The state of New Hampshire seems to be near the top of many lists these days.
U.S. News and World Report has ranked New Hampshire as the second-best state in terms of services for its citizens, coming only behind its New England neighbor, Massachusetts. The Granite State was also the highest-earning state in America in 2016, according to analysis by The Washington Post.
But New Hampshire ranks high on a less-positive score, as well: opioid addiction. The state had the third-highest rate of death due to drug overdose in the country, behind West Virginia and Ohio, according to the Centers for Disease Control and Prevention.
“I’ve spent the vast majority of my professional public health life on the assessment end, counting the cost of this particular public health disaster, which has been a slowly unfolding tsunami for the last decade,” said former New Hampshire chief medical examiner Thomas Andrew at a Post event last week. Andrew retired from his job and entered seminary training after watching drug-overdose deaths soar.
“Part of what drove me in that direction was this endless drumbeat of previously healthy, and to a large extent still healthy, young people whose lives had been ended by misuse of these agents,” he added.
New Hampshire has found itself with an escalating crisis fueled, in part, by easy access to fentanyl paired with a history of lower spending on treatment. The state has enacted a slew of legislation in the past few years to try to handle the issue, such as a law protecting people from prosecution should they seek help for themselves or others in an opioid-overdose situation. New Hampshire has also increased dedicated funding for prevention and treatment, but some state Democratic lawmakers and experts argue that much more needs to be done to significantly address the problem.
Republican state Sen. Gary Daniels, who chairs the New Hampshire Senate’s finance committee, said that the state has spent between $102 million and $103 million to address the crisis, but he recently opposed legislation that would have added more.
“My position is that before we continue to throw money toward the issue, we need to make sure that the money that we have allocated is doing what it’s supposed to. Nobody can answer that right now,” he said.
Research released by Dartmouth’s Center for Technology and Behavioral Health in 2017 found that New Hampshire prescribed significantly higher rates than the national average of long-acting and extended-release pain-relief medications, high-dose opioid pain relievers, and benzodiazepines concurrently.
The research additionally noted New Hampshire’s proximity to the manufacturing of fentanyl in Massachusetts, which can provide consumers a lower-cost, easily available source for opioids. The CDC has said that deaths linked to fentanyl use are helping drive the overdose-death rate in the country.
Despite this, New Hampshire in the past has had lower total and per-capita spending for treatment compared to other New England states and has had lower public health funding per resident than the national average.
The state has taken steps to try to address these issues. “Last year, we made significant strides forward by doubling the alcohol fund, which went directly to prevention, treatment, and recovery services. This July, we will be opening the only youth-addiction-treatment center in our state,” said Gov. Chris Sununu in his State of the State address this month.
But Democrats think more is needed. New Hampshire Senate Democrats threw their support behind a bill that would allow the governor or legislature to tap 10 percent of the Rainy Day Fund, around $10 million in additional resources, to combat the opioid crisis. The bill failed in the Senate on Feb. 15.
Senate Minority Leader Jeff Woodburn, a former teacher and sponsor of the bill, told National Journal that the opioid crisis is an issue that he has witnessed firsthand. “I’ve seen former students get hooked on drugs, their lives get ruined. Some go to prison, some go to graves,” he said. “I also saw the richest state in the country be real stingy and cheap about putting resources into combatting it.”
Efforts to curb the epidemic come as the New Hampshire legislature is working on renewing its Medicaid expansion, which will sunset at the end of this year. “The single most effective way to combat the opioid epidemic in New Hampshire is to reauthorize our Medicaid expansion program,” said New Hampshire Democratic Sen. Dan Feltes.
A bill being considered to reauthorize Medicaid expansion would raise the reimbursement rates to providers of behavioral health, including substance-use disorder and mental-health services.
Center for Technology and Behavioral Health Director Lisa Marsch said that while higher reimbursement helps, it won’t solve all the challenges that providers face. “[Providers] don’t feel like they have sufficient capacity, so I think making sure they have resources to tap into to support them in offering care is also a really important piece,” she said.
The proposal would also implement work requirements, and the state has a pending waiver at the Centers for Medicare and Medicaid Services.
“Work requirements without reasonable exemptions, without reasonable processing of the work requirements, and without barrier-reduction assistance to work is a recipe for kicking people off of their health insurance,” Feltes said.