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Addiction and Recovery

Misuse of prescription drugs, and addiction to alcohol and opiates, including heroin, is now the greatest threat to the quality of life of New Hampshire and our people. Working with experts in recovery, treatment, and prevention, reversing this tragic trend remains my top priority.

In 2015, I spent time in my role as the Chairman of the Greater Portsmouth Chamber of Commerce’s Government Affairs Committee understanding the magnitude of the opiate and heroin crisis, including speaking with various experts towards developing a plan of action. This was the result of asking business leaders about the greatest threats to our economic future – and being told the addiction crisis was so widespread that it had become a workforce problem.

New Hampshire’s governor must be personally invested in identifying the specifics of why this crisis has exploded in our state, what specifically needs to be done to reverse the crisis, how much effective solutions and strategies will cost, and how we will sustainably pay for those solutions.

How this became a crisis

There are several factors which, taken together, have elevated addiction to crisis levels. We must first be candid; opiate and heroin addiction have been growing for some time, but it is only in recent years that it has confronted the lives of relatively suburban, higher-income, and white communities. Residents in urban, lower-income and/or non-white communities have faced this battle for many years prior to the level of media political attention we see today. It is important for us, as policy makers, to avoid similar negligence on future crises, whatever form they may take. When any in our community suffer, we have a collective responsibility to act with compassion and urgency.

The first pressure point is in the prescription of opiates (such as Vicodin, Fentanyl, Durgagesic, Percocet, and OxyContin). About 80% of people who use heroin began with the misuse of prescription opiates. Over the past 15+ years, the increase in prescribed opiates – and in who can prescribe such opiates – has been dramatic. For example, in a 2015 three-month sample taken from a statewide database (April through June), over 108,000 New Hampshire patients had over 16.2 million Schedule II prescriptions filled. 80% of those prescriptions were for pain relievers, such as those listed above. While anybody in a position to make such prescriptions (including physicians, nurses, and dentists) must register through the state’s Prescription Drug Monitoring Program (PDMP), it had not been mandatory to consult the database before making a prescription.

While there has been an increase in the amount of prescription drug theft, the primary source of increased prescription drug misuse is from Schedule II drugs which were initially legally acquired. In 2016, bipartisan work was done to strengthen the use of the PDMP database, and I am committed to providing the relatively modest amount of funding required to strengthen oversight of, and access to, the database.

Prevention

Of course, the most effective way to address misuse, abuse, and addiction is to address the pipeline at its source – lowering initial use of opiates, especially by minors. Recently, penalties were increased for dealing such opiates, which I support. I also support the continued decrease in prescription limits for various Schedule II opiates, decreasing the chances of such opiates being available inside the homes of New Hampshire residents – and their children – for non-prescribed usage.

However, the long-run solution for opiate abuse and addiction must focus on education – not unlike the successful commitment made many years ago relating to tobacco products. We know that children as young as 10 years old are being taught how to administer narcan in some school districts – one of the most dramatic statements of the magnitude of the challenge we face. It is my commitment to work with experts across New Hampshire to put prevention into the culture of our children and their families. This has come up repeatedly in my statewide travels, and as the father of two school-aged daughters, this is as much as a personal commitment as it is a public policy commitment.

Interdiction and Treatment

In conversations with public safety employees,, the challenge they face at the moment of crisis is difficult to imagine. Called to the scene of an overdose, a first responder arrives to face an immediate set of critical decisions, often in unstable environments. First, to save the person overdosing from death through administering the proper dose of narcan. Second, to stabilize the situation around the individual, including getting them to an emergency room. Third, setting a course of action that often forces a decisions between the legal system and a treatment program.

The choice is stark. The legal system provides some protection against immediate relapse – but treats the person as a criminal, rather than as an individual needing treatment and support.

On the other hand, with New Hampshire having dramatically insufficient recovery resources, the chances are high that the individual will be placed on a waiting list for recovery services. We have examples in our state over the last few years of individuals on waiting lists who died of an overdose while awaiting treatment. Increasingly, there is bipartisan agreement that increasing our recovery infrastructure, and treating addiction as a medical – rather than a criminal – situation, is necessary to reversing this crisis. Dedicating the resources needed to provide a full suite of services, including mental health and wellness expertise, is where the rubber meets the road.

From drug courts to divert individuals out of the criminal justice system and into long-term recovery plans; to increased resources to allow recovery centers to provide sustainable, holistic services to all who need it; to additional personnel and equipment to our local public safety departments who face moments of crisis on a daily basis; we will identify what is needed, and we will transparently provide the necessary resources in a sustainable way. Period.

It is not enough to simply provide a 28-day program focused on addressing the direct physical consequences of substance abuse. Experts with whom I have spoken see this as a multi-year, multi-faceted commitment: Physical, chemical, mental, emotional, economic, and interpersonal. There are innovative programs in New Hampshire and across the country focused on peer-to-peer physical rehabilitation, family counseling, and educational and job-training opportunities with local colleges and universities.

We cannot, as a community, expect victims of addiction to be dropped back into the same environment from which they came, and not see high levels of relapse. We can save lives, strengthen communities, improve our workforce, and cherish our quality of life – if we treat this issue as the crisis it is.