BRANDON — Richard Rawson graduated from Otter Valley Union High School in 1968, earned B.S. and a Ph.D. degrees in psychology from the University of Vermont and went on to become a preeminent researcher in the area of opiate addiction and abuse. He spent 40 years overseeing clinical trials on pharmacological and psychosocial addiction treatments.
After working as a professor in the UCLA Department of Psychiatry for more than 20 years and serving as co-director of UCLA Integrated Substance Abuse Programs, Rawson retired in 2015 and moved back to Vermont from California, bought a house in Sudbury and hoped to raise a few goats and relax.
But things changed when he realized how bad the opiate epidemic was here at home.
“I had no intention of doing this,” he told an audience at a recent event at the Brandon Inn. “Since I got back two summers ago, I was real happy about the Hannaford, and Cafe? and Gourmet Provence, but I was stunned by the opiate problem here.”
Rawson said, unofficially, that Vermont has the highest per capita percentage of people in opioid treatment in the U.S., if not the world. That’s not a difficult status for a state with only 620,000 people to achieve.
Rawson is now splitting his time between retirement and researching opioid use in Vermont. He travels around the state interviewing opioid users, as well as those in recovery, for a UVM study, the results of which will be available this summer.
He estimates that there are currently 18,000-20,000 opioid users in the state, roughly 3 percent of the adult population.
As the opiate crisis continues to tighten its grip on New England, small victories are welcome.
On April 27 at the Brandon Inn in front of a packed room of 60 health care officials, law enforcement officers, addiction counselors, legislative aides, parents and educators, Rawson outlined the challenges and the success of Vermont’s efforts to fight the deadly opiate epidemic.
In a presentation titled “Vermont’s Response to the Opiate Crisis: Is it Working?” Rawson lauded the state’s Hub and Spoke model for treating opiate addicts at the local level across the state. The event was presented by Brandon Cares, the nonprofit grassroots organization formed in 2012 to help local opiate addicts and their families get treatment.
“The effort of Vermonters have been literally the most advanced treatment effort in the U.S. in the last five years,” Rawson said. “But the word ‘epidemic’ is not an overstatement. It’s an extensive problem, but the response here in Vermont has been very impressive.”
THE HUB AND SPOKE
Over the last five years, Vermont’s Care Alliance for Opioid Addiction has created a network of eight addiction counseling and rehabilitation centers (the hubs) where opiate addicts can go for treatment. Once they get through rehab, they have to report to the hubs regularly for urine drug testing and counseling. Then they are eligible for outpatient treatment with a local physician closer to where they live (the spokes). There are currently about 150 Vermont physicians participating in the Hub and Spoke model.
The local doctors along with a care coordinator and a clinician comprise a three-person primary care team for each patient. The physicians must become certified to treat patients who are opiate addicts in recovery and to prescribe Suboxone, a prescription drug that combines buprenorphine and naloxone.
Naloxone is the key ingredient in Narcan, a drug used to block the effects of an opioid overdose. Buprenorphine suppresses symptoms of withdrawal, suppresses cravings for opioids, and blocks the effects of other opioids.
There are seven “hubs” in Vermont. Though none of the hubs are in Addison County, in Chittenden County the Howard Center/Chittenden Clinic operates as a hub, with offices at two locations: Burlington and South Burlington. In Rutland County, West Ridge Center for Addiction Recovery (a part of the Rutland Regional Medical Center) is the hub, and there are several doctors in Rutland certified to dispense Suboxone. Dr. George Fjeld and Dr. John Dick of Brandon Medical Center in Brandon started dispensing Suboxone to opiate addicted patients last year.
Dr. Emily Glick at Bristol Internal Medicine is a spoke in Addison County. Although Addison County does not have a hub, addicts can apply for a spot at West Ridge or the hub in Chittenden County. There is also the Turning Point Center in Middlebury, a recovery center offering peer-to-peer support for addicts and their families.
Rawson said that in 2012, prior to the Hub and Spoke model being implemented in Vermont, there were 650 people receiving treatment for opiate addiction and hundreds on waiting lists. In 2016, 3,185 Vermonters were receiving treatment for opiate addiction.
“Vermont’s effort to triple the amount of people in treatment in four years is pretty remarkable,” he said.
And the key to successfully implementing the Hub and Spoke model is to get primary care physicians to sign on and treat local addicts in recovery, Rawson said.
“In everything I’ve seen over the last two years, the way these people are treated is incredible,” Rawson said. “They are treated as patients, not as addicts, and they feel like patients, and I think the prognosis for treatment in places like Brandon Medical Center is very good because the patients are treated like people, and that helps them recover their self-esteem and sense of well-being.”
Vermont’s Hub and Spoke model is so successful, Rawson said, that there are currently eight other states, including California, spending money to replicate Vermont’s model to treat opiate addicts.
“Ninety-one Americans die every day from opiate overdoses, and it’s going up,” Rawson said. “Overdose deaths surpassed automobile deaths in 2010. Overdoses are the number-one cause of accidental death in the country.”
And while the Hub and Spoke model is being lauded, many challenges remain. The nature of opiates changes the brain of the user, Rawson said, in a way that makes certain brain cells behave in a life-or-death manner.
“The bad part is an almost clinical panic disorder where their brain tells them they have to get opioids or they’re going to die,” Rawson said. “Withdrawal looks like a bad case of the flu, but their anxiety about it becomes the overarching issue.”
And that fact is the reason why 70-90 percent of addicts in recovery relapse within the first 90 days, which is perhaps the greatest challenge of the opiate epidemic.
ENTER FENTANYL
In 2014, Rawson said Vermont was really starting to see a measurable decline in opiate overdose deaths as the rest of New England saw OD deaths continue to rise. And then fentanyl came on the heroin market.
Fentanyl is a powerful synthetic opioid 100 times stronger than morphine. It is a prescription drug used to treat severe pain, but it started showing up mixed with heroin in 2013 around New England, and overdose deaths soared.
And that is why Rawson said Vermont should be prepared to tackle the opioid epidemic for years to come. Coupled with the sheer tonnage of opioids available in the world today, and the looming threat of ever more powerful drugs, Rawson said this is a long-term issue.
“It’s estimated that we could stop growing opioids today, and there is enough to sustain every addict in the world for the next five years,” he said. “We have our work cut out for us because the drugs are getting stronger and more lethal. Unfortunately, this isn’t going away for the foreseeable future, because once you get a problem like this with a well- established market, it’s hard to beat.”
THE GOOD NEWS
But thanks to the Hub and Spoke model, Rawson said Vermont is slowing the rise in overdose deaths compared to other New England states. It’s also stemming the societal issues associated with any drug epidemic, Rawson said.
“Hub and Spoke is making a huge impact on the opiate crisis in Vermont,” he said. “It’s reducing crime, it’s reducing heroin use, it’s reducing HIV and Hepatitis C infections, it’s increasing the number of people in treatment, and it’s reducing overdose deaths.”
Every state in the country recently received federal grant funding to fight the opioid crisis. The grant amounts varied according to population and need, but Vermont will get $2 million from the 21st Century Cures Act, provided through the State Targeted Response to the Opioid Crisis Grants administered by the federal Substance Abuse and Mental Health Services Administration.
That money will go a long way in continuing the successful Hub and Spoke model in Vermont.
“I think Vermont has a lot to be proud of,” Rawson said. “Unfortunately, it’s going to take a lot of time and effort, but I’m very proud of what Vermont’s been doing. You people have done a tremendous job in taking care of your communities, and I compliment you.”