A heroin epidemic in Vermont has shown its face frequently at Rutland Regional Medical Center. Addicts were traveling hours to visit the rural hospital. One in particular was a young girl and her father, who pleaded for her to be admitted after being told that a spot wasn't available for weeks.
"She'll be dead by then! Don't you get it? She'll be dead," the distraught father cried, according to Rutland President and CEO Thomas Huebner, who adds, "There's that level of desperation out there in the community."
The situation has grown so pressing that the governor dedicated his most recent state-of-the-state speech to the opioid crisis. Opiate treatment in the state has grown by more than 771 percent since 2000, and the number of people receiving heroin treatment has more than doubled during the same time span. Rutland leaders had been pushing the issue for a decade, but it wasn't until they gained community support that ears opened.
Akikur Mohammad, M.D. — an addiction expert, psychiatrist, treatment center CEO and associate professor at the University of Southern California's Keck School of Medicine — says others in the health care field should take notice. Misuse of opioids is becoming a widespread epidemic, punctuated by last month's death of Academy Award-winning actor Philip Seymour Hoffman. Nationally, use of heroin jumped 79 percent between 2007 and 2012, according to the federal government's National Survey on Drug Use and Health. Centers for Disease Control and Prevention data show that opioid analgesics, such as oxycodone and methadone, were involved in nearly three of every four pharmaceutical overdose deaths in 2010.
Aiming to curb illicit use of opioids, the Centers for Medicare & Medicaid Services in January proposed a rule under Medicare Part D that would impose stricter prescribing guidelines for doctors. Violators would stand to lose their eligibility as a Medicare provider.
Patients increasingly are becoming addicted to opiate painkillers and turning to cheaper and more plentiful heroin when the bottle is empty, Mohammad says.
"We should be at the forefront because addiction really is a chronic medical illness and a painful disease," Mohammad says. "If we doctors are not involved in the treatment and education of the public, then who will be?"
With a $500,000 state grant and $1.5 million in annual funding, Rutland Regional Medical Center converted an old downtown manufacturing space into an opiate treatment center that opened in November. The clinic already has seen high demand, with as many as 15 new patients a week, and the medical center is fielding calls from other Vermont hospitals' looking for advice.
One of the most important parts of the governor's speech was reframing the heroin epidemic as a public health matter, rather than a law enforcement issue, says M. Beatrice Grause, R.N., president and CEO of the Vermont Association of Hospitals and Health Systems. She believes that trying to treat drug addiction comprehensively and early on is "part and parcel" of health care reform and moving to population health.
That means training primary care physicians to recognize the signs of addiction, managing the problem before it ends up in the ED, and linking with community partners such as behavioral health and halfway houses, says Lance Longo, M.D., medical director of addiction services at Aurora Behavioral Health Services in Milwaukee, professor and a fellow at the American Society of Addiction Medicine. Staying prepared for the next drug fad that comes along is key, too, he adds.
"We'd be burying our heads in the sand as health care providers not to acknowledge that addiction is here to stay," Longo says. "I like to say this used to be the land of beer and cheese in Wisconsin, but now we're caught up in the opiate epidemic, just like everybody is, and it's not going to end with heroin. There will be new designer drugs that enter society, and both the reward and the risk in this field is that it's always going to evolve. What we create as a health care entity now will need to bend and flex to meet the needs of the people who are using whatever substance is next."