For years, New Hampshire has relied on a largely patchwork strategy to address the opioid crisis, funding grassroots efforts community by community. That means an individual’s access to services depends a lot on where he or she lives. Now, state officials want to change that. But implementing a new, statewide system is easier said than done. In some cases it will mean replacing initiatives that already exist.
Manchester Fire Chief Dan Goonan says he’s told the story about a million times now.
It goes like this: Spring of 2016, a kid named Cameron walked into the fire station, addicted to opioids. He had hit a low. He didn’t know where else to turn, but he knew he wanted to make a change.
The firefighters welcomed Cameron in the door. They connected him to a recovery organization in town, and he got back on his feet.
But at this point in the crisis, with overdose numbers as high as they were, it was clear to Goonan and his staff that helping one person wasn’t enough.
“Quite frankly, I was ready to jump out the window if I was at another roundtable,” he said. “So we said, hey, we need to do something, and we did.”
Inspired by Cameron, someone who knew intuitively that he could turn to the fire department for help, Goonan put the word out that anyone struggling with drug use could follow in the young man's footsteps -- could walk into any of Manchester’s fire stations, day or night. He called the program: “Safe Station.”
He thought he would maybe see a few people a month looking for help. Less than two years later, the program had logged more than 3,000 intakes. Goonan was getting calls from cities across the country, asking how to replicate their success, and President Donald Trump even stopped by.
Trump’s visit, this past March, came soon after New Hampshire’s two senators announced they had secured a big increase in money aimed at the opioid crisis. State officials had been eying federal relief for a long time, hoping to make a dent in, by many estimates, a dramatically underfunded public health crisis.
The money, totaling about $23 million for New Hampshire for the first year, is finally expected to arrive this month. But it’s now unclear if it will make its way to programs like Goonan’s that have been manning the front lines for years.
Speaking at a packed press conference in August, Governor Chris Sununu announced the state’s plan for the new funds. It’s an ambitious one -- a comprehensive, statewide strategy. “This is the biggest step this state has ever taken in addiction,” he said at the time. “We’re really setting ourselves on a course, finally, to see some appreciable results.”
The state’s goal is similar to that of Safe Station's: to make it easy for anyone to figure out where to go in their community for help, to know which door to walk through first. But Sununu wants to task hospitals with this job. He’s looking to nine medical centers to serve as "hubs," located in such a way that no state resident is more than an hour’s drive away.
The hubs will be a place not just to get an initial screening, but also to be connected to a whole suite of services including medical care, therapy, peer recovery programs, housing assistance and job counseling. They will also keep detailed data on how people are doing through their treatment and recovery.
In many areas of the state, particularly more rural areas, this system will fill a significant void. But in places like Manchester, where community partners have been working for years to build their own infrastructure from the ground up, it could be more complicated.
Safe Stations is a key example. “Safe Stations was really created as, in a way, a hub for Manchester,” Sununu said recently, “as kind of a temporary backfill for services that just weren’t there.”
The new hospital-based hubs should allow that program to wind down, he said.
But from Chief Goonan’s perspective, the idea of phasing out Safe Stations just doesn’t make sense. “I kind of find that offensive,” he said. “I really do. On a personal level.”
He and other Manchester firefighters know first-hand what it takes to build a stigma-free environment where people feel comfortable asking for help, he said, and it’s not as easy as pointing them to a hospital.
Goonan has no plans to wind down his Safe Station program, which is largely funded through donations and grants, he said. But the effort's partners -- organizations providing the screening, treatment and recovery services once individuals leave the fire station -- receive state funding for their work. It's unclear what will become of those contracts next year.
“Everyone’s sort of holding their breath a little,” said Jenny O’Higgins, who works on substance use with a Manchester non-profit and coordinates organizations working locally on the issue. In some ways, Manchester is well positioned to implement a new system, she said, because of the groundwork the city has already laid. But many of the details of how a new hub would actually work are still in the air.
In other areas of the state, too, providers are asking questions about how, exactly, they’ll be involved in the new structure, and how much funding they’ll receive. The money comes with a requirement, though, that it be spent on a tight timeline, with programs up and running as early as this fall. That means it’s likely these changes, no matter what they are, will have to be made fast.