BURLINGTON — For the past two-and-a-half years, Melanie Hanson has helped injection drug users and other people abusing opiates obtain the supplies they need to stay safe.
Her office is a house just off Pearl Street near downtown that looks much like the others on the block except for a neon green door and a small placard that identifies the owner as the Howard Center — the region’s largest social service nonprofit.
Hanson is a case manager at Safe Recovery, a program aimed at reducing the incidence of infectious diseases that can be spread by sharing needles and preventing drug overdoses. They provide HIV and other screenings, operate a needle exchange and distribute naloxone, a drug effective in reversing overdoses.
To date, Safe Recovery is the largest distributor of the life-saving drug in Vermont. At the end of October, Hanson and her colleagues had handed out more than 2,500 naloxone kits. People seeking refills had reported reversing more than 400 overdoses since 2013.
It’s the naloxone, clean needles and disease testing that bring people through the neon door, but once they’re inside, Safe Recovery’s staff has a unique opportunity to offer people counseling, referrals to drug treatment and other services that help them survive addiction, said Tom Dalton, the Safe Recovery program coordinator.
Their work is guided by an old maxim in the harm reduction school of social work with drug users: you have to be alive to recover.
Chittenden County State’s Attorney T.J. Donovan, who is running for Vermont Attorney General, described Dalton, Hanson and their other colleagues as “unsung heroes” who provide a “judgment free zone” and “portal to treatment” for people in the throes of addiction.
But Hanson isn’t going to work with Safe Recovery for much longer. She’s transferring to a new role within the Howard Center’s sprawling organization. That’s because Safe Recovery will lose the majority of its funding at the end of the month.
Since the start of the new fiscal year in July, Safe Recovery has gone from six full-time staff to four, and with the departure of Hanson and another colleague to different roles within Howard Center, it will soon be down to two.
“We’re basically at the point now where we can provide you with syringes and naloxone, but we’re not able to help as much with recovery,” Dalton said. That means his shrinking staff will no longer have the bandwidth to provide counseling, referrals to treatment or the outreach to drug users leaving prison that it has in the past.
That’s bad news for the drug users whose trust Safe Recovery has earned over months or years, Dalton said, people who frequently turn to the program when they relapse or decide they’re ready to seek help.
At the same time, this year is on pace to be the most deadly in Vermont’s opiate crisis, according to recently released figures from the Health Department.
Through the first three quarters of 2015, there were 55 accidental opiate-related overdose deaths. In all of 2013, the most deadly year for opiates since the Health Department changed its methodology for tracking fatal overdoses in 2010, there were 58 accidental opiate-related deaths.
Those figures exclude overdose deaths determined to be suicides and those that involved opiates but where the official cause of death remains undetermined.
Safe Recovery was largely funded through a four-year federal HIV prevention grant that ends in November. The grant was greatly reduced in its final year, from $440,000 last year to $150,000 this year. Safe Recovery’s overall budget went from $554,000 last year to $295,000 this year (the program also received less in donations this year).
The Health Department will continue to fund Safe Recovery’s HIV testing and the syringe exchange at a reduced level through other state and federal money, officials said. The program will also continue to provide naloxone, but the distribution of the drug, which was part of a pilot approved by the Legislature, never included money to support operations.
Vermont is not eligible for the next round of HIV prevention grants because the incidence of the disease in Vermont is too low to meet federal standards going forward, said Tracy Dolan, deputy commissioner for the Health Department.
While she’s not surprised that the grant money supported other activities at Safe Recovery, Dolan said that was not its intended purpose. She acknowledged that losing it will “have an impact on the broader work with (injection drug users), including the important case management and referral work,” she said.
The Health Department’s division of Alcohol and Drug Abuse Programs (ADAP) doesn’t have any oversight of Safe Recovery and beyond naloxone distribution, Dolan said the state doesn’t formally track the program’s role in combating the opiate crisis.
The Howard Center and state officials have known for more than a year that the HIV prevention grant would be ending.
Bob Bick, the Howard Center CEO, said he’s unable to shift money within his organization to shore up the Safe Recovery program. The Howard Center’s $89 million budget comes almost exclusively from Medicaid payments for services and a grant from the state’s General Fund.
Medicaid revenue from other services isn’t sufficient to be diverted away from the programs earning it, and state grant money is tied to specific programs with outcome and reporting requirements of their own that must be met, he said.
The Safe Recovery program is one of several the Howard Center operates at a loss, he said. Transferring the staff to other programs that are generating revenue is a way to avoid laying them off while the Howard Center petitions the state for more money, Bick said.
Given the enormity of the opiate crisis, and the fact that 60 percent of people entering treatment are injection drug users, it would make sense for the state to find a way to pay for Safe Recovery, he said. However, to this point entreaties for more money have gone unanswered, according to Bick.
Bick is asking the state to come up with $72,000 for Safe Recovery as part of the mid-year budget adjustment process and $140,000 for the program in next year’s budget. That will allow Hanson and another employee to return to Safe Recovery, but won’t return the program to its previous staffing level.
“I would like to think we’ve dispensed with stigma for drug users, but if there were another program that likely saved more than 400 people from dying from another medical condition, I can’t imagine that the powers that be would have trouble finding $72,000 to sustain it,” Bick said.
Bick and State’s Attorney Donovan are members of the Governor’s Criminal Justice and Substance Abuse Cabinet, created by executive order in 2014 to address the confluence of drug addiction and criminality. At the last meeting, the group recommended that Gov. Peter Shumlin find the money to preserve Safe Recovery.
“We think this is a priority program,” Donovan said, “This is something I think our entire community should support. It’s an object lesson in how public health can support public safety.”
Andy Pallito, Shumlin’s newly appointed commissioner of Finance and Management and the state’s top budget writer, said the administration hasn’t made any “final decisions” about what will be paid for through budget adjustment or the governor’s budget proposal for next year — but money is tight.
Pallito has said the state will balance a $40 million shortfall in this year’s budget by shifting resources through the budget adjustment process. The administration has not said how it will address an estimated $66 million shortfall for the next budget year.
