Alcohol & Drug Abuse

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?

In 2010, enough of the painkiller OxyContin was prescribed to keep every adult in America high for an entire month. By 2012, enough prescriptions were written to give every American adult their own personal bottle of pills. More than 50 Vermonters die from opioid poisoning every year. Deaths from heroin doubled from 2012 to 2013. Emergency treatment for opioid poisoning rose in 2012. Addiction is a lifelong chronic disease. Young people are most at risk – and the costs are high for those addicted, their families and all of us. Read the June 2014 Brief: The Challenge of Opioid Addiction 

Vermont brought the challenge of opioid addiction to national attention in 2014, and took action to enhance prevention, promote screening and early intervention, monitor prescribing, expand treatment and support recovery. Read the 2017 Brief: Strategies to Reduce Opioid Use Disorder 

2014 Actions

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

sbirt.vermont.gov website

sbirt.vermont.gov
Screening, brief intervention and referral to treatment resources for health professionals.

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.

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

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.

"Overprescribing opioid painkillers is a root cause of the deadly crisis of addiction we are now facing, not only here in Vermont but across the country," said Dr. Chen. "To reverse this trend, we must understand the cultural context that led well-meaning prescribers to this point. Aggressive and misleading marketing by drug manufacturers, and pressure by those bodies that accredit, oversee and reimburse health care organizations and providers to trat pain as the 'fifth vital sign' made for a system that encourages unwarranted prescribing."

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, 1016 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.

Legislation & Rules Enacted 2014-2016

2014

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

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.

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.

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.

Here is information on Screening, Brief Intervention & Referral to Treatment, the Vermont Prescription Monitoring System, and the opioid prescribing rule, which goes into effect 7/1/2017.

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.