Fed Up Vermont: ‘Hub and spoke’ a flawed approach to opioid addiction

Editor’s note: This commentary is by Wendy Galbraith of Manchester, Geri Gilmore of Arlington, Jo Lambling of Manchester Center, and Gretchen Lima of Dorset, all co-founders of Fed Up Vermont.

Each of the four of us — founders of Fed Up Vermont — have suffered devastating personal losses as a result of family members having developed addictions to opioids. Among us we have children and siblings who have lost their lives. We have children as well who simply have gone missing, condemned to lifetime chemical dependencies, ruined futures and lost relationships. We live daily with profound grief. We live, too, with the knowledge that our losses — like the losses suffered by so many families around the country — were caused by addictions started innocuously enough by opioid prescriptions written by physicians.

Despite the heightened awareness of the dangers of prescription opioids, each of us has heard, shockingly, from friends and neighbors in our communities about doctors who continue to this very day to offer, unsolicited, prescriptions for opioids and we continue to hear about doctors who write prescriptions in quantities that far exceed the non-binding prescription-writing guidelines that the Vermont Department of Health wisely wrote two years ago.

As a result, we are each profoundly disappointed by the refusal of legislative leadership to take up and permit testimony and debate on a proposal (one that has the bipartisan support of scores of legislators) that would create a real incentive for the entire medical community in Vermont to come together through peer review and self-regulation to deal with and curb errant prescription-writing practices.

It appears to us very clearly that the current administration, the medical community, and certain legislators are intractably committed to the Vermont “hub-and-spoke” opioid treatment model as our primary strategy to deal with opioid addiction. That model, which bureaucrats and the big-business health care industry claim to represent the “gold standard” approach to opioid addiction, emphasizes treatment over prevention. The strategy focuses on supplying enhanced public funding to the health care industry to provide post-addiction medical care. The strategy also commits substantial public monies to be paid to pharmaceutical companies for suboxone and vivitrol. It is an approach, we submit, that perversely rewards the health care and pharma industry for a problem largely of its own creation.

Most disturbingly, however, the scientific literature tells us that those who are left to this preferred strategic approach — those who are left to the use of “medically assisted treatment” — actually suffer opioid abuse relapse rates exceeding 50 percent.

No doubt, treatment is important. Avoidance of unnecessary deaths through aggressive interventions and care is critical. However, we know all too well from our personal tragedies that prevention of the onset of addiction is a far more effective strategy than endless treatment of the problem. A failure rate of over 50 percent and a strategy that leaves many addicts to a potential lifetime addiction to drugs like suboxone cannot seriously be considered to be the “gold standard” approach to this crisis.

Twenty legislators — Republicans and Democrats alike — this year proposed a bill that would create a real incentive for the medical community to police irresponsible prescription-writing by doctors. H.723 would create a private right for persons injured by physician violations of already existing statewide standards to have access to the courts to address their injuries. Creating a “private right of action” allowing those who can prove injury to pursue recovery from the medical industry is the critical component of this prevention strategy. The rationale is simple: By creating the possibility of liability on the part of pharmaceutical companies and on the part of health care provider organizations who let these violations occur, the bill would effectively motivate the health care community to regulate itself by causing provider entities to require that individual physicians comply with existing Vermont standards as a condition of maintaining the lucrative professional affiliations that exist between these doctors and their hospitals and practice groups. We support H.723 and have strongly urged its passage.

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The four of us recently visited the Statehouse in Montpelier. We were bluntly told, in no uncertain terms by House committee leadership, that H.723 was dead. It would not be considered by the Vermont Legislature. No lay or scientific testimony was or will be taken. No debate or discussion will be allowed to occur. The proposal, we were told, is simply going to die in committee. This, we were also told, was because existing prescription guidelines are believed by some to be enough. Nothing more needs be done, we were told. Not this year and apparently not ever.

Each of us refuse to accept that maintenance of the status quo is an acceptable approach. We believe that a health care model that defers blindly to the medical judgments made by individual physicians armed with opioid prescription pads is a failed model. We believe that an industry-wide cure for an industry-made malady is called for.

We are not so naive as to believe that the health care industry would not fight this proposal with enormous resolve and seek to prevail upon individual legislators to accept its opposition. But our very best strategies to deal with our opioid crisis have flat out failed. Our public health system has been unable to stem the tide of needless deaths and lost futures. We naively expected that our Vermont representatives would consider this proposal fairly and at least take testimony and engage in discussion about better solutions.

The Legislature this year had the opportunity to deal with our opioid crisis with bravery and courage by demanding that our health care industry take real ownership of the problem. It refused to do so. We at Fed Up are passionately committed to our goals in fighting the opioid crisis and we are gaining momentum. We will not let this go. We are not leaving.


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