[Congressional Record Volume 165, Number 37 (Thursday, February 28, 2019)]
[Senate]
[Pages S1585-S1586]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                             OPIOID CRISIS

  Mr. LEAHY. Mr. President, this morning, the Senate Appropriations 
Subcommittee on Labor, Health, and Human Services and Related Agencies 
held a hearing on the opioid epidemic and how States are responding to 
the crisis. I was pleased Beth Tanzman, the executive director of 
Vermont's Blueprint for Health, agreed to be a witness at today's 
hearing to share the innovative approaches Vermont has taken to combat 
opioid use disorders. Ms. Tanzman has also served as Vermont's deputy 
commissioner for mental health and also directed adult mental health 
services for Vermont's Department of Mental Health.
  While certainly not spared from the opioid epidemic, Vermont is ahead 
of much of the country in many ways: Our State openly identified the 
problem, and our former Governor, Peter Shumlin, dedicated his entire 
State of the State address in 2014 to constructively seek ways to not 
just help addicts get clean, but to halt this scourge in its tracks. 
Public health leaders, addiction specialists, doctors, and State 
leaders came together and implemented a system to integrate substance 
abuse treatment with primary healthcare.
  Ms. Tanzman's testimony focused on the system developed through this 
collaboration, known as the Hub and Spoke Model. The plan helps support 
those in recovery with nine regional

[[Page S1586]]

hubs, offering daily medication assisted treatment for those with 
complex addictions, and spokes, where patients receive follow-up care, 
counseling, and general wellness services. This framework has allowed 
Vermont to virtually eliminate wait times for treatment, which can be 
enormous barriers for individuals needing help.
  Every State in the Nation has seen the impacts of opioid abuse. Ms. 
Tanzman's testimony was informative and offers an important perspective 
for other States struggling with treating addiction. I ask unanimous 
consent to that her testimony from the Appropriations Committee hearing 
this morning be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:
         Department of Vermont Health Access, Vermont Blueprint 
           for Health

  Testimony to the U.S. Senate Appropriations Subcommittee on Labor, 
     Health and Human Services, and Education Regarding the Opioid 
                      Epidemic--February 28, 2019


 Beth Tanzman, MSW, Executive Director, Vermont Blueprint for Health, 
                  Department of Vermont Health Access

       Chairman Blunt, Ranking Member Murray, and Senator Leahy 
     and staff thank-you for the opportunity to outline what we 
     are learning in Vermont about addressing the opioid epidemic.
       Vermont is here before you because we have successfully 
     scaled treatment availability for Opioid Use Disorder 
     statewide. Through our Hub and Spoke program we are currently 
     treating over 8,000 Vermonters (1.6% of the adult population) 
     with Medication Assisted Treatment (MAT). Vermont treats a 
     higher percentage of people with Opioid Use Disorder than any 
     other state in the nation.
       We provide Medication Assisted Treatment in primary care 
     offices (Spokes) and in specialty addictions treatment 
     programs (Hubs). Through a Health Home Medicaid plan we've 
     built a programmatic framework that links primary care 
     (Spokes) and addictions treatment programs (Hubs). Patients 
     can move between Hubs and Spokes based on their needs. 
     Clinical expertise is shared across primary care and 
     substance abuse treatment providers.
       There are strong signals that the Hub and Spoke program is 
     facilitating positive outcomes. Vermont has the lowest opioid 
     overdose death rate in New England. Vermonters receiving 
     Medication Assisted Treatment have lower rates of: 
     incarceration, hospitalizations, and emergency department use 
     than do Vermonters with Opioid Use Disorder who receive care 
     as usual. Our system of deploying teams of nurses and 
     counselors to primary care Spokes--2 FTE for every 100 
     Medicaid Members--combined with a strong back-up from Hub 
     programs has dramatically increased the number of primary 
     care providers offering Medication Assisted Treatment in 
     Vermont.
       What we're learning may be helpful to others and a few 
     conclusions stand out.
       Medication Assisted Treatment, the combination of 
     medications and counseling, is the most effective treatment 
     for opioid use disorder and as such, it should be 
     consistently available as the standard of care for this 
     condition.
       Insurance should pay for Medication Assisted Treatment. In 
     Vermont we developed a Medicaid Health Home State Plan 
     Amendment under the authority of section 2703 of the 
     Affordable Care Act to create the Hub and Spoke Program. 
     There are other approaches to using Medicaid that states can 
     employ including: 1115 B Substance Use Waivers, State Plan 
     Amendments, including MAT in managed care organization 
     contracts, and increasing reimbursement rates for targeted 
     services. Commercial payers should also participate: in 
     Vermont two of our major commercial plans are piloting 
     payments for Hub and Spoke Services.
       The health system--especially primary care--has a key role 
     in treating opioid addiction. The addictions treatment system 
     cannot do this alone; there is simply not enough treatment 
     capacity to meet the need brought on by this epidemic. The 
     participation of primary care can effect greater integration 
     of care, especially by coordinating pharmacological 
     treatments with counseling, rehabilitation, and recovery 
     supports.
       The barriers to primary care participation in MAT (not 
     enough provider time, patient complexity, difficulty 
     integrating counseling supports) can be addressed by adding 
     nursing and counseling resources to the primary care 
     prescribing teams, as we did in Vermont.
       Treatment is one element of a comprehensive response to the 
     opioid epidemic. Other elements include prevention--reducing 
     peoples' exposure to opioids in the first place, harm 
     reduction such as wide availability of the overdose reversal 
     medication Narcan to help prevent overdose deaths, and 
     recovery supports--including vocational services to help 
     people in recovery participate fully in our communities.
       Leadership focus matters. I have had the honor of serving 
     under two consecutive Governors, Democratic and Republican, 
     who have both provided leadership and resources to address 
     the opioid epidemic in Vermont.
       In closing, we have made much progress in Vermont, much of 
     it with the support of our federal partners. Yet while we 
     have some of the best access to treatment in the nation, we 
     have not solved this problem. Every week two Vermonters die 
     from a drug overdose. Tragically we've also experienced high 
     numbers of children under the age of five, who come into 
     state custody due to this crisis. We must learn how to do 
     better by our families and communities.
       Thank you.

  (At the request of Mr. Schumer, the following statement was ordered 
to be printed in the Record,)

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