Conference explores role of science in opioid crisis

HANOVER, N.H. (AP) — New Hampshire’s disproportionately high rate of opioid overdoses is the result of prescription practices, underfunded and scarce treatment options and the state’s proximity to the drug supply chain, Dartmouth College researchers said Tuesday.

The rate of death due to synthetic opioids — mainly fentanyl — increased by nearly 1,600 percent from 2010 to 2015. In 2015, the most recent year for which federal data is available, there were 24 such deaths per 100,000 residents, the highest rate in the nation and double what it was the previous year.

With funding from the National Institute on Drug Abuse, researchers at the Dartmouth Center for Technology and Behavioral Health conducted a six-month study of the crisis, the results of which were presented at a conference Tuesday.

“The statistics are tragic, they’re alarming, and they call for urgent action,” said Dartmouth President Philip Hanlon.

Dr. Nora Volkow, director of the National Institute on Drug Abuse, was even more blunt, saying that when she saw the trend, she said to herself: “What the hell is going on in New Hampshire?”

In hopes of finding out, researchers interviewed recent fentanyl users about their trajectory of drug use, their experiences with overdoses and treatment, and other issues. They also interviewed first responders and emergency department workers.

Lisa Marsch, the center’s director, said many participants reported early recreational substance use, substance use among multiple generations of their families, severe injuries warranting prescription opioids or experience self-medicating themselves for mental health conditions. Most said they did not specifically seek out fentanyl alone and were either neutral or averse to it, though they said if they heard it was present in a batch of drugs that caused an overdose, they would seek it out.

“When I hear of an overdose, I want it because I don’t want to buy bad stuff,” one study participant told investigators. “I want the good stuff that’s going to almost kill me.”

Marsch said the interviews also suggested New Hampshire’s rural nature could be a factor.

“There are very tightly-knit social communities in our rural communities,” she said. “There’s also limited access to things to do, and this ‘Live Free or Die,’ culture.”

Recommendations from the study include increased public funds targeting substance use, expanded prevention programs in schools, needle exchange programs and greater availability of medication-assisted treatment.

Duane Compton, dean of Dartmouth’s Geisel School of Medicine, said the drug epidemic has spread like a virus or bacteria, but the difference is that it is fueled by human behavior. The solution, he said, will require a concerted effort to understand the underlying drivers of those behaviors.

Volkow agreed, saying research has shown that repeated use of drugs erodes brain functioning and one’s ability to make a decision and carry through with it.

“It’s like driving a car without steering wheels or brakes,” she said.

In her speech, Volkow described some of the efforts underway at the national level to use science to address the problem, including the development of safer, more effective strategies for pain management, innovations in both the medication and technology used in addiction treatment and advances in overdose reversal medications. The latter is spurred by reports from first responders that higher doses of overdose reversal drugs are needed for fentanyl and other emerging synthetic drugs, she said.