It seems like an old story now. Painkillers prescribed by a well-meaning doctor that lead to addiction and a deadly downward spiral. In the early days of the nation’s opioid epidemic, it seemed everyone knew someone who lost someone to a bottle of little white pills. Two decades later, the storyline has changed, and yet stubbornly remained the same—people are dying, and they don’t have to.
By Kristen Munson
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t starts with a flood. In the mid-’90s, the introduction of oxycontin, a narcotic painkiller heavily—and falsely—marketed to physicians to treat patients without the risk of addiction, set off a cascade of death. Regions of the United States blanketed with prescriptions quickly became plagued with addiction. And when prescriptions ran out, people turned to illicit sources like heroin. In Vermont, Governor Peter Shumlin devoted his 2014 State of the State to address the rising rates of opiate addiction. That year, there were 63 overdose deaths in Vermont. Shumlin called for treating addiction as a chronic illness and expanding drug treatment. He cited Vermont’s innovative huband-spoke model—developed in 2011 by John Brooklyn ’79—as a path forward. The model integrates medication for opioid use disorder (OUD) into primary care settings using a system of hubs—sites that could distribute methadone, an effective but highly regulated medication— and spokes—providers in general medical settings who could prescribe buprenorphine, a medication with fewer restrictions. The move helped eliminate waitlists for treatment in Vermont. “Within four years of Shumlin’s speech Vermont had the highest per capita number of people on medications in the country,” says Rick Rawson ’70, Ph.D. ’74, a research professor at the University of Vermont’s Center on Behavior and Health. “Vermont really is viewed nationally as a leader in how aggressively opioid use disorder was addressed.” It still is. Vermont ranks first in the nation for the percentage of adults with OUD on either methadone or buprenorphine. “No other state comes close,” Brooklyn says.
The Start Treatment and Recovery program at the UVM Medical Center was started to connect people with opioid use disorder when they may be open to treatment: at the emergency department.
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