By Dr. Seleem R. Choudhury

Originally published in the Caledonian Record, Nov. 1, 2018

More than 140 Americans die every day from an opioid overdose, according to the Centers for Disease Control and Prevention.

In 2016, according to the National Institutes of Health National Institute on Drug Abuse there were 101 opioid-related overdose deaths in Vermont, a rate of 18.4 deaths per 100,000 persons, which is above the national rate of 13.3 deaths per 100,000 persons and below New Hampshire’s rate of 39 per 100,000 persons. This Public Health Epidemic, as declared by President Trump earlier this year, has touched numerous lives in our towns and has a huge impact on so many systems, including law enforcement, addictions treatment, health care, social services, and education.

Here in the Northeast Kingdom, we are not immune to the devastating impacts opioid addiction can have on our families and our community, and for a number of years we have been working to address these issues. It is our hope that the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act that was passed by U.S. Congress and signed by President Trump on October 24 will further enforce and support our current strategies.

The bipartisan legislative package, which was designed to address the opioid epidemic, will add about $8 billion in spending for the epidemic and is intended to: (1) reduce use and supply; (2) encourage recovery; (3) support caregivers and families; and (4) drive innovation and long-term solutions. Also included in the SUPPORT Act are several provisions to support and expand telemedicine programs aimed at combatting opioid and heroin addiction, and to prevent addiction by testing alternative pain management protocols, encouraging more screening for substance use disorders, and expanding access to Medication-Assisted Treatment (MAT) services.

Telemedicine, which allows for the delivery of health care services and clinical information using technology, is starting to play a big role in rural health. North Country Hospital uses telemedicine in their Emergency Department to assist their providers, Littleton Regional Hospital uses it for Neurology, and Northeastern Vermont Regional Hospital is exploring the idea of using it in their Intensive Care Unit. Today, all three hospitals use telemedicine to provide mental health evaluations for some patients. The legislation will increase the number of telemedicine choices for rural communities, including making available the most effective treatments for opioid addiction via telemedicine, especially for people living in rural and frontier America.

MAT combines the use of medications with counseling and behavioral therapies to treat substance use disorders. The Hub and Spoke model is Vermont’s system of MAT. In our region, BAART, the “Hub,” supports patients with complex addictions by providing methadone or buprenorphine, and Northern Counties Health Care, the “Spoke,” offers ongoing opioid use disorder treatment with general health care and wellness services. This approach is considered the gold standard in treatment of opioid use disorders and has already shown to have significantly decreased opioid use in the state.

Stigma has been a significant barrier to properly addressing this epidemic, which has affected demographics in every community and nationwide. The President declaring a Public Health Epidemic helps transform the conversation about what it means to have an addiction, as it shines a bright light on the topic, demonstrates commitment from leadership, and provides a strategy with needed resources and funding. This declaration combats the false misconception that substance use disorder is a moral failing or a crime, and reinforces the importance of understanding that treating opioid addiction as a health issue is the pathway towards finding a solution.