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References: Seven Days (2018)."Opioid Deaths Rise in Vermont but Plummet in Chittenden County" https://www.sevendaysvt.com/OffMessage/archives/2019/02/14/opioid-deaths-rise-in-vermont-but-plummet-in-chittenden-county Burlington Free Press (2018). "Opioid Deaths down 50 percent in Chittenden County" https://www.burlingtonfreepress.com/story/news/2019/02/15/opioid-deaths-down-50-percent-chittenden-county-vermont/2882146002/ [post_title] => Opioid-Related Deaths Dropped 50 Percent in Chittenden County in 2018 [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => chittenden-county-opioid-death-decrease [to_ping] => [pinged] => [post_modified] => 2019-10-21 16:29:55 [post_modified_gmt] => 2019-10-21 20:29:55 [post_content_filtered] => [post_parent] => 0 [guid] => https://aspenti.com/?p=59397 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [1] => WP_Post Object ( [ID] => 59356 [post_author] => 13 [post_date] => 2019-02-04 16:24:40 [post_date_gmt] => 2019-02-04 21:24:40 [post_content] => In the last five years, more than 1,600 Maine residents have died from a drug overdose. Governor Janet Mills has only been on the job for a few weeks, but she is planning to execute a lot of changes to alleviate drug overdoses in the state. In her first month. Mills recently named Gordon Smith the state’s first ever Director of Opioid Response, Smith being a long time medical lobbyist. Where is Mills going to start battling the epidemic? She believes more preventative measures must be put into action, like broadening the access to naloxone. Naloxone is an overdose reversal drug that can save the life of someone overdosing on opioids, but it can be costly to taxpayers. “We're preparing an executive order in that regard. Preparing some financial orders that may well help transfer some funds and draw down some federal funds that are already there to help address that problem,” Mills said in response to the potential increase in taxpayers costs. Maine already has safe injection sites, but Mills is expanding access to those as well as getting more Main residents into substance use treatment centers. The numbers in Maine are staggering for overdose deaths, and it’s understandable why Governor Mills is taking such fast action. In 2017, Maine reported 418 drug overdose deaths and there were 180 deaths in the first 6 months of 2018. Reference. 2018 https://wgme.com/news/local/gov-mills-takes-new-approach-to-solving-opioid-crisis WGME [post_title] => What is the Governor of Maine doing to address the opioid crisis? [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => maine-opioid-crisis [to_ping] => [pinged] => [post_modified] => 2019-10-21 16:30:25 [post_modified_gmt] => 2019-10-21 20:30:25 [post_content_filtered] => [post_parent] => 0 [guid] => https://aspenti.com/?p=59356 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 59348 [post_author] => 13 [post_date] => 2019-01-17 15:33:22 [post_date_gmt] => 2019-01-17 20:33:22 [post_content] => The National Safety Council released a study stating that Americans are more likely to die from an accidental opioid overdose than a vehicle crash. “The group analyzed preventable injuries and deaths in 2017 and found the odds of dying by accidental opioid overdose to be 1 in 96 and the odds of a motor vehicle crash 1 in 103.” Each day, 130 Americans die after overdosing on opioids, according to the Centers for Disease Control and Prevention. The drug headlining many of these overdose deaths is illicit fentanyl; a powerful and dangerous synthetic opioid that has spread like wildfire in black markets for drugs. How did we get to this point? How did we arrive at a point in US history where more people are dying from an opioid overdose than a car accident? In the 1990’s pain pills were aggressively marketed by pharmaceutical companies to doctors, and marketed as being “safe”. This led doctors to prescribe pain pills more often, and in higher amounts. Eventually, many patients became addicted and the federal government brought criminal charges to companies for marketing their pain pills as being safer and less addictive then other opioids. In the last 15 years, the DEA and CDC have worked hard to create regulations surrounding pain pills and prescribing them. The CDC has reported that the national life expectancy rate is declining as the number of fatal opioid overdoses rise. Those born in 2017 are expected to live to be 78.6 years old, whereas babies born in 2016 had a 1.2 month higher life expectancy. Stats like this one make the epidemic a very real and scary crisis. However, there are many solutions that can be applied such as expanding access to addiction treatment, giving easier access to medications such as buprenorphine, that treat addiction and reduce mortality rate for patients. “Vermont saw its overdose death rate drop by around 6 percent in 2017 with the continued expansion of a hub and spoke system that integrates addiction treatment into the rest of health care. Rhode Island also saw a roughly 2 percent drop, as it implemented, among other changes, better access to opioid addiction medications in its prisons and jails. And Massachusetts saw a roughly 3 percent drop, along with a public health campaign that has emphasized more addiction treatment, including in emergency rooms, and fewer painkiller prescriptions.”

References: Beth Leipholtz (2018). Opioid Overdose Deaths Surpass Vehicle Crash Deaths For First Time. https://www.thefix.com/opioid-overdose-deaths-surpass-vehicle-crash-deaths-first-time German Lopez (2018). Americans are now more likely to die from opioid overdoses than car crashes. https://www.vox.com/science-and-health/2019/1/15/18183815/opioid-epidemic-car-crashes-national-safety-council Jessica Bursztynsky (2018) Americans more likely to die from opioid overdose today than car accident. https://www.cnbc.com/2019/01/15/americans-more-likely-to-die-from-opioid-overdose-than-car-accident.html [post_title] => Surprisingly, Americans Are More Likely to Perish from an Opioid Overdose Than This... [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => opioid-overdose-death [to_ping] => [pinged] => [post_modified] => 2019-10-21 16:30:35 [post_modified_gmt] => 2019-10-21 20:30:35 [post_content_filtered] => [post_parent] => 0 [guid] => https://aspenti.com/?p=59348 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 57835 [post_author] => 13 [post_date] => 2017-10-27 11:08:20 [post_date_gmt] => 2017-10-27 15:08:20 [post_content] => The opioid crisis has changed our communities dramatically across the country. With so many different channels for Americans’ to become addicted to opioids, it’s at the point where those who have taken an oath to do no harm, might be doing the most long-term harm with their prescribing practices. With the addition of the instant life and death consequences fentanyl attributes to the equation, the fight many healthcare entities are now facing is a completely new, complicated and ever-evolving task at hand. As healthcare companies, treatment facilities, recovery organizations, drug testing labs, and everyday communities across the nation we must now rapidly accelerate our views on how we view Substance Use Disorder. At Aspenti Health we have a dedicated social mission focused on this very cause.

“We enhance the quality of life for our patients and their communities. We acknowledge the responsibility of social stewardship and the importance of partnership and collaboration, as we promote positive change, improve well-being, and create a better world for all.”

Aspenti Health ™ Social Mission Since the launch of the Aspenti Health brand in July of this year, our drug testing lab has done everything it can to enhance the quality of life for our patients and communities we serve. With a focus on patient care, this September’s Recovery Month we hosted Patient Appreciation Day Lunches across our 10 state-wide Patient Service Centers, providing a meal for our patients who may be experiencing food insecurity. To open the eyes of the public through mainstream media this fall Aspenti sponsored a content campaign with Seven Days to shed light on the incredible efforts the VT recovery community is doing while the shadow of the opioid crisis blankets the state. Seven Days worked in close coordination with Aspenti as an incredible editorial partner in helping elevate the narrative of the committed work of Vermont’s Recovery Community partners. With the launch of our new brand we shared our story and our mission of social impact, remaining open to opportunities on how to best contribute to the reduction of stigma surrounding Substance Use Disorder, an opportunity presented itself to us in the form of a challenge. That challenge was granted by Gene Richards, Director of Aviation at the Burlington International Airport. Earlier in the summer Aspenti purchased ad space at the airport to build awareness on our new brand and share the story of our company, once a pillar of the recovery community relaunched to a continue to serve. As we worked with Gene and the airport staff on the awareness campaign, Gene learned more about Aspenti’s social mission initiatives. Gene quickly became inspired and challenged us to collaborate with community members on how to turn a wing outside of the north terminal into a message of hope and change. Without a doubt in our minds, we accepted the challenge to transform the space. We quickly got to work inviting a variety of recovery community members, behavior change experts, and city officials to a discussion group to best develop the message conscience Vermonters would hear and respond to. The discussion group soon agreed; Substance Use Disorder knows no race, lifestyle, economic status, age, or religion. The stigma surrounding Substance Use Disorder prevents many from seeking treatment as they believe they don’t fit the “junkie” or “addict” stereotype. In close collaboration with our community partners, Aspenti developed the messaging; “the only choice in addiction is how we choose to address it together.” Vermonters are special. When our neighbors are stranded by tragedy we rally around them, whether it be hurricane Irene or the everyday occurrence of helping pull a car out of a snowbank in the middle of a Vermont winter. Unfortunately, the stigma surrounding Substance Use Disorder tends to alter the way people react to someone who may be suffering from an opioid addiction.

After months of coordinated work with community partners and the Burlington International Airport, “The Change Corridor” opened on Monday October 2^nd. Proudly attending the opening were our community partners, our congressional leaders Senator Leahy and Congressman Welch and City of Burlington leaders Mayor Weinberger, Burlington Chief of Police Del Pozo, and Gene Richards.With almost no branding insight, “The Change Corridor” is a prime example of how Aspenti Health puts our community first in addressing our social mission. We focus our efforts on the welfare of our patients, collaborations with communities, and most importantly impacting measurable change. We invite everyone to take a few minutes of their day to stop at the airport, open to the public to observe the exhibit and how people react to a heartening message of choice. We invite everyone in the presence of the Change Corridor to reflect on how the messaging and reactions make us feel about our own views on Substance Use Disorder and if they align with other health issues plaguing the nation. When we choose to engage we can make real change.

[post_title] => How a Lab Ended Up at an Airport [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => brand-social-mission [to_ping] => [pinged] => [post_modified] => 2019-10-21 16:34:18 [post_modified_gmt] => 2019-10-21 20:34:18 [post_content_filtered] => [post_parent] => 0 [guid] => http://localhost/aspenti/?p=57835 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 57767 [post_author] => 4 [post_date] => 2017-10-10 13:38:49 [post_date_gmt] => 2017-10-10 17:38:49 [post_content] => The Protecting Access to Medicare Act (PAMA) would save government payors an estimated $670 million, nearly 10 percent of the $7 billion that it currently pays annually for lab tests. In draft form, the proposed reduction in the fee schedule for clinical lab tests will significantly impact labs overall and the smaller, regional toxicology labs to an even greater extent. If the proposed reimbursement reductions are adopted, they will negatively impact how Aspenti Health will be able to provide services to our patients at the height of the opioid epidemic in America.

Aspenti Health ™ is a toxicology lab in Burlington, Vermont. Serving a rural state with a population of just over 600,000. Like most of the nation, we are in the grips of the opioid crisis with people suffering from substance use disorder. The combination of many of our patients residing in hard to reach rural communities and the state's limited economic base offers a host of complexities to care for the patients we serve and their struggles to reach long-term recovery. The Surgeon’s General Report cites “The Treatment Gap” as one of major contributors to the opioid crisis today. Two of the major causes of that gap are the inability to access care and lack of screening for substance misuse. Toxicology labs like Aspenti fill that very gap. Our patient service centers serve as collection locations increasing recovery services, testing access to rural communities, and critical checkpoints in our patient’s substance use disorder treatment plan. The PAMA draft rates would deter toxicology labs from expanding to ease access for those in rural America and only increase “The Treatment Gap” that contributes to this nation's opioid crisis.

Fault in the market representation PAMA used to calculate new pricing models

We believe the data collection process was severely flawed including:

By having a narrow definition of “applicable labs” PAMA excluded most of hospital labs which left the remaining 34% of the lab market to be driven by the data of two major labs representing 80% of the volume. These major labs use their economies of scale to negotiate deeply discounted lab fee schedules in exchange for exclusive contracts with private payers. Using a weighted median vs weighted average further skews the pricing towards the two larger labs.
Smaller commercial laboratories typically have less favorable payor agreements than hospital labs. Therefore, the financial impact is felt far greater to these commercials labs as CMS reduces rates coupled with out of network denials with private commercial payers. We believe the greater financial pressure on smaller, regional labs like Aspenti Health will potentially negatively impact the 3 critical factors to improving patient care – cost, quality & access.
PAMA’s data collection efforts were flawed as the data collection guidelines were not published until after data submission had already commenced.
G code reimbursements are set to decrease by 10% in 2018, and even further in the years to come. CMS stated that data reported to them for definitive G codes reflected reimbursements that were 23-59% lower than Medicare reimbursements for the same codes. However, XIFIN, a leader in the healthcare/laboratory revenue cycle management market, has stated that according to their data, Medicare reimbursements were 15% lower than the commercial market average.

Toxicology Under-Represented

While some types of testing are generalized across the country through standard testing, there are a few forms of more niche fields of laboratory medicine. CMS through the PAMA regulations has appropriately constructed an advisory panel and a mechanism for culling specialized expertise through subcommittees. However, the extent of involvement of area experts appears to be limited to molecular pathology in the advisory panel and the creation of only two subcommittees focusing on Advanced Diagnostic Laboratory Tests and Automated Test Panels (5). The unique nature of the toxicology field, who plays a critical role in the opioid crisis and an ever-expanding incidence of substance use disorders, does not appear to have a representation. It is critical that all specialty laboratory care is represented on the advisory board.

Unique position of toxicology labs in healthcare

Clinical laboratories contribute 2.5% to health care costs but drive 70% of clinical decision-making (1). In this rapidly evolving era of value-based care and patient-centered outcomes, it is critical that the laboratory is not a derivative function. By using large volume-based laboratories' reimbursements to drive CMS fee schedules (2), a greater emphasis is placed on the transactional system rather than an integrative system of care. Clinical laboratories contribute 2.5% to health care costs but drive 70% of clinical decision-making. In the field of toxicology, most of testing remains in the hands of small toxicology laboratories who respond to regional needs (3). By potentially driving the closure of these businesses, access to an effective, inexpensive part of treatment at the time of a declared opioid emergency by the White House (4), we may be unwittingly driving increased health care costs through emergency room visits, increased risks for the consequences of intravenous drug use such as hepatitis C and HIV and an astounding number of unintended downstream consequences. This does not align with the intent of PAMA nor does this represent quality patient care.

Call to Action

We cannot stand by and let inaccurate data alter our ability to serve our patients. The immediate solution is for PAMA to delay implementation of the changes until more accurate data from all segments of the laboratory market is collected. CMS is accepting comments until October 23. Join us in submitting your comment electronically by October 23 to this CMS mailbox: CLFS_Annual_Public_Meeting@cms.hhs.gov

(1) Crawford JM, Shotorbani K, Sharma G, Crossey M, Kothari T, Lorey TS, Prichard JW, Wilkerson M and Fisher N. Improving American Healthcare Through “Clinical Lab 2.0”A Project Santa Fe Report. Acad Pathology 4: April 2017 (2) Four challenges of PAMA (from ACLA?) (3) Curran J. IBISWorld Industry Report OD5459 Toxicology Laboratories in the US, January 2017. (4) https://www.npr.org/sections/health-shots/2017/08/11/542767898/president-trump-to-declare-national-opioid-emergency (5) https://www.cms.gov/Regulations-and-Guidance/Guidance/FACA/AdvisoryPanelonClinicalDiagnosticLaboratoryTests.html

[post_title] => The Impact of PAMA on the Toxicology Lab Industry [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => impact-pama-toxicology-lab-industry [to_ping] => [pinged] => [post_modified] => 2019-10-21 16:34:46 [post_modified_gmt] => 2019-10-21 20:34:46 [post_content_filtered] => [post_parent] => 0 [guid] => http://localhost/aspenti/?p=57767 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [5] => WP_Post Object ( [ID] => 57651 [post_author] => 6 [post_date] => 2017-09-14 11:21:52 [post_date_gmt] => 2017-09-14 15:21:52 [post_content] => Language regarding people with Substance Use Disorder must be clear, accurate and based in truth and compassion. In order for us as professionals, leaders and deeply concerned individuals to raise consciousness and dispel the stigma attached to people with Substance Use Disorder, we must be as unified and unambiguous as possible. We must speak the same language, to each other and to the public.

I am reminded of an interaction with a colleague at a National Conference four years ago where I used the term “addict” during a conversation a small group of us were engaged in. Afterwards she approached me and pointed out that “we,” our profession, we're trying not to use pejorative or limiting terms any longer. She pointed out that the term “addict” limited the definition of the person to one aspect of the whole person and that “person-first-language” was more appropriate and not stigmatizing. She suggested I use the term “person with addiction” or “person with substance use disorder.” I have been mindful of the language I choose ever since that afternoon, and I must say that there is a “softly spoken advocacy” present in many of my formal and informal conversations today as a result. This feels right to me. Here are some examples of suggested changes in language from the Recovery Research Institute’s “Addiction-ary” you may be interested in:

· ABUSER

Stigma Alert A person who exhibits impaired control over engaging in substance use (or other reward-seeking behavior, such as gambling) despite suffering often severe harms caused by such activity. The word “abuser” was found in research to increase stigma, which can affect quality of care and act as a barrier to treatment-seeking in individuals suffering from addiction. Suggested Alternative Instead, many have recommended the use of “person first language"; instead of describing someone as a “drug abuser” to describe him/her as “a person with, or suffering from addiction or substance use disorder.”

· SUBSTANCE MISUSE

Stigma Alert The use of a substance for unintended or intended purposes in improper amounts or doses. Term has a stigma alert, due to the inference of judgment and blame. Suggested Alternative Instead, many recommend using the terms “substance use” or “non-medical use.”

· CO-DEPENDENCY

Stigma Alert – No Suggested Alternative Immoderate emotional or psychological reliance on a partner. Often used with regard to a partner requiring support due to an illness or disease (e.g., substance use disorder). Term has a stigma alert, as the term has not shown scientific merit. These terms surely are most often spoken without malice, but they are, unfortunately, inaccurate at best and they fail to raise consciousness. As leaders, or deeply concerned individuals, we can contribute a lot to this movement to eradicate stigma. We can do something about the tragedy of addiction every day by simply making mindful choices regarding the language we use. I cannot think of another return on an investment being as profitable as this. The link below is to the Recovery Research Institute’s Addiction-ary, a compendium of words and phrases we commonly use on a daily basis. It’s been created by The Recovery Research Institute of Massachusetts General Hospital and Harvard Medical School. It is fairly exhaustive in scope, and a great resource for both professionals in this field and other concerned individuals. I hope you find it useful. https://www.recoveryanswers.org/addiction-ary/ [post_title] => Softly Spoken Advocacy [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => softly-spoken-advocacy [to_ping] => [pinged] => [post_modified] => 2019-10-21 16:35:11 [post_modified_gmt] => 2019-10-21 20:35:11 [post_content_filtered] => [post_parent] => 0 [guid] => http://localhost/aspenti/?p=57651 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [6] => WP_Post Object ( [ID] => 57033 [post_author] => 6 [post_date] => 2017-08-15 17:06:15 [post_date_gmt] => 2017-08-15 21:06:15 [post_content] => Is There Another Drug Use Tragedy Growing in The Shadows of The Opioid Crisis? Treatment systems, law enforcement personnel, hospital emergency rooms, first-responders, and coroners are all back on their heels, struggling to contain and reverse the worst opioid epidemic our country has ever seen. It’s like turning around a giant ocean-liner: a likely continuation of the present direction before an overall reversal occurs. There is every reason to believe with confidence that we will respond effectively and definitively to this national tragedy, as we have with the public health crises caused by tobacco and AIDS. When we focus as a nation, we accomplish great things. But as we devote more and more resources to this present challenge, there is yet another disturbing trend developing -- the increasing use of methamphetamine, an extremely potent psychostimulant with its own tragic consequences. Here are some recent developments:

Seizures of methamphetamine increased from approximately 5,000 kilograms in 2002 to over 40,000 kilograms in 2015 (SAMHSA).
The estimated number of methamphetamine users grew from approximately 314,000 in 2008 to 569,000 in 2014 (National Center for Health Statistics).
Overdose fatalities rose 30% between 2014 and 2015.
Data indicates methamphetamine use is migrating from primarily rural to inner-city areas, and that people with heroin use disorder are using methamphetamine more frequently.

What is it that is causing an increase in use? It now appears that International Criminal Organizations (ICOs) in Mexico have noted an unmet demand for methamphetamine here in the USA beginning in 2006. In 2006 the Combat Methamphetamine Epidemic Act went into effect, placing very tight controls on over-the-counter sales of pharmaceutical medications containing pseudoephedrine. This chemical was a necessary ingredient used in the illicit manufacture of methamphetamine in “meth-labs.” This legislation was largely successful, and the supply of illicit methamphetamine in our country dropped precipitously, resulting in unmet user demand. Since then, Mexican ICOs have been flooding the American drug-market with near 100% pure methamphetamine at record-low prices, the very same way they saturated our communities with high-grade, low-priced heroin and of late, with the most lethal of opioids, fentanyl. [caption id="attachment_57040" align="aligncenter" width="389"]

Methamphetamine also known as crystal meth[/caption] Here are some suggestions on proactive measures we can take to prevent yet another tragic epidemic in our country: Parents/families and educators:

Educate ourselves, our clients, the general-public and our middle and high school-age students regarding the incredible addiction potential of methamphetamine.
Talk to our children heart-to-heart regarding the dangers of this and other drugs. Always remain available to talk.
Support local, state, and national political leaders who demonstrate their commitment to addressing drug use in America.
Report suspicious local activity to proper officials.

For health practitioners:

Interview at-risk patients regarding possible use of this drug: people with a history of drug-use, especially psychostimulants or opioids, and those with depression, PTSD or ADHD.

Conclusion Together we can keep our eyes open for early warning signs in our community, our schools, our families and our medical practices. The opioid crisis crept up on us and exploded like the proverbial “mushroom cloud.” We can prevent future drug-use related epidemics. Let’s talk to each other, share information and act quickly and definitively as individuals and as a culture at the first sign of another drug-related public health threat in our communities. Suggested Reading https://www.unodc.org/doc/wdr2016/WORLD_DRUG_REPORT_2016_web.pdf https://www.nbcnews.com/news/us-news/twin-plagues-meth-rises-shadow-opioids-n776871 https://www.msn.com/en-us/news/us/its-everywhere-again-meth-surges-in-us/ar-BBDzpPG?OCID=ansmsnnews11 https://www.drugfreeworld.org/home.html [post_title] => Is There Another Drug Use Tragedy Growing in The Shadows of The Opioid Crisis? [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => is-there-another-tragedy-growing [to_ping] => [pinged] => [post_modified] => 2019-10-21 16:35:25 [post_modified_gmt] => 2019-10-21 20:35:25 [post_content_filtered] => [post_parent] => 0 [guid] => http://localhost/aspenti/?p=57033 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 7 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 59397 [post_author] => 13 [post_date] => 2019-02-21 11:54:12 [post_date_gmt] => 2019-02-21 16:54:12 [post_content] => Deaths related to opioid overdoses dropped from 35 (in Chittenden County) in 2017, to 17 deaths in 2018. That's a steady decline for Vermont's most populated county and the lowest level they have seen in six years. However, the rates across the rest of the counties in Vermont increased by 36 percent, totaling to 110 deaths this past year, which is up from 108 in 2017. That total is actually a new record for the state of Vermont. The mayor of Burlington, Miro Weinberger, claims the decrease is due to the area's support of MAT, medication-assisted treatment, and joint efforts between Chittenden County Opioid Alliance, hospitals, and local law enforcement. For example, Burlington police have made a promise to not arrest those with buprenorphine found on them, a medication that is used to reduce symptoms of opioid withdrawal. Vermont uses a "hub and spoke" system for the MAT treatment, there are intensive treatment facilities acting as "hubs" and regional, local treatment that is continuous, "spokes". Fentanyl-related deaths increased and the dangerous synthetic opioid was involved in 75 percent of the opioid related deaths last year. That number was triple the amount from 2015 and heroin was involved in 55 percent of the fatalities, often mixed with fentanyl. A majority of these deaths were accidental, and the remaining were not conclusive.