MIDDLEBURY — Addison County will soon see a substantial expansion of Medication Assisted Treatment services for locals who are addicted to narcotic painkillers. That treatment — which includes the prescribing of Suboxone — is now being offered in Middlebury and will soon take root in Vergennes.
And leaders of Mountain Health — a Federally Qualified Health Center in Bristol — confirmed that beginning next month it also will dispense Medically Assisted Treatment, known as MAT.
The Primary Care Vergennes Office — formerly known as the Little City Family Practice — is preparing to provide MAT services “in the near future,” according to UVMHN, Porter Medical Center spokesman Ron Hallman.
These are major new developments in the county’s war on opioid addiction, which continues to claim victims. Until last month only the UMVNH, Porter Primary Care Bristol (formerly known as Bristol Internal Medicine) was offering MAT. Its enrollment has been limited to 110 patients, which is a fraction of the number of area residents who are addicted to illicit narcotics and must currently travel many miles north or south to receive treatment — or simply go without.
“We’ve all learned a lot about the need to pitch in,” said Dr. Will Porter, who for the past three years has been offering MAT services through Porter Primary Care Bristol. His colleague, Dr. Emily Glick, was the first Addison County physician to offer a Suboxone-based MAT program.
But Dr. Porter is now able to offer MAT care to patients for one day a week (Thursdays) in Middlebury, thanks to an agreement with the folks at UVMHN/Porter Podiatry at 76 Court St.
Porter stressed the Porter Podiatry Thursday sessions are for the convenience of some of the practice’s current 110 patients who find it difficult to get to Bristol. Around one-third of those 110 patients are now rotating into the Middlebury location.
“I gave my patients the option of being seen in Middlebury instead of Bristol, and many of them opted for that,” Porter said. “I thought, ‘(Middlebury) is the center of the county, most people live closer to Middlebury than Bristol. Most people with addiction struggle with transportation, so it makes total sense. It’s been a long-term goal to do this.”
Still, Porter is optimistic he’ll soon be able to boost the number of patients to whom he’ll be able to offer MAT services, due to a recent, major change in the way he’s serving people. Rather than seeing patients individually, they have moved to seeing them in groups.
“Group medical visits are a phenomenon in diabetes care and other care; it’s well-recognized that this is therapeutic to have peer support in their treatment, because peers have a lot of perspective,” Porter said.
Here’s how it works.
The physician conducts medical visits with patients in a group, which then meets with a counselor and a case manager. The patients also submit to mandatory urine screening and receive their Suboxone prescription as part of their visit.
“This way, it’s more efficient,” Porter said. “We can see up to 10 patients in an hour and a half, whereas before, I would see three people in an hour and a half doing individual treatment.”
Put another way, instead of seeing 12-14 patients daily in Bristol, Porter will be able to see 16-18 using the group format.
Seeing patients as a group, officials believe, will eventually create additional capacity for local physicians to add to their MAT rolls.
“Medication doesn’t produce the recovery,” Porter said. “Medication gives people the space to do the real work of recovery, which occurs in their heart and in their mind.”
Incarceration isn’t the solution, according to Porter.
“Punishment doesn’t work; treatment works,” Porter said. “This is a condition in which people’s lives and their minds have been changed, and they need help. And medicine works.”
Dr. Porter cautioned, however, that not everyone is cut out for MAT services in a group setting. Above all, Addison County candidates must be motivated. Patients must submit to random urinalysis checks to ensure compliance.
“We very carefully select patients for the program,” Porter said. “Not everyone is appropriate for treatment in that setting. It’s a much less intensive, supervised setting than one of the hubs in Rutland or Burlington, where there’s daily contact between the treatment center and the patient.”
PATHS TO ADDICTION
Porter’s patients have become addicted through various channels. Some became hooked after having been prescribed painkillers following an injury. Others have found drugs in the family medicine chest and wanted more. Still others bought some on a street corner and couldn’t get enough. And once addicted, some people will do anything to get more.
“There are many paths to it,” Porter said. “But one thing you can say for sure is, no one ever set out to be addicted to opiates. It’s not what you want to do. It looks like a solution at first, then it becomes the worst problem you could create for a person.”
Dr. Frank Provato is medical director at Bristol’s Mountain Health, which mainly serves residents of the five-town area of Bristol, Lincoln, Monkton New Haven and Starksboro. It recently added mental health services (through the Counseling Service of Addison County) and dental care.
Mountain Health prides itself in offering care for virtually all of a person’s health care needs, whether they be medical, mental or dental. So when it became clear some of the practice’s patients were struggling with addiction to opioids, it only made sense to offer an MAT program, Provato noted.
“We are aware there’s a waiting list (for MAT services) in Addison County,” Provato said. “We have identified some patients in our practice.”
This won’t be the first time Mountain Health has taken steps to serve people with addiction. The practice already has a drug/alcohol counselor on its staff. That person has not been in a position to issue prescriptions for Suboxone, however. Some Mountain Health providers are currently receiving certification to be able to prescribe Suboxone.
Mountain Health’s staff also includes an acupuncturist who will be able to provide “acudetox” to supplement MAT services, according to Provato.
“This is well-established and uses acupuncture needles,” Provato said. “What it does is it serves as a form of relaxation. There is also evidence that it reduces the urge to use controlled substances.”
Mountain Health officials are not yet putting a specific number on the MAT patients they’ll be able to accommodate. But given the opioid addiction crisis throughout the state and country, it’s probably safe to say they’ll be able to fill all their spots.
THE NO. 1 PRIORITY
A recent New York Times report placed drug overdose deaths in the U.S. at around 59,000 in 2016. That figure exceeds the number of U.S. service men and women who died during the entire Vietnam War, and is more than died during the peak of the AIDS epidemic in 1996.
“The surgeon general has declared (opioid addiction) the number one public health priority for the nation,” Dr. Porter noted. “That’s above dementia, diabetes, obesity, heart disease, stroke, and everything else.”
Still, fewer than 10 percent of people with severe opiate-use disorder are seeking treatment, according to Porter.
“That’s devastating,” Porter said. “What can we do if we can only get one out of 10? It’s invisible and hard to get at. It’s in the shadows.”
Fortunately, providers like Porter and Glick have induced many people to step out of the shadows.
“My experience, in doing this for three years in Addison County, is that when you provide treatment for addiction that is compassionate and high quality, it’s the best advertisement for others to come in for treatment,” Porter said. “I have had the direct experience of taking on patients and then having their family members, their acquaintances seeking treatment.”
How successful is the treatment?
Here’s what Porter has learned and seen during the past few years: If you take 100 people and put them through MAT, around 70 percent will emerge having conquered their addiction to illicit opiates. The success rate is around 5 percent for the same 100 people who go the abstinence only route, according to Porter.
Unfortunately, the domestic health care industry hasn’t made a big transition to MAT.
“In the U.S., 80 percent of the (drug treatment) programs are abstinence-based,” Porter said. “We’re using the wrong tool, because of political, philosophical, judgment-based perspective.”
BUSY FAMILY DOCTORS
Porter isn’t surprised there aren’t more Addison County health care providers in the MAT business. He knows they are extremely busy.
“I fully see that family doctors have been nearly submerged in Addison County,” Porter said. “And in general, everything flows downhill to primary care. Every last detail gets shuffled back to them. (Family doctors) are the dairy farmers of the medical world. They don’t have a moment to take a breath, and they don’t have the leeway to take on more.”
Nonetheless, there’s hope and progress on the horizon, Porter said, including the fact that:
•  Dr. Lynn Wilkinson is returning to UVMHN, Porter Medical Center this September to join the MAT program.
•  Valley Vista has launched substance abuse treatment programs in Vergennes.
•  New state guidelines, which took effect July 1, place limits on the amount of narcotic painkillers that can be prescribed to patients.
Dr. Porter plans to stick with it as an MAT physician.
“I have been practicing medicine for 25 years, and the last three have been the most rewarding of my career,” Porter said.
“The ‘golden age’ of treatment, I think, is coming.”
Reporter John Flowers is at [email protected].