Vermont is embarking on an ambitious initiative to expand medication-assisted treatment (MAT) in response to the state’s prescription opioid addiction epidemic. The expansion represents the first phase of a larger plan for Vermont to develop an integrated treatment continuum for other substance abuse and co-occurring mental health disorders through a managed care approach.
MAT caseloads are expected to increase by approximately 55 percent during the next two fiscal years. And the vast majority of the expansion will be coming from health homes funding under the Federal Affordable Care Act.
“Hub/Spoke” Initiative
Initially there will be five specialty treatment center “Hubs” for opioid addiction. The Hubs will provide comprehensive assessment and treatment protocols; coordinated referral to ongoing care; methadone treatment and support services; initiation of buprenorphine treatment, and care during the initial stabilization period; coordinated care for clinically complex cases; and specialty consultation and support.
The ongoing-care system, the “Spokes,” will consist of a prescribing physician and other professionals who will monitor the patient’s adherence to treatment; coordinate access to recovery support; and provide counseling, contingency management, and case management services. Spokes will also include providers of outpatient substance abuse treatment, primary care providers, independent psychiatrists, Federally Qualified Health Centers, and other facilities and providers, such as correctional facilities and medical homes.
Shifting the Scale toward Methadone
There are currently 2,800 buprenorphine patients and 614 methadone patients receiving MAT in Vermont, and more patients are being treated with buprenorphine than was expected, said Barbara Cimaglio, deputy director for the department of alcohol and drug abuse programs with the Vermont Department of Health. “If we had better access to methadone treatment, we would see a drop in the number of people seeking buprenorphine treatment,” she told AT Forum. “We want to make sure that both medications are readily available.”
According to Bob Bick, director of mental health and substance abuse services for the Howard Center, which runs the Chittenden Center opioid treatment program (OTP) in Burlington, there are currently 100 to 150 patients on their waiting list. The Chittenden Center has 365 patients working toward a cap of 410. It’s difficult to determine how many there will be after the expansion, because some people put their names on more than one waiting list, but Mr. Bick expects to end up with 700 to 800 patients. “We’ll have to hire new people,” he told AT Forum. “We’re already stretched to the limit.” The Howard Center also has a buprenorphine clinic, with 150 patients.
Integrated Treatment Continuum for Substance Use Dependence “Hub/Spoke” Initiative—Phase 1: Opiate Dependence can be accessed at
https://atforum.com/documents/HUBSPOKEBriefingDocV122112.pdf. Accessed February 20, 2012.