Why It Matters
Vermont’s opioid crisis has strained emergency departments and stretched addiction treatment resources across the state for more than a decade. A small regional hospital in Randolph, Vermont is now pioneering an approach that could change how patients first encounter addiction care — by making a longer-acting treatment available the moment someone walks through an emergency room door.
What Happened
Gifford Medical Center has become the only hospital in Vermont to offer Sublocade — an injectable, extended-release form of buprenorphine — directly in its emergency department and inpatient unit. The treatment suppresses opioid cravings for a full four weeks with a single dose, a significant departure from daily oral medications that require consistent patient follow-through.
Rather than ordering the drug on a case-by-case basis, Gifford stocks Sublocade on-site, making it immediately available to any patient who arrives in need. The hospital’s emergency department operates around the clock, meaning patients can access this treatment at any hour.
Roz Vara-Good, a nurse practitioner in addiction medicine at Gifford, described the shift in practical terms. “I haven’t had a single patient switch to Sublocade and want to go back to daily dosing,” she said. “Patients tell me they wake up and simply feel normal.” She framed addiction treatment as a medical issue requiring the same evidence-based approach as any chronic illness: “We just need to make those treatments easier to access than drugs.”
Gifford also operates an outpatient addiction medicine program through its Kingwood Health Center locations in Randolph and Berlin, where roughly 40 patients are currently receiving Sublocade treatment.
By the Numbers
The cost of Sublocade varies considerably depending on insurance coverage. The wholesale price per dose runs approximately $2,200, though Medicare patients pay an average of $97 per month. Costs for Medicare recipients can range as low as 2 cents to as high as $1,607 per dose depending on specific plan terms.
Vermont’s opioid overdose death toll climbed steadily from 2014 through 2022, then began declining in both 2023 and 2024. Into 2026, accidental and undetermined opioid deaths and overdose emergency department visits have remained below the prior three-year average — a trend public health officials consider cautiously encouraging.
Across the border in New Hampshire, drug-related deaths dropped by roughly a third between 2023 and 2024. The state increased its annual spending on drug treatment by 450 percent between 2014 and 2024, a significant investment that health officials credit with driving those results.
Zoom Out
The move at Gifford reflects a broader shift in addiction medicine toward longer-acting treatments that reduce the daily burden on patients and improve retention in care. Extended-release injectable buprenorphine has gained traction in clinical settings because it eliminates the need for patients to self-administer medication each day — a common point of failure in outpatient recovery.
Dartmouth Health, which operates across northern New England, administers both Sublocade and a similar product called Brixadi through its addiction treatment program and through a service called the Doorway, which provides walk-in and crisis services weekdays from 8 a.m. to 5 p.m. in New Hampshire. Dartmouth Health opened a new addiction treatment center near Valley Regional Hospital in Claremont, New Hampshire in March, and has announced plans to expand treatment for pregnant patients struggling with substance use disorder. Construction is also set to begin soon on a standalone residential treatment facility for women and children in Lebanon, New Hampshire.
The regional expansion of accessible, evidence-based opioid treatment reflects a wider national effort to close the gap between crisis intervention and sustained recovery — bringing treatment options directly to patients at their most vulnerable moments rather than requiring them to navigate complex referral systems afterward.
What’s Next
Gifford Medical Center’s model — stocking Sublocade on-site and integrating it into emergency care — may draw interest from other Vermont hospitals looking to strengthen their addiction treatment pathways. Whether the state’s other emergency departments adopt similar protocols will likely depend on cost structures, staffing, and the availability of outpatient follow-up programs to maintain continuity of care after an initial emergency visit.
Vermont health officials continue to monitor overdose trends, with early 2026 data suggesting sustained progress in reducing opioid-related deaths and emergency visits statewide.