Originally posted on seacoastonline.com
This past weekend I attended the New Hampshire Medical Society Annual Scientific Conference on addiction. This timely gathering of physicians and other providers reviewed opiates and the full spectrum of addiction. The take-home message was clear and not news to anyone who has been paying attention to the media recently. We have in the short-term a crisis of opiate misuse that is killing our children, our friends and our neighbors and we have a longer-term problem in New Hampshire of addiction, to opiates, to cocaine, to meth and most of all to alcohol.
I took away some critical points from the conference.
First is that the earliest exposure to opiates in our teenage and young adult population almost universally comes from the free and readily available supply of prescription opiates kept in their parents’ and friends’ parents sock drawers or medicine cabinets. While providers need to change how they prescribe opiates for acute and chronic pain, parents need to ensure that unused opiates are either destroyed or secured in a locked cabinet.
Second is that drug courts do not let violent felons go free. The prosecutor always has veto power over any drug court decision. For the carefully selected individual who has plead guilty to their drug related crime, the drug courts represent the most cost-effective solution both to avoid incarceration and for long-term rehabilitation. With a year in prison costing New Hampshire residents as much as $41,000, the much lower price tag of a comprehensive drug court program is a win-win for the residents of New Hampshire.
When you consider that even one dose of heroin or street fentanyl will likely result in addiction and that its continued use permanently alters the chemistry and molecular structure of the brain, the only model for understanding this addiction is recognizing it as a medical illness. While the actions of an addict may be criminal in nature, addiction itself needs treatment. Our commitment to funding these treatment programs has been woefully inadequate.
While there is much interest in starting new programs, much of this is on hold because the legislature has not taken action to re-authorize Medicaid expansion in the form of the New Hampshire Health Protection Program. Since Medicaid expansion includes substance use disorders and behavioral health in its ten essential benefits and over the last year represents an infusion of more than $200 million federal dollars, it represents the only significant source of new funding for our opiate crisis. Without it, the burden of generating needed revenue will fall squarely on the state budget.
Finally, the long-term success of dealing with both the opiate crisis and addiction in the state of New Hampshire requires effective prevention programs. Speakers this past weekend pointed out that starting programs in junior high school is just too late. The conversation about addiction needs to start in our elementary schools and continue through the years of exposure in junior and senior high schools and beyond. Our young students need to understand addiction to change this culture of experimentation and dependence.
Wearing both hats, as a physician and as a legislator, I am ready to help both in my practice and in Concord. We know what we need to do in the short-term. The governor and the Democratic leadership of both houses have a comprehensive bill ready for introduction, debate and passage at the special session that would address many of the critical issues regarding this crisis. This bill dovetails in a bipartisan way with the priorities outlined by the Republican leadership.
It is intensely frustrating that the Republican leadership of the House and Senate intend to delay the possibility for early intervention by creating a task force. The direct result of creating a task force over passing a bill that addresses our opiate crisis is a 2- to 3-month delay in implementation. In those few months of delay, at the current rate, 56 to 84 more New Hampshire residents will die of opiate related deaths. At such a high price, we cannot allow politics to slow the path to legislative intervention. The citizens of New Hampshire deserve better.
Thomas M. Sherman, MD, is a New Hampshire state representative in Rockingham District 24, representing Rye and New Castle.