Addiction help offered in BMH emergency wing

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BRATTLEBORO — A collaboration between Brattleboro Memorial Hospital, Turning Point of Windham County and the Brattleboro Retreat is providing connections to help people struggling with opioid use disorder to get clean and stay clean.

A new program called Rapid Access to MAT [medication-assisted therapy] has been operational for several months in BMH's Emergency Department, giving physicians the ability to provide buprenorphine to people who are ready to get help in quitting opioids such as heroin, oxycodone and fentanyl.

"The basic idea is that people who come to the ED in urgent withdrawal can be medically assessed, introduced to the idea of starting buprenorphine treatment and, if willing and deemed safe to do so, provided with an initial dose of buprenorphine," said Kurt White, senior director of Ambulatory Services at the Brattleboro Retreat. "Buprenorphine is a medication that is usually needed every day, hence the urgent next-day referral to the Retreat's Hub program."

But it's not just about getting those struggling with addiction into medication assisted therapy. Trained coaches from Turning Point are on hand to provide guidance and build relationships that can lead to recovery.

"Peer recovery coaches have lived experiences with these issues," said Suzie Walker, executive director of Turning Point, during a press conference Wednesday at BMH.

While someone struggling with addiction may push away help at first, she said, having a peer available that understands their struggle makes it easier to start the conversation about recovery.

"Our coaches are seeing people over time," said Walker. "It can be a really slow evolution where they get to the point where they are ready for more substantial changes in their lives. Having the coaches there can help them get from one service to the next."

Rapid Access to MAT provides people in withdrawal who end up in the BMH Emergency Department with support and information from trained recovery coaches, an initial dose of buprenorphine and an urgent next-day referral to the Brattleboro Retreat's Hub program, all during a single visit to BMH.

The Retreat's Hub program is a comprehensive service that, when appropriate, uses buprenorphine, a medication used to treat opioid use disorder.

"The opioid epidemic remains one of the greatest multi-generational public health crises our nation has ever faced," said BMH's Matthew Dove, a nurse practitioner with advanced training in substance use disorders. "This is a collaborative response I think the community wants and deserves."

In 2017, Windham County witnessed 13 overdose deaths and in 2018, 21, the highest per-capita rate in Vermont for both of these years.

Recovery coaches from Turning Point are in BMH's ED 16 hours a day and on call during the overnight hours. They work with the 17 ED physicians BMH shares with Cheshire Medical Center in Keene, N.H., to identify and find support for people ready for medication assisted treatment.

"Their experience in recovery provides hope that recovery is possible and makes it easier for ED patients to share their stories," said Walker. "The ultimate goal is to facilitate access to detox, treatment, and recovery supports when patients express a willingness to do so."

While the initiation of medication assisted therapy in the ED, sometimes called "emergency induction," is at the heart of the collaborative model, the program is not meant to replace more traditional paths to treatment, which can also be quite rapid.

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"From peer support to 12-step work to school-based resources and local psychiatric care clinicians, we wholeheartedly support a trauma-informed, recovery focused community structure that meets individuals in a personalized way at their particular level of need," said Dove.

Becky Burns, BMH's director of community initiatives, said this isn't a unique model and that it has been implemented elsewhere in the state and around the country.

"We've had to tweak it because services differ in each area," she said.

Bringing together the three organizations allowed them to smooth the transition into treatment for people struggling with addiction, she said.

"We do have treatment slots for people seeking recovery," said Kurt White, the Retreat's director of ambulatory services. "We need to do a better job of finding people in their moment of greatest need, which, many times is in the ED. If we can begin treatment there, we can pass them off seamlessly from organization to organization."

Burns said the recovery coaches are crucial to this process, helping to see people through a system that can seem too complex to navigate alone.

"They can say I'll meet you there and we'll do this together," she said.

Geoff Kane, chief of addiction services and HUB medical director, pointed out that addiction is not restricted to one demographic or one segment of society.

"Stereotypes don't work anymore and that's a good thing," he said. "We need to appreciate the needs of every individual who presents for treatment and meet them where they are and help them make progress."

"It does cut across all demographics of society," said White, though those who are struggling with housing insecurity or mental health issues have a harder time dealing with addiction and recovery. "It requires a team effort."

Burns called the new program "a low-barrier approach," that gets people into treatment as quickly as possible.

Alison Kapadia, a doctor of emergency medicine at BMH, said physicians are not normally allowed to start buprenorphine treatment in emergency departments. They need to receive training and what is called an "X waiver" from the federal Drug Enforcement Administration to administer buprenorphine. Currently, she said, seven of the 17 ED physicians have received that waiver.

People can access treatment for opioid-related disorders in a variety of ways. They can go BMH's emergency department when the need is urgent. They can also reach out directly to the Brattleboro Retreat's HUB program by calling 802-258-3700. The HUB program will accept patients who do not have health insurance.

Bob Audette can be contacted at 802-254-2311, ext. 151, or


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