Surrounded by local leaders, U.S. Sen. Jeanne Shaheen brought her breadth of knowledge on the opioid crisis to the old Cheshire County courthouse Friday.
While she was ostensibly there to walk through her new bill, the “Turn the Tide Act” — which would significantly bolster federal grant funding to combat the opioid epidemic — much of the session was dedicated to listening.
The senior senator heard from service providers, lawmakers, county officials, first responders and a recovery peer coach on the biggest challenges they continue to face in prevention and recovery efforts as federal funding remains uncertain.
“One question that I ask everyone [is]: What happens if these federal resources dry up, and you don’t have the funding you’ve had for the last couple of years?” Shaheen, a Democrat, said at the outset, before relaying what she’s heard from other stakeholders in the Granite State. “... One of the other directors put it in much starker terms. He said, ‘People will die.’ ”
Shaheen’s bill would increase State Opioid Response Grants from $1.5 billion per year to $5.5 billion per year in addition to raising the Medicaid reimbursement rate for medical professionals treating substance use disorders.
New Hampshire has the seventh lowest reimbursement rate in the country, according to the Kaiser Family Foundation, which many service providers have attributed to a difficulty in recruiting and retaining a big enough workforce to address the opioid crisis.
In 2016, the only psychiatric ward in Cheshire County closed, with Cheshire Medical Center citing an inability to recruit enough psychiatrists to staff it.
The general ethos of the Turn the Tide Act, Shaheen said, is to improve three fronts in reining in the opioid epidemic by increasing the flexibility of spending federal funds at the local level, prioritizing prevention services and increasing the number of treatment providers.
“One of the concerns that I have is that, like so many other things, Washington has provided some resources to address substance use disorders, and now we’re on to other things,” Shaheen said.
Another component of the bill would provide $10 million to first responders for mental health services.
“About half of our police force has been here five years or less, and they have seen more trauma in the time that they’ve been here than our longer-serving officers have seen over their whole careers — and they need some support,” Mary Punch, co-director of the Phoenix House in Keene, told Shaheen before thanking first responders at the table, including Keene Deputy Fire Chief Jeffrey Chickering.
Shaheen had facts and figures for the bill ready off the top of her head, in addition to other developments in Congress to address the opioid crisis. But she was quick to point out that despite recent progress, she sees threats from the Trump administration that could jeopardize it.
Phil Wyzik, CEO of Monadnock Family Services, noted that Republican efforts to turn Medicaid into block grants for each state — essentially capping the total spending in advance — could spell disaster for those in recovery.
“That would just like, put the kibosh on everything, right?” Wyzik asked Shaheen pertaining to her bill, were the block grant proposal to be signed by Trump.
Shaheen responded by saying that, at least so far, enough Republicans in the Senate have joined Democrats to prevent that from happening.
However, she later added that a broader personnel issue in Congress puts progress in the opioid epidemic at risk, with members not being well enough educated on the issue to make the best decisions.
“We need to refocus the debate on the fact that we have not solved this issue yet,” Shaheen told The Sentinel.
Later on Friday, Shaheen was set to visit the Community Kitchen in Keene.
Beyond federal funding, there is not much left at the state or local levels to help those seeking recovery, according state Sen. Jay V. Kahn, D-Keene, and Jake White, a peer recovery coach at the Keene Serenity Center.
Kahn and others noted that Medicare reimbursement remains an issue, in addition to the program not covering a wide swath of services related to substance use. The state senator deferred to Nelson Hayden, director of The Doorway at Cheshire Medical Center, to illustrate how arbitrary insurance coverage can be in treating these disorders.
“One of the major gaps is once you get into recovery,” Hayden said. “We can treat people for a 28-day program, according to some insurance guru counting the beans saying that 28 days is when someone is going to be healed — which is untrue, just a fictitious number.”
Later on, White got frank about the barriers to helping people who’ve hit rock bottom.
“When a guy can go to rehab, and his insurance can turn him down to pay for it, but will send that same person to a doctor who will prescribe painkillers ... well, if you’re not gonna get me into rehab, might as well use on my insurance — I personally have done that,” White said. “... The biggest barrier I’ve run into — and I’m talkin’ street-level people that I’ve run into who live in tents and wanna get into rehab, wanna get their stuff together and have no insurance, so I send them to The Doorway and they get insurance — but the biggest barrier is money.”
White became visibly frustrated in describing how at seemingly every turn, those wanting to help themselves can’t catch a break with insurance coverage for the programs they seek out.
“To the person walking in off the street that has no insurance, no benefits, no social security — no nothing — you know, it’s an obstacle course,” he said. “It’s much easier to go right down the street [to get high]. It’s an easier solution... And it sucks. I’m sorry, but that’s just me speaking from the front lines.”
Shaheen told White he was right.
The senator also entertained a more philosophical line of inquiry from Dennis Calcutt, project manager for the Monadnock Region System of Care.
Calcutt — who, along with several others, including Wyzik, Hayden, White, Cheshire County Drug Court Coordinator Alison Welsh, Keene City Councilor Mitchell H. Greenwald and Mary Drew, founding CEO of Reality Check in Jaffrey — asked why there is such a demand for drugs in the first place.
“It’s all, in essence — and I don’t mean this in a bad way — reactive,” Calcutt said of Shaheen’s bill and other efforts to combat addiction. “This is reactive funding. This is not proactive funding. This is not thoughtful funding.”
Shaheen noted that grants for youth-oriented prevention programs are in the bill, and would extend existing funding in that realm for an additional five years. But she conceded to Calcutt’s broader point, and agreed that getting to the root causes is “how we avoid this problem for generations to come.”
Earlier on Friday, Executive Councilor and potential gubernatorial candidate Andru Volinksy, D-Concord, said he would not take “the pledge” to never raise income or sales taxes, which Cheshire County Commissioner John G. “Jack” Wozmak said could be part of a longer-term solution to the opioid crisis and other addiction issues in the Granite State.
Any public response to the opioid epidemic, longstanding alcoholism and addiction to other substances in New Hampshire hinges almost exclusively on federal funding, Wozmak said after the session, with property taxpayers left on the hook for everything else.
“I’m not a fan of an income tax, but here’s the thing: The people who take ‘the pledge’ for no new taxes — it’s a fiction,” Wozmak, the state’s former drug czar, told The Sentinel when asked about Volinsky’s comments to WMUR, which he has reiterated previously on the campaign trail.
“Ever since everybody in Concord has taken the pledge — no new taxes — your property taxes have tripled,” Wozmak said. “And so there is new taxes. There’s never been no new taxes. What you have is increasing property taxes.”
Under the status quo, everyone Friday seemed to agree there is more to be done. But with additional funding in the bill for mental health services for first responders, Keene Mayor Kendall W. Lane said he hopes the psychological challenges facing ambulance crews will finally be addressed.
“It’s not what they signed up for,” Lane said.
Those seeking recovery resources in Cheshire County can visit the 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 by calling 211.