[B]URLINGTON — A high ranking city official said Thursday that lobbying for prison reforms to give inmates better access to drug treatment is a top priority for a regional coalition created to battle the opiate epidemic.
“It’s not something that was a priority for us three years ago, but it’s a focus now,” said Brian Lowe, Burlington Mayor Miro Weinberger’s chief of staff.
Lowe was addressing a group of mayors, their staffers, city councilors and public policy experts from across the country, gathered at City Hall for a meeting of the the Mayors Innovation Project. Lowe spoke as a participant on a panel discussing the municipal response to the opiate epidemic.
Joining Lowe on the panel was Ithaca Mayor Svante Myrick, who has gained national attention for his support of safe injection sites that would allow people to use drugs with medical supervision and without fear of arrest.
There are approximately 100 safe injection sites worldwide, but none in the United States, though several cities are considering them. There are also efforts in the Vermont and New York legislature to allow for safe injection sites.
Officials with the Mayors Innovation Project said VTDigger could attend the presentations by panelists but asked its reporter to leave for the subsequent policy discussion, so that mayors and others could be more candid.
A major challenge in battling the crisis is the “diffuse authority” around who should lead the response, and the “fractured information” that must be compiled to inform those decisions, Lowe said.
Mayors are uniquely positioned to centralize authority and information by bringing together stakeholders to share data and be accountable to each other, Lowe said.
That’s the idea behind Burlington’s CommunityStat program, which brings city and state officials together with police, prosecutors, social service workers and medical providers. The model was cribbed from similar initiatives by the New York City Police Department and the city of Baltimore, Maryland that were not focused specifically on opiates.
The model creates “enormous social pressure” to meet obligations set by the group and also creates a central clearinghouse for data on the problem, and helps to ensure stakeholders aren’t duplicating efforts, Lowe said.
“The fundamental question is ‘Who in your city can drive the response across sectors?’” Lowe said, urging mayors to “find your key partners and bring them together.”
CommunityStat has met in the same City Hall auditorium where Lowe was speaking since November. During that time, the lack of access to medication assisted treatment in Vermont’s prisons has emerged as a major obstacle to reducing overdose deaths and helping drug users get into recovery, according to Lowe.
Medication assisted treatment is the combination of counseling and prescription drugs, primarily methadone and buprenorphine, which stave off cravings and withdrawals without getting the user high.
In 2015, VTDigger reported on a cycle of people losing their place in a treatment programs when they’re incarcerated and relapsing while in prison or upon release. Experts say drug users coming out of prison are at greater risk of fatal overdose because of their reduced tolerance.
Mayor Weinberger wrote a letter to lawmakers in March urging them to pass H.468, a bill which would allow prisoners who were in treatment within 90 days of being incarcerated to receive treatment medication indefinitely while in prison — even if they test positive for an illicit substance upon intake. Its sponsor is Rep. Selene Colburn, P-Burlington, a former Burlington city councilor.
Lowe said that the mayors will continue to lobby for prison reforms around access to treatment medications, and those efforts will be bolstered by other CommunityStat stakeholders.
Currently, short-term prisoners can continue on treatment medication, and inmates in two northwest Vermont prisons can take treatment medication for up to 90 days before being tapered off. In the rest of the state, the limit is 30 days.
Department of Corrections policy allows prison medical staff to immediately discontinue or taper off treatment for incoming prisoners who are expected to be held for more than 30 or 90 days. That can happen even before a defendant is sentenced.
Colburn said the bill received a thorough hearing in the House Committee on Corrections and Institutions, but was never brought up for a vote. Over the summer, Colburn said she’s met with DOC officials, including Commissioner Lisa Menard, urging them to expand access without a new law.
“They’re saying they’re going to expand to 90 days at all prisons, but frankly they’ve been saying that for a long time,” she said.
DOC officials did not immediately respond Thursday when asked if the department’s policy has changed in recent months.
Are safe injections sites part of the solution?
Myrick, the Ithaca mayor, said safe injection sites are part of an overall harm reduction strategy.
Harm reduction boils down to answering the question: “If you can’t stop people from doing something that’s harmful, how do you mitigate some of the harm from that behavior?”
Myrick spoke about pushback against safe injection sites that resulted in the morning cable news show “Fox and Friends” requesting he be recalled as mayor.
Harm reduction strategies are frequently controversial when they’re first introduced, he said. People resisted seat belt laws and sex education that teaches about contraception, but both have proven effective, Myrick said.
Vancouver, British Columbia, has had a safe injection site since 2003. Nobody has fatally overdosed at that site, according to multiple reports.
Myrick said safe injection sites don’t enable or encourage drug use, but rather provide medical oversight and an opportunity to connect with treatment providers and other social services.
Survey data from the Vancouver safe injection site shows that people there are not first time users. Most are living on the streets, and when they overdose outside, there may be no one to resuscitate them, he added.
“Often they might go months without anyone asking about their health and wellbeing,” Myrick said, describing the people who might benefit from a safe injection space.
Ithaca’s push for a safe injection site got a boost in June from legislation introduced in the New York State Assembly by Assemblymember Linda Rosenthal, a Democrat representing parts of New York City, according to a report in The Ithaca Voice.
Rep. Colburn has introduced legislation that would allow safe injections sites in Vermont, but that bill languished in committee too. She said she plans to push for its passage again next session.
Colburn said she’s optimistic that it will get more serious consideration when a commission formed by Chittenden County State’s Attorney Sarah George releases its report studying whether the region would benefit from a safe injection site.
George said Thursday that the commission is in the process of drafting its recommendations, and to release its report in October. The report will include survey results from drug users about whether they would use such a facility were it available.
The report will examine the potential benefits and drawbacks, but she expects its recommendations will be “largely in support of safe consumption sites.”
Burlington Police Chief Brandon del Pozo told VTDigger fatal opiate overdoses continue to spike in British Columbia despite the safe injection site.
Del Pozo shared a link to a CBC report that April was the most deadly month on record for opiate overdose in British Columbia. The chief said his point isn’t that safe injection sites have no value, but there’s an “opportunity cost” to pursuing them.
The report attributes the increase in overdose deaths to the rise of fentanyl, a powerful synthetic opioid that has caused massive damage in Vermont as well, and states that Canada’s federal government actually approved more safe injection sites, including three more in British Columbia, as part of its response to the spike in deaths.
Still, del Pozo said the limited resources to fight the opiate epidemic in Vermont should go to ensuring treatment is available on demand, it’s accessible in prison, there is better outreach to those at risk of overdose and other prevention efforts, before it’s spent on opening safe injection sites.
The chief said he believes safe injection sites would be illegal, and called their overall impact on overdose death rates “murky,” making it critical for cities to ask whether it’s money well spent, especially in Burlington where there is still a waiting list for treatment.
“Wealthy cities with strong treatment regimes can try safe injection sites with few opportunity costs. Ithaca and Burlington are not those cities,” he said.
Colburn said she too believes making treatment available on demand should be the top priority, but she’s not convinced the two are mutually exclusive or competing over the same finite resources.
“I think we need safe injection sites. I think it’s definitely part of the puzzle,” she said.
