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From Diseases of Despair to Real Hope

November 11, 2018
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Vermont has made significant strides in managing opioid use disorder, creating an innovative treatment system that is now being replicated in New Hampshire. At the VAHHS Annual Meeting in September, Brattleboro Memorial Hospital President and CEO Steve Gordon led an American College of Healthcare Executives panel on Vermont’s efforts to manage the opioid crisis.
 
At the meeting, which was themed “Small State, Big Ideas,” panelists examined various ways that big ideas have and will be used to combat this massive public health challenge. Vermont’s “hub and spoke” system currently treats 8,000 to 9,000 people, according to Dr. Mark Levine, Vermont’s Commissioner of Health, who participated on the VAHHS panel. In the hub and spoke system, hubs offer daily support for patients with complex addictions and spokes offer ongoing opioid use disorder treatment integrated with primary and wellness care.
 
“Nationally, it’s believed that only two or three out of every 10 people who have an opioid use disorder are actively in treatment. So if you do the math, that means that somewhere between 20,000 and 30,000 people in Vermont have a problem,” he explained.
 
Levine stated that Vermont saw 101 deaths last year from overdoses and we expect a similar number this year. While relative to other states, some of which saw large increases over the last year, we’re doing better, substance use disorder is clearly still an epidemic in Vermont.
 
Grace Keller, program coordinator at Howard Center Safe Recovery, noted that we must find ideas to help Vermonters at all stages of use.
 
“We need to keep people safe while they're using,” she explained, pointing to syringe exchanges, HIV and hepatitis tests and treatment as important measures. “We can also train people to use Narcan and distribute fentanyl testing kits,” she offered. She underscored the importance of being able to offer people treatment the day they ask for it, then triaging and getting them into the right level of care.
 
Dr. Tony Blofson, medical director at Brattleboro Memorial Hospital, spoke to the many ways Vermont is attempting to provide such treatment. He pointed to a new initiative through which emergency department clinicians will write prescriptions for Suboxone for patients who present at the emergency room because of an overdose.
 
He also noted a program through which labor and delivery nurses reach out to pregnant women at local methadone clinics and form relationships with them.
 
“These moms who have great reason to fear going to the labor and delivery department, where they know DCF could be waiting, now have someone they can trust,” he said.
 
Kelly Breeyear, program coordinator for Turning Point Center of Chittenden County, also explained a program for mothers and their children, which she said is getting attention for being “extremely relevant in the long-term process that recovery takes.”
 
Through 200 to 250 monthly support groups, Turning Point provides art therapy, yoga and other support services.
 
“We are open 365 days a year, including holidays, to provide a safe environment for people to work on their recovery,” Breeyear stated.
 
She noted that although Vermont has improved access to treatment, the course of treatment themselves are very short.
 
“Statistics have shown that specifically with heroin, it takes about a year for the brain to repair itself,” she said, noting that the 500 recovery coaches our system seeks to hire in the next five years will help lengthen the treatment that Vermonters can get.
 
All panelists spoke about the importance of the social determinants of health when caring for those with substance use disorders—things like housing insecurity, food insecurity and lack of access to transportation.
 
“Another issue is isolation,” Levine noted. “These diseases, whether they be opioid use disorder, alcoholism, liver disease, suicide—all of these are being clustered together into what are called diseases of despair. It’s the new epidemic. And when we’re starting to think about root causes, we really need to think about these diseases and where they come from—the social determinants,” he explained, noting that isolation is rampant among adolescents.
 
He pointed to recent survey results that showed that 40 percent of our youth don’t feel valued at all.
 
“They don’t feel like their community cares who they are or that they even exist. That’s a pretty compelling statement,” he said.
 
He posited that prevention efforts should ask the question, “How do we help our adolescents between 3 p.m. and 7 p.m.?” citing a recent program in Iceland, which sought to improve conditions for children through after-school activities, introduction to hobbies and crafts and parental involvement.
 
He also pointed to evidence-based programs that he said work well.
 
“One such program, which reduces the incidence of adverse childhood experiences, includes nursing visits for all mothers after they have their babies,” he explained.
 
“These programs help not only the children, but the mothers and fathers as well,” he added.