Epidemic: Treatment is key to addressing substance abuse, officials tell Sen. Shaheen

LACONIA — "I'm really here to listen," United States Senator Jeanne Shaheen told more than two dozen law enforcement officers and substance abuse practitioners who crowded into the community room of the Laconia Police Station yesterday for a roundtable to address the scourge of opiate abuse that the senator called "an epidemic."

Last year at least 300 men and women in New Hampshire died from overdoses of opiates — 10 of them in Laconia. Perhaps even more telling, Narcan, the medication used to counter the effects of opiates, was administered to 3,275 people who overdosed.

Despite the presence of law enforcement, the discussion turned more on the prevention and treatment of substance abuse than on interdicting the traffic in illicit drugs, especially heroin.

"We don't believe we can arrest our way out of this issue," said Captain Mark Armaganian, who heads the Investigative Services Bureau of the New Hampshire State Police, which includes the narcotics unit.

Shaheen began by asking Eric Adams, the PET (prevention, enforcement, treatment) officer in the Laconia Police Department, to describe what she said was "a model I haven't heard about." He explained that he responded to all overdoses to support the individuals and their families and worked closely New Horizons Counseling Center to steer addicts toward treatment and recovery. "I'm not a counselor," he said. "I don't have the education for that, but one thing I do have is compassion." Police Chief Chris Adams added, "It's more about treatment than going out and making arrests."

Mayor Ed Engler recalled a conversation with Adams, who told him that in speaking with addicts they were quick to recollect the trials of their upbringing and childhood, from which he concluded, "despair, hopelessness and poverty are at the root of this issue." Observing that heroin use is "certainly a crisis," he said that it is not unique to New Hampshire but common throughout the country. At the same time, he noted, "It is an issue that affects a very small percentage of our population. The aspect most interesting to me," he continued, "is prevention."

Dr. Paul Racicot of LRGHealthcare, who directs the Nathan Brody Chemical Dependency Program at New Horizons, agreed, stressing the importance of early intervention, including counseling elementary school pupils about the dangers of both prescription and illicit drugs.

He was echoed by Linda Paquette, executive director of New Futures, an advocacy organization, who said that primary care physicians are especially well positioned for "early detection and screening."

Deputy Fire Chief Shawn Riley said that his team of EMTs and paramedic administered Narcan to 41 patients in 2014 and are on track to treat more than 100 this year. "Once we save them," he remarked, "they are still addicted to opiates. A near-death experience is too often not enough to get them to seek treatment.

Paquette said that in New Hampshire there are an estimated 100,000 people in need of treatment, which is one of the highest incidences of substance abuse in the country. But statewide the capacity to treat case is only 6,000, the lowest of any state except Texas.

"We need more resources for prevention, treatment and recovery," she said, "otherwise this problem will grow." She said that New Hampshire is the only state in New England without recovery centers, noting that Vermont operates 11 with positive results.

Belknap County Attorney Melissa Guldbrandsen noted that a significant increase in property crime was associated with the rising incidence of substance abuse and prosecuting these offenses provided an opportunity to treat those responsible while they serve their sentences in county jail. Likewise, she stressed the role of the recovery court, in which 10 people are currently enrolled.

Racicot and Jacqui Abikoff of New Horizons both stressed the importance of "medically assisted treatment," by which recovering addicts are prescribed a maintenance drug such as suboxone or methadone. Abikoff explained that long-term opiate use causes brain damage, which renders recovering addicts unable to benefit from counseling. Administering suboxone, methadone or similar medications enables patients to shed their addiction in a controlled manner, she said.

"We're talking about medication," Abikoff emphasized, "not legal addiction." She noted that apart from a few physicians who prescribe suboxone, medically assisted treatment is not available in the Lakes Region. The nearest methadone clinics are in Concord and Somersworth. "There has not been a lot of support medically assisted treatment locally," she remarked.

Adams said that New Horizons is "overwhelmed" and the cost of other treatment and recovery programs is often an obstacle to addicts seeking help.

Shaheen reminded the group that both the Affordable Care Act and the expanded Medicaid program include a substance abuse benefit, which she expects will increase access to treatment programs.

"We can't forget about the enforcement side," insisted Police Chief Mark Lewandowski of Belmont. Without discounting the need for more capacity for treatment and recovery, he said, "If you don't stop the drugs coming, you're not accomplishing anything."

Shaheen agreed that additional resources are required for both enforcement and treatment, noting that Congress recently approved an appropriation of $7 million to curb substance abuse in northern New England.