Twenty years ago, Nancy Kane could have used a substance use treatment hotline. Her son, plagued by addiction years before the words “opioid epidemic” proliferated household conversations, had few places to turn in the late hours at night when he needed help the most.
“There was no infrastructure,” the Concord resident recalled. “(The crisis) was not at the scale that we’re dealing with in New Hampshire now.”
A lot has changed. As the Granite State continues to grapple with high the overdose death rates and impenetrable delivery networks, state officials are continuing to roll out the “hub and spoke” opioid treatment program that they say offers the best defense.
On Monday, Kane and dozens of others crammed into a conference room at Concord Hospital to attend one of several question-and-answer sessions on the new program, which launched Jan. 2.
Kane, whose son is now 45 and in recovery, left feeling positive. “It’s about time,” she said. “I think it’s a really promising model.”
Developed over the past few months, New Hampshire’s “hub and spoke” program is designed to direct those with behavioral health or substance use disorder problems to treatment. The system, which gives those in need nine regional access points, or hubs, is linked up to the state’s 24-hour advice hotline 211.
As of Jan. 2, those facing a crisis or interested in getting treatment for substance use disorder and other worries can call 211 and be directed to one of the nine hubs – including Riverbend Community Mental Health, which serves the Concord area.
Those who call during business hours will be patched directly to the hubs and into a screening process, at which point an in-person assessment will be scheduled to direct them to care. Those who call after-hours will be directed to specialists at Dartmouth-Hitchcock Medical Center in Lebanon, who will refer them to emergency services if needed or put them on lists to pass on to local hubs the following morning.
Those looking for services can also walk in to the hubs themselves to receive same-day appointments; Concord’s hub is located at Riverbend’s location at 40 Pleasant Street.
The goal, state officials say, is to efficiently match up those in need with beds and services – the “spokes,” or local providers. The program is fueled by a two-year, $45.8 million federal grant, and includes resources for the overdose treatment drug Naloxone and requirements for data collection and patient-by-patient case management.
At Monday’s question and answer session, the first of nine forums around the state to explain the program, medical professionals and members of the public packed the room, and questions varied.
One attendee asked what would happen when a person called 211 at 2 a.m. on a Sunday. Sarah Gagnon explained the process: a quick screening by licensed professionals at Dartmouth-Hitchcock, and a referral to either emergency services right away or a local hub by Monday morning.
Another audience member asked how the system would treat patient confidentiality. Peter Evers, the CEO of Riverbend, said that the information collected would only be shared to the federal Substance Abuse and Mental Health Services Administration (SAMHSA) with the consent of patients, following public guidelines. SAMHSA has imposed data collection requirements for New Hampshire and other states receiving similar funds.
And the officials running the program fielded a simpler question: Why does Concord not have Safe Stations? The successful Manchester program, which uses fire stations as intake points for substance abuse treatment, has not been replicated in smaller cities.
But Evers countered that the hub and spoke program was itself a safe space – the essence of Safe Stations. “It may well not be the fire department, but it will be 40 Pleasant Street, which will be a warm, inviting environment that has … specialists and Naloxene and the ability to keep people safe,” he said.
Exactly how many have already used the new system since it launched is unknown; Health and Human Services officials said data would be provided after the first two weeks. But Department Commissioner Jeff Meyers hailed the rollout. ““Everything that I’ve heard is things are really starting to roll out well,” he said.
To Kane, the availability of round-the-clock help is a major advantage. But she said thought the use of crisis hotlines and emergency departments after hours was a shortcoming.
“While I think it’s true that there are hotlines that could talk someone off the ledge, my hope is that maybe someday at 2 a.m. there might also be someone in the emergency room that this program could evolve into,” she said. “That is time of greatest vulnerability.”