Join us on October 4 for a free panel discussion titled “The State of Opioid Addiction in Vermont: Treatment & Research,” part of Community Medical School at the Larner College of Medicine at UVM. The panel will feature Stephen Leffler, MD, Chief Medical Officer, Charles MacLean, MD, and Patricia Fisher, MD. The event takes place at 6:00-7:30pm at the UVM Given Medical Building – Carpenter Auditorium,  89 Beaumont Avenue, Burlington, VT 05405. Plenty of free parking is available. For more information call 802.847.2886.

The necessary response to the opioid epidemic is bigger than any one component of our community. It’s not just a police problem or a hospital problem – and it won’t be a solved by just one faction of our community. All of us, working together, will solve this crisis.

The UVM Medical Center has two very important roles in this crisis. First, we must be the experts in the clinical component of this problem. Just as important, we have to be strong collaborators with our community to work together on all the issues required.

For the UVM Medical Center, there are four different components to addressing this crisis:

#1 Safe Prescribing:

We have an obligation to our community to educate our providers and learners around safe prescribing and the evolving thinking on important questions that will help us decrease the number of people who become addicted by starting opiates from a prescription: Who should be on chronic narcotic pain medicines? Are there better ways to prescribe for acute illnesses? Are there better ways to prescribe when people are in the hospital?   A lot people who become addicted tell us that when they went back for that second prescription, that is really what got them on the path to addiction. So we’ve learned that the second prescription of opioids should make providers very nervous. There’s also a lot of data questioning opiates for people with chronic pain. We really need to use this information as we educate ourselves about safe prescribing.

#2 Addiction is a Chronic Disease:

Compassionate treatment for patients who have addiction involves treating addiction as a chronic disease, just like hypertension or high cholesterol. We have many patients who are on high blood pressure medications for life, and providers seem to be comfortable with that; but they somehow think that being on a medication for life that controls your addiction is a bad thing. I often give the example of a patient who is on Lipitor for high cholesterol. He comes into his primary care physician on a Monday and confesses that he had four Big Macs at McDonald’s over the weekend. Do we take away his Lipitor? No! But that’s what providers tend to think of doing if an addict on suboxone comes in and says he did heroin over the weekend.

#3 Research:

We need to continue to be a leader in research on pain management and safer treatment on patients who are addicted. Stacey Sigmon, PhD, is one of many who are doing some really compelling research in this area. Her focus is on treatment of addiction. We are also doing research on safe prescribing initially; on multi-modal pain management, integrated health opportunities and on better treatments for people who are addicted. This work must continue.

#4 Advocacy:

The last part of the puzzle is advocacy. We are advocating for our advance practice providers to be able to provide suboxone. Currently, they can prescribe opiates, but they can’t provide suboxone. We are also advocating to our legislature for funding to help treat people with addictions, providing the full spectrum of wraparound support, including mental health services and addiction therapies.

Pulling all this together, I want to emphasize what all of this means in terms of our community being accountable for the care of people who have become addicted to opioids. Many of you have heard about Accountable Care Organizations. In order for us to truly improve the health of our population, we need to become an Accountable Care community. That means we have to come together to focus on social determinants of health like drug addiction, housing, and employment.

We are making progress. Going forward, we will continue to refine what we’re doing, measure our success, and come back together to keep people in our community healthy.

Steve Leffler, MD, is Chief Medical Officer at the University of Vermont Medical Center.

Stephen M. Leffler, Professor at the Larner College of Medicine at UVM and former Medical Director of the Emergency Department, has been a practicing physician for 20 years.

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