Although Vermont now treats more opiate addicts than ever, there is still room for improvement in the statewide treatment system, say state officials and service providers working with patients on the ground.
Data shows wait times to enter treatment have decreased, but it can still take a year to get into treatment, service providers say.
For the first time, the number of people being treated for drug addiction in Vermont surpassed the number of people being treated for alcohol, according to state health statistics.
A year ago, Gov. Peter Shumlin garnered national attention with a State of the State speech that focused solely on tackling the opiate addiction crisis.
A year ago about 1,500 people were receiving treatment. Today, there are 2,517 people being served, according to statistics from the health department. The Chittenden Clinic in South Burlington serves 950 people. The hub in Windsor and Windham counties serves 442 people. The hub serving Essex, Orleans and Caledonia counties serves 461 people right now, according to state statistics. The Rutland and Bennington county hub serves 382 people.
State officials say wait times for addiction treatment at the hubs have decreased, but clinicians tell a different story.
There are now 523 people on the wait lists for the regional treatment hubs that dispense methadone and buprenorphine, drugs designed to help patients kick their habits. A year ago, there were 767 people statewide on the wait list, according to the state health department.
The average wait time for the Chittenden County hub in May was 436 days, according to the health department. That decreased by November to 146 days, said Barbara Cimaglio, deputy commissioner for alcohol and drug abuse programs at the health department.
However, last January the state standardized the wait list definition. Clients who are counted only have been clinically assessed and are ready to enter treatment. In general that made wait lists appear to be shorter, while weeding out people with an addiction who aren’t ready for care.
Cimaglio said the state continues to struggle with not having enough local physicians willing to treat addiction patients, so people don’t have to travel daily to regional hubs.
“Even though we still have a waiting list, we’re seeing the flow going more quickly. So that’s really good news and it shows us that the system is starting to really work and move people through,” Cimaglio said.
There are currently 127 local doctors working with addicts, a number that has stayed steady this fall, according to statistics.
This year, the health department isn’t looking for any major changes to the addiction treatment system from the Legislature, Cimaglio said. Officials want to continue to work on reducing the wait list.
‘A long way to go’
Meanwhile, some treatment providers see a different picture.
Rick DiStefano, vice president for clinical services at Valley Vista, a residential treatment center in Bradford, has struggled with high readmission rates. He has seen the same patients multiple times, after the state shortened the allowable length of stay at his and other in-patient treatment facilities.
Valley Vista has seen a 50 percent increase in admissions to residential treatment in the past year, DiStefano said. Occupancy drops during the holidays but is climbing back up and is around 55 percent right now. The facility can hold 80 people, he said.
The state decreased the allowed length of stay this year from nearly 30 days to around 15. Although state officials have approved nearly every request for an extension Valley Vista staff have requested, DiStefano said the policy nevertheless contributes to a higher rate of readmission.
“We believe we are getting people who are relapsing sooner and seeking readmission,” he said.
Valley Vista just renewed its contract with the state, which pays about $4.9 million per year.
DiStefano said he expects his budget to be level-funded next year. While that is appreciated, “it does translate into a cut in dollars,” he said.
Valley Vista also promotes abstinence from treatment drugs like buprenorphine, whereas state hubs encourage patients to take replacement drugs that help them kick their addiction but which are also addicting and sold on the street.
In general, the state still has a long way to go in fighting opiate addiction, DiStefano said.
“I don’t think we’re making the impact yet that we were hoping to make,” he said.
Alice Larned, a substance abuse clinician with LUND who works with families, said she has recently seen a return of extremely long wait lists in Chittenden County.
In the early part of 2014, wait lists dropped dramatically, Larned said.
Then around May, wait times started to increase again, to about a year, she said. That presents problems for everyone, especially families involved with the Department for Children and Families, she said.
DCF often wants parents who struggle with addiction to get treatment right away, but it is often unavailable for 6 months or more, Larned said.
In the interim, she and DCF work with families to explore other options such as a residential treatment center or cold-turkey detox.
LUND, for example, has become a local treatment center and patients have been able to receive prescription treatment medication as well as complimentary services such as counseling Larned said.
Meanwhile, street buprenorphine, at least in Chittenden County, is becoming harder to find, she said.
That fact is a double-edged sword. Less of the drug is being illegally diverted, but addicts can no longer self-medicate, albeit illegally, while they wait for an opening at a clinic, Larned said.
