Front Lines of Research
As director of the Chittenden Clinic since
2004, Stacey Sigmon, Ph.D.
, has been at the
front lines of the opioid epidemic. She’s seen
the population seeking treatment shift, from
long-time, IV heroin users in their 40s or 50s,
to young people, many in their late teens or
early 20s, some of whom started using heroin
after first getting hooked on prescription
drugs from friends, or their parents’ medicine
cabinet. As the crisis worsened, the clinic
kept pace. The staff has expanded by a factor
of four since Sigmon’s arrival, and they now
treat 1,000 patients with both methadone and
buprenorphine, up from 50 when she first took
Sigmon’s work in the clinic informs her
research as an associate professor of psychiatry
at UVM: She has built a national reputation for
developing and testing innovative treatment
options. One technological solution, called
the Med-O-Wheel, shows promise. The small
computerized device dispenses buprenorphine
at set intervals, lessening the chance for
medication diversion while increasing access.
In one study published in the New England
Journal of Medicine
in 2016, use of the Med-OWheel
combined with daily monitoring calls via
an interactive voice response phone system had
positive results for patients on a waitlist. At the
12-week mark, 68 percent of subjects screened
negative for illicit opioids, compared to zero for
a control group who received no treatment.
“There’s no reason to think this wouldn’t
be effective beyond patients on a waitlist,” says
Sigmon, pointing to its potential usefulness in
areas with few providers, or for patients who
lack regular transportation.
UVM has also been at the frontlines
of testing long-lasting formulations of
buprenorphine, including an implant that
delivers the drug for up to six months. The
device, approved by the FDA two years ago, has
“huge potential for rural areas,” says Sigmon.
The goal is to get treatment to patients who
need it, in a way that’s appropriate for their needs.
In this, Vermont has set the stage for more
innovation to come.
After gathering data from patients and
providers across Vermont, Richard Rawson, Ph.D.,
says there’s no doubt the hub and spoke system is
changing lives, even as the state continues to work
on improvements like the integration of mental
health care and additional support for family.
The data tell one part of the story: Patients in
both hub-and-spoke settings reported a 96
percent decrease in opioid use, including a 92
percent drop in injection drug use. Patients’
lived experiences tell the rest of the story.
“The dynamic for many of these patients
is about their relationship with their doctor,”
says Rawson. “Everything else is nice. Even the
medicine gets rated as less important than the
relationship they have with their physician.
That’s different. We’ve never seen that before.”
Treating patients at the Community
Health Centers of Burlington, Heather
Stein, M.D., understands the value of those
relationships. Not only is she helping patients,
she is introducing medical students entering
their family medicine clerkship to this new
way of treating opioid addiction as part of
primary care. In this, she sees their leadership
potential as they go on to practice medicine
across the country.
“They have this incredible ability to be
ambassadors,” she says. “Like Dr. Brooklyn
here, they may go on to other places and
start a fire.”
Story by Erin Post
Photos by Dave Seaver