VT Discretionary Funding Fiscal Year 2018

In the Governor of Vermont's 2014 State-of-the-State address, the opioid crisis was declared as Vermont's top priority. In response, Vermont has been addressing opioid use and misuse through public information, social marketing and messaging; pain management and prescribing practices; prevention and community mobilization; drug disposal options; early intervention services; overdose prevention and harm reduction programs; and increased access to treatment and recovery services. Vermont initiated the ""Hub and Spoke"" model for Medication Assisted Treatment (MAT), in 2013. This model has served as a blueprint for other rural states combating the opioid crisis. Hubs are regional opioid treatment programs responsible for the coordination of care for individuals with opioid use disorder (OUD) and are licensed to prescribe MAT and Spokes are office-based opioid treatment providers waivered to prescribe MAT. The number of Vermonters served in the Hub and Spoke system has increased 116% during its 5-year existence, and the waiting period for admission to treatment has largely been eliminated. Vermont's Prescription Drug Monitoring System (VPMS), initiated in 2009, allows pharmacists and prescribers to assess and monitor prescriptions to enhance treatment and prevent misuse. In July 2017, Vermont continued to improve prescribing practices by creating legal requirements for prescribing opioids in treating acute pain to minimize opportunities for misuse, diversion, addiction and overdose. This rule, along with prescriber education and VPMS, has resulted in a 26% reduction in dispensed opioids from 2015 to 2017. Vermont also has a robust prevention network that incorporates communities, regional partnerships, schools, and prevention consultants to provide substance use and misuse prevention strategies across the state. These strategies include the use of SAMHSA's Six Strategies for Prevention and implemented using SAMHSA's Strategic Prevention Framework. The goals of Vermont's proposed SOR grant activities are to increase access to MAT, increase workforce capacity to teat substance use disorder (SUD), increase regional capacity to implement community-specific opioid strategies and decrease opioid overdose-related deaths. The activities will focus on the following three populations to improve treatment access and engagement: 1) individuals who are in need of but not actively seeking OUD treatment, 2) individuals awaiting administration of MAT, and 3) individuals who may be at heightened risk for opioid overdose. Vermont will achieve these goals by implementing activities that support and enhance direct service and capitalize on Vermont's existing prevention, treatment, and recovery systems to address opioid misuse and serve all 623,657 Vermonters.