In the heart of New England ski country, heroin is almost as easy to find as a scoop of ice cream.
The number of Vermonters seeking treatment for heroin addiction has soared more than 770 percent since 2000. In 2013, there were twice as many deaths in the state from heroin overdoses as the year before. The governor dedicated his entire annual address this year to the “full-blown heroin crisis” in the state, with concrete proposals for amped up treatment, policing and prevention.
But part of the governor’s plan, which went into effect last summer, has caused relapses to soar as much as 100 percent.
Back to rehab
As of July 2013, the state slashed the number of days of in-patient rehab it would fund with Medicaid, from 28 days to 14, unless a patient gets prior authorization. The directors of two residential treatment centers told America Tonight that since then, the number of patients requiring readmission at their facilities has doubled.
William Young, executive director of Maple Leaf Farm, said they looked at the number of people who called them for readmission since July 1 and compared the data to the same period in 2012. They found that the calls had more than doubled.
The Health Department’s own survey covering the same period registered a 4.9-percent increase in the rate of readmissions. State officials attributed the enormous discrepancy to “methodology.”
Harry Chen, the state’s health commissioner, said he was not “intimately familiar” with the rule, but defended it.
“One of the problems with residential treatment, although everybody swears by it, the fact of the matter is you have to leave that setting,” he explained. “You go back to the setting where you had the problem in the first place.”
“If we can keep them another 60, 90 days, the percentage just goes up,” explained Richard Keane, the director of Serenity House, a rehab facility in Wallingford, Vt. Keane emphasized that “the longer we can keep them in some sort of formal treatment, the better their chances are.”
Dr. Deborah Richter is a family physician and one of Vermont’s leading addiction specialists. Asked whether two weeks was sufficient in-patient care for a recovering addict, Richter said, “Absolutely not!”
“It takes much longer in my experience,” she explained. “You need about 90 days for people to be able to reset their thermostat, so that they can have more resistance.”
The state’s new plan, called “Hub and Spoke,” calls for a significant shift from inpatient rehabilitation to “intensive outpatient” treatment. The strategy is based around opiate-based medications like methadone, buprenorphine and suboxone, which act on the same opioid receptors, without creating heroin’s intensely euphoric highs. The “hubs” refer to five dispensaries around the state, which provide recovering addicts with the powerful replacement drugs. The “spokes” refer to primary care doctors and counselors.
“As we put more capacity on outpatient treatment, whether it be intensive outpatient treatment, or a treatment at the methadone hubs or buprenorphine in the hubs, the less likely, the less we actually will need those extra days,” Chen said.
Keeping addicts out of jail
“I walked out of rehab with 34 days clean,” said Kimberly Jones, 25, who used to do a quick business as a heroin dealer. She chose not to take the replacement drugs usually recommended after rehab.
“It’s replacing one addiction with another,” she said. Now, clean for 16 months, Kimberly is advocating Vermont lawmakers to increase funding for long-term treatment.
“You know, in my first two weeks I wasn’t ready,” she said. “There needs to be a different way not to throw people in jail.”
Eighty percent of the inmates in Vermont’s prisons are there for drug crimes. Among them is Kimberly’s mother, who introduced her to heroin. While Kimberly found her way to rehab, her mother continued dealing. When federal agents asked Kimberly if her mother was still using, she said yes.
“She blamed me for that,” Kimberly said. “That’s why she went to jail, because I wouldn’t lie for her.”
Vermont Gov. Peter Shumlin pointed out the financial illogic himself in his State of the State address in January.
“And listen to the math,” he said. “A week in prison in Vermont costs $1,120, but $123 will buy a week of treatment for a heroin addict at a state-funded center.”
The governor has made a significant effort to channel addicts out of the prison system, and into treatment. Last year, Vermont became the 13th state with a so-called “Good Samaritan” law on the books, which protects people from criminal charges if they seek help for themselves or a friend in the event of an overdose. And the governor is pushing for a criminal justice model that would allow addicts arrested for drug-fueled crimes to avoid criminal prosecution, if they seek immediate treatment.
The state is also doubling its spending for the “Hub and Spoke” outpatient pill-driven plan, seeking $8 million from the government for fiscal year 2014.
The state’s 2013 fiscal year budget for its overall Drug and Alcohol Abuse Treatment program is $29 million. Last month, Shumlin approved an additional $200,000.
The governor signed that budget adjustment bill at the Howard Center in South Burlington, a facility that provides outpatient counseling and replacement drugs. It will receive some of the extra money.
On the other hand, because of the drop in stay-duration, Vermont residential centers like Maple Leaf and Valley Vista are losing money, and cutting staff. But they predict that the spike in relapses will only get higher in a state that has already seen the lasting effects of heroin addiction.
With editing by Claire Gordon