Tag: Opiates

From the Backseat: Deaths of Despair

Did you see the news? Last week, in the town of Sherman, police arrested three people in connection with a meth lab. It was the 123rd incident of its kind in Maine in 2016. That’s more than double the number last year; in 2015 Maine had 56 meth lab-related incidents.

And then on Friday a Hebron man killed his 27-year-old daughter before taking his own life. Did you see that too?

This is the news today, constant radar blips of “the way life should be.” They are markers an assistant professor at Penn State told me about recently: she calls them “deaths of despair.” And Maine is full of them.

Shannon Monnat is a rural demographer. About a month ago I interviewed her for a story about the heroin epidemic. I came across her research on addiction rates and how they relate to a community’s economic prospects. “Deaths of despair” is the phrase she’s coined for spiking addiction, alcoholism and suicide rates across America.

But rates don’t spike equally. Urban centers are largely spared this crisis. Drug addiction today is a rural problem, and the impact is felt heaviest in the rural communities and small cities that have struggled in the global economy.

Small cities. Rural places. Hmm. Sounds like Maine. Go on…

“These small cities and rural towns have borne the brunt of declines in manufacturing, mining, and related industries and are now struggling with the opiate scourge,” said Monnat. “In these places, good jobs and the dignity of work have been replaced by suffering, hopelessness and despair, the feeling that America isn’t so great anymore, and the belief that people in power don’t care about them or their communities. Here, downward mobility is the new normal.”

Suffering. Hopelessness. Despair. The new normal. 123 meth labs in a year. Murder-suicides. We are watching the effects unfold daily, on the news and in our communities. Each event acts as a radar blip. Misery is a tough pill to swallow, and as a meal to eat every day, it’s poison. But when job prospects seem hopeless it’s easy to sink into despair.

Monnat’s analysis doesn’t end there. Her most recent research looks at the 2016 presidential race, comparing election data with addiction data. And what she found is striking: counties awash in misery, those rural communities and smaller cities plagued by higher addiction rates, came out for Donald Trump.

“Clearly there is an association between drug, alcohol and suicide mortality and Trump’s election performance,” said Monnat, though she cautioned the relationship is a complex one. “What these analyses demonstrate is that community-level well-being played an important role in the 2016 election, particularly in the parts of America far-removed from the world of urban elites, media and foundations.”

“Ultimately, at the core of increasingly common ‘deaths of despair’ is a desire to escape,” she continued, “escape pain, stress, anxiety, shame, and hopelessness. These deaths represent only a tiny fraction of those suffering from substance abuse… Drug and alcohol disorders and suicides are occurring within a larger context of people and places desperate for change. Trump promised change.”

Despair, it seems, has political implications in addition to societal.

This almost shouldn’t be news. Every day we get signals about this despair. Some are small—another drug death, another mill shutdown, another suicide—while others are large, the 2016 election outcome being the most prominent. Sitting in quasi-urban Portland, a small city somehow buoyed by its quaint appeal and its status as a haven for NYC exiles, it might be easy to forget we sit surrounded by misery. But we do. We are a rural and small city state. There is so much misery here that drugs, alcohol, suicide and Donald Trump have become rational choices, the result of living in communities where no other path seems open.

Monnat’s research states America’s problem, and Maine’s problem, succinctly: in “many forgotten parts of the U.S. (often referred to as ‘fly-over’ country by those living on the coasts),” she said, “downward mobility is the new normal.”

Despite our coastline, Maine is one big fly-over state. The evidence to that fact fills our newsfeed.

Maybe it will make tomorrow’s headlines.

This column appeared in this week’s Portland Phoenix.

CDS: Heroin “Ground Zero”

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.