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UNCLASSIFIED

NewNew HampshireHampshire DrugDrug MonitoringMonitoring InitiativeInitiative New Hampshire Information & Analysis Center

Phone: (603) 223.3859 [email protected] Fax: (603) 271.0303

NHIAC Product #: 2019-3814 June 2019 Report 8 August 2019 Purpose: The NH Monitoring Initiative (DMI) is a holistic strategy to provide awareness and combat drug distribution and misuse. In line with this ap- proach the DMI will obtain data from various sources (to include, but not limited to, Public Health, Law Enforcement, and EMS) and provide monthly products for stakeholders as well as situational awareness releases as needed. Drug Environment Report—UNCLASSIFIED Table of Contents: Section Title Page #

Overview

Drug Overdose Deaths Deaths Map

EMS Narcan Administration

EMS Narcan Administration Map

Opioid Related Emergency Department Visits

Treatment Admissions

Situational Awareness

Substance Use Disorder Treatment/Recovery Directory

Previous versions of the Drug Environment Report can be found at: https://www.dhhs.nh.gov/dcbcs/bdas/data.htm The monthly online DMI viewer can be found at: https://nhvieww.nh.gov/IAC/DMI/

 Population data source: http://www.nh.gov/osi/data-center/population-estimates.htm  Year/month overview charts are based on annual estimates from the above website. County charts are based on a 2017 estimated population of each county.  If your agency is looking for further breakdowns than what is in this document please contact the NHIAC.

Tracked by NHIAC/HSEC SINs: 03,16 / 05,06 UNCLASSIFIED—AUTHORIZED FOR PUBLIC RELEASE 1 UNCLASSIFIED

NH Drug Monitoring Initiative Drug Environment Report—UNCLASSIFIED

Overview: Trends for Narcan, ED Visits, Treatment Admissions, and Overdose Deaths: EMS Narcan Administration, Related ED Visits, and Treatment Admissions per 100,000 Population July 2018 - June 2019 45.00 Opioid Related ED 40.00 Visits 35.00 30.00 25.00 20.00 Opioid/, 15.00 , & 10.00 /Crack 5.00 Treatment Admissions

Events per 100,000 Events 100,000 perpopulation 0.00 EMS Narcan Administration

Source: NH Division of Public Health Services, NH Bureau of Drug & Services, and NH Bureau of EMS

Drug Overdose Deaths By Year Data Source: NH Medical Examiner's Office 40.00 36.34 36.35 35.08 35.00 30.00 33.00 25.03 25.00 20.00 15.25 15.00 12.34 14.51 10.00 13.45 5.00 0.00

# of Drug Deaths per Drug population of Deaths 100,000 # 2010 2011 2012 2013 2014 2015 2016 2017 2018 2018 numbers are finalized, and based on analysis as of 16 July 2019

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Right click on the paperclip and Drug Overdose Deaths: select “Open File” to Data Source: NH Medical Examiner’s Office view additional data.

Trends: Overdose Deaths by Year per 100,000 Population  As of 16 July 2019, the number of confirmed drug Data Source: NH Medical Examiner's Office overdose deaths for 2018 have been finalized. 471 40.00 36.34 36.35 confirmed drug overdose deaths occurred in 2018. 35.00 33.00 35.08 All Drug  In 2018, Belknap County had the highest suspected drug 30.00 31.28 Deaths 28.08 use resulting in overdose deaths per capita, at 4.75 deaths 26.75 25.00 25.03 per 10,000 population, while Hillsborough and Cheshire 24.65 20.00 / were nearly tied for second, with 4.19 and 4.14 deaths Related per 10,000 population, respectively. 15.00 15.25 15.45 Deaths + 13.45 14.51  12.34 The age group with the largest number of drug overdose 10.00 Cocaine deaths is 30-39 years, which represents 31% of all 6.57 4.77 # of Drug Deaths per Drug pop of Deaths 100,000 # 5.00 2.28 4.63 3.63 4.72 Related overdose deaths for 2018. 2.71 3.68 3.72 1.90 1.97 1.44 2.27 Deaths+ 0.00 *** IMPORTANT DATA NOTES*** 2010 2011 2012 2013 2014 2015 2016 2017 2018  For 2019, as of 16 July there were 156 total, confirmed drug *2018 numbers are finalized, and based on analysis as of 16 July 2019 overdose deaths, and there are 52 cases pending toxicology. + Cocaine and Fentanyl/Heroin Related deaths are not mutually exclusive, several deaths involved both categories  Analysis is based on county where the drug (s) is suspected to have been used. 2018 Overdose Deaths by County per 10,000 Population Data Source: NH Medical Examiner's Office 5.00 Overdose Deaths by Age 2018* 4.75 Data Source: NH Medical Examiner's Office 4.50 4.14 4.19 0.85% 4.00 3.94 3.43 8% 3.50 3.00 2.92 19% 2.70 2.50 17% 0-19 2.00 1.89 20-29 1.50 1.60 1.50 30-39 1.00 40-49 of # deaths per 10,000 pop 0.50 50-59 60+ 0.00 31% 24%

2018 numbers are finalized, and based on analysis as of 16 July 2019 2018 Numbers are finalized, and based on analysis as of 16 July 2019

UNCLASSIFIED—AUTHORIZED FOR PUBLIC RELEASE 3 UNCLASSIFIED NH Drug Monitoring Initiative Drug Environment Report—UNCLASSIFIED Drug Overdose Deaths (Continued): Data Source: NH Medical Examiner’s Office Cocaine and/or Fentanyl Combination Related Drug Deaths 2018 250 *2018 numbers are finalized, and based on analysis as of 16 July 203 2019 200 Source: NH Medical Examiner's Office

150

# of # Deaths 100

52 50 25 13 10 7 6 5 4 3 0

Cocaine and/or Fentanyl Combination Related Drug Deaths that were noted once or twice* , , Fentanyl, Acetyl Fentanyl, , 4-ANPP, Fentanyl, Valeryl Alcohol, Fentanyl, Heroin, , Fentanyl, Valeryl , Cocaine, , , Fentanyl Ethanol, Fentanyl Fentanyl , Fentanyl Methamphetamine, Acetyl Fentanyl, Clonazepam, Fentanyl, Acetyl Fentanyl, Ethanol, Alcohol, Fentanyl, , Amphetamines, Clonazepam, Amphetamines, Fentanyl , , Ethanol, Fentanyl, Buprenorphine, Cocaine Fentanyl Sertraline Fentanyl Acetyl Fentanyl, Alprazolam, Amphetamines, Acetyl Fentanyl, Ethanol, Amphetamines, Fentanyl, Cocaine, , Amphetamines, Fentanyl, Clonazepam, Cocaine, Ethanol, Ethanol, Fentanyl, Oxycodone Cocaine, Diazepam, Oxazepam Fentanyl, Oxycodone Fentanyl Fentanyl Acetyl Fentanyl, Fentanyl, Acetyl Fentanyl, Ethanol, Alprazolam, Amphetamines, Aripirazole, Fentanyl, Cocaine, Diphenhydramine, Cocaine, Diazepam, Fentanyl Fentanyl, Ketamine Fentanyl, Ketamine, MDMA Cocaine, Fentanyl, Morphine Quetiapine Ethanol Alprazolam, Buprenorphine, Acetyl Fentanyl, Fentanyl, Buprenorphine, Fentanyl, MDMA, Cocaine, Ethanol, Morphine, Alprazolam, Fentanyl Fentanyl, Lorazapam, Cocaine, Duloxetine, Fentanyl Heroin Diphenhydramine, Fentanyl Methamphetamine Oxycodone Oxycodone Fentanyl, Methamphetamine, Clonazepam, Cocaine, Acetyl Fentanyl, Fentanyl, , Diazepam, Cocaine, Fentanyl, Alprazolam, Cocaine, Fentanyl Methylenedioxymethampheta Cocaine, Morphine Fentanyl Methadone Ethanol, Fentanyl Methamphetamine mine

Cocaine, Fentanyl, Acetyl Fentanyl, Fentanyl, Bupropion, Fentanyl, Methamphetamine, Cocaine, Alprazolam, Fentanyl, Heroin Diazepam, Ethanol, Fentanyl Fentanyl, Mitragynine Hydroxyzine Methamphetamine Fentanyl, Alprazolam Alcohol, Amphetamines, Alprazolam, Fentanyl, Clonazepam, Cocaine, Diazepam, Fentanyl, Fentanyl, Methadone Fentanyl, Morphine Fentanyl Fentanyl, Morphine Methamphetamine 4-ANPP, Acetyl Fentanyl, Alcohol, Chlorpheniramine, Amitriptyline, Clonazepam, Clonazepam, Cocaine, Duloxetine, Ethanol, Fentanyl, Fentanyl, Fentanyl, Oxycodone Fentanyl Diazepam, Fentanyl Fentanyl, Hydromorphone Parafluoroisobutyrylfentanyl *Cells filled with gray indicate combinations noted twice UNCLASSIFIED—AUTHORIZED FOR PUBLIC RELEASE 4 UNCLASSIFIED

Overdose Deaths by Town* - 2018 + (Data Source: NH Medical Examiner's Office) *Location where the drug(s) is suspected to have been used. Pittsburg +2018 data was reported on July 16, 2019

Clarksville 17

Stewartstown Dixs Second Prepared by: Grant College Colebrook Grant Dixville NH Information & Analysis Center

16 Columbia 15

Millsfield Errol

Odell Stratford Coos Dummer Cambridge

INDEX Stark

Belknap Hillsborough Milan

1 - Center Harbor 18 - Bennington Northumberland Carroll Rockingham Success Berlin 2 - Hales Location 19 - South Hampton Kilkenny Lancaster 3 - Harts Location 20 - Seabrook Coos 21 - East Kingston 4 - Hadleys Purchase 22 - Kensington 23 - Hampton Falls Jefferson Randolph Gorham 5 - Beans Grant Dalton Shelburne 6 - Cutts Grant 24 - Hampton 25 - North Hampton 7 - Sargents Purchase Whitefield 26 - Rye 8 - Pinkhams Grant Littleton 11 14 9 - Crawfords Purchase 27 - Portsmouth 12 Carroll 10 13 10 - Chandlers Purchase 28 - New Castle Beans Purchase Monroe 11 - Low & Burbanks Grant 29 - Newington Bethlehem Lyman 9 8 12 - Thompson & Meserves Purchase Strafford Lisbon Sugar 13 - Greens Grant 30 - Rollinsford 5 Hill 7 14 - Martins Location 31 - Somersworth 6 15 - Ervings Grant Bath Franconia Jackson 16 - Wentworth Location Chatham Landaff 17 - Atkinson & Gilmanton Academy Grant 3 Easton 4

Bartlett Haverhill Lincoln

Benton Livermore 2 Conway Number of Overdose Deaths by Town Woodstock *Location where the drug(s) is suspected Piermont Albany to have been used. Grafton Waterville Valley Warren Thornton Madison Eaton Orford Ellsworth Wentworth Carroll 1 - 4 (78 towns) Sandwich Rumney Campton Tamworth Freedom Lyme

Dorchester 5 - 10 (14 towns) Holderness Effingham Groton Plymouth Ashland Ossipee Moultonborough Hanover 1 11 - 25 (8 towns) Hebron Canaan Tuftonboro

Bridgewater Meredith Lebanon Orange Alexandria Wakefield 26 - 50 (1 town) Bristol Wolfeboro Enfield Brookfield New Hampton Laconia Grafton Plainfield Gilford 51 - 100 (1 town) Danbury Hill Sanbornton Belknap New Durham Grantham Springfield Alton Cornish Franklin Belmont Wilmot Tilton Middleton Croydon Andover Milton New London Gilmanton Northfield Claremont Newport Salisbury Sunapee Farmington Boscawen Canterbury Barnstead Sullivan Sutton Newbury Webster Loudon Unity Strafford Goshen Strafford Rochester Warner Pittsfield Merrimack 31 Bradford Chichester Lempster 30 Charlestown Acworth Concord Epsom Northwood Barrington Hopkinton Madbury Dover Washington Henniker Pembroke Langdon Windsor Hillsborough Deerfield Marlow Bow Allenstown Nottingham Alstead Lee Durham 29 28 Stoddard Weare Dunbarton Deering Hooksett Newmarket Walpole Candia Greenland 27 Gilsum Antrim Raymond Epping Newfields Surry Sullivan 18 Goffstown 26

Rockingham Stratham Nelson Francestown New Boston Manchester Auburn Exeter Fremont 25 Hancock Greenfield Brentwood Westmoreland Keene Chester Sandown Harrisville Hillsborough 24 Roxbury 22 Marlborough Bedford 21 23 Londonderry

Mont Danville Hampstead

Dublin Vernon Merrimack Kingston Chesterfield Cheshire Peterborough Derry 19 20 Lyndeborough Litchfield Amherst Plaistow Swanzey Atkinson Newton Hinsdale Troy Jaffrey Wilton Sharon Milford Temple Windham

Winchester Greenville Salem Brookline 0 5 10 20 30 Richmond Fitzwilliam Hudson Rindge New Ipswich Mason Hollis Nashua Pelham Miles Scale: 1:1,150,000

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NH Drug Monitoring Initiative Drug Environment Report—UNCLASSIFIED

Right click on the paperclip and EMS Narcan Administration: select “Open File” to Data Source: NH Bureau of Emergency Medical Services (EMS) view additional data.

Trends: EMS Narcan Administration by Month per 100,000 Population  EMS Narcan administration incidents decreased by 22% January 2016 - June 2019 from May to June. 25.00  In June, Hillsborough County had the most EMS Narcan

administration incidents per capita with 1.67 incidents per 20.00 10,000 population. Strafford County was second, with

1.42 incidents per 10,000 population. 15.00  The age group with the largest number of EMS Narcan 2016

administration incidents was 30-39, representing 30% of 10.00 2017 all EMS Narcan administrations for June. 2018 5.00 *** IMPORTANT DATA NOTES*** 2019  Narcan data in this report involves the number of incidents where Narcan was administered, NOT the number of doses of Narcan during a certain

# of # Incidents Involving Narcan per 100,000 pop 0.00 time period. Multiple doses may be administered during an incident. Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec  Narcan may be given for a decrease in alertness or respirations due to an overdose or unknown cause. Therefore, it cannot be concluded that all Source: NH Bureau of EMS reported Narcan incidents actually involved .

June EMS Narcan Administration June EMS Narcan Administration by County by Age Group per 10,000 Population 1.23% 2% 1.80 1.67 9% 1.60 1.42 1.40 1.31 24% 1.21 1.20 1.20 0-19 1.04 1.00 20% 20-29 0.91 0.85 0.80 30-39 0.67 0.60 40-49 0.46 50-59 0.40 60+ 0.20 0.00 14% Unknown

30% # of Incidents Involving Narcan per 10,000 pop 10,000 per Narcan Involving Incidents of #

Source: NH Bureau of EMS Source: NH Bureau of EMS

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NH Drug Monitoring Initiative Drug Environment Report—UNCLASSIFIED EMS Narcan Administration (Continued): Data Source: NH Bureau of Emergency Medical Services (EMS) EMS Narcan Administration - Lives Saved EMS Narcan Administration - Lives Saved % 2018 2019 July 2018 - June 2019 Lives Saved Source: NH Bureau of EMS Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 100.00% No Improvement RODS Outcome Lives Saved 90.00% Some Improvement 114 98 79 89 97 91 85 85 82 69 110 84 RODS Score of 8+ 80.00% Negative Improvement Some Improvement 70.00% 35 21 13 18 18 27 14 20 23 22 21 25 60.00% RODS, or Revised Over Dose Score RODS Score of 1-7 is based on the combined delta of 50.00% documented respiratory rate (RR) No Improvement 75 69 54 56 67 51 49 50 46 48 62 44 and Glasgow Coma Score (GCS - RODS Score of 0 40.00% measure of alertness) before and after Narcan administration. For 30.00% Negative Improvement example, RR improved from 6/min 12 20 10 13 8 9 10 13 5 11 15 9 20.00% to 12/min (delta of 6) and GCS Negative RODS Score improved from 10 to 13 (delta of 3), 10.00% the RODS score would be 9. The Total 236 208 156 176 190 178 158 168 156 150 208 162 0.00% delta of the vital signs is calculated RODS , or Revised Over Dose Score is based on the combined delta of documented respiratory rate (RR) per incident, so the patient may and Glasgow Coma Score (GCS - measure of alertness) before and after Narcan administration. For Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May June have received more than one dose of Narcan to achieve the effect in example, RR improved from 6/min to 12/min (delta of 6) and GCS improved from 10-13 (delta of 3), the Source: NH Bureau of EMS the RODS. RODS score would be 9. The delta of the vital signs is calculated per incident, so the patient may have received more than one dose of Narcan to achieve the effect in the RODS. EMS Narcan Administration by County per 10,000 Population 3.50 3.23

3.00

2.50

2.00 1.94 1.96 1.87 1.69 1.67 Apr 1.50 1.55 1.50 1.42 May 1.31 1.20 1.21 June 1.04 1.04 1.04 1.00 0.98 0.82 0.91 0.87 0.82 0.85 0.71 0.60 0.67 0.46

0.50 0.44 # of Incidents Involving Narcan per 10,000 pop 10,000 per Narcan Involving Incidents of # 0.00 Belknap Carroll Cheshire Coos Grafton Hillsborough Merrimack Rockingham Strafford Sullivan Source: NH Bureau of EMS

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EMS/NarcanAdministration Townby 7/1/2018–6/30/2019 D at a Source: NewSource:DataHampshire Bureau EMS of

Pittsburg

Clarksville 17

Stewartstown

Dixs Second Preparedby: Grant College Colebrook Grant NHInformationAnalysis & Center Dixville

INDEX 16 Columbia Belknap Hillsborough 15 1 - Center Harbor- 1 Bennington - 18 Millsfield Errol Carroll Rockingham 2 - HalesLocation - 2 South Hampton- 19 Odell Stratford 3 - Harts Location- 3 Seabrook - 20 Coos KingstonEast - 21 4 - Hadleys - Purchase4 Kensington - 22 Coos Dummer Cambridge 5 - BeansGrant - 5 Hampton - 23 Falls 6 - Cutts - Grant6 Hampton - 24 Stark 7 - Sargents Purchase- 7 North Hampton- 25 26 - Rye - 26 8 - PinkhamsGrant - 8 Milan 9 - Crawfords - 9 Purchase Portsmouth - 27 10 - Chandlers - 10Purchase NewCastle - 28 Northumberland 11 - LowBurbanks & - Grant11 Newington - 29 Success Berlin 12 - Thompson - 12 Meserves& Purchase Strafford Kilkenny Lancaster 13 - Greens Grant- 13 Rollinsford - 30 14 - Martins Location- 14 Somersworth - 31 15 - ErvingsGrant - 15 16 - Wentworth - 16 Location Jefferson Randolph Gorham Shelburne 17 - Atkinson Gilmanton- 17& Academy Grant Dalton

Whitefield Littleton 11 14 12 Carroll 10 13 Beans Purchase Monroe *Incidents Where Narcan Was Administered* Bethlehem Lyman 9 8 Lisbon Sugar 5 Hill 6 7 Bath Franconia Jackson 0 Chatham Landaff 3 Easton 4

Bartlett 1 - 10 Haverhill Lincoln

Benton Livermore 2 Conway Woodstock 11 - 25 Piermont Albany Waterville Valley Warren Thornton Grafton Madison Eaton 26 - 50 Orford Ellsworth Carroll Wentworth Sandwich Rumney Campton Tamworth Freedom Lyme 51 - 100 Dorchester Holderness Effingham Groton Plymouth Ashland Ossipee Moultonborough Hanover 1 Hebron 101 - 200 Canaan Tuftonboro

Bridgewater Meredith Lebanon Orange Alexandria Wakefield Bristol Wolfeboro

Enfield Brookfield 201 - 500 New Hampton Laconia Grafton Plainfield Gilford Danbury Hill Sanbornton

New Durham 501 - 750 Grantham Springfield Belknap Alton Cornish Franklin Belmont Wilmot Tilton Middleton Croydon Andover Milton New London Gilmanton Northfield Claremont Newport Salisbury Sunapee Farmington Boscawen Canterbury Barnstead Sullivan Sutton Newbury Webster Loudon Unity Goshen Strafford Rochester Warner Pittsfield 31

Bradford Chichester Lempster Strafford 30 Charlestown Acworth Merrimack Concord Epsom Northwood Barrington Hopkinton Madbury Dover Washington Henniker Pembroke Langdon Windsor Hillsborough Marlow Deerfield Bow Allenstown Nottingham Alstead Lee Durham 29 28 Stoddard Weare Dunbarton Deering Hooksett Newmarket Greenland Walpole Candia 27 Gilsum Antrim Raymond Epping Newfields Surry Sullivan 18 Hillsborough Goffstown 26 Nelson Francestown New Boston Manchester Auburn Rockingham Exeter Stratham Fremont 25 Cheshire Hancock Greenfield Brentwood Westmoreland Keene Chester Sandown Harrisville 24 Roxbury 22 Marlborough Bedford 21 23 Londonderry

Mont Danville Hampstead

Dublin Vernon Merrimack Kingston Chesterfield Peterborough Derry 19 20

Lyndeborough Litchfield Amherst Plaistow Swanzey Atkinson Newton Hinsdale Troy Jaffrey Wilton Sharon Milford Temple Windham

Winchester Greenville Salem 0 5 10 20 30

Brookline Richmond Fitzwilliam Hudson Rindge New Ipswich Mason Hollis Nashua Pelham Miles Scale: 1:1,150,000

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NH Drug Monitoring Initiative Drug Environment Report—UNCLASSIFIED

Right click on the paperclip and Opioid Related Emergency Department Visits: select “Open File” to Data Source: NH Division of Public Health Services view additional data.

Trends: Emergency Department Opioid Use Visits by Month per 100,000 Population  Opioid related ED visits decreased by 3% from May to January 2016 - June 2019 60.00 June.  In June, residents from Sullivan County had the most 50.00 opioid related ED visits per capita with 8.68 visits per

10,000 population. 40.00  Strafford County residents had the second highest number 2016

of opioid related ED visits per capita with 7.02 visits per 30.00 2017

10,000 population. 2018

 In June, the age group with the largest number of opioid 20.00 2019 related ED visits was tied, with 20-29 year olds and 30-39 year olds, both with 33%. 10.00

*** IMPORTANT DATA NOTES*** pop 100,000 per Visits Use ED Opioid of # 0.00  County represents where the opioid use patient resides. Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec  These data represent any encounter with the term “heroin, opioid, opiate, or fentanyl” listed as chief complaint text. These data also represent any Source: NH Division of Public Health Services encounter with an ICD-10 code that was designated for heroin and .  Currently all but three (3) of the hospitals are sending ICD-10 data.  These data include other opioid-related encounters such as poisonings, June Emergency Department Opioid Use Visits by County withdrawals, and detox. per 10,000 Population

June Emergency Department Opioid Use Visits by 10.00 Age 9.00 8.68 8.00 7.02 1% 7.00 7% 6.00 0-9 5.00 11% 4.58 4.56 10-19 4.00 33% 3.11 3.00 2.89 20-29 2.30 2.00 15% 30-39 1.50 1.00 0.78 0.89 40-49 0.00

50-59 # of ED of # ED Opioid Visits Use per10,000 pop 60+ 33%

Source: NH Division of Public Health Services Source: NH Division of Public Health Services

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NH Drug Monitoring Initiative Drug Environment Report—UNCLASSIFIED Opioid Related Emergency Department Visits (Continued): Data Source: NH Division of Public Health Services Emergency Department Opioid Use Visits per 100,000 Population July 2018 - June 2019 45.00 41.93 40.07 40.74 40.00

35.00 35.60 34.93 35.97 31.51 34.41 34.34 33.67 30.00 33.52 32.03 25.00 20.00 15.00 10.00 5.00 0.00

# of ED Opioid Use Visits per 100,000 pop 100,000 per Visits Use ED Opioid of # Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May June Source: NH Div. of Public Health Services

Emergency Department Opioid Use Visits by County per 10,000 Population 10.00

9.00 8.68 8.12 8.00 7.00 7.02 5.99 6.00 Apr 5.08 5.02 May 5.00 4.58 4.65 4.56 3.90 4.00 June 3.36 3.11 2.89 2.95 3.00 2.72 2.28 2.55 2.30 2.00 1.45 1.42 1.50 1.22 1.04 0.78 0.90 0.89 0.91 1.00 0.68

# of ED Opioid Use Visits per 10,000 pop 10,000 per Visits Use ED Opioid of # 0.00 Belknap Carroll Cheshire Coos Grafton Hillsborough Merrimack Rockingham Strafford Sullivan

Source: NH Div. of Public Health Services

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NH Drug Monitoring Initiative Drug Environment Report—UNCLASSIFIED

Right click on the paperclip and Treatment Admissions: select “Open File” to Data Source: NH Bureau of Drug & Alcohol Services view additional data.

Opioid/Opiate, Methamphetamine, & Cocaine/Crack Treatment Admissions by Month per Trends: 100,000 Population  Opioid/opiate, Methamphetamine, & Cocaine/Crack July 2018 - June 2019 treatment admissions decreased from May to June by 2%. 30.00 27.63  In June, residents from Strafford County were admitted at 27.04 25.00 the highest per capita rate for opioid/opiate treatment, 23.61 22.20 22.42 21.67 21.75 21.82 with 2.52 admissions per 10,000 population. 20.56 20.00  More males than females were admitted to treatment 19.81 18.17 17.65 programs in June for Opioid/Opiate, Methamphetamine, 15.00 & Cocaine/Crack use.  Methamphetamine treatment admissions increased by 10.00 50% from May to June.  Cocaine/Crack treatment admissions decreased by 16% 5.00 from May to June. 0.00 

Heroin/Fentanyl treatment admissions decreased by 5% Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun # of Treatment Admissions per 100,000 pop 100,000 per Admissions Treatment of # from May to June. Source: NH Bureau of Drug & Alcohol Services

*** IMPORTANT DATA NOTES*** June Opioid/Opiate, Methamphetamine, & Cocaine/Crack Treatment Admissions by County  County represents where June Treatment Admissions by per 10,000 Population the patient resides. Gender  These data represent 3.00 treatment admissions to 2.52 state funded facilities. 2.50  These data have 2.08 decreased due to 2.00 42% numerous factors. The Male Opioid/Opiate Affordable Care Act has 58% Female 1.50 been fully implemented, 1.20 Methamphetamine resulting in increased 1.00 0.89 0.87 Cocaine/Crack access to affordable 0.49 0.62 0.56 health insurance and 0.50 0.44 0.39 0.46 Source: NH Bureau of Drug & Alcohol 0.26 0.30 0.22 coverage for substance 0.16 0.11 0.12 0.13 0.03 0.08 use disorder treatment in 0.00 NH. New Hampshire expanded its Medicaid program, which also provided increased opportunities for treatment in the state. Substance use disorder pop 10,000 per Admissions Treatment of # treatment in the state has increased sharply in response to these policies which has shifted clients served by State of New Hampshire contracted Source: NH Bureau of Drug & Alcohol Services treatment providers to other payment models and facilities.

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NH Drug Monitoring Initiative Drug Environment Report—UNCLASSIFIED Treatment Admissions (Continued): Data Source: NH Bureau of Drug & Alcohol Services Heroin/Fentanyl , Rx Opiate, Methamphetamine, & Cocaine/Crack Treatment Admissions by Month per 100,000 Population July 2018 - June 2019 25.00

20.00

15.00 Heroin/Fentanyl Rx Methamphetamine 10.00 Cocaine/Crack

5.00 # of Treatment Admissions per 100,000 pop 100,000 per Admissions Treatment of # 0.00 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Source: NH Bureau of Drug & Alcohol Services

Opioid/Opiate Treatment Admissions by County per 10,000 Population 3.00

2.68 2.62 2.52 2.50 2.40 2.25 2.08 2.00 1.80 1.74 1.61 1.55 1.58 Apr 1.50 1.48 May 1.20 1.15 June 1.04 1.00 0.89 0.87 0.75 0.62 0.65 0.69 0.55 0.56 0.49 0.50 0.46 0.46 0.26 0.23 0.13 0.00 Belknap Carroll Cheshire Coos Grafton Hillsborough Merrimack Rockingham Strafford Sullivan

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NH Drug Monitoring Initiative Drug Environment Report—UNCLASSIFIED

Situational Awareness: New Hampshire Safe Stations Manchester Nashua Manchester Safe Station Began 5/4/2016 As of 7/31/2019 As of 8/2/2019 Nashua Gateway to Recovery Began 11/17/2016 Q2 2019 Total Q2 2019 Total U.S. Drug Czar Tours 'Recovery Friendly' Number of requests at MFD/NFR for Safe Station: 439 5,945 174 3,068 Workplace, Praises Model Number of participants transported to hospitals: 112 1,353 37 376 BOW, N.H. — Jim Carroll, the Trump Administration’s Drug Czar, made a stop in Number of participants taken to Substance Misuse Treatment Facilities: 320 4,546 133 2,663 Bow on June 27 to learn about a key Average length of time company “Not Available”: 12.2 Min 14.4 Min 8.9 Min 10.1 Min initiative of Gov. Chris Sununu’s response to Number of UNIQUE participants: 358 3,447 142 1,711 the opioid crisis: Recovery Friendly Number of REPEAT participants: 258 2,697 96 1,685 Workplaces. Number of unique participants seen in both City’s Safe Station Program 509

Carroll, along with Sununu, toured one of the Grappone family auto To Fight Hepatitis Outbreak, Nashua's Health Workers Bring Vaccines To The dealerships. The company was an early adopter of the recovery friendly Streets model, which asks companies to provide support in a variety of forms to NASHUA, N.H. — New Hampshire is in the midst of an outbreak of hepatitis A. employees and their family members as they struggle with . Since November, 142 people have been diagnosed with hepatitis A in the state

and one person has died. In an average year in New Hampshire, just 7 people “It’s a point of pride for me, and for our HR department, that people know get the virus. that they are safe enough to speak up,” said Amanda Grappone. Carroll, who talked about the struggles one of his own family member’s has had with Hepatitis A is a virus that’s transmitted when someone ingests fecal addiction, praised the initiative and said it should have national reach. “I matter from someone who is infected –usually in tiny undetectable amounts. really think one of the biggest challenges is something that we are talking Symptoms include fever, nausea, diarrhea, and yellowing of the eyes. It’s about today, which is erasing stigma,” said Carroll. generally less severe than hepatitis C which often becomes chronic, but it can

be serious. Carroll oversees the Office of National Drug Control Policy at the White House. In that capacity, he manages a near $40 billion budget, half of which is The virus has been spreading through interpersonal contact, largely among spent on treatment and prevention programs. people experiencing homelessness and/or using drugs. Vaccines are available for little or no cost at community health centers across the State.

Source: www.nhpr.org 6/27/2019 Source: www.nhpr.org 7/01/2019

UNCLASSIFIED—AUTHORIZED FOR PUBLIC RELEASE 13 UNCLASSIFIED NH Drug Monitoring Initiative Drug Environment Report—UNCLASSIFIED Substance Use Disorder Treatment/Recovery Directory: State funded treatment facilities in NH (NOT a complete list) - Data Source: NH Department of Health and Human Services

BETHLEHAM KEENE Families in Transition - New Greater Nashua Mental Health North Country Health Consortium Phoenix House Comprehensive Horizons Center (NCHC)/ Friendship House Addiction Treatment Services 293 Wilson Street 110 West Pearl Street 262 Cottage Street. Suite 230 106 Roxbury Street. Keene, NH Manchester, NH Nashua, NH Bethlehem, NH Phone: 603-358-4041, Option 1 Phone: 603-641-9441 ext. 401 Phone: 603-889-6147 Phone: 603-259-3700 LEBANON Farnum Center ROCHESTER DOVER Headrest 140 Queen City Avenue Hope on Haven Hill Southeastern NH Alcohol and 14 Church Street Manchester, NH PO Box 1271 Drug Abuse Services Lebanon, NH Phone: 603-622-3020 Rochester, NH 03867 272 County Farm Road Phone: 603-448-4400 Phone: 603-247-2043 NASHUA Dover, NH Alice Peck Day Hospital Greater Nashua Council on Crisis Center: 603-516-8181 A full list of Substance Use Disorder 10 Alice Peck Day Drive Main: 603-516-8160 Treatment Facilities can be found Lebanon, NH 12 & 1/2 Amherst Street here. DUBLIN Phone: 603-448-4400 Nashua, NH Phoenix House Comprehensive Phone: 603-943-7971 Ext. 3 A treatment locator can be found West Central Services, Inc. here. Addiction Treatment Services 9 Hanover Street, Suite 2 Greater Nashua Council on 3 Pierce Rd. Dublin, NH Lebanon, NH Alcoholism: Keystone Hall Phone: 603-563-8501, Option 1 Phone: 603-448-0126 615 Amherst Street FRANKLIN Nashua, NH MANCHESTER Farnum Center North Phone: 603-881-4848 Dismas Home of NH, Inc. (Women) Ray House (Women) 102 Fourth Street 14 Holy Cross Road. Franklin, NH Manchester, NH Phone: 603-263-6287 Phone: 603-782-3004

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