Convincing Vt. doctors to treat opiate addicts - WCAX.COM Local Vermont News, Weather and Sports-

Convincing Vt. doctors to treat opiate addicts

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Step into Dr. Patti Fisher's office and her passion is obvious. The faces of children from Haiti surround her, a reminder of who is waiting on her next medical mission trip.

"It's really amazing to see," said Fisher, the medical director for case management & medical staff office at the UVM Medical Center.

On this day, what amazes her is not the children in the photos, but rather another group of people she is helping right now.

"They are taking care of their kids. They are working. They are leading boring lives as they describe it, which is awesome to see them become productive members of society again," Fisher said.

Reporter Julie Kelley: When you heard that Dr. Fisher would treat you?

Dan Brugger/Recovering Opiate Addict: I cried. I was ecstatic, I was so happy. I knew at that point things were going to get better.

Brugger tears up thinking about that day in August of last year. Brugger was in the hospital for an infection, but after nine times in rehab for opiate abuse, he was desperate for help. He says getting aftercare once you leave rehab in Vermont is nearly impossible. He says he was on a waiting list at one point for two years for a methadone clinic. And he says he called dozens of primary doctors, but could not find any who would treat him with an opiate replacement like Suboxone.

"I was begging them to get Suboxone so I would never go back to that situation again. My doctor couldn't prescribe it at the time. I'd been waiting and waiting, and then Patti Fisher saved my life with the option to get Suboxone," Brugger said.

Fisher has been seeing about 45 patients, including Brugger, at a temporary clinic set up by the UVM Medical Center in November. At the time, she was one of the few doctors who had the DEA waiver to prescribe Suboxone.

"The governor came to the hospital and said, you guys need to do more," Fisher said.

Fisher calls her temporary clinic, which she holds in a psychiatrist's office at the medical center's UHC campus, a spokette. She has essentially become the middle person between the hub where addicts initially get help and the spoke where primary doctors take over treatment.

Julie Kelley: At what point did you guys say, as state leaders, we've really got to push this a little bit?

Barbara Cimaglio/Vt. Health Dept. Deputy Commissioner: I think we've talked about it all along the way, but we felt, because the scenario in Chittenden County was so serious and we weren't able to clear the waiting list, that we really had to say all hands on deck here. This is a crisis that requires everybody to step up and do more.

"I have clinics two afternoons a week over there with minimal staff, a nurse and a social worker, and we're taking care of patients and getting them teed up to go into the primary care practices hopefully in February and March," Fisher said.

Fisher says before starting to treat patients with Suboxone, the UVM Medical Center established policies for treatment, including the expectation that patients be 100 percent compliant. They developed wrap around services for providers, including a nurse case manager and a drug counselor to help with each case. And then they began recruiting doctors.

"It was a really tough decision," said Dr. Jennifer Gilwee, a primary care doctor and a division chief for general internal medicine at the UVM Medical Center.

Gilwee has 35 doctors in her division and says it took a lot of convincing to get 10 to agree to go through the training to become DEA approved to prescribe Suboxone. Each has agreed to take about five patients to start, and those are not new patients, rather ones already connected to their practice.

"These are very complex patients and that's where I would say the continuation of the support teams is critical," Gilwee said. "It is mission critical that support and funding to keep going that is the reason that we are even able to engage in conversations with physicians about even wanting to do this."

Right now, Vermont's Department of Health is budgeted to spend $17,773,328 on opiate treatment in the current budget year which goes until July 1. In calendar year 2015, the Department of Vermont Health Access paid $10,181,119 in pharmacy claims for narcotic withdrawal therapy agents, including Suboxone.

Cimaglio says the additional nurse case manager and counselor made available to primary care doctors will be paid for by Medicaid and private insurers.

Fisher says the UVM Medical Center is planning to add a doctor who can prescribe Suboxone to Day One, an established treatment clinic right down the hall from where she is now.

Julie Kelley: How confident are you that we can care for the patients that need the care?

Dr. Patti Fisher: I think we can do it. I think as more and more doctors start doing this the stigma around it will decrease.

Asked how it feels to live a normal life, Brugger says, "You have no idea and a lot of people take it for granted. I felt like I was reborn."

Fisher says the reality is most of these patients who want to stay clean are buying Suboxone on the street and spending a ton of money on it because they can't find doctors who will help them legally.

As for the number of doctors needed to prescribe Suboxone, it depends on the area. UVM is just finishing up getting 30 doctors DEA approved to prescribe Suboxone. Cimaglio with the health department says they could use 20-30 more just in Chittenden County. But in a smaller area like the Northeast Kingdom, she says two or three would have a significant impact on getting recovering addicts out of hubs-- which have waiting lists-- and on to primary care doctors.

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