BURLINGTON — In the first weeks of March, as Vermont and the country entered lockdown, Grace Keller felt a sense of dread. Not just because of the impending pandemic, though that was part of it. But because, after her many years working on overdose prevention at Burlington’s Howard Center, she knew what quarantine, and a pandemic, would mean for drug overdose deaths.
Her fears were well-founded. Nine months into the pandemic, Burlington is still reporting high numbers of overdoses, after a particularly sharp rise in the spring. And the trend is consistent across the state.
By September, 109 people in Vermont had died of an opioid overdose, about 25% higher than the previous three years. Vermont appears likely to break its record for fatal opioid-related deaths in one year — 130, set in 2018.
Other factors — including the growing prevalence of fentanyl, a dangerous synthetic opioid — may also be behind the sustained rise. But health officials, and those working in overdose prevention, point to the pandemic.
Keller is the coordinator of the Howard Center’s Safe Recovery program, a syringe service program and resource center for people struggling with opioid use disorder in and around Chittenden County. When the pandemic hit in March, there was a sense of urgency among staff.
“We didn’t shut down, even for an hour,” Keller said.
Safe Recovery offered services, which include not just syringe exchange and disposal, but distribution of Narcan and connections to treatment, at a distance, through the back window.
“For people who work in overdose prevention,” Keller explained, “the second thought that came immediately following [concerns about the coronavirus] is that isolation is incredibly dangerous. And a lot of times, when we see fatal overdoses, people die because they are alone.”
‘Don’t use alone’
“Don’t use alone” has long been a central public health message to people who are using opioids. If an individual overdoses alone, there is no one to call for help.
The need for social distancing during Covid has made that message complicated. And as Vermont faces another lockdown, health professionals worry what the winter may bring.
“With the new restrictions on social gathering, which impact recovery services, we’re nervous about what we’re going to see in the tail end of the year,” said Kelly Dougherty, deputy commissioner at the Vermont Department of Health.
Already, the rise in overdoses has been felt hard. “When each of these numbers is somebody that you know, and you know their families, and you know how hard they were fighting to stay alive, how much they loved their job, or their children, or their friends — it’s devastating,” Keller said.
In Burlington, police responded to 78 overdoses, including non-fatal incidents, in the first 10 months of 2020, up from 43 in the same period last year. In late summer and fall, overdoses have remained nearly 40% ahead of the fall of 2019. This data, though, is only an indicator. It represents just police contact with overdoses, which does not occur in all cases. “A lot of non-fatal overdoses happen, and nobody knows about them,” Dougherty said.
Statewide data on overdoses show the number of emergency room visits for overdoses has remained consistently high this year, compared to a three-year average. Though the trend has slowed some since the summer, health officials say the numbers are still worrisome. And fatal overdoses have remained high, particularly in Chittenden and Windsor counties.
Chittenden County had reported 17 fatal overdoses through September 2020, up from 12 in the first nine months of 2019 and just nine the year before. “The fact that we’re seeing overdose numbers climbing again is very, very disconcerting,” said Keller. “And very worrisome, and heartbreaking.”
Just two years ago, Chittenden County celebrated a 50% reduction in fatal overdoses from 2017 to 2018, even as numbers rose in the rest of the state. At the time, Burlington Mayor Miro Weinberger credited the city’s efforts to combat the opioid crisis. It had expanded access to medication-assisted treatment and informally decriminalized buprenorphine, a medication used to treat opioid use disorder.
“We were starting to feel like we were headed in the right direction. And we definitely feel that Covid has had an impact here,” Dougherty said.
Across the country, states are reporting similar overdose spikes, she said.
How to get help
The Vermont state Help Link website offers information about treatment and recovery services.
Howard Center’s crisis line connects people seeking treatment with resources. Go online here, or call 802-488-7777.
Fentanyl is more prevalent
There are other factors at play. In recent years, fentanyl, a highly potent synthetic opioid, has become more common in Vermont. Such synthetic opioids, which carry a high risk of overdose, are now a driving force behind the nation’s overdose deaths. Substances like heroin and methamphetamine are increasingly laced with fentanyl, heightening the risk that users will overdose.
In Vermont, the use of fentanyl has spiked dramatically over the past several years. In 2016, about 51% of Vermont’s overdose deaths involved fentanyl. So far in 2020, 88% of overdose deaths have involved the drug.
“Fentanyl is really what has changed the landscape of overdose and fatal overdose in Vermont,” Keller explained. Even before the pandemic, fentanyl was driving up overdose deaths. And across the state, residential treatment centers, recovery resource organizations and programs like Safe Recovery have been on the front lines to combat the trend.
Services more limited
Before the pandemic, many with opioid use disorder have had difficulty obtaining treatment, facing stigma against addiction and systemic incarceration. Now access to services has become even more limited.
In the second quarter of 2020, the number of people receiving residential treatment dropped by 63%, according to an October report from Vermont Department of Health. The number of people in intensive outpatient treatment was down about 61%.
“Accessing drug treatment and recovery supports has become much harder since the Covid-19 crisis started,” said Tom Dalton, executive director of Vermonters for Criminal Justice Reform. “It’s very common right now for people who want residential treatment to wait two or three weeks before they can get treatment.”
The impacts of that wait time can be deadly, he said. “That is a very high-risk time for them to be struggling, and asking for help, and not able to get it.”
Some clinics that provide methadone, Dalton said, have limited the number of times they give out doses of the treatment per week. And people who are incarcerated report that they have faced longer wait times for the medication since the pandemic began.
Recovery programs in Vermont have scrambled to adjust. An in-person component is often critical to counseling and treatment, according to many people working in addiction recovery. But as a result of safety measures for the pandemic, in-person visits to recovery centers had dwindled by 81% in the second quarter of 2020, according to Department of Health data.
Chittenden County’s Turning Point Center, one of those recovery centers, has moved much of its programming online. The change has substantially affected the center’s services, Jesse Bunch, the director of Turning Point, told VTDigger. “We’re serving fewer people,” he said. “The people we serve used to walk right in the door and sit down.” Without that access, he said, it has become difficult to reach them.
Before the pandemic, Bunch said, the center served about 1,000 people per month. Now, the center is serving a few hundred. “It’s a big problem,” he said. “And of course, the biggest problem of all is we don’t know who those [missing] individuals are. We don’t know where they are.”
Lack of access to technology is one reason, Bunch said. Many of the people Turning Point serves don’t have cellphones or access to the internet, meaning that Zoom counseling sessions are not an option for them. Or, if they do have access to the proper technology, many may not know there are online resources available. “There’s a big information gap at the moment,” he said.
Still, Turning Point has continued one of its in-person programs: Its emergency department recovery program, where coaches, who are themselves in recovery from addiction, offer support to people after an emergency room visit. Cam Lauf, the center’s associate director, sees the program as an example of the importance of person-to-person contact for recovery.
“I’ll speak from my own experience here, being a recovering heroin addict,” he said. “Showing up in the emergency department isn’t really the most comforting experience. Somebody might already be in physical withdrawal.” On top of that, he said, there is the stigma around drug addiction, which can be a barrier to treatment.
“Just sharing the space with somebody is extremely powerful,” Lauf said. “For them to understand that they’re not alone, that they have somebody there, who’s been through this similar process, who understands what’s going on — that’s extremely powerful, that’s extremely helpful.”
But even with in-person service, the program is still serving fewer people. It enrolls about half as many individuals as in the months before pandemic, Lauf said, and in April, that number was far lower.
Anticipating similar trends, the Howard Center bought cellphones for some in its counseling services when programming moved online in March. Though challenges remain, Keller said, some counselors report an uptick in patients since the beginning of the pandemic. And that work is critical right now, she said.
“These services are keeping people alive in so many different ways,” she said. “It’s not just Narcan, and reversing overdoses. It’s that human connection that we all need right now.”
Of the hundreds of people that Safe Recovery serves, Keller was aware of only three who had contracted the coronavirus. But she is worried that too will change as the winter approaches. “We talk a lot about fatal overdose, and that is obviously at the heart of what we do,” she said. “But in our low-barrier program, we’ve had people die from many different things.”
“The truth is, getting and keeping people in treatment, and making sure they have connections, and consistent resources, is keeping people alive in so many different ways,” she said. And as the state confronts a new wave of the pandemic, the stakes are high.
