Opioid overdoses and deaths in New Hampshire's two largest cities have dropped dramatically over the past 10 years, driven by a combination of expanded Narcan access, stable government-funded treatment programs, and the human work of meeting people wherever they are in their recovery journey. According to data from American Medical Response (AMR), the ambulance service provider for both cities, overdoses since 2016 have fallen 53 percent in Manchester and 58 percent in Nashua. Opioid deaths have dropped 54 percent in Manchester and 47 percent in Nashua over the same period.
Narcan: The Game-Changer
The turning point, according to AMR's Chris Stawasz, was the availability of naloxone — sold under the brand name Narcan. First approved as a prescription drug in late 2015 and then as an over-the-counter product in 2023, Narcan gave emergency responders and bystanders alike the ability to reverse opioid overdoses in real time. Since Narcan went over the counter, overdoses in Manchester have continued to fall, dropping from 695 in 2023 to 371 in 2025.Nashua saw a similar trajectory, declining from 227 to 155 over the same period. Both cities reached their epidemic peaks years ago — Manchester in 2017with 877 overdoses and 67 deaths, Nashua in 2016 with 361 overdoses and 44deaths. But Stawasz emphasized that Narcan does more than save lives in the moment. By keeping people alive, it creates opportunities for recovery that wouldn't otherwise exist. He described patients who have come back to thank responders after multiple overdoses, saying that it was one specific offer of help — made possible because they were still alive — that finally connected them to recovery.
The Doorway: A Single Point of Entry
A central piece of New Hampshire's recovery infrastructure is The Doorway, a statewide network of nine regional hubs coordinated by the New Hampshire Department of Health and Human Services and funded through the federal Substance Abuse and Mental Health Services Administration's State Opioid Response grant. Launched in January 2019, the program provides screening, evaluation, care planning, medication-assisted treatment, Narcan distribution, and referrals to treatment and recovery services — all through a single point of entry. The Doorway of Greater Manchester, located at 300 Hanover Street, came under the operational oversight of Elliot Health System in July 2025. Program manager Danielle Mackey described how recovery often starts with something as simple as food stamps or a hygiene kit, not a treatment plan. She shared the story of a mother who initially came in looking only for help with food assistance and, over time, entered treatment, gave birth to twin girls, and reunified with all three of her children. Her partner eventually sought treatment independently, and the family is now stable, employed, and healthy. The Doorway of Greater Nashua, which has been operating since 2019, has served more than 4,200 people and partners with Process Recovery to provide after-hours, weekend, and holiday support.
The Evolving Threat
The progress has come against a shifting drug landscape. Stawasz noted that a decade ago, the crisis was driven by prescription opioids stolen from medicine cabinets — legitimate painkillers being misused or sold. As that supply dried up, synthetic opioids like fentanyl filled the gap. Making the emergency response even more complex, drug users increasingly began mixing opioids with stimulants like crack cocaine and methamphetamine. That means responders now face situations where reversing the opioid component with Narcan leaves a patient still under the influence of a stimulant, which can be dangerous. Additionally, carfentanil — a synthetic opioid roughly 10,000 times stronger than morphine — has been increasingly detected in New Hampshire's drug supply, linked to 10 deaths statewide in 2025 compared to seven in all of 2024.
Stable Funding Made the Difference
Stawasz credited the stability of programs like The Doorway with making sustained progress possible. In the early years of the crisis, treatment providers turned over every six months because funding was unreliable. Manchester Mayor Jay Ruais, who has publicly shared his own recovery journey, praised the collaborative effort across state and local agencies. Southern New Hampshire Medical Center in Nashua has also contributed through its "Reverse the Cycle" program, which screens every adult emergency department patient for substance use disorder and embeds a peer recovery coach with the emergency care team. The hospital offers Narcan to anyone at no cost and without a prescription. Annette Escalante, director of substance use services at Elliot Health System, urged people to see the human stories behind the data. "Recovery is possible," she said. "These are humans we're talking about."