The Vermont Legislature and Gov. Peter Shumlin approved legislation last year to create a regional system for opioid addiction treatment.
On Tuesday, Deputy Health Commissioner Barbara Cimaglio, who oversees the Division of Alcohol and Drug Abuse Programs, provided the House Human Services Committee with an update on how that system is progressing.
The opioid treatment system is set to revolve around five regional hubs that provide comprehensive services from assessment through case management. Surrounding each of these hubs are what the department refers to as “spokes.”
A “spoke” is a three-person primary care team with a care coordinator, clinician and physician, explained Jackie Corbally, chief of treatment for Cimaglio’s division.
The hubs can dispense the medications methadone and buprenorphine, while spokes can administer buprenorphine.
The federal law only allows specialized clinicians to administer methadone. Methadone has a cumulative effect, so the “risk of an overdose is much, much greater,” Cimaglio said. Buprenorphine, she said, is safer.
“It has a ceiling effect,” Cimaglio said. “It’s not very easy to overdose. At a certain point, it stops giving so much of an effect.”
In addition to these treatment facilities, the state also has six methadone clinics, one of which is in West Lebanon, N.H.
So far, the state has brought one hub online, The HowardCenter Inc. in Burlington, which is the lead provider for treatment in Chittenden, Franklin, Grand Isle and Addison counties.
“We’ve had some glitches along the way … (but) this is a major new system that is very complicated, and I think the most important thing is that it’s bringing together traditional medical providers and specialty substance abuse providers to address a very serious public health problem.”
Barbara Cimaglio, deputy health commissioner
The center’s leadership would like to consolidate services in a facility near South Burlington High and Middle Schools. But, as the Burlington Free Press reports, the clinic has met consistent opposition from the local school district and community.
Cimaglio is hopeful that hubs in central and southeast Vermont will open in July, and hubs in Rutland, which will also serve Bennington and the Northeast Kingdom will be available in January 2014.
“Providers have been identified in all of those areas … and negotiations have begun,” Cimaglio told the committee on Thursday. “So I think the bottom line is we are on track. We have implemented a hub and a significant number of spokes. We’ve had some glitches along the way … (but) this is a major new system that is very complicated, and I think the most important thing is that it’s bringing together traditional medical providers and specialty substance abuse providers to address a very serious public health problem.”
One such glitch is in Rutland.
Dan Quinn, president and CEO of Rutland Mental Health Services, appeared in front of the House committee on Wednesday to talk about a funding disagreement between his organization and the state.
As Vermont Public Radio reported last week, the state set a condition that Rutland Mental Health Services must enroll 400 clients in the first year or face funding penalties.
Quinn, who has opened similar clinics before, said bringing in 200 clients in a clinic’s first year would be a “home run,” let alone 400. The state, he said, is asking the impossible. Quinn also said the state could not provide an exact payment rate, which left his organization in a precarious financial position.
In the meantime, Cimaglio said, the state approved spokes, or primary care facilities, in the Rutland area to help lessen the strain on opioid addicts while the state finds a new provider or comes to an agreement with Rutland Mental Health Services. Currently, there are 33 such practices across the state.
To jumpstart and maintain the program, the state has applied to the federal Centers for Medicare and Medicaid Services to increase the federal share for Medicaid patients from 55 percent to 90 percent. According to Cimaglio, roughly 65 percent to 70 percent of the opioid addicts the state currently treats are Medicaid beneficiaries.
Cimaglio said Vermonters who need addiction treatment are fortunate. Many other states don’t offer such services.
“Lots of states don’t even cover methadone,” she said. “Many states are self-pay. So to have this as part of our health system and an integral part of our health care reform plan is amazing and allows people to access high, top-notch care.”
