The Daily News

As drug overdoses overtake traffic fatalities as top killer in New Hampshire, officials left seeking answers

By Angeljean Chiaramida

They kill more people in New Hampshire than car crashes.

Drug overdoses claimed 168 lives in the Granite State last year. And methadone, a prescription drug, caused more deaths than any other drug.

Methadone even surpassed heroin — the illegal demon perceived for decades to be the biggest killer of drug users, according to New Hampshire Chief Medical Examiner Dr. Thomas Andrew.
It’s the second straight year that drug deaths have topped fatal traffic accidents in New Hampshire. And the gap is widening.

In 2007, there were 129 traffic deaths and 168 drug deaths, 57 caused by methadone. In 2006, the news was almost as bad: 127 traffic fatalities compared to 142 drug overdose deaths, 53 traced to methadone.

This isn’t a fluke, Andrew said. It’s a deadly trend.

While the rate of traffic fatalities has remained fairly constant since 1995, except for a brief hike in 2004 and 2005, drug deaths have been steadily rising since 1999, increasing from 40 to last year’s high of 168.

“That drug deaths have exceeded traffic deaths in this state is absurd,” Andrew said. “I do not know of another jurisdiction of one million people or more where this is true.

“Although those in public safety will tell you that’s too many traffic deaths, that’s about the same number we’ve had in New Hampshire for years,” he said. “(The number of) traffic deaths has been pretty steady. But drug deaths have been climbing every year, and methadone deaths as well.”

New Hampshire is not alone. Drug overdoses are reaching critical levels across the country, according to statistics from the Centers for Disease Control and Prevention. In Massachusetts, a CDC report found death rates attributed to unintentional and undetermined poisoning increased by 228 percent between 1990 and 2001.

Salisbury police Chief David L’Esperance, who lost his son to a methadone overdose in May 2007, called the statistics disturbing, but, tragically, not surprising.

“A lot of people think the biggest drug problem is heroin or (the prescription drug) oxycodone, but it isn’t,” L’Esperance said. “It’s methadone; I’ve been saying that for years.”

New Hampshire — with a population of about 1.3 million — has another distinction. It ranks in the top five in the nation for overdose deaths attributed to methadone abuse, according to 2005 CDC statistics. The Granite State is tied for fourth with Nevada.

Massachusetts ranks somewhere in the middle, with 1.4 methadone deaths per 100,000 people, compared to New Hampshire’s 3.9. Maine, meanwhile, is at the top of the list, with 4.6 deaths per 100,000 people.

The high ranking of both New Hampshire and Maine is a mystery, Andrew said, especially when their size and location are factored into the equation. Both are typically rural states with relatively small populations.

The drug tide in New Hampshire began to turn in the late 1990s from illegal drugs like heroin, cocaine and marijuana to prescription drugs, which took over as the biggest killer in New Hampshire around 2002, Andrew said. While heroin is still around and dangerous, he said, prescription drugs have become easier to acquire and use.

New Hampshire public health and law enforcement officials suffered a setback in their battle against prescription drug abuse this legislative session. For the third time, lawmakers defeated a statewide prescription drug monitoring program that health officials and authorities hoped would help them catch abusers.

New Hampshire is the only state in New England without a prescription drug monitoring system.
House Bill 630 proposed developing a database of prescription drugs — such as highly addictive and often abused drugs like OxyContin and methadone. It died in the House of Representatives this year by a three-vote margin.

Without a drug database, N.H. Assistant Attorney General Philip Bradley said, convicting drug abusers and dealers is very difficult. Bradley and the state attorney general’s office have lobbied for the bill for years because of the growing problem with illegal trafficking and use of legal prescription drugs.

Andrew blamed the “privacy issue” for the bill’s failure. In the “Live Free or Die” state that prides itself on its protection of citizens’ personal rights and freedoms, opponents feared the collection of prescription data would pose a possible intrusion into people’s lives.

He said while that argument sounds noble, it’s harmful rhetoric. The bill, he said, included safeguards preventing the database from being used by law enforcement officials on a “fishing expedition” and violating citizens’ privacy.

Andrew also said prescription data already exists in pharmacy databases across the state and country. The statewide data collection system would simply gather the information in one place so public health authorities could detect abuse trends.

For example, the monitoring system would spot multiple methadone prescriptions written by different doctors for one individual and filled at different pharmacies within the state.

Claims the bill would cost millions to administrate are also completely false, Andrew said. “This was an epidemiological public health tool that we need and we lost,” he said.

By bringing attention to New Hampshire’s drug crisis and the scope of its prescription drug problem, Andrew and Bradley hope residents will urge their legislators to take a stand in helping to fight it, including eventually passing the monitoring system.

Without it, many officials now fear residents of surrounding states with systems in place will seek out New Hampshire to illegally acquire and sell prescription drugs.

There’s good reason to be fearful, Andrew said. There’s clear evidence, he said, that states without drug monitoring systems see increases in abuse because people feel they won’t get caught.

“It’s not a guess. It’s not a fear. It happens,” Andrew said. “Word gets around there’s less heat in New Hampshire.”

Methadone: A deadly power

Methadone is basically a stronger, synthetic form of morphine. It is best known as a treatment for heroin addiction. It is given in a regulated format at substance abuse treatment facilities and clinics as a replacement drug to wean addicts off heroin.

New Hampshire Chief Medical Examiner Dr. Thomas Andrew said methadone also has a beneficial medicinal purpose. With pain-relieving properties more powerful than morphine, it has frequently been prescribed to manage very severe and chronic pain.

But Andrew said the use of methadone for pain relief and in substance abuse programs and clinics, like the one recently proposed for Seabrook, isn’t what’s causing the problem.

The problem is that methadone — as well as other prescription drugs like OxyContin and Vicodin — has become more easily obtainable in recent years, allowing it to be sold, then diverted to individuals without prescriptions or pain-management needs.

Catching, prosecuting and convicting individuals who divert or sell prescription drugs for illegal use is very difficult, according to both Andrew and law enforcement officials. Where the simple possession of heroin, cocaine or methamphetamine is illegal, methadone is legal as a prescription drug. Unless police catch distributors of prescription drugs in the act of selling them, no law is being broken.

Methadone’s effect on drug pleasure-seekers is legendary. Salisbu
ry police Chief David L’Esperance said previously his son, Christopher, who died of a methadone overdose in May 2007, described methadone’s lure as “an incredible high.” While Christopher L’Esperance could kick the physical need for methadone, his father said, he could not overcome the strong psychological addiction.

L’Esperance said the powerful chemical nature of methadone makes it prime for overdose when used recreationally. After taking too much, he said, drug abusers simply fall asleep, drifting away without a sound.

When Lloyd Chapin Jr. died of a methadone overdose in Seabrook in February 2006, his parents didn’t know until the next morning when they went into his room and couldn’t wake him.

Andrew blames the 40-milligram, long-acting, quarter-size wafers of methadone that were previously available in part for the skyrocketing number of overdose deaths among recreational users.

Intended only to treat the most severe chronic pain, the large-dose wafers, Andrew believes, became increasingly prescribed by doctors unaware of the intricacies and fine points of severe pain management or the power of the medication. From there, it became available for illegal use.
According to Andrew, the Centers for Disease Control recently ranked New Hampshire third in the nation for its prescribed use of the 40-milligram methadone wafer.

As a result of the overdose epidemic, federal authorities recently banned the 40-milligram wafer and also limited the number of 5- and 10-milligram methadone tablets a doctor can prescribe at one time.

That, however, has created problems for patients with severe pain being treated with methadone. They are being forced to return to their physicians sometimes more than once a week for prescriptions.

“The abuse of this drug by those who have no business taking it has harmed the well-being of those in severe pain who need it,” Andrew said.