing drug addiction? As noted previously, early use of drugs increases a person's chances of developing addiction. Remember, drugs change brains-and this can lead to addiction and other serious problems. So, preventing early use of drugs or alcohol may go a long way in reducing these risks.

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UNH Report Raises Alarm Over Rise in Opioid Dependency Among Newborns | New Hampshire Public Radio

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UNH Report Raises Alarm Over Rise in Opioid Dependency Among Newborns | New Hampshire Public Radio

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A new report from UNH's Carsey School of Public Policy is sounding alarm over the growing number of New Hampshire infants born dependent on opioids.

New Futures Kids Count, which advocates on addiction policy and other issues, funded the report.

In 2005, 52 newborns were diagnosed with neonatal abstinence syndrome, or "NAS" - the official term for when a baby goes through withdrawal because of their mother's opioid use. By 2015, more than 260 were facing the same condition. (The report cautions that these figures "may be an underestimate" because of differences in how hospitals document the diagnosis.)

The report also underscores the fact that NAS can lead to longer, more expensive hospital stays. According to data from 2015, babies diagnosed with NAS stay in the hospital an average of 12 days after being born. By the time they leave, their hospital bills can average $33,700 - significantly higher than the average of $7,800 for non-NAS newborns, according to the report.

Those findings caught the attention of Republican Sen. Jeb Bradley and Democratic Sen. Dan Feltes, both of whom plan to introduce bills meant to help moms suffering from addiction. Both senators support reauthorizing the state's Medicaid expansion (albeit through two different approaches), which has expanded access to treatment services.

But the senators also want to expand access to home visiting services, which connect low-income and at-risk families with other medical and social supports.

Beyond expressing support for these measures, the report also said more work is needed to ensure moms who are dependent on opioids don't avoid seeking help, out of fear that they might be punished by child protective services.

Specifically, the report cites "persuasive anecdotal evidence" that recent changes to the state's Child Protection Act are sowing confusion among pregnant women and their medical providers about what kind of disclosure would trigger an intervention from state officials.

"Unintended consequences may include a chilling effect on women seeking prenatal care, their willingness to disclose during pregnancy, and reporting by providers," the report states. "Any of these consequences are detrimental to newborns if pregnant women do not get the treatment and care they need."

The report calls for more study into how the law is being interpreted and more effort to clarify the processes for the public.

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UNH Report Raises Alarm Over Rise in Opioid Dependency Among Newborns

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A new report from UNH's Carsey School of Public Policy is sounding alarm over the growing number of New Hampshire infants born dependent on opioids. New Futures Kids Count, which advocates on addiction policy and other issues, funded the report.

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N.H. Has Third Highest Drug Overdose Death Rate in the U.S. | New Hampshire Public Radio

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N.H. Has Third Highest Drug Overdose Death Rate in the U.S. | New Hampshire Public Radio

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A new report from the Centers for Disease Control shows that New Hampshire had one of the highest drug overdose death rates in the country last year.

The state saw an overdose death rate of 39 people per 100,000 in 2016. That's up from 34 people per 100,000 the previous year.

New Hampshire had the third-highest rate among the states, behind West Virginia and Ohio.

The national average is 20 deaths per 100,000. Since 1999, overdose deaths have risen threefold.

New Hampshire is expected to close out this year with 466 overdose deaths - about 20 fewer than in 2016.

As the rate of drug deaths remains high, New Hampshire's congressional members have sought more money to combat the crisis.

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N.H. Has Third Highest Drug Overdose Death Rate in the U.S.

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A new report from the Centers for Disease Control shows that New Hampshire had one of the highest drug overdose death rates in the country last year. The state saw an overdose death rate of 39 people per 100,000 in 2016. That's up from 34 people per 100,000 the previous year.

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The deadliness of the opioid epidemic has roots in America’s failed response to crack - Vox

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The deadliness of the opioid epidemic has roots in America’s failed response to crack - Vox

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The death toll from the opioid epidemic ravaging the US has been climbing by the thousands for years:In 2015, opioid overdose deaths killed more people in the US - 52,000 - than guns, car crashes, and even HIV/AIDS at its peak, and overdoses since the epidemic began in the late '90s had killed more people than the entire population of Atlanta.Based on preliminary data, 2016 will be worse. And 2017 could be even worse than that, as the deadly synthetic opioid fentanyl continues to spread across the US.

Public health officials at every level of government have been unable to reverse or even stabilize the rising death toll from the crisis, which was sparked by the widespread misuse of highly addictive prescription painkillers. This stark inability to manage the crisis shows just how unprepared America is to deal with such a massive epidemic of addiction.

But that's not because America has never dealt with a drug crisis in the past. Since the 1980s, for instance, devastating and prolonged crack cocaine and methamphetamine epidemics have destroyed and destabilized communities across the country. Rather, the opioid crisis has gotten so far out of control because of the spiraling effects of America's flawed response to those previous crises. And that has a lot to do with who the victims of those crises were, and how that informed the way Americans viewed their struggle.

Consider a hypothetical scenario, raised to me by Atlantic writer Ta-Nehisi Coates: Back in the 1980s and early '90s, America was ravaged by the crack cocaine epidemic, with thousands of overdoses a year and thousands more murders associated with the drug trade at the time. If the US had responded to this crisis by investing in drug addiction treatment, there would be an infrastructure for dealing with such a crisis that could have endured to this day. This may have prevented one of the biggest challenges in the current opioid crisis - that only about 10 percent of people with a drug use disorder get specialty treatment, according to a 2016 report from the surgeon general.

But crack largely afflicted black communities, and the response at the time was not public health-oriented. Instead, it focused almost entirely on criminalizing addiction, passing laws to lock up people who use drugs and drug dealers through exorbitant prison sentences, such as mandatory minimums - an approach that many policymakers, including some Republicans, now consider a mistake and are looking to undo. As a result, the US never got the treatment system it needs to deal with these crises.

Today, white Americans are the ones disproportionately suffering in the opioid crisis. The largely empathetic rhetorical response to their addiction, compared with the way black people addicted to crack were treated decades ago, has been noted many times over. But you can draw a direct line between the fact that the people suffering in this crisis can't get the help that they need and society's failure, 30 years ago, to view black people as worthy of the same help.

"There weren't signs on the billboards and the subways that said save people at all costs," Heather McGhee, president of the left-leaning public policy group Demos, told me. "White Republican politicians weren't saying that this is a national crisis, and 'there but for the grace of God go I,' as Chris Christie has said. There is a difference. There absolutely is a difference." She added, "Racial bias distorts our response and ... made it so we did not create the infrastructure and the policy understanding during the earlier drug epidemics."

This is just one of the many ways that systemic racism ultimately hurts not just those who are the targets of bigotry, but society as a whole. Time and time again, politicians have deployed explicit racism and dog whistles to justify policies to white constituents who harbor racial resentment. But these policies can lead to outcomes that ultimately hurt the white constituents who are activated by racial calls. The opioid epidemic, as the country's deadliest drug overdose crisis in history, is a concrete example of this trend.

"In our interconnected society, racism - both interpersonal and institutional - is the flaw in the machine that often stymies our democracy and our economy," McGhee, who's working on a book on this topic, said. "Racism and bias against full portions of the population color the policy responses of elected officials."

The US was totally unprepared to handle the opioid epidemic

The opioid epidemic is not America's first drug overdose crisis, although it is so far the deadliest. In 2016, preliminary data suggests that 59,000 to 65,000 people died of drug overdoses - the highest death toll from overdoses ever recorded in the US. In the next 10 years, as many as 650,000 people could die from opioid overdoses alone - a death toll that totals more than the entire population of Baltimore.

Policymakers and the public are widely in agreement that people addicted to opioids need treatment. But there is little existing addiction treatment infrastructure in the US, and systems like that cannot be built overnight.

It's common to hear stories across the US, particularly in places hit especially hard by the crisis (such as West Virginia and New Hampshire), about weeks- or months-long waiting periods to get into treatment - if patients can get into care at all.

Take Dean Lemire of New Hampshire: In 2012, as reported by NPR, Lemire was finally fed up with his heroin addiction. He tried to sign up for a state-funded treatment center but was put on a waiting list. He called multiple times a day for three weeks, but after repeated denials, he gave up. He drank some whiskey, got into his car to find heroin, and got into three car crashes before waking up in a jail cell. Only then could the treatment center let him in, apparently deeming his case serious enough.

And Lemire is one of the lucky ones - he survived and ultimately got into care.

States that want to treat a growing wave of newly addicted people just don't have the resources in place to act quickly. That's because they're largely starting from scratch. And starting from scratch is expensive - New Hampshire, which is second in overdose deaths after West Virginia, still doesn't have treatment centers in swaths of the state, especially in rural areas.

Drug policy experts have told me that the US as a whole will likely need to spend tens of billions a year to seriously boost addiction treatment. That may lead to financial savings in the long term, given that studies show addiction treatment prevents all sorts of negative, costly outcomes. But it's a big upfront investment, and it will take years to implement and build on.

Meanwhile, people will continue to die - and so states may be tempted to use their existing criminal justice systems to deal with their overdose crises. Some states have, for example, begun asking prosecutors to bring more drug-induced homicide charges against people who supply opioids to someone who overdoses and dies.

Criminal justice experts widely agree this is not only costly but ineffective. A 2014 review of the research by Peter Reuter at the University of Maryland and Harold Pollack at the University of Chicago, for example, found that while simply prohibiting drugs to some extent does raise their prices, there's no good evidence that tougher punishments or harsher supply-elimination efforts do a better job of driving down access to drugs and substance misuse than lighter penalties. So increasing the severity of the punishment doesn't do much, if anything, to slow the flow of drugs.

As ineffective as that may be, states already have the means to carry out this kind of response. They have enough prisons to make the US the world's leader in incarceration. They have old laws in place that allow prosecutors to pursue stiffer penalties. And they have an incentive to use these systems, because it makes them look like they're doing something about an epidemic that kills tens of thousands of people a year.

America "built up this massive incarceral state, which is a hungry critter," Keith Humphreys, a Stanford drug policy expert, told me.

Put another way, the table is set so that America responds in the same way it has before to drug crises: not much on the public health side, but a lot more on the criminal justice side. And people will suffer and die as a result.

It didn't have to be this way. In the 1980s, America had a chance to implement the sort of public health infrastructure for addiction that states are scrambling to put in place today. Under pressure from the public to do something about the crack epidemic, policymakers could have invested in a serious drug addiction treatment system that could have been scaled or retooled for other drugs, from meth to opioid painkillers and heroin.

Humphreys gave a concrete example of how this could have worked: "Something we could have done then, which is what we've done now, is we could have mainstreamed addiction treatment benefits into the Medicaid system." That, he said, would have let patients more easily afford treatment today - and since health care providers would know those customers are around and now able to pay, they would have been more likely to scale up treatment to match demand even before the opioid epidemic got so bad.

Of course, that didn't happen in the '80s and '90s.

The differences between the response of today and that of the 1980s and '90s

In the 1980s, crack cocaine came to America. Taken up disproportionately by black and poor neighborhoods (while the original powdered version of cocaine remained popular in wealthier, whiter areas), crack quickly became the center of the illicit drug trade - contributing to thousands of overdose deaths as well as a spike in murders and violent crime in the '80s and '90s. As crack addiction strangled black communities in particular, policymakers didn't reach to more treatment to deal with the problem; instead, the response to the crack epidemic was built almost entirely around the criminal justice system.

The media reflected this. There was not a day that the nightly news didn't tell a new, horrifying story of a gang shooting related to crack. The New York Times ran headlines like "New Violence Seen in Users of Cocaine." Stories of "crack babies" dominated much of the news, warning that crack use by single black mothers in particular would lead to a new wave of addicted, stunted, violent youth later called "superpredators" - warnings that later research found to be severely exaggerated.

"The media portrayals during the crack epidemic were exceedingly hostile," Rachel Godsil, co-founder and director of research at the Perception Institute, previously told me. "When they talked about mothers who were crack-addicted, there wasn't, 'What kind of treatment can we provide for them?' but, 'What kind of criminalization can we impose upon them?'"

The prejudiced ties between race and drug use had a long history in America. In 1914, for example, the New York Times ran an article headlined "Negro cocaine 'fiends' are a new southern menace," in which an actual physician claimed that cocaine made black men uniquely violent and even impervious to bullets. Many Americans can now look back at this kind of claim with scorn at its obvious absurdity, but it shows the sort of attitudes that have dominated American views on drugs for decades.

Policymakers responded in kind. Across the country, states passed tougher prison sentences for drugs. The federal government enacted with its own "tough on crime" laws, such as the Anti-Drug Abuse Acts of 1986 and 1988. Republicans backed these measures, but Democrats played a big role too - with former Vice President Joe Biden even helping write some of the "tough on crime" laws of the '80s and '90s while he was a senator. It was a time when it was bipartisan to treat drugs as a moral failure and a criminal justice issue.

Take former President George H.W. Bush, who used his first televised national address in the Oval Office to warn of what he called "the greatest domestic threat facing our nation today": drugs. He held up a bag of crack cocaine - purportedly bought near the White House, though later the story was found to be a bit more complicated - and vowed to escalate the war on drugs.

"Drugs are sapping our strength as a nation," Bush said. "Who's responsible? Let me tell you straight out: everyone who uses drugs, everyone who sells drugs, and everyone who looks the other way." He was as brutal in describing the consequences, arguing that crack is "turning our cities into battle zones" and "murdering our children."

There were also some treatment-focused programs in response to crack, such as the creation of drug courts. But the great majority of the response was punitive.

The opioid epidemic has inspired a different response. Media coverage of the epidemic is much more sympathetic of people struggling with drug addiction, with the New York Times now running headlines such as "In Heroin Crisis, White Families Seek Gentler War on Drugs."

In a rarity in today's politics, the compassion is even bipartisan. Michael Botticelli, President Barack Obama's former drug czar, repeatedly stated that "we can't arrest and incarcerate addiction out of people." New Jersey Gov. Chris Christie, who's leading President Donald Trump's opioid commission, in 2015 gave a passionate speech urging Americans to treat addiction as a medical issue, drawing from a friend's story to argue that "we need to start treating people in this country, not jailing them. We need to give them the tools they need to recover, because every life is precious."

And the one major piece of legislation that Congress has passed related to the opioid epidemic, the 21st Century Cures Act, put $1 billion toward addiction treatment over two years - far from what experts say is necessary, but remarkable in that it approached the crisis exclusively as a public health problem.

Some states have passed laws toughening prison sentences related to opioids, and more have encouraged police and prosecutors to use old "tough on crime" laws to crack down on drug addiction. But these kinds of actions have not reached the all-consuming fervor, at least yet and at least not rhetorically, that engulfed the nation during the crack epidemic in the 1980s and '90s.

Of course, a change in the public perception of addiction - a disease we still don't fully understand but understood even less in the 1980s - has something to do with this disparity. But racism does too.

A key explanation in all of this is race

Consider this chart, which shows that until the early 2000s, black Americans tended to suffer more drug overdose deaths when controlling for population - and now white Americans have taken the lead by far, due to the opioid epidemic:

The trend is central to understanding why America's drug addiction treatment system remains woefully inadequate - to the point that as many as 90 percent of people with drug use disorders won't access it.

Drug addiction was widely seen in the past as a problem that afflicted mostly racial minorities, especially black Americans. So a lot of Americans felt more comfortable treating it not as a medical problem but more as a criminal justice issue, with surveys of the era showing greater support for arresting drug dealers and, to a lesser degree, people who use drugs than later surveys have found.

As an example of how this can work, consider a 2007 study that examined the aftermath of Hurricane Katrina in 2005. In that study, researchers found that people tended to believe that victims in racial groups they don't belong to suffered fewer "uniquely human" emotions like anguish, mourning, and remorse than victims in racial groups they did belong to. And in the aftermath of a natural disaster, that perception of fewer "uniquely human" emotions led participants to be less willing to help victims of a different race.

A 2009 study similarly found that when participants looked at images of people in pain, the parts of their brains that respond to pain tended to show more activity if the person in the image was of the same race as the participant. Those researchers concluded that their findings "support the view that shared common membership enhances a perceiver's empathic concerns for others." Other studies reached similar conclusions.

Really, it seems like common sense: Once someone can relate to the person who's suffering, it becomes much easier to empathize. And when it comes to federal and state legislators - the majority of whom are white - empathy can then translate to more sympathetic policy preferences and outcomes.

So it's not hard to understand why America didn't have much in the way of serious discussions about scaling up drug addiction treatment in the 1980s and '90s but is suddenly discussing the value of treatment in response to the opioid epidemic.

Ithaca, New York, Mayor Svante Myrick, who's black, previously told me the disparity in how crack was approached in previous decades and how opioids are now viewed has led to resentment in much of the black community in his predominantly white town.

"It's very real," he acknowledged. The typical response from his black constituents, he said, goes something like this: "Oh, when it was happening in my neighborhood it was, 'Lock 'em up.' Now that it's happening in the [largely white, wealthy] Heights, the answer is to use my tax dollars to fund treatment centers. Well, my son could have used a treatment center in 1989, and he didn't get one."

Still, Myrick added, "I'm as angry about this as anybody. But just because these are now white kids dying doesn't mean we shouldn't care, because these are still kids dying."

Now, race isn't the only reason these systems turned out as they are today. For one, the crack epidemic was associated with more street violence - there were more shootings and murders during the crack epidemic, as the homicide statistics show, than there have been during the opioid epidemic. To some degree, that justified a criminal justice response at the time. (Although the greater levels of violence in minority communities can also be blamed on institutional racism.)

Class likely plays a role too. The recent meth epidemic was predominantly linked to white Americans, yet it also invited a punitive "tough on crime" response. That may be because it was also linked to poor white Americans, while the opioid crisis is associated more with middle-class white Americans.

And society's understanding of addiction was simply much worse in the 1980s. As Humphreys has noted, activists in the addiction treatment and recovery fields have done a lot to boost the view of addiction as a medical problem in recent years. This kind of awareness simply wasn't around in the '80s, especially as racism colored how Americans viewed addiction.

The result, however, is that America is better suited to deal with drug addiction as a criminal justice, not public health, problem as it faces an extremely deadly overdose crisis.

Racism affects policy outcomes for everyone in all sorts of ways

The response to drug epidemics exemplifies just one way in which race can shape so much of American politics and policy.

A prominent example is President Donald Trump. Several studies suggest that racial resentment was a big predictor of support for his candidacy, which was launched with an infamous speech explicitly attacking Mexican immigrants. Yet his legislative policy agenda so far has focused on efforts to repeal Obamacare, a budget that slashes social services to the poor, and a tax reform package that will mainly benefit the wealthy. As Dylan Matthews explained for Vox, the cuts hit programs that help millions of white Americans and keep millions out of poverty - yet through racial resentment, Trump managed to get people to support this agenda.

"People's level of racial resentment ... was the single best indicator of whether they were against the ACA, or Obamacare, in the outset," Godsil told me. "It is clear that the right used racial resentment and racism and this idea of who's benefiting from certain kinds of government programs to undermine support for [Obamacare]."

There's a lot of social science research behind this idea. As researchers Sean McElwee and Jason McDaniel explained for Vox, racial attitudes are a very strong predictor for beliefs about government spending. "For decades, social scientists have found that attitudes about race, particularly toward African Americans, persistently impact political attitudes and opinions toward government services, spending, and welfare," they wrote.

McElwee and McDaniel measured racial resentment, economic peril, and support for more government spending. They found that higher measured racial resentment correlated with a preference for decreased government spending and services, while more economic insecurity appeared to correlate - but not at a statistically significant level - with more support for increased government spending.

A recent study is particularly illustrative in this regard. In a survey, white respondents were asked about their beliefs on housing assistance. (The researchers only used data from white respondents because support among minority groups for Trump was too low to be statistically reliable.) With the question, survey takers were primed with a subtle image of either a black or white man.

The results were striking: Greater favorability toward Trump highly correlated with more opposition to a federal mortgage aid program, higher levels of anger that some people receive government assistance, and a greater likelihood to say that individuals who receive assistance are to blame for their situation. In contrast, favorability toward Hillary Clinton, Trump's 2016 opponent, did not have a statistically significant effect.

The researchers concluded, "These findings indicate that responses to the racial cue varied as a function of feelings about Donald Trump - but not feelings about Hillary Clinton - during the 2016 presidential election." Trump was clearly attracting people with high levels of racial resentment.

Much of this is driven by the perception of who gets these benefits. If critics can paint a policy as benefiting black people, that makes white people more likely to oppose it. This is why coded rhetoric about "welfare queens" and other recipients of government benefits can be so effective: It suggests the government is taking money from white taxpayers and redistributing that money to people of color who are, McGhee argued, seen as "lazy at best and criminal at worst." Never mind that, as just one example, the plurality of food stamp recipients are white.

This has been a trend for decades, going back to Richard Nixon's "Southern strategy," Ronald Reagan's original use of the term "welfare queen," and now Trump's own coded rhetoric. It's what some experts call the identity politics of the right, and perhaps the big reason, McGhee argued, that a majority of white voters have rejected Democrats in presidential elections after 1964, when the Civil Rights Act passed.

We see this consistently throughout American politics: Race plays a tremendous role in how people respond to certain policy issues and how people vote. That lets politicians like Trump leverage race to get white voters in particular to go along with an agenda that could actually hurt them - whether the issue is housing, welfare, Obamacare, or drug addiction treatment.

"It scapegoats and vilifies people of color," McGhee explained. "It sets up a response among many white people that sees policies that benefit people of color as suspect, regardless of the fact that those policies would also benefit similarly situated white people."

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The deadliness of the opioid epidemic has roots in America's failed response to crack

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The death toll from the opioid epidemic ravaging the US has been climbing by the thousands for years:In 2015, opioid overdose deaths killed more people in the US - 52,000 - than guns, car crashes, and even HIV/AIDS at its peak, and overdoses since the epidemic began in the late '90s had killed more people than the entire population of Atlanta.Based on preliminary data, 2016 will be worse.

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This is the second in a three-part series examining the history of public opinion on illegal drug use. This segment focuses on the 1980s and 90s. The 1980s In 1986, Len Bias, a college basketball star, died of a cocaine overdose two days after he was taken by the Boston Celtics as the overall No. 2 pick in the National Basketball Association draft. President Ronald Reagan signed the Anti-Drug Abuse Act. In 1985, one-third of Americans said they had tried marijuana at some point in their lives.
By the mid-80s, the introduction of crack cocaine turned youth drug use into a truly terrifying issue. Crack was cheap, plentiful and hideously addictive. Its effects -- including gang warfare and crack babies -- were quickly gaining notoriety. A 1986 Gallup poll asked Americans, "Which one of the following do you think is the MOST serious problem for society today: Marijuana, alcohol abuse, heroin, crack, other forms of cocaine or other drugs?" At 42%, "crack" and "other forms of cocaine" beat "alcohol abuse" by eight percentage points -- even though there are far more alcoholics than crack addicts.

As the war on drugs escalated and hard drugs moved into the suburbs, a new form of anti-drug education was born. It was becoming obvious that, as Gary De Blasio, Executive Director of Corner House Counseling Center for Adolescents and Young Adults, said, "Scare tactics don't work." Drug-abuse prevention began to center on education. Instead of giving kids the willies, new outreach programs such as DARE (Drug Abuse Resistance Education) and Partnership for a Drug-Free America (PDFA), began teaching kids how to make good choices -- the willies are temporary, the ability to reason is permanent.

De Blasio's group, based in Princeton, N.J., prefers to use factual information. "We provide kids with refusal strategies, problem-solving and emotional coping skills. We show them that they have choices, and that choices have consequences. They find they have options. Peer education is one of our most effective programs. High school students speak at the junior highs, junior high school students talk to elementary school kids. They tell them that they have alternatives, but what the kids in the audience see are the cool kids NOT taking drugs."
The 1990s Federal funding for the war on drugs reached $17.1 billion dollars. In a Gallup poll, 34% of Americans admitted to having tried marijuana.
By the last decade of the millennium, it appeared that fewer people were using drugs. Gallup polls showed little change in the percentage of adults who said they had used marijuana -- 34% of Americans said they had tried it in a 1999 poll. According to the Gallup Youth Survey, however, the percentage of teens admitting to marijuana use also continued to drop, from 38% in 1981 to 20% in 1999. PDFA reported that teens' "trial" use of marijuana, inhalants, methamphetamines, LSD and -- for the first time -- cocaine, had declined in 1999.

So the recent upswing in the use of heroin and "club drugs" was all the more startling. "Ecstasy and crystal meth are popular in California, meth is big in the Midwest, and the New Jersey Turnpike is just 'the Heroin Highway'," said De Blasio. Heroin is one of the most deadly of the illegal drugs. Luckily, the most common form of ingestion -- injection into a vein -- has repulsed most potential users. Until now. A stronger, purer version of heroin that can be smoked or snorted is becoming available in big cities.

The use of methamphetamines (often called "crystal meth" or "meth") is relatively new among teens. A stimulant, meth creates paranoia, hallucinations and repetitive behavior patterns. Long-term use can lead to toxic psychosis. Recent PDFA studies found that use by high school students more than doubled between 1990 and 1996.

Ecstasy, a club drug (associated with all-night raves and parties), can cause paranoia, confusion, anxiety and severe drug cravings. The long-term effects can include damage to the parts of the brain that control thought and memory. In fact, because Ecstasy spikes the user's heartbeat and temperature, a very long-term effect of just one use can be death from heart failure.

The dangers of these drugs are new to kids -- how many 17-year-olds associate heroin with Janis Joplin's overdose? Many kids thought Ecstasy, which wasn't outlawed until 1985, was harmless. In the future, the challenge for drug educators will be to inform kids about the very real dangers of drugs that most adults have never heard of.
Part three of this series will discuss a 100% successful drug prevention strategy, as well as the demographics of drug use.

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By the mid-1980s, the introduction of crack cocaine turned youth drug use into a truly terrifying issue. Crack was cheap, plentiful and hideously addictive. By the last decade of the millennium, it appeared that fewer people were using drugs. The dangers of these drugs are new to kids.

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Maryland's First Stabilization Center to Open in Baltimore (OH&S) | Baltimore City Health Department

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Maryland's First Stabilization Center to Open in Baltimore (OH&S) | Baltimore City Health Department

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City officials announced Wednesday plans for a stabilization center in Baltimore, Maryland, as part of the city's efforts to combat the opioid crisis. The stabilization center would be the first in the state and would serve as a safe place for drug users to receive basic first aid, withdrawal management, and screening and referral to treatment on-site for those with a substance use disorder.

According to city officials, the center will be a safe place for people under the influence of drugs and alcohol to sober up and receive short-term medical and social interventions, medical screening and monitoring, and referrals to behavioral health and social services. Patients who need it may also be introduced to buprenorphine, an alternative drug used to treat opioid addiction.

"We are in the middle of a national epidemic for opioid addiction and overdose and yet we are still treating people with the disease of addiction different than anyone with any other disease," Baltimore Health Commissioner Dr. Leana S. Wen said. "The stabilization center is one step in the direction of on-demand, evidence-based and compassionate treatment for people with the disease of addiction."

Read the entire story.

Related Stories

Public health saved your life today. You just didn't know it," is a saying of Dr. Leana Wen, the Baltimore City health commissioner.

Read the entire story.

Baltimore will soon open a new center for people who need short-term drug and alcohol treatment. The center will provide basic services such as first aid, withdrawal management and it will refer people who have a substance use disorder to receive further drug and alcohol treatment in a long-term facility.

Read the entire story.

When public health is invisible, we only end up talking about it when things go wrong; people tend to think about public health agencies as entities that respond to infectious disease outbreaks or shut down a restaurant due to health code violations. We frequently think about health as healthcare, but what determines how long and how well we live is less about what happens in the doctor's office and more about where we live, the air we breathe, and the availability of other resources in our communities. At the Baltimore City Health Department (BCHD), we believe that all issues - education, housing, employment, public safety, and beyond - can and should be tied back to health. We are committed to making the progress earned through public health visible, and to make the case for incorporating health-in-all policies across the City.

Read the full blog by Commissioner Dr. Wen and Special Assistant to the CommissionerNarintohn Luangrath here.

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Maryland's First Stabilization Center to Open in Baltimore (OH&S)

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City officials announced Wednesday plans for a stabilization center in Baltimore, Maryland, as part of the city's efforts to combat the opioid crisis. The stabilization center would be the first in the state and would serve as a safe place for drug users to receive basic first aid, withdrawal management, and screening and referral to treatment on-site for those with a substance use disorder.

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The opioid crisis hits home for Maryland man - Baltimore Sun

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The opioid crisis hits home for Maryland man - Baltimore Sun

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In the final days of 2016, a North Carolina halfway house called to say my nephew was missing. It wasn't the first called I'd gotten about Ian. He was like our fifth child and the focus of my attention for many years. We were in touch regularly, and he went with us on vacations and to ballgames.

Ian was a drug addict. We made sure he had access to the best doctors, residential and out-patient recovery programs, counselors and halfway houses. We worked with lawyers and parole officers to deal with his legal problems. We arranged for him to live at the halfway house and work in Asheville, N.C., because one of our daughters lives there.

We did everything we knew to do - and everything experts told us to do - but it wasn't enough. After several days of searching, Ian was found in a hotel room. He was alone, dead from an opioid overdose.

My story is not unusual. In 2015, the most recent year for which the Centers for Disease Control have issued official data, 52,404 Americans died from drug overdoses, an all-time high. A recent CDC study suggests official statistics underestimate the number of opioid-related fatalities.

Overdose deaths now outnumber deaths from auto accidents and guns; only heart disease, stroke and cancer account for more deaths. Eight of every 10 drug-related deaths are due to opioids. The opioid category includes heroin and synthetic fentanyl - a combination of which killed Ian - but also legal pain medications. In fact, prescription drugs now account for more deaths than illicit ones.

As a story in The Sun last week detailed, the devastating impact of the opioid epidemic is hitting Maryland as well: 2,089 Maryland overdose deaths in 2016, a 66 percent increase from the year before. Overdose deaths have increased for six straight years, and have increased 300 percent since 2010.

Opioids account for an average of four deaths per day in the state. This scourge spares no one. In Montgomery County, the wealthiest county in Maryland, opioid-related deaths in 2016 were 40 percent higher than the year before.

Government at all levels is struggling to react as elected officials in both parties are coming to understand that addiction should be treated as a medical issue rather than a criminal issue. Restrictions have been placed on prescriptions for opioid-based pain killers. Naloxone, a lifesaving drug that reverses the effects of opioid overdoses, has been made more widely available for use by first responders. Funds for public education and treatment have been increased.

Shortly before Ian's disappearance, I was shocked to learn that most hospitals will not admit patients who merely want to detox. To fill the gap, many locales are creating detox centers where addicts can detox without fear of arrest and can be referred to professional services.

Unfortunately, these useful steps to eradicate this epidemic are colliding with politics, particularly in the Trump administration. Their budget proposal would cut 95 percent of the funding for the Office of National Drug Control Policy, the office empowered to tackle the opioid crisis. Their health care plan would eliminate Obamacare's requirement for including treatment in basic policies.

Reversing Mr. Obama's enforcement policies, as the administration proposes, will send addicts to jail rather than treatment. This will not help and neither will their belief that treatment and enforcement are best left to the states. In Maryland, only one emergency treatment center was funded rather than the 10 that were proposed.

Even less is being done to confront mental illness, which is closely related to drug abuse. Suicide is on the rise, and now ranks as one of the top three causes of death among Marylanders under 35. Mental health issues receive much less attention than the opioid crisis. In many ways, it is a silent epidemic. And it is deadly.

These crises have stimulated action in the private sector. For example, pharmaceutical companies are expanding efforts to create non-addictive pain treatments. Private foundations, including our family foundation, are helping local health care providers expand mental health and addiction treatment.

But more - much more - is needed, especially by government. Suicide and drug-related deaths are killing our young people, decimating their families, and robbing all of us of their future. Many of those living with addiction are struggling to survive, unable to lead the healthy and productive lives we all want.

We are not living up to our responsibilities as human beings or citizens if we allow these epidemics to go unchecked.
David Trone (dtrone@totalwine.com) is the founder of Total Wine & More, the largest private wine retailer in the country, with 172 stores in 22 states, almost 6,000 employees and headquarters in Bethesda, Md.

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The opioid crisis hits home for Maryland man

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In the final days of 2016, a North Carolina halfway house called to say my nephew was missing. It wasn't the first called I'd gotten about Ian. He was like our fifth child and the focus of my attention for many years. We were in touch regularly, and he went with us on vacations and to ballgames.

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Baltimore City Overdose Prevention and Response Information | Baltimore City Health Department

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Baltimore City Overdose Prevention and Response Information | Baltimore City Health Department

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The Baltimore City Health Department is dedicated to decreasing the number of opioid-related overdose deaths in Baltimore City. Opioid overdose is a major public health crisis. In 2014, 303 people died of drug and alcohol overdoses, a 19% increase from 2013. Of those who died of overdose in 2014, 192 people died as a result of heroin intoxication. This is more than the number of people who died of homicide in our city. Preventing overdose deaths is a top public health priority-it literally will save hundreds of our citizens every year.

24 Hour Mental Health & Substance Use Disorder Help Line - Information & Referral Line: (410) 433 5175
Naloxone: A Life Saving Drug
Naloxone (known by the brand name Narcan) is a prescription medicine that can reverse an opioid-related overdose by quickly restoring breathing and consciousness. The medication can be easily administered by nasal spray or injection and lasts 30-90 minutes. Available only by prescription, naloxone has few side effects, is not addictive, cannot get a person high, and is safe for children and pregnant women. After receiving naloxone, someone will experience symptoms associated with withdrawal (e.g. discomfort, nausea, vomiting, etc.). Naloxone will have no effect on someone who does not have opioids in his or her system. Learn more about overdose education and naloxone distribution.
The Overdose Response Program (ORP)
The state Department of Health and Mental Hygiene (DHMH) oversees the ORP, which authorizes private or public entities to conduct educational training programs. These programs train individuals to recognize and respond to opioid-related overdoses and certify them to safely administer naloxone. Authorized entities issue certificates to successfully-trained individuals and may have a physician or nurse practitioner on site to write prescriptions to certificate holders and dispense naloxone. Learn more on the DHMH website.
Baltimore City Health Department Staying Alive Program
The Baltimore City Health Department Staying Alive Program provides ORP-certified educational training programs to Baltimore City residents. Since 2004, Staying Alive has taught more than 17,500 injection drug users, drug treatment clients and providers, inmates, and corrections officers about how to prevent drug overdoses. More than 230 reversals (lives saved) have been documented. Learn more on the Staying Alive program page.

Along with Staying Alive, four other organizations are authorized to conduct ORP training and certification in Baltimore City: Behavioral Health System Baltimore, Baltimore Student Harm Reduction Coalition, Baltimore Police Department, and Health Care for the Homeless. The Baltimore City Health Department is working closely with these organizations and Staying Alive to expand access to overdose response training and naloxone to all community members.
Public Overdose Response Trainings
Baltimore City community members are encouraged to attend public trainings to learn how to recognize and respond to an opioid overdose. These trainings are designed for anyone who thinks they may be near someone experiencing an overdose. Those who complete the training will receive a certificate, a prescription for naloxone, and a free kit containing naloxone. To find a training near you, please visit our Training Calendar and look for events titled "Opioid Overdose Public Training."

If you are interested in organizing a public training in your community, please contact Evan Behrle.
File(s) available on this page for download requires special software to view. If you do not have that software, you can obtain it from the following source(s): Word (DOC/DOCX): https://www.microsoft.com/en-us/download/details.aspx?id=4

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Baltimore City Overdose Prevention and Response Information

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The Baltimore City Health Department is dedicated to decreasing the number of opioid-related overdose deaths in Baltimore City. Opioid overdose is a major public health crisis. In 2014, 303 people died of drug and alcohol overdoses, a 19% increase from 2013. Of those who died of overdose in 2014, 192 people died as a result of heroin intoxication.

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Before the New Hampshire medical examiner’s office had even finished counting the number of drug deaths in 2015, the 2016

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Before the New Hampshire medical examiner’s office had even finished counting the number of drug deaths in 2015, the 2016

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Before the New Hampshire medical examiner's office had even finished counting the number of drug deaths in 2015, the 2016 numbers were already rolling in.

The latest numbers released this year show 10 deaths confirmed so far in 2016 with 86 more pending. Last year, 428 people died from drug overdoses, with eight cases still pending.

Behind that startling statistic is this one: New Hampshire ranks third-highest for per-capita drug deaths nationwide, falling behind only West Virginia and New Mexico. Its per-capita drug death toll has eclipsed that of other New England states, also dealing with similar heroin and opioid crises.

"The stage was set with the prescription opiate problem," said New Hampshire Medical Examiner Thomas Andrew. "It cut such a wide swath through our population that when those folks switched over . . . to use heroin and ultimately fentanyl, with its increased potency came an increased death rate."

At the same time, the state is racing to improve its ability to treat drug users. An oft-repeated statistic is that New Hampshire is the 49th-worst state when it comes to accessing treatment. A bipartisan group of legislators and treatment advocates is trying to improve access, but health officials in the state say continued funding and staff are needed to stem the tide of addiction.

'Dramatic spike in fentanyl'

Law enforcement officials report synthetic fentanyl flowing over the Massachusetts border into New Hampshire towns and cities. The drug is anywhere from 50 to 100 times stronger than heroin.

Law enforcement experts in the state say that while many drug users are unaware they are buying fentanyl, some are seeking out the drug for a more powerful high. But as the numbers show, chasing that feeling comes with a powerful price.

The drugs are manufactured by Mexico's Sinaloa cartel and transported up to the northeastern United States.

"What we have seen is a dramatic spike in fentanyl in New Hampshire," said Assistant Special Agent Jon DeLena of the DEA, pointing to the spike in fentanyl-related fatalities.

DeLena and his fellow agents used to see batches of heroin laced with fentanyl in the Granite State. Now, "we've seen the shift to fentanyl laced with heroin, to most recently fentanyl laced with some sort of cutting agent, and that's deadly."

Much of New Hampshire's heroin and fentanyl is mixed and packaged in northern Massachusetts, and law enforcement officials say there's little precision to how the drugs are cut and packaged.

"These aren't rocket scientists," said Lt. Brian O'Keefe of the Manchester Police Department.

The end product is usually a haphazard mix of heroin, fentanyl and cutting agents, crudely mixed with blenders. In one drug raid in Lawrence, Mass., law enforcement officials found 10 to 12 blenders used to cut up the product.

Law enforcement officials say these are hitting the streets being marketed as China White, a cleaner, more pure heroin. But by the time drugs get to users, there's no telling whether they're getting the part of the batch that's heroin or the part that's fentanyl.

If it's the latter, "there's no coming back from that, no opiate antagonist like Narcan is bringing you back from that," O'Keefe said.

The drugs flowing into some neighboring states are different.

New York City traffickers mostly supply Vermont and Maine, and are largely still bringing heroin into those states, DeLena said.

"The majority (of opiates) in those states still remains as heroin, although we have seen somewhat of an increase in the presence of fentanyl," he said.

Andrew's office came across its first case of heroin laced with the potent synthetic drug fentanyl in December 2013.

"As winter melted into the spring, that's when the heroin-fentanyl combination became less prominent and the fentanyl alone came to dominate," Andrew said. "That's when the real fentanyl impact has hit us."

Center stage in Legislature

Addiction has come to dominate the political conversation in New Hampshire. It was often discussed during the presidential primary and has become a bipartisan issue in the Legislature.

Some of the bills in front of the Legislature this session include ones to increase access to overdose reversal drug Narcan and trying to decrease barriers to getting insurance coverage for substance abuse issues.

Treatment providers and advocates say expanded Medicaid and its substance abuse benefits are some of the most important tools in the fight against heroin and opioids.

So far, expanding Medicaid has not been much of a fight in the Republican-led Legislature. The state House overwhelmingly reauthorized Medicaid expansion last week and the bill is on its way to the Senate.

Members in both parties have touted the reauthorization as a way to deal with the drug problem and get 48,000 Granite Staters health care.

"I feel like we're on an upward trajectory," said Michelle Michele Merritt, policy director at New Futures, a drug and alcohol treatment advocacy organization. "Reauthorization of the Health Protection Plan is the single most important step that our senators and legislators can take."

Even with the action that's being taken at the state level and in many local communities, law enforcement and health experts don't see this problem going away soon.

Another issue health officials are trying to address is the lack of counselors and staff at New Hampshire treatment facilities.

"We also don't have the workforce we need to deliver those services," said Jaime Powers, a clinical administrator at the Department of Health and Human Services Bureau of Drug and Alcohol Services.

Still, Powers says expanded Medicaid in the state has been pushing things in the right direction and that setting up treatment capacity takes time and manpower. The state currently has a request for proposals for more treatment facilities and is expected to announce the results of that in the coming weeks.

"I do see it growing," Powers said.

With deaths on their current trajectory, Andrew said he also needs another staff person in the medical examiner's office to keep up.

"It's changed the entire face of the practice of forensic pathology," Andrew said. "It's on everyone's lips all the time."

(Ella Nilsen can be reached at 369-3322, enilsen@cmonitor.com or on Twitter @ella_nilsen.)

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Report: New Hampshire has third-highest drug deaths per capita in the nation, with little sign of slowing down

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Before the New Hampshire medical examiner's office had even finished counting the number of drug deaths in 2015, the 2016 numbers were already rolling in. The latest numbers released this year show 10 deaths confirmed so far in 2016 with 86 more pending. Last year, 428 people died from drug overdoses, with eight cases still pending.