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Vermont opioid crisis presents both barriers and opportunties

MIDDLEBURY — Vermont has in recent years made concrete efforts to address the state’s ongoing opioid crisis, but experts say there’s still plenty of work to be done — including in Addison County.

Locally, community members recovering from substance use disorder face barriers in getting support, including a lack of available services and transportation.

“I think the rural landscape of this county makes it really difficult for people to get the support they need,” said Danielle Wallace, executive director of the Turning Point Center of Addison County.

Wallace was one of three professionals to take part in an April 15 panel discussion on Vermont’s drug policy and response to the opioid overdose crisis, an event hosted by the Addison County Democrats in Middlebury. Rutland County State’s Attorney Ian Sullivan and David Mickenberg, a longtime drug policy reform advocate with the Drug Policy Alliance, also participated in the discussion.

Panelists shared their experiences working to address the opioid epidemic, highlighting roadblocks and potential solutions.

LOCAL RESPONSE

Wallace spoke about the situation locally, including programs offered by the Turning Point Center and others in the county.

The nonprofit provides peer-based individual and group support services for people recovering from substance use disorder and other addictions, as well as for their families. Turning Point also collaborates with local organizations like the Counseling Service of Addison County (CSAC) to provide a wider range of supports.

The Turning Point Center’s programs are voluntary, so there’s no requirements or consequences for individuals obtaining services.

David Mickenberg, Danielle Wallace and Ian Sullivan

Wallace said that professionals recently have noticed a rise in the use of stimulants like cocaine and methamphetamine in addition to opioid use.

“Since COVID, we are starting to see a shift from opioid use to a combination of opioid use and stimulant use, and also seeing the consequences of stimulant use,” Wallace said, adding that stimulants and opioids have different effects on individuals.

“I think Middlebury saw that this summer pretty significantly,” Wallace continued. “When people are up for a long time and just the way stimulants work on your brain.”

Wallace said the Turning Point Center currently serves around 40-50 people at any given time, around 75% of whom are from the Middlebury area.

“There’s a lot of people we’re missing,” Wallace acknowledged. “We’re noticing that our numbers really drop off outside of Middlebury.”

Transportation is a major obstacle for community members seeking recovery support, such as meetings and coaching sessions, Wallace said.

“Once you’ve lost your (driver’s) license, the systems to get it back are incredibly difficult to manage, especially after a DUI charge,” she explained.

Outside of her work with Turning Point, Wallace is an instructor for the Impaired Driver Rehabilitation Program, a mandatory program for Vermonters seeking to reinstate their driver’s license after alcohol or substance-related driving offenses.

“It’s $400 to take the course, which for some of the people I work with, that’s maybe a million,” Wallace said. “There isn’t a scholarship, and there is no sunset provision. So, sometimes I’m working with someone who had a DUI 10 years ago and they’ve been sober for eight of it, but they can’t get their license back because they can’t come up with $400.”

Wallace noted there are virtual options available for some services, though those options present their own set of challenges.

“We’re also dealing with a population that struggles with that pretty significantly, the ability to use technology, to be able to get onto a Zoom meeting,” she explained. “And it’s just not the same. That in-person, one-on-one support is different and the ability to get to in-person meetings is also different.”

Addison County also has a significantly smaller population than that of neighboring Chittenden and Rutland counties. Wallace said the county’s population limits the services available for those recovering from substance use disorder.

“I think what we see in this county is that because the numbers are smaller, sometimes it doesn’t have as much of an impact, so there are not the supports available,” she said.

For example, Addison County does not offer treatment court, an alternative to incarceration for people experiencing addiction that provides participants with substance use disorder treatment and other support.

“We have the option to send people to the Chittenden treatment court, but we’re dealing with a population that doesn’t have transportation. So, we’re asking them to commit to something that’s nearly impossible,” she said.

Wallace added the county doesn’t have an intensive out-patient program for individuals struggling with substance use disorder.

“CSAC is really our go-to option for substance use, and typically people are met with long waiting lists, months at times, to even get assessed to see where they may fit within what kind of treatment that (professionals) recommend,” she said.

Wallace said the Turning Point Center is exploring ways to address barriers like transportation, such as by bringing support services to individuals.

“We’re really working on how we can get to people instead of requiring them to get to us,” she said. “We’re hoping to secure funding so we can do more of an outreach, similar to a home health model, so that we can actually do coaching at people’s houses.”

STATEWIDE EFFORTS

Panelists also highlighted efforts to address the opioid crisis in other parts of the state.

Sullivan provided an overview of the current state of the opioid overdose epidemic in Vermont. According to Vermont Department of Health data, there were 50 opioid-related deaths in the state in 2012. In 2022, that number was 244.

“There are very few families, very few people I talk to, that have gone untouched by these deaths,” Sullivan said.

The Vermont Department of Health also reports an increased involvement of drugs like gabapentin and xylazine (often used in horse tranquilizers) in fatal opioid overdoses.

“For reasons that I can’t fully explain, those drugs have made an increasing appearance in the drug supply in Vermont,” Sullivan said.

The state’s attorney also spoke about his experience running a treatment court docket in Rutland County. The county is one of four in the state to offer treatment court as an alternative to traditional prosecution.

Sullivan explained the jail diversion program is intended for high-need/high-risk individuals, a population determined by their risk of reoffending and the intensity of their substance use disorder.

Throughout the process, participants with case managers and treatment providers, as well as check in regularly with a judge.

“If a person is successful to get to graduation, there is no jail time. There is either dismissal or a reduction of charges,” Sullivan explained. “If they are not successful, a traditional jail sentence is imposed.”

Key components of the program include a continuum of care available to participants and complimentary treatment and social services to support lasting sobriety.

“If we put that person in jail, they leave jail and they’re still driven by their substance use disorder, odds are good we’re going to see them again,” Sullivan said. “If through engagement with our treatment courts, the person achieves a lasting and durable sobriety, that’s a powerful public safety outcome that we do not achieve with nearly the same regularity in a traditional criminal justice system.”

Zooming out to the state level, Mickenberg highlighted recent legislative efforts to address the drug overdose epidemic. Those efforts include adopting a law in 2021 that decriminalized the procession of a certain amount of buprenorphine, a prescription drug used to treat opioid use disorder.

Mickenberg said Vermont OK’d a law last year that would allow individuals to have their drugs tested for the presence of drugs like xylazine and fentanyl.

A bill, H.72, currently making its way through the Legislature is seeking to further address the opioid overdose crisis by establishing an overdose prevention center in the state. At such facilities, Vermonters could consume their own opioids while being monitored by trained professionals, as well as access resources for treatment in a safe environment.

Another bill, H.423, seeking to decriminalize the personal-use possession of controlled substances Vermont was introduced last year.

“The idea is that when we take criminality out of it, we can then focus on the things that are actually going to impact people’s lives in a positive way,” Mickenberg said. “And not just the individual, but people’s families and our communities. The consequences of criminality are significant.”

Mickenberg stressed that when considering long-term solutions to the opioid epidemic, Vermont must approach the crisis through a public health lens and consider the other issues intertwined with drug use.

“We isolate this conversation about drug policy and make it about drugs, but I think people much smarter than me, and experts, would say this is really a conversation that we should be having about housing, about food insecurity, about transportation,” Mickenberg said. “The conversation about those root causes and then the continuation of people’s lives in which they can’t access the type of services that they need because of poverty, because of trauma and all those things, I think those conversations need to go hand in hand.”

Wallace added that solutions must also focus on long-term support for individuals recovering from substance use disorder.

“We need to put funds into how we give people support beyond ‘we’ll get the drugs out of system, but then go back to the homeless shelter or wherever you were staying prior that caused these issues,’” she said.

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