Most Vermonters are aware through their own experience of the deadly reach of the state’s opioid epidemic. Overdoses have claimed hundreds of lives, and addiction has ensnared many thousands. Lives are being lost, not among a marginal class of readily neglected criminals, but throughout the state among all kinds of people. Participants in a panel discussion on Monday in Montpelier did a good job of describing the dimensions of the crisis: — About 20,000 to 30,000 people addicted. — About 8,000 people in treatment. — About two people dying each week of overdoses. The corrosion of social bonds, the effects on children, the economic damage, the heartache and loss — these are less easy to quantify, but they are real. Yet the spirit of commitment among the caregivers, police officers and other public officials present at the session on Monday provided significant rays of hope, the most important of which was the recognition by all that by treating addiction as a treatable medical condition, progress was possible. Dr. Javad Mashkuri, medical director of the emergency department at Central Vermont Medical Center, observed that addiction is a “disease,” like diabetes, and that treating addicts with medication is comparable to treating diabetics with insulin. It is important to refrain from moral judgment about the addiction itself, even if addicted people resort to immoral behavior to support their addiction. Medication-assisted treatment has proven to be a successful response to addiction, and Vermont’s comprehensive system of hub-and-spoke treatment centers appears to be setting a new standard for effectiveness. Dr. Mark Levine, state commissioner of health, cited a recent study that found that among 100 addicts in treatment there had been no overdoses and only minimal relapses. All participants in the panel on Monday spoke of the importance of collaboration among the various agencies and providers who are engaged with the crisis. These include hospitals, treatment centers, mental health centers, prevention programs, treatment courts and police departments. Attention from state policymakers has already had an effect in dramatically cutting back on the prescription of opioid painkillers by Vermont physicians and distribution by Vermont pharmacies. The number of pills prescribed has fallen by nearly half since 2013, according to Dr. Joshua Plavin, medical director at Blue Cross and Blue Shield of Vermont. A new system has been put in place to prevent people from going from doctor to doctor and pharmacy to pharmacy in a quest for pills, and it appears to be working. Waiting lists for obtaining treatment have also been reduced to zero, according to Levine. Neil Martel, captain of the Montpelier Police Department, said that anyone who comes into the police department in need of help gets treatment. Rory Thibault, Washington County state’s attorney, said his office views an incidence of crime associated with addiction as “an opportunity to intervene.” The development of treatment courts — previously referred to as drug courts — is a reflection of the coordinated efforts by law enforcement, health-care providers and social workers to bring to bear the assistance needed when a troubled person is most vulnerable and most likely to benefit from treatment. The coordinated efforts underway in Washington County parallel the efforts undertaken in Rutland County under the aegis of Project VISION, which enlists police officers, health-care providers, social workers, housing specialists, educators and others in an ongoing partnership to look at the problem of addiction in a holistic fashion. As in Washington County, about 400 people every day receive medication to treat their addiction, and more receive treatments through the medical practices that form the spokes surrounding the central hub. There is no solution except the ongoing work of caring for our friends and neighbors. It is never easy. According to Deborah Hopkins, director of Central Vermont Substance Abuse Services, statistics suggest that it generally takes about seven attempts for someone to recover from addiction. There is more that Vermont can do. Mary Moulton, director of Washington County Mental health Services, stressed that the workforce is not sufficient. Her agency and others need more people dedicated to the task, especially if the goal of bringing more and more people into treatment is achieved. Vermonters are stepping up to the challenge, but much more must be done.

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