Peter Fifield says the moment when someone struggling with addiction decides they are ready for help can be a fleeting one. The mental health and drug and alcohol counselor sees it firsthand. He manages one of nine locations around New Hampshire where people can seek help.
These “hubs” are part of the state’s new Doorway program, launched in January with federal funding to address the state’s addiction crisis. “The walk-in access is paramount,” Fifield said on The Exchange. “They can just walk in and get connected.”
(For the full Exchange conversation, listen here. The quotes excerpted here have been edited lightly for clarity.)
At the Doorway center affiliated with Wentworth-Douglass Hospital in Dover, Fifield says, “We assess all their needs: housing needs, work needs, child care needs. Recovery isn’t just not using. Recovery is a long-term process.”
And therein is a major challenge. The Doorway hubs are supposed to help direct people to treatment services, otherwise known as the “spokes” of the new system. And these are too often inadequate or missing.
“If an individual does walk in and they're ready right now but they have a two-week wait to get into treatment, then you can see the gap there in terms of actually getting them connected to a treatment source,” Fifield says.
Doorways are also not available 24 hours, seven days of the week — a key problem, according to many working in the new system. People in need can call 211 at any time, and federal funding has helped bolster that service.
Still, Fifield says, Doorways can provide a place to connect beyond that initial contact. “They are a place where you could do work towards recovery. They can come in, do phone calls. They can hang out, get a cup of coffee and just talk to a care coordinator. We can connect them with recovery coaches.”
John Burns, director of the SOS Recovery Community Organization in Strafford County, insists Doorways should be open around the clock. Burns works closely with Fifield and has high praise for the Wentworth-Douglass hub. He sees progress under the new program but says “spokes,” such as recovery centers, need more money.
Filling in the gaps
Tym Rourke, director of substance use disorders grant-making for the New Hampshire Charitable Foundation, says the solutions are evident – recovery coaches, detox beds, inpatient and outpatient care. What’s missing, he says, is money.
“We have 13 recovery centers, in part because there was a decision to put resources into the operation of recovery centers. We have these Doorways. We now have places people can go to start their recovery journey, in part because there was money. I think that we have to continue to think about how we finance a health care system that can provide the fullest, greatest of services. At the moment, the patient is ready wherever the patient is. And that is something where we have a lot more work to do.”
Rourke does see progress: “There’s been a five-fold increase in treatment, access and recovery support access.”
But low Medicaid reimbursement rates that do not cover the cost of treatment continue to plague the system, says Rourke.
“The increase that was included in the final version of the budget was a 3 % increase, which is not nearly enough, but at least a step forward,” Rourke says. “Of course, the budget is in continuing resolution right now, and so in the absence of a new budget, those rates have not yet come to pass. And so still, Medicaid rates are an enormous issue and an enormous barrier to building out capacity to provide services to folks in the state of New Hampshire.”
Meanwhile, as of this month , 212 people died from opioid overdoses this year, with 56 still under investigation, Rourke said. “We’re not out of the woods even remotely.”
Safe Stations Still Playing A Critical Role
Manchester Fire Chief Daniel Goonan says the city’s Safe Station program – located throughout the city at ten fire stations – was set up for people who are ready for help.
“What we what we were trying to do is just capture that one moment where somebody feels that they could use the help most. Whether they’ve hit rock bottom or have some sort of epiphany or their parents convinced them to finally seek some help,” he said. “And we've become a pretty natural access point. And it's a great way for the fire department to step up and help during this crisis that we've been seeing.”
Manchester’s official hub is Granite Pathways, an organization that also serves Nashua. Goonan says the Safe Station program is “kind of a hub to the hub.”
“In my opinion is if they didn't have the firehouse to make these triage moves here, the hub would be completely overwhelmed with people that are extremely sick and definitely too sick to be talking to a recovery coach or a LADC (Licensed Alcohol and Drug Counselor).”
As of now, about 50% of the people showing up at safe stations are from Manchester, Goonan says. The rest are from outside of Manchester, he said, mainly from Dover and Laconia. They arrive from almost 200 New Hampshire communities, he said, as well as seven other states. He said he’s hopeful that the new Doorway system will increase its capacity and lighten that load.
Burns meanwhile fully admits he’s sending people to Manchester. His recovery service is available around the clock and last month received more than 1,000 visits. He said at times, the only choice for people who are homeless and desperate is to send them to Manchester, where there are more services, though the city says it’s now overloaded.
More than opioids
As Goonan sees it, the opioid crisis is now just part of the story. This weekend, almost 20 people in Manchester overdosed on spice, a synthetic marijuana product.
"This is an all-of-the above crisis. We're seeing so much methamphetamine, so much spice. It's almost like the opiates have passed us by and drugs are just poly-substances. I kind of miss the good old-fashioned alcoholics only, or opiate addicts, because we have medications we can treat them with. But when someone comes in and says, yeah, I'm an opiate addict, but I also use methamphetamines and spice and alcohol and all of the above, it's really changing what we see every day.”