Five insiders and experts discussed the causes of opiate addiction, how well Vermont is treating it, and who is to blame for the epidemic during a panel discussion Wednesday evening in White River Junction.
The discussion was hosted by VTDigger and Dartmouth Hitchcock Medical Center, with supporting sponsorship from Blue Cross and Blue Shield of Vermont, and driven by questions that readers submitted.
Dr. Mark McGovern, a professor of psychiatry and a clinician at Dartmouth College, is a specialist in addiction medicine and part of the team that helped build out Vermont’s treatment network. A presentation he showed at Wednesday’s event can be downloaded here. (Watch a video of the entire panel discussion here.)
McGovern drew a connection between the proliferation in opiate painkillers in recent years and a dramatic increase in use of the street-common cousins of those drugs. While there’s been an effort to curb the availability of opiate painkillers, heroin is more common on the street. Sometimes it is laced with fentanyl, a potent synthetic opiate used medically in anesthesia.
“As the transition goes from things that are nicely packaged in a pill or capsule, quality controlled at places like (pharmaceutical companies), now we’re seeing packages of white powdery substances,” McGovern said. “Contents unknown.”
Overall, McGovern said, Vermont’s response to the opiate crisis has been great. The efforts to expand treatment options have resulted in a higher number of addicts being able to get help.
In January 2013, there were fewer than 1,000 Vermonters on methadone. Today the number has approximately tripled, according to figures McGovern presented.
McGovern said there are still many ways the state can improve the medication-assisted treatment system. He would like to see hospitals play a greater role.
Questions submitted by VTDigger readers guided the conversation among the five panelists. One of the most common questions from readers involved whether pharmaceutical companies, or some other parties, are to blame for the opiate addiction epidemic.
Annie Ramniceanu, who heads the statewide pretrial services program, sees some similarities between the current discussion around painkillers and the debate decades ago about the health risks of cigarettes.
Medical evidence shows the positive power of opiate prescription drugs, but evidence also shows their addictive nature, she said.
Ramniceanu said “there is a burden of responsibility that needs to be placed with the pharmaceutical companies.”
“Pharma is always an easy target,” McGovern said.
He noted that medical professionals are trained to routinely check in with patients about levels of pain. There’s a lot driving the market for pain medications, he said, including a desire by patients not to feel pain. When it comes to assigning responsibility, he said, “It’s complicated.”
But, for many who become dependent on opiates, the driving factor is not necessarily physical pain but an internal, emotional struggle.
Filmmaker Bess O’Brien, director of the documentary “The Hungry Heart,” observed that opiates are a crutch for many who are looking to fill a hole. She referenced one of the subjects of her film, a Northeast Kingdom doctor, who reflected that his job was not just treating addiction, but treating people’s self-esteem.
Sarah Loras is an Upper Valley native and a former addict who has been in recovery for four years. Loras said she was diagnosed as manic-depressive.
Through her recovery, she said, she needed to remind herself, “I am not a bad person trying to get good. I am a sick person trying to get well.”
Renee Davis, the substance abuse and criminal justice program director at the Clara Martin Center, emphasized the need to provide individualized services for each patient. What works for one recovering addict may not work for another. Developing a path to recovery requires a high level of support and routine checkups on what is working for them and what is not, she said.
There is no one-size-fits-all, cookie-cutter solution, she said.
Asked why some recovering addicts relapse, O’Brien said, “Because it’s really friggin’ hard.”
According to O’Brien, Vermont could benefit from putting into place more services to support recovering addicts in many different parts of their lives.
Other panelists agreed. Ramniceanu said the biggest gap in Vermont’s current system is a lack of stable housing options for recovering addicts. Davis also echoed the need to help people have the fundamentals — things like clothes and food — to build the foundation for recovery.
More than 200 people attended the panel discussion, an audience that included local community members, medical professionals and a handful of state officials.
Macgregor Montano said she was motivated to come to the forum by a combination of professional and personal interest. She is the mother of four boys between the ages of 15 and 21, a demographic she characterized as particularly vulnerable.
Montano is also a pharmacist at the Veterans Affairs medical center in White River Junction. From that perspective, she said, it was interesting to hear about the issues of culpability. She also raised the issue of coordination between different avenues of treatment, noting that building those connections can be frustrating.
Ultimately, though, Montano said she found the discussion, with its diversity, to be a hopeful one. She walked away “feeling like maybe there’s a solution,” she said.
Christina Joanis, a Vermont resident who teaches at a school in New Hampshire, said she has experienced the “domino effect” of opiate addiction. Young children are coming into the classroom and struggling because of the impact addiction is having on their homes.
“Kids are very aware of substance abuse because they’re seeing it in their lives,” she said.
Kendra Colburn, a Strafford resident who grew up in Tunbridge, said she has seen opiate addiction take a big toll on the community there. She came to the event as a concerned citizen, friend and family member, she said.
Colburn pointed to a question submitted by a reader whose daughter spent three weeks in a correctional facility because of a lack of vacant treatment beds. She said she didn’t think the discussion focused enough on the shortage of resources and the need for further investment.
