Vermont’s medication assisted treatment program shows encouraging results

For the first time since 1918 during WWI when a flu pandemic swept the nation, life expectancy in the U.S. has dropped for each of the last three years.

Suicide and drug overdose are edging the country downward.

According to the Centers for Disease Control, there were 72,000 drug overdoses in 2017, up from 63,000 in 2016.

New England has seen its fair share of the crisis, with New Hampshire among the worst in the county with a rate of 34 deaths per 100,000 in 2017, more than double the national average of 14.6.

Vermont saw a rate of 20 deaths per 100,000 people in 2017. The state had a 2% increase in deaths in 2018.

While the overall rate is still climbing, there are glimmers of hope as this rate is down from a high of a 31% increase in 2016 and 12% in 2017.

With its Hub and Spoke System of Care, first put in place in 2014, Vermont began to address the crisis with a state-wide system of medication assisted treatment (MAT.)

“We know how difficult it is for people, so we must be innovative in addressing this crisis,” said Vermont Health Commissioner Mark Levine, M.D.

“Our goal is to have as many doors open as possible. We do this by making it a priority across state government to provide effective and timely intervention, prevention, treatment, and recovery programs for people struggling with an opioid use disorder.”

The program has eliminated the once-lengthy waiting list for treatment. People dealing with addiction can enter the system at any hub or spoke and will be placed appropriately according to the level of need.

As recovery continues, patients move from one of six hubs to services with outlying spoke locations.

“Our hubs are not isolated islands providing treatment,” said Levine. “They are a part of the fabric of our communities, where more than 8,000 Vermonters currently receive medication-assisted treatment.”

At a time when using medication to address addiction is still largely stigmatized, the state has embraced evidence showing that treatment using methadone or buprenorphine improves survival, increases retention in treatment, and decreases illicit opiate use.

“There is still significant stigma associated with substance abuse in general and the use of medication to treat,” said Dana Poverman, LADC, director of outpatient and MAT programs at the Howard Center in Burlington.

“There are still people who will insist that we are just replacing one drug with another. But they are missing the point. When someone is taking the medication as prescribed, they are not getting high, and they are not showing signs of addiction.”

A study done in 2017 showed that for those who utilize the Hub and Spoke System, there has been a 96 percent decrease in opioid use, and a 100 percent drop in overdose incidents.

There was also an 89% decrease in emergency department visits, a 90% reduction in illegal activities and police involvement, and a decrease in family conflict and in feelings of depression, anxiety, and anger.

“It is a remarkable thing what the state has been able to accomplish,” said Poverman, whose Chittenden County saw a 50% reduction in number of deaths from 2017 to 2018. “Anyone seeking treatment can get it within 72 hours. We have done a lot of work between all the major providers, here and in other cities, too.”

The report also pointed to areas that should be enhanced, such as more assistance in finding employment, improvement in accessing additional mental health services, an increase in access to services in all areas of the state, and creation of more consistency in policies at different treatment sites.

Participants also reported that because hub sites only work with people with opioid use disorders, there is more stigma involved, the sites have greater turnover, and there are more instances of people trying to sell drugs on premises.

The governor’s Opioid Coordination Council has issued a strategic plan to address these concerns.

Getting people into treatment will be a continued focus.

In 2017, eight of 10 people with opioid addiction actively sought help in Vermont, Levine said.

“The end of this crisis is not yet in sight,” Levine said. “But we take encouragement from the increasing number of people each year who can and do get the treatment services they need for a successful recovery. We take solace in the fact that, state-wide, the rate of increase in opioid-related deaths has dropped significantly over the past several years. We are on the right road.”