NH's $27.7M Opioid Doorway Program Has Data on 7% of Clients

New Hampshire's Doorway Program is the state's front door into addiction treatment: nine hospital-run sites, each within a 60-minute drive of any resident, screening and referring people with substance use disorder (SUD) into care.▸ In June 2026, New Hampshire's Office of Legislative Budget Assistant⧉ -- the state legislature's own nonpartisan audit office, the equivalent of a state-level GAO -- audited how well the Department of Health and Human Services (DHHS) has run it. The program spent more than $27 million⧉ in state fiscal years 2022 through 2024 and served 5,415 unduplicated clients over those three years. The audit's core finding: DHHS can only measure what happened to a small fraction of them, because the interviews the program itself relies on to track outcomes mostly never get done.

New Hampshire's estimated adult SUD prevalence was 18.9% in 2023/2024⧉, above the 17.8% national average -- the backdrop for why the state built the Doorway network in the first place.▸ DHHS contracts with nine hospitals -- in Berlin, Concord, Dover, Keene, Laconia, Lebanon, Littleton, Manchester, and Nashua -- to run single points of entry for screening, referrals, and care coordination. The money comes almost entirely from Washington: a federal Substance Abuse and Mental Health Services Administration (SAMHSA) block grant covers 97.8% of spending, with the state's Governor's Commission on Addiction, Treatment, and Prevention (GCATP) -- funded by a 5% cut of state liquor-store profits -- covering the remaining 2.2%.

The audit reports two headline effectiveness numbers, both with the same footnote attached: a 16.5% "successful completion rate," and 45.5% of clients reporting improved quality of life (QoL) after six months -- both, the auditors write, "based on a non-random subpopulation that had data available to analyze" and not something that "should be projected to the entire population."▸ That footnote is the whole story. The QoL figure specifically comes from 404 clients whose intake and six-month follow-up interviews both existed and could be paired: 184 reported life had improved, 81 reported no change, and 139 reported it had gotten worse. Compared against the 5,415 unduplicated clients the program's own Figure 3 says it served over those same three years, 404 is 7.5% -- meaning more than 92% of clients who came through a doorway have no outcome data behind either headline rate at all.

DHHS's own written response to the audit frames the same 404 clients differently: as 1.6% of "24,857 individuals served," a count nearly five times larger than the audited client figure.▸ The auditors didn't let that pass -- their reply, printed alongside DHHS's response, says the 24,857 figure counts friends and family members who called the program on someone else's behalf as if they were clients, and that DHHS's own method "overstated the actual number of clients served." Whichever denominator is used, the underlying fact doesn't move: 404 completed interview pairs is what fourteen fiscal quarters of a $27.7 million program produced.

SAMHSA's grant terms set two data-collection floors DHHS is contractually expected to hit: a 100%-of-clients intake interview rate, and an 80% six-month follow-up rate -- the second interview being what makes the QoL comparison possible at all.▸ In federal fiscal year 2025, New Hampshire's intake rate was 60.1%⧉; its six-month follow-up rate was 4.9%⧉ -- about 16 times below the 80% SAMHSA requires. Program staff told auditors the interview itself is a barrier: roughly 105 questions, conducted face to face, taking at least 45 minutes, for a population the audit describes as frequently transient and hard to reach once an immediate crisis -- housing, transportation -- has been resolved. Without that second interview, there is no pair to compare, and the client simply doesn't enter the 404.

DHHS concurred, in full or in part, with all 12 of the audit's recommendations, including using the federally required interview data -- not the low-response optional client survey it had been leaning on instead -- to measure outcomes, and complying with SAMHSA's data-collection requirements going forward.▸ None of DHHS's written responses commit to a date by which follow-up or intake rates will hit SAMHSA's floors; the department points instead to a new federal tool, SAMHSA's Unified Performance Reporting Tool, that replaced the GPRA interview in October 2025 and that DHHS says it hopes will improve response rates. The audit doesn't independently verify that expectation -- it hadn't launched long enough, as of the audit, to have a record.

Every doorway's contract requires DHHS to pay a complete, approved invoice within 30 calendar days.▸ In a random sample of 65 of the 662 invoices doorways submitted over the audit period, it took an average of 39 days from submission to payment -- and 18 of 63 invoices with complete timing data, 28.6%, ran past the 30-day deadline outright, including one that took 113 days, 83 days beyond the contracted limit. DHHS concurred with the recommendation to review the process, pointing to vendor training sessions it has already run for doorway staff on invoicing and documentation requirements.

DHHS does point to one outcome it can measure and did hit: opioid overdose fatalities statewide fell 38.5% between calendar years 2023 and 2024, one of three goals DHHS set for itself in its own state budget document.▸ The audit credits the number but not the causal story -- it notes the decline "may have been attributed to factors both related and unrelated to Program initiatives," since nothing in the data isolates the Doorway Program's contribution from broader trends like naloxone availability. Meanwhile the Governor's Commission on Addiction, Treatment, and Prevention (GCATP), which supplies part of the Program's funding and is required by statute to file annual and mid-year reports to the Governor and legislature, filed exactly one annual report and zero mid-year reports across the audit's four years.