New Hampshire has been named the healthiest state in the country two years running by the United Health Foundation, largely because of its low rates of homicide, poverty, and unemployment.
It’s doing considerably worse when it comes to deaths related to suicide, drugs, and alcohol, according to a new report from Trust for America’s Health, a national health policy and research organization.
The Granite State percentage increases were “way above” the national average in all three categories and particularly high in drug deaths related to fentanyl, cocaine, and other psychostimulants, which includes methamphetamine, said Brandon Reavis, one of the report’s co-authors.
The report, which measured changes between 2021 and 2022, showed all opioid deaths in New Hampshire increased 13 percent compared to 1 percent nationwide. Deaths due to synthetic opioids, which includes fentanyl, went up 20 percent, far higher than the 4 percent increase nationwide.
Cocaine- and other psychostimulant-related overdose deaths were up 39 percent and 50 percent, respectively. Nationally, the increases were 12 percent and 4 percent, according to the report.
“These are significant numbers, and I think it really points to the role of fentanyl in increasing the danger of our drug supply,” Reavis said.
The report includes policy recommendations, such as measures to improve economic and social factors, and reduce negative childhood experiences associated with substance-use disorder.
The report also shows where New Hampshire is doing well. That includes legislation lawmakers passed a year ago that legalized testing strips for fentanyl and xylazine, a veterinary sedative that doesn’t respond to Narcan.
“That’s an important development,” Reavis said. “But our focus primarily is on how do we prevent and mitigate adverse childhood experiences like abuse and neglect, because those traumatic experiences do have a direct connection to serious mental illness and addiction later in life, as well as a whole range of physical health issues. We won’t be able to get the kind of foundational and generational changes that we’re looking for until we address those connections.”
The numbers
In 2022, New Hampshire saw 1,014 deaths from either suicide, alcohol, or drugs. That was a 10 percent increase from 2021, the greatest increase of any state; nationwide those deaths dropped 1 percent, the report said.
Broken down by cause, 247 deaths were attributed to suicide, 486 to drugs, and 295 to causes related to alcohol. (The sum of those numbers is slightly higher than the overall count because the latter does not include the 14 people who died from more than one factor.)
Among the drug overdose deaths, each of which can involve multiple drugs, synthetic opioids like fentanyl played a role in most of them at 415.
The report also looked at behaviors between 2021 and 2022.
For people aged 12 and above, 16 percent reported using illicit drugs in the prior month. Among high schoolers, 25 percent reported having serious thoughts of suicide in the past year and 36 percent said their mental health was “not good” most or all of the time. New Hampshire did worse in both categories than the rest of New England.
The report also looked at the rates of adverse childhood experiences, which include experiencing abuse and neglect; being abandoned by a parent; having a parent with a mental health issue; living in a home where someone is incarcerated or substance use is a problem.
Sixteen percent of New Hampshire children under 17 had at least two adverse childhood experiences. In New England, only Vermont and Maine reported higher rates, 20 percent and 18 percent, respectively.
Room for improvement
The state implemented the 988 suicide and crisis lifeline two years ago but hasn’t provided permanent funding, Reavis said.
There is also now a mobile crisis response team in every county, though response times have been slow, according to reporting by the Concord Monitor. Mental health advocates have said the state needs more teams to meet the need.
According to a June study from Inseparable, a mental health advocacy group, New Hampshire could generate $1.3 million a year for the 988 line if it required telecommunication companies to charge customers 98 cents a month. The state uses a similar approach to help pay for 911.
“I think an area of focus at the state level is to make sure that there is a sustainable plan in place to fund the lifeline,” Reavis said. “Then folks in crisis can access the services they deserve and need. That will be a way to address the suicide rate that we see for New Hampshire, at least in part.”
Trust for America’s Health recommends states invest in harm reduction programs to mitigate drug overdose deaths.
While New Hampshire lawmakers legalized the drug testing strips, they have rejected efforts to expand harm-reduction measures to include other drug testing equipment. Bills seeking to use state money for syringe exchange programs, which now use at times unreliable grant funding, have also failed.
On the right track
New Hampshire has implemented some of the preventative measures Trust for America’s Health said could help reduce the risks of deaths related to suicide, alcohol, and drugs.
It has a safe gun law intended to protect minors younger than 16.
A person can be fined up to $1,000 if they know or should have known a child under 16 could access a firearm without a parent’s permission, but only if the firearm is used in a reckless or threatening manner, to commit a crime, or is recklessly discharged.
In recent years and especially since the pandemic, the state has significantly increased its behavioral health investments.
It has used $30 million in federal pandemic aid to purchase and help build behavioral health hospitals. Lawmakers significantly increased Medicaid rates in the last budget to provide more funding for community mental health centers, the largest provider of behavioral health counseling for low-income children and adults.
Lawmakers have also expanded Medicaid coverage to new mothers, from 60 days to one year after giving birth.
The state has expanded access to medication that can reverse drug overdoses. It has also joined lawsuits against drug manufacturers, and as of February had invested $24 million from legal settlements in addressing the opioid crisis, according to the state Department of Justice.
The state has also invested in programs to address the consequences of adverse childhood experiences, including a pilot program passed in 2022 for children up to age 6.
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