CVMC introduces new addiction treatment program


BERLIN — Three weeks ago the Central Vermont Medical Center started up a substance abuse rehabilitation service, Rapid Access Medication-assisted Treatment, which allows patients to request more comprehensive onsite treatment of addiction. This program is an evolution of the SBIRT (Screening, Brief Intervention, and Referral to Treatment) program, which started by way of a federal grant in February 2013. The hospital is calling Rapid Access the first of its kind in Vermont. It was started by Javed Mashkuri, the medical director of CVMC's Emergency Department, who hopes to offer another open door for patients to utilize. “Traditionally, it’s not something you’d associate with going to the Emergency Department,” Mashkuri said. “If medical treatment is one of the key steps of recovery, why shouldn’t we start?” Barbara Gramuglia, a behavioral health clinician who came to the hospital under the federal SBIRT grant in 2014, wants to reduce the stigma surrounding substance abuse. “(The patients) are not to blame,” Gramuglia said, recalling an early experience with a patient who believed falling into substance abuse was solely their fault. SBIRT-VT is overseen by the Vermont Department of Health, Alcohol and Drug Abuse Programs division, and claims more than 51,000 Vermonters have been screened since its inception. Both Gramuglia and Mashkuri agreed that addiction should be viewed, and treated, like a disease. “Your heart beats fast? Give you medication,” said Mashkuri. “Beats too slow? Give you electricity. Medication, electricity, medication, electricity. It’s way harder to treat an opioid addiction than it is a heart.” If a patient wants to take part in the Rapid Access program, they must sign a nonbinding agreement that states he or she will be asked specific questions about substance use, complete a physical exam, fill out a form, and provide urine and blood samples. Once the agreement is signed, Rapid Access will act as a stepping stone between the patient's  acknowledgment they need treatment and clinical recovery, giving patients a full medical evaluation and — in cases where a patient is in a state of withdrawal at the time of evaluation — the offer of a full medication dose and two days of follow-up medication. The drug administered at the time of evaluation is Buprenorphine, which triggers the same neural receptor of many other opioids, but does not give the same “high." The medication prescribed to patients afterward is Suboxone, a combination of Buprenorphine and another form of a medication called Naloxone, which will cause withdrawal-like symptoms if Buprenorphine is injected, helping to stop abuse. One of the key components of the Rapid Access program involves working with a recovery coach, a layperson who has personal experience with addiction who will offer consultation with the patients, help the patients set up appointments at treatment clinics, and proceed to call and check up with the patient for 10 days, as well as being available 24/7. The SBIRT program was first started as a preliminary way to address substance abuse problems by implementing a rudimentary triage protocol with a series of questions posed to the patient when he or she entered the Emergency Department. “Smoking, drinking and drugs were always questions,” said Mashkuri. “But never at the level of detail where we could get anything from it.” After being given a “score” on the triage, a screening associate was sent in to speak with the patients, based on that score, which the patient could openly refuse. It was from this system that Mashkuri and his staff believed that the next logical step was to somehow intertwine the screening program with the Emergency Department, leading to the creation of the Rapid Access program. “It’s a community problem,” said Mashkuri. “It’s not just one generation.” For questions about the Rapid Access program, call the confidential SBIRT clinicians' line at 371-4190.

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