I attended medical school in Vermont in the 1980s and learned about opiate overdoses in textbooks. I never saw a single opiate overdose in four years of medical school in Burlington. I did my residency in New Mexico and saw opiate overdoses every day. When I came home in 1993 I thought I had likely seen my last opiate overdose. Initially I was right, but I am sad to say that it is now a frequent occurrence in the University of Vermont Medical Center’s Emergency Department.
We have a crisis in Vermont. Many of our family members, friends and neighbors are suffering from the devastating effects of opiate addiction. They have become addicted in a variety of ways. Some had access to illicit street drugs, some illegally acquired prescription drugs from others, and some became addicted from prescriptions written by their health care providers. Once addicted, our friends, family and neighbors face significant health and social issues that disrupt every aspect of their lives.
Opiate addiction is killing Vermonters at an alarming rate. They are dying from overdoses, serious infections, and from dangerous behaviors when impaired. Last year, opiate overdoses killed more Vermonters than car accidents. We must understand and accept that anyone can become addicted to opiates.
To attack this problem we must work together in partnership with our community to understand and address all the paths that are leading to addiction. Working with our partners in health care delivery, social service agencies, schools, government, and law enforcement we can decrease the number of new addictions, compassionately treat people with active addiction, and research better methods of prescribing and treatment.
The UVM Medical Center is working with our community partners to address all components of our opiate addiction crisis. We are partnering with the Vermont Department of Health, the United Way of Chittenden County, and the Burlington Police Department on a community collaborative to bring all of the resources of our community to bear on this crisis. Additionally, we are developing safe prescribing guidelines. We want to ensure that our patients get the right amount of pain medications; enough medication to adequately control their acute pain but not so much that there are pills left over that could fall into the wrong hands. We want to be sure that we are prescribing medications for the right reasons and with steps in place to prevent addiction from developing.
We are also working to provide better care for patients who are currently addicted to opiates. Vermont is fortunate to have a hub and spoke system that can treat patients with addiction initially in a specialty clinic, and then once stabilized, return them to their primary care providers for ongoing treatment. This model has been shown to be very successful for many patients and can help people get their lives back. Their risk of serious health issues is greatly reduced and they can return to productive lives.
In Vermont, we currently don’t have enough capacity to treat everyone who requests treatment. As an emergency physician, I see what happens over and over again when we are unable to treat patients who are asking for help. We should do better for our fellow Vermonters. UVM Medical Center and our community partners, such as the Howard Center, have been working hard to help make sure there is treatment for everyone who needs it. We have a long way yet to go, but are making great progress.
Since the fall of 2015, we have reduced the number of patients on the active waiting list from approximately 250 to 175. Initially, we worked with the Howard Center to open an “emergency clinic” to move some people rapidly off the waiting list. We have now started a permanent new clinic to bridge people back to their primary care providers. Most importantly, we have increased our capacity to care for these patients in our primary care offices by training more than 30 of our providers in addiction treatment. This will lead to long term increased capacity to treat opiate addiction. Finally, we need to carefully research better treatment options for patients who currently suffer from addiction. There is exciting research occurring at UVM that could lead to treatments that would be less disruptive to the lives of our patients.
Vermont’s opiate addiction crisis will not just go away. It is going to require new ways of thinking about how we do things, new partnerships, and ongoing dialogue to understand what is working and where we need to refocus our efforts. We can overcome this crisis with sustained and focused effort.
Stephen M. Leffler, MD, is Chief Medical Officer at The University of Vermont Medical Center.