Vermont Taking New Steps to Address Opiate Addiction

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Six New England governors are urging Congress to expand the types of medical professionals who can prescribe the addiction treatment medication buprenorphine (Suboxone®) so Vermont and other states can better meet the needs of those who are addicted and seeking treatment

Vermont Governor Peter Shumlin

As part of the comprehensive approach to fighting the heroin and opiate crisis in Vermont, Gov. Peter Shumlin outlined a number of steps to better control the prescribing of powerful opioid painkillers in an effort to prevent opioid dependence and addiction. The Governor is also leading an effort of the six New England governors to urge Congress to expand the types of medical professionals who can prescribe the addiction treatment medication buprenorphine (Suboxone®) so Vermont and other states can better meet the needs of those who are addicted and seeking treatment.

The moves come two weeks after the Governor announced the addition of a new treatment medication option for those suffering from opiate addiction. The medication – naltrexone (Vivitrol®) – works to block the ‘high’ individuals get from using opioid drugs like heroin or prescription painkillers.

“In the fight against opiate addiction, Vermont has made incredible progress,” Gov. Shumlin said. “But when we took on this fight, we knew the challenge was great. That hasn’t changed. We still have much work to do. We are fighting this battle on two fronts: Helping those already addicted get into treatment and recovery and stopping addiction from taking hold in the first place.”

On the latter front, the Governor, joined by Health Commissioner Harry Chen, MD, outlined three administrative rule changes designed to limit the number of opioid prescriptions in Vermont:

  • The Vermont Prescription Monitoring System Rule implements the requirement that prescribers of controlled substances register with VPMS, and check the system before writing a prescription.
  • A new Rule Governing the Prescribing of Opioids for Chronic Pain specifies that before prescribing, the physician must conduct and document a risk assessment, consider non-opioid and non-pharmacological treatments, and follow up with every patient to be sure treatment is working.
  • An amendment to the Rules Governing Medication-Assisted Therapy for Opioid Dependence for: 1) Office-Based Opioid Treatment Providers Prescribing Buprenorphine; 2) Opioid Treatment Providers – State Regulations – will apply the same rules to any physician who prescribes buprenorphine, regardless of the number of patients. This is expected to become effective in early 2016. This will help address the issue of diversion by requiring physicians to actively take steps to monitor their patients’ behavior with their medication.

Also today, UVM Medical Center CEO John Brumsted announced a new hotline to help primary care physicians across Vermont treat patients who may be experiencing chronic pain – an ailment that afflicts over 100 million Americans according the Institute of Medicine. Starting in January, once a week, any provider from Vermont will be able to call in and speak with UVM Medical Center chronic pain specialists about challenging cases they’re dealing with.

The Governor is also leading a bipartisan effort of the six New England governors to urge Congress to amend federal law to allow medical professionals such as nurse practitioners and physician assistants to prescribe the treatment medication buprenorphine for opiate addiction. Currently, nurse practitioners can prescribe addictive narcotics for pain, but under the Drug Abuse Treatment Act of 2000 are barred from prescribing medications designed to break addiction to those deadly narcotics and heroin.

The Governor today released a letter to congressional leaders urging them to make the change. The letter is signed by Gov. Shumlin (D), Gov. Charlie Baker (R) of Massachusetts, Gov. Paul LePage (R) of Maine, Gov. Dannel Malloy (D) of Connecticut, Gov. Maggie Hassan (D) of New Hampshire, and Gov. Gina Raimondo (D) of Rhode Island. The text of that letter is copied below.

Dear Senate Majority Leader McConnell and House Speaker Paul Ryan,

In order to help address the nation’s opiate addiction epidemic, we ask that Congress approve legislation to expand the types of qualifying practitioners who can prescribe Medication Assisted Treatment (MAT), such as buprenorphine.

As you are aware, federal law must change to expand the definition of “qualifying practitioner.” Specifically, one correction would need to be made, allowing for nurse practitioners and physician assistants to prescribe MAT drugs under the supervision of qualified physicians.

Nurse practitioners can prescribe addictive narcotics for pain, but under the Drug Treatment Act of 2000 are barred from prescribing MAT drugs designed to break addiction to those deadly narcotics and heroin.

Nationally, 53 percent of primary care physicians work with nurse practitioners or physician assistants. By ignoring this important and successful partnership in the treatment of addiction, we significantly limit access to MAT. Building on this strong partnership between physician and non-physician providers is vital in expanding access to effective treatment.

The need has never been greater, as the number of people seeking treatment is continuing to grow.

In Vermont alone, as of August 2015, more than 2,804 people are in treatment in the state’s opiate treatment centers, up from 1,704 in January 2014. The waiting list for services is 427 and remains unacceptably high. The number of people seeking treatment continues to overwhelm the capacity of our system, despite the rapid service expansion spurred by the recognition of this crisis. If we had the opportunity to add to our workforce, a significant pressure would be relieved. There are simply not enough physicians to respond to the escalating demand.

Vermont’s numbers reflect a regional trend in the northeast and across the nation. No state is immune to this crisis.

It is imperative that we remove the barriers to treatment. The health of our families, our communities and our economy rests on our ability to ensure men, women and children who are addicted to deadly drugs have every opportunity to turn their lives around.

Our states have worked together to align our efforts in addressing the opiate crisis. One of the areas defined is improving treatment access, in part to address the workforce shortages that we are all experiencing and the challenges in making enough services available to meet the need. The expansion of qualifying practitioners would help us meet this important goal.

The Recovery Enhancement for Addiction Treatment Act (TREAT Act), has been introduced into the Senate and the House sponsored by Senator Markey (Massachusetts) and Representative Higgins (New York) as S.1455 and H.R.2536 respectively. It would allow certain nurse practitioners and physicians assistants to treat up to 100 patients per year with buprenorphine, provided they meet important requirements.

We feel that this provision supports a responsible approach to increase prescribing capacity, while ensuring that practitioners are adequately trained and supervised. In the Northeast, we have broad support for this approach and could implement changes quickly once Congress acts to pass legislation.

Sincerely,

New England Governors

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