Pubdate: Sun, 03 Aug 2014
Source: Burlington Free Press (VT)
Copyright: 2014 Burlington Free Press
Author: Tim Johnson


This fall, a routine visit to the University of Vermont's student 
health center - say, for a sprained ankle - will expose the patient 
to an entirely new routine.

The ankle will be examined, of course, but the student will also be 
offered an opportunity to disclose how much he or she has been 
drinking, or smoking weed, or using other drugs, including heroin.

Any such disclosure will be voluntary - and confidential, with no 
legal or disciplinary ramifications. It might have nothing to do with 
the ankle sprain. But it might lead to further conversations or 
interventions that will affect the student's well-being long after 
the ankle has healed.

Screening every patient for alcohol and substance abuse is an unusual 
step for a university health system, but it's something that Jon 
Porter, director of the Center for Health & Wellbeing, is firmly 
behind. Focusing only on the ankle, he said, "is not being very 
pertinent to issues that really threaten success here on campus, and 
health on campus, which is alcohol and substances."

The brief, self-reported survey that will begin the patient's visit 
represents "a major shift in paradigm" for the clinician, Porter said.

"This is putting a preventive effort right up front in every visit," 
he said. His hope is that this effort will engage a small subset of 
student substance abusers - opiate addicts - who typically don't 
respond to traditional forms of educational outreach.

The prevalence of opioid use at UVM mirrors the national rate on 
college campuses according to surveys - about 1 percent, Porter said. 
At UVM, that amounts to roughly 100 students. Most use 
pharmaceuticals such as Oxycontine, Porter said, but some have 
shifted to heroin, a cheaper alternative. Many began developing the 
dependency before coming to UVM, he said, often in middle school.

While alcohol and marijuana remain the predominant substances 
colleges struggle with, opiates have made inroads, too - apparently 
part of the "rising tide of drug addiction" in Vermont that Gov. 
Peter Shumlin spoke of in his State of the State address in January.

"What started as an Oxycontin and prescription drug addiction problem 
in Vermont has now grown into a full-blown heroin crisis," Shumlin 
said. "We have seen an over 250 percent increase in people receiving 
heroin treatment here in Vermont since 2000, with the greatest 
percentage increase, nearly 40 percent, in just the past year."

Heroin and synthetic pharmaceuticals in the opioid family, such as 
oxycodone (of which OxyContin is a brand), are chemically related and 
produce the same physiological effects and the same forms of addiction.

Overall use has shifted away from pharmaceuticals to heroin in recent 
years for several reasons. The state's medical establishment has 
tightened oversight of prescription drugs, and pharmaceutical 
companies have reformulated medications to make the active 
ingredients more difficult to extract. Moreover, the price of heroin 
has dropped significantly, so it is cheaper than the pills. There's 
no quality control, however, so heroin users wind up exposing 
themselves to varying degrees of purity, raising the risk of overdose.

"Last year, we had nearly double the number of deaths in Vermont from 
heroin overdose as the prior year," Shumlin said.

Burlington police responded to 37 overdose calls last year, up from 
28 the year before. Criminal citations for heroin possession totaled 
32 last year, up from 22 the year before; and 12 citations for heroin 
sale, compared to 11 the previous year.

The department's statistics don't specify the types of overdoses or 
whether any of the citations were to students.

Campus numbers

By all accounts, alcohol and marijuana use still far exceeds heroin 
on Vermont college campuses, but statistics are hard to come by.

Federally mandated public safety reports under the Clery Act, 
available on campus websites and through the U.S. Department of 
Education, report annual "drug violations," defined as arrests and 
referrals to college disciplinary systems, without a breakdown of the 
types of drugs. Marijuana is believed to be the most common, by far.

The University of Vermont, like other institutions, posts Clery 
statistics for three recent calendar years, ending in 2012. In 2012, 
drug arrests totaled 45, and drug violations referred for 
disciplinary action, 513. By comparison, liquor law arrests in that 
year totaled 4, and liquor law violations referred for discipline, 1,188.

Other Vermont colleges reported similarly small numbers of arrests 
compared to referrals. Drug violation data for other schools for 
2012: Middlebury College, 7 arrests, 50 referrals; Champlain College, 
1 arrest, 198 referrals; Johnson State College, 2 arrests, 71 
referrals; Saint Michael's College, 9 arrests, 61 referrals.

The only specific references to heroin are found in referrals to 
Vermont District Court: over the last four fiscal years, two people 
have been cited into court for heroin trafficking and four for heroin 

"We have not been impacted by heroin overdoes," said Tim Bilodeau, 
deputy chief at UVM. The primary health-and-safety concerns for UVM 
students, he said, "alcohol and some other drugs."

Dawn Ellinwood, who has served as vice president for student affairs 
at Saint Michael's College for two years, said there have been "one 
or two" heroin "incidents" in her time there.

Tim Donovan, chancellor of Vermont State Colleges, said no heroin use 
has been reported recently at any of the five schools. Same at 
Middlebury College, according to spokeswoman Sarah Ray.

Castleton State College has had two documented cases of heroin use 
and no other opioid use in the last three years, according to 
spokesman Jeff Weld.

"We do not see heroin as an issue on our campus," he wrote in an 
email, adding: "Our reported drug violations are almost exclusively 
for possession and/or use of marijuana."

Luke Lewis, a counselor and alcohol/drug educator at Champlain 
College since 2010, said he might see a handful of students each 
semester about opioid use, but seldom heroin. The low prevalence of 
heroin seems to be born out by campus surveys, which indicate less 
than 1 percent of the student population had used opiates in the last 30 days.

These surveys ask about "opiates," which technically means poppy 
derivatives (including heroin, morphine, codeine) but which might 
easily be taken to be synonymous with the the more generic "opioid," 
which includes those drugs and synthetic prescription pain killers 
such as oxycodone.

A national Core Institute survey in 2012, of 168,499 college 
students, put the "lifetime prevalence" of opiate use at 2.7 percent, 
and the 30-day prevalence at 0.8 percent.

John Brooklyn, medical director of the Chittenden Clinic, which 
comprises two methadone centers, said only a handful of college 
students have sought treatment over the last few years. He suggested 
that a student might have more difficulty sustaining an academic 
career with a heroin addiction than with some other addictions, such 
as to alcohol or cocaine.

Once a heroin addiction is well-established, Brooklyn said, the user 
isn't so much chasing a high as trying to avoid the sickness of 
withdrawal. The resulting obsession and the need for regular fixes, 
plus the sick interludes, could easily obstruct one's studies.

The new screen

Alcohol and marijuana, while the primary substances of concern to 
campus regulators, are nevertheless socially condoned, unlike heroin.

That's the observation of Amy Boyd Austin, director of UVM's 
Collegiate Recovery Community, a fellowship of mutual support for 
students of any addiction. Last semester, the group had 18 active members.

"The group of students using opiates is isolated in a lot of ways," 
Porter, the UVM health center director, said, perhaps in part because 
"using other substances or alcohol is much more favorably looked on 
in some ways."

Porter said traditional outreach, such as social messaging and 
posters, may be less effective on opiate users.

One reason, he said, is that maintaining this addiction can be a 
full-time job, on top of schoolwork. That's why the new screening 
might reach some students who might otherwise elude intervention.

"I think most people who are using opiates, when they go into a 
doctor's office, aren't asked if they're using," Porter said, adding: 
"People want to get information that will help them be successful. 
Raising the issue makes it acceptable to talk about."

The survey that UVM patients will be asked to complete takes about a 
minute-and-a-half to complete. It's called SBIRT (Screening, Brief 
Intervention, and Referral to Treatment), a public-health instrument 
that the federal Substance Abuse and Mental Health Services 
Administration has been promoting.

The questionnaire asks, among other things, whether the patient wears 
a bike helmet, texts while driving, smokes tobacco. It asks about the 
frequency of use of alcohol, marijuana, prescription medication and 
"other illegal drugs." Another question gauges levels of depression. 
Patients have has the option of refusing to answer or answering untruthfully.

A respondent who replies positively to one of the substance questions 
will meet with a clinician who has been trained in "motivational interviewing."

"Motivational interviewing involves being nonjudgmental with the 
patient," Porter said, "getting information about what's good about 
the behavior, what's not so good, helping the patient see, this isn't 
working for me in some ways, and then coming to some pretty clear 
goals that you use and follow up on with them."

Higher levels of intervention could accompany self-reports of riskier behavior.

Data from the surveys will be entered in a registry, so that students 
may be tracked over time to assess the effectiveness of the interventions.

Porter contrasted this approach with the past practice of simply 
treating the symptom presented.

"A common scenario on Saturday morning in the clinic: a student comes 
in with a boxer's fracture - it's a male, right? Fourth metacarpal, 
broken. Well, how did that happen? In a traditional setting or in 
many emergency rooms, the fracture gets taken care of. The issue that 
he was drunk and got angry at his partner doesn't come up."

The new system might offer the opportunity to confer with that 
student at an earlier visit, perhaps addressing the drinking by 
saying "You know, you're drinking at level that's higher than your 
peers. Here's some ways that you you may want to think about that.'"

"It's that early intervention," Porter said, "and I think that's the 
best way to reach anybody, whether it's alcohol, marijuana, opiates."

"We know from big studies that this approach works," he said. "I 
think colleges are doing it in some places, but it's by no means the 
standard approach. The reason I really love it is, it makes the work 
meaningful. It's actually trying to go after things that harm people."


Get the reports:

To get the federally mandated campus safety and security report for a 
college or a group of institutions, go to:
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MAP posted-by: Jay Bergstrom