M

ANCHESTER, N.H. — Frank Guinta was the kind of mayor who once walked into a seedy nightclub here wearing a bulletproof vest to show he was tough on crime.

When he ran for Congress a third time and won his second term in 2014, he flatly dismissed treatment as the answer to the opioid epidemic in the Granite State. Instead, he wanted to get rid of the drug dealers.

“We’ve got to take this on and take it on tough,” he said during a debate with his opponent that year.

A very different Frank Guinta will be on the ballot this November. He is leading a congressional task force dedicated to the heroin crisis, helping shape opioid legislation that is attracting bipartisan support in Congress, and raising money for recovery centers.

The Republican congressman now believes drug addiction is a disease, a lesson learned in the midst of a crisis that claimed more than 400 lives last year alone in New Hampshire.

“Up to that point, I did not see addiction to heroin as an illness,” Guinta said in an interview with STAT. He said that this concept of addiction — one embraced by the scientific community in the 1990s — was something “I didn’t originally believe.”

Guinta isn’t alone. An overwhelming number of Americans now say that people caught with small amounts of painkillers without a prescription or heroin should be sent to treatment instead of jail, a remarkable shift from a not-too-distant past when criminalization was seen as a cure-all for drug abuse.

His conversion also comes, it is impossible to ignore, at a time when opioid abuse has become a major political issue in many parts of the country and a central focus of campaigns in New Hampshire, Ohio, and elsewhere. Every presidential candidate needed an answer during this state’s first-in-the-nation primary for what he or she would do about it.

Opioids have already become a contentious topic in New Hampshire’s crucial US Senate contest, with a conservative group accusing Democratic Governor Maggie Hassan of not doing enough to tackle heroin addiction and Hassan’s campaign accusing Republican incumbent Kelly Ayotte, by proxy, of politicizing the issue.

Guinta is entering what is likely to be a tight race against Carol Shea-Porter, his opponent in the last three House races. When he was back here in New Hampshire late last month, he told a group of Republicans in the town of Stratham that addressing the opioid epidemic was “the most important work that I’ve been doing.”

Opioids, he added, were “an area I never thought I’d be focusing my attention on.”

Guinta describes the crisis as the “the No. 1 issue” in the state.

“You’re going to hear a lot from everyone running for office,” he said in his interview with STAT.

Hope For New Hampshire
The Manchester neighborhood where Hope for NH Recovery is located is known to be an area of increased drug activity in the city. In the alley behind the center, a three-family house stands boarded up after it was raided by a state police narcotics unit in September 2015. John Happel for STAT
Hope For New Hampshire
Participants at a meeting of Hope for NH Recovery listen to readings delivered during “Share the Hope Not the Dope”— one of three weekly meetings at the Manchester center specifically geared towards heroin abuse. John Happel for STAT

‘We are a movement’

You don’t have to look far to see why.

A 10-minute walk from his office, 40 or so people were gathered the other day at the Manchester Recovery Community Center for a Heroin Anonymous meeting. Most of them looked no older than 35. Behind the man leading the meeting was a sign, white letters on a lavender background: “WE RECOVER AND WE VOTE.”

That is the reality for Guinta and other politicians. Nationwide, more than 40 percent of Americans say they know someone who has abused prescription drugs in the last five years. In places like New Hampshire and Ohio, the epicenters of the painkiller and heroin epidemic that is killing nearly 30,000 Americans a year, that number is surely higher.

Some in the recovery community want to see that experience turned into political power.

“This is a movement. We are a movement,” said Kelly Riley, who runs the center for the nonprofit group Hope for NH Recovery. “The population that we’re serving has lost their right to vote. So while we’re bringing all these people in, we’re talking to them, telling them: ‘You have a say.’”

Riley, like many other people who work at the center, has an addiction story of her own. Nine years ago, her 24-year-old son died after overdosing on Oxycontin.

Recovery has become her life. As she walks through downtown Manchester and sits down for lunch, she waves to people and points out others wandering the streets. She knows their names, their stories, and their struggles.

“I deal with parents on a daily basis that their kids are dying. We have a whole generation wiped out,” Riley said in a thick New England accent. “We have babies having babies born addicted.”

When it comes to politics, she is something of a cynic. The Manchester center became a popular stop for presidential candidates during the primary. Carly Fiorina, Jeb Bush, and Chris Christie visited. Riley has seen the TV ads from Ayotte and Hassan on opioids. She knows about Frank Guinta.

She, like many other Americans, is still skeptical of politicians.

“They say they’re going to do something, it looks really good, and then nobody really does,” Riley said.

But seeing the epidemic up close can have a profound impact on other people who, like Guinta, once viewed drug abuse very differently.

Chris Hickey, a firefighter at the station just a few blocks away from the recovery center, is one of those people. These days, he is helping run a program called Safe Station. If people struggling with addiction show up at a fire station, the crew will bring them without repercussions to Hope for NH Recovery, which will make sure that they get into treatment. Since the program started two months ago, 180 people have taken the firefighters up on the offer.

When Hickey came to Manchester in 2001, that idea might have sounded strange to him. But now, with his crew responding to two or three overdoses each day, he has come to see things differently.

“Drug addiction always used to be associated with nasty, dirty, back-alley bums. It was like the seedy underbelly. Now it’s part of our society,” he said. “With what I know about opiate addiction, trying to go through the withdrawals of it and get the recovery and stay in recovery for it is, in my mind, one of the hardest things a human can do.”

Hope For New Hampshire
Kelly Riley, the supervisor at Hope for NH Recovery, offers support to a young man who was brought to the center from the fire department after he was treated for a heroin overdose earlier that day. John Happel for STAT

‘Once you have the facts, it’s very clear’

Guinta said he has been through a similar journey.

When he stood on stage with Shea-Porter on Oct. 21, 2014, and said that “her proposal of treatment just doesn’t eradicate the drug problem here in the state of New Hampshire,” that was a belief shaped by years of trying to drive out crime as a Manchester alderman and then as the city’s mayor.

Before he ran for mayor, Guinta had spearheaded a Keep Manchester Safe campaign centered on opposing a federal halfway house for outgoing prison inmates, which would have included substance abuse services. He continued that fight as mayor, eventually losing at the state Supreme Court in 2008. He also opposed a transition program for parolees — 85 percent of whom would have substance abuse problems, according to those planning to run the program — and another abuse treatment facility while mayor, according to news reports at the time.

There was a widespread concern back then in Manchester about these programs, among those worried that the city could become a haven for addicts and ex-cons.

“People were just nervous,” said Richard O’Leary, a former police chief who was involved in planning the federal halfway house.

“’Not in my backyard’ and ‘Why more?’ That was the battle,” O’Leary said.

Guinta’s crime plan rested on hiring more police officers and promoting the DARE program. In his first year as mayor, a drug sweep yielded 54 arrests. In 2007, the New Hampshire Union Leader reported that Guinta believed treating drug addiction was one way to reduce crime, but that the mayor wasn’t sure if the city provided addiction services. The Manchester health director told the newspaper that the city didn’t offer much.

Guinta “did nothing spectacular to head up any programs or anything for the abuse of alcohol and drugs,” recalled Louis Craig, another former police chief who helped run another recovery center in Manchester at the time.

The crime issue persisted throughout Guinta’s time as mayor. City police reported a decrease in violent crime during his first year on the job, but an increase in overall and violent crime during 2009, his last year as mayor.

The congressman is upfront about how that experience shaped his view of the drug problem, and he said more than once that the issues Manchester faced then were “different” than the current opioid crisis. “The mayor in me says you always have to fight back on the criminal side,” he said.

But after he won his second term as a congressman in 2014, as the crisis worsened, he began what he calls his “research.”

He met with physicians who explained to him how opioids hijack the brain and get people hooked. He went to recovery centers and talked with the staff and those they were helping.

One of the women he met had become addicted to heroin, hitting bottom when she was eight months pregnant and days from dying. When Guinta met her in January, she was nine months sober. They still text regularly.

Hope For New Hampshire
A man rests during the afternoon at an opioid overdose respite set up at the Hope for NH Recovery in Manchester. The respite — nicknamed “Amber’s Place” in remembrance of Manchester youth who succumbed to her addiction in 2014 — is a waypoint between the street and longer-term treatment programs. John Happel for STAT
Hope For New Hampshire
A sign offering support for addiction recovery is posted at the corner Union and Central streets, a block away from Hope for NH Recovery. John Happel for STAT

“After the research that I’ve done and the people that I’ve talked to, both people who are addicted and people in the field, as well as law enforcement, I believe that addiction is an illness and we need to treat it as such,” Guinta said. “Once you have the facts, it’s very clear to you.”

He has taken that new understanding to Capitol Hill. He cofounded a task force that has helped drive a package of opioid-related bills through Congress.

But that legislation has not come without controversy, with some critics worried there won’t be sufficient funding for treatment and recovery services. Guinta, after some prodding from New Hampshire advocates, introduced an amendment, which was approved, to authorize funding for those efforts.

Shea-Porter told STAT that she won’t criticize Guinta “for passing any policy that can help.”

But she pointed out that he opposed President Obama’s budget, which requested $1.1 billion in funding to address the opioid crisis. Guinta said he supports more funding to address the crisis, but believes it can be offset with spending cuts elsewhere.

“They can pass some legislation, and I’m so glad if they do,” Shea-Porter said. “But the issue is the funding. Show me the budget.”

Sign up to our Weekend Reads newsletter

Please enter a valid email address.

As for Guinta’s newfound understanding of addiction, she characterized it this way: “Frank is being Frank.”

“It really means that he changes his position frequently and whatever works at the moment,” she said. “I’m happy if he gets done anything on this. That is good.”

While she was in Congress, Shea-Porter supported a 2008 law that requires insurance companies to better cover mental health and substance abuse services. She said that, as a former social worker, she has been worried about drug addiction “for a very long time.”

In the end, it will likely be impossible to tease out how opioids specifically influence the November election, especially with Guinta still dogged by a well-publicized campaign-finance scandal.

But whatever happens, Guinta said his education isn’t over. His next project is learning more about fentanyl, the deadly opioid that is often laced with heroin and is believed to be driving up overdoses in New Hampshire and elsewhere.

As he talked about fentanyl, Guinta spoke of a “war on drugs,” a reminder that the crime-fighting paradigm still informs some of his thoughts on the opioid crisis. He visited military and law enforcement officials in El Paso, Texas, this year, arguing that cracking down to secure the US-Mexican border would stop drug cartels from smuggling heroin to New Hampshire.

“That’s an interesting term because it brings back a lot of different memories for people,” he said. “Some people say, ‘Well, you can’t win that war.’”

“Look, when 50,000 people nationally died just from this epidemic, I think we’ve got an obligation to try to figure out a way to solve it.”

Leave a Comment

Please enter your name.
Please enter a comment.

  • Here’s to hoping Frank doesn’t decide to start practicing medicine!
    Many people base their professional behaviors on SCIENCE not ideology. The fact that Frank seems to go there last is very disturbing.
    In fact, the most effective treatment for opioid addiction is methadone treatment — Frank could help empower all medical providers to utilize this evidence-based action if guided by SCIENCE. As well, synthetic opioids including fentanyl, are often a fill-in for too great a demand for heroin along with insufficient supply. In other words, the “war on drugs” causes an increase in OD deaths… How ’bout them apples Frank? What will you do next I wonder?

    • Dan Bigg is so right I just have to comment. I’ve been involved for many years with the first district race and Frank Guinta. The science has been there all along. Oh well

      But Dan Bigg is also right about Methadone. I had my first shot of heroin when I was 20 and my last at 47. Methadone saved my life. When I wasn’t ready to quit using it kept my alive until I WAS ready.
      It’s a tough political sell, but methadone on demand would save many young lives by stabilizing them for the short run. There are drawback, but this is life or death.

    • As a small correction to this article, and to augment what you say about fentanyl: Fentanyl is often added by drug dealers to a few “bags” of heroin in a batch as a marketing ploy. A batch of heroin will have a distinguishing logo (or “brand”, if you will); when a customer ODs on a fentanyl-laced bag, it increases customer demand for that “brand” of heroin. Why? Because it must be good stuff if so-and-so OD’d on it. The dealers don’t care about death or about adding to an atmosphere that makes it harder for responsible pain patients to get their medication (in this case, fentanyl.) It is diabolical!

Recommended Stories

Sign up for our
Daily Recap newsletter

A roundup of STAT’s top stories of the day in science and medicine — delivered straight to your inbox every weekday afternoon.