Opioids

Vermont mountains and field in summer

The Challenge of Opioid Addiction

Opioids – such as prescription painkillers and heroin – are powerful drugs and powerfully addictive. Opioids slow breathing and heartbeat, and act on the brain to relieve pain and increase feelings of pleasure. Addiction to opioid drugs is a serious public health problem, with potentially devastating consequences – both for people who have opioid use disorder and for our communities.

Why do we call opioid addiction a health crisis?

The use of heroin and misuse of other opioids and prescription medications is a major public health challenge in Vermont and nationwide. More than 49,000 people died from opioid misuse in the U.S. in 2017 alone. Substance use disorders – including opioid use disorders – have far-reaching, and all too often tragic, impacts on our families and communities, and increase pressure on our health care, child protection, and criminal justice systems.

Where can Vermonters go for help?

Find resources for alcohol and drug misuse treatment
Connect with recovery support services  

Where can Vermonters find out more about prevention?

Learn about community prevention efforts
Dispose of prescription drugs properly
Ask questions before taking opioids prescribed by a doctor

2018 Actions

January 2018 - Study shows hub-and-spoke system made significant impact on opioid addiction
An evaluation of the Care Alliance for Opioid Addiction, Vermont’s Hub and Spoke system of care, showed people in treatment for opioid addiction reported a 96 percent decrease in opioid use, and a 100 percent drop in overdose incidences.

JAN. 22, 2018: Hub and Spoke Evaluation Shows Significant Impact Being Made on Opioid Addiction

February 2018 - Gov. Phil Scott testifies before Congress on opioid epidemic
Joined by Secretary of Human Services Al Gobeille, Health Commissioner Mark Levine, MD and Blueprint for Health Director Beth Tanzman, Governor Scott outlined Vermont’s successes and continued challenges in responding to the opioid epidemic.

FEB. 6, 2018 NEWS: Governor Phil Scott, Members of his Administration, Testify Before Congress on Opioid Epidemic

April 2018 - Vermont participates in National Prescription Drug Takeback Day
Vermonters turned in nearly 6,000 pounds of unused, expired, or unwanted medications at Take Back Day, which included medications collected through the Lamoille County Sheriff Drug Disposal Pilot Project.

APRIL 24, 2018 NEWS: Turn in Unused, Unwanted, Expired Prescription Drugs on Take Back Day this Saturday – and all year long

August 2018 - Prescription medication mail-back program introduced
Free mail-back envelopes for prescription medication were made widely available as a safe, simple and secure way to dispose of unwanted and unused medications.

AUG. 2, 2018 NEWS: Medication Mail-Back Envelopes Expand on State’s Call for Safe Use, Storage and Disposal of Prescription Drugs

September 2018 - Peer Recovery Coaches in the Emergency Department Program begins
Recovery coaches provide support and assistance in emergency departments to individuals with substance use disorders. It was introduced by the Department of Health in close collaboration with three of the state’s Turning Point Centers, their area hospitals and the Vermont Recovery Network.

SEPT. 26, 2018 NEWS: Peer Recovery Coaches Provide Support and Assistance in Emergency Departments to Individuals with Substance Use Disorders

November 2018 - Commissioner Mark Levine, MD, national article about addressing opioids.
Dr. Levine outlined six essential elements for addressing the nation’s opioid crisis in an article published in the Annals of Internal Medicine. 

NOV. 8, 2018 NEWS: ‘Elements of a Comprehensive Public Health Response to the Opioid Crisis’ By Health Commissioner Mark Levine Published in the Annals of Internal Medicine

2017 Actions

April 2017 - Vermont participates in Prescription Drug Takeback Day
The state again joined the U.S. Drug Enforcement Agency in opening sites throughout Vermont for people to drop off their unused and unwanted medications.

APRIL 26, 2017 NEWS: Clear Out Your Medicine Cabinet of Vermont's Most Dangerous Leftovers

April 2017 - Health Department discusses new opioid rules with prescribers
The Department of Health conducted a series of presentations for health care professionals about revised rules governing opioid prescribing. The rules seek to minimize opportunities for misuse, abuse, diversion, addiction and overdoses, and to help patients better understand alternatives to opioids.

APRIL 18, 2017 NEWS: Presentations for Health Care Providers to Cover New Opioid Prescribing Rules

April 2017 - ParentUpVT.org resources expanded
To help families start the conversation in a meaningful way with their teens about drugs and alcohol, the Health Department expanded the scope of its ParentUpVT.org web resource to include more interactive tools and how-to guides for parents and caregivers.

APRIL 11, 2017 NEWS: ParentUpVT.org Helps Start Discussions about Substance Misuse

May 2017 - Residential drug treatment centers expand capacity
The state’s two residential drug treatment providers increased the number of available beds for inpatient treatment, filling the need brought about by the closure of Maple Leaf Treatment Center.

MAY 3, 2017 NEWS: Vermont’s Residential Drug Treatment Centers Expand Capacity

June 2017 - New regional opioid treatment center opens in St. Albans
Vermont added a sixth regional treatment center for people with opioid use disorders in St. Albans.

JUNE 29, 2017 NEWS: Newest Opioid Treatment Hub Opens in St. Albans

October 2017 - Permanent drug take-back sites begin
Vermont moved to establish year-round, permanent take-back sites around the state, and tested innovative programs such as the Law Enforcement Drug Disposal Pilot Program through a grant to the Lamoille County Sheriff’s Office.

OCTOBER 24, 2017 NEWS: More Vermonters Turning in Unused and Unwanted Prescription Drugs

2016 Actions

January 2016 – Chittenden County Opioid Alliance Organized
State, local government, police and non-profit leaders and community members have organized to mount a comprehensive, mutually reinforcing approach to reduce opioid abuse in Burlington and Chittenden County. Four action teams are focused on treatment access and recovery support, communitty-level rapid intervention, community prevention, and workforce development.

MAR 31, 2016 NEWS: Community Solutions to Opioid Addiction Conference

April 2016 – Joined Petition to Change Aggressive Pain Management Rules
In an effort to reduce overprescribing of opioid pain relievers, Health Commissioner Harry Chen, MD and dozens of public health officials, health care organizations, medical experts and consumer advocacy groups from across the country petitioned the Joint Commission, an agency that accredits health care organizations and the federal agency that oversees Medicare. Signers requested changes to pain management requirements they believe foster dangerous prescribing practices.

April 2016 – Hosted Statewide Community Solutions Conference
250+ participants from around the state learned about the efforts at the federal, state and local levels to support prevention, intervention and treatment related to opiates. Keynote speaker Dr. Steven Leffler from the University of Vermont Medical Center discussed the impact of opiates in the medical setting, and actions being taken.

APR 29, 2016 NEWS: April 30 is National Prescription Take Back Day

June 2016 – Convened national experts to discuss prevalence and treatment need data
The Health Department and the University of Vermont co-chaired a meeting of national experts to help determine best methods and data sources to use to monitor opioid use (prevalence) in Vermont.

June 2016 – More Vermonters screened through SBIRT
From February 2014 through June 2016, more than 60,000 people were screened in emergency departments, primary care practices and free clinics. Collaborations with the Department of Vermont Health Access have resulted in a Vermont SBIRT strategic plan for health information technology integration, and integration of the SBIRT approach into the Federally Qualified Health Care system. 

August 2016 – Pharmacies allowed to sell naloxone to anyone without a prescription
Health Commissioner Harry Chen, MD signed a standing order that allows any pharmacy to sell naloxone to any person who wants to have it, without a prescription. The order also allows insurers and Medicaid to cover the cost so people don't have to pay out of pocket.
AUG 25, 2016 NEWS: Vermont Pharmacies Can Now Sell Naloxone Without a Prescription

September 2016 – Won new grant to strengthen provider and community prevention messaging
The Health Department was awarded a grant from the Substance Abuse & Mental Health Services Administration (SAMHSA) to expand prescription drug overdose prevention efforts. The goal is to incorporate discussion about prescription drug prevention in pediatric adolescent well child visits and to strengthen prevention messaging in the media and within communities.

SEP 2, 2016 NEWS: Collaborating for Families Affected by Substance Use

October 2016 – Fewer people are waiting for treatment
In 2016, more than 6,000 Vermonters were receiving medication-assisted treatment through the Care Alliance for Opioid Addiction's Hub & Spoke treatment model. This is about double the number in 2012, and fewer people are on wait lists for treatment.

October 2016 – Vermont can share prescription drug monitoring data with New York, Massachusetts, New Hampshire and Connecticut

Naloxone Overdose Rescue Project Expanded
Expanded pilot project over the year by providing overdose rescue kits free of charge at 19 community distribution sites by the end of 2016.

2015 Actions

Expanded access to medication-assisted treatment

ParentUpVT website

ParentUpVT.org
Parents – You are your teen's #1 influence. Get tips for talking with your teen about alcohol, drugs and the pressures they're facing.

Expanded the Care Alliance for Opioid Addiction to five service regions, increased number of spoke providers, adding approximately 100 new waivered physicians who can now prescribe buprenorphine.

Enhanced primary care spoke providers through the Blueprint for Health model

More than 125 physicians were treating more than 2,000 patients in primary care settings throughout the state. The Blueprint funded approximately 50 masters-prepared clinicians and nurse-care managers in this enhanced health home model.

Expanded access to naltrexone (Vivitrol®)

Naltrexone is another medication-assisted treatment option recognized by the U.S. Substance Abuse & Mental Health Services Administration (SAMHSA), along with methadone and buprenorphine to be effective medications for treating opiate addiction. Several Hubs are now prescribing to patients. Two Hubs and one Spoke are participating in a federal grant that provides additional education to the clinics, and support for the clients who may choose this medication.

April 2015 – Strengthened support for parents and teens with ParentUp

The Health Department redesigned and expanded its ParentUpvt.org website to include many new resources and interactive tools that take into account different parenting styles. Community coalitions help promote campaign messaging with outreach materials and social media, and support drug take-back events.
APR 28, 2015 NEWS: ParentUpVT.org Helps Start Discussions about Substance Abuse

July 2015 – Supported Regional Prevention Partnerships

Vermont received a grant from the U.S. Department of Health & Human Services to reduce prescription drug abuse, marijuana use and underage drinking among youth and young adults. The grant provided funding to expand regional prevention partnerships to include Addison, Bennington, Caledonia, Essex/Orleans, Franklin and Windsor counties.
JUL 6, 2015 NEWS: Federal Grant Announced for Substance Abuse Prevention Partnerships

August 2015 – Expanded treatment for clients in the correctional and child welfare systems

Vermont was one of 11 states to receive a grant from the U.S. Substance Abuse & Mental Health Services Administration to expand medication-assisted treatment capacity, and to link peer recovery support services to clients in recovery from opioid addiction.
AUG 7, 2015 NEWS: Federal Funding through SAMHSA to Expand Opioid Treatment

September 2015 – Enhanced the Vermont Prescription Drug Monitoring System (VPMS)

Vermont was awarded a CDC grant to expand prescription drug overdose prevention efforts. The goal is to decrease opioid and heroin fatalities, decrease opioid overdose emergency department visits, increase access to treatment, and decrease non-medical use of pain relievers. This will be accomplished through improving features of VPMS, training and technical assistance for medical professionals, improving communication with prescribers concerning evidence-based prescribing practices and alternatives to narcotics for treating chronic pain, expanding surveillance capacity, and better understanding the view of those abusing prescription drugs and heroin.
SEP 4, 2015 NEWS: Health Department Receives $4M to Combat Prescription Drug Overdoses

November 2015 – Produced Vermont's Most Dangerous Leftovers and Naloxone public service messages

In partnership with the U.S. Department of Justice, Vermont District, the Health Department created and widely distributed 'Vermont's Most Dangerous Leftovers' and naloxone PSAs. NOV 16, 2015 NEWS: Health Commissioner Warns of Most Dangerous Leftovers

2014 Actions

January 8, 2014 – Vermont recognizes opioid addiction as a health challenge

Then Governor Peter Shumlin made the case that opioid addiction is a public health and health care challenge, not solely a law enforcement challenge, devoting his entire State of the State address to the subject. Vermont inspired a new national and regional approach. Read JAN 17, 2014 OPINION: Coming Out of the Darkness

January 2014 – Began distributing naloxone to reverse opioid overdoses

In 2013, the Vermont Legislature authorized the Health Department to develop and adminster a pilot program to distribute emergency overdose rescue kits to people at risk, and to family members and others who may be positioned to help.

February 2014 – Health Department pilots SBIRT: Screening, Brief Intervention & Referral to Treatment

We created a website and tools to help providers conduct screening, brief intervention and referral – known as SBIRT – at 14 sites. This work is funded by a grant from the U.S. Substance Abuse & Mental Health Services Administration (SAMHSA) to expand such services for adults over a five-year time period. The goal is to make SBIRT a routine part of regular health care practice. Vermont has also used the federal Centers for Medicare & Medicaid Innovation (CMMI) State Innovation Model (SIM) funds to support SBIRT site development.

June 2014 – Hosted a meeting of governors/staffs from New England and New York
Out of that meeting came a work plan with five priority directions: 1) coordinating substance abuse prevention messages; 2) promoting unified prescribing guidelines for pain management; 3) sharing prescription drug monitoring systems; 4) integrating opiate addiction into primary care; 5) expanding access to a variety of treatment services.

June 2014 – Convened Governor's Forum on Opiate Addiction and called for community action
2000+ experts and community members from across the state came together to share and inspire community solutions. Following the state forum, the Health Department's 12 local health offices coordinated community forums and and follow-up events involving 500+ more Vermonters in all regions of the state. Community teams developed action plans with strategies for prevention, intervention, recovery and law enforcement – and identified resources already available, resource gaps, action steps, and how they will measure progress. As a result, several communities organized community partnerships.

August 2014 – Co-chaired with Nevada the National Governor's Association Drug Abuse Academy
This is a six-state police academy to help states develop and implement a system for eliminating the illicit use of prescription drugs, and preserving access for appropriate use to share through the NGA.

SEP 25, 2014 NEWS: Vermont's Leadership on Opioid Abuse Takes Center Stage at New England Rural Health Conference

October 2014 – Launched 'Vermont's Most Dangerous Leftovers' campaign
The Partnerships for Success grant supports regional prescription drug misuse prevention strategies in six Health Department districts. The Health Department developed a statewide safe storage and disposal of prescription drugs campaign, including outreach materials and social media messaging for each month of the year to aid community mobilization.

November 2014 – Implemented the Care Alliance for Opioid Addiction Hub & Spoke treatment model
Developed and fully implemented the Care Alliance for Opioid Addiction – a Hub & Spoke model of treatment and system of care. This is a statewide partnership of clinicians and treatment centers that provide medication-assisted treatment to Vermonters addicted to opioids.

Legislation & Rules Enacted 2014-2017

2017

A new rule, which went into effect July 1, 2017, for the first time gave guidance to prescribers and set legal limits on the dosage and number of opioid painkillers that may be prescribed. Prescribing Opioids for Pain Rule, enacted by the Health Department, creates a system of universal precautions, including education about safe storage and disposal of opioid prescriptions, and information about alternatives and risks.

2016

Act 173 was signed into law to combat opioid abuse in Vermont by strengthening prescribing guidelines and requirements in the Vermont Prescription Monitoring System. This legislation also funds a drug take-back system and access to naloxone statewide. To reflect legislative changes, the Health Department updated rules governing Medication-Assisted Therapy for Opioid Dependence for office-based opioid treatment providers prescribing buprenorphine, and opioid treatment providers.

2015

The Health Department enacted a rule governing the Prescribing of Opioids for Chronic Pain. This rule provides legal requirements for the appropriate use of opioids in treating chronic pain in order to minimize opportunities for misuse, abuse and diversion, and optimize prevention of addiction and overdose.

2014

Act 195 strengthened pre-trial services, risk assessments, and alternatives to incarceration for Vermonters at risk of entering the criminal justice system. 

In This Section

The Health Department works with law enforcement, health care, youth-serving organizations, schools and communities to reduce risks that contribute to addiction while promoting healthy lifestyles.

The Care Alliance for Opioid Addiction (Hub & Spoke system) is a statewide partnership of clinicians and treatment centers that provide medication-assisted therapy to Vermonters addicted to opioid drugs.

The Vermont Governor’s Opioid Coordination Council has 22 members appointed by Governor Scott, representing state and local government, service providers, people who have experienced opioid addiction personally and in their families, law enforcement and emergency responders from all parts of Vermont.

Here is information on Screening, Brief Intervention & Referral to Treatment, the Vermont Prescription Monitoring System, and the opioid prescribing rule, which went into effect July 1, 2017.

In an overdose, opioids can slow breathing to the point of death. To save lives, the Health Department gives out a medication called naloxone (brand name Narcan®) that can reverse an overdose.