ADDISON COUNTY — Porter Medical Center and the Counseling Service of Addison County are in discussions to collaborate on a clinic to provide suboxone, a drug designed to help a growing number of Addison County addicts break their dependence on opiates.
“Porter and the Counseling Service have been trying really hard to figure out some collaborative approach to address this very serious public health issue,” Porter spokesman Ron Hallman said. “We both identify it as a huge public health issue that’s getting worse.”
Addison County law enforcement officials said they are dealing with more drug-related cases than ever before.
“There is a consistent undercurrent in Addison County and the state — everything we are encountering has some sort of drug component to it,” Vermont State Police Det. Cpl. Chris Campbell said in alluding to the various burglaries, untimely deaths, property crimes and domestic abuse cases to which authorities have been responding.
And Det. Sgt. Ruth Whitney, leader of the Addison County Unit for Special Investigations, said the illicit drug use they are seeing is different than a few decades ago. Back then, Whitney said, marijuana was the drug of choice among the criminal element. But these days, police are encountering more heroin and prescription drug users.
And young people are getting an earlier initiation to prescription drugs, according to the Vermont Department of Health. The department every other year administers a Youth Risk Behavior Survey to high school students. That survey polls students on risky behavior ranging from binge drinking to drug abuse. The most recent survey statistics, from 2011, indicate 12 percent of Middlebury-area students in grades 9-12 reported having misused prescription drugs. The report indicated an emergency room discharge rate (in 2009) of roughly 102 individuals (per 10,000 population) aged 18-24 following treatment for prescription drug abuse.
“Obviously, it’s very disturbing,” Barbara Cimaglio, deputy commissioner for Alcohol & Drug Abuse Programs for the state of Vermont, said of the Addison County and statewide substance-abuse trends.
Some of those trends are outlined in a report on opioid addiction treatment programs that Vermont Health Commissioner Harry Chen made to the state Legislature on Dec. 15, 2013.
Chen reported, among other things, that Vermont had the second-highest per capita rate of all states for admissions to treatment for prescription opiates in 2011, with around 2,500. And 57 percent of those admissions involved people age 20-29, according to the report.
Throughout the past decade, the Vermont Department of Health’s Division of Alcohol and Drug Abuse programs has partnered with the state’s Medicaid program to support Vermont physicians in delivering “medication-assisted treatment,” such as buprenorphine and suboxone, in office settings. By 2010, the number of prescribing physicians increased to more than 150, according to Chen’s report. The demand for medication-assisted treatment continues to outpace supply, he noted. And that’s particularly true in Addison County, where only one physician — Dr. Emily Glick of Bristol — currently prescribes suboxone.
Glick began prescribing the drug last October after some of her patients asked for her help in dealing with opiate addiction. One of those patients had developed an infection in her arm from shooting heroin.
“I got tired of telling them, ‘I’m sorry, I can’t help you,’” Glick recalled. “I just figured it was something I could do, and should do, for people who really need help.”
Glick stressed that she does not keep suboxone on premises and has reached the limit of patients for whom she can prescribe the drug. She said she might have the capacity to add some new patients during the months to come.
“One of the biggest stresses now is having to turn people away,” Glick said. “Everyone who calls is desperate for help; you want to help, but you can’t.”
Glick is surprised to be the only Addison Count physician currently prescribing the drug, but understands why some of her colleagues are reluctant to join in. She said a physician who used to prescribe the drug stopped doing so after a bad experience. Glick said other physicians might still be wary of taking on the task.
She added that suboxone is not a cure for opiate addiction, and that some patients end up taking it the rest of their lives.
“It provides the support people need to build the skills to lead productive lives,” Glick said.
Indeed, treatment options continue to be limited for Addison County addicts, most of whom have to go north to Chittenden County or south to Rutland County to receive medication-assisted treatment. The Counseling Service courted the town of Middlebury to host a methadone clinic back in 2011, but that initiative failed to win local support. Addison County continues to be a metaphorical spoke in relation to the treatment hubs of Rutland and Chittenden counties, according to state officials. The Department of Health wants addicts to get stabilized at the treatment hubs and then get support services from “spoke” communities like Middlebury.
“These are complex patients to manage,” Hallman said of the reluctance some local doctors have had in dispensing medication-assisted treatment. “There is a certain amount of surveillance that has to occur with this patient population and monitoring. I think there are sometimes hesitations among providers to try to integrate those patient populations into a general practice setting. It sometimes feel like it’s not really the best environment for the patient, the provider of other people who are there.”
Treatment efforts in Addison County received another, at least temporary, setback last month when the owner of 1 Alden Place in Vergennes announced a major snag in selling the property to Valley Vista for use as a treatment center for young women suffering from drug dependency and/or self-injury behavior. Property owner John LaBerge told the Independent that Valley Vista had failed to meet conditions of the sale. But Valley Vista officials stressed they had not abandoned the project.
WAITING FOR HELP
There were, as of December, a combined total of 1,190 people statewide waiting for either out-patient or residential services for substance abuse issues, according to Chen’s report.
With that in mind, the Counseling Service and Porter Medical Center officials are hoping to forge an agreement on a suboxone clinic in the near future in order to provide more convenient help to area addicts.
Details that need to be resolved, according to organizers, include the specific location of the clinic and which area physicians will participate in administering the suboxone.
“We’re not only talking about dispensing the drugs, but having wrap-around services with the Counseling Service,” Hallman said. “We are talking about a comprehensive approach and not just sort of opening up the doors and saying, ‘Come on in and get your medicine and then leave.’”
Local officials stressed the state will also need to be a partner in the new clinic, particularly in its funding.
“We are going to need the state of Vermont to be an active partner,” Hallman said. “(The state) has been playing a role, but we still haven’t figured out exactly what that partnership is going to look like and who is going to provide the resources.”
Robert Thorn, executive director of the Counseling Service of Addison County, is optimistic at the prospect of the clinic becoming a reality.
“I think everybody understands the importance of this,” Thorn said. “It has taken some time to figure this out, and that has been frustrating. But everyone at the table understands the need and understands we need to address it. It feels like we are close to being able to enhance the services in Addison County.”
Counseling Service Operations Director Cheryl Huntley is already exploring some counseling programs, therapy and case management services to complement the medication patients would receive at the new clinic.
“We are all pretty motivated to make this happen as soon as possible,” Huntley said.
Cimaglio is keen on increasing treatment options in the Middlebury area.
“There is a need in Addison County,” she said. “Hopefully, things are moving in the right direction.”
Bill Brim is director of the Turningpoint Center of Addison County, a nonprofit organization based in Middlebury’s Marble Works complex that provides peer support for recovering addicts and their families. The Turningpoint Center offers encouragement and education programs for people seeking to wean themselves off opiates. Brim interacts with many local people he believes could benefit from a suboxone clinic.
“I would like to see more physicians come on board to become providers of medication-assisted treatment,” Brim said. “One physician can’t handle (the county’s needs) on their own.”
He believes society must change its perception of drug addicts in order for treatment to become more accepted by the public.
“We need to understand that (addicts) are part of our community,” Brim said.
Annie Ramniceanu is associate executive director of clinical programs for Spectrum Youth & Family Services, a Burlington nonprofit that helps young people (and their families) struggling with homelessness, academic problems, unstable family situations, mental health issues and substance abuse.
Spectrum serves “a number of families” who drive up from Addison County, according to Ramniceanu. She acknowledged the paucity of medication-assisted treatment options in the Middlebury area and said one of the likely reasons for this is adjacent Chittenden County and its offerings.
Ramniceanu added that federal law stipulates that only physicians and nurses can administer drugs like suboxone. So psychiatrists and mental health counselors can’t fulfill that task.
“There’s a big gap (in medication-assisted treatment) in the middle of the state,” Ramniceanu said.
She said she’s concerned about the number of physicians who aren’t dispensing suboxone and other related medicine to patients with addiction problems. She equated addiction with other diseases or ailments that the medical community must treat.
“It’s like if you decided not to treat earaches,” she said.
LOCAL ALLIANCE
Bob Donnis is leader of the 5-Town Drug and Safety Alliance–Treatment Committee, a self-described coalition of concerned citizens, community and religious leaders and members of the counseling and medical community in the Bristol area. In a recent letter to the Addison Independent, Donnis (on behalf of the Alliance) said society must find ways to reduce demand for drugs and treat those who are addicted, “rather than simply doling out punishment, claiming victory, and moving on to our next conviction.”
The mix of services, according to the Alliance, should include medication-assisted treatment, out-patient and residential counseling, and peer-based recovery programs such as Narcotics Anonymous.
“We need more doctors willing to treat addicts,” Donnis said. “Today, most Addison County opiate addicts must travel to Rutland or Burlington for treatment, sometimes multiple times per week. For addicts who have lost their car either to support their habit or for (driving under the influence), this presents a huge hurdle to obtaining treatment, and is often a showstopper for addicts to seek treatment. We need more treatment options right here in Addison County.”
Donnis called on residents to ask their physicians to consider providing addiction treatment and offered a petition of support, available at [email protected].
And of course tragically, some addicts never find their way back home after their final fix.
Paul Miller is an EMT volunteer with Town Line First Response and Middlebury Regional EMS. He told a crowd at Monday’s legislative breakfast in Bridport about trying to save a young man who had overdosed.
“I failed, and I take that personally,” he said.
Miller urged lawmakers to pass a law that would enable rescue teams to dispense drugs like narcan that counteract the effects of opiate overdose. He believes that if the family of the overdose victim he tried to rescue last month had had access to narcan, he might have survived.
“I had to look a mother in the eye and tell her that her son wasn’t going to make it,” Miller said. “I’m still upset by it.”
Reporter John Flowers is at [email protected].