On the front lines of NH’s overdose crisis with a life-saving van
Health, harm reduction, and hope during one night in Rochester
The overdose prevention van operated by the New Hampshire Harm Reduction Coalition offers a syringe exchange, fentanyl test strips, safety kits, wound care, and other supplies. (Hadley Barndollar | New Hampshire Bulletin)
The man in the Celtics hat leaned over the handlebars of his electric scooter, a cigarette dangling between his fingers. His hands were stained and weathered, aged beyond his 30 years. Embedded in the creases and folds were signs of a hard life – the kind of grime soap doesn’t get rid of.
A cool wind scattered the embers of his cigarette across the dusty pavement.
Dusk had fallen on the industrial downtown of Rochester with a frosty burst of air. On a side street, high above the roof of a rusting aluminum-sided building, the sky turned shades of slate and indigo. A vacant lot next door was flecked with weeds spurting through fissures in the asphalt: a touch of green on a late March evening, on the doorstep of spring.
Moments prior, the man had arrived in the nondescript parking lot to empty a considerable amount of used needles into a five-gallon utility bucket. In return, he received a supply of brand new needles. Also available to him were fentanyl test strips, naloxone to reverse overdoses, and kits for safer injection, smoking, and snorting.
The new syringes would hold him over until the following week, when he would return to the same Rochester parking lot just as he does every Monday. Many people do the same in Concord, Manchester, Dover, and Somersworth when the nonprofit New Hampshire Harm Reduction Coalition arrives in its new overdose prevention van, serving around 2,000 program participants statewide.
Visitors to the van seek ways to stay infection-free – and alive – in a drug landscape where each injection could be fatal. And, in many ways, they seek a deeper empathy and understanding beyond the little that society affords them.
Palana Belken opened the heavy sliding doors of the deep blue van. Jumping inside, she recalled a time when people sold used needles on Facebook Marketplace for $5.
That was before 2017, when the state made it legal for syringe exchange and harm reduction programs to operate – giving people options for safe syringe disposal, and in turn, the opportunity to access a clean supply.
Belken is the coalition’s director of operations. A former Rochester city councilor, she’s also one-half of an instrumental alternative and psychedelic duo called “Palana vs. The Man.”
She explained syringe exchanges are just a piece of harm reduction, the larger public health framework that’s gaining attention nationally. The Centers for Disease Control and Prevention names harm reduction as an evidence-based strategy for preventing opioid overdose, and it’s been designated as a priority area for the U.S. Department of Health and Human Services’ prevention work.
Belken said there’s more interest in New Hampshire than ever before, though it’s been a long road to get there.
Harm reduction philosophy is about dignity and humanity: accepting that people are going to use drugs regardless, and focusing on minimizing negative impacts to individuals and communities.
It’s not about funneling people to recovery or telling them to get clean. It’s about providing safer tools, connection, and resources – meeting them where they’re at and keeping them engaged. And oftentimes, it’s simply making sure they live to see the next day.
“Our bread and butter is getting Narcan to people who use it,” Belken said. “People have to stay alive in order to make it to recovery.”
Recovery isn’t the end goal for everyone, either. Some will use drugs for their entire lives, and according to the harm reduction model, that’s OK, too. It doesn’t mean their life has any less value.
In many ways, it’s “radical love,” a term NHHRC uses often on its website and in distributed materials.
“Radical love is just showing up for people as they are,” Belken said. “Treating people with compassion. I feel like with how stigmatized drug use is, that showing this particular group of people compassion is just inherently radical, unfortunately. I wish that wasn’t the case.”
Going through the van’s tightly packed shelves and drawers, Belken pointed out water bottles, jackets, sleeping bags, HIV and COVID-19 test kits, condoms, Plan B, wound care supplies, and general hygiene products.
She fanned out fentanyl testing strips in her hand, saying they carry “thousands.” Fentanyl has all but replaced heroin in New Hampshire and is increasingly creeping into cocaine, prescription pills, and other substances.
Test, test, test is what they tell all of their program participants.
NHHRC had been operating its mobile services out of the trunks of volunteers’ cars for several years. The new van, which hit the streets this winter, can reach more people and stock supplies to scale. It looks like an Amazon delivery van, and Belken laughed that it was challenging to purchase one because the e-commerce tycoon buys them all up.
Depending on the city and expected demand for services, some nights see three staffers and volunteers on site, others see six or more.
Belken said the van is “opening up new opportunities,” one being conversation. While driving around the state, she often catches people checking it out at stoplights and intersections. Sometimes, people walk up and ask questions about it.
Nothing is being hidden from the public, and that’s part of the goal. The van’s exterior features colorful artwork depicting nasal naloxone, and in big letters across the back reads “overdose reversal.”
Set up next to the van, two volunteers talked quietly amongst themselves as they oversaw the buckets where people dropped off used needles.
They greeted anyone who approached with warmth. One woman pulled up in her car with a plastic Target bag filled with syringes, which she carefully placed in a bucket. She softly asked for hand warmers and Plan B before leaving.
“Thank you guys, appreciate you,” she said.
Another man parked his car discreetly off to the side and hurried away after dropping off a collection of syringes.
Last year, NHHRC took in more than 500,000 syringes, representing an average return rate from their program participants of about 87 percent.
Rebecca Martin sat on the bumper of her car, flashing closed-lip smiles and initiating small talk. She started in this line of work as a peer recovery support specialist with the Concord Doorway, one “hub” of the state’s hub and spoke model for substance use treatment. Now she’s a certified recovery support worker and serves as the coalition’s care coordinator for Dover, Rochester, and Somersworth.
Martin advises people based on what they ask for, she said. She doesn’t wave around pamphlets for the nearest recovery program, though she certainly has them and is ready to deploy if needed. Rather, she tries to educate on utilizing fentanyl test strips every time someone uses, for example.
“Usually I get asked, ‘Where’s a meeting?’” she said. “Or for resources like tents, flashlights, batteries.”
Martin often sees emerging trends coming down the pipeline based on what clients share with her at weekly van visits. One that’s being increasingly discussed is xylazine – a powerful tranquilizer typically used by veterinarians, known on the street as “tranq,” that’s made its way into New Hampshire’s drug supply.
Xylazine is especially scary because it’s not reactive to naloxone. It can cause severe wounds, including necrosis, the rotting of human tissue, the Drug Enforcement Administration warns.
A wound care provider joins the van for most weekly visits – a highly utilized service, Belken noted. They’re seeing “really terrible, bizarre wounds.” And yet, in terms of how prevalent xylazine is becoming, New Hampshire is flying blind and at the mercy of data coming out of Massachusetts, because the Granite State doesn’t have its own comprehensive drug testing system.
Belken hopes they’ll soon have access to xylazine testing strips, which just hit the market last month. So far, they’ve been hard to find, though.
Martin sifted through a bag in the trunk of her car, taking out a dose of intramuscular naloxone. She doesn’t often advertise that she carries it, but people are increasingly interested, she said.
Naloxone, often used interchangeably with brand name Narcan, is frequently administered nasally, but the intramuscular kind is like an EpiPen. It can be injected straight through pants and into the muscle. Martin called it a “heavy duty dose.”
NHHRC distributes huge amounts of nasal Narcan, and the data shows lives are being saved because of it. In 2022, program participants statewide reported reversing 1,459 drug overdoses. Belken said 2021 saw even more than that.
This month, the Department of Health and Human Services announced a large-scale initiative to deploy more than 700 public NaloxBoxes – overdose reversal kits – across the state in all 10 counties.
There are growing risks associated with injection drug use: HIV and hepatitis C, skin infections, and a more potent chance of overdose. The coalition assembles kits for safer injection, smoking, and snorting, trying to educate program participants on alternatives, or at the very least, cleaner and less harmful methods.
Belken cited “real growth in moving away from injection.” In fact, some people prefer pipes to syringes when they have access to them.
The CDC says people who regularly utilize syringe exchange programs are nearly three times more likely to stop or reduce injection.
“When you’re putting the drug directly into your vein, that’s just mainlining it,” Belken said. “(With smoking and snorting), obviously it doesn’t mean a free pass, that you can just smoke or snort as much as you want. But it does help negate the consequences associated with injecting.”
Belken said she looks to Massachusetts-based Smoke Works as her information source on pipe use as an alternative to injection. By reducing syringe use, Smoke Works says, disease and infection transmission is minimized. Pipes also allow people to achieve a phased high, as opposed to a hurried injection that hits all at once, and maybe too much.
The coalition’s safer injection kits have been very popular. Last year, NHHRC gave out close to 10,000 of them, all containing sterile syringes, clean “cookers,” sterile water, dental cottons to filter out impurities, tourniquets, alcohol pads, and fentanyl test strips.
All of NHHRC’s kits contain educational inserts with information on naloxone and the “Never Use Alone” hotline.
As a nonprofit, NHHRC gets its funding from a combination of sources, including private donations, grants, and a contract with the state. In 2020, the coalition entered into a $770,000 contract with the Department of Health and Human Services to increase harm reduction offerings. The contract specifically noted all of the money was federal funding, and that stipulations were attached in terms of what it could be used for.
The evening grew darker as Belken and Martin traded laughs with Adriane Apicelli, who was on site conducting surveys for the University of New Hampshire’s Harm Reduction Education and Technical Assistance Project.
“What would happen if policy makers got direct feedback from people who use drugs?”
“What do you think people get wrong about drug use?”
Apicelli spoke with a perfect combination of humor, kindness, and discretion, showing extreme care for the stories being shared.
“People don’t know what people’s lives have been like, why they do the drugs,” said the man in the Celtics hat.
He recounted trauma in his youth. He spoke openly about it, tracing his drug addiction back to the suffering that altered the course of his life forever. Behind him, engines hummed through a downtown thoroughfare, past a hair salon, seafood restaurant, and electrical supply store.
“I don’t even know what the hell a sober life is, because I was so f—— young,” he said.
A talkative man in his late 50s, wearing a ball cap and glasses, had been hanging around the parking lot for at least 30 minutes making genial conversation. He debated with staffers and volunteers over which was better: Hannaford or Market Basket.
When he saw an opening, he cut in: “When is it my turn to take the survey?”
A woman bundled in a soft pink hoodie and thick winter coat had arrived with the man in the Celtics hat; she, too, was riding an electric scooter.
She said she was 35 years old, and had been accessing the syringe exchange services for the last three to four years.
When she was in high school, she was interested in phlebotomy, she said – collecting blood samples from patients and preparing them for testing. She shared that small detail from her life with pride.
“A lot of people have something they’re running from,” she remarked casually, looking down the dim, empty street leading away from downtown. She’d just dropped off two containers overflowing with used needles in exchange for new ones.
“It literally just numbs the pain.”
She stuffed her backpack with the clean syringes and other supplies she’d been given, offering affectionate thanks, goodbyes, and “see you laters.” She put on a headlamp and mounted her scooter, motoring away into another night, nearing blackness.
- NH Harm Reduction Coalition (Concord, Manchester, Somersworth, Dover, Rochester)
603-545-5506 (Concord), 603-223-7245 (Manchester), 603-333-6547 (Tri Cities)
- SOS Recovery (Dover, Rochester, Hampton)
- Revive Recovery Center (Nashua)
- The Doorway @ Wentworth Douglass (Dover)
Call 211, select option #1
- HIV/HCV Resource Center at Valley Regional Hospital (Claremont)
- GROW Syringe Services (Keene)
- Mt. Washington Valley Support Recovery Coalition (Center Conway)
- Another Day Harm Reduction (Manchester)
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