NH county opioid program model needs innovation and expansion, official says
The Dover Doorway program is not working as designed, and the number of individuals seeking help from each area is severely disproportionate
By Hadley Barndollar
Portsmouth Herald, N.H.
PORTSMOUTH, N.H. — The Doorway-NH state program constructed to fight the opioid crisis isn't working for Rockingham County as designed, according to Peter Fifield, program manager for the Dover location.
The Dover Doorway, across the street from Wentworth-Douglass Hospital, was devised to serve both Strafford and Rockingham counties, but the number of individuals seeking help from each area is severely disproportionate. Since the location's opening in January, 77% of individuals served have been from Strafford County, ultimately signaling that those struggling with substance abuse disorders in Rockingham County aren't crossing the Little Bay bridge to seek help.
For people in Seabrook, which Fifield called a "high-need area" when it comes to the opioid epidemic, that trip could be upwards of 45 minutes and includes two tolls. Those barriers are enough to deter someone from making the trek.
Fifield detailed the hurdles currently faced by the Doorway program during a steering committee meeting of the Portsmouth Community Coordinated Response to Substance Misuse initiative Thursday at Safe Harbor Recovery Center in Portsmouth. The committee has 19 members, drawing from various sectors including city government, social services, public health, emergency response, schools and others.
It was the group's third meeting assessing gaps in communication and existing resources in both Portsmouth and Rockingham County as a whole. The group is slated to present its recommendations to the Portsmouth City Council in December, which will include a one-year continuation of the Portsmouth Rotary Club seed-funded effort, and the formation of six priority-area task forces, according to draft recommendations.
State officials created The Doorway, also commonly known as the "the hub-and-spoke model," after receiving a two-year grant of nearly $46 million from the Federal Substance Abuse and Mental Health Services Administration. It's been one of Gov. Chris Sununu's highly-touted accomplishments while in office; a concerted attempt to increase access to treatment and services through nine locations — Berlin, Concord, Dover, Keene, Laconia, Lebanon, Littleton, Manchester and Nashua — in a small state that has been unduly impacted by the opioid scourge.
But the model is proving a need for innovation and expansion, Fifield said Thursday.
"We've done everything we can to spread the word," he said. "It needs to be diffused more into the communities, because I do think it's effective, it works. I think it would prove very effective down in Seabrook. But it's a very protective, tight-knit community and it takes a while to trust. They need something homegrown to them, not something thrown in by the state up in Dover. It's about being realistic not only in geography, but in human behavior."
Since 2012, Seabrook police have responded to 450 reported overdoses, resulting in 52 deaths. The deaths reported in 2019 are already the most since 2015, in a community of just over 8,000 people. At a forum in Seabrook last week, Fifield said only eight individuals from the town had accessed The Doorway Dover location since its opening.
"How do we collectively think of a way to get a satellite, or its own hub, a little farther south?" Fifield asked. "The original design needs to be beefed up. The 40-minute drive and two tolls on the way are not realistic. It's a long haul."
Fifield noted it's easier for someone in Seabrook to access the Manchester Doorway location, because it's a "straight shot up Route 101 with no toll." There's also the barriers of transportation in the first place, as well as childcare and housing if the individual is homeless, of which 42% of those who have accessed the Dover Doorway are.
Department of Health and Human Services Commissioner Jeffrey Meyers previously said the state is working on filling those access gaps, including $1 million for transportation assistance to be used across all nine hubs, and $2.5 million for housing vouchers.
Patricia Reed, state director of Granite Pathways, said the Nashua Doorway has been able to embed representatives in local recovery centers, to get the people where they're already going. Fifield said it would make sense to set up satellite locations at Safe Harbor, SOS in Hampton, or Portsmouth Regional Hospital, for example.
"I think The Doorway is a replicable model," Fifield said. "When you locate it in a hospital, you get a lot of access to other services. I think every hospital should have a Doorway. If they're from Portsmouth, they go to Portsmouth Regional Hospital. It's really low hanging fruit financially when you're talking about what hospitals make, our budget line is not that big. And the resources this can provide, it's tremendous bang for your buck."
Heather Blumenfeld, director of Safe Harbor Recovery Center in Portsmouth, said the small number of Rockingham County residents accessing The Doorway is not reflective of the county's need. Portsmouth continues to be the No. 1 community of residence Safe Harbor sees in its clients, largely because the center is in close proximity to Cross Roads House homeless shelter and a number of the city's homeless camps.
"For a lot of those people that we see, Dover seems like it's a million miles away," Blumenfeld said.
Portsmouth Fire Chief Todd Germain said the state of the city's opioid crisis remains "steady," with overdose calls trending down this year over last. However, Germain said with today's accessibility of Narcan, an overdose reversal medicine, that could mean people are administering it at home and not calling 911.
"So I would hate to say the crisis itself is waning," Germain said, "because we don't know why our calls are down a little over last year."'
Committee Chair Cliff Lazenby, Portsmouth's assistant mayor, said the coordinated community response, which is facilitated by the Pine Tree Institute, has allowed stakeholders to increase communication and convene more organized conversations -- something that had been identified as lacking.
"When you coordinate better, you become more efficient and effective," Lazenby said.
Tammy Joslyn, executive director of Operation Blessing, said for her the effort is all about communication because she doesn't like giving referrals to clients for services elsewhere that may go unanswered. Joslyn said there needs to be a coordinated effort among organizations to keep vulnerable individuals from falling through the cracks, potentially resulting in them plunging back or deeper into addiction.
"I think this group is long overdue, and I think we have the potential to make some real change here in Rockingham County," Blumenfeld said.
At the Dover Police Department on Saturday, Sept. 28, the city's police and fire chiefs will host a forum addressing Dover's response to the drug epidemic from 9 a.m. to 11 a.m.
©2019 Portsmouth Herald, N.H.