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LRH assumes new role as regional "hub" for substance abuse treatment



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Jarrett Stern, Lars Nielson, Bob Nutter, and Ed Duffyy, the key leadership team for Littleton Regional Hospital's new role as a "hub" in a statewide anti-substance program. (Photo by Justin Roshak) (click for larger version)
January 17, 2019
LITTLETON—Last Wednesday, Littleton Regional Hospital hosted a roll-out meeting for its new substance-abuse resource model, in which the hospital will play a central role in its region. The meeting brought together, physicians, law enforcement officers, academics, and local and state officials, and is part of a larger, statewide effort.

"We're very pleased with Governor Sununu's efforts," said Hospital President Bob Nutter. "This is a great visionary effort."

Jarrett Stern, executive in charge of the project at both Littleton Regional and Androscogin Valley Hospital, said the program was a response to acute need.

"Certain states are facing it more than others," said Stern. "New Hampshire is one of those states."

New Hampshire received a two year, $42 million federal grant to address the opioid crisis, with funds distributed locally at nine "hub" locations. Hub stations were strategically chosen around the state, with intent to minimize driving time for patients. Drives will be longest in the North Country.

Of the grant, a minority of the funds for health programs will go to hubs, with the remainder directed toward community service providers. This approach is expected to "expand capacity". Vermont is also pursuing a "hub-and-spoke" model.

Both Littleton Regional Hospital and Androscoggin Valley Hospital received hub status and grant monies. They are empowered to sub-contract with "spokes" in their coverage area to provide necessary services. Both have contracted with Weeks Medical Center, which is one of LRH's sister organizations within North Country Healthcare.

The Littleton hub region will cover a portion of Coos, and much of Grafton County. Its physical location will be off-site, on Riverglen Lane. It will be staffed with a trained substance disorder councilor, medical assistant who will help with intake, and case manager who will focus on other factors such as transportation and employment. The hubs are not equipped to deal with acute overdoses.

The program opened on Jan. 2, and to hear Stern tell it, the Hospital is still getting its feet wet—exploring, discovering, and shaping programs to local needs in real time. At the same time, the governor's allies have expressed hope that the program will reduce disparities in care between the southern cities and northern townships.

Stern said that the hub-and-spoke model allows local care centers to tailor their approaches to unique local needs.

Katja Fox, Director of Public Health at NH Health and Human Services, said "What has been most impressive is the response we've received from Littleton and Berlin."

She said the hub centers would provide a central resource for patients, and streamline organization. She also said that the program was not specific to opioid-based substance disorders:

"All individuals who have a substance use disorder—no one is going to be turned away," Fox said.

Littleton Regional's clinics are open Monday-Friday, 8 a.m.-5 p.m., and Stern acknowledged that substance crisis isn't restricted to business hours. Dartmouth Hitchcock Medical Center, a major partner, will assist with triage after hours.

DHMC's program coordinator, Christine Spring, said that after 5 p.m., 211 phone calls will transfer to on-call evening clinicians at her facility.

She said that in the first week, they have had on average two to three calls per night. In one case, a family member called about another family member; in others, patients called for themselves. In the latter case, the focus is on getting them through the night, and providing them with options for 8 am. In the event of a major crisis, DHMC will connect them with overnight resources, likely an emergency room.

Sugar Hill Fire Chief Alan Clark urged Littleton Regional program leadership to consider expanding their own hours, as some safe-station-type facilities have done in the south:

"In all my experience, opioid overdose never takes place in the morning," Clark said, and cautioned, "Don't think that because we live in the North Country, we don't have an opioid problem. Don't think that because you live in a rich town, you don't have an opioid problem."

Stern replied that the program was just getting started, and that while he would never rule out expanded hours, financing would be a constraint. He also said that on-call clinicians would be able to provide assistance beyond merely directing the call to emergency medical services.

"This program is not designed to just refer to an emergency room," he said.

Lars Nielson, Medical Director and Proscriber at Littleton Regional and Androscoggin Valley Hospital, said that the program would expand on resources for addressing substance abuse deaths, which he said had been very limited.

Littleton's hub will use suboxone, a two-drug treatment that reduces cravings and reduces the risk of overdosing. The medication is part of a larger, medically-assisted treatment plan. A monthly injection is also available, which reduces the risk of medication "diversion", and induces strong negative effects if narcotics are taken while on the medication. Methadone will not be used, Nielson said.

Garnet Hill
Martin Lord Osman
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