Secretary Al Gobeille speaks during the press conference Thursday at the Howard Center in Burlington. VBM photo.
by Timothy McQuiston Vermont Business Magazine The state of Vermont has virtually eliminated the waitlist for those needing to receive opioid treatment, but officials admit that victory over substance abuse is far from at hand. Still, the politicians and health care administrators and providers who gathered at the Howard Center in Burlington agreed that today’s announcement was significant.
Governor Phil Scott was joined today by state and local officials and treatment and recovery professionals to announce that the waitlist in Chittenden County has been eliminated through months of hard work and partnership between state, local and community partners. The state can now quickly meet the demand for treatment services in all 14 counties.
Scott acknowledged the courageous stance Governor Peter Shumlin took in using his 2014 State of the State address to announce that Vermont had a problem with opioid abuse and that it must be dealt with aggressively.
Governor Scott said: “Addressing the waitlist for treatment in Burlington and across the state is an outstanding milestone, but we all know we have much more work to do across all 14 counties. This epidemic touches nearly every Vermont family. It has stolen the lives of those suffering from addiction, and any sense of peace from those who love them. But, we will continue to address this like the public health crisis it is and, together, we can end this epidemic.”
According to the Vermont Department of Health, 112 people died from opioid overdoses in 2016, or 76 percent of all fatal overdoses (148). In 2010, there were 49 opioid related fatalities, representing 55 percent of all overdose death (75). Overall, the overdose deaths in 2016 were the highest in at least the past decade.
About half of these deaths now are due to fentanyl overdoses, which is a prescription opioid but is often made illegally.
Fentanyl, the officials agree, is a growing problem and driving the new wave of fatalities, which are expected in 2017 to exceed those from 2016.
Meanwhile, prescription-related fatalities peaked in 2013 at 45, before health officials began to reassess the prescription problem, but is climbing again since a low of 25 deaths in 2014. In 2015 there were 31 and in 2016 there were 38. By comparison, there were 12 fentanyl fatalities in 2013 and 51 last year.
There has also been a steep increase in the number of heroin deaths, nearly doubling from 29 in 2015 to 51 in 2016.
When visiting Vermont in July, Office of National Drug Control Policy Director Richard Baum said, “Vermont has made more progress on that challenge [of expanding treatment capacity] than any other state in the country.”
Governor Scott was joined at the press conference by Burlington Mayor Miro Weinberger, Burlington Police Chief Brandon del Pozo, Howard Center CEO Bob Bick, UVM Medical Center President and Chief Operating Officer Eileen Whalen, MHA, RN, Vermont Attorney General TJ Donovan, Agency of Human Services Secretary Al Gobeille, Health Commissioner Mark Levine, MD, and Director of Drug Policy & Prevention Jolinda LaClair.
Chief del Pozo said he learned from his previous jobs as a police officer in New York City that police officers need to know that health care providers and politicians understand what this problem ultimately is all about. He found out immediately that in Burlington and in Vermont, that they understood it wasn’t just an enforcement issue.
“I can tell my police officers that everyone has their back in making this a public health crisis,” he said.
At the Howard Center: Mayor Weinberger, UVMMC President Whelan, Chief Del Pozo; Governor Scott, Secretary Gobeille, Attorney General Donovan, Sept 14, 2017. VBM photo
Dr Levine reiterated the other speakers in saying that Vermont is far from resolving this crisis. He said only about 20 percent of all addicts are in treatment in Vermont. He also emphasized that addiction is a chronic disease, like diabetes, and a patient who has gone through successful treatment could have a relapse.
“This crisis is affecting an entire generation (21-40),” Levine said.
Howard Center’s Bick also pointed out that there are many unknowns related to this crisis.
For instance, beyond the high percentage of users not seeking treatment is the fact that more than half are women, for reasons he cannot explain.
Typically in a treatment program, the ratio is 2:1 male to female. In Howard’s opioid program, 51 percent are female. Perhaps, he said, women might feel more responsible to get treatment, as many are also mothers (Howard has treated 450 pregnant women). Or maybe they use opioids at a higher level, which is somehow related to pain treatment. Or maybe there is a greater percentage of men not seeking treatment for this particular addiction than for other types. Bick said he simply did not know.
What is clear to him is that these users of opioids have had substance abuse issues previously. Heroin in particular, he said, is cheap and available.
The opening of a new Hub program in St Albans, expansion of Hub services at the Howard Center – which provides medical services for those struggling with substance use disorder – and additional access to physician practices at the University of Vermont Medical Center have helped close capacity gaps in Vermont’s statewide system.
This work included a team of dedicated professionals meeting weekly in Burlington to focus on waitlist reduction, finding needed resources, connecting with those waiting for care, and working to break down the barriers in the way of providing care.
The Scott Administration has committed to building upon the progress of previous administrations, re-focusing efforts in the areas of education and prevention, treatment, recovery and enforcement. Collaboration has been key to achieving these waitlist reduction milestones.
State and local law enforcement and the courts are working with the health system to get individuals treatment and prosecute the large dealers. State government – including the Departments of Health and Public Safety, the Blueprint for Health, Governor Scott’s Opioid Coordination Council and the Vermont Legislature – are focused on efforts to address the complex challenge.
Local officials and the provider community have also played a critical role in this achievement.
“Mayor Miro Weinberger has been instrumental in tackling this issue, and partnerships between doctors in the University of Vermont Medical Center Network and the Howard Center, serving as the hub, have made this announcement possible,” Governor Scott said.
Mayor Weinberger said: “I am very grateful that, during his first months in office, Governor Scott made opening the St Albans Hub such a high priority, and that he is taking other important steps to get us to this longstanding goal of treatment without delay. We all know this is just the beginning of the effort it will take to turn this crisis around. I look forward to working with Governor Scott, Attorney General TJ Donovan, UVM Medical Center, the Howard Center, and all of our partners to continue this urgent work.”
Al Gobeille said: “For the individuals and families affected, this is a deeply personal and often urgent concern. As policy-makers we have taken an ‘all hands on’ approach to making sure the people who need or want treatment care can get it – right away and near to where they live. There is so much more to do, but every step forward can mean lives saved and addiction recovery for many Vermonters.”
Bick said: “Although significant work remains to eradicate the opioid epidemic, the elimination of the waiting list at the Chittenden Clinic and the number of overdose reversals recorded by Safe Recovery represent important and critical milestones toward treatment on demand and demonstrates both our progress and our community’s compassionate and committed response.”
UVMMC’s Eileen Whalen said: “We are so proud of the physicians, advanced practice providers and other clinicians in our region who have committed to treating patients with opioid use disorder. Working together with our community partners through efforts like the Chittenden County Opioid Alliance, we know we can make a difference.”
Vermont Attorney General TJ Donovan, in his previously role as Chittenden County State’s Attorney, is credited with insisting that the opioid crisis be dealt with as a health care issue first.
At the press conference he said: "This is an incredible example of the community coming together to address an issue that affects us all. Thank you to the Howard Center and their staff and the UVM Medical Center and their staff and so many more community members. Let us continue to work together because there is more work to do.”
About the Care Alliance for Opioid Addiction – Vermont’s Hub & Spoke System of Care
Within the Agency of Human Services, the Vermont Department of Health’s division of Alcohol & Drug Abuse Programs, and the Department of Vermont Health Access/Blueprint for Health have implemented a statewide treatment program. The Care Alliance for Opioid Addiction is a statewide partnership of clinicians and treatment centers that provide medication-assisted treatment (MAT) to Vermonters who are struggling with opioid addiction. The Care Alliance uses a Hub (treatment facility) and Spoke (physician-led team) model to make sure that each patient’s care is effective and coordinated, and is supported by the nurses and counselors who work to connect each person with community-based support services. Each patient in treatment will have an established medical home, a single MAT prescriber, a pharmacy home, access to existing Blueprint Community Health Teams.