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Since the start of the pandemic in New Hampshire, emergency calls about opioid overdoses have dropped significantly in Manchester, Nashua and other cities, but law enforcement and recovery professionals say it’s unlikely that drug use has decreased, and they are not yet celebrating victory in the state’s overdose epidemic.
According to statistics provided by American Medical Response (AMR), which provides ambulance service for the two cities, Manchester saw 29 overdose calls in March, 24 in April and 30 in May as of May 26. Last year, Manchester saw 59, 50 and 63 overdose calls in the same months respectively, making this year’s numbers roughly a 50 percent drop.
One doesn’t have to look far for a more stark comparison. In April 2017 there were 93 overdoses and 8 fatalities in the Queen City; compared with just one fatality amid the 24 overdoses in April this year.
In Nashua, where overall overdose numbers are generally lower than in Manchester, there have historically been about 30 overdoses per month in March, April and May. This year, there were 15, 11 and 17 respectively, a decrease of roughly 29-54 percent.
There were no opioid-related fatalities in Nashua, suspected or otherwise, counted by AMR in March and April. The last time the Gate City went a whole month without an opioid-related fatality was in 2015.
“We experienced some of the lowest numbers of opioid OD’s over the last two months than ever before,” AMR Regional Director Chris Stawasz said. “I have to imagine that it is somehow related to the stay-at-home order and COVID-19 pandemic, although I am not factually sure how yet.”
Possible changes to the drug supply chain
While the number of opioid overdoses had been trending downward even before the pandemic hit the state, there are some indications that the virus and its impact has had ripple effects in the regional drug trade.
The U.S. Drug Enforcement Administration’s New England office shared some telling statistics: since the start of the national state of emergency in March, federal agents have made significant drug supplier busts in New England states, netting 19 kilograms of fentanyl, 67 kilos of cocaine, $7.9 million in cash and 174 arrests.
“There’s been a lot of seizures,” Associate Special Agent In Charge Jon DeLena said.
While he did not wish to disclose specific tactics or identify individual places where the drug busts took place, DeLena said the pandemic opened up a few vulnerabilities within drug trafficking organizations that the DEA was able to exploit.
Additionally, DeLena said federal agents in New England and across the country have been successful at locating drug smugglers carrying significant shipments on roadways, in part because of the reduced traffic during stay-at-home orders.
It’s possible the potency of the fentanyl — which has replaced heroin as the primary black market opioid sold in powder form — has been affected by supply constraints after the DEA’s recent seizures, said Manchester Police Capt. Mark Sanclemente, who heads up the Special Enforcement Division. To make the existing inventory last longer, drug dealers may be adulterating the powder more than usual, making it less likely to lead to overdose.
“There isn’t any definitive answer, but it is possible there are more cutting agents being used in fentanyl. Ultimately it helps them make more,” Sanclemente said.
Jeffrey Stewart, a Concord paramedic, recovery coach and the head of the Concord Fire Department’s Project First program, said he and his colleagues have encountered fentanyl that’s less potent.
“We’re finding a lot of adulterated product,” Stewart said.
Still, DeLena emphasized that traffickers are not taking a day off.
“They’re going to continue to find ways (to sell),” DeLena said. “They’re gonna do whatever it takes.”
Experts say it’s unlikely that drug use is down
It’s possible that some street level drug deals have been impacted by the pandemic, with buyers afraid of being exposed to the virus or getting caught on streets when traffic is low, DeLena said. However, he doesn’t believe demand for drugs is down — in fact, it’s likely that demand will spike amid the pandemic and recession.
“The virus is probably impacting demand more than ever, since so many Americans are dealing with depression and anxiety as a result of so many things they’re dealing with in their lives,” DeLena said.
Many people who abuse opioids do so as a coping mechanism for a variety of mental illnesses, which the pandemic and its economic impact could exacerbate. Each percentage increase of unemployment, for example, has been linked to a 3.6% increase in overdose deaths, according to a 2017 study.
Keith Howard, the director of Hope for NH Recovery, said he’s glad to hear overdoses appear to be trending downward. However, he said those numbers may not accurately reflect every overdose that’s happening, as some users may be stockpiling naloxone provided by the state and choosing not to call first responders.
Sanclemente, of the Manchester Police Department, agrees.
“We don’t believe the pandemic has any impact on drug movement, sales or usage,” he said.
Stewart expects the state to see more overdoses as people — and possible drugs — begin moving more freely again.
“We’re gonna start to see the impact of the isolation, and when we start to open things up, the flow will be there,” he said.
Alcohol, meth use may be increasing
In Concord, medical calls for acute alcohol poisoning and drug overdoses have increased by 40 percent overall from March 1 to May 25, Stewart said. The composition of the calls have changed, however. In 2019 opioid overdoses made up 67 percent of the calls, but this year they’ve made up just 38 percent. Meanwhile, calls for alcohol-related medical issues rose from 10 percent of substance-related calls in 2019, to 42 percent in 2020.
The growing prevalence of other stimulant drugs like methamphetamine may also be contributing to decreased opioid overdose rates, DeLena said. Mexican cartels have ramped up meth production in a big way, he said. Sanclemente has also seen more methamphetamine use.
“The increased availability of meth may be part of it, and cost. While meth is more expensive than fentanyl, it has come down in cost,” Sanclemente said.
A gram of meth costs approximately $100 on the street, while fentanyl costs $30 to $50 a gram, Sanclemente said.
It’s unclear if the fentanyl market in New Hampshire is seeing any upward pressure on its street prices to compensate for supply issues. In Manchester, Sanclemente said there’s been a steady decline in prices since fentanyl was introduced and ultimately replaced heroin.
DeLena said there have been minor fluctuations in pricing in some source cities throughout New England, which he thinks is the result of enforcement actions that have disrupted the fentanyl supply chain. However, he believes there is still a significant supply of fentanyl in the region.
“They still could be working off older stockpiles and we could eventually see a dip,” DeLena said.
Overdose rates vary by city
The trends of opioid overdoses are inconsistent in the state in 2020. While some towns have seen a dramatic decrease, others have had virtually no change, or even a slight increase in overdoses.
In Londonderry, overdoses during the first five months of the year decreased by 50 percent, from 22 last year to 11 this year, according to the Londonderry Police Department. Laconia saw a similar decrease, with overdoses during March, April and May dropping from 15 to eight over the course of a year. Laconia Fire Lt. Brian Keyes attributes that to recovery and treatment efforts. Keene saw a slight decrease in overdoses requiring naloxone, with 15 occurring between March 1 to May 20 2019, and 12 happening over the same time period this year.
In Salem, the fire department reported a slight increase in overdoses (tracked by patients who received naloxone treatment), happening between March 1 and May 28, from nine in 2019 to 12 this year. Assistant Salem Fire Chief Jeff Emanuelson said the department doesn’t view the change as a statistically significant increase, but rather as business as usual. An increase that small could be attributed to any number of anomalies, he said.
Portsmouth had about seven overdose calls during that period in both 2019 and 2020, Fire Chief Todd Germain reported.
Meanwhile, drug-related fatalities statewide in the past few months seem to be on par with 2019 numbers, according to statistics from the state Medical Examiner’s office.
The office counted 39 confirmed drug-related deaths in March 2019; and 38 confirmed and suspected overdose deaths in March 2020. April 2019 had 32 deaths, while this past April had 37, most of which are still pending confirmation. Those numbers include deaths involving non-opioid drugs, such as methamphetamine, cocaine and prescription pills.
“It is pretty close to last year,” said Kim Fallon, chief forensic investigator for the ME’s office.
Still, recovery professionals are concerned that isolation and economic stressors will be a breeding ground for relapse, even as the recovery community adjusts to the pandemic with innovations like teleconference meetings.
“It’s still not the same as sitting in a room or sitting in a circle … in a group session and having that face-to-face positive socialization process,” Stewart said.
Speaking anecdotally, Howard of Hope for NH Recovery has heard a few cases of people relapsing and of relationships ending during stay-at-home orders, but said it’s impossible to know the true scope of the state’s mental health issues and the prevalence of substance use disorder right now.
“I worry about the terrible things that are going on behind closed doors,” Howard said.
These articles are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org.