The statewide effort to provide more access to medication-assisted treatment and harm reduction programs has saved lives.
One county in rural Vermont reduced opioid overdose deaths by 50% last year, using a combination of strategies meant to stop opioid abuse and reduce harm to people who choose to continue using.
In Chittenden County, which includes the state capital of Burlington, opioid overdose deaths dropped from 35 in 2017 to just 17 last year. Bob Bick, CEO of the region’s largest treatment provider, said that a number of interventions paid off significantly.
“You’ve had this coming together of a whole bunch of strategies that were directly targeting active users and high-risk users,” Bick told VT Digger.
One of the most effective means of intervention was offering people the chance to start medication-assisted treatment (MAT) as soon as they expressed interest.
Rather than having to wait to get into a MAT program, people in Chittenden County could receive MAT at any time through two area emergency rooms, at University of Vermont Medical Center and Central Vermont Medical Center. The program has since been expanded to all emergency rooms in the area.
Dr. Stephen Leffler, MD, chief population health and quality officer for the health network that includes the two hospitals, said that the program makes a big difference for people who have a moment of wanting help.
“They are already showing positive results,” he said. “This is a statewide, team effort.”
In addition to connecting people with treatment quickly, the county also focused on reducing deaths among people who chose to continue using drugs. They did this by distributing fentanyl test kits to active users.
“We know that relapse is part of the recovery process,” Bick said. “So we wanted to make these widely available.”
He noted that people reported not using drugs that tested positive for fentanyl. A program called Safe Recovery in the state also provides naloxone and clean needles to people to request them. While this is harm reduction in and of itself, people who came in for needles were also offered the chance to begin MAT immediately.
“We are seeing the people who need us the most, and we need to be able to see them when they ask for help,” Program Director Grace Keller said at a panel recently.
Under the model, primary care providers serve as the “spoke” who provide ongoing treatment and channel people toward “hubs,” like Safe Recovery, that provide medication-assisted treatment.
“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,” John Brooklyn, a family doctor and addiction specialist in Vermont who helped design the system, said in 2017. “The nexus of this was really to try to integrate substance use treatment in primary care.”