COVID-19 pandemic threatens progress in substance abuse recovery communities in N.H.

  • Laconia Fire Chief Kirk Beattie (right) with firefighters and advanced EMT first responders and recovery coaches Matt Murphy (left) and David DiTommaso at the central fire station. Beattie is hopeful the decline in opioid calls in 2020 represents a larger trend. GEOFF FORESTER / Monitor staff

  • Concord Police Chief Bradley Osgood speaks outside the police headquarters on Green Street in downtown Concord on Thursday. GEOFF FORESTER / Monitor staff

  • Concord Police Chief Bradley Osgood outside the police headquarters on Green Street in downtown Concord on Thursday, May 21, 2020. GEOFF FORESTER—Monitor staff

Monitor staff
Published: 5/23/2020 4:36:06 PM

While the state’s fight against the new coronavirus dominates public policy decisions and daily conversations, an epidemic that placed New Hampshire under a national microscope for years is fading from the forefront.

The substance abuse crisis still rages on in the Granite State but efforts to combat it are now being shaped by a global health emergency not seen in more than a century.

Social distancing measures and stay-at-home orders designed to slow the spread of an often unpredictable and, in some cases, deadly coronavirus have created more challenges for those trying to access drug treatment services. Further, experts say fear of contracting the virus is keeping some from seeking help early on and preventing admissions into sober living homes.

Experts and first responders anticipate that the coronavirus pandemic will exacerbate the state’s drug abuse problem, and simultaneously cause financial hardship for providers who caution that remote services alone are not a long-term replacement for in-person care and counseling.

“After years of building up New Hampshire’s treatment and recovery system, this public health crisis is threatening to undo that progress, limiting access to care for individuals and families in need at a time when we can least afford it,” said Jake Berry, vice president of policy at New Futures, a Concord-based nonprofit organization which recently co-hosted a video conference on the state of New Hampshire’s addiction crisis with U.S. Rep. Annie Kuster.

Since the Granite State’s first positive cases of COVID-19 in early March, first responders throughout Merrimack County have seen a decline in opioid and drug-related calls, and police officers are also making fewer arrests than last year at this time. While there has been a notable drop in reported overdoses, including in Concord, officials say they’re not convinced drug use has slowed nor that the need for social services is less than it was before the onset of the pandemic. The drugs, they say, are still flowing into the state.

“The unfortunate reality is it’s driven people with acute issues into not calling for help soon enough,” said Concord Fire Captain Alan Robidas. “And one of the things we’re going to struggle to ever measure or quantify is how many people were negatively impacted by this virus or unfortunately perished, not due to the virus, but because they waited, because they were fearful of the virus.”

Treatment and recovery experts are preparing for a potential surge of requests for services and referrals as government officials relax the state’s stay-at-home order and more people feel comfortable returning to their daily routines.

In the past few weeks, officials in Franklin and Laconia noted that they’re starting to see a few additional drug-related calls for service but the numbers don’t come close to pre-pandemic activity. They do anticipate more of a return to normal during the summer months but fear the calls may be more complex and require intervention for co-occurring diagnoses of substance abuse and mental illness.

“Are there people who were sober pre-pandemic who no longer are because they relapsed and felt they couldn’t access services?” Concord Police Chief Bradley Osgood asked during a recent interview. “Were there people who were fairly stable despite suffering from acute mental health issues who now aren’t getting the treatment they need or can’t afford their medications?”

“We don’t know how this is going to play out in the coming weeks, but we need to recognize that the need will be great,” he continued.

Emergency calls and enforcement

After schools transitioned to remote learning, retail stores temporarily closed and some offices mandated that their employees work from home, calls to police and fire departments plummeted. Around that same time, many fire and police departments locked their lobbies and took reports by phone in an effort to curb the spread of the virus.

While officers continue to reassure the public that they’re responding to every emergency, they have reduced proactive community policing efforts, including motor vehicle stops and some foot patrols. Behind the scenes, detectives are still moving forward with drug investigations but undercover buys and raids have taken a backseat during the pandemic, and that means arrests are down.

In Concord, officers responded to roughly 33% fewer calls in the past two months compared to the same time period in 2019. When considering drug-related calls alone, the number of arrests are just a fraction of what they were in prior years; police made 15 arrests between March 13 and May 4, whereas 53 were charged with drug-related crimes in 2019. Two overdose deaths are currently under investigation in the Capital City and likely opioid-related, Osgood said.

Calls for service to the Laconia Police Department were down more than 20% in April compared to the same time last year.

“We’re limiting or have been limiting some of our more proactive drug work for sure,” Laconia Police Chief Matthew Canfield told the Monitor. “Our officers aren’t necessarily making an arrest right away but issuing warrants and then the arrest is being made at a later date. We’re still trying to limit our contact with people in non-emergency situations.”

Canfield said the department had averaged an overdose call each shift and now they respond to just a few calls each week.

Overdoses have fallen from year-to-year in Laconia since at least 2017, and the city’s fire chief, Kirk Beattie, said he is hopeful the decline in early 2020 is representative of the larger trend. However, he acknowledged that the pandemic is a variable no one expected.

The department logged 106 overdoes in 2017, a total of 31 in 2018 and 30 last year.

“So many more communities are working across the state to combat this, and we are seeing those programs work,” Beattie said.

He noted that the fire department employs four staffers as recovery coaches, who are trained to counsel people suffering from addiction in crisis situations.

There was an initial downward trend in Franklin, too, but in the past couple of weeks the numbers have slowly risen again. The shift comes as Gov. Chris Sununu loosened the state’s stay-at-home order to allow for the gradual reopening of some businesses and retail services.

“When the media started to report this and the CDC started, we saw a reduction that was obvious almost immediately,” Franklin Fire Chief Michael Foss said.

“The first weeks, the call volume dropped in half,” he said. “Recently calls have been back up. Even if it’s not less dangerous, people are having a new comfort level.”

Franklin Police Chief David Goldstein said the pandemic has not stopped people in the throes of their addiction from traveling for drug buys, or the suppliers from funneling the drugs into the state.

“Certainly it’s still out there. There is no question about that based on what we’ve seen in a couple of recent motor vehicle stops,” Goldstein said, citing a recent case in which police seized thousands of dollars in cash, a handgun, methamphetamine and a mixture of heroin and fentanyl.

Police chiefs agreed that opioid use remains a top concern in New Hampshire. They say the pandemic likely affected supply chains throughout the country but dealers aren’t deterred; they’re finding alternative routes when necessary.

Treatment network on ‘fragile footing’

New Hampshire’s care providers are worried about the ongoing substance abuse crisis combined with what will likely be long-term fallout from the pandemic.

While some providers have seen a decline in patient outreach, health care workers at most of the state’s nine Doorways, the hubs of New Hampshire’s $64.5 million treatment network, report pre-pandemic levels of patient volume. They have worked to meet those needs by enacting social distancing guidelines and instituting new telehealth services.

Patrick Tufts, chair of the Governor’s Commission on Alcohol and Drug Abuse Prevention, said New Hampshire has had historically high alcohol addiction rates and that has not changed during the pandemic. He cited calls to 211 NH, the statewide service referral hotline, regarding substance abuse remaining in the top three. The top two referrals calls are related to COVID-19 and financial concerns.

In Concord, Doorway staff handle six to 10 intakes per week, but they expect the number of calls to the program and the severity of those cases to rise in the coming weeks, said Shanna Large, director of substance use disorders at Riverbend Community Mental Health Center.

“We know that substance abuse treatment is still needed and that people are using and probably using more than ever right now to handle this situation,” Large said during the recent video conference with Kuster.

Large, who oversees the Doorway at Concord, said the global pandemic has forced health care workers to take a step back and revisit how they’re going to maintain the same level of care and potentially expand their services during a time of economic downturn.

“It’s terrifying,” she said.

In just a few weeks, the pandemic has left some centers and recovery homes on “fragile footing,” said Berry, who led the video conference call on behalf of New Futures. Providers quickly suspended most in-person services and migrated to remote care models, but the online platform doesn’t work well for everyone in recovery and some struggle with access to it, he said.

The New Hampshire Coalition of Recovery Residences has certified 25 sober living homes on a voluntary basis since its founding as a nonprofit organization in the state in 2017. Those homes now serve more than 400 people in recovery, said Executive Director Kim Bock.

She said those programs are experiencing financial hardship largely because so many residents have lost their jobs, don’t qualify for unemployment and can’t pay rent. Consequently, four sober living homes have closed in recent weeks, meaning there are 68 fewer beds to serve those in need now and on the other side of the pandemic, she said.

Referrals to residential care facilities are down since the stay-at-home order took effect in March. Bock said people are deferring treatment decisions because there are too many unknowns.

“People are afraid to go into treatment right now. They’re afraid to go into any kind of emergency room. They’re afraid of contracting COVID,” she said. “So, they’re not going into recovery; they’re not going into treatment.

“We expect an incredible surge,” she continued. “There will not be enough beds available for the need if we predict what’s going to happen happens.”

Staff writer Ray Duckler contributed to this story. Material from journalist Susan Geier was included in this report through the Granite State News Collaborative.

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