How do we create a ‘launch pad’ for those in need of treatment for addiction?
MANCHESTER, NH – Wednesday’s meeting of the minds at the city Health Department was actually a call to action, to solve the public health crisis of addiction.
More than 100 decision makers, public health specialists, emergency medical workers, law enforcement officials and recovery advocates gathered to participate in the Greater Manchester Regional Public Health Network Continuum of Care Project.
Led by city Health Department Director Tim Soucy, the three-hour session provided insight from both the state and local level as to the scope of the problem here and around the state, and the urgency everywhere for immediate access to help for those battling addiction, particularly those addicted to heroin and opiates.
Cheryle Pacapelli, Director of Hope for NH Recovery, shared with the group her own moment of clarity, when she reached out for help 25 years ago from the place of being a hopeless addict in Connecticut.
“When I asked for treatment it was 4:30 in the morning, I picked up the phone and said ‘I need help.’ Within two hours I was in treatment – and it took a half an hour to drive there. I got access immediately,” Pacapelli said. “When I came [to New Hampshire] and I heard people have to wait six weeks to get into treatment, it made my stomach turn. If I’d had to wait six weeks, I don’t know that I’d be standing here today. Something came over me and all of a sudden I knew I needed help, and I asked for it, and I got it.”
The premise of the continuum of care project is that the city needs to build a four-legged stool of services that includes prevention, intervention, treatment and recovery, something Mayor Ted Gatsas says is urgently needed.
“The voice is getting louder, and the four-legged stool needs to be built so that we all understand what’s out there and how someone finds treatment and recovery,” said Gatsas, who attended the meeting.
Other speakers included Tym Rourke, chairman of the Governor’s Commission on Alcohol and Drug Abuse Prevention, Intervention and Treatment; Mary Forsythe-Taber, of Greater Manchester Public Health and Executive Director of Makin’ It Happen Coalition; Rik Cornell of Greater Manchester Mental Health; and Stephanie Savard of Families in Transition.
Rourke reminded the group that heroin may be the current drug and health crisis demon, but such problems are not new and will never go away completely. There will be another demon down the road. The question is how will Manchester prepare itself now for supporting future generations.
“Right now we’re in damage control, and the damage control right now is treatment and recovery. But there has to be sustained treatment and recovery options,” said Rourke. “If we don’t make sure we are protecting the next generation we will never shut off the pipe line. Your work is big. Your work is challenging, but I’m proud of the work you’re doing here, and proud to bring your voice up to the legislature.”
Pacapelli said she believes the model of a peer-to-peer recovery treatment center will revolutionize the way Manchester meets the need for those seeking support, continuing the care they need after receiving intervention and treatment. Hope for NH Recovery is ready to open such a center in Manchester, once they finalize a location to house the phone-based operation.
Savard spoke about some of the barriers to treatment that exist in the city.
“We are a magnet site for treatment for people from around the state, and our resources are limited. But I also know pretty confidently that even if nobody from outside of Manchester were allowed to come here for treatment, we’d still have a wait,” Savard said.
And what is the current wait for treatment in Manchester?
Although the reality of available openings fluctuates from day to day, there is currently a four- to six-week wait for a bed at a treatment center or transitional living program. There is no wait for outpatient treatment, while other modalities, including Intensive Out Patient treatment (IOP) or medication-assisted treatments vary between a one to two-week wait.
“What we know is that the waitlist can’t happen. When someone has a problem today they need treatment today, when their motivation is high,” Savard said. “If they’re told to wait, we all know the motivation level changes, like that. If we’re not there on a dime to open the door, the problem is going to continue.”
According to information gathered from Child & Family Services, the current drug of choice among a majority of addicts in the city is heroin. They also report a trend in younger addicts, 15- and 16-year-olds, where the norm used to be in the 18-22 range.
Families In Transition reports that more than 65 percent of their participants are dealing with opioid addiction. And while there are many success stories, the lack of available treatment and recovery support is the greatest barrier to turning the city-wide epidemic around.
Beyond addiction, there is also growing concern about fallout from addiction, which includes increased risk of hepatitis B, hepatitis C, HIV/AIDS or health risks for women who are pregnant and mothering young children.
“What we know is that Child & Family Services is seeing an increase in hepatitis and HIV. They just dealt with a young adult who was recently diagnosed with HIV, so that’s a real concern. Heroin use and sex work for survival is drastically increasing the risk of disease happening in our community,” Savard said.
According to Soucy, the city is concerned with a rise in blood-borne diseases like Hep B and C and HIV, given the increase in IV drug use.
“We’re in regular contact with police, AMR and Manchester Fire Department to track what’s going on out there. In the short term we’re concerned with the number of overdoses, but in the bigger picture, it’s an epidemic and a public health crisis,” Soucy said.
“We’re seeing people using needles in cars, public restrooms, often with children present. Not only are we dealing with the strain overdoses put on our EMS and hospital emergency rooms, but of course, from a health perspective, how we’re going to deal with increased HIV, Hep B and Hep C,” Soucy said.
State Epidemiologist Dr. Ben Chan confirmed that while Hep C is currently not a reportable condition and therefore not tracked statewide, there were 30 new cases of HIV infection reported in 2014.
“We do have numbers on HIV and Hep B, but there are other consequences from drug use – not just the social, psychological and economic issues. There are other infections that can be introduced into the blood, one of the more common ones is bloodstream infections from bacteria, such as endocarditis, an infection of the heart or heart valve,” Chan said. “We don’t track that specifically around the state, but as a physician and clinician I can tell you it’s not uncommon to see people presenting in our hospitals with blood stream infections.”
Savard spoke about how although Medicaid expansion is increasing the number of people with access to services through primary caregivers, which will open more doors of opportunity for intervention, referral and treatment, there is still a dead end. Even if more screening is available, the hands of healthcare providers are tied because of the lack of treatment and recovery options.
She said New Hampshire is beyond needing a safety net for those battling addiction.
“We can do a really good job of building a safety net, but when it comes to treatment and intervention, it needs to be a launching pad; no more safety nets. Let’s have a launching pad into a recovery system for them after treatment that’s going to help them maintain recovery and help them contribute to this community in a positive and healthy way,” Savard said.
The conversation will continue at a public meeting concerning Hope for NH Recovery’s proposed Manchester Recovery Center on May 14 at 6 p.m. at 161 S. Beech St. in Manchester. The group is also holding a screening of “The Anonymous People” on May 28 at the Palace Theatre as a fundraiser to support their efforts in launching the recovery center.