Dr. Lisa Marsch and colleagues at the Dartmouth Center for Technology and Behavioral Health conducted a study in NH designed to understand what gave rise to the opioid crisis. She and her team interviewed 75 Fentanyl and heroin users and 36 emergency personnel from the fire, police, and medical departments.
They found that there were three main factors that gave rise to the opioid crisis: affordability and potency of Fentanyl, New Hampshire's low treatment capacity, and lack of linkage to care.
Dr. Marsch and colleagues found that Fentanyl came to be preferred over heroin because it was less expensive and more potent, meaning less had to get used to get the same effect. Consequently, Fentanyl was easier to conceal, since it could be carried in small doses. However, the high from Fentanyl lasted much less than from heroin, so individuals used Fentanyl much more frequently, thereby increasing their risk of overdose. Every single Fentanyl user reported having observed one or more Fentanyl-induced overdoses, and yet their use still exists. This is in part due to the long-term effects of opioids on the brain. Click on the following links to learn more about the neurobiology of the beginning of the addiction, withdrawal, and cravings.
Unfortunately, Fentanyl became more prominent but access to prevention and treatment resources in New Hampshire was limited. New Hampshire has the second lowest treatment capacity in the nation. Treatments are often not evidence-based approaches, there are no needle-exchange programs available, and there few physicians have availability of medications that can help reduce cravings and be used as 'replacement' therapy.
Staff at emergency departments documented a phenomenon of "tidal wave" opioid-related overdoses. It was common for physicians to see the same person enter the emergency department multiple times a day due to an overdose due to the lack of current options to link patients with care.
Medical personnel and justice system departments want to see links to effective treatment resources being provided to patients suffering from drug addiction to help prevent relapse and support their recovery.
Dr. Lisa Marsch presented the findings at a Congressional hearing on a House Bipartisan Task Force to Combat the Heroin Epidemic on February 6, 2017. To view the hearing, click here.