The drug-death data announced by the state Wednesday tell what’s become a familiar story. Year by year, they chart fatal overdoses rising sharply in New Hampshire, starting in 2013, before dipping in 2018.
And while the continued decrease in fatal overdoses in Cheshire County and the state last year is cause to celebrate, local addiction experts say there is still much work to be done in combating the opioid crisis.
“On the surface this is very positive as we see the data showing a slight decrease,” Shorey Dow of Phoenix House New England said in an email. “However ... we cannot let our guards down.”
The data released by the N.H. Office of the Chief Medical Examiner offer a glimpse at the circumstances behind the 415 deaths confirmed for 2019.
They show that 288 — nearly 70 percent of those who died — were male, while the other 127 were female.
Twenty-one of the overdoses were in Cheshire County — 11 in Keene alone — ranking them as the sixth highest county and city in the state. This is one rank lower for both than in 2018.
A majority of the fatal overdoses (92 percent) statewide were accidental, 6 percent were deemed suicide, and the cause of 2 percent was undetermined.
Accidental overdoses were most common among those in their 30s, while suicides were most prevalent in those age 50 to 59.
Two of those who died accidentally from drugs were between the ages of 16 and 19.
The data also break down which drugs were used in last year’s fatal overdoses.
Of the 415 deaths documented in 2019, 372 involved opioids — 339 of them fentanyl either by itself or with another drug.
Methamphetamine was used in 52 deaths, as compared to 22 in 2018, and cocaine in 79, compared with 65 the year before. In most of these cases in both years, opioids were also in the mix.
“Death by stimulants alone is rare,” Nelson Hayden, executive director of The Doorway in Keene, explained in an email. “Therefore the increase in deaths involving cocaine and methamphetamine are likely ... in conjunction with fentanyl. This is a common practice and may be initiated by the user or mixed into the product they are purchasing.”
Alcohol was the cause of three overdose deaths in 2019, the data state, and contributed to 65 more.
A silver lining in the data is that drug deaths overall dropped about 12 percent. Cheshire County saw a 34 percent decrease.
This could be tied to a handful of factors — increased education on substance-use disorders, wider access to overdose-reversal drugs like Narcan and local- and state-led initiatives to combat the crisis, such as the hub-and-spoke Doorway referral model launched in January of 2019.
But amid the COVID-19 pandemic, experts worry we’ll see another spike, with more people in isolation to help slow the virus’ spread, coupled with high unemployment rates and treatment resources further limited by the pandemic.
“We need to continue to encourage communities to not turn away from this and/or forget about this issue,” Dow said. “We as providers are here to assist and help anyone where they are at, especially during these difficult times related to the pandemic.”
So far this year, 236 drug deaths had been confirmed statewide as of last month — 202 of them involving opioids — with a determination of the cause of another 55 deaths pending toxicology testing.
“We need to continue to have providers to be able to wrap our arms around the entire community,” Dow said, “to educate, support and remember that ‘recovery is possible’.”
If you or a loved one is struggling with a substance-use disorder, The Doorway — a recovery services referral hub at 24 Railroad St. in Keene — is open Monday through Friday, 8 a.m. to 5 p.m. Support through the state’s 24/7 hotline is available at 211.
There has never been a standard nationwide curriculum to train physician assistants to treat addiction, but students and faculty in Franklin Pierce University’s master of physician assistant studies program soon will help change that.
The school is one of 10 colleges nationwide recently selected to participate in a pilot program to develop a standardized course of study for physician assistants to treat substance-use disorder. Franklin Pierce University is based in Rindge and operates its PA program at its academic center in West Lebanon.
Through the pilot, students “have a firsthand opportunity to set a standard nationally for how future PAs will be trained in substance-use disorder,” Priscilla Marsicovetere, director of Franklin Pierce’s physician assistant program, said in an interview Thursday.
That’s important, Marsicovetere added, because physician assistants focus on primary care, which is the level at which substance-use disorder patients normally receive treatment.
“We often see that these are not the kind of patients who go to specialists for care,” she said. “This is the kind of thing that needs to be addressed at the primary-care level, and that is the main goal of PA programs across the country — creating primary-care providers. This is just another tool in their toolkit for how to give really holistic care to patients.”
There is also a nationwide shortage of health-care providers trained to treat people suffering from addiction, according to Dr. Frederick Lord, an addiction medicine specialist based in Windsor, Vt., who also teaches some Franklin Pierce PA students during their clinical rotations.
“And obviously with the opioid crisis, and particularly with this pandemic aggravating the opioid crisis again, it is so important to have an adequate number of well trained, informed practitioners who can take care of these patients and do a good job,” he said.
A standardized PA curriculum will put everyone on the same plane, Lord added, and hopefully will make more practitioners willing to care for people with substance-use disorder, which is often stigmatized.
“There are many people, who, sadly, do not like to take care of these patients — they don’t want to take care of these patients,” he said. “And so it’s important to have people who do.”
Since Marsicovetere took over Franklin Pierce’s PA program three years ago, she has overseen the addition of substance-use disorder training into the program’s curriculum. In addition to classroom instruction on the topic, Franklin Pierce has added a five-week addiction medicine clinical rotation, including the one that Lord leads, and made training in medication-assisted treatment of substance use disorder a mandatory part of the curriculum.
“We have included in our curriculum specific training on substance-use disorder — what it is, what it does to the brain, how the patients present, and then how you treat the patients,” she said.
These curriculum components already in place at Franklin Pierce are a big reason why the school was selected to join the national program, Marsicovetere added.
“We were selected [for the national pilot program] because we have demonstrated, I believe, a true commitment to being involved in the battle against substance-use disorder,” she said. “... This is a wonderful culmination of what we’ve been trying to do for a couple of years.”
Franklin Pierce University is part of the second cohort of schools chosen for the national pilot program. Last year, another 10 schools worked to develop a first draft of the standardized curriculum. Early in the spring, 21 Franklin Pierce students, who are in the second of three phases of the 27-month PA program, will study under this curriculum, and then, along with faculty members, will offer feedback to refine it. The Franklin Pierce PA program, which began in 2009, admits 24 students each year.
The Physician Assistant Education Association, an organization that represents all accredited PA programs, then will disseminate the curriculum to programs across the country, though Marsicovetere said Thursday she’s not sure yet when the curriculum will be finalized. The PAEA selected the schools that are participating in the program, and provided funding through the Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services.
While addiction, and the need for physician assistants trained in treating it, are nationwide problems, Marsicovetere said Franklin Pierce University specifically aims to make an impact in its own community.
“The program is unique in that it has a focus on rural and medically underserved patients, and treating those kinds of populations,” she said. “... We’re located in New Hampshire, one of the hardest-hit areas in the country for substance-use disorder. We are a small state. We are a small program, even, and so substance-use disorder, for us, hits really close to home.”
That’s why, Marsicovetere said, she and the Franklin Pierce PA faculty and students feel a duty to participate in the development of a national substance-use disorder curriculum.
“We want to make sure PA students, who are soon going to be PA practitioners, are all well equipped to be able to treat substance-use disorder no matter where they encounter it,” she said. “... So, to ensure that students were being trained well, we wanted to make sure there was a standard curriculum that covered at least all the basic things.”
Even after the national curriculum is finalized, schools certainly can add more substance-use disorder training to their physician assistant programs, Marsicovetere added.
“But [a standard curriculum] would at least give a guarantee of baseline level of preparation for each and every PA student in the country, so that no matter where they go, they’ve got at least this set toolkit for helping, hopefully, to combat substance-use disorder,” she said.
New Hampshire continues its slow but steady climb out of the recession, but it still has a long way to go.
Some 2,005 people filed initial unemployment claims the week ending Sept. 26, 5.3 percent fewer than the previous week’s revised figures. The latest total is still about four times pre-pandemic levels.
Those new jobless are joining the 34,335 Granite Staters already unemployed, a number that itself represents a 7.8 percent drop, or 2,906 individuals, from the previous week.
The good news is that more people are going back to work then getting laid off.
In other words, the economy is bad not horrible, and is getting better. But it isn’t getting better for those who still can’t find work. That’s because this is the third week since the ending of a federal weekly benefits enhancement of $300 (already down from the original $600), meaning that their checks, on average, are less than half of the amount they were.
There are congressional talks to bring some of those enhanced benefits back, but given the acrimony over the upcoming election and Supreme Court battle, most observers are not optimistic that the next COVID-19 stimulus package will be passed in October.
New Hampshire’s recovery has been easily outpacing the nation’s, but this week it did only slightly better. Nationally, some 837,000 were laid off last week, a 4.1 percent decline. There were 11.8 million jobless Americans on Sept. 19, an improvement of 7.7 percent.