Granite State of Mind, #145: New Hampshire
New Hampshire is in the national news today, and it's not even primary season (or is it already?). Our President clumsily made reference to the state as a "drug-infested den". I take issue with his word choice, and his right to make such a remark when his administration's policy and budget priorities exacerbate the problem.
That said, there is a drug problem in New Hampshire. Opioid abuse in the United States has been experiencing marked and accelerating growth in the last fifteen years, with a fourfold increase in opioid overdose-related deaths since 1999. New Hampshire has been particularly hard hit by this growing public health epidemic, ranking third among all states for drug-related death rates. While the Chief Medical Examiner projected 400 opioid-related overdose deaths in 2015, the final figure was 439, and the official 2016 figure is still climbing past 500. That number would reflect a nearly 300% jump in just four years. In New Hampshire, someone dies every day from a mortal opioid overdose.
Each of the state’s ten counties has experienced an increase in per-capita opioid-overdose deaths in the last fifteen years, with the most dramatic increase in Coos County, the northernmost and most rural county. As phrased by Manchester paramedic Chris Hickey, “you have people of all backgrounds, of all ages, who are overdosing.” The scope of the problem cuts across socioeconomic strata, geography, age, and ethnicity. It has therefore taken firm root in the public consciousness as a major public policy challenge. A May 2017 poll by the University of New Hampshire Survey Center found that 53% of respondents ranked drugs as the state’s top issue, ahead of jobs, the economy, taxes, and health care. It was the first time in the poll’s sixteen-year history that any issue had topped fifty percent. Drug use did not register on the poll as recently as 2012. Much of that has to do with social construction - once the drug problem expanded from the poor and minorities to suburban white children, it graduated from being perceived as a criminal issue to a public health crisis.
Jack Riley, the Deputy Administrator of the federal Drug Enforcement Administration, said in October 2016 that “[the opioid epidemic] is in every corner of the country, but I have to tell you, I think the Northeast, in particular New Hampshire, is ground zero."
“Fifteen years ago there were twice as many highway deaths as overdose deaths,” testified state Attorney General Joseph Foster in 2016, “today, there are 4 times as many overdose deaths as highway deaths.” The Chief of Police in Manchester, NH, Nick Willard, termed it “an apocalypse.”
The problem is severe, it is escalating, and it affects a broad swath of the population. So does that make NH a drug-infested den? Yes and no. We have a drug problem. One that we need help working to solve. We need funding for medically-assisted treatment beds, and the trained professionals to staff them. We need prevention programs and needle exchange sites and mandated prescription drug monitoring and a whole host of practical strategies based on empirical evidence from the field, not antiquated homilies and a return to the failed tactics of the 1980s War on Drugs.
This is why I take issue with Mr. Trump's comments. It's not that he's factually wrong (except for when he claims to have won New Hampshire). It's that his Department of Justice wants to double down on a strategy of criminalizing substance abuse that has failed for decades. A public health approach is not only more effective, it's more financially efficient. The Affordable Care Act that you want so desperately to repeal has been the most important public health law in a generation when it comes to destigmatizing mental health and substance abuse and ensuring access to care for those who suffer from them. The walls we need to build aren't across a border, but those housing prevention and treatment and recovery programs. The economy we need isn't one with tax cuts for the wealthiest but with investment in opportunities for the middle class. Education, health, infrastructure.
New Hampshire is my favorite place in the world, and it's suffering. We have a ton of work to do. Mr. President, if you're not willing to roll up your sleeves and lend a hand, then shut up about what you don't understand and get the hell out of the way.