MANCHESTER, NH – “This is scary stuff,” said Dr. Joseph Pepe, President and CEO of Catholic Medical Center, after hearing from a round-table of first responders and hospital staff last week on the latest iteration of the city’s ongoing drug crisis. “Carfentanil is a weapon, and this community is at war,” he said.
Carfentanil is an animal tranquilizer with no legitimate human use. It was designed for veterinarians to subdue horses, elephants, and other zoo animals. It has been identified as the latest threat to public health in New Hampshire – after a rash of overdoses linked to carfentanil, police on May 5 arrested a city man suspected of dealing the drug. The synthetic opioid is 100 times more powerful than fentanyl, and can be absorbed through air and skin contact.
Pepe’s statement is not hyperbole.
Last fall media reports indicated that for decades before being discovered by drug dealers, carfentanil and substances like it were researched as chemical weapons by the U.S., U.K., Russia, Israel, China, the Czech Republic and India. They are banned from the battlefield under the Chemical Weapons Convention.
The threat of carfentanil has resulted not only in an uptick of overdoses around the state, but also puts first responders in jeopardy. Every drug overdose call could potentially involve carfentanil, prompting the NH Department of Health and Human Services to update protocol for medical and law enforcement crews, in this order: Stay safe; protect yourself; don’t touch; administer Narcan.
Manchester Fire Chief Dan Goonan said more intensive training is underway, as his crews are working closely with Manchester Police Chief Nick Willard, as well as ambulance crews with guidance from the city’s EMS officer Chris Hickey, to make sure first-responders have the training they need to stay safe while continuing to save lives.
“In the city right now we really have a fentanyl problem. There’s no heroin here. When they come to Safe Station, they tell us they’re addicted to fentanyl. No one refers to heroin anymore,” Goonan said. “We noticed in early April that we had a bad problem on the streets, and we decided to reach out to our law enforcement to say that we’ve had to up the amount of Narcan we’re administering , which has been startling.”
He said agencies quickly realized something was “happening” on the streets of Manchester, elevating the drug crisis to another level. “But I’m really amazed at how we came together in terms of sharing information and getting everyone quickly up to speed,” Goonan said.
Pepe said despite the city’s best efforts, he’s concerned that this is a “tip of the iceberg” situation, dealing with a drug that, in minuscule amounts, “can bring a 250-pound man down. I wonder what we’re doing to get the education about this drug out there on the streets?” Pepe said.
Law enforcement agents have received baseline training, according to an undercover officer who was part of the round-table discussion. They now routinely don protective masks, glasses and double gloves, not just to protect from a needle prick, but from any direct contact with fentanyl or carfentanil.
Carfentanil: Dealing Death
Also of concern: How to make sure the scene of a drug raid is completely safe from drug residue. This is an issue that has been raised following an April 28 DEA raid at a Sentinel Court residence which eventually led to the arrest of Preston Thorpe. Until this particular threat subsides – and police believe it will – they will continue to take extraordinary measures to protect their first responders.
“This [carfentanil] is new to everyone. People can order it from the Internet, and as soon as someone hears its in town, they’re looking for it. I don’t know why, but they’re looking,” Mayor Ted Gatsas said.
But they are also well aware that there is always another drug of choice waiting in the wings – and because drug dealers don’t want to lose all their customers, law enforcement agents say they are beginning to see a resurgence in other drugs, particularly methamphetamines.
Gatsas said the last thing the city needs is an increase in the kind of violent behavior associated with meth addiction.
Although the city’s innovative Safe Station model has gained national attention, it also means that Manchester is on the front lines when it comes to figuring out how best to deal with the new threat from carfentanil. Gatsas voiced strong advocacy for stiffer sentencing, beginning with the bail process for drug dealers.
“That’s probably what scares most of us. This is nothing like we saw two years ago. Safe Station has had 1,700 visits in the past year, there’s respite care and finally, we’re getting some long-term care, but this is much different. This is something that the legislature has to step up. When somebody gets caught dealing this – because this is dealing death, it’s not about dealing drugs – it’s a whole different issue. They need to find some legislation, put something in place right now, that says if anybody gets caught dealing carfentanil, the punishment has to be pretty severe,” Gatsas said.
He said when Preston Thorpe came before the judge, the prosecutor was looking for $100,000 bail.
“Well, he probably could have found that in his right pocket. Fortunately, the judge raised it to $500,000 – judges have to step up. They have to be leading the charge in fighting this epidemic, along with the rest of us,” Gatsas said. “When Manchester Police Department is out arresting someone on Tuesday, and they’re out on personal recognizance for dealing drugs on Thursday, there’s something wrong with that. I understand the person who has a disease – that’s not the person I’m talking about. When somebody goes out of their way to order carfentanil from China, and it’s delivered, there should be a severe penalty for that.”
City Health Department Director Tim Soucy said the message they’re getting from a majority of those seeking help for addiction is that they are afraid of carfentanil – even though some do seek it out. There is a new sense of urgency about making sure the warning about carfentanil is clear, and that it is not being glorified among users.
Fall-out from addiction
There are other concerns that reach beyond the current crisis and into the next generation, says Dr. William Goodman, Catholic Medical Center’s Medicine Director. He noted that the number of babies being born to women with opioid addiction has increased over the past three years, doubling the number of infants born with neonatal alcohol syndrome, from 3-6 percent, requiring higher levels of intensive care.
“There’s no way around it; we’re all paying for it, socially, morally and financially. And there are adults who are suffering consequences, as well. We hear a lot about overdoses and Narcan, but there are people who are still alive but they suffered such oxygen deprivation that their brain is not working so well, so they require lifelong assistance,” Goodman said.
It’s the fall-out from addiction that is often overlooked in this discussion, because it’s too complicated for a television sound bite, Goodman said.
“We have patients who have infections on their heart valves – we do a lot of heart surgery at CMC, and so we’re seeing a tripling of the number of people requiring valve replacement because of infection, the percentage has escalated due to complications of intravenous drug use,” at a cost of about $200,000 per procedure, including antibiotics and follow-up care, he said.
“It would be a wise investment for the state and federal government to upstream [funding] to prevent this problem, instead of downstreaming [costs] to hospitals, where paying for it is so expensive,” Goodman said.
He said collaborative efforts of law enforcement, the medical and recovery communities, and city health officials allows for the social issues surrounding addiction to be addressed, including homelessness and employment security. Long-term recovery and resources are the key to breaking the cycle of addiction and the revolving doors that keep people stuck in a cycle of Emergency Department visits, 28-day programs and jail cells.
Goodman also noted one of the persistent issues for those within the recovery community is the lack of available mental health services – directly related to the challenge of hiring and retaining licensed drug and alcohol counselors, or LADCs.
There are many moving parts if the city is going to see reverse the current trends, from reducing supply and demand, enforcing harsher sentencing for dealers, and building a more comprehensive recovery system that includes more treatment beds, as well as more sober living and transitional housing.
Although the drug crisis has resulted in more homelessness in the city, the group emphasized that addiction is an equal-opportunity destroyer of lives, and is bearing down on all socio-economic segments of society.
Chief Goonan said it’s become clear to him through his work with Safe Station that the 28-day programs that spit people back out into the street, where they become homeless again.
“I see it over and over again. As you become more and more vested in this crisis and our Safe Station program, you really start worrying about what’s on the back-end of this, and what happens to people after they get through. I don’t think it’s going to get truly better until we figure these things out,” Goonan said.
Silence = Death
Dominic Donahue, Clinical Director for Serenity Place said a new challenge for those in the field is keeping clients new in recovery safe from what amounts to predatory dealers. It’s gotten to the point where he recognizes their vehicles, and can count them as they hover outside Serenity Place, waiting for 5 p.m. to come, when the center closes
“I’ve said this to our CEO, that I’m not working in treatment anymore, and I don’t do treatment anymore, because we’ve gone past treatment. One of the biggest challenges we face is that we have so many dealers in this city. They’re sitting in their cars outside our treatment centers,” Donahue said. “I have clients I have to shoo away from dealers and get them back into the building, as the dealers are circling the building. And it’s not just with drugs and alcohol. I work with a lot of women clients who are used in sex trafficking, so there are so many variables involved in this. If I could hold my clients inside for 24 hours a day, 365 days a year, I would. They might have a chance. That’s the big challenge right now,” Donahue said.
Holly Cekala, Executive Director of HOPE for NH Recovery, shared her observations, as someone in long-term recovery.
“Silence equals death, we have to talk more about it, in our schools, in our homes, with our loved ones. We have to talk about appropriate ways to collaborate, to extend that continuum of care without getting in the way of one another,” Cekala said. “How do we do that? How do we get people elongated treatment time so they can feel confident to get a job? Well, we have to do that with love. I feel it just comes down to loving the place you live and loving the people around you, and you have to be vocal about it.”
Cekala took exception with Mayor Gatsas’ criticism of the Good Samaritan bill, passed in 2015, which protects a person who calls 911 for medical help in the event of a drug overdose from arrest, prosecution, or conviction for the crime of possession of the controlled drug. The protection extends to alcohol overdoses, with the intention of relieving fear of arrest in an underage drinking situation. It does not extend immunity to someone dealing drugs or providing alcohol to minors.
Gatsas says the bill ties the hands of law enforcement officials from pursuing charges when drugs are present in a place where an overdose has taken place.
Cekala said that law has saved her niece’s life – three times.
“My brother saved my niece’s life three times, and he wasn’t arrested – and that was because he had that protection – although I do understand, Mayor, I want Homeland Security to be able to come in and cart off some carfentanil dealer as a domestic terrorist – I don’t think it’s a felony; it’s an act of domestic terrorism. They’re killing our children, and that’s not coming from a person who’s in favor of mass incarceration; it’s from a place of love,” Cekala said.
“People I love are gone, and so many more will die if we can’t come from a place of love. Silence equals death. There are ways to get help. Certainly there are some things we have challenges with all the time, with homelessness and people needing a safe place to stay, but we’re not just talking about an indigent population. High class, middle class, lower class, this disease does not discriminate,” Cekala said. “It’s not just finding respite homes, it’s helping parents to learn how better to talk with their child, how to educe the trauma in their homes. That’s what we’re trying to do at our centers, to reach people before they end up at Emergency Departments.”
She also said it’s imperative that people who are in recovery take the lead, step up and talk about life after addiction.
‘”Recovery is a reality. A lot of people will get there if the support they need is there. A lot of people are looking toward Manchester for guidance because we’ve figured some things out. There are good things, really phenomenal things, happening here. Those are the success stories you have to market, because there are thousands of people coming through recovery centers because of the hard work of police, and fire, and hospitals, and that’s what I get to witness, more than a lot of you,” Cekala said. “I’m glad people are talking more about it, and really we just have to amplify that, because these are dark times.”