Burlington, VT – On Thursday evening, Mayor Miro Weinberger received the 2019 Circle of Stars award at the Turning Point Center’s 10th annual Circle of Stars benefit dinner. In accepting the award, Mayor Weinberger called for a next chapter in the fight against the opioid epidemic – one focused on retaining people in medication-assisted treatment and supporting “sustained recovery.”
“I want to explicitly make the case to all of you in the room tonight that this is no time to let up and move on to other demands,” said Mayor Weinberger in his remarks. “We have much more work to do together to fully free Chittenden County from the grip of the opioid crisis. It is time for us to start a new chapter of our collective work together – a chapter that is focused on supporting “sustained recovery.”
In recent years, Vermont and Chittenden County have worked to make it easier for Vermonters suffering from opioid use disorder to begin receiving treatment with anti-addiction medicines, Mayor Weinberger explained in his remarks. “We have done this because it is very clear that this medication-assisted treatment, or MAT, is the evidence-based, gold standard of care,” he said. This approach has worked, and become a national model. Yet, at the same time, the numbers suggest a troubling trend: “Many patients are staying in treatment for only a matter of weeks, or months, not the years that many need to be… despite [what the science shows], the system we have built is not focused on long-term retention.
“I am convinced that to beat this epidemic, to bring these tragic, avoidable deaths to an end, we must do better at treatment retention,” said Mayor Weinberger.
“We need all programs that work with opioid use disorder patients to systematically audit their practices for barriers to treatment and retention. We must all ask ourselves the questions: In what ways are we and our programs relentless about keeping people in treatment? In what ways can we be more so?”
The other specific reforms that the Mayor called for included:
· Measuring and monitoring retention and sustained recovery throughout the node-hub-spoke system;
· Expanding the sober house system and ensuring that the system accepts individuals on MAT, and prioritizes their retention;
· Remembering, in every discussion about prevention, that treatment is the best form of prevention, and that evidence shows that when people stop using illicit opioids, they also stop being vectors for a disease that spreads in social settings and through addiction-motivated drug sales;
· Continuing to innovate in search of strategies and technologies that support sustained recovery. For example, Vermont should become part of the effort to explore the promise of depot injections – sub-dermal injections of buprenorphine that are absorbed by the body over 30 days or more – that dramatically reduce the effort required by patients to stay on MAT; and
· Ensuring that funding goes to the right programs, as millions of dollars of new funding begins to flow from the federal government, and millions more will come to Vermont in the years ahead as the pharmaceutical industry is held to account for its role driving this crisis. When it arrives, this money must go to service providers who are doing the costly, labor-intensive work of supporting sustained, medication-assisted treatment.
Mayor Weinberger ended his remarks with a story about one of his proudest moments in office, and then, a final call to action: “We are on the cusp of breaking the back of this epidemic,” he said. “Together, let’s finish the job.”
Please see the Mayor’s complete remarks below.
Thank you Grace for that introduction, and moreover for the incredible work you do every day at Howard Center Safe Recovery. I will talk about that work and your program more later, but want to express here at the outset my great respect and appreciation for the commitment and wisdom you bring to this work.
Thank you to T.J. for emceeing tonight, and for the early push that helped show me how the Office of the Mayor could be part of the response to the opioid epidemic.
For the past four years, that work has been done in partnership with Burlington Police Chief Brandon del Pozo, and Jackie Corbally, who is our Drug, Mental Health, Homelessness Policy & Operations Manager – a position we specifically created and funded in 2016 to respond to the opioid crisis. Brandon and Jackie are here tonight, both have been remarkably committed to this work, and they deserve recognition for the City’s efforts tonight as much as I do.
Finally, I want to thank my parents, Ethel and Michael for traveling up through the snow today to be here, and my wonderful partner in life, Stacy. It would not be possible for me to do the work that we are talking about tonight without Stacy’s partnership and support.
I am honored to receive this award. I remember well when I was on the board of the Turning Point Center back in 2010 when we started this dinner. Back then – even though TPC was serving thousands of Chittenden County residents struggling with addictions – at our board meetings we grappled with projections showing us running out of money in just a few months. We launched the dinner a little bit out of desperation as a way to try to inject some funds into this important organization. To be the honoree at the 10th annual dinner, which now sells out and tonight has raised a record total $65,000 – double the previous high – is amazing. Thank you in particular to Mike Kanarick, who served as my representative on the planning committee for this dinner and did incredible work to fundraise for this organization that I believe so deeply in. What’s more, the Turning Point Center is now an organization that has established recovery coaching as an essential service, this past summer bought its own downtown building, and is serving more people better than ever. On many levels, all of this has been heartwarming to see Congratulations Gary, the board, and all of TPC’s members and volunteers on a decade of tremendous success!
I am also thankful to be able to share some thoughts with you now, at a critical time in the battle against the opioid epidemic. We are gathered at a hopeful moment. It appears that, after years of hard work in the face of a growing public health crisis, we have turned a corner in Chittenden County. In 2018, we saw a 50 percent reduction in opioid-related accidental overdose deaths. Now, in 2019, we appear to have cemented this progress and are on track for a second year of reduced deaths at approximately the same level. Statewide, the preliminary data suggest that we are on track for 2019 to be a year of lower deaths as well.
There is no doubt that these gains have been driven through proactive, coordinated efforts between many of the organizations here in the room – state agencies, local officials, hospitals, treatment providers, prosecutors, police officers, and housing providers, among others. Thanks to this collaborative work, we have been able to dramatically reduce overprescribing of opioid analgesics, deploy naloxone ubiquitously, eliminate the waiting list for medication-assisted treatment at the County level, rapidly grow the number of primary care physicians treating opioid addiction using medication, and reduce stigma by stopping arrests and prosecution for non-prescribed buprenorphine, and more.
This is not what the picture looks like elsewhere in the country. As has been noted by the New York Times and many others, what we are doing is working. And yet, with this progress, I sense pressure and temptation to move our focus elsewhere, perhaps toward prevention efforts, or perhaps even to other issues entirely.
I want to explicitly make the case to all of you in the room tonight that this is no time to let up and move on to other demands. We have much more work to do together to fully free Chittenden County from the grip of the opioid crisis. It is time for us to start a new chapter of our collective work together – a chapter that is focused on supporting “sustained recovery.”
Let me explain what I mean by this.
For years, much of our collective work has focused on doing everything we can to get Vermonters suffering from opioid use disorder, or OUD, to begin receiving treatment with the anti-addiction medicines buprenorphine or methadone. We have done this because it is very clear that this medication-assisted treatment, or MAT, is the evidence-based, gold standard of care. An individual’s risk of dying from opioid overdose drops to almost zero when that individual is receiving MAT.
Inspired by the life-saving potential of these medicines, over the last seven years, Vermont has built a statewide clinical infrastructure of hubs – large clinics focused solely on treating OUD patients – and spokes – generally primary care settings – where people can receive treatment. This “hub and spoke” model is being widely emulated by other states.
Here in Chittenden County, around the table at CommunityStat – the monthly data-driven, rapid-action meeting of 50-75 stakeholders that I have hosted and chaired every month for the last three years – we concluded that the hub and spoke system alone was not enough, and that we were missing key opportunities to get more of our friends, colleagues, and neighbors into treatment. For the last two years much of our focus has been on supplementing this state architecture by standing up new, low-barrier “nodes” into treatment in other settings where, because of the nature of the disease, people suffering from OUD are often found. Today, because of the work of many partners, the University of Vermont Medical Center emergency room, the needle exchange at Howard Center Safe Recovery, the Burlington Police Department, and every prison in the state are now effectively functioning as new nodes into treatment.
I want to pause here to highlight the role that the Turning Point Center is playing in making some of these nodes successful. A key element of the Emergency Room node at UVMMC is that the Turning Point Center has embedded trained recovery coaches in this program, who are on-site or on-call 24 hours a day. The work that the Turning Point Center has done over the last decade to professionalize and expand peer counseling is fundamentally changing the experience of all substance addiction recovery.
This focus on inducement has worked. Thanks to this effort, there are now more than 2,100 people in treatment in Chittenden County, and 262 have been inducted over the last year through the ER and Safe Recovery nodes alone. There is every reason to believe that this focus on MAT induction is what drove down accidental opioid overdose deaths more here than perhaps anywhere else in the country in 2018.
However, at the CommunityStat table each month we continue to hear stories of unthinkable tragedy. The loss of a heavy construction machinery operator who left behind two young kids. The young mom who had been in recovery for over a year, relapsed one night, and died of an accidental overdose. The death of an insurance agent who loved the Red Sox and his children and was not known to law enforcement before his death.
When we look together at the numbers we see a troubling trend. Even as we have been getting better about inducing more and more people into treatment, the growth of the number of people in treatment is slowing dramatically – even though all available evidence suggests that even now, only perhaps one-third of the Chittenden County residents who need MAT are getting it.
This is troubling. The slowed growth rate is almost certainly a function of the reality that many, perhaps most, patients are staying in treatment for only a matter of weeks, or months, not the years that many need to be.
This is a serious problem. As we have learned at CommunityStat, not only are patients who stop treatment too soon at high-risk of accidental overdose, they face many other elevated risks. The chance of an OUD patient dying of any cause is 75 percent lower when they are receiving medication-assisted treatment.
Yet, despite this science, the system we have built is not focused on long-term retention. Few programs seem to be measuring and monitoring long-term retention, and despite the millions of dollars flowing to Vermont to study our challenges, little research is focused on why patients are dropping out of treatment prematurely.
The providers who work with patients, however, know all too well the reasons that people battling addictions drop out. Many patients face transportation barriers getting to their clinical appointments, or simply find the rigors of frequent (in many cases, daily) doctor’s trips incompatible with job and parenting responsibilities. Some patients listen to misguided advice from peers and loved ones that they are not really clean until they are off of any kind of medication. And too many patients are kicked out of treatment or sober homes because of overly rigid program policies that are incompatible with the reality that successful recovery from opioid addiction very often includes episodes of relapse and recommitment.
I am convinced that to beat this epidemic, to bring these tragic, avoidable deaths to an end, we must do better at treatment retention. We must take the powerful infrastructure of nodes, hubs, and spokes that we have built to induce treatment, and widen the aperture of its focus to include retaining patients in treatment to foster sustained, long-term recovery.
And I am convinced that success with this expanded focus is possible. For indisputable proof, we need only look at the remarkable success that Howard Center’s Safe Recovery Program, under Grace’s leadership, has had over the last year since becoming a node.
For many years, individuals who use the needle exchange have been asked whether they want to go into treatment every time they come in. About a year ago, Howard Center Safe Recovery began offering immediate, on-site access to medication.
Here I want to pause for a moment to recognize the doctor who, when almost no other doctor was willing to act, made this possible by putting her medical license on the line to get this innovative program off the ground. Dr. Kimberly Blake is here with us tonight. Dr. Blake’s story is one of the things that keeps me going in this work. Dr. Blake lost her beautiful son Sean to an accidental overdose in 2017 after he was taken off MAT too quickly. Instead of succumbing to the unfounded stigma that has silenced so many that have lost loved ones, Dr. Blake and her husband Tim immediately began to speak about Sean’s addiction at CommunityStat and in public. And then she committed her career to trying to save other families from the pain she has endured by joining the Howard Center Safe Recovery team. Dr. Blake – we are so thankful for your strength and your service.
Since the pilot began, 144 individuals have begun buprenorphine treatment through this new node. The population that comes to Safe Recovery to exchange needles is, in many ways, the most complicated to treat. By definition these individuals have addictions that have progressed to the most extreme delivery method, intravenous injection, and the great majority of these patients had previously been kicked out of or resisted treatment in clinical settings.
At Howard Center Safe Recovery, however, something very different happens for these patients. As of today, 138 of these individuals – 96 percent – are still in treatment, either at Safe Recovery or through being transferred to another hub or spoke.
Ninety-six percent. How is this possible? Howard Center Safe Recovery deploys many tactics to make this happen, but fundamentally the success comes down to two principles: Safe Recovery is relentless – truly relentless – about sticking with the people they serve, and Safe Recovery believes, as Grace puts it, that “Everyone has the potential to do very well – you just need to meet them where they are.”
We owe it to the people suffering from OUD and their loved ones to be relentless. We must never let ourselves forget that their suffering is function of the failures of our institutions to anticipate and stop this manmade public health epidemic.
But it is not just that – we should recommit ourselves to this work because this is a battle we can win, and in doing so heal some of the worst wounds in our society. Medication-assisted treatment works, allowing even individuals who appear to have the most destructive addictions to return to being parents, neighbors, partners, and responsible members of their communities.
We know that stunning success is possible. France, for instance, brought their heroin epidemic of the 1980s and 1990s to an end, reducing overdose deaths by 79 percent over four years, when they went all-in on medication-assisted treatment. To that end, here is what I think an expanded focus on sustained recovery looks like:
We need all programs that work with OUD patients to systematically audit their systems and practices for barriers to treatment and retention. We must all ask ourselves the questions that Howard Center Safe Recovery asks: In what ways are we and our programs relentless about keeping people in treatment? In what ways can we be more so?
We need to start measuring and monitoring retention and sustained recovery throughout the node-hub-spoke system.
We need to expand the sober house system and ensure that the system accepts individuals on MAT, and prioritizes their retention.
In every discussion about prevention, we must remember that treatment is the best form of prevention. The evidence supports this – when people stop using illicit opioids they stop being vectors for a disease that spreads in social settings and through addiction-motivated drug sales.
We must continue to innovate in search of strategies, and technologies that support sustained recovery. For example, Vermont should become part of the effort to explore the promise of depot injections – sub-dermal injections of buprenorphine that are absorbed by the body over 30 days or more – that dramatically reduce the effort required by OUD patients to stay on MAT.
And we must ensure that funding goes to the right programs. Millions of dollars of new funding has begun to flow from the federal government, and – with our great Attorney General on the case – millions more will come to Vermont in the years ahead as the pharmaceutical industry is held to account for their role driving this crisis. When it arrives, this money must go to service providers who are doing the costly, labor-intensive work of supporting sustained, medication-assisted treatment.
I will close with a short story. I often get asked what my proudest moment in this job has been. It happened a few months ago when I was out for breakfast downtown. The waiter that morning was new to me, a young man, in his twenties, tall, hearty, warm, and attentive. When he poured the coffee I sensed that he wanted to say something, but he held back until the end of meal. Then, he came back to the table, and told me that he was from the west coast, and had come to Burlington for the first time as part of a long cross-country road trip. He never planned to stay, but when he got here he was able to get help for his long-standing opioid addiction, and he had now been in treatment for many months. He had thought about moving back west to be with his mom, but when he looked into it, he realized that her region has none of the supports that we have built here in Vermont. He had been following the work of CommunityStat and decided that there was no place better in America for him to be. “Thank you,” he said, “thank you for keeping me safe.”
Everyone here tonight, everyone who has contributed time, effort, or financial resources to this tremendous battle should be proud of what we have built. We are on the cusp of breaking the back of this epidemic – together, let’s finish the job.