ST. ALBANS – The successes and struggles with addressing Vermont’s opiate crisis were the topic du jour at the relatively young St. Albans BAART clinic Tuesday morning when Governor Phil Scott, accompanied by his Human Services Secretary Al Gobeille and Commissioner of Health Dr. Mark Levine, met with BAART officials.

The meeting was a part of a larger “Capitol for A Day” event that saw Scott and his cabinet members disperse around Franklin County to meet with local officials, partners – like BAART, which builds a sizable piece of Vermont’s “hub and spoke” model for addressing the opiate crisis – and businesses.

Joining Scott and company were BAART Treatment Center Director Shannon Rodgers and BAART Regional Director of Operations Jason Goguen, who spoke with the governor about how BAART clinics statewide, and in particular St. Albans, had impacted the state’s opiate crisis.

Goguen reported that, as of yesterday morning, 361 patients were registered with the St. Albans BAART clinic, with over 500 intakes to the clinic. Many of those, added Rodgers, were already transitioned out to “spokes.”

In the “hub and spoke” model employed by the state of Vermont, a set of centralized “hubs” are dispersed around the state. At the hubs, patients struggling with addiction receive more intense care often needed at the start of rehabilitation and sometimes throughout, depending on the personal needs of the patient.

The “spokes,” meanwhile, are smaller healthcare providers spread out around the hub where patients seeking a less complicated and intense treatment are able to receive help at a more local level.

“We’ve brought in 500 and transitioned many back out to community providers,” Goguen said. “The ‘hub and spoke’ model is a wonderful model if you have spokes.”

Reports weren’t quite as optimistic elsewhere in the state, Goguen added, explaining that the model was harder to manage elsewhere in the state, such as Newport, where, according to Goguen, there weren’t as many community providers to serve as the region’s spokes.

“We see about 270 of them every day, and that’s actually a little bit less on the weekend,” Goguen said. “If we have patients that do well, we let them earn take home medication so they don’t have to come in on certain days” depending on the particular drug treatment.

Goguen added that the opening of a BAART hub in St. Albans managed to clear up some of the traffic at other hubs in Chittenden and Newport, where Franklin County patients were usually transported for treatment. The end result, in the case of the clinic in Chittenden County, was 93 patients transferred to St. Albans’s clinic and the whittling down of Chittenden’s larger waitlist.

Goguen and Rodgers explained that there were still some “growing pains” with the expansion of a formal hub to St. Albans. A shortage of counselors had reportedly troubled the early months of the St. Albans clinic that, according to Goguen, had improved at least in Franklin County.

“We’re fully staffed, I believe?” Goguen asked Rodgers, who confirmed with a nod.

As far as the number of those seeking treatment, Goguen reported that the numbers seen by the St. Albans clinic had plateaued.

“I wouldn’t say it’s slowed down,” Goguen said. “It’s been consistent – we’ve been bringing about five to eight patients in every week.”

Compared to other states, Goguen reported that Vermont was doing a lot better as far as addressing the opiate crisis was concerned, leading at least a few states to look at Vermont’s “hub and spoke” system as a model to address their own opiate crises.

Levine reported that a Louisiana delegation was in state just a day before the meeting at BAART to observe Vermont’s opiate programs, and that California had adopted the “hub and spoke” model as well.

“It’s been taxing, for sure,” Goguen said, reporting that their model required BAART clinics to treat patients with a sense of immediacy that, if neglected, could lose a patient. “The sad part of this population is that they call or they walk through our door, and if we don’t capture them within 48 or 72 hours, they’re gone.”

Scott asked about BAART’s take-home program for treatment, which Rodgers answered by explaining that patients needed to receive treatment for a certain period of time and had to be engaged in counseling before qualifying for take home treatments. Patients also had to demonstrate stability and social activity.

“Typically… it’s after they’ve been in treatment for two years,” Rodgers explained, adding that they monitored take home treatments via the clinic’s callback system. “It’s a real responsibility to have this medication in your possession.”

Scott asked about whether or not there was a certain time of day people would come into the clinic seeking treatment. Rodgers answered by stating that there tended to be routine as to when an individual would come in, but that that could be different for any particular patient.

She did say, however, that there was a workers’ window early in the morning – where patients would be able to come in for treatment ahead of their workday – that would frequently see higher traffic. The last half-hour ahead of the clinic’s closing time also frequently saw more people come in.

“It’s kind of flatlining across the state”

“Is there any light at the end of the tunnel?” Scott asked both the BAART officials and his own health commissioner. Levine would later call it the “toughest question.”

Elsewhere around the state, Goguen reported that things seemed to at least be leveling out. He reported that the intake at the clinic in Berlin, Scott’s hometown, had evened out while Newport, however, was still gradually increasing.

Statewide, however, the trend was consistent, with Goguen summarizing “it’s kind of flatlining across the state.”

He also reported that it was difficult to find nurses – a problem afflicting healthcare providers nationwide – and counselors, especially in the Northeast Kingdom, something he attributed less to competitive pay and more to the general workforce shortage afflicting parts of Vermont.


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