Constitutional amendment requiring 5% of liquor profits to be spent on alcohol and other drug abuse prevention, treatment, and recovery services.
Heroin Addiction: Treatment Funding
Those seeking information about treatment for heroin or opioid addiction can call (800) 662-HELP anytime day or night for information about treatment facilities, support groups and other resources.
Heroin Treatment Options:
Heroin addiction can be treated through behavioral therapies or medication, or a combination of both.
- Medications like methadone can reduce withdrawal symptoms and craving or block opioid receptors in the brain so that heroin no longer has an effect on the user.
- Naloxone (Narcan) counteracts the effects of a heroin overdose and is often used as an emergency treatment.
- Both cognitive behavioral therapy and contingency management therapy have been used to effectively fight heroin addiction.
Both types of addiction therapies can be delivered through either residential or outpatient programs.
According to Donald West at the Dartmouth-Hitchcock Medical Center, inpatient heroin addiction treatment can cost roughly $14,000 to $15,000 per month. Intensive outpatient care costs approximately $3,000 to $4,000 per month.
The Affordable Care Act prevents insurance companies from turning away applicants based on their history of substance abuse, and requires that all health care plans offered through state or federal insurance exchanges cover substance abuse treatment services at a level comparable to coverage for physical health services.
Medicaid expansion patients (under NH Health Protection Program) are covered for a range of substance abuse treatments, from counseling services, methadone or buprenorphine administration, and outpatient care to residential programs. Traditional Medicaid subscribers (under NH Healthy Families) may access a more limited range of services, which does not include ambulatory detox services. Limits and requirements for coverage vary.
In 2000, the Legislature authorized the creation of a dedicated fund for alcohol and drug abuse prevention, treatment and intervention (RSA 176-A:1). The fund is scheduled to receive 5% of profits from sales at state liquor stores, as well as a portion of funds from fines and penalties related to alcohol abuse or violations of alcoholic beverage laws. However, the fund only received its full statutory appropriation in 2003, the first year it was created. Since then, a portion of funds has regularly been diverted to the general fund or other line items.
Insurance coverage for substance abuse treatment does not necessarily mean that such services are readily available. A 2014 survey by the NH Department of Health and Human Services found that:
- Demand currently exceeds capacity for residential substance abuse services and intensive outpatient counseling.
- The availability of services is not evenly distributed through the state.
- Some regions lack any residential treatment centers.
- Others have no providers of medication assisted treatment, or only one for the region.
- Some regions have low numbers of licensed drug counselors.
- Not all providers accept insurance or Medicaid, with 22% of independent providers and 13% of private practice groups only accepting self-pay patients.
- Many service providers plan to expand their capacity and/or range of offered services in the near future.
Possible Policy Responses
Suggested policy responses related to the expansion of heroin addiction treatment funding in New Hampshire include:
- Fully funding the Alcohol Abuse Prevention and Treatment Fund
- Continuing to renew Medicaid expansion
- Increasing substance abuse benefits for traditional Medicaid patients
- Simplifying licensing requirements for substance abuse treatment centers
- Increasing state subsidies for uninsured or underinsured patients
PROS & CONS
"NH should provide more funding for heroin treatment."
- Heroin treatment programs represent a smart investment, saving lives and reducing crime by reducing incarcerations and the risk of reoffending.
- Wait lists mean that patients seeking help may be turned away when they are in most need of assistance.
- Additional subsidies would help to expand capacity and subsidize the cost of treatment for those who cannot afford it.
- Funding is necessary to provide important services not normally covered by Medicaid or insurance, such as recovery programs or early intervention.
"More funding is not the answer to NH’s heroin problem."
- More money does not necessarily equal better results, and lawmakers should acquire data on the effectiveness of programs before approving increased funding.
- Drug treatment programs can serve as a ‘revolving door’, with patients relapsing and returning for additional services.
- Heroin addiction is a private problem based on an individual’s choice, so it should be an individual’s responsibility to find the funds for treatment.
- In tight budgetary times, there are higher priorities for limited state dollars than funding heroin treatment.
Authorizes the Department of Health and Human Services to contract with a physician to provide guidance related to medication assisted treatment and non-medication related treatment for substance use disorders.
Requires the Department of Health and Human Services, in conjuction with the governor's Commission on Alcohol and Drug Abuse Prevention, Treatment and Recovery, to make an annual report on the cost effectiveness and outcomes of programs funded by the commission.
Establishes a nursing professionals' health program for aiding nurses impaired by mental or physical illness, including substance abuse. A similar program exists for physicians, dentists and pharmacists and is funded through their license fees.
Sends 40% of the money from the Drug Forfeiture Fund to the Alcohol Drug Abuse Prevention and Treatment Fund.
Increases the share of gross liquor profits deposited into the Alcohol Abuse Prevention and Treatment Fund, from 3.4% to 5%. This bill also repeals a law that gave the governor power to transfer funds to cover costs at the Sununu Youth Services Center in the event of an emergency. A conference committee amended the bill to instead appropriate up to $2.7 million for the Sununu Youth Services Center, require a monthly report from the Center, and establish a committee to study alternatives to the continued use Center.
Establishes a state substance use disorder treatment services program in the Department of Health and Human Services (DHHS). According to the House Executive Departments and Administration committee, the bill codifies DHHS oversight of drug and alcohol misuse treatment centers. This bill also adds a certified recovery support worker on the Board of Licensing for Alcohol and Other Drug Use Professionals. Lastly, this bill modifies the requirements for licensure as a clinical social worker, clinical mental health counselor, or marriage and family therapist, particularly the amount of training required.
Permits the use of up to 10% of the Rainy Day Fund to address a public health emergency, as declared by the Governor or the Legislature.
Makes a supplemental appropriation to address estimated budget shortfalls in relation to the Sununu Youth Services Center. This bill also requires health care providers to report any child born with substance abuse or withdrawal symptoms and to develop a plan of safe care in conjunction with the Department of Health and Human Services. The Senate amended the bill to remove the funding for the Sununu Youth Services Center.
Requires the Department of Health and Human Services (DHHS) to establish a three year pilot program providing therapeutic intervention to infants diagnosed with neonatal abstinence syndrome (NAS). The Senate amended the bill to require DHHS to develop a plan for a pilot program, which would need approval from the legislature before it started.
Establishes a business tax credit for donations made to the Community Development Finance Authority for recovery friendly workplace initiatives. According to the bill, "'recovery friendly workplace initiatives' means evidence-based practices that reduce substance misuse in the workplace and create a work environment that is conducive to enabling persons in addiction and mental health recovery to sustain and re-enter the workforce as productive members of society."
Allows the Department of Health and Human Services to waive the work requirement in the child care scholarship program for applicants or recipients participating in a mental health or substance use treatment program. The child care scholarship program gives working parents under 250% of the federal poverty level financial assistance for child care.
Broadens a definition in the Safe School Zones law to require reporting of a broader list of crimes by school employees. The Senate amended the bill to allow needle exchange programs to operate within drug-free school zones with permission of the school district. The Senate voted down an amendment to this bill that would have allowed schools to ban firearms; current law allows adults with concealed carry permits to carry firearms on school grounds.
Makes various changes to the regulation of dentists and dental hygienists, including requiring criminal history records checks for new applicants. This bill also requires the Board of Dental Examiners provide a rehabilitative program for impaired dentists, including dentists with substance abuse disorder.
Creates a new account, funded by a surplus from the Children's Health Insurance Program, to fund more child protective service workers. In particular, this bill funds twenty-five new child protection social workers, two new supervisors, two new executive secretaries, two licensed alcohol and drug counselors, and two attorneys. The bill also authorizes $500,000 for foster care and adoption programs, $250,000 for home visiting services, $250,000 for child care services, and $1.5 million for voluntary services offered to families in "unfounded but with reasonable concern" cases of possible child abuse or neglect. The bill requires the state to pay for those voluntary services. This bill also authorizes $500,000 for the Department of Health and Human Services to develop community-based parental assistance programs. Much of this funding will come from federal Temporary Assistance for Needy Families (TANF) funds. Lastly, this bill establishes a committee to study family drug courts.
Directs the Juvenile Justice Advisory Board and the Governor's Commission on Alcohol and Drug Abuse Prevention, Treatment, and Recovery to develop a procedure to refer minors to the John H. Sununu Youth Services Center for drug treatment after being revived with Narcan.
Establishes the position of state demographer, establishes a commission on demographic trends, requires state agencies to prepare 10-year cost projections, and requires the legislative budget assistant to include demographic impact notes on legislation. A conference committee amended the bill to add many new provisions. First, the amendment raises some state employee salaries. The amended bill also appropriates $20 million for red list bridge repair and $10.4 million municipally-owned high traffic volume bridge projects, and sends $10 million to the Rainy Day Fund. Another $2.5 million is appropriated for transitional housing for those leaving mental health and substance use disorder treatment facilities. $300,000 is sent to the state loan repayment program, which helps employees in certain critical fields pay back student loans. The amended bill also appropriates $1 million to support "recovery friendly workplace programs" offered by nonprofits, such as programs that train employers how to reduce substance misuse in the workplace. Lastly, the conference committee revised the formula for "disproportionate share hospital payments," which go to hospitals for providing uncompensated care to low income patients.
Adds illicit drugs and drug paraphernalia to the drug take-back programs.
Creates a dedicated fund for the bulk purchase of narcan and naloxone, so that the state can offer Narcan and naloxone at a discounted price. The fund would be supported by public and private sources including, but not limited to gifts, grants, donations, rebates, and funds from agreements or settlements received by the Department of Justice.
If a first responder administers Narcan to a youth age 14-17 for an overdose, this bill requires the state to assess whether the youth should be placed at the Sununu Youth Services Center.
Authorizes community-based needle exchange programs and requires the Department of Health and Human Services to develop rules for such programs.
Requires health carrier network adequacy rules to include access to providers for persons with substance use disorder. This bill also requires health carriers to notify covered persons of their rights, including the ability to appeal decisions and seek care out-of-network.
Declares that if substance use disorder services are a covered under a health benefit plan, prior authorization for prescribed medications for a substance use disorder is only required once a year.
Makes it easier for grandparents to get guardianship of grandchildren as the result of a parent's substance abuse or dependence.
Repeals the state definition of "mental illness" and replaces it with "mental disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders fifth edition." This bill also allows involuntary commitment for opioid addiction.
Increases the percentage of the previous year's gross liquor profits deposited into the Alcohol Abuse Prevention and Treatment Fund, from 1.7% to 3.4%.
Legalizes trace amounts of drugs in needles, and authorizes persons other than pharmacists to dispense hypodermic syringes and needles. This bill would allow needle exchange programs.
Revises prior authorization requirements under the managed care law for substance use services.
Appropriates $51,520 in the biennium ending June 30, 2017 to the TIGER (educational theatre) program at Plymouth State University and establishes the heroin and opiate prevention education (HOPE) grant program for public high schools.
Makes a general fund appropriation of $2 million to the Housing Finance Authority to fund supportive housing for persons with substance use disorders.
Requires the Department of Health and Human Services to evaluate the cost effectiveness of alcohol and drug abuse prevention, recovery, and treatment programs which receive state or federal funds, and requires organizations receiving such funds to spend the money on the most cost effective programs.
Originally written to make various changes to the Prescription Drug Monitoring Program. The Senate amended the bill to instead create a commission to study the overdose-reversing drug Narcan.
Allows the county convention in each county to establish heroin use prevention and treatment programs.
Requires hospitals in Hillsborough county to offer patients who have received Narcan for a drug overdose an opportunity to speak with a recovery coach or receive contact information for a recovery coach.
Expands drug take-back programs to include drugs such as cocaine.
Requires treatment and recovery programs for substance abuse disorders to use an integrative approach, including homeopathic remedies, when treating patients.
Establishes the position of licensed alcohol and drug counselor in the Department of Safety. The person holding the position shall be responsible for establishing a training program for fire and emergency medical services personnel and developing a pilot program through which local communities hire licensed alcohol and drug counselors.
Establishes a commission to study long-term peer-to-peer recovery services in New Hampshire.
Requires public schools to provide age appropriate drug and alcohol education to pupils in kindergarten through grade 12.
Makes some changes to the licensing of alcohol and drug counselors.
Establishes the statewide drug court grant program.
This bill includes many regulations aimed at combating heroin and prescription drug abuse. For example, this bill increases the penalties for abusing fentanyl and provides funding for an upgrade to the Prescription Drug Monitoring Program.
Requires the insurance commissioner to investigate insurance carriers for conduct which may violate the provisions of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
Provides that evidence of a parent's opioid drug abuse creates a presumption of harm under the Child Protection Act. The bill also permits the court to order periodic alcohol or drug testing and provides that the parent may be responsible for the cost of such tests.
Constitutional amendment that prohibits use of money from the substance abuse treatment fund for anything other than substance abuse treatment.
Increases access to overdose-reversing drugs such as Narcan by allowing doctors to pescribe to friends, family members of addicts.
Establishes a committee to study opioid misuse.
Should NH increase funding for heroin treatment programs?
NH was approved to receive a $45.8 million federal grant to help fund addiction treatment services. The state will use the money to establish nine regional addiction treatment hubs which will coordinate services and track patients' progress through both treatment and recovery. DHHS is in the process of finalizing contracts with seven hospitals.
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