This story is part of Pain in America, a nine-part series looking at some of the underlying causes of the opioid addiction crisis and how we treat pain.
Daisy Pierce has heard all the promises that politicians who want to be president make when they come to New Hampshire, including their vows to combat the state’s opioid addiction crisis.
As executive director of Navigating Recovery in Laconia, Pierce works with people striving to control their substance use disorder. She knows the toll that opioids and other drugs have taken in her state, one of the hardest-hit by the epidemic.
After several years of intensified federal, state and local efforts, there are some promising signs. Opioid overdose deaths are down here, as they are nationwide. Last year, 364 people died from opioid overdoses in New Hampshire, a drop from 471 the prior year and 490 in 2017, after rising consistently in the previous five years.
Doctors in the U.S. are writing fewer opioid prescriptions, and federal funding has enabled states to improve the infrastructure for treating people with substance use disorder. Pharmaceutical companies and drug distributors face hundreds of billions of dollars in payouts to states that sued them over the proliferation of opioids, and the federal government is conducting a criminal investigation into the drug industry.
Pierce is grateful for the help that has come in the last four years, especially the federal grants that enabled New Hampshire to broaden access to addiction treatments. But she doesn’t have a lot of faith in the things people say when they’re trying to win votes. She hasn’t seen evidence that the high-minded rhetoric from 2016 translated into the kind of bold action still needed.
“Oftentimes, when something’s promised, I don’t put much stock in it,” Pierce said. “I was skeptical because [while] I appreciate that people were talking about it as an issue that needed to be addressed, I wasn’t always convinced that the person talking about it understood exactly what it would take.”
An Ongoing Emergency
Whatever their shortcomings, government efforts to tackle the opioid epidemic have shown some success, Pierce said. New Hampshire had zero peer recovery centers like Navigating Recovery five years ago and today, there are 17, she said. These nonprofit operations offer counseling, usually provided by people in long-term recovery themselves, and connect patients to other aid such as housing, transportation, health care and employment services as well as medications to treat addiction.
And yet addiction remains a serious problem here and across the country
Thirty-four people died from opioid overdoses for every 100,000 residents of New Hampshire in 2017, more than double the national rate according to the most recent statistics from the National Institutes of Health. Nationwide, some 1.7 million Americans were addicted to pain medication in 2017, and other statistics suggested a resurgence of addiction to methamphetamine and cocaine as well.
Treatment is still out of reach for too many people, Pierce said. There aren’t enough addiction counselors and other mental and behavioral health providers to meet the demand, she said. Although the number of people dying from opioid overdoses has been lower recently, these drugs remain responsible for more deaths than car crashes.
Because New Hampshire is an early presidential primary state, its opioid epidemic got a lot of attention in 2016. Then, as now, New Hampshirites rank drugs as the top issue facing the state, according to polling from the University of New Hampshire.
Four years ago, candidates from now-President Donald Trump to Sen. Bernie Sanders (I-Vt.) toured the state with promises that they had a plan to help. They nodded along gravely as voters shared tales of their own struggles with substance use disorder or of the friends and loved ones they’d lost. The candidates explained how policies they favored for other reasons were also the solutions to the opioid epidemic.
Trump cited the availability of heroin and smuggled prescription pills as arguments for the border wall he wanted to build between the United States and Mexico.
“All of the problems ― the single biggest problem is heroin that pours across our southern border. It’s just pouring and destroying their youth. It’s poisoning the blood of their youth and plenty of other people,” he said of New Hampshire during a debate with Hillary Clinton in October 2016. “We have to have strong borders. We have to keep the drugs out of our country. We are ― right now, we’re getting the drugs, they’re getting the cash. We need strong borders.”
The future president also infamously referred to New Hampshire as a “drug-infested den” during the 2016 campaign.
Sanders, meanwhile, often responded to questions from voters about addiction by touting his proposal to create a national health care system.
During a Democratic primary debate in December 2015, he said, “The reason I believe in a health-care-for-all program ― we need to understand that addiction is a disease, not a criminal activity. And that means radically changing the way we deal with mental health and addiction issues. When somebody is addicted and seeking help, they should not have to wait three, four months in order to get that help.”
In 2018, Congress passed the bipartisan SUPPORT Act which included a slew of new policies to address the opioid epidemic, including federal money for states,
But now, advocates are concerned that policymakers, especially at the federal level, have moved on and that the presidential candidates aren’t as focused this year as they were in 2016.
To be sure, all the Democrats running in the presidential primary this year have plans. Sanders still sees his “Medicare for All” program and proposed prosecution of pharmaceutical manufacturers as central to his opioids policy. Sen. Elizabeth Warren (Mass.) authored legislation, the CARE Act, that would set aside $100 billion over 10 years for substance abuse initiatives, and most of that money would go to states and local authorities.
Sen. Amy Klobuchar (Minn.) and former South Bend, Indiana, Mayor Pete Buttigieg have $100 billion plans of their own, and former Vice President Joe Biden and the other Democrats have floated proposals, too. These Democratic plans tend to have key elements in common, such as promotion of medication-assisted treatment and funding for community-based programs.
Grassroots Demand For Action
Politicians paid attention in 2016 because voters demanded it, said John Burns, director of SOS Recovery Community Organization, which has locations in Dover, Hampton and Rochester, New Hampshire.
“You’d be hard-pressed not to say that the majority of the influence came from the grassroots, the recovery community, family members who have been impacted and lost loved ones,” said Burns, who is in long-term recovery and has a daughter who struggles with mental health problems and substance use.
Now another presidential election has come around. Not as much has changed as advocates and New Hampshirites had hoped, including the rhetoric from White House hopefuls.
“Every four years, we have a slew of presidential candidates that descend on New Hampshire and Iowa and other early states in these contests, and they offer a lot of platitudes in terms of how they are going to address the addiction crisis. And not much happens. The problem seems to get worse,” said Las Vegas-based activist Ryan Hampton, a former Clinton White House aide who is in long-term recovery from addiction.
“That type of stuff is frustrating to me because it makes me feel like our community ― my friends who I’ve lost, people who are struggling right now ― we’re being used as political footballs,” Hampton said.
In office, the Trump administration’s anti-opioid efforts haven’t been limited to border security measures. The president declared a public health state of emergency about the crisis in 2017. And he signed the SUPPORT Act, which set aside $1.8 billion in grants for states to implement addiction treatment programs ― New Hampshire got $40 million for 2019 and 2020.
Trump also called for executing all drug dealers during a White House summit on the opioids crisis in 2018.
“The problem with the Trump administration is: There is some good policy going on, but I think that the president reverses a lot of it when he makes statements like that,” said Hampton, who was present at the summit.
More critically, Trump is asking the courts to eliminate the Affordable Care Act, which would end that law’s expansion of Medicaid to millions of poor adults. And he is attacking the program through executive authority by proposing to allow states to curtail its benefits. Trump’s new budget request to Congress includes additional Medicaid cuts. Yet 38% of people addicted to opioids are covered by Medicaid, according to federal data analyzed by the Henry J. Kaiser Family Foundation, and there is evidence that Medicaid expansion prevented overdose deaths.
“Medicaid and Medicaid expansion have been lifesavers. Without it, we could not do the work that we do,” Pierce said.
Even as New Hampshirites prepare to go to the polls in the 2020 presidential primary on Tuesday, the opioid crisis has barely appeared on the candidates’ radar, bolstering worries that politicians have become less attentive to the issue.
“One of the fears that we had around the SUPPORT Act being passed was that Congress would then kind of push pause on real, substantial funding to combat the addiction crisis until after the election, that they would kind of wave, take a victory lap, and say, ‘We’ve dealt with it,’” Hampton said.
But he said, “This isn’t something that can be solved with one mediocre legislative package. This is something that needs to be ongoing.”
Hampton noted that opioid addiction is a “decades-old problem.”
“All of a sudden it’s become a political hot topic, so everybody wants to talk about solutions. Politicians, presidential candidates want to get on the front page of the paper. They all say the right things,” he said. “But what progress are we actually making? It’s a failure of the government.”
Since the SUPPORT Act became law two years ago, Congress has mostly ignored addiction, Hampton said, noting that the House version of Warren’s CARE Act hasn’t received a committee hearing even though Democrats have a majority.
He sees the same inaction and inattention among the 2020 presidential contenders. “Very few candidates have been getting ahead of the issue,” Hampton said.
The policies put in place since 2016 to fight the opioid epidemic have helped, but only marginally, and more needs to be done, Burns said.
“It’s still like a drop in the bucket,” he said. “What other public health crisis in this country could we ever have, with the level of attention that this has gotten, and still be so significantly underfunded and not dealt with, given the devastation it has on families?”
Need help with substance use disorder or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.