Most of Shumlin’s opiate addiction agenda realized

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Most of Shumlin’s opiate addiction agenda realized

Tue, 05/20/2014 - 7:38am -- tim

by Laura Krantz Governor Peter Shumlin lit a firecracker as the legislative session began this year when he made opiate addiction his top priority.

“In every corner of our state, heroin and opiate drug addiction threatens us. It threatens the safety that has always blessed our state,” Shumlin said in his state of the state address in January.

By the end of the session, talk of opiate addiction treatment had faded to a whisper. Legislators who in January hustled to learn what was happening in clinics and counseling sessions from Burlington to Brattleboro by May were more focused on balancing the state’s bottom line.

Gov. Shumlin gestures while delivering his remarks Wednesday.

Gov. Shumlin gestures while delivering his remarks last Wednesday.

Nevertheless, lawmakers this session passed several bills to improve opiate addiction prevention, treatment and recovery, and behind the scenes, health officials say they are continuing to make the system better.

Shumlin’s speech and the Vermont approach to opiate addiction garnered national attention this session. Federal officials visited Vermont and state officials, the governor and some legislators traveled to Washington D.C., to share what Vermont is doing and the national media parachuted in.

“We in Vermont started a difficult discussion about our drug addiction crisis, and now we are being joined by other states,” Shumlin said Thursday in a statement. “I thank Vermont lawmakers for moving swiftly to tackle this problem here at home, and look forward to working with our regional neighbors and states across the country through the National Governors Association as we all do everything reasonably possible to keep our families healthy and our communities safe.”

A look back at Shumlin’s state of the state speech reveals the governor accomplished each of his goals related to curbing opiate addiction.

But legislators, state officials and the governor agree: While the spotlight has faded somewhat, there is still work to be done.

Bills about opiate addiction treatment passed

State alcohol- and drug-abuse officials say the two biggest bills that will affect them are S.295 and the budget.

Senate bill 295 is a broad criminal justice bill that made its way through six legislative committees and, through amendments, included a number of public health measures as well.

It includes a medication-assisted therapy pilot program that continues treatment for prisoners who were receiving medication before they became incarcerated.

It requires doctors to follow more stringent rules for checking the online prescription monitoring database, which is designed to cut down on diversion and abuse of powerful pain medications such as oxycodone.

The bill also attempts to make sure patients of doctors who treat fewer than 30 opiate addiction patients have equal access to counseling and other services as patients treated in larger offices.

The legislation also allows pharmacies to sell an overdose-reversing drug, naloxone hydrochloride, over the counter at pharmacies, a measure health officials say will save lives.

The other important bill for opiate addiction treatment this year is the state budget. In addition to allocating money for treatment facilities, it asks the health department to prove how successful those programs are.

The FY 2015 budget gives $6.7 million to the hub and spoke treatment program once officials show that the program is successful. State officials expect to save that amount in health care expenditures as a result of using the hub and spoke system.

The budget calls for a series of reports about how the state manages substance abuse treatment, including ways to create a more cohesive health care delivery system in which substance abuse and mental health services are woven in with physical and mental health services. That could mean organizational restructuring within the Agency of Human Services.

The bill requires a study on the best way to coordinate payments for substance abuse and mental health services.

Shumlin’s goals

Shumlin laid out four goals for attacking opiate addiction in his address.

First, he called for $200,000 in a mid-year budget adjustment to help reduce the wait lists at treatment facilities. Treatment centers still struggle to hire and retain staff, but wait lists have shrunk, in part thanks to that money.

Second, he called for rapid-intervention court programs to help addicts receive treatment faster. S.295 started that ball rolling, although it did not go as far as the governor originally proposed. The budget includes $760,000 to launch risk assessment programs, although experts say it will eventually need more money, and a permanent revenue stream.

Third, Shumlin called for “more coordinated law enforcement” to crack down on drug criminals. He called specifically for tougher sentences for people transporting drugs into Vermont, and enhanced penalties for carrying weapons during home invasions. Both of those were provisions of S.295.

Lastly, the governor called for new ways to treat addiction. A statewide community forum on addiction is scheduled in June.

Opener of “The Hungry Heart,” Bess O’Brien’s documentary about drug addiction and the St. Albans pediatrician who is working to help addicts.  Photo by Dirk Van Susteren

Opener of “The Hungry Heart,” Bess O’Brien’s documentary about drug addiction and the St. Albans pediatrician who is working to help addicts. Photo by Dirk Van Susteren

Shumlin also requested additional funding to show a documentary about opiate addiction, “The Hungry Heart,” and succeeded in securing $20,000 to do that, according to Shumlin’s spokeswoman.

The governor succeeded in framing opiate addiction as a public health problem, which made the topic less intimidating for public officials and local residents to discuss. Vermont treatment providers, meanwhile, say they have addressed addiction as a public health matter for years.

Behind the scenes

While the Legislature crafted bills, state health officials continued to work behind the scenes to improve the state’s opiate treatment system, informing lawmakers along the way.

The Senate Health and Welfare Committee this session took nearly a week of testimony on the hub and spoke opiate treatment system, as well as other services that help addicts.

Chairwoman Sen. Claire Ayer, D-Addison, said the committee may consider proposing a bill next year, but this year they simply wanted a better idea of how services work and whether they mesh.

“We’ve made considerable progress,” Health Department Deputy Commissioner Barbara Cimaglio said.

Health officials this spring asked treatment providers to recalculate their wait lists, to make sure the lists only include people who have been clinically assessed and are ready, at a moment’s notice, to enter treatment.

Hubs, which serve as regional methadone-dispensing treatment facilities, had 384 people on their wait lists statewide, down from 640 in January. The hubs that serve Rutland, Bennington, Windsor and Windham counties have no one on their wait lists, according to the April report.

The health department is just beginning to comb through this year’s legislation to find other sections that apply to them. Cimaglio testified extensively on S.295’s addiction treatment sections.

“We’re happy,” she said.

The health department already has ways of evaluating the success of the treatment programs. Reporting to the Legislature on program effectiveness will not be a huge burden, Cimaglio said.

More work to do

While out-patient centers that provide medication-assisted treatment are busier than ever, staff at residential treatment facilities say they are hurting.

A new state requirement effectively cutting in half the number of days a patient can stay at a residential program such as Valley Vista or Maple Leaf Farm has led to higher admission rates but also higher relapse rates, in addition to less revenue and more work, said Rick DiStephano, vice president of clinical services at Valley Vista.

“I think that the state has looked at one area,” DiStephano said.

The rate at which patients are placed on medication to treat their addiction is unsustainable, he said. Valley Vista works with patients to wean them completely off treatment drugs.

Rep. Ann Pugh, D-South Burlington, chair of the House Human Services Committee, said the biggest disappointment this session was the elimination of a provision her committee pushed for that would have allowed licensed alcohol and drug counselors in private practices to bill Medicaid, the federal health insurance program for low-income people. Budget committees removed the language because of the cost.

“That would just put more providers into the marketplace,” Pugh said.

Pugh said the substance abuse treatment system in Vermont needs to become more cohesive. Good programs aren’t necessarily linked, she said.

“We need to have the same targeted focus on substance abuse as we’ve had on other areas, like mental health and physical health … we’re doing a lot of creative and good and best practice things. The connections aren’t always as clear.”

Cimaglio said the goal is to connect programs that start with prevention and extend through recovery.

“We feel our goal is clearly to be comprehensive and to work in a holistic manner,” she said.