In the shadow of the pandemic, an epidemic has raged on.
Inside Rutland’s Turning Point Center, a bulletin board hosts obituaries of area residents who have died from opioid use disorder. It’s crowded — much of the space is occupied by faces and stories of people who have died since the pandemic began.
Since March 2020, Covid-19 has demanded the attention of the public. In Vermont, 148 people died from the virus in 2020, and many more lost jobs, suffered long-haul effects from the virus, closed businesses and had their daily lives upturned.
For many people with opioid use disorder, the pandemic has taken an alarming toll.
“Part of that is the isolation — that people are using alone more often, which is a huge risk factor,” said Tom Dalton, executive director of Vermont for Criminal Justice Reform. “Also, we all are feeling a lot of stress and anxiety, and pain of loss, not only from people dying from Covid-19, but also loss of employment, loss of contact with family members and with friends, and with activities that are healthy.”
Covid-19 has exacerbated the opioid epidemic, but those close to the issue say it has also highlighted an existing problem that has only become worse over the years.
In 2014, then-Gov. Peter Shumlin dedicated his entire state of the state address to the opioid crisis. The New York Times wrote about the drastic toll the epidemic took on Rutland, which was brought to the forefront when an unconscious driver, who was high, crashed into a local teen, killing her.
Local and state officials sprang into action, starting new programs and dedicating millions in funds to the problem. Seemingly addressed, public awareness about the epidemic began to fade.
Dalton has long advocated for more overdose prevention measures. He said he’s seeing “opioid crisis fatigue” — legislators, the media and the public haven’t been talking about substance use disorder in a way that reflects the extent of the crisis.
“There’s a perception that it’s gotten better when it hasn’t,” he said. “Part of the reason people think that is because they’re not hearing about it as much, and so even if they see somebody that they know that has passed away, it could feel like it’s more of an isolated incident.”
A look at fatal overdose data in the past several years shows the problem has only worsened. In 2014, the year Shumlin gave his speech, 63 Vermonters died of overdoses. That number climbed to 96 in 2016, then to 130 in 2018. Overdose deaths declined for the first time in 2019.
In 2020, three Vermonters died per week, on average. A preliminary figure, which doesn’t include deaths that occurred out of state, shows that at least 157 people died from an overdose last year — more than Covid-19. That number marked a 38% increase from the previous year.
“It feels like I’m standing on the battlefield,” said Brenda Siegel, an activist in Windham County who lost her nephew to a heroin overdose in 2018. “People are just dying all around me.”
Officials say help is on the way: $12 million in Covid-19 relief funds will soon be funneled into programs that promise quicker access to services and harm-reduction efforts — something advocates around the state have underlined as a top priority.
The Legislature has preliminarily approved a bill, H.225, that would legalize the possession of small amounts of nonprescribed buprenorphine, a drug that helps people with substance use disorder enter recovery. Some legislators, first skeptical about legalizing the drug when it isn’t prescribed, changed their minds after an outpouring of testimony from Vermonters close to the issue.
But Siegel, who helped push for the bill to be introduced, said those actions haven’t yet improved the situation on the ground. Over the past several weeks, she’s watched the movement of H.225 closely.
“When it became clear that they were going to pass it out of committee,” she said, “seconds after I heard that, I heard that another young person in my community died.”
‘Where are they going to go?’
Thursdays are busy at Rutland’s Turning Point Center, when recovery coaches invite residents to stop by for a weekly cookout.
Normally, the center is a social environment. Pottery, bingo, woodburning and grilling outside are typical activities. But when the pandemic hit, Turning Point was forced to close temporarily.
“We were closed for a few weeks,” said Tonya Wright, a recovery coach at Turning Point. “We tried to stay open as long as possible. But it got to the point where we had to shut down. Face-to-face meetings came to a complete stop. Everything stopped.”
At the time, the center was setting up a program in which it would respond to calls from the hospital emergency department, giving patients recovery resources. Eventually, that program transitioned to Zoom.
“We have people coming in here on a daily basis, and now they can’t, and so where are they going to go?” Wright said, describing concern she felt when the pandemic first hit. “How do we know how they’re doing and where they are, and if they need anything? So that was super rough on this staff because these are people that you form relationships with and care about.”
The center reopened a few weeks later. Recovery coaches have forged ahead with outreach, but most have stories about losing someone with whom they’ve worked.
“When you find out that the person has lost their fight with the battle, it really hits you,” said Mike Daly, another recovery coach, who said he knows of at least eight people who died from overdoses in the past year.
“Every person that’s on that wall has hit us in a bunch of different ways,” he said, referring to the center’s memorial wall. “We’ve got parents that come here and have loved ones who have died. They get coached — because we do family recovery coaching here as well. It’s definitely a big impact when you lose somebody.”
Sheena Daniel, director of emergency services at Rutland Regional Medical Center, said she has seen nonfatal overdoses increase in the past year, too.
“We saw a 62% increase in patients between 2020 and 2021 who were discharged with the diagnosis of opioid addiction, overdose or dependence,” she said.
The department had 21 such patients between Jan. 1, 2020, and May 1, 2020, and 34 patients in the same time period in 2021.
“I think the biggest thing that we’ve all noticed is that we’re seeing patients that we haven’t seen before,” Daniel said.
The coaches at Turning Point have some personal experience with recovery — either they’ve struggled with opioid use disorder, or they know someone who has.
Jenn Loso, a new coach with the center, entered recovery earlier this year. After a number of surgeries, doctors prescribed opioids, and she developed a dependence.
Aware that 80% of people who use heroin have had a previous dependence on prescription opioids, the state worked to reduce the number of opioids prescribed to patients. Between 2016 and 2020, that number had decreased by 45%.
At the time, that drastic shift left Loso with nowhere to turn, then she was introduced to heroin.
“Sadly, I had become really addicted and started getting in trouble,” she said.
Covid-19 ultimately helped Loso, she said. The isolation kept her from people who weren’t supportive of recovery. At home, her family gave her the right support.
“I’ve noticed that, because we get a lot of the people that are in the hotels or they’re homeless, they just don’t have the support,” she said. “That’s what’s making it so much harder.”
‘System navigation is a nightmare’
Turning Point coaches have also extended their services to more rural areas within Rutland County in what’s called the Peer Recovery Outreach Program.
In Fair Haven, Kyle Burditt sits on a couch below stained glass windows in the First Congregational Church, hoping to meet some locals interested in beginning recovery.
He piloted the program because he knows it’s hard for people outside of Rutland City to access support. Transportation, namely, poses a significant barrier.
Burditt says recovery coaches do not diagnose or prescribe medications to the people they help. Rather, they encourage them, and help them understand the system.
“When you are at the kitchen table, pen and paper, lots of time carved out, system navigation is a challenge,” Burditt said. “If you don’t know where you’re going to sleep tonight, whether or not you’ll eat today, where your dollars are coming from, system navigation is a nightmare.”
For people experiencing opioid use disorder and homelessness, motels across the state, which are used in Vermont’s emergency housing program, can be a difficult place to find recovery.
“You’re surrounded by it,” said Tracie Hauck, executive director of the Rutland Turning Point, who said the organization has been working to offer resources to those staying at the motels. “You have a bad moment when you feel crappy, and it’s right there.”
In January 2021 alone, the state documented 11 deaths from opioid overdose. All of them involved fentanyl.
The rise of fentanyl
In 2020, fentanyl — a synthetic opioid that’s 80 to 100 times stronger than morphine — was found in 88% of Vermont’s opioid overdose fatality cases and is “currently the most prevalent substance involved in opioid-related deaths,” according to a state fact sheet.
That marks a big change from recent years. In 2009, fentanyl was only found in 9% of fatal overdoses.
Cindy Seivwright, director of the state’s Alcohol and Drug Abuse Program, said the state is trying to address a rise in stimulants, such as cocaine, which can also be mixed with fentanyl.
“Since Gov. Shumlin’s address, it was prescription opioids that we were seeing and that people were getting addicted to and overdosing on,” Seivwright said.
Fentanyl, however, is a much harder substance to control. Jess Kirby, a case manager with Howard Center Safe Recovery, said she’s seen the presence of fentanyl dramatically increase in the past several years.
“We have fentanyl testing strips, and I would say, over the past one to two years, it’s become more and more common,” she said. “Now it’s the norm that people test their substances, and they’re telling us that it’s always coming back positive.”
The presence of fentanyl drastically heightens the danger of overdose, and Kirby said she’s concerned about her clients who she knows are coming in contact with it.
“They’re talking about having multiple overdoses, sometimes in a week. They’re talking about reversing overdoses of friends and family,” she said.
She said it’s made staff ensure they’re instructing clients about fentanyl testing strips and proper use of Narcan, a medication designed to rapidly reverse opioid overdose.
“If people are using several times a day, and it’s fentanyl, then their lives are at risk several times a day. So it just feels like the stakes are a lot higher,” she said.
Treatment during Covid-19
State officials have maintained that Covid-19 hasn’t taken resources away from the opioid crisis in Vermont, but at a recent press conference held to discuss incoming funds that will go to programs that address substance use disorder, Gov. Phil Scott said the pandemic has taken priority.
“The pandemic, in a lot of respects, has overshadowed everything across the world,” he said. “It’s not so we haven’t been doing anything with the opioid crisis, but certainly our focus has been on the pandemic.”
“We have been doing a lot of work, but admittedly, not enough in some respects,” he said.
While other states’ programs have closed during the pandemic, Vermont’s programs have remained open, Seivwright said.
“As far as the work that we were doing across the state, that never stopped,” she said. “And that’s something I am so proud of in Vermont.”
Kirby said Howard Center Safe Recovery has kept its syringe exchange program and low-barrier buprenorphine programs open throughout the pandemic, and she saw a steady number of people use those programs.
She said Covid-19 has also brought flexibility to recovery that didn’t exist before — the ability to stay at home during telehealth appointments, for example. But in-person services, which benefited many of the center’s clients, had to be reduced during the height of the pandemic.
“People, all day, every day, would come in and get help with crisis management — substance use crisis, mental health crisis, sometimes criminal justice crisis, and they would just drop in,” she said.
Kirby said that, throughout the pandemic, the center allowed people who needed in-person treatment to come in, though services mostly switched to virtual. The center is now slowly pivoting back to its normal services, which Kirby said will be good for patients.
Access to buprenorphine
Kirby has been working at the Safe Recovery Center — a low-barrier harm-reduction program — for five years. The program provides rapid access to buprenorphine for people who are at high risk of overdose.
“The state has been a leader in that in the sense that there is a low-barrier program in Burlington safe recovery that provides access to buprenorphine,” Dalton said. “But that’s not available statewide.”
The first time Kirby encountered the program, she was a patient.
Kirby started using opioids in a bathroom when she was in seventh grade and stopped only when she gained access to nonprescribed buprenorphine. Kirby testified recently on H.225 in front of the Senate Judiciary Committee, detailing her own long-term recovery from opioid use disorder.
“Like a lot of my clients, I really, really wanted to stop using,” she said. “I ended up using nonprescribed bupe that I accessed through friends or partners.”
Kirby told VTDigger that she was terrified of going through withdrawal symptoms.
“I had experienced them, and it was worse than anything that I had ever been through,” she said. “My entire life was about trying to avoid that because it was so scary. People talk about withdrawal symptoms being uncomfortable, and that is not the correct word. I would say more like tortuous.”
Having been rejected from a number of programs and after receiving “one too many dirty looks,” she lost trust in the medical and social service systems.
“I had never known a way out. I could never see a way forward,” she said.
“I remember being filled with relief when I first gave it a try, like a real go, and realizing that it really worked, and that I could be free from the withdrawal symptoms that have been debilitating my life for years,” she said.
Kirby has been in long-term recovery for more than 13 years. Now, at the Howard Center, she helps people gain that kind of immediate access to buprenorphine.
“If somebody drops off for a little while or loses contact for a couple of weeks, or decides that they don’t want to be in treatment right now, they can come right back to us and we’ll prioritize them in the same way that we did on that first day,” Kirby said.
She said asking people to wait over the weekend for treatment, or even just for a few hours, can be “minutes or hours that we lose people.”
“With fentanyl being as potent as it is, and with the overdose rates so high, we really want to be able to give people treatment in the moment when they ask for it,” she said.
State data shows that 9,271 Vermonters are currently receiving medication-assisted treatment for an opioid, but estimates that a total of between 15,000 and 20,000 Vermonters need that treatment, including those who already receive it.
“Vermont has done a lot more than most states to increase access to treatment,” Dalton said. “But according to the health department’s own estimates, fewer than half of the people that need access to medication assisted treatment are actually getting it under our current system.”
Several state’s attorney’s offices have already stopped prosecuting for possession of small amounts of buprenorphine. If Vermont legalizes the treatment, it will become the first in the nation to do so.
An open door
While many advocates have been pushing for immediate access to treatment and the legalization of buprenorphine, another seemingly simple tool has the potential to bring meaningful change: compassion.
Many who have suffered from opioid use disorder say stigma prevented them from seeking help sooner.
“I was really feeling a fear of failure,” Kirby said. “I was really feeling like, I don’t want to try to be in treatment until I really feel like I’m ready and I actually think I’m going to be successful. So I would put it off because I just wouldn’t feel at that right point. But then things got worse and worse.”
She said she didn’t want people to think she wasn’t trying hard enough.
“All of that makes it an extremely hard thing to do, to walk in somewhere, pick up the phone and to ask for help.”
In his 2014 speech, Shumlin asked Vermonters to view opioid use disorder as an illness instead of a crime. Since then, Kirby said, Vermont has come a long way in leaving stigma behind. But it isn’t gone.
“Since I was struggling, I think that we’ve come an enormously long way,” Kirby said. “But I still think that the internalized stigma that people feel is very real and is still there.”
Dalton points to the criminalization of substance use disorder.
“A lot of people are afraid to seek help through the treatment system,” he said. “They don’t want the fact that they have an opioid use disorder documented in their medical record. We take people’s children away from them for having opioid use disorder, and people don’t want that identified to the Department for Children and Families that they’re struggling. It’s a process for people to come to the point that they’re willing to access the hub and spoke treatment system.”
Burditt, sitting in the church in Fair Haven, said he’s looking to open a conversation with people who are considering entering recovery.
“I just want to sit and connect with somebody,” he said. “The folks we’re working with on a daily basis are those folks that have been marginalized by society, marginalized by their families, by their friends. That sense of connection becomes so very important in a person’s world.”
For some, lived experience provides a gateway to helping others with the hurdles of recovery.
“I always just try to tell people that no matter what, just come back, or just give me a call, and we can start there,” Kirby said. “It doesn’t have to go any further than that. I’m going to be here for you. Regardless of whether you’re accessing treatment or not, I’ll be here with the door open.”
State officials encourage anyone who needs help with substance use disorder to visit vthelplink.org.
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