I felt utterly stripped of safety and love. And so, what tormented - PowerPoint PPT Presentation

“ I felt utterly stripped of safety and love. And so, what tormented me most as I shook through August of 1988 wasn’t the nausea and chills but the recurring fear that I’d never have lasting comfort or joy again.” -Maia Szalavitz

Update: Low Barrier Buprenorphine at Safe Recovery

In a review of 4 randomized trials, interim treatment (daily medication & emergency counseling): ↓Illicit opioid use ↑ Retention ↓ Criminality ↑ Likelihood of entry into comprehensive treatment

Patients receiving interim buprenorphine treatment: ↑ Percent of specimens testing negative for illicit opioids ↓ Use of any intravenous drug

San Francisco will begin supplying anti-addiction medication to long-term drug users and homeless people on city streets, an attempt to overcome a formidable obstacle to treatment that has complicated efforts to address the opioid crisis. The city announced Thursday that its medical providers will offer buprenorphine and naltrexone prescriptions at needle exchanges, in parks and in other places where people with opioid disorders congregate. Users will be able to pick up the medications, which block the craving for opioids and the painful symptoms of withdrawal, at a centrally located city-run pharmacy. https://www.washingtonpost.com/national/health-science/san-francisco-will-bring-anti-addiction-medication-to-users-on-the- streets/2018/05/16/432238ee-593a-11e8-b656-a5f8c2a9295d_story.html?noredirect=on&utm_term=.528344da7e13

Board of Medical Practice

Board of Medical Practice Stats Over the 5-year period from January 2011 through December 2015: Number of Licensees: ~ 4,000 to 4,500 Average Number of Investigations: 197 Average Number Public Discipline Cases: <9 Percentage of Licensees Investigated in a Year ~ 5% Average Rate of Actions in Investigations ~ 1 in 22 Cases about Buprenorphine 2011 – 2015 6 Cases about Buprenorphine since 2011 8* *Does not include one case in which a licensee originally disciplined over buprenorphine was disciplined for ongoing failures to comply with the disciplinary order from the original case, which is included in the number. Board of Medical Practice May 24, 2018

Buprenorphine Issues Subutex – prescribing for large numbers of men, based on claimed allergy without objective confirmation of allergy Failure to respond (or document) response to repeated aberrant urinalysis results – positive for opioids and/or negative for buprenorphine Failure to use informed consents, patient agreements Failure to confirm or provide counseling Prescribing for a friend who was never examined Prescribing for a patient with no known/no confirmed opioid use or dependence Failure to perform and document history & physical exam, failure to do urinalysis testing, failure to have written patient agreements, failure to do medication counts, multiple early refills, no counseling, etc. Respondent testified “I believe that this stuff should be available just like condoms.” Board of Medical Practice May 24, 2018

Contact Info Executive Director: David Herlihy – david.herlihy@vermont.gov Investigators: Paula Nenninger – paula.nenninger@vermont.gov Scott Frennier – scott.frennier@vermont.gov Office Telephone: 802-657-4220 Web page: http://healthvermont.gov/hc/med_board/bmp.aspx Board of Medical Practice May 24, 2018

Assessing the State of Chittenden’s Hub and Spoke System of Care

Individuals Enrolled, Admitted, and Waiting by Month at the Chittenden Hub 70 1040 60 1020 50 1000 987 40 980 30 960 22 20 940 16 10 920 0 900 Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr Waiting Admitted Enrolled Data Source: Howard Center Chittenden Clinic

Chittenden Spokes Patient and Provider Census All Payer MAT waivered All Payer MAT waivered Spoke Site Spoke Site Patients Providers Patients Providers Dr. M 1 1 Pain Clinic 12 1 UPEDS Burlington** 1 2 Hinesburg 16 4 Good Health 2 1 SBFM/South Burlington 19 7 EAPC/Given Essex** 2 3 BAPC/Given Burlington 19 4 Appletree Bay 3 1 Lund 22 1 Affiliates in OBGYN 3 1 COGS 28 4 Evergreen Family Health 4 1 Colchester Family Practice 29 8 Thomas Chittenden 7 1 Milton 30 6 Green Mountain 8 1 ATP 40 4 WAPC/Williston 9 2 Howard 80 1.4 SBAPC/Aesculapius 9 5 CHCB 408 12 Winooski Family Health 10 2 Total 774 74.4 Alder Brook Family Health 12 1 UVMMC traditional spokes **Two locations have fewer patients than waivered prescribers UVMMC specialty spokes Community Practices CHCB Data Source: Pam Farnham, UVMMC

Chittenden Spokes Patient and Provider Census All Payer MAT waivered Spoke Site Patients Providers 1 Lund 22 Community Practices 38 7 UVMMC Specialty Spokes 80 9 Howard 80 1.4 UVMMC Traditional Spokes 134 41 15 CHCB 420 Total 774 74.4 Data Source: Pam Farnham, UVMMC

CHCB is prescribing to 54% of patients in Chittenden Spokes, but only has 20% of waivered providers Percent of Patients Percent of waivered Providers Howard 11% 17% CHCB 20% 2% Lund 5% 1% UVMMC Specialty 55% 12% 10% Spokes Community Practices 3% 10% UVMMC Traditional 54% Spokes Data Source: Pam Farnham, UVMMC

Chittenden Spokes Patient to Provider Ratio All Payer MAT waivered Patients per Spoke Site Patients Providers Provider Howard 80 1.4 57 CHCB 420 15 28 Lund 22 1 22 UVMMC Specialty Spokes 80 9 9 Community Practices 38 7 5 UVMMC Traditional Spokes 134 41 3 Total 774 74.4 10 Data Source: Pam Farnham, UVMMC

How many patients should each provider have? All Payer MAT waivered Patients per Spoke Site Patients Providers Provider Howard 80 1.4 57 CHCB 420 15 28 Lund 22 1 22 UVMMC Specialty Spokes 80 9 9 Community Practices 38 7 5 UVMMC Traditional Spokes 134 41 3 Total 774 74.4 10 Data Source: Pam Farnham, UVMMC

Are enough providers waivered? • We do not know who many total providers there are in Chittenden County • There are approximately 225 total providers (MDs, NPs, PAs) at the existing spokes in Chittenden County • Of the 225 providers at spokes, 74 are waivered to prescribe MAT (33%) • 150 more could be waivered

Can the system support everyone who may need treatment? • The Hub is near capacity • 12 patients ready to be transferred now • 314 patients are on bupe and could be transferred soon • There are 774 patients receiving MAT at all of the Chittenden County spokes • 1300 clients seen at Safe Recovery in 2017 • 228 were linked to a Hub or Spoke • At least some of the remaining 1000 may need treatment in the future

Are spokes (black dots) accessible? The number of people on buprenorphine currently receiving treatment at the Hub (n=314)

Are spokes (black dots) accessible? The number of people on buprenorphine currently receiving treatment at the Hub (n=314)

Takeaways: • The Hub is near capacity • CHCB is serving more than 50% of Chittenden spoke patients • We may need more waivered providers or for currently waivered providers take more patients to meet demand • There are inconstancies in screening, policies, transfers, and communication between the levels of care • There is concern that the ATP is more stringent than the Hub

Next CommStat Meeting • 6/28 (Thursday) 8:30-11:00 AM • Burlington Electric Department