Working Together to Take on the Opioid Crisis

Mar 29, 2017, 8:00 AM, Posted by Tim Soucy

Drug overdose deaths are fueling a dramatic increase in premature deaths nationally. This community is taking action—here’s how.

I’ve lived in Manchester, New Hampshire, my entire life and led the health department here for more than a decade. So for me, the opioid crisis that has hit the city and surrounding region hard feels like a very personal kick to the gut. Between 2003 and 2015, overdose deaths in Manchester increased 12-fold, and until recently, our emergency responders were seeing 60 to 70 suspected overdoses each month in this city of 110,000 people.

We’ve seen more and more in the news that the drug overdose epidemic has become a national crisis, and the 2017 County Health Rankings released today reveal the extent of its terrible impact. Drug overdose deaths are now the leading cause of death in the United States among 25- to 44-year-olds, cutting short the lives of too many people and underlying a national rise in premature death rates.

Fueled largely by overdose deaths from opioid prescription drugs, heroin, and illegally manufactured fentanyl, the epidemic killed more than half a million people from 2000 to 2015.

There’s no one size fits all solution to overdose deaths. Among the strategies proven to work are:

  • Promoting responsible prescribing by health professionals;
  • Creating policies that increase access to life-saving Naloxone, an antidote drug;
  • Implementing measures to curtail overprescribing or inappropriate prescribing of opioids by doctors.

In Manchester, we’ve taken some of those steps, and we’ve also recognized that our community had to come together with compassion and new ideas in order to stem the crisis. So often Americans think of addiction as a personal failing rather than the disease that it is. But what if we reached out to people when they were ready to ask for help?

A firefighter stands in front of a fire engine. Chris Hickey, Founder of Safe Station

Point of Entry

A Manchester paramedic, Chris Hickey, came up with the plan to turn our city’s fire stations into “safe stations,” where people now come before they get to the point of overdosing. No questions are asked, and if they are not in medical distress (in which case they get immediate medical attention), the firefighters promptly refer them to treatment at a nearby addiction services nonprofit. Since the Safe Station program launched last May, there have been nearly 1,400 visits to the fire station by people seeking help for addiction—most often for opioids.

The program is still in its infancy, so we can’t say what kind of long-term effect it might have for people experiencing addiction, their families, and the community as a whole. But early signs are promising. In the first two months of 2017, our overdose rate fell by about half compared to the same period last year.

We’re amazed by how successful Safe Station has been at getting people through the door. We now know we need more addiction counselors and respite beds, and a host of other resources to ensure everyone who comes to Safe Station gets the help they need, exactly when they need it.

Lessons Learned

Here’s what it takes to start and maintain a program like ours:

  • Get buy-in from first responders.

Manchester’s Safe Station program was started by Chris Hickey, a paramedic, who got his colleagues in the fire department on board. If you want to start a similar program with fire stations as the point of entry, it’s important not only to make sure your fire department is on board, but also that its personnel understand addiction, the cycle of change (a social work theory for modifying addictive behaviors) and when people need—and can most benefit from—help. We think part of the reason Manchester’s program has worked is that people trust firefighters and feel safe at a fire station. That’s a powerful argument to make to your firefighters’ union.

  • Make sure you have the capacity to provide treatment.

Safe Station would not work if we didn’t have Serenity Place, a nonprofit substance-abuse treatment provider, willing to take patients at a moment’s notice. Our track record is excellent: 70 percent of people who have been admitted to treatment through Safe Station have stayed in treatment. But that also means Serenity Place needs more space and staff to keep up with demand. The organization is working with public and private funders around the state to pull together the funds to expand. Meanwhile, New Hampshire health officials are working to figure out how to recruit more substance-use professionals to Manchester and the rest of the state. A statewide workgroup that includes behavioral health providers, doctors, hospitals, and community-based organizations is looking at workforce development, and we’re considering steps such as speeding up licensing so practitioners can more easily come to New Hampshire from another state.

  • Partner with an overnight respite provider that can offer shelter to people in treatment.

It makes no sense for someone to go to treatment during the day and then go right back to a place where people are using drugs. Our respite care provider, Helping Hands, offers a safe and drug-free facility, a bed, a hot meal for dinner, and case management to help people get the services they need and connect them to long-term housing. Unlike Serenity Place, Helping Hands is not a treatment or recovery center. It offers shelter and case management services for those who need it.

  • Provide a link to health care.

People recovering from addiction often have infections that arise from intravenous drug use. They may not have been to a doctor in years. Many are uninsured. And before a residential detox program will admit them, they have to be medically cleared as healthy. To provide health services to people who seek help through Safe Station, we partner with Manchester’s Health Care for the Homeless program. Because their space, located in the basement of a homeless shelter, is tight, we hit on the idea of embedding their health care workers right at Serenity Place to connect primary care and substance abuse treatment.

  • Advocate for health care access for all.

So many people who need treatment are uninsured or underinsured. We don’t believe Safe Station—or our overall efforts to deal with opioids—can continue to be successful unless people in the throes of addiction have access to health care when they need it most.

As a nation, we can’t let the opioid epidemic go unchecked and wait for people to overdose before we help them. Ending this crisis requires a deep change in how we view addiction as well as collaboration within and across communities. Our experience in Manchester shows that with the right mix of expertise, resources and empathy, we can eventually put a stop to opioid abuse.

Explore your county’s health in the 2017 County Health Rankings.

Tim Soucy is Manchester, New Hampshire’s, public health director.