New Hampshire's Attorney General made waves earlier this week when it brought its first lawsuit against a pharmaceutical giant, Purdue, over its alleged role in the state’s opioid crisis. But this is just the latest in a decades-long trend of states taking big industries to court.Read More
Over the past two years, the nonprofit organization HOPE for New Hampshire Recovery has expanded from a single modest space in Manchester to seven drug recovery centers statewide – making it the largest such organization in New Hampshire.
Hope for New Hampshire’s growth hasn’t gone smoothly. Several employees quit claiming they were mistreated. There are allegations that staffers used and at times sold drugs at work. One center has closed. Former employees spoke with NHPR about serious problems plaguing a key player in the state’s fight against opioid addiction.
When Hope for New Hampshire Recovery moved into its new flagship space in Manchester this past December, top names in local and state politics attended the ribbon cutting, including newly-elected Governor Chris Sununu.
"I do want to take this moment and also recognize some of the other folks," Sununu said as he began to list some of the people in the crowd. "Mayor Gatsas, Chief Willard, Governor Hassan of course, Senator D’Allesandro, Senator Soucy..."
Also attending was top backer Andy Crews. He’s the president and CEO of AutoFair Automotive Group and also the husband of HOPE board member and former chair Melissa Crews.
Over the years, the pair has given tens of thousands of dollars in contributions to state political candidates.
HOPE’s growth has been fueled by both private and public money, including nearly half a million dollars in state contracts last year.
But many who have worked with HOPE say the organization has struggled to deliver what it promised. I talked with more than half a dozen former HOPE employees. They gave similar accounts of an organization where staff oversight was minimal, employees were encouraged to fudge numbers and bullying was a common leadership style.
Michelle Parenteau is one of those former employees.
“I could not continue to work with a company that was unethical – that literally did not care about its employees and really did not care about the members that were coming in,” Parenteau said.
Parenteau resigned from HOPE in February after working as a recovery coach for eight months at the Claremont center. Since then, she’s filed official complaints with state and county regulators.
In them, she describes being verbally abused and bullied by HOPE’s leadership. She claims management failed to assist her in dealing with drug use at the center and incidents of sexual harassment.
Parenteau, who’s been in recovery for six years, says some of her fellow coaches were hired with as little as 30 days of sobriety. This, she said, led to high staff turnover and dysfunction at some of HOPE’s centers.
“The centers are never consistent. It’s always changing – meetings are always changing – some days it was closed – some days it was open and they’re just hiring anyone,” Parenteau described.
She and others I spoke with tied a lot of problems to former-Executive Director Holly Cekala.
Parenteau says Cekala pushed employees to become certified recovery support workers - something required in order to allow HOPE to bill insurance companies.
But Parenteau says Cekala signed off on that certification for her and others without actually doing the necessary supervision.
“I needed 500 hours supervised in order to get that and within two weeks they gave me my 500 hours," she said.
500 hours takes much longer than that.
"A few months – at least. I mean 40 hours a week," Michelle said with a chuckle.
Cekala would not comment for this story. She was removed last month from the top job at HOPE but she still works for the organization - managing its hospital and insurance contracts.
Kim Shepard says she had similar experiences as a manager at the Concord and Franklin Centers.
She and others I talked to say they were told to inflate the number of people being helped at each center. Under its state contract, HOPE was required to provide these head counts.
“They were having staff people sign in, recovery coaches in training, the postal person, they were counting all the groups that were conducted by AA or HA, which had nothing to do, they were using the space,” Shepard said.
The organization was also awarded $25,000 from Sullivan County to run two centers in Newport and Claremont. But last month when HOPE sought more money – the county said "no"citing what it called HOPE’s “unclear financials.”
I reached out to HOPE’s Board Chair Scott Bickford by email to talk about these complaints and other issues. He said he couldn’t talk because the complaints are confidential, but he said the Board is “treating these matters with the seriousness that they deserve.”
Former employee Dana Lemire says the problems at HOPE for New Hampshire have been building for a long time.
Lemire now runs a recovery house in Manchester. He says when he began working at HOPE in November of 2015, he wondered how all these new centers would stay afloat.
“Way, way over their heads – no business plan, no strategic plan, no forward thinking capitalization plan – how are we going to do this," Lemire said. "To launch something and then try to figure out how you are going to fund it is usually in the business world a formula for failure.”
Lemire says the organization meant well but just couldn’t deliver.
Former employees told me that some people in recovery have even stopped going to the centers because they feel unsafe.
So far the state has received at least four complaints from former HOPE employees. Officials at DHHS declined to speak on tape about the organization. But a spokesman told me that the department “takes its oversight responsibilities very seriously and is responding accordingly.”
When recovering from an opioid addiction, one important step is finding safe, drug-free housing.
There are a lot of places in New Hampshire that call themselves 'sober living.' But with no state oversight there’s no real way to check how sober these houses actually are.
If you ask those in the recovery community about sober living in Manchester, most will describe it like this:
“Anybody and everybody can say they’re a recovery house and nobody knows who is really and who isn’t a recovery house – it’s a crap shoot.”
Cheryle Pacapelli is on the state’s recovery task force. She’s helping draft new housing standards for the state.
But what she and many others see right now is what they call: “the wild, wild west.”
To see first-hand what this looked like, I spent a day last week riding along with the city’s fire chief Dan Goonan.
“Is the house manager here? We are just doing a walk-through of some of the recovery housing," Goonan said. "Oh, this isn't a recovery house anymore," one of the tenants answered.
The reason the fire department suspected this place was running a recovery house is they’ve visited it several times before – for overdose calls.
And Chief Goonan believes it’s still operating.
“You know what, I bet you a million bucks this is sober living,” Goonan said as we walked back to the car.
The house was falling apart, chipped paint everywhere, overgrown grass and trash in the yard. The next house – a similar situation.
“Is there like a house manager here?" Goonan asked, after he knocked on the back door. "Last time I was here, there was a house manager that kind of gave us a quickie tour."
"He's not here," one of the tenants said, right before he closed the door.
With the demand for this type of housing so high, places like this have been running under the radar – some maybe not for the right reasons.
If you do the math, with an average rent of $150 a week and 12 people in a house, that comes out to $7,200 a month or more than $86,000 a year. So the profit is definitely there.
These concerns are not just limited to Manchester. Nashua seems to be experiencing similar problems and officials in places like Keene and Concord suspect it’s happening too.
Pacapelli ran sober living houses for 15 years. She says some places have good intentions, but just don’t understand how much work it is.
“You have to provide them with an ear and a way to find a job and it’s 24-7 if you’re running a good house,” Pacapelli said.
That’s why more than 20 states, including Massachusetts, Connecticut and Maine, have some form of set standards and policies these houses have to live up to - such as occupancy numbers, around the clock staffing and required drug testing.
Jennifer Macia works at the treatment center Serenity Place in Manchester, which sees about 100 people a month.
This aspect of care, Macia says, is paramount in making sure people remain in recovery.
“If we have someone leave treatment and they have nowhere to go – we will see them again – I promise, because you cannot just go into treatment and get out and go back to the places that were unhealthy for you,” she said.
There are several places in the city that are providing quality care. Richie’s Recovery has two sober houses in Manchester. Erik Peterson is the house manager and he’s in recovery himself. He said when he sought out sober living in Manchester, the house didn’t have any rules or support system.
“I had guys tempting me with free drugs, watching guys drinking, watching guys nodding out like in the house on methadone or opioids,” he said.
Now that he’s in charge, that’s different. Peterson and another manager both live in the house. They check in on the guys, randomly drug test them and make sure the place stays clean.
The house is homey, too. There are paintings on the wall handmade by one of the tenants, a barbershop-style chair in one of the kitchens, and each room has its own personal flair and decorations.
On one of the floors, I bumped into a pair of tenants listening to rock music as they cooked spaghetti and meatballs together for dinner.
Fifty-year-old Erik Bradbury is from North Conway but he’s been living here for two months now. He’s been sober for six.
“Things have been going really well – I’m starting to get my life back together. I’m working, starting to save up for a car. This place has really been a savior for me.”
But making sure all these places are operating under the best interests of the tenants is really hard to manage.
Under federal law, cities and towns can’t deny housing to addicts and alcoholics. So they can’t just shut down a shady operation - the best thing they can do is enforce building and fire codes.
Those who do operate legitimate sober living in the state say they would welcome more standards and oversight. Eric Spofford has been running recovery housing for nearly ten years. He’s disheartened by some of the places that have been popping up lately and hopes the state will start to do something.
“You know that guy who showed up at the wrong place and that very brief opportunity that he was willing to get help and he was willing to come to that spot – well guess what, that window is closed. And when he relapses it may be weeks, months, years or he may never make it back.”
Currently, the state is looking into adopting standards - but how to enforce them, who would enforce them and whether any money would be attached to them, is all up in the air right now.
A new drug that’s 10,000 times stronger than morphine has hit the streets of New Hampshire. And that’s leaving many first responders scrambling to figure out how to deal with and treat this deadly substance.
At a press conference Tuesday, Governor Chris Sununu delivered some grim news: carfentanil, a powerful new opioid, has been linked to two deaths in Manchester.
Hours later fire officials in the city were preparing.
"Just be hyper, hyper vigilant of what is out there, hyper vigilant of where you put your hands, what you come in contact with," Manchester Fire's EMS Director Chris Hickey told the city's firefighters during one of his two training sessions Wednesday.
This kind of drug is unlike anything they’ve dealt with before. It’s designed to be used as a tranquilizer...for elephants. And its lethal dosage is 20 micrograms, which is as tiny as a snowflake. Even getting it on your skin could be deadly.
“There is nothing out there other than going in in hazmat suits on every single overdose that is going to completely protect us. We just have to be super, super careful with it,” Hickey told his men.
And treating overdoses – isn’t too simple either. Hickey says in the past few weeks his guys have had to use 6 to 8 doses of the overdose reversal drug Narcan to revive someone, which is more than twice the normal dose.
Dr. William Goodman is the CMO at Catholic Medical Center in Manchester where they treat overdoses on a daily basis. Now that Carfentanil is in the picture – he says Narcan may not be enough to do the trick.
“Usually Narcan is stronger than heroin so it out-competes and it blocks the receptor and heroin can’t trigger the new receptor and that is how it works. But Carfentanil is so strong it out-competes the Narcan, so it would really be an arms race – of the drug versus the antidote," Goodman said.
But Goodman says he isn’t aware of any other antidote on the market. So for now – multiple doses will have to do.
There’s no shortage of Narcan but the state will likely need a lot more, not just to treat drug users but also first responders, who may need it in case of exposure.
New Hampshire is the first New England state to have Carfentanil. But it’s been found in about a dozen other states across the country.
The drug originates in China, and first responders in New Hampshire say you can simply buy it online. But whether that’s how it’s getting into New Hampshire - is a mystery.
Stephanie Bergeron heads the treatment center Serenity Place in Manchester. She says her patients started seeing this drug weeks ago. They’ve said dealers even have been giving it out for free.
“I think they are nervous because they don’t know – they think they could even be buying fentanyl and it could be something else or the heroin is cut with like it was before with fentanyl and now it is heroin cut with Carfentanil. They may be cautious with using less but even less is deadly,” Bergeron said.
In the past week, Serenity Place has handed out more than 40 Narcan kits to their clients. And it’s making sure staff members carry them as well.
“That’s the part that is scary is just literally not knowing what it is so our conversations with the clients are more about staying safe and staying alive instead of what is next in your treatment plan.”
As of now reports of Carfentanil seem to be limited to Manchester. But first-responders in other places, like Franklin Police Chief David Goldstein – are all preparing their staff for its arrival.
“This is kind of a wait and see and when it happens," Goldstein said. "We will hopefully be as ready as we can be for it because in our world it is not a matter of if it happens but when it happens.”
And the Director of the state’s Drug Lab Tim Pifer agrees.
“There’s going to be more, there’s probably more in our backlog, there’s more on the streets – this is certainly unfortunately just the tip of the iceberg.”
Nashua’s Health Department wants you to stop using the word “addict.”
“We need to talk about substance use disorder like the disease that it is,” health educator Aly McKnight told a captive audience of thirty or so in the basement of Nashua Public Library last month. She pointed to a list of “stigmatizing” words projected onto a screen. “Alcoholic,” “junkie,” even “addiction” should be avoided, it said.
Residents had come to the Department of Public Health event to learn how to save someone from an overdose by administering the reversal drug Narcan. Each would receive a free package of the drug at the end of the night.
But first, there would be a vocabulary lesson. Instead of “addiction,” or “substance abuse,” McKnight said, try “substance use disorder.” Instead of “addict,” or “alcoholic,” say “person with a substance use disorder.”
“I think that’s some heavy lifting there,” said audience member Eric Eastman after the event. Still, he said, “I think it’s constructive.”
The initial push to change the language around addiction was specifically geared toward federal agencies and medical practitioners. Obama White House Drug Czar, Michael Botticelli sent a memo outlining recommendations to federal agencies, and co-authored an article containing similar recommendations in the Journal of the American Medical Association.
Botticelli’s recommendations referred to research, including a randomized study from the Center for Addiction Medicine at Massachusetts General Hospital. That study compared two sets of mental health providers. One received a survey referring to patients as "substance abusers." The other set got the same survey, except it referred to people “with substance use disorder.” The health providers, it turned out, were more likely to recommend punitive measures like jail time to the “abusers,” and more likely to recommend medical treatment to the people with a “disorder.”
Different labels lead to different outcomes.
But what about that old tenet of recovery - that you have to own your addiction with statements like “Hi I’m Sarah, I’m an addict in recovery”?
This is how Sarah Longval likes to introduce herself at recovery group meetings. I met with her and three other women at an addiction recovery center in Concord. Dawn Torregrossa was sitting next to her, and said coming to terms with the phrase “I am an addict” helped her seek help. “That denial can last for a really long time," said Torregrossa. "It’s when that light bulb goes on and you say ‘I am an addict, and I have a serious problem...A lot of people have to hit rock bottom before they come to those terms.”
Those advocating for a new addiction vocabulary make it clear that people in recovery should use whatever words they choose to describe themselves.
Still, Torregrossa seemed to indicate that something useful might get lost in a vocabulary overhaul.
Michael Botticelli, from the Obama administration, has thought about this. “I’ve been a member of a twelve step organization for a long time,” he said over the phone. He, too, is in recovery.
Still, Botticelli said that iconic “I am an addict,” admission is only useful when the medical community has fallen down on their job. “We can do a better job at intervening with people before they have to hit rock bottom,” he said.
His point was, doctors don’t wait for someone with heart disease to have a heart attack before they prescribe statins. They also wouldn’t wait for a diabetes patient to confess “I am a diabetic,” before prescribing insulin. Why do that with people who have substance use disorder? It’s a question for medical professionals. And, perhaps, for the rest of us, too.
A handout provided by Nashua's Department of Public Health and Community Services
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