CONWAY — By this point, we are used to hearing about an opiate crisis has reached pandemic proportions. More people dying from overdoses each year than car crashes. A cheaper, stronger heroin that is often mixed with powerful synthetics like fentanyl and destroying lives across the social spectrum.

And while it’s in every corner of the country, according to U.S. Drug Enforcement Administration Deputy Administrator Jack Riley, who spoke to WMUR last month, “the Northeast, in particular New Hampshire, is ground zero,” he said.

As if on cue, two days later, the New Hampshire branch of the U.S. Department of Justice announced indicting more than two dozen individuals, mostly from Massachusetts and Manchester, on heroin-trafficking charges.

Locally, news stories about heroin show up with regularity: a Conway man out on bail for one heroin complaint arrested a week later on a second; a Bartlett couple arrested with more than 5 grams of heroin and $4,000 cash; a selectman’s adult son charged with conspiracy to sell heroin; a pair arrested at the public library allegedly using heroin; a homeless man arrested for heroin possession with intent to distribute; a man arrested twice in two months on heroin-related charges. Police are doing what they can to combat addiction and trafficking, but the uptick continues.

But heroin is more than just a headline or a quick story. It is the everyday experience of many in the Mount Washington Valley, from police officers to doctors, EMTs to midwives.

“The question is how we deal with this problem,” Conway Police Lt. Chris Mattei said after a bust in March of 2015. “When we hinder the accessibility of one drug, addicts have proven that they will find another source to feed their addiction. The way to attack the drug issues long-term within a community is to help the addicts who utilize these illicit drugs.”

He is not the only local police official pushing for more prevention.

“We know we cannot arrest our way out of this,” Bartlett Police Chief Janet Hadley Champlin said last month. “As long as there is demand for drugs, there will be suppliers. For all of those in our community who are addicted to drugs, now is the time to get help.”

But there are few options for recovery. The state’s own report on New Hampshire’s substance use disorder treatment service capacity lists Carroll County as one of four regions without any residential programs, and according to addicted.org there is not a single long-term recovery program northeast of Lebanon and Tilton.

New Hampshire, meanwhile, ranks third in the nation for prescription rates of long-acting/extended-release opioids, according to a Federal Reserve Bank of Boston report released in September. Neighboring Coös County ranks as one of seven counties in New England with an overdose mortality rate of more than 20 per 100,000 deaths. And Carroll County is not far behind: one of the 20 New England counties with overdose mortality rate above 16 per 100,000.

Dr. Matt Dunn works nights in Memorial Hospital’s emergency department. He grew up in the valley, graduated from Kennett High in 1991, but he did his medical training in Albany, N.Y. He worked in a 400-bed hospital in Glen Falls, N.Y., before returning here almost three years ago. Dunn sees patients with opiate-related complaints “multiple times a week,” he said. “I see much more frequent issues with heroin here than I ever did in New York.”

The heroin-related complaints Dunn deals with fall into three categories: overdoses where the patient “is just about to die,” injection-related infections and people coming in asking for help.

These days, it is EMS personnel who do the heavy lifting in overdose cases. New protocols have enabled almost anyone to administer naloxone (Narcan), an opiate antidote, and “often by the time overdose patients get to me they’re awake and talking,” Dunn said. Many, he said, “get up and leave.”

Ambulance personnel see something else.

“The heroin snore,” Rick Murnik, director of the Bartlett/Jackson Ambulance Service, said referring the depressed breathing of overdose patients. “Once you see it, you’ll never forget what it looks like.”

An overdose leaves the patient taking only four or five breaths a minute — too few to keep them alive.

“Our first heroin overdose was five or six years ago,” Murnik said. “We didn’t know what it was.”

Now the service, which responds to only about 500 calls a year, sees several a month.

Conway Fire Chief Steve Solomon described what his EMTs see all too often: a patient reported to be unconscious, pale, breathing at less than half the normal rate, maybe lodged between the bed and a wall or sprawled in the bathroom.

“We’ll find well-meaning people have tried to revive them by pouring water on them,” he said. But water doesn’t work.

What does work is Narcan, which in Conway is usually given via IV and nasally in Bartlett.

“Within a minute or two, that person will wake up,” Solomon said, and sometimes they’ll be grateful that the EMTs that just saved their life. But some will be angry, upset that someone interrupted their high.

“We’re using Narcan to bring these people back from death,” Solomon said, and ambulance staff may end up getting yelled at.

In Conway, there may be no overdoses for a while, Solomon said, and then the next day there’s one at noontime, another in the evening, two more at night. His guess is overdoses surge when a new batch of drugs comes to town. “It’s not so much there are more people doing drugs,” he said. “It’s that the drugs have changed. The dose they give themselves to get high is now a lethal dose.”

One girl in her 20s “we’ve brought back from the dead three times,” Solomon said. “Most of our narcotic overdose patients we’ve seen before.”

But, says Shannon Monnat, an assistant professor at Pennsylvania State University and a fellow with the University of New Hampshire Carsey School of Public Policy, “we’re not going to Narcan our way out of this.” What her research has uncovered is that addiction takes root in rural communities and small cities left stagnant by structural economic change.

In the face of sustained economic hardship and uncertainty, “drugs and alcohol are a way to cope.”

“The problem is not a new problem,” she said. “The problem has been building for three decades.”

Access to Narcan and improved mental health services are “important first steps,” but “we need to get to the underlying cause. People without a college education need opportunities for a livable wage,” she said. “People need to feel their role in this country is important.”

In the valley, organizations are still figuring out how to serve a population with growing addictions.

Memorial Hospital, for instance, launched a prenatal program in March after more than a year of watching the number of heroin-addicted mothers-to-be skyrocket.

“We were seeing more and more moms coming in who were addicted,” said Dr. Marni Madnick, an OB/GYN at Memorial. “We felt we had to do something.”

Ten percent of pregnancies at Memorial involve opioid — primarily heroin — dependence. In 2014, that meant roughly 24 women.

Infants born to addicted moms require more treatment than traditional moms, which can mean days in an acute care setting.

But concentrated support upfront can reduce the services addicted babies need. So Memorial’s midwives, OB/GYNs and birthing center staff drew up plans for the New Life prenatal program, combining pre- and postnatal care, community support services and access to social workers with drug treatment and substance abuse counseling.

“It’s a lot more work,” Madnick said. These moms often face additional challenges even beyond addiction, like transportation problems, financial limitations and domestic violence issues. But if the team can meet these challenges, they can make a real difference.

Since the center opened, it has helped four women give birth. Each received the prescription drug Subutex to treat the mom’s opiate cravings and the fetus’ addiction.

“Our goal is to keep these moms with us for one year postpartum,” Madnick said.

Ten more moms are set to deliver at New Life over the next nine months.

Dr. Dunn, meanwhile, focuses his prevention efforts on high school students. Research shows the majority of heroin users report first experimenting with opiates between age 17 and 25, so he has been holding forums at Kennett High to talk about the risks.

“Once this decision is made, it often becomes a lifelong issue,” Dunn said. Therefore, it is vitally important to reach people before they take their first dose.

“I’ve seen straight-A honor students die,” he said.

“This can be anyone, from any walk of life,” he said. “It’s a tragedy everywhere. But this is where we live.”

---

This story ran in the Conway Daily Sun.