[T]he first methadone clinic in Vermont opened in Burlington in 1991 amid great controversy after being opposed by then Gov. Howard Dean, a doctor, who thought it would attract more addicts. It served 75 patients.
Today, the state has an elaborate structure to help with drug treatment, and last year, more than 6,000 Vermonters received help.
Barbara Cimaglio, the deputy health commissioner, is on the front lines in the state’s effort to combat prescription drug and heroin addiction. In this edition of Digger Dialogue, Cimaglio talks about what additional steps the state needs to take to prevent an increase in the number of overdoses, approximately 100 a year. She also talks about the power of addiction, including her own successful effort to stop smoking cigarettes.
Despite the expansion in treatment programs, Cimaglio says the heroin epidemic has not peaked — that there are more users getting hooked faster than people can be successfully treated.
“I agree we probably haven’t peaked yet because we still don’t have treatment on demand,” she said in a 40-minute interview, “but it’s much better than all of our surrounding states.” The state currently has a system of helping people with five regional centers that include a network of doctors, called the “hub and spoke” approach.
Cimaglio said there is virtually no wait for treatment in some areas of the state. However, she said overall there is a shortage of doctors to handle the treatment programs, which usually involves prescribing a substitute drug to block cravings. Stopping cold turkey, she said, is less successful and results in more relapses than the medication-assisted approach.
Cimaglio sees three challenges in the drug battle: One, preventing more new users, particularly children, from becoming addicts; two, keeping those that are already addicted from getting worse, and three, cutting the supply of drugs either coming in illegally from other states or because of overprescribing by doctors.
Cimaglio says Gov. Peter Shumlin’s focus on the opiate problem — he made it the sole subject of his 2014 State of the State address — resulted in the Legislature appropriating more money for treatment. Without that boost, she said, the problem would be worse.
Despite all the public attention to the current problem, Cimaglio said drug abuse has never really subsided in Vermont.
“I don’t think it was every under control. We see peaks and troughs,” she said. In the 1980s, the drug of choice was cocaine; in the 90s, she said it was amphetamines including meth, and then in the last 10 years, the prescription drug abuse problem exploded. When the availability and cost squeezed pill poppers, many turned to cheap heroin for their high. The drug is easy to buy, she said, because it is profitable and dealers from New York and Hartford can increase their prices when they sell in Vermont.
The only way out of the addiction cycle, Cimaglio said, is to convince younger people to never start and for older people, doctors to prescribe fewer painkillers. She noted health officials can be successful cutting the addiction numbers, but a new crop of young people need to be educated about the effects and dangers every year.
“We can’t let up,” she said. “Just like any disease.”
Asked why addiction and abuse were so prevalent, Cimaglio said: “That’s the million dollar question. I think we live in a society where the solution to a lot of things is to take a pill, have a drink, it’s our culture,” she said.
