The Middlebury Campus

State Renews Effort to Address Opioid Addiction

By ISABEL EMSFELD

Every day, over 115 people die from an opioid overdose in the United States. The leading cause of death for Americans under the age of 50 is drug overdose. The Center for Disease Control and Prevention estimates that the “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment and criminal justice involvement, according to the National Institution on Drug Abuse.

These statistics are startling. Opioid addiction is a pervasive and dangerous epidemic that continues to plague Vermont and the greater country. While this crisis may seem hopeless, many states, including Vermont, are making remarkable progress in the fight against opioid and heroin addiction.

One major issue that Vermont is tackling is the instigation of opioid-addiction treatment for prisoners; the Senate recently voted to improve opioid rehabilitation programs. On Friday, April 27 representatives from the House pushed to expand the program even further, giving final approval to bill S.166.

The bill was proposed “to enable opioid-dependent inmates to receive medication-assisted treatment in State correctional facilities from providers employed by opioid treatment programs throughout the State.” As the bill defines, “‘medication-assisted treatment’ means the use of certain medications, including either methadone or buprenorphine, in combination with counseling and behavioral therapies for the treatment of a substance use disorder.”

Vermont has had success with their “hub and spoke” system, which offers buprenorphine and methadone distributed by “hubs” spread geographically across the state. These programs also employ 77 physician officers, who provide other options for medication-assisted treatment.

The hub and spoke patient number is approaching 3,500. Additionally, surveys have shown a “dramatic reduction” in drug use, overdoses, hospital visits and arrests (VTDigger), demonstrating the efficacy of these programs.

However, not everyone has access to such programs or to medication-assisted rehabilitation. Currently, prisoners that enter the system without a prescription are not entitled to start methadone or buprenorphine treatments. This causes inmates to have withdrawal, which has proven to lead to higher risk of relapse and overdose (VTDigger).

Without the proper support or resources, prisoners in the state of Vermont suffering from opioid addictions are vulnerable to addiction once released, and the crisis is perpetuated.

To counter this cycle, S.166 adds methadone and buprenorphine to the list of drugs approved for inmates to continue receiving while in the system. Additionally, it allows prisoners who did not previously have a prescription to receive buprenorphine.

It also implements a screening for opioid addiction within 24 hours of the inmate’s imprisonment.

According to the VTDigger, the expansion of methadone prescriptions in prisons represented a source of some concern for the Vermont Corrections Department especially in light of stringent federal regulations on the drug. Consequently, in lieu of setting up an independent distribution system for methadone, the department plans to continue use of the “hub and spoke” system.

The bill also mandates that medication-assisted treatment be required in the release plan for inmates who need it. Additionally, the House added some revisions to the bill that require the Corrections Department to evaluate the success and effectiveness of the program by January 2022. The House also revised the Senate’s 120-day time limit for medical-assisted treatment to “as long as medically necessary.”

The bill now must be sent back to the Senate for approval with the new revisions from the House. In addition to the hub and spoke system and bill S.166, Vermont has implemented several other methods to combat opioid and heroin drug abuse and addiction.

On Saturday, April 28, 2018, several dozen Vermont towns designated locations that were open from 10 a.m. to 2 p.m. for people to get rid of drugs, part of the National Prescription Drug Take Back Day. Last year, state collection sites together collected over two and a half tons of drugs during the state’s one day event (Vermont Public Radio).

As Vermont Health Commissioner Mark Levine told the Vermont Edition, “Drugs that are left at home unused in medicine cabinets are fertile ground for abuse.” According to the National Institute on Drug Abuse, about 21 to 29 percent of patients prescribed opioids for chronic pain misuse them. Between eight and 12 percent develop an opioid use problem. Additionally, four to six percent of people who misuse opioids transition to heroin.

A new report from the Blue Cross Blue Shield of Vermont shows that the “state’s new limit on painkiller prescriptions is having a big effect on the number of such pills distributed in the state. Since the rules went into effect on July 1, the “average number of opioid pills dispensed to [Blue Cross Blue Shield] members each month has fallen 25 percent,” the insurer said. Blue Cross Blue Shield estimates that its members will get 672,000 fewer opioid pills annually due to the state’s new rules (VTDigger).

The trends are clear; opioids have huge potential to be abused and are serious causes of addiction, incarceration and death. It is imperative that the state continue taking steps to resolve what has become a national epidemic.

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