Thursday, August 13, 2015

Drug Czar

John "Jack" Wozmak is New Hampshire's so called "drug czar" and his main job is to coordinate the state's drug treatment, prevention and recovery efforts. His actual title is Senior Director of Substance Abuse and Behavioral Health. The position has been funded for the first year ( 2015) by a grant from the NH Charitable Foundation for $112,500.  In 2014, 326 people in New Hampshire died of drug overdoses, mostly from heroin or the synthetic opioid fentanyl. As of July 1 this year, there were 132 fatal overdoses. 
On July 1st, Wozmak issued a list of 22 very broad recommendations to combat this very serious problem:
  1. Increase Narcan Availability
  2. Move up the Expansion of Substance Abuse Services to the Existing Medicaid Population
  3. Reauthorize the New Hampshire Health Protection Program
  4. Expand Drug Courts and Treatment Options
  5. Better Utilize the State’s Prescription Drug Monitoring Program
  6. Expand Health Care Provider Education on Best Practices Regarding Opioid Prescribing
  7. Review State Medicaid System Policies Regarding Opioid Prescribing
  8. Develop a System to Monitor Parity Compliance
  9. Facilitate the Implementation of Programs and Prevention Efforts for Schools
  10. Assess the Need for Mandatory SUD/BH Coverage
  11. Implement the Use of Naltrexone (Vivitrol) in Correctional Settings
  12. Partner with New Hampshire 211 to Expand Access for Individuals Seeking Information on Treatment and Recovery Services
  13. Expand Treatment Options
  14. Establish a Network of Independent, Standardized Assessment Centers
  15. Consider Strict Regulation/Oversight of Methadone Clinics
  16. Review Regulation/Oversight of Free-Standing Pain Clinics
  17. Increase the Number of Medication Take-Back Boxes
  18. Establish Increased Housing Opportunities for Those with Substance Misuse/Behavioral Health Disorders
  19. Increase Transitional Housing for Women
  20. Increase the Availability of Data to Law Enforcement Agencies
  21. Facilitate the Creation of a Coordinated Statewide Telehealth System
  22. Establish a Network of Recovery Houses


There was considerable debate as to whether to continue to accept grant funding for the remainder of the year as some in the NH Senate thought that the recommendations were too broad and didn't include any cost or measurable outcomes. I can't argue with that, but don't throw out the baby with the bathwater. The wide ranging concepts he presented are on target, and besides, he has only been on the job less than half a year. 
Republican Sen. Andy Sanborn called for Wozmak to resign after reports that police chiefs around the state said they have not met with him since he’s began his job. He has stated he will not step down. Sen. Sanborn's concerns are misguided. Solving the drug problem with law enforcement as the first step is not the way to go. Prevention does not start with incarceration. When it gets to that point, the battle is already lost.
There are some known root causes and one major one is prescription opioid abuse. The epidemic of heroin abuse is driven by opioid addiction. According to the JAMA Psychiatry  60 percent of heroin abusers said they started out abusing prescription narcotics. Key to Wozmak's plan is to increase substance abuse treatment and work with providers. In an article in the Concord Monitor  Wozmak told lawmakers “We have 12,000 professionals that are capable of prescribing opioids. Each and every one of them needs to be exposed to standardized, acceptable education on opioid practice and pain management, that would not be happening if my position did not exist.”
 Beyond the deaths, many abusers are unable to hold jobs or are far less productive in them. Various studies estimate the cost in the billions to scores of billions,with nearly half  related to workplace. Whether Wozmak's position will be funded into 2016 is any ones  guess. Measuring success in this endeavour is not an easy metric and it may take years to see positive results. The question will be whether lawmakers in Concord can put aside politics for once and address this very serious issue in a bipartisan effort.

21 comments:

Town Hall Junkie said...

Treatment facilities in N H almost non -existent. Moultonboro quietly pulled a NIMBY , and denied permits to use a local empty, for sale, motel for a treatment center. Bad for our image......so is the crime, and dead addicts...

Anonymous said...

The ones that need to be educated are Doctors, Dentists and health care professionals who overprescribe. My husband and I have had our share of medical proceedures over the years from tooth extraction to surgery. It's our expericence that Doctors and Dentists are quick to overprescribe medication. We always decline the heavy duty presciptions in favor of over the counter pain killers. The war on drugs should begin with educating healthcare professionals.

Take Responsibility said...

22 recommendations for treatment, state run programs, education, housing and Narcan. Where is there any mention of enforcement, personal responsibility and threat of retributive justice. Back in April after many many attempts of salvaging the life of a young woman addicted to heroin with various treatments, Narcan, and counseling, the family wrote her obit with a message for those in her same path, rather than cover over her addiction. My point is some of these programs are likely a good option. Narcan works but enables the user for several repeat offenses. At some point there needs to be a level of personal responsibility. Giving Narcan to the same addict 9, 10 times or more is covering over the issue and enabling the user.
After each od experience there should be an arrest-trial-sentencining experience and an opportunity for a treatment program as part of the sentence. However, after a given number of failed attempts (3-5) the cold turkey incarceration should be the option.
As for drug dealers (including the medical professionals who over prescribe), they should be dealt with in the most severe way we can. We shouldn't be decriminalizing drug crimes; rather longer more severe sentencing. The lack of communication between the PD's and the drug czar is very revealing as to his lack of understanding of responsibility.

Anonymous said...

Great list of actions. Here is one more. Decriminalize pot now and sharpen focus on the real drug problem.

Anonymous said...

Town Hall Junkie, I am greatly relieved that our town "pulled a NIMBY" and refused a treatment center at the Berry Pond Motel. That place would be a focal point for drug dealing. Ask any cop, he/she will confirm that. There is a lot of drug dealing going on at the other motel in town, prostitution too. With a treatment center at Berry Pond I could envision junkies walking/driving up and down Lee Road checking out houses and cars for things to "boost".

One good way to attack the heroin problem would be to suspend the use of Narcan. Ask any EMT, they will tell you that there are many repeat "customers" for Narcan. They will also tell you that they hate retreating the same people time and again. I say save them once, if they OD again let them go, that particular drug problem will go away. Yeah, cruel. So be it.

Anonymous said...

We have a great humanitarian here ( anony at 0537). No treatment and no narcan. Just let them die. Yeah, right, that will solve the problem.

An Ounce of Prevention said...

Hate to sound hard hearted too but giving addicts Narcan time after time is not working. Very little emphasis in the overall conversation is put on parenting and personal responsibility. Drug problems begin in the home with denial and/or absentee parents. Time to chage the focus to where it might have more of an impact, parenting.

Anonymous said...


Right legalize marijuana.....brilliant.....not! Time for you to ditch the weed. Which one are you Cheech or Chung?

http://marijuanaaddictiontreatment.org/statistics-facts.html

Foghorn Leghorn said...

The post at 8:26am is idiotic. Parenting is the problem for the heroin epidemic? Please. There are many parents that have seen their scholar child turn into an addict. Cheech or Chong (not Chung) has is wrong as well. No one is advocating just give 'em weed, but rather a way to get off the substance to find out what is UNDERNEATH the abuse/addiction of drugs. There usually is some sort of pain, mostly emotional due to a number of different causes. Such as: trauma of many sorts, broken or dysfunctional families, abuse of many kinds, hopelessness, etc. Drugs and even alcohol, are a relief to all that emotional pain. Trouble is counseling costs money. Drug rehab costs money. And TIME. Many people, not just drug addicts do not want to deal with their problems and bury them one way or another, until they hit rock bottom. We as a community do need to face we have a real crisis on our hands and we have to deal with it. We pay one way or another and jails do not rehabilitate. It's time to stop with the Not in MY backyard attitude. These problems are in OUR backyard.

Anonymous said...

I hate to break it to you Foghorn but lots of people suffer trauma and pain and don't turn to drugs and alcohol, that's a cop out.

Anonymous said...

@Anon @ 11:38 PM. I am glad that life is so simple for you. You just solved one of the major problems in the world - just don't cop out.

Foghorn Leghorn said...

Foghorn here. A cop out? How heartless you are. What about those people that suffer from addiction? You are fooling yourself if you think this heroin crisis is not a real problem. Your life must be easy with no 'cop out' around you. Good for you but what about those that are dying from addiction? Cop out my foot.

Anonymous said...

How did these people become addicted? Ever hear of cause and effect? Live is not simple, but learing to make good choices sure helps.

Anonymous said...

Remarkable how out of touch some of you are. Parents can only do so much. You are also assuming 2 parents are in the house. Nowadays also if there are two parents both probably have to work. Peer pressure, internet have huge influence on society. Many, many families with good parents have children that are on drugs. You are copping out by avoiding trying to solve the problem by simplifying the solution to its the parents fault and they should just make better choices. I also support a treatment center here in town. We can't be nimbys and help solve problems.

Joseph Cormier said...

Heroine on heroin.

https://www.ayotte.senate.gov/?p=press_release&id=2126




Let's see how that gets interpreted ... and maybe move on to the other subjects.



SB2 anyone?


sb2? said...

SB2 Joe? Going nowhere. It is a settled issue in this town. I doubt you would get 40% of the vote, far less than a super majority required. We're just tired of the topic Joe. It won't pass! Let it go Joe!

Anonymous said...

Parents can only do so much? Are these the same parents that see nothing wrong with condoning underage drinking parties? What kind of message does that send young people?

Foghorn Leghorn said...

Another comment at 6:54 pm that is so naive. Addiction and treatment are the issues. An underage drinking party is not going to cause someone to become an addict. It's an example of a stupid decision of some parents. Just googling causes of addiction will give one some insight. Environmental and genetics. Environmental are family beliefs and attitudes and peer pressure that encourages drug use, that play a role in initial drug use. Genetics - once one has started using genetics play a role in the speed the addiction progresses. Thus it explains why some people can use for many years before addiction kicks in and others will be addicts in a few years. The power of some pain killers (and other drugs) can be immediately addictive. So trying to place blame on parents or others is quite naive. There are many, many reasons why people use and abuse. Frankly, it doesn't matter. People NEED treatment. Period. Addicts need more than to stop using the drug. They need to learn how to live and cope with the issues that led them to abusing. Let's also not forget the criminal behaviors that are associated with supporting drug habits. It effects entire communities with robberies, thefts, break ins, etc. So, please stop pointing fingers and making dumb posts without a solution. I have yet to read any solution, only criticism or not in my town attitude.

Anonymous said...

Foghorn, the need treatment route is not working. It's you that has the rose colored glasses on. Children learn from example and good roll models, both in short supply.

Anonymous said...

I totally agree with Foghorn. How can you possibly say that need treatment route is not working when we don't have nearly enough treatment facilities? You are terribly misinformed on this issue. Children also learn from peer pressure and TV and internet. Some of the best parents have children that are addicts Read Sen Ayottes piece that Joe posted a link to and get informed.

Anonymous said...

Anonymous @ 8:37. Tell us where all of the treatment centers are in NH. Also, I suspect you are an older person. If so, did you try alcohol before you were a legal adult? Alcohol is a drug. Parents can raise two children, one perfect in every way and the other an addict. You tell me what went wrong. Some of the brightest people to see the light of day have been either alcoholics or drug addicts. Who knows why.