Health Care

Burlington, partners taking new steps to tackle opiate crisis

Miro Weinberger
Burlington Mayor Miro Weinberger, left, speaks at a news conference Thursday with Chittenden County State’s Attorney Sarah George, UVM Medical Center Chief Medical Officer Dr. Stephen Leffler and Burlington Police Chief Brandon del Pozo. Photo by Morgan True/VTDigger
BURLINGTON — Officials unveiled several new partnerships and initiatives Thursday meant to help address the region’s opiate addiction crisis, which claimed a record number of lives last year.

Figures released recently by the Vermont Health Department show the number of fatal opiate overdoses in Vermont jumped from 76 in 2015 to 105 in 2016.

Three years ago, Gov. Peter Shumlin brought the opioid crisis to the forefront in his State of the State address. “In the time since, many individuals have worked extremely hard on this issue and achieved important successes,” said Mayor Miro Weinberger at a news conference to announce the new efforts.

“Despite this hard work by so many for so long, it is also unmistakably clear that this opioid crisis has continued to deepen, taking lives at an unprecedented rate and ravaging the community,” Weinberger said.

Burlington Police Chief Brandon del Pozo pointed to data from the Department for Children and Families from 2015 showing that in 51 percent of 276 cases where children younger than 6 were placed in state custody, the reason was the parent or guardian’s opiate use.

“If the number of deaths doesn’t grip you, then the number of children growing up in fractured households should,” del Pozo said. “It’s literally tearing families apart.”

Hospital to reduce opiate prescriptions

The mayor and police chief were joined by recently appointed Chittenden County State’s Attorney Sarah George, Health Department Commissioner Dr. Harry Chen and the University of Vermont Medical Center’s chief medical officer, Dr. Stephen Leffler, to outline the new partnerships and initiatives as well as a set of guiding principles for the battle against opiate addiction.

One of the principles is that “prescription opioids can be as dangerous as heroin.” Although people do overdose on prescribed medication, many more become addicted and eventually turn to cheaper street drugs like heroin.

The Burlington Police Department analyzed federal data for Medicare Part D beneficiaries from 2014, finding that Vermont doctors prescribed opioids to those patients at a 17 percent higher rate than the average for other New England states.

That doesn’t necessarily mean Vermont doctors prescribe more opiates overall than their counterparts in other states, because Part D beneficiaries are only 14 percent of insured Vermonters.

Harry Chen
State Health Commissioner Dr. Harry Chen. File photo by Erin Mansfield/VTDigger
Chen declined to comment on the Medicare data, which he said “limited the universe” of patients. But he said he agrees that Vermont doctors were overprescribing opioids in 2014 and continue to do so.

“We prescribed enough opiates in Vermont in 2015 to give every man, woman and child a bottle of 100 Percocets. That’s just too much,” Chen said.

There are other data sets using all patient populations that show Vermont is in the middle when it comes to prescribing opioids, “but it’s still too much,” he added.

Leffler said the UVM Medical Center is “committed to driving down the amount of opiates that we are prescribing” and greater transparency around its prescribing practices. To that end, the hospital will release prescription data sometime in the next 90 days, he said.

Leffler provided no detail about what data the hospital is planning to release, saying only that “we’ll be transparent with data to show we’re having effective results” in prescribing fewer opiates.

More timely data collection planned

Representatives of the Health Department and the Chittenden County state’s attorney’s office said they are both committed to providing more timely data on overdose deaths to help inform local partnerships such as the Chittenden County Opioid Alliance.

Chen said his department will begin providing monthly fatal overdose totals by county to agencies and community groups working to tackle the crisis, instead of publishing annual figures as has been its practice. George said that, because her office is legally required to be notified when any untimely deaths occur in the county, it will compile weekly reports of likely overdose deaths for the same purpose.

The Winooski and South Burlington police departments will join Burlington’s CommunityStat program, which aims to track data related to opiate use, such as how quickly drug users released from prison come back in contact with the criminal justice system.

It’s hoped that data will allow police, social workers and treatment providers to track high-risk users and get them help before they overdose or commit further crimes, del Pozo said. Adding the two neighboring cities will help identify and assist those people, the chief said.

Waiting lists for drug treatment persist

That jibes with another of the principles for tackling the opiate crisis officials laid out Thursday, which is the idea that police should give amnesty to users seeking help for addiction and send them to treatment.

Currently, that’s a difficult proposition because there is still a statewide waiting list for so-called hub providers, large-scale state-supported centers that provide medication-assisted treatment.

Waitlist, Opiates
The Chittenden Clinic in South Burlington. File photo by Morgan True/VTDigger
That wait list has decreased steadily over the last three years as capacity has grown, but the most recent figures from the Health Department show 191 people waiting for placement at a treatment hub. The lion’s share of people waiting are in Chittenden County, the state’s most populous.

Officials did not provide figures showing how long people are waiting, just how many, but in October 2015, when close to 400 people were on the waiting list, the average period a person had spent waiting to enter the Chittenden Clinic in South Burlington was 358 days.

While there are other treatment options, the hubs are the primary entry point for drug users looking to get clean.

Del Pozo said his department has encountered other challenges getting people who are arrested directly to treatment, though he didn’t go into detail. Six people have been arrested and sent by “special arrangement” to treatment programs, but all six were kicked out of those programs, del Pozo said.

“So we’re looking at a more effective way to deliver that treatment,” the chief said, adding that he planned to announce how that will work soon.

Another of the principles outlined Thursday is a commitment to tackling the opiate crisis as a public health problem, and del Pozo said his officers and their state and federal colleagues have not lost sight of that goal either.

His department has strong partnerships with the Drug Enforcement Administration, del Pozo said, and the “volume of major heroin dealing arrests” in Burlington has increased.

The “risk price” — a term the chief borrowed from finance — needs to be increased to deter out-of-state drug dealers from trafficking in Vermont, he said. Most drugs come to the state from criminal operations in major cities within driving distance, according to him.

“We need to make enough arrests to send a signal to Boston and New York that this is not easy pickings,” he said.

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  • Dave Bellini

    Good luck with this. VT is unrealistic in believing that substitution treatment is the way. I believe non-drug therapy should always be tried first and “MAT” should be a treatment of last resort. To do otherwise is a disservice.

    • Ed Piper

      It is indeed unrealistic to look to substitution strategies to move us forward in this epidemic. Nor is it scientifically accurate to not include these “treatment” agonists as “prescribed opiates” in any legitimate evidence base. It should not come as a surprise that since we began looking to, promoting, and offering replacement treatments, that the number of souls now dependent on opiates would not diminish, but balloon.
      It is frustrating to see effective, time proven abstinence approaches ignored in favor of the same naive medical/pharmaceutical industry that set this barn on fire. Recovery is not easy, but it’s worth the effort. Promising easier half measures not only disappoints, it is about as helpful as the neighbor who starts feeding your cats.

      • Neil Johnson

        You’re raining on Big Pharma’s parade, they want to treat drugs with drugs, the perfect cycle, plus they get the STATE to pay for the treatment drugs. It’s like the perfect swindle, hook them on a more expensive treatment to cure the original problem they caused with their own drugs. Then keep them alive with Naloxone, when you are about to loose a customer for life. Perhaps we should be treating them on life support too, might get them a few more years. It’s like we’ve sold our souls to Big Pharma. The whole thing is disgusting.

  • juliacurry

    This should also spur the medical community – and insurers – to include pain management techniques other than drugs.

  • Jim Candon

    This crisis has been mismanaged from the beginning. The fundamental starting point for opiate use and abuse has been Rx opiates for decades. So where has been the emphasis? Heroin! It’s never going to stop unless you stop the diversion of Rx opiates. That’s where it begins! As far back as the late 1970’s, ARCOS reports clearly showed the per capita use of many Rx opiates in Vt ranked near the top compared to other states. At that time, state police diversion investigations confirmed the widespread abuse in Vt of Rx opiates not only on the street but also in the ranks of medical professionals with easy access to these dangerous drugs. It’s been known for 60 years the danger these Rx drugs present due to their potential to become habit forming and subject to abuse.
    The Vt legislature and others applied the pressure to virtually stop meaningful oversight of the distribution of these dangerous drugs due to “patient privacy” concerns years ago. State police access to appropriate pharmacy records, including prescriptions, which is granted under Title 18 Chapter 84 was stopped and coincides with the beginnings of the current epedimic.
    Despite millions being spent every year in treatment, this epedimic will not end until tough measures are taken at the front end of the problem; Rx opiates. These drugs come out of Vt pharmacies and are prescribed by Vt doctors. Keeping the collective “head in the sand” will not make the problem go away.

    • Neil Johnson

      So true…..but we have no place to complain that will do anything. No real ethic in Vermont. Great notes.

  • Jim Candon

    The opiate epedimic began with the abuse of Rx opiates and continues to this day. So where has all the emphasis been placed? On heroin! Until these “experts” can wrap their minds around the abuse of Rx opiates and begin to understand the widespread abuse of these drugs, the death toll will continue to rise.
    In the late 1970’s it was clear Vt had a widespread Rx opiate problem. ARCOS reports showed that on a percapita basis Vt led most states in the consumption of many of these dangerous Rx drugs. At the same time state police diversion investigations showed that Rx opiates, prescribed by Vt physicians and dispensed by Vt pharmacies, were widely abused not only by the street but abused by medical professionals as well.
    Even though the state police are assigned the “duty” to oversee the legal distribution of these dangerous drugs in Chapter 84 of Title 18, including access to records of these drugs within a pharmacy , meaningful oversight has not been done in years. Why? Because forces in the legislature and elsewhere decided that “patient privacy concerns” prohibit the state police from viewing prescriptions for these dangerous drugs. The time when these meaningful diversion inspections stopped coincides with the explosion of the beginnings of the opiate crisis we see today.
    The “experts” were told this for years. However, the political correctness of ” patient privacy” has trumped the broader demands of public health and safety of Vermonters. The absurdity of overdose deaths, armed robberies, child neglect and other social wreckage as well as spending million upon millions in taxpayer dollars on treatment are the result.

  • Ken Cadow

    In 2012, a study conducted by the CDC showed Vermont to be in the lowest category of the number of opioid prescriptions per 100 people. (copy and paste: ) This doesn’t mean that we don’t have a problem. We happen to be among the first states to address it as a state-wide issue. This same link above will show that nationwide, sources of opioids for addicts in 2012 were primarily from unused portions of prescriptions that were given to someone else. I’m not sure how this compares to Vermont then, or today. It seems, however, that it would be worthwhile to track the prescription tendencies of individual physicians, including dentists, in an attempt to increase individual physician accountability. Does Vermont do this? If not, there may be stumbling blocks to setting up such a system, but it would be worth fighting for.

    Also, and this may appear to be completely off-topic, but public educators should be part of the upstream response. High school health classes teaching about the dangers of, and routes to addiiction are an obvious answer, but a deeper approach is asking what role education can play in helping to avoid a sense of alienation in the first place. What are the reasons that people who are not in physical pain wish to escape or to check out? Vermont’s Act 77 and its Personal Learning Plan is intended to put students and student-perceived strengths at the center of education programming. Some schools are enacting this in earnest, others are simply paying lip-service with single-page documents. The work of Stefanie DeLuca from Johns Hopkins University suggests that 40% of students, nationwide, fall into a “forgotten” category. I’d argue that a sense of not belonging puts one at higher risk for risky behavior and addiction. I hope that there is someone from the VT Agency of Ed on the opiate problem task force.

    • Neil Johnson

      High Schools and Jail are the easiest places to get drugs. If we were at all serious we would at least attempt to keep them from these two buildings.

    • Jim Candon

      Ken Cadow- who knows where the CDC figures came from in 2012. Those figures don’t comport with the Medicare part D data above or what’s been seen historically in Vt. As for tracking problem prescribing or dispensing practices in Vt; that’s what the Vermont Prescription Monitoring System is supposed to be doing. Heard much from them lately?

    • Martha Stretton

      “a deeper approach is asking what role education can play in helping to avoid a sense of alienation in the first place” — This alienation is due largely to lack of local family and community ties. We have lost much of our sense of belonging and our ability to make meaningful lives as local groups of humans. If education can find a way to help rebuild families, civic organizations, and person-to-person connections, it can certainly help. But I’m not sure this is within the time and energy constraints we already place on educators.

  • Peter Chick

    I suggest not advertising as a sanctuary city. By allowing unlawful behavior you are promoting unlawful behavior.

    • Neil Johnson

      Jail is a networking chamber of commerce for Drug Dealers.

      We have in place a system to monitor Doctors and Opiates. We fail to use it, it’s called a license to practice medicine. All the Pharmacists know who the abusers are. 100 Percocet for every person in Vermont?

      Every town knows where and who the local drug dealers are.

      Yet we do nothing. It’s so easy to be a drug dealer in VT, no permits needed!

  • Neil Johnson

    Mayor Weinberger clearly wants to run Vermont from his Mayoral office. Certainly gets a ton of state wide press for everything he does. Clearly the favored progressive by media.

    Meanwhile he’s working on getting the entire state to pay for his town’s lack of planning and budgeting of the environmental catastrophe known as municipal sewer, or the North Beach Brown Trout Hatchery program, take your pick.

    After Burlington residents pony up $20k each for a septic repair as we do in the rest of the state….only then should we be talking about state money for their towns problems.

  • Ben Levitt

    It is so hard to hear these politicians and officials talk about how much they acknowledge and are concerned with the opiate crisis while on the same time criminalizing people seeking out herbal treatments, i.e. kratom. Kratom saves lives and Vermont, supposedly a forward thinking and progressive state, is one of the few states in the country to make it illegal.

  • Liz Leyden

    Believe it or not, most opioid users do not become heroin addicts. Reducing or further scrutinizing opiate prescriptions has resulted in plenty of suffering for people with chronic pain.

    • Jim Candon

      Very much agree that Rx opiates are very necessary medicines for “legitimate” pain sufferers. We absolutely need them. We also need to acknowledge that “pain” for illegitimate drug seekers is easy to fake ( like headache and backache), especially when presented to naive prescribers.