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The latest stop in Tom Price’s opioid crisis listening tour brought the health and human services secretary to the New Hampshire State House on Wednesday. He wasn’t alone, though. Always near him was Kellyanne Conway, counselor to President Donald Trump. They were joined by Gov. Chris Sununu, state Health and Human Services Commissioner Jeffrey Meyers, and Democratic U.S. Rep. Annie Kuster of New Hampshire, among other treatment providers, law enforcement, first responders, and families who have been impacted by the substance abuse crisis.

The meeting in Concord only lasted about an hour and members of the press were not allowed to be in the Executive Council chambers where the listening session took place. Afterwards, Price and Conway went to Manchester Fire Department to learn about the city’s Safe Station program. Press were also kicked out at first, but were then invited back in.

At a press conference after the listening session, Price said solving the opioid crisis is a priority for the Trump administration and his visit was a chance to see how states are dealing with it at the ground level.

“The Department is all in, the President is all in,” he said. “He has such passion for this issue, because he knows the misery and the suffering that has occurred across this land, and wants to help, help solve it.”

Price points to the recent $3.1 million in funds — with more money on the way — being sent to New Hampshire as evidence of the administration’s commitment to getting more resources out into the field.

Yet, more funds are needed for the Granite State, which has the second-highest overdose deaths per capita in the country. Nearly 500 people have overdosed on drugs in 2016. New Futures, a nonprofit focused on the opioid crisis, released a report Monday that found substance misuse costs the state’s economy about $2.36 billion each year.

Sununu praised the White House for its “tremendous” effort in reaching out to the states to see what they think of certain policies and solutions to combat opioid misuse.

“This administration has provided a great philosophy in that they want to set a foundation and a platform for good policy out of Washington but they look to the states to implement it,” he said. “Unlike the previous administration where Washington was going to implement and control everything, they want the states to be the implementers.”

However, Democrats are blasting the U.S. House of Representatives’ passage of the American Health Care Act, which would make major changes to Medicaid expansion. Democrats argue that the bill would weaken funding for federal programs to battle the drug epidemic.

Just before Price and Conway’s arrival, protesters staged a “die-in,” laying on the floor in the hallways of the State House, holding up signs that said, “Trump lied, I died” and “I died for a billionaire’s caviar.”

Protestors at the #DieIn today ready to welcome @HHSGov Sec Tom Price & reject the #AHCA #nhpolitics #thisisnotnormal #handsoffourhealthcare pic.twitter.com/Gy6w1cYe7c

— Ashley Marcoux (@ashmarx9) May 10, 2017

Democrats held their own press conference while Price and Conway met with New Hampshire leaders, criticizing Sununu for holding a closed-door meeting.

“New Hampshire won’t stand for a plan where premiums skyrocket, benefits shrink, and thousands are booted off [health care] coverage,” said Senate Minority Leader Jeff Woodburn.

Price said Trump is committed “to make certain that every individual has access to the kind of coverage that they want for themselves and for their family.”

“I think it’s important to step back and say is the Medicaid program the most appropriate program for every individual in that economic setting,” he added. “Is there a better way to provide coverage? Is there a better way to provide services? Whatever the answer to that is the president is committed and we’re committed to making certain every single American has a seamless transition.”

He vowed “that nobody falls through the cracks. That no rug is pulled out from anybody and that we make certain that the coverage and the care is available to every single American.”

Sununu said he had “some severe reservations” about the House’s health care bill, but he appreciates “the progress the House made.”

“We have to move that ball forward,” he said. I do have reservations in some areas when you look at the details. But people have to understand this is simply one part of the process. The Senate is going to go through their process. It shows that Congress isn’t stalled, not stagnated. They’re not going to do nothing. I think we’ve had eight years of a lot of do nothing. They’re doing something and they’re standing up for the American people.”

Conway said the opioid epidemic should be a bipartisan issue that Democrats and Republicans solve together.

“We look at this as a non-partisan issue in need of a bipartisan solution,” she said. “And we are working with people on both sides of the aisle in Washington and within each of the states to do exactly that.”

However, there are instances of disagreement between Republicans, especially on the American Health Care Act. It also appears that New Hampshire leaders and the White House aren’t always on the same page.

Several media outlets reported that the Trump administration was contemplating a 95 percent cut for the White House Office of National Drug Control Policy (ONDCP), which houses the agency’s high-intensity drug trafficking program and drug-free communities support program. Officials dismissed the claims and reaffirmed Trump’s support for ending the opioid crisis. Sununu called the reports “very disconcerting.”

Price and Conway did not mention the national drug czar’s office during their visit. While New Hampshire is one of the hardest hit states of the drug epidemic, it appears an official from the state has not been invited to sit on the President’s Commission on Combatting Drug Addiction and the Opioid Crisis, leaving many to question how committed Trump is to fulfilling his campaign promise.

New Jersey Gov. Chris Christie is chairing the commission, and it was announced Wednesday that Democratic Gov. Roy Cooper of North Carolina, Republican Gov. Charlie Baker of Massachusetts, and former Democratic Rep. Patrick Kennedy of Rhode Island will also serve on the commission. Bertha Madras, a former deputy director of the Office of National Drug Control Policy, will also work on the commission, but no one from the Granite State.

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New Hampshire became the latest state to have three residents die of overdoses from one of the most deadly opioid drugs in the world, adding to the growing list of communities nationwide trying to handle the crisis. Gov. Chris Sununu and public health officials announced last week that for the first time in the Granite State, the synthetic opioid carfentanil was found in the bloodstream of three people who died from overdoses in March.

Two of the deaths were in Manchester, and the third was in Meredith. The substance is so potent that it’s not intended for human consumption. It’s 100 times more potent than fentanyl and is commonly used to tranquilize elephants.

“Unfortunately, today is the first day that we’ve been able to confirm this,” Sununu said at a Tuesday press conference. “And worse yet, I think we all understand that it is likely not the last day that we talk about this issue.”

New Hampshire is the first New England state to have confirmed deaths from carfentanil and its effects are being felt by many key players in the opioid crisis, including public health officials, first responders, and treatment and recovery providers.

While these are the first confirmed cases in New Hampshire, the rise in carfentanil overdoses has been happening throughout the United States over the last few months. At least 96 heroin users overdosed in one devastating week in August in just one Ohio county, with several of the overdoses linked to carfentanil. In September, the Drug Enforcement Administration issued a nationwide warning about the powerful opioid.

Tom Pifer, forensic lab director for the N.H. State Police, said the drug was developed in the mid-1970s by a pharmaceutical company, but was never made public due to its high potency.

It takes just two milligrams of carfentanil to knock out a 2,000-pound African elephant. When veterinarians or zookeepers do that, they wear gloves and face masks to prevent exposure to the drug because a dose the size of a grain of salt could kill a person. A dose may even be lethal when absorbed through the skin or potentially through inhalation. That’s why the state asked law enforcement and first responders to stop field testing drugs. The problem is that users might not know they are even taking the drug since dealers have been cutting heroin with fentanyl or carfentanil to give it a boost and stretch their supply further.

“You cannot tell the difference between heroin and fentanyl and certainly not fentanyl and carfentanil,” Pifer told New Hampshire Public Radio. “You are literally rolling the dice with any sort of dosage unit you’re purchasing on the street.”

It’s not only incredibly powerful, but it’s also incredibly resistant to naloxone — also known as Narcan, the opioid antidote that can save someone’s life from a heroin overdose. A typical overdose requires one or two shots to work, but when a dosage is laced with carfentanil, it could require six or more shots to be effective — if it works at all.

Even though there is an abundant supply of Narcan in states battling the opioid crisis, an increase in carfentanil overdoses could deplete the antidote supply fairly quickly and drain money from states who need to purchase more. With drug overdose deaths rising, state crime labs could also see a backlog of cases to investigate. In New Hampshire, there are thousands of cases dating back from 2015 that have yet to be investigated.

A criticism in New Hampshire of government officials is that funding from the state and federal government to tackle the crisis has been slow to come out.

Congress signed the 21st Century Act in December, which would provide more funding to states for the opioid crisis. In April, U.S. Sen. Jeanne Shaheen, D-N.H., said $485 million in grants would soon be administered to states. It’s not clear exactly when that would happen.

New Hampshire is ranked as the second hardest hit state in the opioid crisis based on per capita deaths. Yet, it’s only supposed to receive $3 million out of the $485 million promised to states since the formula is based on total mortality. Shaheen is urging Trump’s administration to revise the funding formula for next year.

The other Democratic senator from New Hampshire, Maggie Hassan, and Shaheen wrote in a letter last week to U.S. Health and Human Services Secretary Tom Price that the formula should be re-tooled. Officials have indicated that they will review the formula and the two senators were optimistic after their meeting with New Jersey Gov. Chris Christie, who is heading President Donald Trump’s national opioid commission.

In March, Trump created The President’s Commission on Combating Drug Addiction and the Opioid Crisis with Christie at its helm to start fulfilling his campaign promise to end the opioid crisis.

Trump promised the people of New Hampshire that he would build a wall between the U.S.-Mexico border to curb the opioid crisis and stop the flow of drugs into the area.

“New Hampshire has a tremendous drug epidemic,” he said in October. “I am going to create borders. No drugs are coming in. We’re going to build a wall. You know what I’m talking about. You have confidence in me. Believe me, I will solve the problem. They will stop coming to New Hampshire. They will stop coming to our country.”

While heroin supplies mostly come from Mexico, synthetic opioids, like fentanyl and carfentanil, are believed to originate in China. Even though it’s illegal there, secret labs in the country manufacture the drug before shipping it to the United States. People can order it online, and it’s shipped through the U.S. Postal Service before it makes its way into the local heroin supply.

It’s still not immediately clear how the drug made it into New Hampshire. It’s likely that either someone bought it online, or it was purchased in another state and then followed the traditional route of heroin and fentanyl into the Granite State, which is from major distribution centers like Philadelphia and New York and then through Massachusetts.

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Earlier this month, Democrat Steve Marchand announced he would run for governor in 2018. It’s only three months into Republican Gov. Chris Sununu’s term, which is why Marchand’s announcement was surprising.

Marchand is a Manchester-native and is a first generation Granite Stater. His parents immigrated from Quebec. He was a small business owner, the former mayor of Portsmouth, and director of corporate relations for the University of New Hampshire. He came in second in the Democratic gubernatorial primary in September 2016.

Marchand has been laying the ground work for his gubernatorial campaign for the past few months, meeting with various Democratic groups and committees. He’s already being attacked by the Republican Governors Association for his position on taxes and single-payer healthcare.

NH Journal spoke with Marchand shortly after his announcement to discuss his campaign, what he learned from his previous run, and what voters can expect to see in the coming months. Some responses were lightly edited for length.

NH Journal: Tell me again why you decided to run, and why did you announce so early?

Steve Marchand: The reason I’m running really stems off of my experience last year. We live in a very challenging time in New Hampshire. I believe we need a mission statement that drives…our efforts and resources towards achieving a specific mission and that mission is to be the best state in America to start a family and to start a business. The reason I say that is because I think our two biggest challenges at stake if we are to thrive in the next [few] years is we need to get younger and we need to get more entrepreneurial and nimble as an economy. I don’t believe, with all due respect to our current governor, that there is a specific mission to what he’s trying to achieve, and I don’t believe the policies that he pursued up to this point would move us toward a more younger and entrepreneurial economy. I want to get us in the right direction. If you look at the lack of organization, the lack of focus, and the lack of success early on in 2017, it is a direct reflection of a lack of specific vision, purpose, and mission in Gov. Sununu.

NH Journal: But why did you announce so early? It’s only been three months into Gov. Sununu’s term.

Marchand: It is a little bit earlier than usual, but these are unusual times. A lot of that is driven at the national level with President [Donald] Trump who is already doing rallies for 2020. Gov. Sununu was doing fundraising in Washington for his 2018 campaign. Because we live in these unusual times…it means that if you want to move in the right direction, you don’t have the luxury of waiting while others move forward, no matter how early on the calendar it happens.

NH Journal: You came in second in the Democratic primary after jumping into the race late in the game. Besides announcing early, what is going to be different about this campaign?

Marchand: I got in awfully late last year. It was not a strategy. It was just the way life foregoes. A number of people approached me in March of last year suggesting I would make a very good candidate because they know my background. I had very little money, very little time. I spent about $100,000 total. I got outspent 18 to 1 by the person who beat me [former Democratic gubernatorial nominee Colin Van Ostern]. With very little time and no TV ads or direct mail, it really was the definition of a grassroots effort. So I believe that the message, which is a data-driven message, focused on the mission as I mentioned earlier, resonates not just with Democrats, but across the political spectrum. So starting early allows to me invest more time on the ground. It will make me a better governor. I will continue to learn from people as I campaign. It also means I start with a base of significant support and name identification that simply was not there a year ago when I started.

Photo Credit: Steve Marchand for New Hampshire Facebook page

NH Journal: You ran as a progressive, but fiscally responsible candidate last time. Is that still you? Are there any changes in your platform from before?

Marchand: My value set and my view of the priorities will look very familiar to people who followed my candidacy in 2016. There are some places where there has been a refinement or continued development of knowledge. I am a proud progressive and I’ve got a proud record of fiscal responsibility, and I’m always looking for ways to move ideas and turn them into law.

NH Journal: Gov. Sununu has made encouraging new businesses to come and stay in the state a priority. How would you plan on doing that?

Marchand: I’ve known Gov. Sununu for a long time and he’s a good guy, so it’s obviously nothing personal. However,…the policies he has pursued to grow the economy, largely run 180 degrees from what the data tell us we should be doing if we actually want to create jobs and see economic growth. For example, Chris and the Republican legislature want to cut the Business Profits Tax. Anybody who has spent anytime with entrepreneurs or being an entrepreneur will tell you that most new businesses don’t make a profit in the first five years. They lose money at the beginning. It’s really hard to start a business and see it to the point where it becomes a profitable entity. When we cut the Business Profits Tax, we accelerate what has been going on in the state for 50 years under both Democratic and Republican administrations and that is the downshifting of responsibilities and cost from the state level to the town and local level. If you focus on local property taxes and cutting the Business Enterprise Tax, you will be directly and positively impacting the segment of economy where 80 percent of net new job growth comes to fruition. I think that Chris is focused on talking points when he focuses on the Business Profits Tax, but we need to focus on the data. And the data tells me that focusing on the Business Enterprise Tax and on reducing local property taxes is the winning formula for tax reform that will lead to job creation and economic growth.

NH Journal: You say that it’s crucial to have young people in New Hampshire to become the best state in America. How do you plan to encourage them to stay in the state?

Marchand: I think of dealing with the younger population as a two-part challenge. I don’t think the current governor thinks of it this way. I don’t think our legislature thinks of it this way. I call them [young people] the numerator and denominator problem. The denominator problem is how can we attract young people to come work and live in the state. The problem with that is when you have an ever shrinking number of young kids in the state, you can’t keep 100 percent of them, even if you made college free for everyone. We have to be the most inclusive state that we can be as it relates to immigration. The states that are getting the youngest are seeing the largest influx of immigrants. Some of the rhetoric that has come from President Trump, Gov. Sununu, and members from the Republican legislature make it more difficult for immigrants to see New Hampshire as a great place to come. That’s a shame. If we’re going to get younger and more entrepreneurial, aggressively pursuing pro-immigration policies is going to be an important part of solving our denominator problem because the numerator problem is how can we keep more kids that are already here in the state. The pilot program between higher education and New Hampshire businesses I would pursue that would cost approximately $5 million a year in three programs: computer science, nursing, and education because those are three places where we don’t have enough talent to match the demands. It would create a debt-free college experience for students that enter the program…to work with New Hampshire-based companies or entities. And if they did that, kept their nose clean, kept their grades up, and then worked for one of those New Hampshire-based employers for a period of years after graduation, they would have no debt. It would be half-paid by the private sector participants and half-paid by the targeted state grant for these programs.

NH Journal: You have previously discussed legalizing and taxing marijuana, and increasing the gas tax as ways to increase revenue for the state. Are those positions you still support?

Marchand: Those are areas I continue to discuss. I do favor the legalization, regulation, and taxation of marijuana. I do feel it would have a net positive impact in terms of lowering costs for law enforcement and judicial [entities]. I also think that it will improve health outcomes and reduce addiction rates, and it will generate revenue. The gas tax is…not desirable. That’s definitely a flaw, but I believe when you can attach the revenue stream to the use of the revenue stream, that’s a more transparent system and because infrastructure is a priority. The business leaders I’ve talked to over the years also identified it as a priority. For now, the gas tax is one of the most direct tools in the toolbox. It is something I still have on the table because I think [infrastructure] is one of the biggest barriers we face to economic growth if we do not address and updated electric grid, ensured drinking water, improved Internet access particularly in rural areas, and improving our roads and bridges. Conservative business people tell me ‘why would I invest in New Hampshire, if New Hampshire doesn’t invest in New Hampshire,’ and they meant these infrastructure issues.

NH Journal: What about sales tax and income tax? You were against those previously. Are you still against them?

Marchand: That is correct.

Photo Credit: Steve Marchand For New Hampshire Facebook page

NH Journal: One of the most important issues still facing the state today is the opioid crisis. What do you think still needs to be done to tackle this problem?

Marchand: This is one area in New Hampshire where we have seen bipartisan efforts. I applaud people on both sides of the aisle. Over the last few years, I think they have taken this issue with the level of gravity that is required and I believe there are many more opportunities in the next several years to continue that bipartisan spirit. It doesn’t mean we’re anywhere near where we need to end up, but we have everyone rowing in the same direction about the situation. We need to continue to provide the resources that continue to give a suite of services to those in the midst of recovery, beyond simply detoxification of the addictive substance. Until recently, I think a lot of people in the world of politics saw recovery as largely detoxification. The reality is that if we simply just detoxify people and then we put folks back in a situation where addiction became the norm, the likelihood of relapsing is really high. We need to work together and it requires a level of collaboration that is not inexpensive. But it’s a hell of a lot less expensive than not doing it. That needs to be our attitude. I priced it out last year in that it would be an additional $8 to 10 million a year of resources that would provide a level of stability for local and regional recovery centers to focus less on having to worry about where the next grant will come from in order to stay open. It would allow these people who are doing amazing work in the field of recovery to be able to focus on their gifts and skills to help people. I think it’s a relatively low amount of money…that would improve lives, reduce costs, and directly address what New Hampshireites say is the most important issue facing us.

NH Journal: What do you think needs to happen next year in order for the Democratic Party to gain seats back in the Legislature?

Marchand: Once every four years, the country reorganizes what it means to be a Republican and Democrat. We are in the midst of the next resorting of how people look at what it means to be a Democrat and a Republican. We are not close to the end of that process. We are right in the middle of it. Donald Trump and Bernie Sanders understood better than most the level of economic anxiety that millions of Americans across party lines are feeling. There are a lot of people who are really angry and I get it. I believe that in 2018 and beyond, and it’s part of why I am passionate about this marathon that I’ve begun as a candidate, is to rebuild the future coalition that I believe can be a Democratic majority is one that is passionate about civil liberties, that is passionate about entrepreneurship as the centerpiece to economic growth, that understands that if you think about the economy right way, you can lower income inequality, which right now is splitting our country up in highly destructive ways. We need people that have spent time professionally, politically, and in their personal lives understanding these aspects of it and are unafraid and confident to use that data, experience, and information to lead that way forward. That’s part of what excites me about this marathon that I’ve begun is I feel I have a good idea about where we need to go as a state and want to help us get there.

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There’s a new presidential opioid commission in town, but drug policy experts remain skeptical about its mission and effectiveness. It also appears that New Hampshire does not have a seat at the table, for now at least.

The President’s Commission on Combating Drug Addiction and the Opioid Crisis was announced Wednesday when President Donald Trump signed the executive order laying out its blueprint. It will be chaired by New Jersey Gov. Chris Christie, who has made the opioid crisis a priority as governor, and will study appropriate steps for lawmakers and federal officials to take to combat the epidemic.

“This is an epidemic that knows no boundaries and shows no mercy, and we will show great compassion and resolve as we work together on this important issue,” Trump said.

The panel’s mission would be to identify federal funding streams that could be directed to address the crisis, determine the best practices for prevention and recovery, evaluate federal programs and the U.S. health system to identify regulatory barriers or ineffective initiatives like prescribing practices, and consider changes to the criminal justice system.

More than 52,000 Americans died from a drug overdose in 2015 — up from 47,000 in the previous year — according to the U.S. Centers for Disease Control, and nearly two-thirds of those deaths involved an opioid.

The commission would make interim recommendations within 90 days of its establishment along with a final report in October. The agencies involved would be expected to take actions implementing those policies.

The commission would be composed of Attorney General Jeff Sessions, Health and Human Services (HHS) Secretary Tom Price, Veterans Affairs Secretary David Shulkin, and Defense Secretary James Mattis. Another five members from state governments, law enforcement, and other groups would finish it. Massachusetts Republican Gov. Charlie Baker and North Carolina Democratic Gov. Roy Cooper are reportedly set to sit on the panel.

When the commission was announced, a spokesman for New Hampshire Republican Gov. Chris Sununu told NH1 News that he “doesn’t have a formal role with the commission.”

If that stands, it would be an interesting position from the White House. The Granite State has the second-highest overdose deaths in the country. While Massachusetts has also been devastated by the opioid crisis, Baker did not support Trump in the 2016 presidential election and Governor John Sununu never once wavered from his support for Trump.

There was also no one from New Hampshire taking part in the listening session at the White House when they announced the commission. None of New Hampshire’s Democratic congressional delegation took part in the session.

That’s worth noting because Trump and Christie as presidential candidates often discussed the opioid crisis during their campaign visits in New Hampshire.

“A wall will not only keep out dangerous cartels and criminals, but it will also keep out the drugs and heroin poisoning our youth,” Trump said in a stop in the Granite State in October.

However, drug policy experts are concerned that Trump is focusing on just the criminal justice side of the crisis, and not enough on treatment and prevention.

“We don’t yet fully know what the Trump policy towards the opioid crisis will be,” said Leo Beletsky,a law professor at Northeastern University who specializes in health and drug policy, in an interview with NH Journal.

“During the campaign, he made statements supporting treatment access and focusing on interdiction at the US-Mexico border,” he added. ‘Since the election, we have heard much about the ‘Wall,’ other interdiction efforts, and criminal justice tools to combat the crisis, but not so much about the treatment issue.”

Other advocates are frustrated with actions the Trump administration has already taken that could actually worsen the crisis.

The Office for National Drug Control Policy (ONDCP) would support the commission, and the office’s director — known as the “drug czar” — would represent the president. Yet, the ONDCP post is still unfilled, despite reports that former U.S. Rep. Frank Guinta of New Hampshire was being considered for the job.

A new spending plan reported last week would cut the Substance Abuse and Mental Health Services Administration’s mental health block grant by $100 million in 2017. Trump’s proposed 2018 budget for HHS would cut the agency’s funding by nearly 20 percent.

Beletsky was also concerned about Sessions being involved in the commission due his skepticism about treatment and favoring a punishment system to handle the opioid crisis.

“Further, Jeff Sessions is a long-time adherent to the idea that we can arrest and punish our way out of substance misuse in this country — an idea that has been a demonstrable failure and one that has frankly brought us to where we are today,” he said.

Several experts also question the value of the commission and how its efforts could be duplicative of actions and groups already in existence.

In November, Surgeon General Vivek Murthy released the office’s first-ever report on opioids and addiction, which included tools and recommendations to combat substance abuse.

There’s also the Bipartisan Task Force for Combating the Heroin Epidemic, which was created in 2015 by Guinta and New Hampshire’s other delegate, Democrat U.S. Rep. Annie Kuster. It’s mission has transformed as the crisis evolved from just heroin to include opioids and fentanyl, but it remains a legislative approach to handling the epidemic.

“The Presidential Commission…appears to be weighed heavily towards a more partisan and more criminal justice-focused approach, in a tone set by the AG,” Beletsky said. “As far as I know, there is not one public health expert on the Commission, which is as clear signal as any that Obama Administration’s mantras of ‘public health approach’ and ‘we can’t arrest our way out of this problem’ will not find much support in this group.”

Kuster appeared supportive of Trump’s efforts to tackle the opioid crisis and create a presidential commission, but cautioned against repealing parts of the Affordable Care Act that provide support for individuals seeking substance abuse treatment.

“We also know that there is not enough capacity for those seeking treatment, and I was pleased to see that part of the Commission’s mission will be to assess the availability of substance use treatment and recovery services,” she said in a statement. “I look forward to working with the Commission and discussing how the Bipartisan Heroin Task Force can be a productive partner in the House of Representatives to advance policies to address the opioid addiction crisis.”

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When it comes to Medicaid expansion in New Hampshire, Gov. Chris Sununu is in a tight spot. It’s not just him, actually. A lot of Republican governors across the country are having a difficult time figuring out how to balance the “repeal and replace” rhetoric on Obamacare within their party, while also seeking to protect certain provisions of the health care law, like Medicaid, that help the residents of their states.

It’s a balancing act that Sununu, the first GOP governor in the Granite State in 12 years, waded into last week. He said in its current form, he’s not “signing on” to the House Republicans’ American Health Care Act due to his concerns over Medicaid funding and coverage.

“The bill that’s been proposed in Congress gives us concerns on a lot of different levels,” Sununu said on Tuesday. “Expanded Medicaid is part of that discussion. There’s no doubt expanded Medicaid has provided [drug] recovery, treatment options for a lot of folks that otherwise may not have had that option available.”

The Congressional Budget Office estimates that $880 million less in federal money would be spent on Medicaid over the next decade. The Republican plan phases out the program by 2020 with states receiving funding for existing expansion recipients as long as they maintain continuous Medicaid coverage.

The Medicaid provisions in the Republican’s bill are reigniting a longstanding debate between conservatives and moderates of the party. Conservatives are critical of the program’s cost and performance, while moderates are worried that cuts to the program will result in a loss of funds in their state’s budget, leaving patients without help.

Sununu falls into the latter category. He has previously indicated his support for Medicaid expansion, yet doesn’t want to make the program permanent. He’s waiting to see how the Medicaid battle plays out in Congress before taking any action in the state.

New Hampshire was one of 31 states that expanded Medicaid under former President Barack Obama’s Affordable Care Act. Former Democratic Gov. Maggie Hassan, now a U.S. senator for the state, signed the plan into law in 2014 after working with Republican legislators to approve it in two-year increments. She signed the latest expansion bill in 2016, with the program scheduled to expire at the end of 2018. New Hampshire has more than 187,000 individuals enrolled in either traditional or expanded Medicaid, according to state health officials.

During Sununu’s 2016 gubernatorial bid, he said extending the state’s Medicaid program until 2018 was “probably a good step forward,” but lawmakers shouldn’t keep doing it every two years.

“I like the idea that we’re moving forward without any tax payer burden, any tax burden on the taxpayers back,” he told NH1 News in February 2016. “We have essentially a public-private partnership helping to fund it as we move forward, and those are very positive steps. What I would like to see is a long term strategy for this state, not simply taking it in two- or four- year chunks.”

Democrats attempted to paint him as opposing Medicaid expansion because of his 2014 Executive Council vote against a $292 million state contract to implement Medicaid expansion. However, the item was added to the agenda at the last minute and he tried unsuccessfully for a two-week delay to fully understand the contract. He said the council shouldn’t vote on something that hasn’t been read thoroughly.

Yet, throughout the campaign, he was ambiguous about his plans for the future of Medicaid in New Hampshire. He didn’t indicate if he was supportive of extending past 2018 or would support an outright repeal of the program.

Those in New Hampshire who were concerned about Medicaid’s future were also not consoled by a letter Sununu sent to Congressional GOP leadership in January. With Republican President Donald Trump in the White House and GOP majorities in the U.S. House and Senate, it appeared that the repeal of Obamacare was imminent.

As a result, Sununu sent a letter to U.S. House Majority Leader Kevin McCarthy, urging Congress to give states as much flexibility as possible to design their own health care systems.

“We urge Congress to untie the hands of the States,” he wrote in the letter. “Let us have the flexibility to design a New Hampshire system for New Hampshire citizens.”

However, his letter left out any mention or comment on Medicaid expansion.

It wasn’t until February that Sununu became more clear on what he thinks about the program. He said “there’s no doubt that it’s [Medicaid expansion] been helpful.”

“It was a price tag of somewhere between $400 and $500 million,” he told NHPR. “We’ve been able to do it to date without a single New Hampshire taxpayer dollar. No state taxes go into it.”

Later that month, he expanded on what he wanted to see from Medicaid in the GOP’s health care plan.

“When we hear the term block grants coming out of Washington, especially with healthcare, the opportunities are tremendous for us,” he said at a meeting of the Concord Chamber of Commerce. “We spend tens of millions of dollars on the state level on things we simply don’t need. So give us a block grant.”

When Republicans initially rolled out their health care plan, block grants weren’t included. The House plan focused on paying states a fixed per-capita amount to cover their population based on their average expenses, but a Republican amendment to the bill allowed the option for states to choose a Medicaid block grant in lieu of the capped reimbursement model.

Under current health care laws, when an eligible person enrolls in Medicaid there are matching federal funds to ensure that they get care. The block grant proposal caps that federal share, letting states decide how to spend the dollars on care. However, many health care professionals say capping Medicaid funding in block grants could hurt access to quality health care for the poor, children, and elderly by cutting the amount of federal dollars available.

It’s not immediately clear if Sununu approves of the most recent, updated version of the American Health Care Act, but Sununu said he would work with Trump to to ensure that the bill gives states the opportunity to create “flexible” and “nimble” health care program.

Democrats in the state, including Hassan, believe block grants would fail to sustain the expanded Medicaid program. It’s a position that’s shared with many advocacy groups, including AARP, which released a “fact sheet” last week about how changing Medicaid to a block grant or per capita cap could hurt New Hampshire residents.

“The House bill will impact health care seriously, but what it would do to Medicaid expansion … it would in fact repeal it,” Hassan said at a press conference last week. “That [block grants] will make health insurance out of reach for thousands of Granite Staters, and it hurts the ability of those on the front lines to save lives and fight this [opioid] epidemic.”

New Hampshire has one of the highest drug overdose death rates in the country. Nearly 500 people died from drug overdoses in 2016 and approximately 6,000 Medicaid expansion recipients have accessed treatment, state health officials said.

Sununu, and other state Republican leaders, believe block grants will allow them to allocate the money to places that need it most, such as towns hardest hit by the opioid crisis. Yet, some policy experts argue that block grants will severely strain state budgets and leave states vulnerable when they have to deal with unexpected issues, like drug outbreaks that raise the average cost of treating individual patients.

Sununu said he has spoken with Trump and Vice President Mike Pence about the importance of Medicaid with treatment and recovery for the opioid crisis, and how that requirement should continue under the GOP plan.

The N.H. Senate tabled a bill Thursday, without debate, that would make Medicaid expansion permanent. The senators said they wanted to wait to see what will happen at the national level before they tackle it in the state.

As conservatives and moderates battle it out on Medicaid provisions in the GOP health care bill, it appears New Hampshire, and Sununu, will wait for the dust to settle.

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If John Carter had been involuntary committed after he overdosed on opioids, then he might still be alive. That’s what some members of his family said when they spoke in favor of a bill that would add opioid addiction to the state’s mental illness definition in order to expand the involuntary commitment criteria for admission to mental health institutions.

John, better known as Bubba, started his drug addiction at the young age of 13 years old by smoking marijuana. By 16 years old, he went to his first drug rehabilitation center. He went more than three times during a three-year period, unable to beat his addiction. At 18 years old, he started to use intravenous drugs, and two weeks before his fatal overdose, his family went to the police to get him committed. The police said their hands were tied and couldn’t do anything, his father Jack Carter told a Senate committee on Tuesday.

“We don’t have time to wait,” he said. “There’s no reason for more families to bury their kids. These are our children. Something has to get done. President [Donald] Trump called New Hampshire ground zero for the opioid crisis. It’s time to step up and do something for these families, for us, for the kids of our future.”

Senate Majority Leader Jeb Bradley introduced Senate Bill 220 in the the Senate Health and Human Services Committee. If enacted, it would expand the state’s mental illness definition to include those listed in the “Diagnostic and Statistical Manual of Mental Disorders,” which is published by the American Psychiatric Association and includes substance abuse and addiction as a mental disorder. The bill would also expand the involuntary commitment criteria for the state’s mental health services system.

In order to be committed, the bill states, “The person has ingested opioid substances such that the person’s behavior demonstrates that he or she lacks the capacity to care for his or her own welfare and that there is a likelihood of death, serious bodily injury or serious debilitation if admission is not ordered.”

Bradley said he understands that some people might oppose his bill on the grounds that treatment only works if the person is willing to seek it and that hospitals currently don’t have the space or funds to handle involuntary commitment.

“I know there are a couple of issues,” he said. “We are clearly a ‘live free or die’ state and we believe in individual responsibility,” he said. “But responsibility falls on [everyone] who sees someone who is addicted to substances, which is an illness, and needs help. And sometimes people don’t want to seek help and then it becomes our responsibility to help those people. We ought to be able to have this tool to help people who are reluctant to seek out help. I don’t think there is any disagreement about that even in our live free or die state.”

Bradley expects the bill to be retained and worked on over the following months to discuss what the new law would cost the state and improve the language to better define what the process to be uncommitted would entail. Yet, it has bipartisan support with Democratic and Republican cosponsors.

From 2014 to 2015, New Hampshire saw a 31 percent increase in deaths from drug overdose, which is the second highest in the nation, according to the Centers for Disease Control and Prevention. The Office of the Chief Medical Examiner of New Hampshire estimates 470 deaths will be attributed to drug overdoses in 2016, but the number officially stands at 385, as 85 cases are still being investigated. The chief medical examiner predicts more than 450 people will die from an overdose in 2017.

As of 2011, 38 states had some form of an involuntary substance abuse treatment law that are separate from any kind of criminal issues, according to the Partnership for Drug-Free Kids.

From the other people who testified, the overall sentiment was general support for trying to combat the opioid crisis, but they also sought more information on the specifics of the bill.

“This is a very complex issue,” said Alexander de Nesnera, interim chief medical officer at New Hampshire Hospital. “When individuals go through detox, they are usually on many medications and it could complicate the medical detox process if they’re not monitored very carefully. When you look at developing a system for individuals to be involuntary hospitalized, we need to make sure the receiving facility is linked to a hospital directly, so they can receive treatment if there are severe complications of detox that occur.”

De Nesera also cautioned lawmakers on the possible consequences of the bill.

“By changing the definition of mental illness, you would greatly expand the number of people. Currently, there are 44 patients that are waiting admission to New Hampshire Hospital,” he said.”If we were to expand the definition of mental illness, the numbers in the queue would expand greatly. We only have 168 beds, and with that limited capacity, patients are in waiting rooms to get treatment. That’s not the answer.”

He encouraged legislators to think about investing in more outpatient programs and to have a conversation with the hospitals in the state about what would work for them.

New Hampshire is poised to receive some federal assistance from the 21st Century Cures Act, but not nearly as much as lawmakers expected. When President Barack Obama signed the act into law last year, New Hampshire officials anticipated getting $10 million over the next biennium. It turned out the state is only getting $6 million. State officials thought the money would be distributed based on per-capita overdose deaths, but that’s not what happened. New Hampshire has the second highest overdose deaths per capita in the country, yet California, who has a per-capita rate that is nearly two-thirds lower than New Hampshire, will receive the most money.

“I think our members of Congress across the country have started to recognize that the heroin epidemic is a serious problem and needs more resources,” Bradley said. “I’m surprised to see the way it’s been allocated in New Hampshire. Hopefully, that can be rectified. That being said, we also have to continue what we’ve been doing in the last budget and allocate more of our resources.”

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It’s not often where there is a war of words between a governor and a mayor of neighboring state. Yet, that’s what happened last week between New Hampshire Gov. Chris Sununu and Mayor Daniel Rivera of Lawrence, Mass., when discussing who’s to blame for the Northeast’s growing opioid crisis.

“It’s coming from Lawrence,” Sununu said Wednesday at the Greater Manchester Chamber of Commerce breakfast. “Eighty-five percent of the fentanyl in this state is coming straight out of Lawrence, Massachusetts.”

He also pointed to Lawrence again in an interview later that day with Boston Herald Radio, saying the city’s status as a “sanctuary city” is causing problems for New Hampshire.

Sununu said he had a meeting with other New England governors when they met in Washington D.C. for the National Governors Association annual winter meetings.

“I sat down with [Massachusetts Gov.] Charlie Baker and all the governors from the New England regions and said we’re going to cross borders, you better get ready,” Sununu said. “I’m working with the DEA [Drug Enforcement Administration] in Bedford, working with the DEA in Boston, our state police, their state police.”

Sununu then vowed that “we’re going in.”

“We’re going to get tough on these guys, and I want to scare every dealer that wants to come across that border,” he said. “We’re not giving dealers nine months on parole and probation anymore. We’re putting them away for the five, 10 and 15 years that they deserve.”

Sununu’s “tough on drugs” rhetoric makes sense — albeit an interesting political move to pick a battle with a town in another state. He’s the first Republican governor in 12 years and the opioid crisis is still rampant in New Hampshire. He campaigned on the epidemic being the number one priority the state faces and depending on what he does to curb the crisis in his two-year term, could be a factor in his 2018 reelection campaign.

Despite several media reports about the subsequent back-and-forth between Sununu and Rivera, there is some legitimacy in Sununu’s claim about Lawrence being a hot bed of activity for heroin and fentanyl.

Most of the heroin coming to New England originates in Colombia and travels through Mexico, according to a 2013 report from The New York Times. Despite an increase in the number of seizures along the southern U.S. border, enough is still getting through to major distribution centers, including Philadelphia and New York, which then makes its way into northern New England, “often through Lowell, Lawerence, and Holyoke, Mass.”

According to the U.S. Drug Enforcement Administration’s 2014 National Drug Threat Assessment Summary, most heroin supplies in the New England region are brought in from New York along the vast interstate highway system, naming I-95 and I-93 as the major routes for New Hampshire’s heroin trafficking routes. The report also named Lawrence as a main distribution center for northern New England states.

“Massachusetts also serves as a staging area or interim transportation point for heroin being transported north,” the report states. “Lawrence and Lowell, north of Boston, are distribution centers for northern New England and Canada. Maine, New Hampshire, and Vermont are supplied with heroin chiefly by drug groups in northeastern Massachusetts, particularly in Lawrence and Lowell.”

Western Massachusetts is one of the staging areas for distribution in Vermont, Maine, and New Hampshire because drug dealers from those states who want the product have to drive to Massachusetts to get it because drug penalties in Vermont, Maine, and New Hampshire are stricter in the three northern New England states.

Because Lawrence sits on the I-93 highway, police have said many drug deals occur at fast-food restaurants off the highway exits.

It is so widely known that Lawrence is a main distributor for the opioid crisis, that even Massachusetts Attorney General Maura Healey said it to the Times in 2016.

“Massachusetts is the epicenter for the heroin/fentanyl trade,” she said. “From Lawrence, it’s being trafficked and sold all over the New England states.”

For example, undercover detectives followed a car on a heroin buying mission from Manchester to Lawrence and back on Sept. 15, 2015, which resulted in one arrest.

Still, despite these reports and former statements that show Lawrence is a main distributor of heroin and fentanyl for New England, Rivera took offense that Sununu called out his city.

“Just like the President is finding out that health care is complicated, I think that the governor is going to find out that this is a complicated issue,” Rivera said in a hastily scheduled press conference on Thursday. “I’m not sure that he meant to threaten the sovereignty of the Commonwealth of Massachusetts, but he did.”

One of the major problems Rivera had was with Sununu’s claim that 85 percent of the fentanyl entering New Hampshire came from Lawrence.

“I would ask you guys to ask him where he got that number from,” he charged reporters. “I don’t know if it’s a true number. I think the problem is if you think like ‘oh you snuff out what’s happening in Lawrence, it will all go away.’ I know he’s only been on the job 60 days, but the reality is it’s like water, it will find another place to go.”

Rivera and Sununu eventually spoke on Thursday afternoon, and Sununu released a statement after the call.

“The Mayor and his local law enforcement personnel have been doing a good job on this issue, but we must recognize this is a cross-border problem that requires cross-border solutions,” Sununu said. “It has no geographic boundaries and it remains incumbent upon all of us to come together and work collaboratively across our borders along with federal, state and local law enforcement.”

Sununu’s office has not offered any evidence of his “85-percent” claim, but regardless, Lawrence’s role in the opioid crisis cannot be disputed.

Baker, the Massachusetts governor, weighed in on the controversy, and said, “I do view this as a problem that affects us all and I think singling out a single community or a single state is not accurate.”

New Hampshire Senate Democratic Leader Jeff Woodburn offered his two cents.

“Instead of antagonizing key regional partners in our collective fight to combat the devastating effects of the opioid crisis, Governor Sununu should be fighting for our state’s successful Medicaid expansion program which has helped over 100,000 Granite Staters gain access to mental health and substance abuse treatment,” he said in a statement. “New Hampshire needs steady and serious leadership from the Governor’s office that focuses on a holistic approach to solving this public health crisis, not reckless, cavalier comments.”

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As expected, it didn’t take long for Democrats in New Hampshire to point out what proposals they didn’t like in Gov. Chris Sununu’s budget speech last week.

“I am encouraged by statements of Governor Sununu in support of full-day kindergarten and funding for the developmentally disabled, but as we all know, the devil is in the details,” said House Democratic Leader Steve Shurtleff in a statement. “The Governor’s budget address made no mention of the successful NH Health Protection Program, leaving serious unanswered questions for the 50,000 Granite Staters who rely on the program for their health care coverage.”

But the more divisive statements came from the Senate Democratic Caucus and New Hampshire Democratic Party (NHDP). While they applauded Sununu for keeping several initiatives put in place by former Gov. Maggie Hassan, they criticized him for not fully funding the Alcohol Fund to combat the opioid crisis.

“And in the midst of a substance abuse crisis, we need to find out why Governor Sununu chose not to fully fund the Alcohol Fund, which supports our effort to combat this crisis,” said Senate Minority Leader Jeff Woodburn in a statement.

NHDP Chairman Ray Buckley echoed Woodburn’s sentiments saying he was “disheartened to see that the governor did not fully fund the state’s alcohol fund, which would provide key resources to combat this epidemic.”

The Alcohol Abuse Prevention and Treatment Fund was created in 2000 by the Legislature, and it’s a mechanism that takes 5 percent of the gross profits from the sale of alcohol to support education, prevention, treatment, and recovery programs for alcohol and drugs. The fund has only been fully financed one time since its inception, which was in the 2003-2004 biennium — the first year it began. In his budget speech, Sununu proposed increasing the funds to 3.4 percent, double the 1.7 percent rate the previous budget had set.

In each budget after that, the governor or Legislature transferred the revenue to the general fund and only appropriated a small amount to the Alcohol Fund, which means Republican Gov. Craig Benson and Democratic Govs. John Lynch and Maggie Hassan suspended funding during their terms.

In the most recent budget, for the 2016-2017 budget biennium, Hassan and the House proposed suspending the funding formula. Hassan proposed giving the fund $9.6 million over the two-year period, but the Republican-controlled House dropped that figure to $3.6 million. Senators proposed bringing the formula back and lowering the cap to 1.7 percent, which would give the fund $6.7 million.

If the fund was fully financed for the whole biennium, it would have received approximately $19 million, still nearly $10 million less than what Hassan suggested. After the Senate put forward its recommendation for the budget, the NHDP called their budget “unbalanced and partisan” with “irresponsible gimmicks.”

It’s interesting that the NHDP would criticize Sununu for not fully funding the Alcohol Fund, when previous Democratic governors did not fully fund it either.

“We haven’t had a Democratic governor who has fought as hard as Sununu is fighting for it [the Alcohol Fund] right now,” said former state Rep. Joe Hannon, R-Lee, who made his mark in the Legislature by focusing on the opioid crisis.

“No one has taken the leadership on this, and the battle will be in the House and Senate Finance Committees,” he told NH Journal. “I’m always happy when the governor speaks about how he is addressing substance abuse treatment. He gets it, and that’s something I haven’t seen in awhile from leadership in the state.”

New Futures, a nonprofit group looking to curb substance abuse in the state, is a fervent supporter of fully funding the Alcohol Fund at 5 percent. They believe the money from the non-lapsing, flexible fund could be used for creative and innovative solutions to stop the opioid epidemic.

“We are encouraged by the fact that Gov. Sununu has increased the funding for the Alcohol Fund by doubling the current amount,” said Linda Paquette, president and CEO of New Futures. “However, we anxiously await the release of House Bill 2 in order to clarify the support in the budget for addressing New Hampshire’s substance abuse epidemic.”

Paquette said she was “very curious” what Sununu meant when he talked about “incentives” with the Alcohol Fund.

“First, I propose we double the Alcohol Fund, increasing these important resources by more than $3 million and creating incentives to ensure that those funds are truly spent,” he said in his Thursday speech.

Pacquette said she is hopeful that the Alcohol Fund will be a priority for the Republican-controlled State House because the funds are “not restricted.” New Hampshire is expected to receive federal money from grants and the 21st Century Cures Act, legislation approved by Congress and former President Barack Obama in December 2016, which gives $6.3 billion in funding to circumvent the opioid crisis and enhance medical research and development.

“The Alcohol Fund can be used to fill gaps where grant money and federal funds are restricted for certain uses,” Paquette told NH Journal. “It can be used for supporting recovery housing and investing in early childcare as a substance abuse prevention strategy. He [Sununu] clearly has made the opioid crisis a priority of his administration.”

Sununu presented his budget to the House and Senate Finance Committee in a Tuesday joint committee meeting. The House Finance Committee will take a look at his budget first and put forward recommendations to the full House later in the spring. After passage in the House, the Senate Finance Committee will review that budget and put it up for a vote to the full Senate, before returning to the governor’s desk for his signature or veto.

“We’re going to double that fund and get the money where we can have a lot of impact,” he said in the meeting. “Not just in the high-density areas, but really all across the state. None of our communities have been immune to that.”

The Senate Finance Committee recommended passage of Senate Bill 196 on Tuesday, which was amended to increase the Alcohol Fund to the 3.4 percent rate proposed by Sununu. If the House changes the formula or suspends it in its budget recommendations, this bill could override it and fund it at the rate Sununu proposed.

“This is a sound proposal that I and a majority of the Senate Finance Committee supported today by recommending a bill to do just that,” said Senate Finance Chair Gary Daniels, R-Milford, in a statement. “We have established a number of initiatives that serve to stem substance abuse, including the heroin crisis, and I know we can do more with the funding Governor Sununu has proposed as part of his budget.”

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Another year is gone and New Hampshire is still one of the states hit hardest by the opioid crisis. Now, a new legislature is again trying to figure out how to curb the rampant use of opioids.

Lawmakers might be hesitant to allocate more funds to the effort, since it can appear previous funding has had little effect. But advocacy groups, health experts, and recovering addicts say money is only part of the solution. According to them, the state needs to be more flexible with how the funds are spent and amenable to creative solutions.

That was one of the themes discussed at the State House on Tuesday, where advocates asked the Senate Finance Committee to approve a bill funding the state’s Alcohol Fund.

It’s a unique mechanism created by the legislature in 2000 that takes 5 percent of the gross profits from the sale of alcohol to support alcohol and drug education, abuse prevention, and treatment programs. In the past year, approximately $19 million would have gone to service providers and recovery centers that are dealing with the opioid crisis at a local level.

The Alcohol Fund has only been fully financed one time in its history. In previous biennium budgets, the governor or legislature have transferred the revenue to the general fund and only appropriated a small amount to the Alcohol Fund.

Supporters of the bill say the fund is a creative solution the state should use because it already exists in law and is designed to aid prevention and treatment of issues like the opioid epidemic.

“Two governors have called substance abuse the biggest problem in this state,” Keene Democrat Sen. Jay Kahn said, noting Gov. Chris Sununu called for putting more money into treatment, prevention, and recovery in his inauguration speech.

“I completely agree,” Kahn added. “This legislation provides an innovative solution to the real problems confronting the state.”

A similar proposal was introduced in the Boston City Council, where councilors tried to add a 2 percent tax on alcohol sold in Boston to help fund substance abuse prevention programs. The council eventually voted against the proposal.

New Hampshire’s Alcohol Fund is different. In the “Live Free or Die” state, voters wouldn’t be too happy about a tax on their alcohol (a major reason why Bay Staters cross the border). The Alcohol Fund uses revenue the state is already making from sales.

That’s the reason former state Sen. Ned Gordon, R-Bristol, authored that 2000 law establishing the fund. And while it’s focus back then was mostly on alcohol abuse and prevention, the language was broad enough to evolve over time to include other substance abuse.

“The state adopted a policy that if we are going to aggressively market alcohol, we are going to accept the consequences,” Gordon testified Tuesday. “You can’t be just committed to a treatment program. You have to be committed to a recovery, so we need more resources going to prevention and recovery. Unless you provide the funding to do it, you won’t have the capacity to do it.”

While the Alcohol Fund revenue goes to the Governor’s Commission on Alcohol and Drug Abuse Prevention, Intervention, and Treatment for their determination on what contracts, programs, and centers need the funds most, advocates said more funding could be used for New Hampshire’s Safe Station programs — another unique and creative approach to the opioid crisis.

Safe Station is the brainchild of Chris Hickey of the Manchester Fire Department. The program launched in May 2016, and anyone who is struggling with drug addiction can go to any one of the 10 fire stations in the Queen City any time and connect with recovery resources.

Anyone who visits the fire stations will go to Serenity Place, an outpatient program focusing on recovery work, or a similar center, and no one is turned away if they go through that method. Safe Station doesn’t receive any direct funding from the state, which can place limits on the program. Overall it’s seen as a success for the city, but it may still be too early to tell. Nashua also opened their first Safe Station in November.

From May to December 2016, there were 509 overdoses and 49 deaths — a slight drop from the same time period in 2015.

The American Medical Response group recently announced there was a slight increase in overdoses and deaths from 2015 to 2016 for Manchester and Nashua.

In 2015, Nashua saw 250 overdoses, with 19 fatalities. In 2016, the city’s total overdose number rose to 365 with 40 fatalities. For Manchester, there were 729 overdoses with 88 fatalities in 2015 and then 785 overdoses and 90 fatalities in 2016.

Traci Green, associate professor of emergency medicine at Boston University School of Medicine, is hopeful those numbers will decrease in 2017 as the Safe Station programs expand.

“I hope this is one new entree into an expanded hub for people to enter,” she told NH Journal. “There is great hope in trying to think about how public health and public safety can work together to get people to go to a place where it’s safe and connect with other peers in a time when they’re feeling extremely vulnerable. It seems like a great working relationship.”

Green called for states to be more creative in their thinking on how to address the opioid crisis, and make sure that it fits with the individual needs of their towns and cities. She applauded fire departments, law enforcement, and public health groups taking a role in prevention, treatment, and recovery rather than one entity trying to do everything.

“The entree into treatment and recovery seem to really work in Manchester, and people can have their clear roles and responsibilities,” she said. “I think that’s really important.”

It may be difficult to replicate Safe Station programs throughout New Hampshire, since fire stations must be staffed 24/7 and have access to a treatment center or emergency shelter nearby. It’s a problem the state will wrestle with as they decide how to disburse funding to all communities.

“Manchester has available resources that a place like Concord just certainly wouldn’t have,” James Vara, the state’s “drug czar,” said in September. “So, you have to look at them and temper that with the fact that these approaches may not all work. Safe Station is a great access point for people who are suffering, but they also have available resources like Serenity Place, which many of your districts wouldn’t have.”

It’s possible Sununu could address solutions like funding the Alcohol Fund and Safe Station programs throughout the state in his proposed 2018-2019 biennium budget, scheduled for released Thursday. Sununu said the opioid crisis was the state’s top priority, and funding to fix the crisis is expected to be a significant part of his budget proposal.

Combatting the epidemic is usually a bipartisan issue, though it may depend on how creative lawmakers in the State House can get.

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Despite several inches of snow in most parts of the state, substance abuse prevention advocates and recovering addicts made the trek to the State House to show support for a bill that would be able to fund more recovery programs in the Granite State.

“What are we waiting for?,” deputy director at New Futures Kate Frey asked at a Tuesday press conference. New Futures is a nonprofit advocacy organization looking to prevent and reduce substance abuse in the New Hampshire. According to her, the state is suffering a serious epidemic and needs creativity to get out of it.

One of those creative solutions unique to New Hampshire and endorsed by New Futures should be fully funding the state’s Alcohol Fund.

The New Hampshire Alcohol Fund was created in 2000 as a non-lapsing and continually appropriated fund to support alcohol and drug education, abuse prevention, and treatment programs. The law provides 5 percent of the gross profits from the sale of alcohol to support such programs. The funds would be allocated to the Governor’s Commission on Alcohol and Drug Abuse Prevention, Intervention, and Treatment to pay contracts for service providers in the communities hardest hit by opioid abuse.

The fund began during the 2003-2004 biennium and was fully funded in that budget. But every year since, the 5 percent funding has been suspended by either the governor or the legislature, and revenue transferred to the General Fund. In the subsequent years, the legislature appropriated only a small amount of general funds — significantly less than the 5 percent that was mandated by law for prevention and treatment.

The 2016-2017 state budget allocated only 1.7 percent to the Alcohol Fund. That total amount equated to about $6.6 million, instead of the $19 million had the fund received the total 5 percent. In the previous legislative session, lawmakers allocated an additional $2.5 million from the General Fund for prevention, treatment, and recovery in 2017, bringing the total to $9.1 million.

But a bill in the Senate would fully fund the Alcohol Fund for the 2017-2018 biennium at the 5 percent rate. At a hearing for Senate Bill 166 on Tuesday before the Senate Finance Committee, prime sponsor Sen. Jay Kahn, D-Kenne, said if the state is going to be serious about addressing the opioid crisis by focusing on prevention, intervention, treatment, and recovery, then legislators should be doing everything possible to get ahead of the problem.

“Where we invest our money is a direct reflection of our priorities, and our priorities ought to be with people in New Hampshire who need care,” he said. Kahn also called for creative ways to fight to crisis with “yankee ingenuity.”

But it might not be an easy task to convince the Legislature that this is a worthwhile endeavor.

In the last biennium budget, lawmakers approved $42 million in substance abuse funding. Former Gov. Maggie Hassan was criticized for originally vetoing the budget, delaying the appropriation of the funds by three months. The total amount was $14 million more than the 2014-2015 budget. During the legislative session, lawmakers approved at least $5 million in additional funding.

Some legislators on the Senate Finance Committee were concerned that the state has already spent a significant amount of money, yet didn’t seem to fix anything.

“If we just throw money at the problem, we don’t necessarily solve the problem,” Sen. Bob Giuda, R-Warren, said.

Gov. Chris Sununu is scheduled to release his budget proposal for the 2018-2019 biennium on Thursday, so it remains to be seen how much money he’s putting towards the opioid crisis or if he plans to fully fund the Alcohol Fund. During his bid for the corner office, Sununu and his Democratic challenger Colin van Ostern said they supported returning the Alcohol Fund to 5 percent.

In his inauguration speech, Sununu said getting the opioid crisis under control was the state’s top priority.

“I believe we need to start in the beginning in terms of our schools,” he said on January 5. “Aggressive prevention programs in our schools that start earlier, that are more aggressive. And I think we need to start bringing in the parents and the stakeholders into those programs. There is a different path for everybody and we need to be open to all the paths. We need to put resources behind our words and take real action.”

NH Journal previously reported fully funding the Alcohol Fund had bipartisan support among most of the gubernatorial candidates. And when the fund was first debated in 2000, it received widespread, bipartisan support in the House and Senate. Former Gov. Jeanne Shaheen vetoed the original legislation establishing the Alcohol Fund, but a two-thirds majority in the House and Senate overrode her veto, so it has the potential to appeal to lawmakers on both sides of the aisle.

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