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Finding a new approach to the opioid crisis

New Hampshire Sunday News

January 20. 2018 5:45PM
Louisa Chen, left, and Nasim Azizgolshani, medical students at Dartmouth's Geisel School of Medicine, started a safe syringe program in Claremont last year. They said such programs can prevent the spread of diseases such as HIV and Hepatitis C, and connect drug users with critical services, including treatment. (Shawne K. Wickham/Sunday News)

Lots of solutions, and millions of dollars, have been thrown at the opioid crisis that's been ravaging New Hampshire and other states since the beginning of the decade.

Now a new grass-roots coalition is looking at a different approach.

It's called harm reduction. And while some strategies - such as needle exchange programs and safe injection sites - often meet with strong community opposition, proponents say the approach saves lives.

"Harm Reduction in an Opioid Era" was the theme of the 11th annual C. Everett Koop Addiction Medicine Symposium, sponsored by Dartmouth-Hitchcock last Thursday in Concord.

"It's not about condoning or endorsing or encouraging drug use," said Kevin Irwin, a founding member of the New Hampshire Harm Reduction Coalition. "It's not a Trojan horse for decriminalization or legalization."

And it doesn't minimize the damage that drug use causes, he said. "It accepts, for better and for worse, that licit and illicit drug use is part of our world, and chooses to work to minimize the harmful effects rather than simply ignore or condemn them."

Participants heard from medical, corrections, law enforcement and substance abuse experts. Speakers emphasized meeting drug users where they are, to prevent overdoses, disease, criminal activity and other ill effects of the epidemic.

Last year, just days after New Hampshire passed a law allowing needle exchange programs, two medical students at Dartmouth's Geisel School of Medicine, started a program at Claremont's soup kitchen. In addition to clean needles, users are offered tips for safer use, Narcan (an overdose antidote) and support.

Organizers Louisa Chen and Nasim Azizgolshani said such programs don't encourage drug use; instead, they become places where users get connected with critical services, including treatment. As future physicians, Chen said, "For us, an ounce of prevention is worth a pound of cure."

"We are serving as a safe place for people to come and say they need help," she said. "So that when they are ready and they do want treatment, they trust us. And we're buying them some time to make that decision."

A few months after they opened, however, they had to shut down because of a clause in the new law that bans programs within 1,000 feet of a school; they're currently looking for a new location.

But in just over three months of operation, volunteers collected 329 used needles and distributed 1,760 clean needles. "Every single one of those clean needles means somebody has not transmitted HIV or hepatitis C to somebody else," Chen said.

Dr. Charles Brackett, an assistant professor of medicine at Dartmouth, said New Hampshire has the nation's second-highest rate of fatal overdoses. "Deaths are what we measure and what grab the headlines, but they're only the tip of the iceberg in terms of measuring the suffering and cost caused by opiates," he said.

Brackett talked about the success of treating addiction with medications that block the opioid receptors in the brain. Studies show that drugs such as methadone and buprenorphine reduce mortality, criminal activity, needle sharing and transmission of diseases, he said. And patients can resume normal activities such as child-rearing and work, he said.

Brackett advocates getting primary care physicians involved in prescribing such medications along with counseling. "If policy's going to follow science, we should not be investing in detox beds but instead in chairs," he said.

Dean LeMire of Dover, who is in long-term recovery, stressed the importance of peer support. He serves on the Harm Reduction Coalition and helped start a safe syringe program on the Seacoast.

"It turns out the syringe is an excellent engagement tool," he said. "A syringe has real value to somebody who injects drugs in New Hampshire."

Such programs are not just about preventing the spread of HIV and hepatitis C, LeMire said. "For me personally, as a volunteer, it's about what else we can do for these people," he said.

Tuftonborough Police Chief Andrew Shagoury, president of the N.H. Association of Chiefs of Police, offered a law enforcement perspective. "Yes, it's a disease but there are victims," he said. "So yes, I understand they need treatment, but there are also real people that got hurt by some of the actions that some of these people do."

But Farmington Police Chief John Drury said it's important to remember that every drug user is someone's child - or parent. In his town, he said, "We've had to get really creative."

First responders, community groups and churches are working together to help those struggling with addiction. They've held public forums "to dispel fear and stigma," and "pancake breakfasts with Narcan," he said.

"It's tough in a rural community," Drury said. "There's not a lot of services available, but there are a lot of friends."

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