Three years ago, Dean LeMire thought he would die before getting treatment for heroin addiction in New Hampshire.
A University of New Hampshire graduate who grew up in in Exeter, LeMire, 29, began drinking as a teenager, progressed to prescription opiates after stealing pain medication from a relative and then started using heroin. Before long he was suicidal.
"The heroin had stopped working," he said.
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He finally secured a place at the only state-funded in-patient treatment center in his area — but only after calling every day for three weeks.
“I was one of those people who was definitely nearly a casualty of the heroin crisis,” he said.
More than 47,000 people died in the United States from opioid drug overdoses in 2014, an all-time record, the Centers for Disease Control and Prevention reported Friday.
And as the presidential candidates criss-cross New Hampshire wooing voters for the country’s first primary in February, the state’s struggle to confront its own opioid epidemic is in the national spotlight — its relative lack of funds, too few beds and long waiting lists. Among 18- to 25-year-olds, New Hampshire ranked among the highest of all states for binge drinking and use of illicit drugs in the previous 30 days, according to the most recent National Survey on Drug Use and Health.
Politicians Confront Opioids
Pressed by residents, the visiting candidates have added drug addition as a top talking point alongside the economy and terrorism. A video of New Jersey's Republican Gov. Chris Christie describing the care his mother, a longtime smoker addicted to nicotine, received for lung cancer got more than 3 million views. He also shared the story of a law school friend who became addicted to Percocet after injuring his back.
“And he couldn’t get help and he’s dead,” Christie told a New Hampshire audience as he advocated for treatment.
Ohio Gov. John Kasich described increasing prison drug rehabilitation and law enforcement in his state. Former Florida Gov. Jeb Bush talked about his daughter’s struggle with drug addiction, former Hewlett-Packard CEO Carly Fiorina about the death of her step-daughter from a drug overdose.
On the Democratic side, Hillary Clinton put forward a $10 billion plan for treatment. Sen. Bernie Sanders in neighboring Vermont advocates for the overdose antidote, naloxone, to be made more widely available.
Across the country, overdoses from heroin have soared in the last decade, with the rate of heroin-related deaths nearly quadrupling between 2002 and 2013, according to the Centers for Disease Control and Prevention. More than 8,200 people died in 2013.
New England officials have been outspoken about the epidemic. Last year, Vermont Gov. Peter Shumlin devoted his entire State of the State address to the state’s heroin problem and budgeted money for medication-assisted treatment. Connecticut improved prescription drug monitoring and Rhode Island school nurses pushed for supplies of naloxone. Maine’s Gov. Paul LePage earlier this month focused on enforcement and authorized hiring 10 new drug agents.
The Gloucester Revolution
But it was the police chief in Gloucester, Massachusetts, who sparked imitators eager for a new approach when he announced on Facebook at the beginning of the year that his department would assist addicts seeking help.
“Any addict who walks into the police station with the remainder of their drug equipment (needles, etc) or drugs and asks for help will NOT be charged,” Chief Leonard Campanello wrote in May. “Instead we will walk them through the system toward detox and recovery. We will assign them an 'angel' who will be their guide through the process. Not in hours or days, but on the spot.”
In an update posted on Dec. 11, the chief wrote that 310 people had been placed in treatment — with 85 centers participating. Forty-five police agencies in more than 10 states are now helping addicts to find treatment and another 85 others are expected to develop programs based on Gloucester's.
“We treat all with this DISEASE as a valued member of our community and work to support their families with dignity and respect,” he wrote. “DO NOT BE ASHAMED OF YOUR ILLNESS. DO NOT HIDE IT.”
New Hampshire, which hopes to put similar programs in place, spends less than any other state in New England on alcohol and drug services, $8.81 per person in state and federal funds compared to $14.32 in Rhode Island, the next lowest spender, or $48.35 in Connecticut at the high end, according to figures from the federal Substance Abuse and Mental Health Services Administration. The average for New England is $25.70.
Getting Help in the 'Live Free or Die' State
Adding to its challenge are the people newly eligible for treatment under the New Hampshire Health Protection Program, the state’s expansion of Medicaid under Obamacare, but for whom the states does not have enough programs or professionals. Between the beginning of September and the end of March, 1,800 people sought drug and alcohol treatment under the expansion, which must be reauthorized next year.
“We’re building infrastructure in the middle of a crisis,” said Melissa Silvey, the director for continuum of care for One Voice for Strafford County, a recovery coalition.
New Hampshire has 1,200 beds in residential treatment programs, Silvey said. The waiting period is six to eight weeks and for some of the programs, addicts must call in three times a day. If they fail to, they are bumped to the end of the waiting list, a policy that discourages Silvey.
“Just picture it,” she said. “You’re an addict. You’re not quite thinking about, ‘Call that treatment facility.’ You’re dope sick.”
LeMire said he tried to stop drinking after college and when he no longer had access to opiates he turned to heroin instead.
He started seeking treatment on Mother’s Day in 2012, telling his mother he was addicted to shooting heroin. She helped him find a bed in a program run by Southeastern New Hampshire Alcohol & Drug Abuse Services.
“On June 2, I got in my last drunken car accident," he said in an email. "June 5 I took my last drink while withdrawing from opiates and June 6, I entered rehab."
Raiding New Hampshire's Treatment Fund
New Hampshire could have more money available to fund substance abuse treatment and prevention. Fifteen years ago, it created an Alcohol Abuse Prevention and Treatment Fund, which was supposed to get 5 percent of the New Hampshire Liquor Commission’s yearly gross profit, but which has been fully financed only once.
The Alcohol Fund will receive $6.656 million for the next two years, far short of the $19 million it would have gotten if fully funded. Legislators decided to set the amount awarded at 1.7 percent instead of 5 percent.
Had New Hampshire spent more money on prevention and treatment it might have avoided the severity of the epidemic, said Linda Paquette of New Futures, a non-profit group in Concord that works to prevent drug and alcohol problems.
In 2012, her organization issued a report, "We Need Treatment," that noted that 14 residential facilities had closed over the previous decade because they were not receiving adequate reimbursements for care they provided. They were not replaced, she said.
"So over the years, resources for our alcohol and drug services system have been strangled essentially," she said.
The epidemic is cutting a wide path of destruction. Three hundred and twenty-five people died in New Hampshire last year. That is more deaths from drugs than traffic accidents, a statistic true in 36 states and Washington D.C., according to “The Facts Hurt: A State-By-State Injury Prevention Policy Report,” a survey by the Trust for America’s Health and the Robert Wood Johnson Foundation.
Heroin use has risen across the board — among men and women, most age groups and all income levels, the CDC reported. Some of the greatest increases have been among those with historically low rates of use, women and people with higher incomes.
One cause of the epidemic: abuse of prescription opioid painkillers. Forty-five percent of people who use heroin are also addicted to painkillers, according to the CDC. Heroin laced with the synthetic painkiller fentanyl is worsening the problem.
New Hampshire Gov. Maggie Hassan created a task force last month to study an array of issues around the epidemic, including insurance coverage for treatment, drug courts, prescription drug monitoring and improving law enforcement. The task force this week recommended speeding up the review of some changes including removing prior authorization for first visits for drug treatment and aligning penalties for distributing and manufacturing fentanyl with those for heroin.
Balancing Budget Demands
The chairman of the state House of Representatives Finance Committee, Republican Rep. Neal Kurk, wants New Hampshire to better evaluate the programs that it is being asked to fund — both in terms of how well they work and how cost effective they are. Five percent of alcohol sales was an arbitrary figure, he said.
New Hampshire, like other states, does not have unlimited funds, he said.
“Remember, a dollar that we spend on an opioid program can’t be spent on the developmentally disabled,” he said. “So we have to choose.”
Treatment advocates will continue to fight for a full 5 percent of alcohol sales, said Timothy Rourke, chairman of Gov. Maggie Hassan’s Commission on Alcohol and Drug Abuse Prevention, Treatment and Recovery, which dispenses the funds.
“The general public thinks we have an opiate epidemic and while that is true, it is the tip of an iceberg,” Rourke said. “New Hampshire has had some of the highest rates of substance abuse of any state in the United States since at least the late '90s if not longer.”
LeMire, now a substance misuse prevention coordinator for One Voice for Strafford County, recently traveled to Scarborough, Maine, with members of the Dover, New Hampshire, police department, to study a program that began there in September. Modeled on the one in Gloucester, it pairs the police department and a recovery center, with volunteers walking addicts through the steps of getting help.
"The waiting lists at our local state-funded rehabs are three to four weeks," he said. "People just die. They don't get into treatment."
New Hampshire, like other states, is facing what were once big city problems in its small towns and needs the services that cities have implemented: needle exchanges, access to naloxone and teams to reach out to people who are battling homelessness, substance abuse problems, and mental illness, he said.
"All the energy, passion and expertise, it's right there," he said. "It's really obvious to us, at least to me, that we can't wait for the state to act on this. So we don't."
LeMire said that his recovery from heroin addiction was possible because of the love and guidance from others who had dealt with their own drug addiction.
"So I feel like the same principals apply to a community that needs to recover from an opiate epidemic or from addiction on whole, which is it takes a lot of us, setting aside of old ideas that don't work and welcoming of new ideas, and especially from people who have done this thing before," he said.