Sunshine Week: N.H. keeps inconsistent records on drug treatment spending

Monitor staff
Tuesday, March 14, 2017

As the deaths from opioid overdoses have spiked in recent years, New Hampshire has been dedicating significantly more money toward treatment and recovery programs.

But exactly how much money the state is spending and who receives it can get foggy.

The state spent about $50.3 million on treatment, prevention and law enforcement programs last year, more than double the $23.9 million it spent in 2010, according to yearly fiscal reports from the Governor’s Commission on Alcohol and Drug Abuse.

Data from 2014, on the other hand, are missing.

An analysis of the state’s spending on treatment and recovery initiatives over the last six years shows an incomplete picture of the amount of money state agencies – including the Department of Health and Human Services, the Department of Education and the Department of Justice – have funneled toward these programs, because of inconsistent data reporting to the commission.

“It is a challenge to wrap one’s arm around what the state is spending on substance abuse,” said Tym Rourke, chairman of the Commission on Alcohol and Drug Abuse and a member since 2010.

Some agencies simply didn’t report what they spent during certain years, while others over-reported.

For instance, in 2011, the amount of money state agencies reported spending on drug treatment and prevention was a whopping $72.2 million.

But that year’s fiscal report included numbers that were much higher than normal; the Department of Safety included their entire $45 million budget for the Division of State Police as one of their programs to fight the drug crisis, “to enforce criminal and motor vehicle laws statewide.”

The following year, the Department of Safety reported spending $5.9 million on programs toward the drug crisis, with the budget for state police dropping to just $63,154, and another $1.8 million being spent on prosecutions and hearings. Funds that year were also put toward blood and urine toxicology, continuing the D.A.R.E. program statewide and money for the state’s controlled drug unit.

By 2013, the funds reported by the entire Department of Safety dropped dramatically to just $303,586, with the department reporting only its D.A.R.E. program, a pharmacy diversion investigation unit and a federal marijuana eradication grant.

Besides the commission’s reports, firm numbers on how treatment money is being spent are hard to find.

Despite substance abuse being widely seen as the biggest public health crises facing the state, the N.H. Department of Health and Human Services monthly dashboard does not include a section on spending on addiction treatment services.

“For such a high-priority issue, there’s no specific data,” said Steve Norton, executive director of New Hampshire Center for Public Policy Studies. “If we’re going to make this a public policy priority, and we want to understand the impact of spending money there relative to other places, like higher education, you want a sense of at least where the money is going.”

Weare state Rep. Neal Kurk, the chairman of the House Finance Committee, said he’s asked DHHS for data to show that treatment and prevention programs are working.

“There’s some real problems in trying to get information,” he said. “What you get is some data for some programs but not comprehensive for the entire system.”

Federal slice

Many of the addiction treatment, prevention and recovery programs in New Hampshire are mostly funded by federal sources, with a smaller amount of state money going toward them.

In fiscal year 2015-16, the federal Substance Abuse and Mental Health Services Administration provided $25.3 million to New Hampshire to support mental health and addiction services.

Some of that money went to support the state’s drug courts in Cheshire and Hillsborough counties. Each received $325,000 from the federal government to expand each county’s existing program.

In 2016, former governor Maggie Hassan and the New Hampshire Executive Council approved $40.5 million in contracts to go to various programs for treatment, sober housing for recovery and prevention programs targeted to students.

Federal money paid for half or three-quarters of many of the largest contracts, including ones going toward improving the state’s treatment services and infrastructure and peer recovery support services.

The two biggest contracts approved by the governor and council in 2016 included $12 million in workforce rate increases for the staff of Goodwin Community Health and Tri-County CAP, and another $11.5 million paid out to unspecified “multiple vendors” for treatment services.

Both contracts were paid for with a mix of state and federal funding, with federal dollars making up the majority share.

Is it enough?

Generally speaking, the state had been stingy with money for treatment and prevention programs. In 2013, a ranking by the federal Substance Abuse and Mental Health Services Administration put New Hampshire 49th nationwide in terms of the amount of money it spent on treatment for addiction.

New Hampshire is now on track to break its own record of drug deaths – the state is expected to have 478 fatal drug overdoses in 2016, according to the latest data from the state medical examiner.

So, is the state doing enough to stem the tide?

That’s a tough question to answer, in part because of the nature of addiction, Rourke said.

Unlike other chronic diseases like diabetes, people with addiction often deny they have a problem for months or years, and there is always a potential for relapse even after the person completes treatment, Rourke said. Therefore, treatment outcomes are harder to measure.

“Taxpayers want to know that; the Legislature wants to know it; I want to know it,” Rourke said. “There’s not a scientific way to figure it out.”

But right now, it seems the state is getting closer to hitting the mark.

A few years ago, the commission did an analysis of the money the state should be spending on these programs and came up with $60 million, including insurance and Medicaid covering the cost of services.

“We as a state are probably pretty close to that metric,” Rourke said.

The state’s Bureau of Drug and Alcohol Services does keep data on people who leave state-contracted drug and alcohol treatment programs, finding that 51 percent reported remaining abstinent from drugs 30 days after their treatment had ended, and 53 percent reported remaining abstinent from alcohol.

But unanswered questions remain.

Kurk said he wants more detail about what the state is getting for the money it puts into treatment and other programs.

“I don’t know if we have any data on that, what we are getting for the money we are spending,” he said.

(Ella Nilsen can be reached at 369-3322, enilsen@cmonitor.com or on Twitter