The rise of fentanyl, xylazine, and stimulants is undercutting the effectiveness of addiction medications, Taylor Sisk reports for the Richmond Register. As a result, Vermont’s pioneering efforts in establishing a statewide program for medication for opioid use disorder, known as Hub and Spoke, are now finding that buprenorphine and naloxone have proved less effective against fentanyl, and commonly used doses can trigger violent, immediate withdrawal. Vermont had the 10th-largest increase in fentanyl deaths for the 12-month period ending in April and the state’s Department of Health’s Division of Substance Use Programs, said fentanyl is now implicated in about 96 percent of overdose deaths. Vermont now prescribes more medication for opioid use disorder per capita than any other state. Advocates encourage more widespread access to methadone as an alternative to buprenorphine, which is often proving less effective in countering the potency of fentanyl.