WHITE RIVER JUNCTION — The four southernmost counties in Vermont were the deadliest for opioid-related fatalities in 2018, according to state health statistics.
And two of New Hampshire’s southern counties also were among the highest in per-capita drug-related deaths, though Belknap County, home to Laconia and part of the Lakes Region, registered the highest, with 30 deaths, or 4.91 drug overdose deaths per 10,000 population in 2018.
Grafton County tallied 15 deaths, and Sullivan County seven in 2018, according to data compiled by the New Hampshire Drug Monitoring Initiative.
Several people close to the subject said there could be several factors driving those statistics, including the southern counties’ proximity to the Massachusetts border and interstates 91 and 93, where many of the drugs are trafficked, and, in Vermont’s case, sparser treatment and other resources in the most-affected areas.
Windham County leads the Green Mountain State in opioid-related fatalities by population, with 24 people dying in the county in 2018, or 5.6 people per 10,000 residents. Windsor County ranked second, with 18 people dying in that time frame, or 3.3 per 10,000, followed by Bennington and Rutland counties, according to statistics from the Vermont Department of Health.
“What is driving the opioid crisis and its resulting numbers of accidental overdoses is tremendously complex,” said Ben Truman, spokesman for the Vermont Department of Health. “It is difficult to identify why some communities are impacted to different degrees than others.”
But a few people who follow the issue closely have working theories.
Hartford Police Chief Phil Kasten said he thinks the higher statistics in southern Vermont have something to do with geography. Authorities have determined that drug dealers from the western Massachusetts cities of Springfield and Holyoke traffic heroin, fentanyl and other drugs north on I-91, and that some Vermonters with addictions also go there to pick up the drugs and drive them back.
“Brattleboro is the first major stop on the way in. Then Bellows Falls, Springfield, Windsor, Hartford,” Kasten said, adding that dealers are known to stop along the way in those communities and deal or “shoot up” before continuing north.
Vermont State Police Lt. Casey Daniell, who heads the State Police Drug Task Force investigations in southern Vermont, agreed geography plays into the higher death rate. Perhaps a larger contributor, he said, is a dearth of treatment resources in southern counties as well as economic distress on residents in those communities.
“The more rural areas, they don’t have the availability and the resources that Chittenden County has,” Daniell said.
Last year saw a shift in Chittenden County, home to the state’s largest city, Burlington. In 2018, Chittenden County saw a roughly 50% decrease in the number of people who died of opioid-related deaths, a change Burlington Mayor Miro Weinberger attributed in part to increased access to medication-assisted treatment programs, according to a February news release.
But while the Chittenden County opioid deaths fell from 35 to 17 between 2017 and 2018, they rose from 14 to 24 in Windham County and from 12 to 18 in Windsor County.
Windsor County State’s Attorney David Cahill said areas with “high unemployment and low-quality employment” seem to have been hit hardest by the opioid epidemic. And Vermont towns such as Bellows Falls and Springfield were suffering from financial, social and “visionary perspective” problems before heroin and fentanyl invaded the state, he said.
“I’m not surprised that our hotspots include towns like Bellows Falls and Springfield,” Cahill said.
The statistics drew attention.
“To say people were disappointed isn’t quite strong enough,” Prudence McKinney, the Vermont Department of Health’s Brattleboro district manager, told the Brattleboro Reformer last month. But Windham County is working to rebound.
Last year, 13 organizations in the county came together and created the Windham County Consortium On Substance Use, a group that works “across the continuum of substance use prevention, harm reduction, treatment and recovery to address the impacts of opioid and other substance use,” said Chad Simmons, the consortium’s coordinator, who works for Health Care & Rehabilitation Services, which holds a federal planning grant to do the work in the southeastern Vermont county.
The group is in initial planning phases and is assessing the impact of opioids on users, their families and first responders, so it can determine how best to respond, Simmons said.
“We are relying on and building from existing best practices to better connect people with treatment and recovery supports,” he said.
“The latest data are nothing less than soul-crushing,” he added.
Efforts to combat the statistics are underway in other counties, too.
In Orange County, the Vermont Department of Health is helping connect people who visit Gifford Medical Center’s emergency department in Randolph and who are in need of assistance with “peer recovery coaches,” individuals who can help them move from crisis to recovery, said Truman, with the health department. Leaders in Windham and Windsor counties also are working on similar collaborations with medical professionals in emergency rooms.
Officials in Windsor County also have put their heads together to “attack the problem” from all angles, said Jill Lord, Mt. Ascutney Hospital and Health Center’s director of community health.
The group, comprising treatment providers, law enforcement officials, recovery center specialists and many others, has brainstormed several goals, one being to create a community protocol to connect opioid users with treatment and support services. As part of that, the county soon will launch a program where people with drug addictions who express an interest in getting clean can go to the emergency department at Mt. Ascutney Hospital, receive a dose of medication-assisted treatment and be linked with recovery services.
The hospital also is hoping to soon become a distribution site for the opioid overdose-reversal drug naloxone. Both states have pushed to get naloxone, or Narcan, into the hands of anyone who may need to use it or administer it.
The Vermont Department of Health has distributed more than 10,000 doses of naloxone to EMS and police agencies; EMS administered 848 doses in 2017 and 742 doses in 2018, the department reports. The department also distributed about 25,000 naloxone kits to the public, with about 1,500 reportedly being used.
“We don’t want to be one of the highest in the state and the coordination and collaboration between agencies is stellar. I think we have a chance to make a difference,” Lord said.
She added: “Nobody knows enough about what is driving the statistics. Is it access to treatment or access to the drugs? … You have to approach it from multiple levels.”
Also in Windsor County, the Hartford Community Coalition has been working to reduce substance misuse, among many other things, in town since 2014; it’s hosted community forums on prevention and distributed information about prescription medication safety. Hartford Fire Chief Scott Cooney, who is a member of the coalition, recently was appointed to Gov. Phil Scott’s Opioid Coordination Council.
Leaders in New Hampshire also have been working to dig their way out of the opioid epidemic.
The federal government last year awarded New Hampshire $45.8 million to fund a project called “The Doorway-NH” initiative, a “hub and spoke” model that aims to ensure no one struggling with addiction is more than an hour away from services. The hub in the Upper Valley is located at Dartmouth-Hitchcock Medical Center.
“It’s all about getting people the services they need at a location near where they live, as well as building capacity throughout the state to provide those services,” said David Mara, Gov. Chris Sununu’s adviser on addiction and behavioral health.
Several New Hampshire cities have seen success through the creation of Safe Station programs, which provide a space for drug users seeking help to drop in and be connected with services. The program started at Manchester fire stations.
Overall, the number of drug overdose deaths in New Hampshire fell from 488 in 2017 to 446 in 2018, though some cases were still being analyzed. In Vermont, opioid-related deaths rose slightly, from 114 to 116 between 2017 and 2018, though officials view the leveling off as progress after years of sharper increases.
Mara said he isn’t sure why Belknap County’s per-capita statistics are so high. The 2018 totals in New Hampshire include not just opioids but all fatal drug overdoses.
He said he remains hopeful that New Hampshire, one of the first states to be hit hard by the opioid crisis, will be “one of the first states to get out of it.”
“I believe that,” Mara said. “If you get enough people working together, it can have a big impact.”
The number of drug-related overdoses dropped from 26 in 2017 in Grafton County to 15 last year. But Sullivan County saw an increase, from four to seven.
Kasten, the Hartford police chief, said he would like to see more of an investment in long-term treatment options in Vermont — and the funding to support them. Daniell, with Vermont State Police, agreed, saying there should be an eye on making it easier for “everyone” to get into treatment.
“In rural areas, there are transportation barriers,” he noted.
But additional treatment options alone won’t solve the problem, the officials said. Treatment, recovery and enforcement are just a few pieces of the puzzle.
“Solving the problem is not just a question of building more robust treatment networks,” said Cahill, the prosecutor. “It’s solving the underlying problem — helping individuals reinvent themselves for the 21st century.”
He envisioned a mill town, like Springfield, thriving.
“How many people are going to buy heroin when they walk out the door?” he said. “If young working folks have a sense of purpose in their career and optimism about their life’s trajectory, they’re simply not going to overdose at the rate we are seeing now.”
From a criminal justice perspective, Cahill said the situation has in fact “turned a corner.” The volume of overdose calls has decreased and the number of new faces entering the criminal justice system for an opioid-related crime has gone down, he said.
Truman also remained positive about the situation. More than 8,000 Vermonters currently are receiving medication-assisted treatment in state-supported facilities. With that said, the state estimates there are another 15,000 to 20,000 Vermonters with opioid dependencies who need treatment.
“We are continuing to slow the upward spiral of accidental opioid deaths,” Truman said. “This means more Vermonters are alive today to seek treatment and succeed in their recovery. But despite the encouraging trends, every death is a tragic reminder of how far we have yet to go.”
Jordan Cuddemi can be reached at jcuddemi@vnews.com or 603-727-3248.