Special Series: 'Alternatives' - N.H. Gets Creative to Curb Ongoing Opioid Crisis

Sep 20, 2017

New Hampshire has invested millions of dollars into curbing its opioid epidemic. But progress has been slow. That’s pushed some state policymakers and others to get creative.

This week, in a three-part series called “Alternatives,” NHPR’s Paige Sutherland reports on some less traditional approaches.

Video: Paige Sutherland talks about the series

 Series stories:

Part 1: Slow rollout for needle exchanges

Part 2: Acupuncture on the front lines

Part 3: Involuntary commitment for addicts 

PART 1: Injection Drug Users Can Now Get Clean Needles in N.H. But Rollout is Slow

Louisa Chen, 23, organizes clean usage supplies for the needle exchange program she helps run at the Claremont Soup Kitchen.
Credit Nasim Azizgolshani

[Editor's note: We recommend listening to this story]

The Claremont Soup Kitchen has been around for more than 34 years, serving hot meals four days a week.

But as of a few months ago – it’s been offering something new.

“Hi, were you looking for the needle exchange," Louisa Chen asks one of the people entering the soup kitchen.

"Yes, awesome, we are actually working in there today if you could just go in there, that would be great,” said Chen, who's one of five Dartmouth Medical students who help run the exchange.

Credit Sara Plourde

This syringe program runs out of the soup kitchen twice a month. Organizers collect used needles from drug users and swap them for clean ones.

This kind of program is common in many other states but it’s the first of its kind in the state since legislation was signed in June.

Prior to that, injection drug users could only buy their needles at a pharmacy. Many chose instead to reuse and share needles, which can lead to the spread of diseases including HIV and Hepatitis C.

Even after just a few weeks, the Claremont exchange has drawn people from all over the region.

Nasim Azizgolshani, 25, tracks the supplies given out Monday during the syringe exchange hours. That day 14 people showed up.
Credit Courtesy of Louisa Chen

“This is it," said Nasim Azizgolshani who also helps run the exchange. "Otherwise people have to go all the way out to White River Junction, which is a thirty minute drive from here and God knows how long if you’re inland and this summer we actually had someone come in from Maine.”

The day I was there, Azizgolshani helped ten people; a mom looking for the overdose reversal drug Narcan for her daughter, a veteran seeking clean needles, a married couple with their two small children looking for alcohol wipes and a box for their used syringes and a longtime user named Dusty.

“For every single one you give back to us we will give you an extra one – so I will give you two today but next time you come I will give you more," Azizgolshani told Dusty supplies in hand.

"Do you need more Narcan?,” Azizgolshani asked. “I would take more Narcan because I used the last one on a friend,” Dusty replied, who been using heroin since he was fifteen.

Dusty didn’t want to give his last name because he’s still using drugs. He’s been coming to the exchange since it opened two months ago.

He says there’s a real need for this in the area.

“It’s the easiest thing possible – you walk in, you eat a meal, you go get your needles and then you leave – good deal," Dusty said. "So I’m all for it, I don’t want people sharing needles or anything like that. I don’t care what you do but do it smart.”

The group behind the exchange relies on grants and donations. They use the space at the soup kitchen free of charge.

Click here to view the state's registration form for syringe exchange programs.

Credit Sara Plourde

It took a long time to get to this point in New Hampshire. Critics were worried needle exchanges would enable more drug use. And once the legislation passed, the state didn’t put any money behind it.

Beth Daly of the state’s infectious disease department said that’s made it hard for the department to help out.

“Because there was no funding attached to this, our role at the health department is going to be very limited," Daly said. "There's no resources to fund these agencies or to oversee them in any way.”

With the state not really in the picture, local groups have had to step in.

In Dover, the New Hampshire Harm Reduction Coalition has been meeting for months. It’s made up of doctors, nurses, those in recovery and those working in recovery.

The coalition has now launched its own syringe exchange program. But it’s different than Claremont. Instead, volunteers approach drug users right on the street and offer them clean needles.

Kevin Irwin leads the group and has worked on needle exchanges worldwide. He says this approach is best suited to the rural parts of the state, where privacy may be a concern for drug users.

“Networks of small towns don’t lend themselves to any kind of bricks and mortar or even mobile health van types of services because they are just too visible so we don’t ever want to create disincentives for folks," Irwin said.

Irwin will lead a training session later this month to help organizations interested in running their own exchange services in the state.

An assortment of the clean usage supplies given out at the Claremont exchange - it includes short and long needles, alcohol wipes and sharps containers.
Credit Courtesy of Louisa Chen

But advocates still see a lot of challenges ahead.

“There is one thing when there is the law on the books and then there’s the how it really looks on the ground," said Laura Byrne, who runs an HIV resource center in Lebanon and two exchange programs across the border in Vermont.

Under the new law, a person found with drugs on a used syringe only faces a misdemeanor. If they’re heading to a needle exchange program, police have to let them go.

But Byrne says many of her New Hampshire clients still worry.

“I think it takes a couple of years for law enforcement to fully comply with the intention of the law and I think New Hampshire residents are wary – they fear arrest,” Byrne said.

As Dartmouth Medical student Louisa Chen packs up her supplies for the day at the soup kitchen in Claremont, she knows next time she’ll likely see the same clients but that doesn’t bother her.

“We want to be here not to solve this crisis because we are incapable of doing that," Chen said. "For us, our main goal is to just mitigate the issues as they come up. We want to make sure people are safe when they are using, we want to make sure nobody dies because they’re using and we want to make sure that anybody that wants to go into recovery has an easy path to it.”

It’s these reoccurring visits, that advocates hope will lead people into recovery…when they’re finally ready.

Tips on safe usage for drug injection users created by the N.H. Harm Reduction Coalition.
Credit N.H. Harm Reduction Coalition

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PART 2: Those on the Frontlines Will  Soon Have a New Tool to Help Addicts...Acupuncture

At the Revive Recovery House in Nashua, acupuncturist Elizabeth Ropp gives ear treatment designed for drug addiction to those battling a substance abuse problem.
Credit Paige Sutherland/NHPR

Drug recovery workers in New Hampshire will soon have a new tool to help their clients: acupuncture. It’s a kind specifically designed to help addicts deal with withdrawal symptoms and cravings.

For decades, this treatment could only be administered by licensed acupuncturists but as of July , New Hampshire joins more than 20 other states in allowing those on the frontlines to offer this care too.  

[Editor's note: We recommend listening to this story]

Credit Sara Plourde

It’s a hot summer evening in Nashua. A peer support group at the Revive Recovery house has just wrapped up a meeting, but a few women stay behind to get some “additional treatment.”

Seven women sit in a wide circle as another woman places small orange needles…in both their ears.

So, you are going to feel a little pinch – but you’ve had this before?," said Elizabeth Ropp, an acupuncturist in Manchester.

"Oh, yeah, I’m used to needles. It’s cool. Aw, I feel it already. Oh that one was good," Kristine Tirone said while getting the ear acupuncture.

"Is there anything burning, pinching or stinging? Okay, let me know if anything is uncomfortable," Ropp tells Tirone.

Kristine Tirone, 23, says the 5-point ear treatment made her feel less anxious, cured her migraine and helped with her sleep that night.
Credit Paige Sutherland/NHPR

Tirone, who's 23, is in a residential treatment facility for a heroin addiction. She’s received acupuncture before while in detox, but this time she says she’s more clear headed and noticing the results.

“I can’t believe I am sitting down this long," Tirone said with acupuncture needles sticking out of both her ears.

"I’m usually way over stimulated and I’m just sitting here...it’s amazing.”

Tirone said after the treatment she felt less anxious, her migraine went away and that night she said she slept like a baby.

Studies have shown acupuncture can also help with acute withdrawal symptoms.

“They are something that is going to help with the nausea, with the fluctuations with body temperature, with the anxiety, with the sleep," said Ropp.

For the past few months, Ropp’s been going to recovery centers like Revive to give free ear treatments.

According to the National Acupuncture Detoxification Association, the 5-point ear treatment is designed to help with those battling a substance abuse problem as well as curb withdrawal symptoms.

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Click on the circles above to see what each trigger point is supposed to help with.

Ropp said the ear makes sense. It has five distinct trigger points and the treatment can be given in group therapy sessions while fully clothed.

It’s cheap too. The supplies to do an ear treatment cost about thirty-five cents.

Ropp said the hard part is getting the treatment to the people who want it.

“Many people who are looking for help aren’t necessarily going to think to walk into an acupuncture clinic," Ropp said. "And the people who are working on the frontline in the trenches with people who are in acute detox aren’t necessarily the licensed professionals.”

Credit Sara Plourde

There are about 130 acupuncturists in the state and they’ve all been through thousands of hours of training. But few have been specifically trained on how to give this treatment to addicts.

A new state law now allows licensed health care professionals, recovery coaches and peer counselors to administer this ear treatment after completing a 70-hour course.

Advocates for the change say this training designed by a national group has been around for decades and it has a good safety record. But some acupuncturists in the state have concerns.

Kathryn Wantuck of the New Hampshire Acupuncture Licensing Board said the board thinks the training should be New Hampshire based.

“The way the statue is written leaves the board’s somewhat tied and leaves it up to this national organization as to what the training is, how many hours are required, how much this course is going to cost?" 

The board is hoping to have the certification process finalized in the next few months.

And once they do, 27-year-old Ryan Fowler wants to get trained.

Ryan Fowler has been in recovery from heroin for three years and is now a recovery worker in Concord. He plans to get the ear treatment training as soon as its available.
Credit Paige Sutherland/NHPR

Fowler has been in recovery from heroin for almost three years. Acupuncture is part of his ongoing treatment and he’s seen it help others when he was working at a recovery shelter in Manchester.

“There were two or three nights where I could just feel the energy in the whole facility just kind of become more calm, just a lot more peaceful," Fowler said.

"It was really cool to see a group of people who are just hurt just calm down a little bit even if just for a little bit.”

Fowler is now a recovery worker in Concord. He hopes to start acupuncture training soon and when he’s done – he said he’ll carry acupuncture needles with him wherever he goes.

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PART 3: What Happens When an Addict Doesn't Want Treatment? A Tale of Two Families in Different States Who Saw Very Different Outcomes

John Carter's family holds up a portrait of John. He died at age 18 from an overdose of fentanyl.
Credit Courtesy of Kailynd Biggar

[Editor's note: We recommend listening to this story]

Throughout New Hampshire, a shortage of treatment beds has made it difficult for people with drug addiction to get treatment. But what happens if an addict doesn’t want help?

In almost every state, addicts can be forced into treatment, through a practice called involuntary commitment but not in New Hampshire.

For the final part of this week’s series, “Alternatives,” you’ll hear the story of two families in different states who saw very different outcomes.

Credit Sara Plourde

John Carter was the youngest of four children. Most people in his hometown of Pelham, New Hampshire knew him as Bubba. He had big blue eyes and a smile his family says was contagious.

“So many people loved him – teachers loved him, parents of friends loved him – he was the most generous, loving person I knew,” said John’s older sister Kailynd Biggar.

Biggar gave him his nickname when he was a baby. His father Jack Carter says John started doing drugs as a teenager but the family struggled to get him help.

A photo of John Carter as a child. His sister Kailynd Biggar (right) says John was always smiling.
Credit Courtesy of Kailynd Biggar

"His sister had seen track marks on his arm and we need to do something, so I came to her house and went over to the Pelham Police Department and asked them for help,” his father Jack recalls.

“They spent probably 45 minutes just trying to talk to him and they stressed they wished there was something they could do but right now our hands are tied,” Biggar said.

John’s family thought what they needed to help John that day was a rather extreme option: forcing him into treatment, to get him away from the drugs.

“You’re not thinking clearly – the disease is calling the shots, the drugs are calling the shots,” Jack said. “But if you give yourself a little bit of time to clear your head and have that moment of clarity, you might be able to make some good decisions.”

Ever since John's passing in July of 2016 - his family have been advocates within the drug recovery community.
Credit Courtesy of Kailynd Biggar

But after they left the police station – John fell back into his drug habit.

“He passed away two weeks later of an overdose of Fentanyl,” Jack said.

This was July of last year; John was 18.

This forced treatment that John’s family was looking for is known as involuntary commitment

It allows a family member, police officer or doctor to ask a judge to mandate treatment.

About 40 other states have some version of involuntary commitment on the books but it’s not allowed in New Hampshire.

One of John Carter’s high school friends from Pelham moved to Dracut, Massachusetts after graduation.

Savanna Maybury is 21 but like John, she fell into drug use as a teenager. Massachusetts does allow involuntary commitment – there, they call it being “Sectioned”, a reference to the state law.

Her mother Tracy Maybury forced Savanna into treatment last November. Maybury vividly remembers the overdose that almost killed her daughter.

Credit Sara Plourde

“She told me that day in the hospital that I’m not done using and I said, ‘Oh hell yeah, you are. I couldn’t do it as a parent – watch her suffer,” Tracy Maybury said.

Savanna remembers that moment too.

“I had gone home that night and had woken up to cops in my house along with my parents,” Savanna recalled.

“We went to the court house – they had her downstairs in the holding cell. We waited for her case to be presented to the judge – he deemed her to be sectioned,” Maybury said. “And a few hours later she was held at the police station for a few hours and they took her to the Women’s Addiction Treatment Center in Bedford.”

“Other than losing three family members in my life – this was the hardest thing I ever had to do,” her mother said while holding back tears.  “But I would do it again.”

Savanna spent over a month in treatment. She resisted it at first but she’s since come to believe involuntary commitment saved her life. She can’t help but wonder how it could have helped her friend John.

Savanna Maybury and her mother Tracy Maybury (left) have joined forces with the Carter family to get involuntary commitment in NH.
Credit Paige Sutherland/NHPR

"Sometimes I don’t think people are ready to get the help on their own – I think people need that extra push to get a taste of what sobriety really looks like,” Savanna said.

Last spring lawmakers considered bringing this policy to New Hampshire. John’s family was the first to testify.

But not everyone thinks involuntary commitment is a good idea. Some argue if addicts haven’t made their own decision to get help – they won’t stick with treatment. In New Hampshire there’s already a shortage of treatment beds and state lawmakers were reluctant to spend money on any more…so the legislation was shelved.

Jack Carter and Kailynd Biggard in March pleaded to state lawmakers in Concord to get involuntary commitment in New Hampshire.
Credit Paige Sutherland/NHPR

John’s mother, Sheryl Mercier, has a unique perspective on this. She lives in Pelham, New Hampshire, but works just a few miles across the state border, as a cop in Lowell, Massachusetts – where she has personally asked a judge to send addicts into treatment.

“I have the capability to walk into a courtroom if I know someone is a harm to themselves and others because of drugs and section them. I can do that at my job at any time,” Mercier said. “But once I cross the border and get to New Hampshire – I couldn’t help my own child.”

Advocates say this policy is no silver bullet…but for some families it could be the only option that works.