New Hampshire "drug czar" David Mara discusses the state's efforts to address the on-going addiction crisis. Is the Granite state spending enough to prevent and treat addiction? What's the right balance between law enforcement and treatment? And is there adequate oversight of the state's drug treatment infrastructure? We also look at lessons learned from the closure of Serenity Place, Manchester's addiction treatment center associated with the Safe Station program.
Also, we hear from NHPR's Paige Sutherland on her extensive reporting on the opioid crisis in New Hampshire.
- David Mara - The Governor's Advisor on Addiction and Behavioral Health. Mara was previously Manchester Police Chief and interim police chief in Portsmouth.
- Paige Sutherland - NHPR reporter.
Interview excerpts have been edited for length and clarity.
After six months in this position, what have you learned about the state's addiction problem?
At this point what we're trying to do is fill the gaps -- from the time somebody seeks help to the time that they get out of treatment and start recovery. We have to make sure we fill the gaps to get people the help they need, the services that they need, and to make sure that if they have a relapse that they just get right back into that continuum of care.
What I've learned is that this has affected the state economically. It's affected the cost of medical care. But most importantly I've seen that this has really impacted families and that is something that we're going to be dealing with for a while and we have to make sure that we really start focusing on prevention as well. Because right now we're trying to help people that are already suffering from addiction.
But now we have to save the next generation. So we have to make sure we're starting earlier. We have to encourage parents to talk to their kids and continue talking to their kids. And don't assume that you can talk to them once. You have to continue the conversation in a way where they're going to engage with you.
We have to be able to reach out to kids in the way that they listen. Kids don't watch TV; they don't watch commercials. The Governor was telling me he had a conversation with a young man, and he said 'I don't watch the news. I don't watch TV. I didn't know any of this was going on.' So we have to listen to what the kids are saying. We have to go to them in the medium that they understand.
How much does getting tougher on drug dealers help?
It does help. You hear people say, 'Well, you arrest one drug dealer and there's going to be two to take that dealer's place.' But you have to keep up the enforcement. If you don't, New Hampshire will be friendly to drug dealers. They'll move up here. There will be no incentive for them to stay out of the state. So, we are really going after the drug dealers. We are really trying to stop the drugs flowing from the Massachusetts border and all our borders. We've enhanced our capability to do highway intervention. And we have Granite Hammer, where officers from different departments are grouped together in particular areas, and they learn about how to do drug investigations. And that saves resources. New Hampshire's a state where the vast majority of police departments don't have the manpower. So this is a great way they can pool their resources and get out there and try to stop the flow of drugs from coming in.
On the role of doctors and medication-assisted treatment.
There is a change of attitude within the medical community and what we are trying to do on the state level is to encourage more doctors to get certified to be able to participate in medication-assisted treatment. It’s proven that its success rate is higher than just treatment itself.
I've talked to a couple of doctors. And sometimes it's 'I don't want to get involved,' and 'It will take away from my practice.' And again the stigma part comes in. There are a lot of different reasons but it's something that is needed in the state, and we need some dedicated physicians to step up and to help the situation.
How big is the workforce problem?
We could hypothetically build right now a 50 bed facility somewhere. But we would not be able to staff it at this point because another problem New Hampshire has is the workforce. We're having a problem hiring people in the profession – doctors, licensed alcohol and drug addiction counselors, nurse practitioners, because we're in competition with Massachusetts, which pays higher. And so we're trying to work on that, with a loan-repayment program; we're trying to recruit people to come up here. And it is a battle. Before this happened, it was difficult to do. But now that these professionals are in such demand it's even more difficult. So what the Governor has advocated is that we try to keep the people that get training here, that get their education in the profession here, that we try to retain them and keep them here.
If somebody is in Massachusetts and they are a licensed alcohol and drug addiction counselor or nurse practitioner, right now, they have to jump through a lot of hoops to get licensed here. It takes a while. It can be costly and we need people right away. That's another thing that we're working on.
On the closure of Serenity Place.
Serenity Place was made up of a lot of people that stepped up, they wanted to help, but at the end of the day they weren't equipped to be able to deal with those numbers. Now, with the help of Families In Transition and the Farnum Center, and a lot of different organizations, they have now transformed to better handle the problem, and I believe they're not going to miss a step.
But what it illustrated, with all the people coming to Manchester's Safe Station program, is that there were gaps as far as treatment throughout the state. That’s why people come. You can’t blame them.
Some good signs.
We’re seeing a lot of signs, things are changing. Who would have thought New Hampshire would have a syringe service program. Who would have thought that we would have all these methadone clinics. So we have to build capacity. But it doesn't happen overnight.
We have distributed a lot of Narcan. We are going to continue to do that. We're always looking for funding sources to be able to do that. But that is something that we are working very hard on. Narcan is something that's positive happening in the state. In 2016, we had 485 overdose deaths; we’re probably going to be right around there at this point. But if it wasn’t for Narcan, those numbers would be through the roof.
On Safe Stations.
They wouldn't work for everybody. Nashua has a successful program that they've modeled and they've partnered with Harbor Homes and they've seen a decrease in emergency room visits I was told and they have a system that’s integrated. Somebody comes in. Somebody comes in to get treated for addiction, they're also looked at by a doctor, a nutritionist and a dentist. They also can go there for detox. On the other end is housing. So it all depends. It doesn't work for every community.
Let's look at it this way: In a perfect world I believe we shouldn’t just be sending our citizens to firehouses. They should be able to walk into a medical facility. So, short term, a safe station is a MASH unit,because it's so visible. And with the stigma, people felt comfortable going to a fire station, initially. But we have to work on that. We have to make sure that people know this is a disease. We have to get it treated like any other disease.