John Burns says the drastic drop in the amount of people coming into his three recovery centers in Dover, Rochester, and Hampton for help worries him. Burns is director of the SOS Recovery Community Organization.
“I think they're afraid of physical contact. I don't know how they're doing – but I can guess. And the isolation is a problem.”
Burns joined NHPR's The Exchange for an update on the opioid crisis and addiction treatment in New Hampshire.
“People just aren't coming into the centers,” Burns said. “They want to come in and have coffee and snacks and sit in meetings, and they can't do that. They'd have to wear a face mask, and so we're balancing the pandemic and an epidemic all at the same time. It makes it super challenging, super complex.”
The only bright side these days is a boon in digital communication, he said, with about 70 Zoom meetings a week. “We run eight meetings a day, seven for all individuals struggling with addiction and one for family members, seven nights a week.”
Participation in those meetings has gone international, he said, with people from 32 countries logging in and reaching almost 300,000 people. However, says Burns: “It's more what we are not seeing that concerns me.”
Burns's centers work closely with Wentworth-Douglass hospital in Dover, which serves as a so-called hub, helping people in acute need and referring them to Burns's center for support and follow up. There are nine such hubs around the state, affiliated with hospitals. These, along with recovery centers and other support services, make up the state's federally funded Doorway program, also known as the hub-and-spoke system.
Federal money can be slow to get where needed most.
John Burns said two of his centers have experienced a 38% cut in funding and his third recovery center, which had been funded with federal State Opioid Relief (SOR) money, has been operating without funding since October. He says the state has been slow to address the issue.
“Although we've gotten a lot of wink-wink, nod-nod, don't worry the money is coming ,we're going to make it whole, we have yet gotten a commitment on that,” he said.
Burns is not alone in struggling financially, according to Jake Berry, Vice president of policy for New Futures, a nonpartisan, nonprofit organization that advocates for health policies in New Hampshire.
Berry says a New Futures survey found that more than 80% of addiction treatment providers in the state reported significant financial hardship. About half of those who responded to the survey were forced to cancel fundraisers and other critical income-generating events. And about 75% experienced unexpected costs related to PPE and new technologies to adapt to the telehealth model.
“A lot of these organizations have a very thin bottom line. So the impact could be catastrophic unless addressed,” Berry said. “This addiction epidemic is absolutely debilitating to our state and it's something that needs to be addressed fully.”
Katja Fox, Director of the Division of Behavioral Health at New Hampshire's Department of Health and Human Services, explained the complex process for releasing SOR funds.
“We did not receive the award for next federal fiscal year until August. And that necessitates us to go through a process – with our Joint Legislative Fiscal Committee, as well as our Governor and Council, to accept the funds and allow us to expend them. Then they have to go through a contracting process,” she said.
“We do know there have been gaps. Cash needs to be on hand especially for organizations that rely heavily on these state grants. While we understand that cash flow issue, we are working very, very hard and diligently to ensure the recovery centers are able to function.”
The state has been awarded $28 million – the first installment of a second two-year SOR grant awarded by the federal Substance Abuse and Mental Health Services Agency.
The data tells a mixed story
The Associated Press reports that although national data is incomplete, U.S. Drug overdose deaths appear to be on track to reach an all-time high. Before the pandemic arrived, the U.S. was in the midst of the deadliest drug overdose epidemic in history, the AP reports, with a record 71,000 overdose deaths last year. In recent years, New Hampshire has had among the highest opioid overdose deaths in the country.
State data shows an increase in the number of opioid-related calls when comparing a more recent period with a pre-pandemic period. In September, there were 339 calls related to opioid use, compared with 251 opioid-related calls in February – before the pandemic hit in March.
But Katja Fox points to a decline in overdose deaths in New Hampshire. When the state received its first two-year State Opioid Response (SOR) grant in 2018, there were 471 deaths reported, she said. As of mid-August this year, there were 200 deaths, a 12% reduction.
“But looking at numbers and looking at reductions makes no difference when we have one person who is lost to addiction. And to those family members and individuals who are impacted our work isn't done until we see that number at zero,” Fox said.
The state has worked hard to widely distribute Narcan, the overdose reversal drug that can reduce fatalities, according to Fox. “That's our front line. That's where EMS workers are using it and more importantly our community members are using it. This is not something that should be hard to find. So we have tried to make it ubiquitous throughout the state in a number of different ways.“
Some SOR funds are now contributing to more widely distributing Narcan – including to Doorways and recovery centers. “But more recently, through the pandemic, we've distributed it through different channels you'd not typically think of – churches and food pantries,” Fox said.
Federal funding has also gone toward increasing Medication Assisted Treatment (MAT) – using drugs such as Buprenorphine, methadone, and naltrexone to treat opioid addiction. Katja Fox says the state is still trying to make inroads with many "sober houses," where people in recovery live temporarily, working to convince these residences to allow MAT drugs on the premises.
“Housing is so significant," she said. "We are lucky enough to have a few sober houses open to hearing about medication.”
Laconia Services See Some Improvement and Some New Struggles
Federal dollars have helped establish the Doorway system in the Laconia region, enhancing people's ability to access treatment, said Corey Gately, Director of Substance Use Services at the LRGHealthcare Recovery Clinic.
“Even though we are managing services a world better than we were 10 years ago, there are still some significant gaps,” Gately said. “Although we're continuing to see a lot of people accessing services, we're seeing more and more of the people who have been with us for a long time doing poorly through the pandemic, relapsing and struggling in general with things that they weren't struggling with pre-pandemic.”
Gately says her clinic serves about 550 participants at any given time, representing a wide variety of ages. “We probably are seeing more and more folks who are older who are seeking treatment.”
Working closely with recovery organizations such as Navigating Recovery of the Lakes Region, LRGHealthcare has been able to get people more quickly into treatment, Gately said. “But getting someone with alcohol use disorder in somewhere quickly for treatment that's still very difficult for us to do,” she said.
Alcohol, a growing problem, with few resources dedicated to alcoholism treatment.
Although SOR funding was originally narrowly focused on opioid treatment, eventually methamphetamine and other stimulant drugs were included.
But SOR funding still doesn't cover alcohol abuse.
“To me it makes no sense,” said John Burns. “Alcohol is just ignored in this state, while we make so much money off it, we're not addressing it. Right now, our Doorway says there's about a two week wait for residential treatment in this state, but there's a longer wait often for detox beds.”
Katja Fox, too, expresses frustration when it comes to treatment for alcoholism. “Addiction is addiction. We all get frustrated when we have to categorize people and match them up with a particular substance to match them up with a funding sourcem" she said.
"Alcohol is the number one substance used by individuals especially in New Hampshire.”