The Opioid Epidemic
by Devon Green
VAHHS VP of Government Relations
President Trump last week declared the opioid epidemic a “public health emergency,” raising awareness of a nationwide crisis that has hit Vermont as acutely as any other state. A troubling fact: as many as 65,000 people in the U.S. died of overdoses last year alone, more than the number who died of AIDS at the height of that epidemic in the mid-1990s and more than the number of soldiers killed in the entire Vietnam War (Source: VOX).
Despite progress in our state, there were more than 112 opioid-related fatalities in Vermont last year, roughly one person every three days (Source: HealthVermont.gov). Nationwide, 91 Americans die from opioid overdoses each day, according to the CDC. These startling numbers are one reason consensus has emerged among the medical, mental health, public health and social services communities that this epidemic requires urgent and substantial attention.
Acting U.S. Health and Human Services (HHS) Secretary Eric Hargan officially declared a “public health emergency” following Trump’s directive. This declaration will provide federal and state authorities with the flexibility to do the following:
- States can shift federal funds currently dedicated towards HIV to fight opioid addiction because opioid use can spread HIV through shared needles.
- States will have access to the Public Health Emergency Fund. Unfortunately, only $57,000 exists in this fund at the moment.
- HHS can hire specialized personnel to deal with the crisis and may be a resource to the states.
- Patients may use telemedicine to obtain medication-assisted treatment, which is particularly helpful in rural states like Vermont.
- People with opioid addiction may receive National Dislocated Workers Grants.
While this effort at the federal level is a step in the right direction and will bring awareness and resources to the issue, it should be noted that a public health emergency does not come with the same access to funding as a national state of emergency, which is usually reserved for natural disasters.
As the federal government takes these steps to respond to the opioid crisis, Vermont has made great strides in combatting addiction by partnering with community organizations. In September, Gov. Phil Scott announced that the waitlist for opiate addiction treatment in Chittenden County was eliminated through a coalition effort including the University of Vermont (UVM) Medical Center and the Howard Center.
Accordingly, the Office of National Drug Control Policy Director Richard Baum noted that “Vermont has made more progress on that challenge of [expanding treatment capacity] than any other state in the country.”
Vermont’s hospitals continue to partner with the state to fight the opioid crisis through their work with Agency of Administration’s Director of Drug Policy & Prevention, Jolinda LaClair, on efforts including sharps disposal and outreach/education to Vermont youth.
Vermont hospitals also work within their own organizations to address opioid addiction and continue to improve prevention and treatment.
Vermont’s hub-and-spoke system for coordination addiction treatment has demonstrated significant progress. Since the program’s start in 2012, “Vermont has continued to see a decline in all age groups reporting misuse of a prescription pain reliever in the past year. At the same time, the number of Vermonters receiving treatment for opioid abuse and dependence has spiked, a direct result of the expansion of care through the Hub and Spoke Model” (Source: Addiction Policy Forum).
In the hub and spoke model, “hubs” administer medication assisted treatment (MAT) and “spokes” provide local team-coordinated home health, primary and supportive care.
At a leadership breakfast on the opioid epidemic hosted last week by UVM Medical Center, addiction specialists, primary care physicians and other providers and community leaders discussed Vermont’s progress and the continued hard work required to reduce addiction rates.
Part of moving forward effectively requires viewing the opioid epidemic as just that: a condition that affects a disproportionately large number of individuals within a population at the same time. If the crisis is viewed only as a social problem and not seen as a true public health emergency, the coalitions required to make progress will not come together.
Speakers at the UVM Medical Center event agreed that opioid addiction must be addressed as an epidemic—with research, prevention, science and evidence-based treatment as the bedrock of prevention and management.