Vermont May Have Found The Key To Handling The Opioid Crisis

By Kelly Burch 11/07/17

The keys to their improved outcome are simple, but will the federal government ever be ready to offer funding to implement it across the nation? 

Former Vermont Governor Peter Shumlin
Former Vermont Governor Peter Shumlin made the opioid epidemic his

Three years before President Trump declared the opioid epidemic a national public health emergency, then-Vermont Governor Peter Shumlin dedicated his entire State of the State address to the opioid crisis. 

“In every corner of our state, heroin and opiate drug addiction threatens us,” he said during the speech

Many people are skeptical about how President Trump’s declaration will change things, especially since it did not come with funds earmarked for prevention or treatment services. However, Vermont has shown that governments can push back on the opioid epidemic with the right structure in place, according to a report on Vox.

A few years ago Vermont was hit hard by opioid addiction. New England still has the highest average rate of overdose deaths in the country (24.6 per 100,000 people in 2015, the most recent data available)—but through innovative programs to improve access to treatment, Vermont has a death rate well below the regional average at just 15.8 (which is also below the national average of 16.3 deaths per 100,000 people). 

As Vermont has improved outcomes, its neighbor New Hampshire, a state that is comparable in size and demographics, has become the state with the second-highest opioid overdose rate in the nation. 

Vermont relies heavily on medication-assisted treatment (MAT) that is administered through a "hub-and-spoke" model throughout the state. The "hubs" are addiction specialists and medication-assisted treatment (MAT). The "spokes" are primary care providers who give ongoing treatment. 

The hub-and-spoke model takes pressure off primary care providers who may be overwhelmed by treating the many needs of patients with substance use disorder. 

“The parallel universe would be cardiology or infectious disease, where if you get sick and your primary care doc can’t take care of you, you’d get referred to a cardiologist,” said John Brooklyn, a family doctor and addiction specialist in Vermont who helped design the system. “The nexus of this was really to try to integrate substance use treatment in primary care.”

That way, “if [a doctor] had a patient that they didn’t really know what to do with, they could refer them to someone like myself who’s board-certified in addiction medicine.”

In addition, the state provides support to doctors with so-called "MAT teams," a nurse and a behavioralist who handle some of the extra work that comes with treating addiction patients, including counting pills and daily check-ins. 

The results have been impressive. In 2014, Vermont had 1,751 people in treatment, and 513 on a waiting list. In July 2017, there were 3,148 people in treatment and just 110 on a waiting list. Because of that, the tiny state has received national attention, with other states seeking to replicate the hub-and-spoke model. 

“They really should be applauded,” said Tom Hill, vice president of addiction and recovery at the National Council for Behavioral Health. 

Read more about Vermont’s work against the opioid epidemic here

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.