New Hampshire HotSpot Study Finds Extensive Poly Drug Use in Fentanyl-related Deaths

The National Drug Early Warning System (NDEWS) on Sept. 12 announced the results of a study in New Hampshire assessing a sharp increase in illicit fentanyl-related overdose deaths in 2016 that was recognized as a public health emergency. New Hampshire deaths related to fentanyl use climbed from 145 in 2014 to 362 in 2016.

Pharmaceutical fentanyl is a powerful synthetic opioid analgesic used to treat patients with severe pain. Fentanyl and its analogues are also illicitly manufactured and sold on the street in combination with other illicit drugs, such as heroin or cocaine, or are disguised as pharmaceutical drugs. Fentanyl is 50-100 times more potent than morphine.

Many types of fentanyl mixtures of varying potency were discovered in the study, and toxicology tests showed decedents tested positive for multiple drugs, with 20% of samples having 10 or more drugs present. The average number of parent drugs identified in each decedent’s blood was 6.2.

“While the media tend to emphasize heroin or fentanyl as the ‘primary’ drug problem, it is clear from our research that the users of these drugs tend to use many other drugs,” said Dr. Eric Wish, Principal Investigator of NDEWS and Director of UMD’s Center for Substance Abuse Research (CESAR). “To be effective, treatment must focus on each person’s total drug problem, rather than on a single drug.”

NDEWS researchers, with support from the National Institutes of Health and the National Institute on Drug Abuse, conducted a HotSpot study including a site visit to four locations in New Hampshire and analysis of available data.

“I met with researchers, policymakers and first responders across New Hampshire who told me about the availability and use of fentanyl in their communities,” says Erin Artigiani, Co-Investigator on the NDEWS project.

Sub-contracts were then initiated with research scientists at Dartmouth College and the University of Maine to conduct rapid analyses of fentanyl-related overdose decedents and to conduct interviews with fentanyl users, first responders, and Emergency Department personnel.

The policy implications for public health from the New Hampshire HotSpot study include the need to:

·       eliminate barriers to accessing and using naloxone (opioid overdose reversal medication);

·       increase the availability of comprehensive treatment that addresses multiple drug use disorders in fentanyl users; and

·        increase the availability of needle exchanges.

At an NDEWS Presents webinar to be held on Tuesday, September 12 at noon EDT,Dr. Marcella Sorg and Dr. Lisa Marsch will present their study findings and answer questions from the audience. Register for the webinar here:

Dr. Kathleen Stewart, Director of the Center for Geospatial Information Science at the University of Maryland, also collaborated on this research. She provided innovative geospatial analyses of the fentanyl-related deaths. Highlights from the NDEWS New Hampshire HotSpot Study and the full reports prepared by the Dartmouth College and University of Maine researchers including the geospatial analyses are available on the NDEWS website:



The National Drug Early Warning System (NDEWS) detects, monitors, and follows up on emerging drug use trends to enable health experts, researchers, and concerned citizens across the country to respond quickly and to develop a more complete and accurate understanding of drug use in our country. The Center for Substance Abuse Research (CESAR) in the College of Behavioral and Social Sciences at the University of Maryland, College Park, manages the NDEWS Coordinating Center with support from the National Institute on Drug Abuse at the National Institutes of Health. For more information, visit

NDEWS is the first national multi-disciplinary system to connect concerned citizens with leading drug experts.

NDEWS is supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number U01DA038360.