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What Vermont Can Teach Us About Fighting the Opioid Epidemic

New England is the region most adversely affected by the opioid crisis, with a fatal overdose rate of nearly 25 people for every 100,000, whereas the national average is closer to 16. New Hampshire, in particular, has the second highest rate of fatal overdoses in the country, behind West Virginia. Despite that, New Hampshire’s neighbor, Vermont, has, in recent years, cut it’s rate of fatal overdoses to below the national average. This is the result of a deliberate effort and Vermont may serve as a model for other states to replicate. How did Vermont do it?

According to a recent Vox article, the solution is simple, but not easy: Vermont made evidence-based treatment more easily available to more people. To do this they used what they call a hub-and-spokes model. Essentially, it’s a way of delegating various aspects of addiction treatment to people who are best able to handle them. The most intensive phase of treatment is handled at the hub.

The people who work at the hubs are addiction specialists, including doctors board-certified in addiction medicine, addiction therapists, and nurses. This is where a comprehensive plan of treatment is worked out, including medication, therapy, and engagement to make sure people keep showing up and working on their recovery. In the initial phases of treatment, people come to the hub daily to get medication and sometimes therapy. When they get more established in recovery, they move to the spokes for ongoing care.

The spokes are doctors who are not addiction specialists, but consult with the hub. Each spoke is supported by a full-time nurse and a behavioral specialist from the hub. Once a patient is stable in recovery, she can move to less frequent visits at the spokes for follow-up support. This allows non-specialists to take some of the workload from addiction specialists, so more people can be treated.

Another critical part of Vermont’s  success is medication assisted treatment, or MAT. This is using medication–usually buprenorphine, but also methadone and sometimes naltrexone–to get patients off of opioids. Despite the success of MAT, it remains controversial because of the widespread belief that it is merely replacing one addiction with another. The crucial difference, though, is that it replaces a destructive, potentially fatal addiction with one that’s safer and allows the patient to function normally. In the face of ballooning rates of fatal overdoses, it seems like a pretty good tradeoff, and one that has worked in Vermont.

Implementing similar systems in other states won’t be easy. Vermont is a small state with a small population. The success of its program required cooperation, commitment, and funds made available by Obamacare. However other states decide to tackle the problem, these two elements–greater availability of treatment and embracing MAT–will likely be crucial.

If you or someone you love is struggling with opioid addiction, Gardens Wellness Center can help you detox safely and decide on a treatment strategy. Call us today at 844-828-1050 or email us at to learn more.