'Significant Challenge': Treating Substance Use Disorder At A Social Distance
The Hub and Spoke drug treatment program brought international attention to how Vermont was addressing the opioid crisis. The model was built around the idea that patients would visit treatment centers every day to pick up their medicine and receive face-to-face support.
But in these days of social distancing, that model has had to change.
For the past year, Paula Dlubac has been making the daily drive from her home in Wardsboro, a small town about 30 miles outside of Brattleboro, to the Brattleboro Retreat. That's where she receives her medication that helps her battle her opioid use disorder.
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“I tell you, my sobriety means a lot to me. I’m 50 years old now, and I’ve been an addict since I was 14, and this place saved my life,” Dlubac said. “Without this program, I’d be lost. So the Retreat has been a big part of my life and a big part of my sobriety.”
But the Retreat has limited its in-person counseling due to the new coronavirus, and most patients are now taking home a few weeks’ worth of medicine so they don’t have to risk coming down to the hospital every day during the pandemic.
"I just hope this virus goes away soon, you know, so I can get back into things here, because this is the only support that I have." — Paula Dlubac, Brattleboro Retreat Hub patient
Dlubac said she can handle taking her medicine at home, but she admits it’s hard not being able to physically meet with her counselor.
“I just hope this virus goes away soon, you know, so I can get back into things here, because this is the only support that I have,” she said. “With my addiction, I put my family through an awful lot, and I don’t get much support at home. This is the only support that I have, and I miss it.”
According to the Kurt White, who runs the Retreat's Hub and Spoke program, the need for social distancing has posed a "significant challenge."
“We are literally meeting every day about it to try to figure out better and better ways of being in touch and supporting folks," he said. “We really are inventing a whole different way of working.”
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Prior to the COVID-19 pandemic, the federal government had tight restrictions on how medication was distributed at treatment centers. And for the most part, patients had to come in every day to get their doses.
The U.S. Department of Health and Human Services eased up those restrictions in March to recognize the stay-at-home orders many states were adopting as the coronavirus spread across the country. Treatment centers are now allowed to let patients go home with 14 or 28 days’ worth of medicine, depending on how stable the doctors determine their patients are.
White said more than 90% of the patients who used to come in every day are now going home with a few weeks’ worth of medicine. He added that while the Retreat stepped up its teleconferencing with patients, as well as reaching out by phone, he's worried about patients relapsing.
“I’m worried that with the significantly increased stress that everyone is under, especially if you have several other difficulties like struggling with poverty, or now all of a sudden a different kind of child care, you’re homeschooling your kids, that turning to using substances now is something that is going to be, I think, a major challenge for folks to stay away from,” White said.
"We are literally meeting every day about it to try to figure out better and better ways of being in touch and supporting folks." — Kurt White, Brattleboro Retreat
The medicine that patients receive can be sold or mis-used, so doctors have to evaluate who can take home the extra doses.
Vermont has nine Hub sites, and more than 9,000 patients are enrolled in the Hub and Spoke program. Tony Folland, the State Opioid Treatment Authority with the Department of Health, said it’s not always clear which patients can best handle the new distribution strategies.
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“We’ve historically had people coming in seven days a week, who are highly unstable, to make sure that every day ... that they were safe and that they were taking their medicine,” Folland said. “But we made those choices, and the doctors made those choices, to say, 'We have to juggle the benefits of treatment, and the risk of potentially bad things happening with their medicine,' versus the risk of disease transmission by having people come in every day.”
Folland added it’s too early to see if the change, or the stress brought on by the public health crisis, will lead to an increase in overdose deaths.
The Brattleboro Retreat is a VPR underwriter.