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In northern NH, the opioid crisis is getting worse. Communities are searching for answers — and more attention.

Colebrook, New Hampshire
Paul Cuno-Booth
Colebrook Police Chief Paul Rella says the fentanyl crisis came late to his town, but it’s now in full force. Last year alone, five people died of overdoses — one for every 400 residents.

This is the first in a two-part series on the opioid crisis in northern New Hampshire. Read the other story here: ‘It's about a change of culture.’ In Littleton, supporting people in recovery is a team effort.

On a weekday evening in July, four dozen people sat on folding chairs in a college cafeteria in Berlin. The group included city leaders, local residents, public health workers and others — all touched in some way by the drug epidemic and looking for a way forward.

The police chief, Dan Buteau, walked up to a mic.

He’s been on the force for two decades, as the opioid crisis has swelled. But last year was the worst he’s ever seen. In this city of 9,000 people, 11 died of overdoses.

“These numbers represent, as you know, sons, daughters, mothers, fathers, friends, brothers, sisters,” he said. “And these numbers have names and faces.”

After a few years of what seemed like progress, overdose deaths are again rising across New Hampshire. Discussions of the state’s drug crisis often focus on cities, but rural areas have also been hit hard. Last year in Coos County, people died at twice the rate that they did in New Hampshire as a whole.

And people here say they face outsized challenges as they try to respond to this crisis. While accessing treatment and finding support in recovery can be difficult across New Hampshire, that’s made even harder by this region’s limited services and scarce financial resources.

Crystal Holton speaks at a community meeting in Berlin about the opioid crisis.
Paul Cuno-Booth
Crystal Holton has been in recovery for nearly eight years. But it hasn’t been easy. “We have nothing up here,” she told the crowd at a recent community meeting in Berlin about the opioid crisis. “We need help up here.”

"We only have one treatment center in the entire North Country,” said Jennifer Goulet, the recovery support manager for the Littleton-based North Country Health Consortium. “That's not enough capacity.”

And what services do exist — such as the growing number of clinics prescribing medication to treat opioid addiction — can be out of reach for people who don’t have reliable transportation.

“Our geography is unique,” Goulet said. “You could travel 45 minutes to see a doctor depending on where you live."

Crystal Holton has lived those challenges. She grew up in Berlin and later became addicted to the painkillers her husband got for an injury. Her turning point came when a friend she was staying with threatened to kick her out and separate her from her daughter.

“Treatment is not easy for us up here,” she said. “I had to do bed checks. I had to call rehabs every morning to see if there was a bed available.”

It took her nine days to get a spot at a treatment center — three hours south in Cheshire County. She almost didn’t make it.

Holton’s now been in recovery for nearly eight years. But it hasn’t been easy. One of the 11 people who died in Berlin last year was the father of her godson. Just recently, she found out a childhood friend had also overdosed and died.

“We have nothing up here,” she said. “We need help up here. People don’t need nine days to get into treatment. Those nine days – they could die.”

‘It can feel like you’re surrounded by people who don’t understand’

Bear Rock Adventures, in Pittsburg, was recently designated as New Hampshire's northernmost "Recovery Friendly Workplace."
Paul Cuno-Booth
Bear Rock Adventures, in Pittsburg, was recently designated as New Hampshire's northernmost "Recovery Friendly Workplace." Erik Petersen’s parents own this store, and they’re hoping to make it more welcoming for people who, like him, are in recovery.

Along with barriers to treatment, the solitude can take a toll. And many places in the North Country lack peer-based recovery supports — meetings, one-on-one recovery coaching, drop-in resource centers and activities that help people feel like they’re not going through recovery alone.

“Without those, early recovery is very difficult,” said Erik Petersen, a consultant with Upper Connecticut Valley Hospital in Colebrook. “It can feel very isolative. it can feel like you're surrounded by people who don't understand – if you’re surrounded by people at all.”

Petersen thinks the lack of recovery supports is one reason people are struggling so much in New Hampshire’s northernmost region. And the need here is growing.

Police Chief Paul Rella says the fentanyl crisis came late to Colebrook, but it’s now in full force. He says he gets regular calls about discarded needles and drug use in public bathrooms. Last year, five people died of overdoses in Colebrook alone — one for every 400 residents.

“I don't think I covered an overdose death my whole police career until probably four years ago,” Rella said.

Colebrook, New Hampshire
Paul Cuno-Booth
Colebrook, New Hampshire

Petersen grew up spending summers in Colebrook, a town of 2,000 not far from the Canadian border. His parents now live here. He feels a deep connection to this place. But he’s currently splitting his time between Colebrook and Portland, Maine, three hours away.

Portland is where Petersen began his own recovery from drug addiction, seven years ago. He said the community he found there is why he’s still in recovery today.

“When I was first in Portland, [I] knew I belonged,” he said. “Because I saw a thousand carbon copies of myself walking into the rooms.”

They were people he went to recovery meetings with and could talk to when things got tough — people his age, who’d been through similar things and shared the same frustrations and dreams. But it was so much more than that. He was making friends, playing sports and learning that a life in recovery wasn’t just possible — it was fun.

“I could see that so many people just like me had come before me and done the same thing and succeeded,” he said.

But Petersen says there’s really nothing like that in Colebrook, except for a couple long-running Alcoholics Anonymous meetings.

It’s been hard on him as someone with years of recovery under his belt. But he said it can also be alienating for someone who’s actively struggling with substance use or just entering recovery. And in small communities, where you’re constantly seeing people who know you, the sense of stigma can feel crushing.

“Being in the midst of an addiction in a small community like this, it is incredibly difficult,” he said. “Especially if you feel like nobody is out there who understands.”

Signs of progress

Berlin, New Hampshire
Paul Cuno-Booth
Berlin, New Hampshire

In Berlin, the crisis has sparked calls for change. Buteau, the police chief, got together with other community leaders last year to figure out a way forward. They decided the city’s biggest need was a recovery center — a place where people could find 12-step groups, recovery coaching and other peer-to-peer support.

At the community meeting last month, a representative from White Horse Recovery — which runs recovery centers in several other communities in New Hampshire — told the crowd they had just received state funding to open one in Berlin. He said they plan to be up and running by October.

Community members agree it’s not all that’s needed. But they hope it starts to make people in recovery feel a little more at home here.

One of them is Casandra Mercer. She moved to Berlin in 2016, after going to treatment for opioid addiction and then spending several years outside of New Hampshire. She found vibrant recovery communities in other cities that helped her find her way.

But in Berlin, she struggled to find connection. She found herself holed up at home, alone, attending online meetings with people in other places. If not for the supportive group of coworkers she eventually found here, she doesn’t know if she’d have made it this far.

“It's being surrounded by people who understand addiction and recovery. And that’s what we're missing for the people who actually live here,” she said.

Petersen’s also seeing signs of progress in Colebrook.

He’s worked with the local hospital to connect people with treatment directly — finding them rides or signing them up for insurance on the spot, if that’s what it takes. He’s pushing to make the overdose-reversal drug naloxone more widely available, though he says some police departments are still resistant to it.

Last month, his parents’ ATV and snowmobile rental business in nearby Pittsburg, Bear Rock Adventures, became the northernmost employer in New Hampshire to join the state’s “recovery friendly workplaces initiative.” A worker installed a first-aid box with naloxone on the store’s wall, near off-road tires and a stack of waterproof boots.

Petersen is trying to show this community that he’s in it for the long haul. He said they’ve seen a lot of people show up promising great things, only to leave after a year or two when their grant funding runs out.

And services that exist on paper don’t always reach this far north. That can leave people feeling like they just have to go it alone.

“It's a matter of convincing important people that just a few people are very important,” he said, “and that they deserve the same shot that that a larger population has.”

Paul Cuno-Booth covers health and equity for NHPR. He previously worked as a reporter and editor for The Keene Sentinel, where he wrote about police accountability, local government and a range of other topics. He can be reached at
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