There's been a lot of national attention on the opioid crisis, culminating in the President's declaration last week of a national public health emergency. And that may mean more funding is coming to New Hampshire.
But where should that money go? What's the fix?
We asked folks who have been on the front lines of the epidemic here for years for solutions. Here's what they offered.'Unfettered access' Tym Rourke
(left) has chaired the Governor's Commission on Alcohol & Drug Abuse Prevention, Intervention and Treatment for eight years. He said he hopes the President's declaration will bring more flexibility and funding to the table.
"Regardless of what part of the continuum you want to think about - more prevention, more treatment, more recovery - it's about making sure that any individual has immediate, unfettered access to the things they need," he said.
However, Rourke said, "None of this matters unless we can finally as a nation approach this disease just like we approach every other one. And the way we do that is people have insurance cards and they work."
If people can't access services, nothing will change, Rourke said. "Quite frankly, addiction (treatment) should not be paid for by grant," he said.Recovery housing Bryan Patriquin
(left, showing his tattoos that read, "To thine own self be true"), 27, of Manchester has been in recovery from heroin addiction for nearly six years. A senior at Southern New Hampshire University, he has his own business and plans to pursue graduate school in clinical mental health counseling.
Patriquin says the greatest need for those new to recovery is safe housing. "When an individual gets out of treatment, very rarely does that person have a job waiting for them. Very rarely does that person have loved ones that are happy to see them," he said. "Where does that individual go?"
Too often, he said, they end up back in their old environments and fall back into addiction.
Investing in recovery housing doesn't get a lot of attention, Patriquin said. "But it's going to save lives." Susan Markievitz
(left) of Windham lost her 25-year-old son Chad to an overdose in 2014; she has another son in recovery. She now runs a support group for parents like her in Derry.
If she had the ear of the President, she'd urge him to fund sober living programs that offer education and job search skills to help people get back on their feet after treatment. "Not only are they fighting their addiction, but their minds are also swirling: 'Where am I going to get a job? How can I work?'"Full-service recovery Donna Marston
(left) became an unwilling expert on opioid addiction when her son became addicted. Since then, she's created support groups for parents, written two books about her family's journey, and started a scholarship program to help those in recovery with expenses. She also hosts an online support group that draws members from all over the country.
Marston said if she had a million dollars, she would build a full-service campus to bring people through detox, inpatient treatment and recovery. "The program would fill in the gaps that people often fall through when they are in early recovery such as day care, transportation, how to live a life without drama, chaos and lying," she said.
It also would provide parents and other family members support services. Insurance coverage Sarah Freeman
(left) is executive director of New Hampshire Providers Association, which represents prevention, treatment and recovery providers. She said in the view of providers, two of the biggest barriers are financial uncertainty and workforce shortages.
She said it's difficult for providers to expand services when they don't know if programs such as Medicaid expansion will even be there; it's currently due to sunset at the end of 2018. "If we're not going to have a way to pay providers who treat those folks, there's no safety net," she said. Michele Merritt
(left), senior vice president and policy director at New Futures, said making sure that Medicaid and private insurance cover treatment and recovery is critical. "If we're going to make a dent in the opioid crisis, the things we should be doing are ensuring that people have access to affordable health coverage, and once they have that coverage, that they can actually use it."
Merritt said New Hampshire has been able to increase investment in recovery support services and prevention only because Medicaid expansion covers the cost of treatment for thousands of state residents.Mentor the youth
Laconia Police Chief Matthew Canfield
(left) says it will take a multi-pronged approach to address the crisis, including treatment, law enforcement and drug courts.
But Canfield said what's often overlooked is prevention.
His idea is to have police officers serve as mentors to middle-school students, and have students do their own research about the devastating effects of drugs and then teach their peers.
"Because once somebody is addicted to heroin, it takes such a strong hold on them," he said. "Even if they get treatment and they become sober, it's a lifelong struggle.
"So let's put more time and effort and resources into prevention before people have the opportunity to try this stuff," he said.Cut the strings Melissa Crews
(left) serves on the board of Hope for New Hampshire Recovery. A successful business owner, she's been in recovery for 24 years.
She wants to see more funding for accredited peer support programs "without burdensome strings or mandating billing system requirements."
And it's the same for recovery housing, she said. "Push National Addiction Recovery Residence accreditation and let that be enough to help these houses get up and running."
Crews said it's critical to have services available immediately. "It takes guts and courage to ask for help," she said. "When you are turned away, it is devastating."Higher reimbursement Eric Spofford
(left) is founder and CEO of Salem-based Granite Recovery Centers, which has five facilities in New Hampshire that provide the full range of services from medical detox to sober living.
Spofford is a recovering heroin addict; he'll celebrate 11 years of sobriety in December.
He said one needed fix is an increase in Medicaid reimbursement rates for inpatient residential treatment, currently $162 a day. He said that is a fraction of what private insurance will reimburse for such treatment, and doesn't cover his operating costs.
Merritt from New Futures said reimbursement rates for substance use disorder services are "chronically low, which makes it really difficult to attract clinicians to serve this population."
"An incentive in the form of enhanced reimbursement would make a world of difference," she said.
And Freeman from N.H. Providers Association proposes the state adopt loan forgiveness programs for young people who go into the treatment field, especially in underserved areas where they're needed.
If Donna Marston could ask one thing of the President about opioid addiction, she said, "It would be to educate people that this is a brain disease."
"They're good people who are sick," she said. "They've got a hole in their soul and they're looking to fill it. And they fill it with drugs."
Marston said she's one of the "lucky ones."
Her son has been in recovery for more than 9 years; he has a "beautiful wife," she said. And their first child, a son, was born on Friday.
"So blessings come out of this nightmare," she said.