Editor’s note: This commentary is by Barbara Cimaglio, who is deputy commissioner of the Vermont Department of Health, and Tom Simpatico, MD, the chief medical officer for the Department of Vermont Health Access.
[F]rom our view at the Department of Vermont Health Access and the Health Department, we are troubled by Dr. Rick Barnett’s April 26 commentary, “Maintenance Medication Madness.” His assertion that “We’ve embraced … the alleged evidence-based, maintenance medication craze” while decreasing support for psychosocial treatment, does not accurately represent what we are doing in Vermont.
According to a U.S. Department of Health & Human Services, Substance Abuse & Mental Health Services Administration (SAMHSA) publication: Medication-assisted treatment is one way to help those with opioid addiction recover their lives. There are three equally important parts to this form of treatment: medication, counseling and support from family and friends.
For every $1 spent on MAT, $1.80 is saved across all medical and social services.
This is the model that we support. Both the Hubs (treatment facilities) and the Spokes (physician practices) in Vermont’s Care Alliance for Opioid Addiction require medication, counseling and other supports as part of the bundle of services for which they are reimbursed.
Psychotherapy/counseling is an inherent part of our medication-assisted treatment (MAT) model. The Health Department’s rule for treatment providers and physicians requires that all patients be assessed for their need for psychotherapy/counseling. Dr. Barnett misleads by portraying the role of psychotherapy as an either/or choice.
MAT is overwhelming regarded as the most effective strategy available to minimize the short- and long-term medical and societal harm resulting from the illicit use of opioids. MAT both saves lives and minimizes harm. It improves the quality of life for those who are addicted, their loved ones, and society as a whole. And economic modeling repeatedly shows that states get a considerable return on investment: For every $1 spent on MAT, $1.80 is saved across all medical and social services.
Vermont is considered a national leader in identifying and responding to the public health crisis of opiate abuse and addiction. We employ the current state-of-the-art array of tools available to have the greatest impact on saving the lives and improving the quality of life of Vermonters. Our philosophy underlying all treatment approaches is that there are many paths to recovery, all treatment should be individualized for the patient, and patient choice is foundational to the care received.
