Following news reports about a recent spike in heroin overdoses in central and northern Vermont, the Vermont Department of Health issued a warning to street drug users about a particularly powerful strain of heroin that has turned up in several communities and caused at least 10 individuals, one of whom later died, to overdose in a 50 hour stretch during the weekend of Aug. 13 and 14.
The heroin in question was possibly laced with fentanyl (a man-made opioid 50 times stronger than heroin) rendering it so powerful that multiple doses of the opioid-reversing medicine naloxone (Narcan) were required to revive most of the patients.
We are fortunate to have naloxone in our medical tool kit. It can literally pull people back from the brink of death. But the fact remains that the opioid crisis in Vermont remains in full swing with opioid-related drug deaths up nearly 50 percent between the years 2010 and 2015.
This is just one of many reasons why we should not lose sight of the fact that people who struggle with opioid addiction need — and deserve — a variety of supports and options that will help them avoid potentially lethal overdose situations in the first place.
Efforts to reduce the amount of opioid-based pain killers prescribed by physicians and other healthcare providers are aimed at prevention, and prevention is always our safest and least expensive option. Vermont's shift toward outpatient medication-assisted treatment programs (HUB and Spoke) has proven to be an effective option for many people who are medically able to withdraw from opioids without inpatient treatment.
The hospital where I serve as CEO, the Brattleboro Retreat, operates a successful HUB and Spoke service that is always full. Few can argue that this hasn't also been a significant cost saver for the Department of Vermont Health Access, the agency that administers Medicaid payments in the state. Yet as the availability and potency of heroin and related substances continues to fuel the ongoing opioid crisis we should remember that addiction treatment is not a one-size-fits-all issue. We know, for example, that depending on a person's history of drug use, age, psychiatric issues, physical and medical condition, and other factors, a treatment that might work best to help one patient stay alive may be too much — or not enough — for another patient.
To the extent that our current approach to caring for people who are addicted to opioids limits their ability to receive necessary inpatient detox services, I am compelled to raise a flag on their behalf and point out that budget/policy decisions should never create a gap in the continuum of care these patients need and deserve.
Unit Chief Jennifer Fyler, MD, my colleague at the Retreat, summed it up in a recent meeting when she said: "Opioid addiction is a life-threatening illness, and until the state is able to provide readily available outpatient maintenance services, which is far from the case, we need to allow all points of entry into the continuum of care including inpatient detox services."
Establishing medical necessity in order for an individual to receive hospital-level opioid detox is prudent practice; but today, when the risk of death from opioid use is so high, it should not create such a high bar that it prevents patients from receiving the life-saving care they desperately need.
Op-Ed was published on August 26, 2016 by the Brattleboro Reformer written by Louis Josephson, PhD., President & CEO of the Brattleboro Retreat.
