Health Care

Tobacco ban at residential treatment centers deters clients

Catey Iacuzzi
Maple Leaf Farm Executive Director Catey Iacuzzi testifies in the Senate Health and Welfare Committee earlier this month. Photo by Elizabeth Hewitt/VTDigger
During the first two weeks of the year, fewer than half of the 41 beds at Maple Leaf Farm, a residential opiate treatment facility in Underhill, were full.

For a facility that usually has a waiting list of 34 and a wait of two weeks to get a bed, that’s unusual.

The sudden drop in clients at Maple Leaf Farm coincided with the implementation of a Vermont Health Department policy requiring residential drug treatment centers to be tobacco-free. Intended as a step toward improving public health and the well-being of clients, the anti-smoking policy instead deterred patients from receiving treatment for opiate addiction at the center.

While Maple Leaf Farm Executive Director Catey Iacuzzi sat in a committee room one morning earlier this month for testimony on opiate addiction services, she received emails notifying her that two clients had left the program because they were not allowed to light up at the facility.

The smoke-free policy was a long time coming. The Health Department began crafting it about two years ago. The goal: to make treatment facilities tobacco-free, in the same way that hospitals and other health services offices are, according to Deputy Commissioner Barbara Cimaglio.

Initially, the department planned to have the state’s residential treatment centers go tobacco-free by July 1, 2015, but the facilities asked for a six-month delay, so it went into place at the beginning of this year.

There are “a lot of myths” about tobacco use and addiction treatment, Cimaglio said Tuesday. Many people believe someone can’t give up smoking while also going through treatment for drug addiction. But research shows that’s not true, Cimaglio said.

She said the department adopted the tobacco-free policy with the intention that quitting smoking could be part of a patient’s treatment plan.

“It isn’t intended to be punitive,” Cimaglio said. “It’s intended to help the patients see that tobacco is a serious problem.”

When patients come into a program, they won’t be expected to quit cold turkey, she said. They’ll have access to nicotine patches and gum, and clinicians can refer them to other support services, like the Vermont Quit Line, Cimaglio said.

The department drew on scientific research in crafting the policy and looked to similar in policies in other states, especially New York, for guidance, she said.

Initially, Iacuzzi supported Cimaglio and Health Commissioner Harry Chen in the move to cut down smoking in residential treatment facilities as a matter of public health.

But the implementation of the policy played out differently than research suggested.

Staff at Maple Leaf Farm spent the first few weeks of the year chasing down tobacco-dependent clients to enforce the new policy, she said. Maple Leaf Farm is one of four residential treatment centers in Vermont and handles almost 800 patients annually, with an average treatment length of about two weeks.

With the ban in place, clients were going to great lengths to get a cigarette, Iacuzzi said. She saw one patient crouched behind one of the buildings on the facility’s campus to get a smoke.

Some clients who were smokers left the program because quitting was too daunting; others never even began the program because of the ban, she said. Meanwhile, the policy was frustrating for nonsmokers who felt the focus of the opiate addiction program was distracted by the tobacco crackdown.

“It felt like we were the cigarette police, and we weren’t able to focus on other needs,” Iacuzzi said Wednesday.

Making the decision to go into treatment for opiate addiction is already stressful, Iacuzzi said. Clients experience intense anxiety and fear while going through withdrawal, she said. When patients were told they couldn’t smoke, it magnified that fear.

“The level of anxiety went through the roof when it was already at the roof,” Iacuzzi said.

Iacuzzi said she still supports the intent of the tobacco-free policy and would like patients at Maple Leaf Farm to get more information about the health risks of smoking and get support to quit. But, she said, there needs to be consideration of the different levels of risk associated with opiate and tobacco use.

“Someone tonight could die from an opiate overdose,” Iacuzzi said. “They’re not going to die tonight from tobacco use.”

In light of the concerns from some providers, the department is working with the state’s residential facilities to offer support during the rollout of the policy.

Health Department officials spoke with treatment providers this week about the issue. For the moment, the department isn’t requiring that the tobacco-free policy be enforced. Lawmakers on the Senate Health and Welfare Committee will take testimony on the policy Friday.

Though the policy is eased for the moment, Cimaglio said the department still hopes to bring treatment centers in line with the tobacco-free policy in Vermont’s other health centers.

The policy is still in its early days, she said, and it will take time to challenge the perception that quitting smoking is not compatible with other substance addiction treatment.

“This is the right thing to do for public health,” Cimaglio said.

In the meantime, enrollment numbers at Maple Leaf Farm have bounced back since the facility stopped cracking down on smoking, according to Iacuzzi. It is at full capacity.

Iacuzzi said she is aware of one patient who had dropped out who has been back in touch to get some form of services. But when patients drop out of the program, it becomes difficult to keep in touch with them or track their well-being, Iacuzzi said.

“There’s a handful of clients that I’m worried about,” she said.

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Elizabeth Hewitt

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  • Paul Lorenzini

    Vaping is the best cure for cigarette addiction, hands down. There is no patch in the world, or gum, or psychoactive prescription, that can help people stop inhaling carcinogens like ecigs can. Why are there 3 billion nicotine addicts on the planet? Because it soes some good things.

  • Lee Stirling

    Not only is quitting smoking the best choice for a person’s health, but it is also the best choice for a person’s wallet. How much easier must it be for people in general (not just those recovering from opiate/drug addiction) to make ends meet, get and keep employment, and find/afford decent housing if they did not smoke and spend all that money on cigarettes?

    • Alex Aloi

      Lee, Maybe you should offer yourself up as pro-bono financial planner for opiate addicts given your insight into their economic situation.

      While what your saying is true, the implied assumption that everyone has equal access to resources, equal education, and equal ability when it comes to addiction treatment is strange to me and not at all in line with the reality of most addicts.

      I think we could all do with a little more empathy, a little less moralizing, and a heaping helping of pragmatism.

  • William Hays

    Same thing happened to me when Amtrak banned smoking. Haven’t been in a bar since, either. Already quit flying, so no problema. New York City? Fuggedaboudit. The list goes on…

  • Alex Aloi

    Quitting smoking is great, but to require that in order to receive treatment seems counterproductive. We are talking about people who are undergoing big changes in their life, highly stressful changes at that. So now we are going to have them fighting one more battle while fighting for their lives? Why? Lets be honest, it is hard to quit smoking under normal circumstances, how about when the patterns of your life have shifted under you? What about those who are dealing with mental illness on top of addiction…Do we add one more thing to their plate?

  • Chuck Shannon

    Cigarettes are 10 bucks a pack. That’s $3,650 dollars a year. If you are on foodstamps then you can’t afford to smoke. Not to mention the additional cost of healthcare.

    • John Burks

      If you can afford to buy your opiates, you can afford to smoke. The $3650 is artificially inflated by the nanny state. The true cost is closer to $3 a pack which works out to a doable $1000 per year.

      • William Hays

        Lots of variables in the calculations here. I smoke 1.5 packs of cigarettes a day at a cost of ~$4.40/pack, which equals ~$2,400 p. a.. Most of that cost is taxes. A pack of cigs costs ~$0.20/pack to produce and market, with a decent profit included. At a fair market price, the nannys would lose ~$2,290 in tax revenue from my custom.

  • Dave Bellini

    Sounds like MLF made a business decision. If they’re not getting enough “customers” they probably lose revenue. I suspect this has more to do with economics than anything else.

  • Rich Lachapelle

    This issue exposes the long-standing hypocritical double standard that exists in Vermont where the LEGAL habit of tobacco/nicotine consumption is given the long, bony finger of indignation and second-class citizen status meanwhile the Governor, the Legislature and the taxpayers roll out the red carpet to those whose addiction of choice is to opioids. The use of illicit opioids is associated with an out-of-control wave of all manner of property and violent crimes. As expensive as the anti-tobacco jihadists have made the habit of using tobacco, can any real crime be attributed to those seeking to finance that addiction? Meanwhile, our response to the opioid addicts is to offer them clean needles, substitution drugs such as methadone and buprenorphine (which are heavily abused and sold on the street), and widely distributed naloxone to keep them from teetering over the edge. If someone is addicted to both nicotine and opioids, I think it is obvious which of these takes the larger toll on decent society and which we should be putting the biggest priority on managing. For God’s sake, if someone is giving it their best effort to kick their opioid addiction by an honest attempt in a treatment facility, the least we can do is let them satisfy their nicotine itch with a vape since no argument can really be made about second hand smoke. Even people in prison get to drink coffee to satisfy their caffeine craving.
    Sure seems to me that the treatment INDUSTRY is trying to deliberately decrease the success rate to generate more business for their “non profit” operations.

    • Fred Woogmaster

      I strongly agree with the spirit of this comment!

  • Timothy Fair

    Let’s make recovery even tougher for addicts, so that the condescending and self righteous anti-smokers can feel that much better about their superior life-style choices.

    • Vidda Crochetta

      It’s about time the addiction treatment centers have banned tobacco smoking on premise.

      Cigarette smoking is not criminalized but that doesn’t mean that they are innocent drug users. After all, cigarette smokers are drug addicts. And, through their addiction they are the most dangerous animals on the plant. They death they leave in their wake exceeds the mortality rates of all wars and accidents combined. It’s ironic that anti-tobacco people have often been characterized in a bad light while tobacco drug addicts are defended because of their “right” to smoke, which, realistically is a license to kill because of the deadly ingredients in modern cigarettes.

      I am however a supporter of vaping in general, (but not in treatment centers with a tobacco ban), as long as vaping doesn’t contain deadly ingredients like cigarettes. I’m not saying vaping is entirely safe but I am saying vaping is a useful harm reduction measure.

  • Daniel Hammond

    First and foremost take the hardest addiction first and deal with it alone. Then the second hardest may it be Xanax or something else. Then after wards if the person is willing you can talk to them about smoking. First things first you cant deal with a small minor problem just because prohibitionists hate smokers. That’s where the non smoking policy is coming from PROHIBITIONISTS. As yet they cant even prove a smoking disease even exists.

    Every claim they’ve made so far is old age related not tobacco related.

  • daniel Hammond

    Your just pumping ecigs. Smokers don’t want ecigs they want to smoke it relieves stress during the withdrawel process. I myself got hooked on prescription loritabs at 4/10s a day after a hospital stay. I forgot the golden rule no more than 3 weeks or dependency begins.

    Ive self detoxed at home over 2 months down to just .5mg at nite. My problem is deep back pain after 24 hour with no opiate in the system. Its whats killing me stopping completely but Ive acclimated to the .5mg dose now after a week and no day time withdrawels.

    Now if I hadn’t been able to smoke,Id have left that facility str8 out at home you can suffer it out and not be frigging harassed by do gooder prohibitionists and their mentality.

    The same goes for mental health clinics and wards,smoking is a great healer with these people and an aid in maintaining them. The same applies to drug withdrawel.

    I really never met the criteria for a 2 week drug rehab unit,I talked with them last week and said my god you went from 4 a day to just a half at nite all by yourself……

    Yet they have the same problem in Tenn no smoking so most of their beds stay empty too!

    Smoking isn’t any big deal to begin with,its the control freaks pushing anti smoking that have the problem.

  • daniel Hammond

    First and foremost take the hardest addiction first and deal with it alone. Then the second hardest may it be Xanax or something else. Then after wards if the person is willing you can talk to them about smoking. First things first you cant deal with a small minor problem just because prohibitionists hate smokers. That’s where the non smoking policy is coming from PROHIBITIONISTS. As yet they cant even prove a smoking disease even exists.

    Every claim they’ve made so far is old age related not tobacco related

  • Kathy Scott

    Yes, we all understand tobacco is harmful, but banning tobacco products from treatment centers adds an additional burden to someone struggling with an issue with negative effects more urgent (in most cases) than tobacco use. They should not be allowed to use tobacco when and wherever convenient (to them); but there should be a place where they can use tobacco. Many people struggling with mental health issues such as bipolar disorder or ptsd or alcohol,addiction find smoking calming. I see no benefit to making the rules on this so rigid you drive them away.

  • Anne Blanchard

    I pretty much agree with Alex Aloi. I have a close family member that has to go every day to the Methadone Clinic in Newport. Believe me, dealing with that is the main, important thing. Of course Smoking is bad for your health, but that is something that can be dealt with later, when things have stabilized. To add that on right now would be the Straw that broke the Camel’s back, One thing at a time. As for the expense of cigarettes – many of these people get the no-brand type cigarettes over in NY State where they’re much cheaper.

  • Paul Cook

    The smoking police have gone too far in putting addicts lives at immediate risk. There are likely no recovering individuals involved in the “crafting” of this policy. I would encourage our lawmakers to address the issue from the perspective of “which of these activities is likely to kill the addict or those around them first?” and recognize that the decision to seek help for addiction is one that is frequently made as an addict’s last resort. Not a perfect time to suggest that they cease another less harmful addiction at the same time.

  • David Dempsey

    What’s next. Another serious health issue like sugar. No sugar in your coffee, no soda that contains sugar. chocolate bars, forget it. Maple syrup on the pancakes or chocolate milk, milk shakes, ice cream are all fine. We don’t want to tee off the farmers. The way things are going, a joint will certainly be allowed. Give me a break.

  • Fr. Jack Kearney

    This is absolutely unethical. It violates the ethical principle of autonomy, which says that competent patients self-direct their own care. We have treatment center here in California that has seen an 80% reduction in smoking by handing out vaping supplies to folks who want to use them.