Before the worldwide spread of COVID-19 epidemic outbreaks grew into a pandemic, the epidemic deservedly capturing the most attention here was the opioid- and substance-abuse crisis that had swept across the country. In New Hampshire, its impact was particularly severe, as overdose deaths rose dramatically beginning in 2013, peaking in 2017 at 490 before slowing the two subsequent years, with 415 fatal overdoses reported by the state in 2019.

Although no one was claiming victory, the encouraging turn in the fatality trendline pointed to heightened awareness, federal and state funding and the development of more interconnected services, most recently the Doorway, the hub-and-spoke system implemented by Gov. Chris Sununu’s administration. Even so, the challenge of opioids and other substance abuse remained as 2020 dawned: New Hampshire in 2019 had the third highest per capita rate of fatal overdoses in the country.

Then, COVID-19 arrived, and efforts to control its spread meant stay-at-home, social distancing and other restrictions to limit human interaction and also brought economic pressures from unemployment. It is said that isolation is the enemy of recovery, and substance-abuse advocates warned that progress in easing the crisis was threatened. Sadly, the most recent statistics released last week by the N.H. Chief Medical Examiner’s Office bear that out. During the March to July period, confirmed fatal overdoses rose by over 12 percent, and the increase will likely be higher due to pending toxicology testing results on a number of deaths.

With the stay-at-home order now lifted and the economy beginning to reopen, it might be hoped that trend would start to reverse itself. But continued treatment and access to services will be critical, and the economic double whammy of the COVID-19 virus has many of New Hampshire’s substance use treatment providers struggling, according to a July report of New Futures, the statewide nonprofit public health advocacy organization.

In a survey of 23 large and small substance-use treatment providers, including four in the Monadnock Region, New Futures found substantial financial losses that were likely to result in staffing reductions beyond layoffs and furloughs that have already occurred. That will surely further limit treatment capacity and, according to Nelson Hayden, executive director of Keene’s Doorway hub, could have serious implications for the state’s ability to fight the drug epidemic.

Across the state’s 10 Doorway locations, there was a 5 percent decrease in patients in the second quarter of 2020 from the preceding quarter. Hayden suggested the different experience in this region may have resulted from Keene’s hub continuing to offer in-person services throughout the pandemic or from simply more people needing help. That the Doorway in Keene has recently increased its visibility and accessibility with its move downtown may also have been a factor.

The hub-and-spoke approach is a fragile ecosystem, however. Even if the Doorway trends statewide reverse and Keene’s continue in a positive direction, cutbacks or closing at treatment-provider spokes will limit the referral options available to the hubs, likely resulting in longer wait times and difficulty in delivering needed services. With this serious concern in mind, when releasing its report, New Futures called on Gov. Sununu to allocate an additional $15 million-$18 million of federal CARES Act funding to the financially imperiled treatment and recovery organizations. We agree.

Before the pandemic hit, New Hampshire’s hub-and-spoke system had started to show promising results in tackling the substance-abuse epidemic, but the system needs swift propping up if the recent upward trend in fatal overdose data is to be reversed. Noting the Monadnock Region and others in the state have worked over the years to expand addiction treatment and recovery services, New Futures President and CEO Michele Merritt told The Sentinel, “[t]he financial losses experienced by local providers threatens to undermine this progress and propel the region backward in its fight against the addiction crisis.” Although she was addressing this region specifically, her words surely apply statewide as well.