Small but mighty, that’s the state of Vermont when it comes to confronting a formidable heroin and opiate addiction crisis. Its governor grabbed national attention a year ago with a State of the State address that focused almost entirely on the need to battle its heroin and opiate abuse problem. Governor Pete Shumlin called it a “full-blown … crisis” that threatened “every corner” of the tiny New England state, as he pointed to its number of deaths from heroin as nearly doubling in a year, and said that the first 12 years of century saw the number of Vermonters in treatment for opiate dependence rise by over 770 percent. It wasn’t just Gov. Shumlin’s focus on fighting addiction that generated headlines, though, but his pledge to dramatically shift the state’s approach to combatting it — from a primarily criminal matter to a major public-health issue. Labeling that strategy “common sense,” the second-term Democratic governor called for “providing treatment and support, rather than simply doling out punishment, claiming victory, and moving onto our next conviction.” In the Northeast, a region that’s been at that epicenter of a nationwide explosion in opiate trafficking and addiction, Shumlin’s office now sees evidence of a turnaround in Vermont. It cites as proof:
- Distribution of more than 800 Naloxone Opioid Rescue Kits, at least 10 percent of which were credited with reversing possible overdoses
- Implementation of an “evidence-based protocol” to screen 13,000 residents for suspected substance abuse, as a way to direct them to early intervention and treatment
- Nearly 1,000 more people in treatment
- “Progress” as the result of a law “designed to bypass the court process for those people addicted to drugs and who can be safely treated in a community setting”
- Guidelines which would require those being cited as drug offenders to not only be informed by police of their rights, but of the availability of pretrial services
Getting the System to Work
“The one thing that’s very clear in Vermont is [that] people are working as a system, from the governor on down to the community,” says its deputy health commissioner, Barbara Cimaglio, “Everyone is working to get people into treatment and supporting that treatment.” A key to getting that system running, Cimaglio says, was partnering with police and prosecutors at the front end, to get opiate-addicted arrestees who “aren’t criminals” into treatment. It was also crucial, she says, for health insurance to “work as it’s supposed to” under the Affordable Care Act, with insurers fulfilling their responsibility to cover mental health and addiction treatment.
Crunching the Numbers
And money was needed to fund it all — about $6.7 million in state funds — which wasn’t an easy sell in times of budget-strapped government. Shumlin had argued in his speech that “a week in prison in Vermont costs about $1,120, but $123 will buy a week of treatment for a heroin addict at a state-funded center.” And here Vermont benefitted from another provision of the ACA: Nine dollars in matching federal funding for every dollar that a state dedicates toward creation of centers that provide medical and mental-health treatment, including addiction care. It also didn’t hurt that Vermont is relatively small (its population is about that of Portland, Oregon) because then “it’s easier get everyone on board,” Cimaglio says.
Crafting a Statewide Model
The deputy commissioner says that Vermont has put in place a statewide model for treatment that has at its hub a medication-assisted treatment program, which includes dispensing methadone and buprenorphine as part of comprehensive treatment-services counseling. The spokes extending from that hub are the local physicians who assist in managing treatment patients. “It’s just been amazing to see people getting the support and help needed,” Cimaglio says, “so it’s helped get people to realize that treatment does work.” Even at this early stage, Vermont’s approach has prompted governors in other states to at least take another look at their approaches to battling addiction, while a few even appear to be considering the same path. In one of the states hardest hit by heroin addiction, Maryland, Republican Gov. Larry Hogan followed up a pledge last year to declare a “state of emergency” by announcing that he’ll soon execute an executive order “to address this epidemic.” In Virginia, Democratic Gov. Terry McAuliffe introduced six heroin-related bills, including those that would increase access to naloxone and fund a study of drug-diversion programs. And in neighboring New Jersey, presumptive GOP presidential candidate Gov. Chris Christie just signed into law bills allowing first responders to administer naloxone and mandating that inmates have access to mental health and substance abuse. By Nancy Wride Follow Nancy on Twitter at @NWride
