After finishing my first year at the University of Vermont College of Medicine, I had the chance to go back to my hometown of Springfield, Vermont, to help with a public health problem that has had a devastating effect on many of the families I grew up with: Opioid addiction. Through a summer research project with the Southern Vermont Area Health Education Center (SVAHEC), I spent a couple of weeks talking to patients seeking treatment, exploring what about the current treatment model is working and what additional resources could be useful.
Like so many other towns across Vermont, Springfield has been hit hard by the current opioid addiction crisis. Well-paying jobs are hard to come by: Historically, Springfield was a leader in the machine-tool industry, but when most of the companies went under in the 1980s, the town’s economy went too. A constant stream of drugs coming in from Springfield, Mass., and New Jersey are sold at an increased profit in Vermont and New Hampshire. To combat this, in January of 2013 Vermont introduced the Health Home Hub and Spoke initiative as an integrated response to opioid addiction. While the problem is slowly becoming more well-understood and openly discussed, a lack of resources and the stigma associated with addiction continue to be huge hurdles.
The goal of our AHEC project was to determine what about Hub and Spoke is working, and what resources exist in the community for people who are looking for help with treatment or recovery. As we interviewed more people, patterns began to emerge: Most people did not have easy access to a vehicle; many had a household income of less than $20,000 a year, and fewer than half had regular full- or part-time employment. Many of the barriers to recovery were cited multiple times: Friends and family still using, easy access to drugs, lack of understanding/support from the general community, difficulty finding a rehab program or buprenorphine provider they qualified for, lack of support through the relapse-recovery cycle, poverty, lack of safe and/or stable housing, using drugs to self-medicate, as well as a lack of desire or motivation to get clean. It was clear that the barriers to recovery are often complex, involving multiple social and environmental factors, and are overwhelming to individuals struggling with the disease.
The lack of access to a vehicle makes getting to treatment very difficult. If daily treatment at a methadone clinic (hub) is needed, people coming from Springfield have to find a ride 40 minutes each way. This can disrupt the day enough that it is difficult to hold a job. Even those being treated with buprenorphine (which can be prescribed a week or several weeks at a time at a hub or spoke treatment center) encounter difficulties, as many buprenorphine providers are not taking on new patients. Many other providers are hesitant to become buprenorphine-certified as they have to look out for diversion of medications, since buprenorphine itself is an abusable substance. Ironically, many people affected by opioid addiction who are not able to find providers will self-medicate with buprenorphine obtained illegally, often through the same dealers they bought opioids from. This contact with the dealers puts them at increased risk for relapse. Even when providers are available, many have hardline rules regarding other drug use, and will cut off treatment after too many strikes. These “rules” exist and are important because barbiturates and alcohol have very dangerous interactions with opioids, but many providers include marijuana on the list. It is difficult for many individuals to cut out marijuana along with everything else, as it is often used to self-medicate for anxiety. This leads to people being kicked out of helpful providers’ offices where they receive not only buprenorphine, but additional counseling and support. As relapses are a well-known step in recovery from opioid addiction, many of the people we spoke to expressed a need for support through relapses, rather than a cessation of treatment.
With this project, we were able to gain a better understanding of what people go through with opioid addiction, and the complicating factors they are often up against in trying to reach a stable recovery. I am so grateful to the people that were willing to share their experiences with us. This project gave me the opportunity to explore my hometown community in a new way, and in a way that will inform my future practice. Opioid addiction is a complex problem, but I hope our work this summer helps to inform future treatment options in Vermont.
Emily Forbes-Mobus ’18 shares more about her summer experience with SVAHEC during a summer opportunities info session and panel discussion on November 20 at noon in the Sullivan Classroom. The event is hosted by the UVM College of Medicine Office of Medical Student Education.