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General discontent: Communities warily eye future of region's iconic local stores

After two general stores closed in local communities within a month of each other, area residents expressed dismay at the loss of businesses that serve myriad roles in small towns.

The Gilsum Village Store’s last day was New Year’s Eve. Raymond F. Britton bought the property in the heart of town and reopened the business in 2008, and he ran it until Jerry Gomarlo took over at the tail end of 2018, though Britton maintained ownership of the building. Gomarlo, who also owns Gomarlo’s Shop and Save Supermarket in Swanzey, declined to give a reason for the closure late last month and wasn’t reachable for comment Friday.

In late November, Sullivan’s Little Country Store shuttered after decades in business. The owner, John F. Little, cited a steep decline in customers during construction on Route 9, which detoured traffic away from his store.

Sullivan Selectman Laura Merrifield, a 25-year resident, lamented the loss of the store, which she said lived up to more than its title. Little cooked pre-made meals for customers to take home, she said, and he was famous for his doughnuts.

Businesses like his are not only a convenience to town residents by allowing them to avoid a longer trip to Keene for a few grocery items, she argued, but they also present a safer option during icy winters.

And oftentimes, these shops are the only spot to run into neighbors, Merrifield added.

“When you’re in a very small community like Sullivan, there aren’t that many gathering places. The store was really the only commercial entity in town,” she said. Libraries can act as a public space to convene, but “is that a replacement? Not necessarily.”

Merrifield also acknowledged, however, how difficult the competition must be “when you can go to Aldi’s and get a half a gallon of milk for 90 cents.”

Gilsum Selectman Tim May said losing his town’s village store is a shame, noting its role as a vendor of locally made goods for travelers to take home. It’s always been popular during Gilsum’s annual rock swap, he said.

Like Merrifield, though, he also recognized the challenges in keeping these “true country stores” alive.

“It’s much easier to be on the sidelines complaining about it or wishing it was still here, but to get people involved is another thing,” May said.

He pointed to the model of the Acworth Village Store, as many people did during these discussions, and wondered if that might be a viable solution for other stores like it.

The town’s historical society owns the building, and a nonprofit group, the Acworth Community Project, runs the 155-year-old business. When the store took a hit in 2018 during nearby bridge construction, residents pitched in and contributed $10,000 to help recuperate the losses.

Harrisville’s general store is also run by the nonprofit Historical Harrisville Inc.

In other towns, such businesses have found success by filling a void left in the wake of other closures. Nearly a year after the Alstead Village Market on Mechanic Street shuttered, the Alstead General Store opened in the same space in mid-2018 with a social media audience that followed every step of its progress.

Bobbie T. Wilson has lived in Alstead for just over 22 years.

“You’re talking to somebody who really believes in shopping local,” she said.

She’s a lieutenant emergency medical technician with the town’s ambulance department and also runs a community Facebook page that shares news and events in the Fall Mountain area.

Shunning big-box stores and online retail, Wilson’s mission is supporting area businesses and encouraging her friends and neighbors to do the same. She stressed the importance of spending money at the places that give back to their towns, both in local taxes and philanthropy. It may cost more, she said, but buying even one or two items at the nearby general store helps.

Wilson said many of these mom-and-pop shops thrive when they find their niche. The Alstead store has excelled in adapting to its customers’ needs, she added, and has adjusted its offerings based on feedback.

Britton, who ran the Gilsum store for 10 years, echoed many of the sentiments others shared about country stores’ benefits, as well as the barriers to keeping them open. Though he loved the business and enjoyed seeing so many faces come through the door, Britton said it was time to hand over the reins.

“A lifespan of a store owner is short,” he said. “It’s a tough business, it’s a lot of hours, it’s a lot of work.”

He declined to discuss the specifics of his arrangement with Gomarlo but said the closure was unexpected.

The store’s absence affects Gilsum, of course, but also surrounding communities that don’t have their own equivalent business, Britton noted.

“I want to make sure the community is taken care of, and it’s just really sad, especially for my Marlow friends. Now they have to travel quite a ways to get a gallon of milk,” he said.

The pull isn’t just the convenience, he added, “because at the end of the day you can go to Keene and get things cheaper.” Britton touted village stores as “the heart of the community” where people can congregate and get informed about town goings-on.

A former Gilsum selectman, he said he always made information about town government and area events accessible when he ran the store, and he wasn’t alone in that goal. In Sullivan, Merrifield said Little offered the same service to his customers.

Referencing state efforts to protect covered bridges and historic barns, Britton wondered if there could be a similar program for country stores, such as a tax break, to preserve this piece of New England culture.

As for the Gilsum store, Britton said he’s in the process of trying to get a tenant in the space.

“In the back of my mind I still think about reopening it for myself, but I’m not there yet,” he said. “I’m hoping to find someone who has interest in my town and wants to be there.”

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Seeing more patients, Phoenix House broadens services in Keene, Brattleboro

Seeing a recent surge in patient volume, Phoenix House New England is expanding its services in Keene and Brattleboro.

The not-for-profit behavioral health provider specializes in the treatment and prevention of substance use disorders and mental health disorders, according to its website. Phoenix House has 97 locations across 10 states, including in New Hampshire and Vermont.

Each Phoenix House location offers different services depending on the area’s needs, according to Phoenix House New England President and CEO Peter Mumma. But in recent months, the organization has offered more services due to an increase in patients at its New England sites.

This includes adding more outpatient services for substance use treatment in Keene, plans for outpatient treatment in Brattleboro and telehealth services for both substance use and behavioral health disorders across the state of Vermont.

“Our volume specifically has increased over the past few months, and we grew at the speed the community needed us to,” he said.

Keene’s location, for example, has seen a 23 percent uptick in the past six months and an 83 percent rise over the past two and a half years, according to data provided by Mumma.

Mumma said the increase in patients could be related to the region’s growing focus on combating addiction.

“We’re seeing a large focus and increase on overdose prevention,” he said. “Largely, I think it’s just an increase that we are seeing in requests for care with more and more discussion on the need and benefit of treatment.”

Programs like The Doorway — New Hampshire’s “hub and spoke” system, launched last year, to screen, assess and refer people to treatment and support services in the community — have also helped bring attention to the issue, Mumma noted.

The New Hampshire program is modeled after a Vermont initiative that began in 2014, designed to increase access to medications that aid in recovery from opioid addiction.

In Vermont, the Phoenix House has two sobriety houses in Brattleboro — one for men and one for women — and a men’s home in Bellow Falls.

The program — Recovery in an Independent, Sober Environment (RISE) — supports people who have experienced a repeated pattern of drug or alcohol addiction as they learn how to sustain long-term recovery. Clients spend between three and 24 months in the program, the website states. To enroll, a person must have completed a residential or intensive outpatient treatment program within the past six months.

But Phoenix House does not offer outpatient or inpatient treatment in Windham County.

Mumma said the agency is filling part of that service gap by adding outpatient mental heath services and medication-assisted treatment for substance use disorders in Brattleboro. The services, expected to launch in a few weeks, will be offered inside the RISE Women’s Supported Living Program at 300 Maple St.

This comes at a time of uncertainty for another local provider, the Brattleboro Retreat, whose president and CEO recently announced it could close or scale back its services due to financial pressures.

President and CEO Louis Josephson told The Commons this past week that downsizing to fewer beds was the more likely of the two scenarios.

The Retreat, among other mental health services, offers Suboxone treatment through Vermont’s hub and spoke system. Suboxone is one of three medications approved by the U.S. Food and Drug Administration to treat opioid-use disorders.

If the Retreat shutters, Mumma said previously, Phoenix House’s expansion in Brattleboro could help make up for the loss.

Phoenix House’s Brattleboro and Burlington locations will also soon be centers for telehealth services across Vermont, according to Mumma.

Telehealth — which connects patients and doctors virtually through video conferencing — will be available for RISE program clients or any Vermont resident seeking treatment for substance use or behavioral health disorders.

“Anyone in Vermont will be able to access the prescription and clinical services without experiencing any of the other barriers, like transportation,” Mumma said.

The Brattleboro and Burlington offices already have psychiatric nurse practitioners and therapists on staff, so patient consultations will be conducted from those locations, Mumma noted.

“We hope that this will follow the progression of needing to meet people with health care needs at the speed they need it,” he said. “They’ve called because they need it right now. It’s not a matter of even waiting a couple of days.”

The organization’s telehealth services are slated to be available in a few months, according to Mumma.

An intensive option in Keene

The Phoenix House location in Keene, at 106 Roxbury St., offers medication-assisted treatment, residential care, partial hospitalization and outpatient services for behavioral health and substance use disorders.

The site recently added intensive outpatient treatment for the latter, Mumma said.

The intensive program — which is for patients who need a higher level of care than people in standard outpatient treatment — provides supportive sessions to identify substance use triggers, while teaching skills for reduction of use or abstinence, the website states. The program also requires outpatient drug and alcohol treatment group sessions, which meet three times a week for three hours.

Most patients live at home during this program, but boarding is available for those who want a more intense program, which lasts seven days.

Phoenix House also has a residential treatment program in Dublin for adults with substance use disorders, but it’s not part of the recent expansion.

By adding these services, Mumma said the organization hopes to help more people through recovery.

“Every community has a huge amount of need,” he said. “We’re specifically positioning ourselves to be more health-care focused and focusing on the whole person ... this is about community care, engagement and really being there as a community health care provider.”

Those seeking recovery can call the Phoenix House at 1-888-671-9392 to schedule an appointment.

For immediate assistance, Cheshire County residents can visit The Doorway at 640 Marlboro Road in Keene (the Curran Building on Route 101) Monday through Friday, from 8 a.m. to 5 p.m., or seek support through the state’s 24/7 hotline at 211.

Information on Vermont’s hub and spoke program can be found at blueprintforhealth.vermont.gov.

Medicaid expansion may have saved thousands from drug overdose deaths

Expanding Medicaid rolls under the Affordable Care Act may have saved as many as 8,132 people from fatal opioid overdoses, virtually all involving heroin and fentanyl, a study released Friday suggests.

The research is the latest evidence that allowing more people to enroll in Medicaid has saved lives and improved health.

The researchers concluded that additional access to drug-abuse treatment was linked to a 6 percent lower overdose rate for states that allowed more people to enroll in Medicaid than in states that did not. That translated into 1,678 to 8,132 fewer deaths in those states from 2015 to 2017, they wrote in an examination of data from 49 states and the District of Columbia.

The research, published in JAMA Network Open, was not designed to prove cause and effect. Rather, it found an association between the decline in overdose deaths in the 32 states and the District of Columbia that had expanded Medicaid at the time of the study.

Other reviews of Medicaid expansion have shown that low-income people with asthma and diabetes were less likely to be admitted to hospitals; that smokers received help quitting tobacco; and that some states sharply increased spending on services for people with substance use disorders.

Critics of President Donald Trump’s efforts to undermine the Affordable Care Act, also known as Obamacare, have frequently said that doing so conflicts with his work to stem the nation’s opioid crisis, which has taken more than 400,000 lives over the past two decades.

The new study appears to be the first to conduct a county-by-county examination of overdose deaths and Medicaid expansion. It found an 11 percent decline in the death rate from heroin overdoses and a 10 percent drop in deaths from illegal fentanyl and its analogs.

“As states invest more resources in addressing the opioid overdose epidemic, attention should be paid to the role that Medicaid expansion can play in reducing opioid overdose mortality,” most likely through the provision of anti-addiction medication, the researchers wrote.

The study found no link between Medicaid expansion and declines in overdose deaths from prescription narcotics. In an interview, the leaders of the research team — Nicole Kravitz-Wirtz of the University of California, Davis School of Medicine and Magdalena Cerda, of the NYU Grossman School of Medicine — said that Medicaid expansion likely brought many of the poorest Americans into the insurance program. That group was more likely to be using street drugs than prescription narcotics, they said.

Other research has indicated that by dramatically increasing the availability of the overdose antidote naloxone on the streets, Medicaid expansion also may have cut the number of overdose deaths.

The study unexpectedly found a rise in overdose deaths caused by methadone in states that expanded Medicaid. The drug is most commonly known as a treatment for opioid use disorder, but it is also prescribed for pain, though much less frequently than drugs like oxycodone.

Kravitz-Wirtz said Medicaid recipients are more likely to receive the drug as a painkiller, and that further research is needed to explain why the review found the increase in those deaths. Previous research has shown methadone to be safe and effective in suppressing the use of opioids, particularly heroin.