Editor’s note: In September, the Caledonian Record published an exclusive series by AP award-winning writer Bethany Knight of Glover on poverty and cash welfare benefits in the Northeast Kingdom. The Caledonian Record and Knight have graciously allowed VTDigger to republish an edited version of the series.
Reach Up participants have a self-reported low incidence of substance abuse, but they often have to cope with addiction and substance abuse in their family circle. Parents, siblings, spouses and partners are frequently drug dependent and sometimes selling prescriptions on the streets.
Vermont’s Department of Children and Families Commissioner David Yacovone asks: “Is it the addiction that brought them to poverty, or the poverty that drove them to addiction?”
“There’s definitely a lot of money to be made,” says one Reach Up participant. “For so many different people, pills are like candy.” Street prices are $1 per milligram for a controlled narcotic, regardless of the drug, “So $5 for five mgs, $80 for 80.”
He tells of addicts who go to the emergency room with fabricated pain, just to get another prescription. “I’ve seen some people leave the worksite, actually clock out,” he says, “to purchase or sell. We don’t have to say why we’re leaving.”
“Most pay zero for their prescriptions, not even a co-pay,” says Ruggles of Barton, speaking of his customers on welfare. “Mainly the government pays the bills. We’ve created a class of dependent people and they keep businesses going. … Who complains? No one. They’re all making money.”
When Jack Ruggles sold Pierce’s Pharmacy in Barton in 2000, it had been in the family since 1954, and it was where his pharmacist father Cortland A. Ruggles worked for 30 years and Jack for 46 years, 31 as a pharmacist. He now works for a St. Johnsbury pharmacy.
“Most pay zero for their prescriptions, not even a co-pay,” says Ruggles of Barton, speaking of his customers on welfare. “Mainly the government pays the bills. We’ve created a class of dependent people and they keep businesses going. … Who complains? No one. They’re all making money.”
Ruggles is angry at drug companies and doctors that aggressively endorse treating any and all pain with pills. He sees hospitals as equally complicit and is disgusted by bogus ER visits for fabricated ailments, requiring five refills of Vicodin.
“In the old days, I might have sold 50 pills a week for pain, like Percocet,” he said. Until the 1990s, his customers weren’t prompted by drug company advertising, he says, and doctors counseled patients to manage pain in other ways. Today’s pain killers weren’t invented.
Vicodin is the biggest seller out there, Ruggles says, “And prescriptions triple on the weekends.”
“Now, I go through 1,500 Percocet and 2,000 Vicodin in a week,” at the St. Johnsbury pharmacy where he works, he said. The hottest drug is Suboxone, he said, used when heroin and Vicodin don’t work. He estimates he sells a dozen boxes of 30 film tabs a week.
Class II narcotics, “are scary, because they are so addicting,” Ruggles says. “Oh my God, I have customers under 30 with eight and 10 prescriptions: painkillers, anti-anxiety, anti-depressants. Respiratory for COPD, though they still smoke, diabetes,” he says, “and the doctors add and add more.”
Ruggles estimates 95 percent of his Medicaid customers are young poor people with multiple prescriptions. “If they ever took Vermont Medicaid away, we would be out of business,” he claims.
A broader problem
Across town, Northeast Kingdom Community Action (NEKCA) director Jan Rossier sits in her tiny Lincoln School office and echoes Ruggles’ concerns.
“This is a problem that far exceeds the scope of the services we provide and has deep roots in the medical and pharmaceutical professions, an area where human service workers have no clout,” she says.
For 17 years, Rossier has helped the poor of the Northeast Kingdom “navigate and advocate.” But she knows only the motivated addict can be helped.
NEKCA offers a voluntary pre-treatment group and works closely with the local recovery center. Case managers make referrals, sometimes direct connections, when participants are willing and ready. The Lincoln School work site has pursued offering a 12-step program but has been stymied by the required anonymity.
“This is a problem that far exceeds the scope of the services we provide and has deep roots in the medical and pharmaceutical professions, an area where human service workers have no clout,” says Jan Rossier, NEKCA director.
Addiction is, “a symptom of those living in poverty,” Rossier says. “Often being less educated, folks are more susceptible to taking addictive medications prescribed by physicians, not knowing the risks. Initial use can result in a feeling of euphoria that is something they have never experienced, hence the desire for continued use.”
Rossier also confirms drug commerce on the streets. “Pills are also viewed as a street commodity that generates revenue, and with limited options to make a livable wage, folks make desperate judgment calls. It the supply would diminish, the abusive misuse would not be possible.
“The source of the problem lies elsewhere; the outcome of the problem is again damaging the very lifeblood of the disenfranchised,” she says.
Her colleague Kathy Metras in Newport concurs.
“Substance abuse is a huge problem we have been trying to work around,” Metras says.
A NEKCA department manager who oversees a myriad of programs, Metras is exploring housing models for participants completing a substance abuse program and returning to the area. “I can think of one individual that moved to the outskirts of Burlington because he couldn’t stay clean here in the NEK, because of friends and family.”
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Addiction robs all classes
Former Vermont Corrections commissioner and now executive director of NEKCA Joe Patrissi emphasizes the poor aren’t the only strata of society battling addiction.
“It goes beyond those in poverty to other economic spectrums because of some of the same reasons … once addicted, you need to support your habit,” he says.
Addiction among the poor is a complex problem, says Patrissi, “because it can be an economic issue as well as an escape from the stress.”
More than 22 million Americans suffer from substance dependence or abuse due to drugs, alcohol or both.
National data on the welfare population from 2000 shows about one in five recipients abuses drugs or alcohol. Within Vermont’s Reach Up population, “About 5 percent of the caseload has identified as having a substance abuse issue,” says Paul Dragon, Vermont’s Reach Up/Temporary Aid to Needy Families (TANF) director. Vermont’s data is collected from answers given by Reach Up participants themselves, when identifying what barriers keep them from working.
“What this tells me is that there is no compelling data to suggest Reach Up participants have higher rates of substance abuse than the general population although in the U.S. TANF (welfare) recipients do have higher rates,” Dragon says.
Bethany Knight of Glover is a former newspaper reporter, magazine editor, college journalism instructor, gubernatorial speech writer and health care executive. She co-authored five reports on Vermont issues produced by the Ethan Allen Institute. A licensed nursing home administrator, Knight’s books for caregivers are sold by Hartman Publishing. Her first novel, “On the Edge of Tickle,” can be found at www.smashwords.com.
