State, health care providers outline resources to address opioids and substance use disorder
Health Commissioner Dr Mark Levine speaks Thursday at Central Vermont Medical Center in Berlin as Governor Scott, behind him, listen. Screen grab from press conference.
Vermont Business Magazine At his weekly media briefing on Thursday at Central Vermont Medical Center in Berlin, Governor Phil Scott highlighted available resources and new state investments passed this year to combat the opioid epidemic and support those with substance use disorder, including nearly $9 million in new investments for prevention, treatment and recovery.
The governor was joined by state leaders from the Department of Health, including Health Commissioner Dr Mark Levine, as well as representatives from the UVM Health Network, community prevention coalitions and health care providers.
In total, across all funds, the state budget this year invests $66.2 million for substance use programs at the Vermont Department of Health. This includes nearly $9 million in new or additional state funding for the following:
- $4 million to local and regional substance misuse prevention coalitions
- $2 million for substance use disorder treatment and recovery beds
- $1.2 million in rate increase for preferred providers to support treatment and recovery
- $1.54 million for recovery centers, employment services and regional recovery partners, like Jenna’s House
If you or someone you know is struggling with substance use, or in need of services, you can access the following resources and supports:
More details can be found in the below transcript of Governor Scott’s remarks or by clicking here to view the press conference.
You can also view a transcript of remarks from additional speakers by clicking on the below links.
Dr. Mark Levine, MD, commissioner, Department of Health
Melanie Sheehan, regional prevention program manager, Mt. Ascutney Hospital; and vice chair, Vermont Substance Misuse Prevention Oversight & Advisory Council
Anna Noonan, president and chief operating officer, Central Vermont Medical Center
Dr. Javad Mashkuri, MD
Governor Scott: Good afternoon and thanks for being here. I want to start by thanking the staff at Central Vermont Medical Center for hosting us today. For more than two and a half years, just about everything we did was shaped by the pandemic. I know that was especially true for health care workers. So, thank you all for what you have done, and continue to do.
We know COVID affected us in so many ways and not just because of the virus, but because of the negative impact of isolation and other measures that were necessary before vaccines. This included many people turning to, or returning to, harmful substances, often as a way to cope, whether due to illness, isolation, or emotional and financial stresses.
Regardless of the reason, we know substance misuse and the opioid epidemic have plagued us for far too long. And unfortunately, the pandemic made this much, much worse – here and across the country.
That’s why today, we’ll be talking about substance use, the resources available to help, and our efforts to provide Vermonters who need and want it, with treatment, harm reduction strategies to protect their lives, and recovery services including employment to support them as they rebuild their lives.
Vermont has been a national leader in addressing substance use, but we have never rested on our laurels. Even before the pandemic, we were expanding on the work that had been bending the curve, reducing overdoses and getting more people than ever into treatment.
But there’s no doubt the pandemic created a situation that set us back, despite the very best efforts of providers who kept services going. And tragically, we – like the rest of the country – have seen an increase in the loss of life due to overdoses.
We’ve talked a lot about the lives lost to COVID over the last few years. But we must also recognize that other lives were lost as a result of the pandemic, including from overdose and suicide. These were also parents, children, sisters, brothers, and loved ones.
That’s why it is critical we focus on reversing these trends, and today we will talk about what we are doing to meet that challenge, which includes new and enhanced measures, building on our systems of care, expanding services, and making more use of statewide partnerships.
Just this year, we invested nearly $9 million more to address substance use disorder here in Vermont.
It is important we approach this from all angles, which is why this new funding covers prevention, treatment and recovery. We cannot focus on just one area or one tool, because that is just not going to give us the results we need.
This funding strategically prioritizes prevention efforts at a local level because keeping Vermonters from becoming addicted in the first place is the most effective way to save lives.
I also want to briefly mention the fourth leg of the stool as we work to address this challenge, and that is enforcement.
Vermont has been a leader in recognizing opioid addiction and substance misuse as a public health crisis – and it is.
And as I have said before, law enforcement cannot be, should not be, and is not, the primary tool in this work. But it’s clear there is an important role for enforcement to cut off the supply and stop those who prey on our youth.
As many of you probably saw, I introduced the framework for a public safety plan yesterday, and we’ll be talking a lot more about that in the coming weeks. So, I’d like to keep today focused on our prevention work and these new investments.
I believe prevention is where we can strengthen our state response and make a real difference, saving lives before they are put at risk.
And, here at CVMC, an important partner in this work, they have been pioneering some new ways to help people impacted by substance misuse.
So, you’ll hear from CVMC President and COO Anna Noonan and Dr. Javad Mashkuri to talk about their innovative work to help Vermonters.
But first, Dr. Levine will share more details on what the State is doing, and Melanie Sheehan, the regional prevention program manager at Mt. Ascutney Hospital and vice chair of the Vermont Substance Misuse Prevention Oversight & Advisory Council, will talk more about prevention.
Dr. Mark Levine, MD: Before the pandemic, Vermont had been making steady progress in slowing the rate of opioid-related deaths. But tragically, COVID-19 quickly reversed those trends, as many faced isolation, anxiety, and other changes to their support systems.
It is difficult to understate the challenges in getting people the substance use prevention and treatment services they needed, while in the midst of the greatest public health crisis in more than a century.
The loss of life to accidental overdoses, and the increase in substance use have been tragic additions to the illnesses and deaths suffered these past two and a half years.
According to data released in April, Vermont’s opioid-related deaths increased 34.5% from 158 deaths in 2020, to 215 in 2021 – the highest number we have seen in Vermont.
We must remember that these numbers represent friends, neighbors and loved ones. Each death is one too many, and we feel for the families coping with their loss.
We did not lose sight of this during our response to the virus. We are proud that Vermont was able to adapt quickly, and work through the barriers the pandemic created. Through state efforts, in partnership with our broad network of community and medical partners – to whom I am grateful – Vermont was able to ensure services critical to saving lives were again available, even if in somewhat different forms to meet the new realities.
I am hopeful that COVID-19’s ongoing evolution to an endemic state will mean fewer barriers to care and services. Our focus is to continue to restore the statewide network and safety nets that had us bending the curve on substance use and overdoses.
In addition, as the Governor has discussed here and in other briefings, we – the State and our partners – will build on these efforts, keeping Vermont in the forefront of programs, services and partnerships to support the mental, emotional and physical health of Vermonters.
Of note, the State is providing $8.7 million dollars to support and grow enhanced capacity and the provision of innovative substance use prevention and treatment programs throughout the state. The largest component – almost half – will be in the prevention arena, specifically a marked expansion in funding substance misuse prevention coalitions across the state. Melanie will tell you more about those.
The treatment community is being further supported by rate increases to support this workforce’s critical and ever-expanding work. And $3.5 million is in support of recovery, which if you think about it is really supporting prevention of relapse for those who already have an opioid use disorder and maximizing their likelihood for a successful future free of substances. So, in this category are investments in recovery housing, recovery employment pilots, increased financial support for recovery centers and innovative community recovery facilities, and an investment in those transitioning out of the criminal justice system.
At the same time, we recognize the pandemic will have long-term impacts for many – particularly related to substance use and overdose prevention. This is why our work will continue to be responsive to changing needs, ensuring access to prevention, intervention, treatment and recovery programs – for opioids and all substances.
For example, we continue to find fentanyl at the heart of so many incidences of accidental overdoses. In 2021, fentanyl was involved in 93% of opioid-related fatal overdoses.
The Health Department worked to help prevent and reverse overdoses, by supporting the distribution of over 47,157 doses of Narcan® (naloxone), and more than 83,000 fentanyl test strips to our community partners to provide to individuals.
Vermont EMS are key partners in our efforts. As required, EMS responders offer naloxone to any person who overdosed on opioids and refused transportation to the hospital for additional care. In 2020, this protocol also required naloxone “leave behind” kits to be given to people who may exhibit signs of opioid misuse when EMS arrives on scene for a non-overdose emergency. The kits can also be given to a bystander or family member who may be in a position to save a life.
Prescribers also play a critical role on reducing the risk of overdoses. Between 2016 and 2022, we’ve seen a 54% reduction in prescription opioids dispensed and the percentage of opioid-related fatal overdoses involving prescription opioids has decreased dramatically in that same timeframe. These successes are due in large part to the Vermont medical community’s implementation of the universal precautions for prescribing opioids and their partnership with the Department of Health’s prescription monitoring system.
Our work through Drug Take Back Days collecting unwanted and expired medications also continues to help prevent medication misuse from ever starting.
And I must again highlight VT Helplink (VTHelplink.org). Whether you’re seeking help for yourself or a loved one, this statewide public resource offers caring and expert support for navigating the Vermont treatment and recovery system and has been successfully connecting Vermonters to drug and alcohol support services since 2020.
We know one of the best ways to save lives is through harm reduction – meeting people where they are at, and encouraging substances be used safely.
Our dedicated Syringe Service Programs ensures Vermonters at highest risk of overdose have access to recovery and referrals and overdose prevention resources in a non-stigmatizing environment.
We also focus on reaching people at risk of an overdose and their loved ones through our KnowOD campaign. These steps include:
- Never use alone—if you OD while alone, you can die
- Go slow— start with a small amount to test drug strength
- Call 911—in case of an overdose
- Use new syringes— to reduce risk of infections and help to protect vein health
- Test for fentanyl—fentanyl can be dangerous, so test with easy-to-use strips
- Carry naloxone—Narcan® nasal spray can reverse an overdose
You can find more information at KnowODVT.com.
And let me emphasize, as I have in the past, how critical it is to acknowledge the stigma that substance use disorders can create. And that stigma can keep people from seeking the help they need. We can all help people understand that these disorders are medical conditions. And we should remain non-judgmental and empathetic to those working through treatment and recovery. As a department and a state, we are committed to providing the services, supports and information to change how we view substance use disorder. Learn more about what you can do, at EndAddictionStigmaVT.com.
We will continually monitor our efforts through data, and I look forward to expanding the newer approaches to access services, like virtual options. And as the lead agency that is part of the State’s Opioid Settlement Committee, we will provide evidence-based recommendations on how to spend Vermont’s share of funds coming from litigation settlements with drug manufacturers and distribution companies over the toll of prescription opioids.
Melanie Sheehan: Good Afternoon. It is my pleasure to be here today with Governor Scott, Dr. Levine, and all of you. My name is Melanie Sheehan; I am the regional prevention program manager at Mt. Ascutney Hospital and Health Center in Windsor, Vt., and vice chair of Vermont’s Substance Misuse Prevention Oversight and Advisory Council, which we call the SMPC. I am here today to talk specifically about substance use prevention.
On behalf of the SMPC and my colleagues in the field, I want to thank the Governor for his vision in putting prevention in the state budget. And thanks to our legislators for seeing that vision through. Funding prevention with state dollars shows that Vermont is committed to investing in the root causes of substance use. Our state is working to create a generational shift that will decrease the need, over time, for substance use crisis services, harm reduction approaches, and overdose death interventions.
Until this year, prevention has not received any state funding. For decades, my colleagues and I have worked solely on federal grant funds, either directly or flowing through the State. While we have good outcomes in regions with strong representation, not every area of the state has the capacity to manage federal system requirements. Federal dollars are also restrictive. This means that we do not always reach the populations of our communities who are in greatest need or target the issues that are most relevant to individual communities. Until now, Vermonters have not had equal access or opportunity to prevention resources, either geographically, programmatically, or both.
Investments in prevention will help to stabilize the prevention infrastructure across the state. This means that regardless of the presence of a prevention organization working directly in a hometown, every community will experience prevention strategies. These dollars will help us overcome silos created by federal funding streams, either by substance or by population group. Thus, we will be able to work across all substances, and across all age groups. By doing so, we are addressing gaps identified by a prevention inventory the SMPC conducted in September of 2020. Lastly, these funds will also allow us to be responsive to our local communities, the places where we see and feel, very tangibly, the dilemma of substance use. We will target effective interventions based on community need, which is a truly local approach. What works in Barre may not work in Windsor. We can adjust the work according to each individual community’s needs.
For those who are not aware, substance use prevention is a professional field of practice, established with public health science and accountable to the Strategic Prevention Framework. The strategies and initiatives implemented by prevention professionals and coalitions are evidence-based and comprehensive. This means that they ensure a comprehensive public health approach by implementing a portfolio of strategies at every level: individuals, organizations, communities, and policies and systems. We do not just run programs; we operationalize any funding opportunity across a socio-ecological model to engage and reach a higher percentage of the population. This allows dollars to stretch and effectively reach a greater proportion of people than direct service is able to do.
Thank you again Governor Scott and Legislators. First of all, for establishing the SMPC; then for valuing the work and supporting identified needs by allocating resources; and for trusting in our partners at the Vermont Department of Health to create a strong and sustained prevention infrastructure and prevention professional workforce for Vermont.
On the heels of the pandemic, we have a very real example of how prevention works. Substance use prevention may not be as tangible as masking and hand gel, but the concept is the same. Careful planning and effective collaboration to put resources where they’re most needed can save lives.
To find a prevention coalition or professional in your area, visit www.preventionworksvermont.org. Thank you all!
Anna Noonan: I want to thank to Gov Scott, Dr. Levine and Melanie for being here today to share in the State of Vermont’s commitment to supporting innovative approaches to substance use treatment and recovery.
Addressing substance use is a public health priority in central Vermont, across this state and the throughout the nation. The pandemic created additional challenges for people with substance use disorders. Improving treatment remains a population health priority for CVMC and the UVMH Network as a whole.
It is incumbent upon us as health care providers to create the conditions for success in helping people recover from alcohol and drug addiction.
At CVMC, we understand that the entire community needs to be engaged and committed to bring the expertise and resources together to support individuals in their treatment and recovery. CVMC is proud to have helped found the Central Vermont Prevention Coalition, a group of over 25 organizations in our region, all dedicated to developing innovative, collaborative approaches to treatment and support to those with substance use.
We are fortunate to have so many dedicated partners in the Central Vermont Prevention Coalition. including organizations like the Turning Point Center, Washington County Mental Health, Vermont CARES, Treatment Associates, the community justice centers in Barre and Montpelier, among many others.
I am grateful for their deep commitment and dedication to this partnership.
At its core, alcohol and substance abuse touches each and every one of us. It erodes not only the health of the individual, but of our community as a whole. And there is no silver bullet. The work we and our partners do each and every day is not only for the right now, but for the next generation.
I want to acknowledge Dr. Javad Mashkuri, Dr. Mark Depman and Dr. Ben Smith who have been integral to driving innovative treatment practices within the Emergency Department setting. I am fortunate to now have the privilege of welcoming Dr. Mashkuri to the podium.
Dr. Javad Mashkuri: Click here to view Dr. Mashkuri’s remarks (beginning at the 24:20 mark).
8.18.2022. Montpelier www.vermont.gov