[B]URLINGTON — With 2015 on pace to be the deadliest year for opiates in Vermont, Gov. Peter Shumlin is calling on Congress to increase the range of providers who can prescribe addiction treatment drugs like buprenorphine.
In the first nine months of this year, 55 people died from accidental opiate overdoses. In 2013, the most deadly in the previous four years, 58 people died of accidental opiate overdoses over the 12-month period, according to figures from the health department.
“We are treating now 65 percent more folks than when we started addressing this problem back in 2014,” Shumlin said at a Tuesday news conference. “One of the big challenges we face is having enough docs who are able to treat the people who want treatment.”
Buprenorphine, which is widely known by the brand name Suboxone, delivers enough opioids to prevent someone who is addicted from getting sick and going into withdrawals, but not enough to feel a high. Combined with therapy, it’s widely recognized as an effective treatment for opiate addiction.
Despite efforts to increase access to treatment, there are 427 Vermonters on waiting lists, according to Shumlin. More than half, 284 people, are waiting to get into treatment at the Chittenden Clinic in South Burlington, according to the Howard Center, which operates the clinic.
Service providers point to a lack of doctors who are able or willing to prescribe drugs like buprenorphine. Unlike the methadone given to people at the Chittenden Clinic, which must be taken on site, doctors can prescribe buprenorphine from their offices, and patients who are ready can take it without supervision.
Shumlin and the other New England governors penned letters to congressional leaders urging them to pass legislation that would allow nurse practitioners to prescribe so-called “maintenance drugs,” which would dramatically increase the availability of treatment.
That would in turn increase capacity at outpatient rehab facilities like the Chittenden Clinic, where patients who are ready to move on to treatment in a primary care office can’t because there aren’t enough doctors available to treat them.
In his letter, Shumlin notes the irony that nurse practitioners are able to prescribe “addictive narcotics for pain,” which Shumlin largely blames for the current opiate epidemic, but federal law bars them from prescribing drugs “designed to break addiction to those deadly narcotics and heroin.”
Nurse practitioners and physician assistants are playing an increasing role in primary care in Vermont and nationwide, says Dr. Rosemary Dale, a professor at UVM’s College of Nursing and Health Sciences. Nationwide, 53 percent of primary care doctors work with nurse practitioners, and in Vermont that number is closer to 75 percent.
In Vermont, there are nearly 700 nurse practitioners, the vast majority of whom work in primary care, Dale said. That number has increased nearly 40 percent in the past four years. Many currently treat opiate addicted patients, but are unable to treat them “in the best and most comprehensive way,” Dale said.
The University of Vermont Medical Center is also taking steps to treat more opiate addicts through its primary care network. That’s partly the result of a “frank” conversation two months ago between Burlington Mayor Miro Weinberger, officials from the governor’s office, Chittenden County State’s Attorney T.J. Donovan and others about the hospital needing to play a greater role in responding to the opiate crisis, according to Howard Center CEO Bob Bick, who was part of that dialogue.
There are now 25 UVM Medical Center doctors certified to prescribe buprenorphine, up from 14 in September. Dr. Patricia Fisher recently created a temporary clinic for close to 50 patients from the Chittenden Clinic who were ready to move on, but hadn’t found a primary care doctor to treat them in an office setting.
Starting in January, the medical center’s Day One Clinic will begin to take stable patients from the Chittenden Clinic and transition them into primary care. The Day One Clinic will ramp up to serving 100 patients on a rolling basis, according to UVMMC CEO Dr. John Brumsted.
New regulations promulgated for prescribing opiate painkillers
“There’s no puzzle where this crisis is coming from. The increase in opiate addiction in America is directly related to the FDA approval of Oxycontin and other painkillers,” Shumlin said at Tuesday’s news conference.
“In 2010 — I know I sound like a broken record, but this is extraordinary — in 2010 we prescribed enough Oxycontin in America to keep every adult high for a month,” Shumlin added.
The governor praised new regulations promulgated over the summer by the Health Department aimed at reducing the number of people who become addicted to prescribed opiate painkillers. Dr. Harry Chen, the health commissioner, said the measures will also make it more difficult for people to divert prescribed medication to others.
One new rule requires doctors to conduct a risk assessment for patients before prescribing opiate painkillers, consider non-opioid options and follow up with every patient to be sure treatment is working.
Another new rule requires doctors prescribing opiate painkillers and other controlled substances to register with the Vermont Prescription Monitoring Program and check the system before writing a prescription.
An amendment to current rules will require physicians prescribing buprenorphine and other maintenance drugs to follow the same rules that govern opiate painkillers in order to prevent those drugs from being diverted.
Some of the maintenance drugs can be tampered with and injected to get users high. Suboxone and bupe command a high price on the street.
