The challenge faced by people struggling with addiction has been exacerbated by lengthy waitlists for treatment. The backlog is now starting to shrink. And the positive trend is thanks in part to local doctors making a special effort to do more.
The impact in the lives of Vermonters suffering from addiction is clear.
Lorreta, for example, who asks that we not use her last name, says it took her a year and a half to get into the Chittenden clinic in South Burlington.
“I had some trauma in my life happen when I was younger that I never dealt with," she says. "And I was afraid that if I didn’t get into counseling and deal with this, I was afraid that I was going to pick up and use."
In the past six months, the number of people waiting for treatment at Vermont's hub centers has dropped by about 100. Meanwhile, the number of Vermonters in treatment has increased by several hundred.
So what has changed?
Enter Dr. Patti Fisher of the University of Vermont Medical Center in Burlington. Last fall, Fisher was asked to help address the waiting list at the state’s busiest hub for opiate addiction treatment.
The request came from Gov. Peter Shumlin after he visited the hospital and made a plea for doctors to do more.
“We were asked by the governor to do more. And they put me into my own little clinic with a nurse and a social worker. And we took 45 patients out of the Chittenden Center," Fisher explained.
Fisher already had experience with prescribing buprenorphine, also known as Suboxone. As a physician at a community health center in Burlington, she had treated patients for addiction disorders as part of routine care.
Doctors in Vermont can prescribe the drug after they complete eight hours of training and get a special license. But Fisher says not many other physicians were signing up.
“I’ve heard people say, ‘We don’t want those patients in our waiting rooms,'" she says. "My response has been: ‘They’re already in your waiting rooms. You’re just managing everything else but their addiction.’"
Fisher set about undoing some of the misconceptions doctors had – for example, that such patients can be "too time consuming or too complicated." In large part, Fisher says, patients are young and healthy, and don’t have other complex issues to deal with.
"I've heard people say, 'We don't want those patients in our waiting rooms.' My response has been, 'They're already in your waiting rooms. You're just managing everything else but their addiction.'" — Dr. Patti Fisher, UVM Medical Center
The distinction is an important one.
Fisher estimates that half of the patients currently at the Chittenden clinic are "pretty stable" and could be treated elsewhere — by physicians like her — in a primary care setting.
That would open up more slots for people needing more intensive services: People like Lorreta, who – after a long wait – got into the Chittenden clinic in South Burlington. She now receives bupenorphine and has been working through other issues in her life.
“I’m now working with a counselor, because, you know, the trauma ... I’m trying to do mindfulness, learning how to identify triggers, different things. And I love it, it’s really helpful," she says.
The good news for Lorreta and others seeking medication-based treatment is that in just the last six months more physicians have become licensed to prescribe buprenorphine in their practices.
According to Dr. Fisher, the progress has been "amazing."
"Since last year, when the governor came to us, we have 30 providers now that have gotten their waivers to be able to prescribe," Fisher says. "They’ve all agreed to take at least five patients off the bat. So that’s 150 patients that were previously in our system ... And hopefully as people realize it’s not as onerous – it doesn’t take a lot of extra time out of their day – they’ll be agreeable to taking more patients. That would certainly be the goal.”
A small goal, perhaps, but one that can make a big difference to people in recovery – people like Lorreta. She’s been going to the Chittenden clinic for nine months now, and she’s filled with hope.
“Everybody is different, but it’s not just about taking medication," Lorreta says. "You have to have support people. You have to have a safe environment. To have support people, go to meetings. I go to AA and then NA. They help. When I go to a meeting I get to see people who are 25 years clean. And if they can do it I can do it. And I see hope. There’s hope in those rooms. And that’s all I need to see.”
