N.H. DRUG DEATHS SPIKE

Drug-overdose deaths have climbed sharply in New Hampshire over the
last 10 years, and they show no sign of slacking.

Chief Medical Examiner Dr. Thomas Andrew has compiled statistics on
fatal drug overdoses in the state for several years, and his records
show drug overdoses have risen steadily, from 39 in 1995 to 153 last year.

"There is a 150 to 175 percent increase in drug-related deaths over
the past five years in New Hampshire," Andrew said.

"There was a time when we thought drug overdose deaths were going to
exceed traffic deaths in New Hampshire, but drivers sort of sunk to
the challenge," and motor vehicle fatalities have increased, as well,
Andrew said. (There were 171 traffic-related deaths in the state in 2004.)

The state Department of Health and Human Services also keeps
statistics on hospital admissions, which include treatment for
non-fatal overdoses, but those records are less clear-cut.

Opiates remain the leading cause of fatal overdoses, and methadone
has become the single biggest killer, topping even heroin, Andrew said.

"Methadone is driving this bus," Andrew said. "Methadone has emerged
as public enemy number one."

Andrew said most methadone abused by addicts comes not from
addiction-treatment clinics, but from Internet sales and pharmacies.
Andrew called the idea that methadone clinics create a source for
illicit distribution "an utterly disprovable myth."

"The source of methadone are the pills and tablets that are either
being dispensed for treatment of chronic pain, or they're being
illicitly obtained from the Internet or other means," Andrew said.

Methadone alone accounted for 23 of the 153 fatal overdoses last
year, and it was present in the bloodstream of an additional 52
overdose victims, Andrew's records show.

Andrew counts the total number of deaths caused by overdose,
accidental and otherwise, but in most cases, the deceased had been
using more than one drug, his records show.

Heroin shows as a small number in the figures because it's so rarely
detected, Andrew said. The human body quickly converts heroin, he
said, but heroin is believed to account for most of the unclassified
"opiate" deaths.

Other prescription pharmaceuticals, including various opiates,
antidepressants and other mood-altering drugs, also account for a
large number of deaths collectively, Andrew said.

Last year, a group of law enforcement and medical professionals
formed the Prescription Monitoring Program Ad Hoc Committee and
drafted legislation to create a system to monitor prescription drugs
to prevent "doctor shopping."

There is nothing to stop a person from visiting several doctors and
getting prescriptions from each for the same condition, Andrew said.
The bill proposed a $35 fee to be paid by doctors licensed to write
prescriptions to fund a computer network that would allow doctors and
pharmacies to check whether a patient already has prescriptions from
another doctor or pharmacy, Andrew said.

Maine and Massachusetts already have such systems in place, and
Vermont recently approved a program, Andrew said.

"Far more attention should be paid on establishing some sort of
monitoring system," Andrew said. "It's one man's opinion, but it
seemed to me after looking at it in detail for 2 1/2 years that a
prescription monitoring program could make inroads into this problem."

The House at first approved the bill, then reconsidered and voted to
send it back for further study in March, effectively killing the bill
for now. The House Health, Human Services and Elderly Affairs
Committee will make further recommendations sometime this fall, House
clerk Karen Wadsworth said, but the bill would have to be
reintroduced for any further action.

Andrew said he was surprised the bill failed to pass outright.
Opposition focused on the perceived cost and privacy concerns, he said.

"It was deemed to be sort of the heavy hand of the state invading the
lives of New Hampshire citizens," Andrew said, adding later, "I had
no idea that this would fail. This seemed to me to be a no-brainer.

"Money talks, and 150 deaths apparently does not."

The proposed monitoring system wouldn't have been able to make a dent
in Internet drug sales, Andrew said.

"At this point, there is no way to get a handle on the inflow of
pharmaceuticals coming from the Internet," he said.

While heroin and cocaine have become chronic problems around the
state, law-enforcement professionals lately have focused their
attention on methamphetamine. Methamphetamine deaths have been rare
in New Hampshire, with only one last year, but statistics from other
states suggest police and prosecutors are right to worry, Andrew said.

"It is an exceedingly dangerous drug. . . . It's a very scary agent,"
Andrew said. "If methamphetamine manages to take hold here as it has
in other jurisdictions, we'll have big problems."

Statistics on hospitalization for non-fatal overdoses are harder to
come by, Andrew and other state officials said. The Department of
Health and Human Service's Bureau of Health Statistics gathers data
from hospitals around the state, but there is no comprehensive system
for gathering data on treatment for drug abuse, injury surveillance
Manager David Reichel said.

"There's a tremendous amount of interest in getting a better handle
on drug abuse," Reichel said. "It's such an important public health
issue, and we do have a lot of people working with drug overdoses,
but we really do have a problem with data, how to count them."

The bureau produced a report on hospital admissions for various
drug-related issues in 2002, breaking down the number of inpatient
and outpatient treatments by age group and county.

That report shows there were 134 inpatient hospital admissions for
opiate poisoning or dependence in Hillsborough County in 2002, more
than half of them (69) involving people ages 20-39. People ages 40-59
accounted for about 28 percent of them (38), while those ages 10-20
accounted for about 15 percent (20) of the total.

That report serves as a snapshot of 2002, but there is no readily
available ongoing data, Reichel said.

The state receives hospital treatment information based on billing
and insurance codes, and because medical problems and treatment can
be complex, the data for any one particular hospital admission isn't
always clear-cut, Reichel said.

"It seems like every time we get a data request, we have to go back
and start from scratch," he said. ". . . We don't have just a
standard set of codes and decision rules for counting drug abuse and
drug overdose. Drug overdose is just a big question mark."