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Connecticut has seen a staggering loss of life. Methadone, other meds are changing that.

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Connecticut has seen a staggering loss of life. Methadone, other meds are changing that.


By the time Belmarie Lugo stepped into the treatment clinic in January 2022, her body was malnourished.

Her connections to her family had fractured, and she estimates she had overdosed on heroin and fentanyl more than a dozen times.

Now, nearly two years later, Lugo is in recovery. She’s mended her relationships with her parents and brother, and she is finally able to contemplate her future — something that was not possible in the past when she was under the influence of illicit opioids.

Lugo, a resident of East Hartford, attributes much of her turnaround to the methadone maintenance program she enrolled in at the Root Center, which is the largest provider of medication-assisted treatment services in Connecticut.

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“I’m victorious because of this place,” Lugo said, as she sat in one of the counseling rooms at the Root Center’s Manchester office. “It’s so easy to go backwards.”

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Methadone is one of several medications that are used to help people with opioid use disorders to lessen their dependence on lethal narcotics while limiting the pain and most severe symptoms that can accompany opioid withdrawal.

The precisely measured dosages of methadone that are prescribed to patients at places like the Root Center have been proven to lessen people’s chances of relapsing and dying from an overdose.

Even more, the health professionals who administer methadone — and another commonly used treatment drug called buprenorphine — say the medications enable people to find new jobs, to regain custody of their children and to more easily recover from the mind-altering effects of opioids.

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Lugo is just one of the tens of thousands of people who benefitted from a methadone treatment program in Connecticut in recent years, but state officials want to see that number increase even more to combat the state’s ongoing epidemic.

A special advisory committee, set up to manage roughly $600 million in opioid settlement funds for Connecticut, published a report earlier this year that laid out several key strategies for curtailing opioid overdoses in the state, and it argued that increasing the accessibility and use of methadone and buprenorphine would be the most effective approach to stemming the mounting death toll.

Evidence-based

That wasn’t the first time that Connecticut officials received that advice.

A state report that was published in 2016 made the exact same recommendation, citing the mountain of medical evidence surrounding the two opioid treatment medications and the comparative success of those medications when compared to abstinence-based recovery programs.

“There is very strong evidence for treatment using medications. And I don’t say ‘very strong’ lightly,” said Dr. Joshua Sharfstein, the vice dean of the Johns Hopkins University school of public health.

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Sharfstein helped organize a coalition of more than 30 health organizations to create several basic principles that states and local governments can rely on when spending their settlement funds, which they are receiving through several lawsuits that were filed against major opioid manufacturers, distributors and retailers.

Two of those principles are that the settlement money should be used to save lives and that it should be directed toward efforts that are backed up by medical evidence.

Women with opioid use disorder face stigma in getting help, seeking treatment

Sharfstein, who also cowrote a book titled “The Opioid Epidemic: What Everyone Needs to Know,” said treatment programs that incorporate methadone and buprenorphine meet both of those principles.

The effectiveness of medication-assisted treatment, Sharfstein said, has been reviewed by the American Medical Association, the American Psychiatric Association and the National Academies of Sciences, Engineering, and Medicine.

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And research has suggested that the use of methadone and buprenorphine in treating opioid use disorders can substantially reduce people’s chances of fatally overdosing — some studies suggest by up to 50%.

“For a disease that is killing many Americans, that is a significant reduction in mortality that you can get with appropriate treatment that includes medications,”  Sharfstein said. “And that I think is just an incredibly important point to keep in mind as officials are thinking about expanding access to treatment.”

Loosening the regulations

Connecticut saw a significant increase in patients who were receiving methadone or buprenorphine over the past decade as part of their treatment for opioid use disorders.

The number of people receiving methadone at a federally regulated clinics in Connecticut jumped between 2012 and 2017 from roughly 14,000 to more than 21,000. And the number of people who were prescribed buprenorphine through a licensed medical provider grew from roughly 21,000 in 2015 to an estimated 30,000 in 2020.

But those numbers have largely plateaued since then.

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The same cannot be said for the number of overdoses linked to heroin, fentanyl and prescription painkillers, which have claimed the lives of nearly 5,000 Connecticut residents since 2020.

The researchers who put together the report this year for the state’s Opioid Settlement Advisory Committee said that staggering loss of life is evidence enough that more needs to be done to connect people with medication-assisted treatment and to retain those patients once they enroll in a program.

If there is any benefit of the COVID pandemic, it’s that the federal government has allowed the relaxed policies to remain in place.

“There are no reliable estimates of the number of people in the state at risk for overdose who would benefit from treatment with medication for opioid use disorder,” the researchers wrote. “Nonetheless, the rising number of opioid overdoses indicates there is an unmet need for these treatments in the state.”

There have been several big changes in recent years to make it easier for people in Connecticut and the rest of the United States to access medications for opioid use disorders and to continue using those medications once they start.

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Federal legislators passed a law late last year that removed a long-standing requirement for doctors to have a special waiver if they wanted to prescribe buprenorphine to patients with opioid use disorders.

That waiver requirement severely restricted the number of physicians who could legally administer buprenorphine to their patients in the past.

The federal government also lowered one of the biggest barriers that patients often encountered once they were enrolled in a methadone treatment program: how much methadone someone could take home with them from a clinic.

Prior to the coronavirus pandemic, most patients receiving methadone had to report to a federally licensed clinic nearly every day to receive their dose of the medication under the supervision of staff. It was part of a tightly regulated system that had been erected around methadone in the United States over decades.

The public health emergency in 2020, however, prompted the federal government to allow a larger number of people to take home up enough bottles of the liquid methadone to last them up to 28 days, and federal officials are now pushing for a permanent regulatory change that would allow patients to continue to benefit from that practice.

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Dr. Robert Heimer, a professor at Yale University who has widely studied opioid addiction, said the loosening of the federal rules surrounding methadone and buprenorphine is likely to have a positive effect.

“We’re finally moving away from that. Thank goodness,” Heimer said of the federal regulations. “If there is any benefit of the COVID pandemic, it’s that the federal government has allowed the relaxed policies to remain in place.”

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Unmet needs

Even so, Heimer and other medical professionals argue there are still barriers that limit how many people are utilizing methadone and buprenorphine in Connecticut.

The new report that Heimer helped to produce for Connecticut’s opioid settlement advisory committee listed several of those obstacles.

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There is still an inadequate number of physicians willing to prescribe buprenorphine to their patients, the report noted, and some pharmacies don’t even stock it.

Adequate transportation to the state’s licensed methadone clinics, which are largely concentrated in the state’s urban centers, can still be a problem for newer patients who need to show up in-person on a daily basis at the beginning of their treatment.

Additionally, Heimer said, some of the methadone clinics in the state have operating hours that don’t accommodate patients who have jobs at odd hours, or other methadone providers don’t have physicians at all of their sites who are capable of performing the required physicals on patients who are starting methadone treatment.

Steven Zuckerman, the CEO of the Root Center, which operates more than 10 sites in Connecticut, said his organization has the capacity to treat more people.

Even though the Root Center already serves nearly 6,000 patients a day, Zuckerman said his staff is capable of administering the first dose of methadone to someone the same day they walk in.

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Medicaid and Medicare, which insures more than 90% of the Root Center’s patients, covers the cost of that treatment, he said.

The bigger issue, Zuckerman said, is addressing all of the other related issues that many of the patients have.

People with opioid use disorders may be unemployed. They may be fighting to regain custody of their kids. They might be facing legal charges. Some have other mental health disorders that have gone untreated. And many don’t have reliable housing.

Data collected by the state last year found that nearly 8% of the people who overdosed in 2022 in Connecticut were either homeless or struggling with housing instability.

Zuckerman argued that the nearly $600 million in settlement funds that the state is expecting to receive over the next two decades could be used to help correct some of those issues for people entering treatment.

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“Getting the medication-assisted treatment is the initial step. Obviously, that starts the whole ball rolling. But once sobriety comes for you, there’s so much else that’s needed to get you moving,” Zuckerman said.

The report produced for the state advisory committee this year suggested portions of Connecticut’s opioid settlement funding could help by expanding the operating hours at existing methadone clinics or by financing new mobile methadone clinics, which federal and state regulators also recently approved.

The report also suggested that the settlement funds could be used on a variety of related services for patients with opioid use disorders, including improved transportation services, help with insurance enrollment, employment assistance program and subsidized child care services.

In Lugo’s case, she was able to rely on her family members to help with many of her most basic needs once she entered treatment.

Her brother, who is also in recovery, provided her with a place to live above his barber shop in East Hartford. And her father was also available to support her.

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“It takes an army just for one person to recover,” Lugo said.

Stopping the stigma

The biggest impediment to people accessing methadone and buprenorphine, however, isn’t caused by a government regulation, and it can’t be solved solely by spending opioid settlement funding.

It’s the public stigma that keeps many people from utilizing those treatment medications, several people told The Connecticut Mirror.

Heimer, the Yale professor, said there is still a misconception among large portions of the American population that taking methadone or buprenorphine to treat opioid use disorder is like trading one drug for another.

“The problem is that the 50 years of a very controlled, draconian approach to dispensing methadone has led to methadone being stigmatized,” Heimer said. “So even though it’s been easier to get, I don’t think there has been a huge increase in the number of people taking advantage of it.”

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That stigmatization can persist even after people realize the benefits the treatment medications can have on someone who is struggling with an opioid use disorder.

Heimer recounted an interaction that he had a few years ago with a woman he met at a community event. The woman, who was in her twenties, was a strong advocate for methadone. She told Heimer that the medication allowed her to work through her opioid use disorder and to reconnect with her family and her child.

Eventually, she told him that she was doing so well on her treatment program that she was considering halting her use of methadone.

Heimer said he tried to persuade the woman not to do that, and he emphasized that if the treatment was working she should stay the course. He explained to her that using opioids for a significant period of time can change someone’s brain chemistry.

Despite that warning, Heimer later learned the woman died of an overdose within six weeks of their conversation after she stopped utilizing methadone as part of her treatment.

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“There’s still this overwhelming belief — unsupported by data — that abstinence, not taking opioids, is the proper end goal for people with opioid use disorders,” Heimer said.

He said that is like arguing that a diabetic needs to stop using insulin, or that someone with high cholesterol needs to stop taking their statin medication.

Some advocates don’t even like to refer to methadone and buprenorphine as medication-assisted treatment for that very reason. They believe it makes those forms of treatment seem out of the ordinary, when, in fact, they are the gold standard for treating someone with an opioid use disorder.

Lugo said she’s seen people voice those negative perceptions in the past, but she said she wouldn’t have made it as far in her recovery without the methadone treatment she’s received over the past two years.

“They don’t see it as a disease,” Lugo said.

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This story is part of an ongoing series on opioids in Connecticut. Want to share what you know? Send your tips and personal stories to tips@ctmirror.org.

Andrew Brown is a reporter for The Connecticut Mirror (https://ctmirror.org/ ). Copyright 2023 © The Connecticut Mirror.

 



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Connecticut

O Little Town of Bethlehem: Connecticut Town Celebrates Christmas All Year Long

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O Little Town of Bethlehem: Connecticut Town Celebrates Christmas All Year Long


A rural town connects beautifully to the miraculous event so long ago.

“O little town of Bethlehem, how still we see thee lie,” begins a beloved Christmas carol sung since 1868, paying homage to Jesus’ birthplace.

But have you heard of Bethlehem, Connecticut?

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It’s a favorite destination because of its Christmas connection. With approximately 3,400 residents, modest in size like its ancient namesake once was, the rural town of Bethlehem has two places that connect beautifully to that miraculous event of the Nativity.

The Nutmeg State’s Bethlehem is home to Regina Laudis Abbey, a community of cloistered Benedictine nuns founded after World War II. Here, the nuns have a magnificent early-18th-century Neapolitan crèche, displayed in a restored barn nearly as old and donated specifically to house this Nativity scene. Both the crèche and barn received a meticulous four-year restoration completed less than two decades ago by experts from the Metropolitan Museum of Art in New York City.

This is no small Neapolitan crèche. It spans 16 feet wide and 6 feet deep. The Nativity scene takes place before a backdrop mural of an 18th-century seaside and an azure sky.

A wider panorama of the Christmas display(Photo: Joseph Pronechen)

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Jesus, Mary and Joseph are at the heart of the crèche where our Savior’s birth is set vividly in a Neapolitan mountainside village — complete with angels hovering in wonderment and awe and scores of villagers react in different ways to the overwhelming presence of the Holy Family.

Simple peasants close to the Holy Family stand in awe and mingle with the Three Kings. Some villagers stop to contemplate Jesus’ birth. Others go on with everyday life as if nothing unusual or life-changing is happening.

The animated scene’s 68 figures and 20 animals of carved wood, ceramic, metal and plant fiber stand up to 16 inches high. They’re dressed in their original period dress that the Metropolitan Museum specialists also carefully restored to pristine condition.

From all indications and evidence, this crèche was a gift to Victor Amadeus II of Sardinia on his coronation in 1720. In 1948, it was brought to America and then in 1949 the woman who then owned it donated it to the abbey to preserve and display it.

Also on the abbey’s grounds is a simple, life-size Nativity scene of the Holy Family, located in a simple shed, with Joseph dressed in a checked farmer’s jacket. Abbey visitors might even spot a sheep or two.

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Later during the Christmas season, you might want to watch the 1949 film Come to the Stable that tells the story of Regina Laudis Abbey and whose main characters, two nuns played by Loretta Young and Celeste Holm, are based on the actual Benedictine nuns who came from France after World War II to establish it. It’s a much neglected classic.

Church Highlights Nativity All Year

In nearly a straight line, less than 3 miles from the abbey and a few yards from the center of town, the Church of the Nativity remembers the birth of Jesus year-round. Now a part of Prince of Peace parish, ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­the church was built in 1992 of fieldstone and wood and specifically designed to suggest or look like a large crèche. The church is topped with a star that is lit at night and directs people to the sacred edifice like the star directed the Magi.

The focal point of the church vestibule is a life-size manger scene. The figures were carved from a single pine tree by a Maine artist.

Church of the Nativity manger scene, Bethlehem CT
The Church of the Nativity vestibule has a life-size manger scene.(Photo: Joseph Pronechen)

A panorama of the town of Bethlehem is etched high on the glass behind the Holy Family. Etched on another glass panel are the Three Kings, depicted following the star to adore the Newborn King.

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In the nave, the church’s interior of stone, wood and large beams intentionally add to the manger atmosphere — as do the words “O Come All Ye Faithful” that stretch and beckon from high behind the altar.

The Nativity atmosphere continues all year. The Knights of Columbus built a 20-foot crèche on the parish’s front lawn.

Another Major Nativity

A little over 500 feet away is the Bethlehem Post Office, which, of course sees lots of extra traffic at this time of year — people enjoy getting their Christmas cards postmarked from “Bethlehem” and envelopes stamped with a Christmas greeting from the town.

Those who do visit these two Nativity treasures can continue singing Little Town of Bethlehem’s later verses:

How silently, how silently The wondrous gift is given! So God imparts to human hearts The blessings of His heaven. No ear may hear His coming, But in this world of sin, Where meek souls will receive him still, The dear Christ enters in.

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O holy Child of Bethlehem Descend to us, we pray Cast out our sin and enter in Be born to us today O come to us, abide with us Our Lord Emmanuel!

PLAN YOUR VISIT

Visiting hours for the abbey crèche: Wednesdays through Sundays from 10 a.m. – 3 p.m. Closed Mondays and Tuesdays. Winter Closure: Jan. 7-Easter Sunday; free.





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Man shot, killed in New Haven

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Man shot, killed in New Haven


A man has died after he was shot in the Elm City Tuesday night.

While details remain limited, police say the shooting happened on Edgewood Avenue.

No arrests have been made at this time and police are only tentatively identifying the man as a 43-year-old New Haven resident.

Anyone with any information is being asked to contact New Haven Police.

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Lawmakers split over CT Medicaid funding spend, ahead of legislative session

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Lawmakers split over CT Medicaid funding spend, ahead of legislative session


President-elect Donald Trump, a longtime opponent to the Affordable Care Act (ACA), has the backing of a soon-to-be controlled Republican House and Senate to make changes to the ACA.

The proposed changes could result in how Medicaid is financed in Connecticut and across the U.S. Well over a half of Medicaid spending by states is financed by the federal government, with Connecticut receiving 63.4% of its Medicaid spending share in fiscal year 2023, according to KFF.

State lawmakers, however, are not overly concerned just yet.

“There have been some worrisome noises, but nothing to date that’s concrete,” State Sen. Matt Lesser, co-chair of the Human Services Committee, said.

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Lesser said lawmakers are paying close attention since federal changes to Medicaid would significantly impact “over almost half of the kids in the state, pregnant women, [and] retirees.”

The state-funded Medicaid program, known as HUSKY in Connecticut, provides coverage to undocumented children. On July 1, the cap was raised to include undocumented young people up to age 15.

Medicaid cost overruns could put access for low-income patients at risk

State finances will be central to Connecticut lawmakers’ discussions in the upcoming legislative session Jan. 8, with the potential expansion of Medicaid eligibility among undocumented immigrants.

Connecticut’s Medicaid program experienced cost overruns in the hundreds of millions of dollars at the start of the current fiscal year. The Connecticut Mirror reported that the Department of Social Services (DSS) is tallying usage and cost for the program, which has had a much higher interest in enrollments than expected, according to the DSS. The total cost is expected to be out before Gov. Ned Lamont releases his budget in February.

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State minority leaders have proposed to tighten the Medicaid fiscal belt.

Stephen Harding, Senate Republican Leader, and Vincent Candelora, House Republican Leader, said in a statement that the state should “suspend this policy immediately with the goal of eliminating it in the next budget cycle.”

The passage of the proposal would need the full approval of the state General Assembly.

But Democrat lawmakers seek to further expand the age cap for Medicaid eligibility among undocumented people.

State Rep. Jillian Gilchrest, co-chair of the Human Services Committee, is among lawmakers and advocates who hope to push the cap higher this session – to 18 years.

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Gilchrest said lack of access to health care would mean that “their need is going to be heightened down the road, and we’re going to have to cover the cost of higher cost health care.”

And that would also apply to other Connecticut residents enrolled in Medicaid, she said.

“We need to have conversations about what access to care looks like for a population that continues to increase in our state because they are experiencing economic inequality,” Gilchrest said.





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