NEW HAMPSHIRE – New Hampshire has seen a 33.4 percent decline in drug-related fatalities between 2023 and 2024, the sharpest year-over-year reduction in 10 years, according to a report by the New Hampshire Fiscal Policy Institute (NHFPI).
Co-occurringly, from 2014 to 2024, NH has increased its annual spending on substance use disorder (SUD) services by about 450 percent, having invested more than $834.7 million since 2014. According to NHFPI, increased allocations are the result of Medicaid Expansion in the state, and the addition of funding sources such as the federal State Opioid Response (SOR) Grant and settlement funds into the Opioid Abatement Trust Fund.
Following the report by Jessica Williams, NHFPI held a webinar on Oct. 9 with professionals working in advocacy and recovery to continue the discussion.
Daisy Pierce – executive director at Navigating Recovery in Laconia – says that the data aligns with the changes seen by those who are working boots on the ground.
Since 2021, Navigating Recovery has seen about a 168 percent increase in participant engagement. Pierce says the increase in funding has helped them to serve more effectively, with more staff and more training for workers, which allows for extended outreach, and better living wages for employees that helps retain staff and improve the continuity of care.
While Pierce said the 33.4 percent decrease is “encouraging and incredible,” she says it is important to understand the context behind the improvement.
“The changes we’re seeing aren’t necessarily due to fewer people struggling with substance use disorder, but rather [a] more effective and accessible system of care and intervention that we’ve put in place,” Pierce said.
Since 2015, the number of recovery community organizations in the state has gone from five to more than 20.
And since its launch in 2019, Doorways now has nine regional locations in the state as well as a satellite site.
Still, 3 out of 4 Granite Staters did not receive the treatment they needed from 2022 to 2023 according to NHFPI’s report.
From her perspective, Pierce says there are a number of immediate barriers she sees in the Lakes Region, such as access limited to treatment covered by medicare, transportation to access points that may not be close by, a lack of beds for stabilization and treatment for individuals with a co-occurring mental health disorder, and the stigma surrounding SUD.
The housing shortage also poses a challenge.
“Entering treatment can feel very risky or even pointless if there’s no stable place to return to afterwards,” Pierce said.
Some larger New Hampshire communities have seen an increase in drug-related deaths, and trends differ across regions. In 2024, Hillsborough County experienced the highest-drug related fatality rate at 25.8 deaths per 100,000 NH residents, followed by Cheshire County at 23.6 per 100,000 residents.
According to NHFPI, research suggests that rural areas may experience higher rates of drug-related mortality due to decreased availability of resources, likely driven by workforce shortages.
While opioids remain the primary cause of drug-related fatalities – 83.6 percent of reported drug related deaths in 2024 involved opioids – New Future’s vice president of advocacy Kate Frey says drug overdose data tells only part of the story.
According to NHFPI executive director Gene Martin, alcohol use disorder is tracked separately from SUD in most data sets.
“We have an alcohol use problem in the state and nationally, and it’s important to keep in mind that alcohol kills more than any other drug combined,” Frey said.
She added that alcohol deaths have steadily climbed over the past decade, having especially accelerated during the pandemic.
In 2023, New Hampshire saw 54 deaths due to alcohol related overdoses, and 228 due to chronic liver disease and cirrhosis, conditions that can be associated with chronic alcohol misuse.
While funding for SUD services has improved, Frey said there are concerns around medicaid reforms and changes to the Addiction Treatment and Prevention Fund which is seeing a reduction in funding of $1.2 million a year from general funds.
“When we think about three out of four people not accessing treatment, part of that might be because they don’t know about the Doorway system or where their local recovery organization is, and maybe their neighbor does, but they’re not willing to talk to them because maybe they’re embarrassed or ashamed,” Pierce said. “By having community members who are compassionate and understanding and recognize this as an actual disease and not a moral failing, people will be more willing to say ‘okay I’m struggling and I need help.’”