Chronic Pain and Addiction Treatment in Vermont

How is chronic pain treated when someone also has a substance use disorder?

Chronic pain alongside a substance use disorder is usually treated with one shared plan, in which the pain clinician and the addiction clinician agree on medication, therapy and follow-up instead of working separately. Vermont care teams may discuss several options, and decisions about the mix sit with the person and their clinicians.

Taking a long-term opioid as prescribed can cause physical dependence, which is not the same as a use disorder. Telling the two apart is a clinical judgment. Options can include buprenorphine, which treats opioid use disorder and also relieves pain, methadone through an opioid treatment program, non-opioid pain medicines and non-drug therapies.

Physical therapy and cognitive behavioral therapy are among the non-drug approaches, often offered through outpatient programs. Any reduction in a long-term opioid or benzodiazepine prescription should be a planned taper set with the prescriber, because abrupt changes can bring withdrawal and a spike in pain.

Pain care can usually continue during addiction treatment as long as the treatment program and the pain prescriber stay in contact and work from a single plan. Each clinician should see the complete medication list, since opioids combined with benzodiazepines, gabapentinoids or alcohol raise the risk of dangerously slowed breathing.

Is it safe to stop or reduce pain medication on my own?

Stopping or cutting a long-term opioid or benzodiazepine prescription abruptly is not considered safe, and any taper should be planned with the prescriber. Sudden changes can bring withdrawal, a spike in pain and a higher chance of return to use or turning to unprescribed drugs. A planned taper sets the pace and can slow down if symptoms flare. Combining opioids with benzodiazepines, gabapentinoids or alcohol raises the risk of dangerously slowed breathing, so every clinician involved needs the full medication list. Vermont listings for benzodiazepine treatment are gathered on a separate page.

Can I keep getting pain treatment while in addiction treatment in Vermont?

Pain care can usually continue during addiction treatment in Vermont when the program and the pain prescriber share information and agree on one plan. Vermont organizes opioid use disorder care as a hub-and-spoke system in five regions: Northwest, Northeast, Central, Southeast and Southwest. Each region has had at least one hub since the Bennington hub opened in July 2025. Hubs are opioid treatment programs, while office-based spoke practices prescribe buprenorphine elsewhere. Vermont’s 2024 rules for medications for opioid use disorder allow some required evaluations, and the office-based intake exam, by telehealth when federal guidelines permit. See telehealth options in Vermont.

Vermont rules you may meet

Vermont prescribers work within state prescription monitoring and opioid prescribing rules, so ask yours how those rules shape your dose and refills. Naloxone needs no prescription under a statewide standing order. VT Helplink mails it free, and pharmacies, clinics, syringe services programs, treatment programs and recovery centers also hand it out.

Vermont’s pain and addiction listings are 80 percent rural. Every one sits within 25 miles of a river, a median of 2.8 miles away, most often the Cold River or the La Platte River. Patrick Leahy Burlington International and Rutland-Southern Vermont Regional are each the nearest airport for about a third of listings, at a median of 21.1 miles. That distance is useful to know when hub visits mean regular travel.

How do I pay for pain and addiction treatment in Vermont?

Vermont Medicaid, run by the Department of Vermont Health Access (DVHA), is the main public way to pay. DVHA pays for behavioral health and substance use services directly rather than through private managed care plans. Vermont expanded Medicaid in January 2014, and DVHA covers clinically appropriate telemedicine for substance use treatment, including some audio-only phone visits. Ask each program which levels of care and medications it bills to Medicaid. Programs taking Medicaid are listed separately.

Private plans that cover mental health and substance use care must, under federal parity law, handle those benefits no more strictly than medical care. Ask your plan about prior authorization for buprenorphine, pain therapies and residential stays. Without coverage, ask about state-funded treatment in Vermont through the Division of Substance Use Programs at the Vermont Department of Health. The Division certifies treatment programs and funds preferred providers by contract or grant.

What should I ask a Vermont program before starting?

Ask a Vermont program three things before starting:

• Whether it treats pain and substance use together.
• Whether it can continue or start medication for opioid use disorder.
• Whether it will coordinate with your pain prescriber.

Wait times, levels of care and family involvement are worth raising too. Programs that also address mental health appear under dual diagnosis care in Vermont, and opioid-focused options under opioid treatment in Vermont.

Free places to start

VT Helplink answers calls and texts 24/7 at 802-565-5465 or toll-free 833-565-5465. The service is free and confidential, with an online treatment finder. The national treatment referral line is also free and open around the clock, and anyone in crisis can call or text 988. Broader listings start on the Vermont treatment page, and background on the term is in the national pain and addiction guide.