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Opioid warriors seeing rays of hope

BRISTOL — Therese Giles, a registered nurse at Primary Care Bristol and case manager for its Medication-Assisted Treatment program, is fighting on the front lines of the opioid crisis, and she is seeing some small signs of hope in the battle.
Helping patients with what medical professionals are calling “Substance Use Disorder” get treatment is “like playing a Country and Western song backwards,” Giles said. “They get their life back. They get their kids back. They get their car back. They get their license back. Consequently they get their self-respect back.”
Eight medical, law enforcement and community professionals — including Giles — along with two patients in long-term recovery from substance use disorder, considered the state of the opioid abuse crisis in Vermont at a May 23 panel discussion at the Bristol Fire House.
“The main objective of the panel discussion was to be aware of the opioid crisis and to know the local resources available,” said panel organizer Linda Andrews, chair of the Bristol Vermont Democrats.
Opioids are a highly addictive class of drugs that include heroin, the synthetic drug fentanyl, and prescription painkillers like OxyContin and Vicodin. According to the Vermont Department of Health, in 2010 there were 41 opioid-related deaths statewide. In 2016 that number jumped to 106. Last year the number increased slightly, to 107, suggesting to hopeful health officials a leveling off.
A report by the Department of Health released this month suggested that “the data for opioid-specific fatalities appears to show we are beginning to bend the curve on the upward spiral of opioid-related fatalities.”
HUB AND SPOKE MODEL
Vermont’s Medication-Assisted Treatment programs, which use FDA-approved medications, along with counseling and other therapies, to provide a “whole-patient” approach to the treatment of Substance Use Disorder, are organized into a Hub and Spoke network. 
Nine Hubs (usually in larger population areas) provide daily treatment for complex addictions, while more than 75 local Spokes, consisting of doctors, nurses and counselors, integrate Substance Use Disorder treatment with general healthcare and wellness services.
Bristol has two Spokes: Primary Care Bristol, where physicians Emily Glick and Will Porter treat 116 patients, and Mountain Health Center, where Dr. Frank Provato treats roughly 30 patients.
It seems to be working.
“At any given time, 95 percent of our patients are free from illegal opiate use,” Giles said.
“I found that most (MAT patients) are just so appreciative that they’re in a family practice, where they don’t feel a stigma attached to their care,” said Marion Atocha, a registered nurse at Mountain Health.
Dr. Provato’s announcement during the panel discussion that “there is no longer a waiting list” for Mountain Health’s Medication-Assisted Treatment program was greeted with applause and gratitude by the roughly 30 people in attendance.
PREVENTION
“We’re not going to arrest our way out of this,” said Vermont State Police Lt. Jeffrey Danoski, the New Haven station commander.
Danoski and Jesse Brooks, the United Way of Addison County’s regional prevention partnership coordinator, discussed their work together on projects like the Heroin Epidemic Learning Program (known as HELP) and the Addison County Substance Abuse Prevention Committee.
Danoski’s troopers must carry in their cars or on their persons a Heroin/Opioid Prevention Resource Guide designed by Brooks. The size of a large business card, the guide lists contact information for prevention, treatment, recovery and law enforcement agencies in Addison County. Troopers will often pass along the cards to people they encounter, even in exchanges where drugs are not involved.
“It’s had extremely positive effects,” Danoski said. 
But there is still much work to be done.
“Prevention does not get mentioned as much as it should,” Brooks said, then recalled her own childhood with a mother who struggled with an opiate disorder.
“I was exposed to that from a very young age — 13. I watched my mom overdose multiple times. I walked in on her. I had to go to the hospital at Porter and say goodbye to her one day because they told me that she was not going to come out of it. We were pulled out of Mount Abraham High School, my brother and I, and we were told to go say goodbye to our mom. This was before we had an ‘epidemic.’”
Brooks went on to explain that it took her years to get her own life in order after these experiences.
“How we treat our youth now will determine whether or not we have an opioid epidemic in 10 years,” she said.
Part of the effort to combat substance use disorder is providing places where people can get away from pressures that otherwise might drive them to drugs.
“The Turning Point Center of Addison County is a place where people can drop in, be safe and won’t encounter anyone under the influence of drugs,” said executive director Stacy Jones.
The TPC’s offerings include not only peer-support resources and meetings, such as 12-step, smart-recovery, all-recovery and even Buddhist-based programs, but also programs that help people reestablish daily routines and work habits.
“Peer support is different from counseling,” she acknowledged, “but it’s still a powerful and critical tool for relearning how to communicate effectively in recovery.”
SOBERING NUMBERS
While the number of opioid deaths in Vermont may be leveling off, other numbers are sounding alarms.
Fentanyl use, for instance, is on the rise in Vermont, accounting for more than half of opioid-related deaths last year, said Bristol Police Lt. Bruce Nason. Fentanyl-related deaths in the state have doubled since 2015.
Because the synthetic painkiller is cheaper than heroin, it’s often mixed with or used as a substitute for it — often without the user’s knowledge. Its danger lies in the fact that it is 30 to 50 times more potent than heroin and kills people much more quickly.
In April police in Nebraska seized nearly 120 pounds of fentanyl, which the U.S. Drug Enforcement Agency said was enough to kill 26 million people.
Nason pointed out that not only are medical first responders administering the opioid antagonist Narcan to overdose patients more often, but they are having to administer multiple doses more often. The number of people requiring more than one dose increased by 16 percent between 2014 and 2015, according the Vermont Department of Health — likely a result of the increase in fentanyl use.
Still, Nason remains hopeful and committed.
“There are towns and cities that have a more serious problem with opioid use than we do in Bristol,” he told the Independent the day after the panel discussion. “I would not view it as a crisis level here. We are grateful for the community forum last night and are focused on becoming more proactive in assisting those in crisis. I agree with VSP Lt. Jeffrey Danoski: we are not going to arrest our way out of this problem. It is going to take the cooperative efforts of all community stakeholders to achieve better solutions.”
Reach Christopher Ross at [email protected]

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