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While the pandemic demanded the attention of the public last year, preliminary data shows that at least 157 Vermonters died in 2020 due to opioid-related overdoses — even more than the state lost to Covid.
Advocates say that while the crisis has been worsening for years, the pandemic brought unique challenges.
Kyle Burditt, a recovery coach at the Turning Point Center in Rutland, said that people seeking help with opioid use disorder last year lost crucial connections. Basic support groups like Alcoholics Anonymous or Narcotics Anonymous were unavailable, and recovery centers struggled to make contact with people.
“When you take away all that connection — at the drop of a hat, it’s just gone — it does unpleasant things to individuals,” Burditt said.
On this week’s podcast, Burditt describes how recovery programs have adapted. Plus, VTDigger’s Emma Cotton discusses her reporting on the dual public health crises of Covid-19 and opioid use disorder. Below is a partial transcript, edited for length and clarity.
What does a recovery coach do?
Kyle Burditt: We are peer recovery coaches. All of us have struggled with substance use at some point in our lives, and found our path to recovery. And that’s ultimately the job, is helping other people to find their path.
You have a message in your email signature that says, “If you are struggling, and your people are just watching you struggle, those are not your people.” What does that mean? And why do you keep that there?
Kyle Burditt: I put that there, actually, within the first couple of weeks of becoming a clinical counselor. I was looking around at some of the individuals I was trying to work with, and all of their “friends” were all of the people that they were using with. And that when those people come into treatment and leave treatment, they go right back out into that world. Their “friends” are encouraging them to pick up the bottle. Or encouraging them to pick up another needle, put something up your nose.
Those aren’t your friends. Those aren’t your friends, if you’re hurting and they’re just watching. That’s it. Just something about that process really highlighted it for me. I kind of lucked out. My world — all that’s left there are the people that are supportive now.
How much does your own experience with substance use still inform what you do on the day to day?
Kyle Burditt: Oh, very much. Now I can look at someone in front of me that’s hurting and tell them, “Yeah, I get it.” And there’s power in the knowledge that I really do.
I know what it’s like to have drank my paycheck again. I know what it’s like to not know where I’m going tonight. I know what it’s like to not know when I’m going to eat next. And there’s power in that. That’s part of that connection I’m looking to make with individuals. Versus — and I’m not trying to take away from the clinical work in any way, shape, or form; I appreciate its value — but when a clinical counselor tries to identify that, it’s much more of an “I understand.”
I get it. I have an understanding of it as well; I learned a bunch of stuff in school. So I understand as well, but I get it because I’ve been there. And that informs my work every day.
I’m curious if you could take me back to the opening weeks of the pandemic, when we first started getting news about self isolation, lockdowns. What’s going through your head as you start to hear about things like that?
Kyle Burditt: For me personally, I was kind of panicking for our people. We went from a bustling center — we are right off from downtown in Rutland, so foot traffic is pretty big — we had arts and crafts groups, we had groups here, three, four times a week that we are hosting people coming in. So we were always busy, always surrounded by our people. And then we were all working from our kitchen tables independently. And relying on digital means — the telephone, Facebook even — whatever digital means that our people were connected to as our only resource for staying connected with them.
I didn’t think it was going to work. I’ll be perfectly honest with you — I just didn’t think it was going to work. And I’m really glad I was wrong.
We did lose some people to the isolation. I feel like that set them back into some old patterns, old thought patterns and old emotional patterns. But we managed to maintain contact with a large majority of our population, and in fact, even increased our contact through that we picked up new individuals by being willing to adapt.
What’s the significance of that first point of contact? Why is it so important to be able to access people right at that initial moment?
Kyle Burditt: To oversimplify what we do — at the core of recovery coaching is making connection with individuals. And so that first contact, that’s that moment we’re hoping to connect in some real way with an individual. Versus just being another provider, or someone that’s going to provide just another diagnosis or another referral. We want to make connections with people.
Johann Hari has a theory of addiction that says that the opposite of addiction is not sobriety, but rather, it’s connection. And we very much operate under that philosophy.
We know, from looking at the numbers from last year, that overdoses went up by a lot. I know that’s really only one way to quantify the scope of the crisis here — I wonder, on the ground, what those rising overdoses look like to you?
It looks like we’re losing a lot of friends. It looks like we’re losing people that we have connection with. That’s the tough side of the work that we do is, we really are making connections with people. I care for the people that I work with, and we’re losing them. That’s what it looks like to us.
How much do you feel like this increase has to do with Covid?
Kyle Burditt: I don’t want to say 100%. But pretty high.
When our individuals lost direct contact with their primary support groups — and I’m talking AA, NA sorts of groups. That isolation for our individuals — the immediate isolation, the lockdown — I’ve got to believe that it tremendously affected people. And if that wasn’t the direct cause, it was certainly sort of the opening of the valve, as we all went through the reality of a pandemic.
When you take away all that connection — at the drop of a hat, it’s just gone — it does unpleasant things to individuals. Let’s add in a nice healthy stimulus check. Let’s give somebody a larger amount of money than they’ve had in a very long time. It is almost a comedy of errors that I feel like sort of set up a lot of individuals for the ultimate cost of this.
We know that this past year has been incredibly unusual, with the pandemic, for everyone. But you’ve been reporting on how it’s impacted the opioid problem in Vermont, on both the prevention side and the treatment side. How do we go about quantifying the problem, as we’ve seen it over the past few years, and as we’ve seen it change during the pandemic?
Emma Cotton: We heard a lot about the opioid epidemic in around 2013. In 2014, Gov. Shumlin, at that point, gave his state of the state address, and specifically dedicated it to the opioid crisis.
Around that time, the New York Times also had a story about Rutland, how Rutland had sort of fallen victim to heroin, and crime rates were going up. The issue was receiving quite a lot of attention at that point.
In 2014, at 63, Vermonters died of overdose. And I think there’s sort of been somewhat of an impression, among those of us who are not super close to the issue, that maybe there was enough action at that point taken; this issue has gotten better. I’ve spoken to people who were under the impression that that’s the case. And in reality, fatalities that are related to opioid overdose have increased every year except for 2018.
So in 2020, we saw a 38% increase in opioid related fatalities. And that’s only a preliminary number. We know that at least 157 people died, Vermonters died, which is around three people per week. And it’s actually more than the number of people who died due to Covid-19 in 2020.
I’ve been hearing from advocates and people who are on the ground — recovery coaches who are close to this issue — who are just sort of crying out that this is existential for a lot of these people, that this is a really, really serious problem right now.
What do we know about how much Covid has or has not played a role in those numbers?
Emma Cotton: It’s really hard to say definitively whether it is the cause. But I think most people are saying that it is really reasonable to expect that the pandemic has exacerbated opioid overdose and opioid use.
I’ve heard from people who say, Covid-19 is causing so much pain, people are losing people, there’s a lot of grief. People have lost their jobs. People are isolated. Opioids are pain relievers, and people are, I think, turning to this right now.
The isolation is really difficult for a number of reasons. People are using alone more than they were before the pandemic. And I’ve heard over and over how — Narcan has been used quite a bit recently. I think people sort of have an understanding that they should have that around, they should have someone with them who has it. So in case they overdose, they have someone there who can immediately reverse that overdose. And if someone is using alone, obviously, that is not an option. That’s been really dangerous.
The other thing that we’re seeing an increase with is fentanyl. And I think that’s really chiefly behind the rise in fatalities. Vermont has done a number of things, including reducing the number of opioids that are prescribed to people, but you know — that’s sort of a solvable problem. Fentanyl is a much harder thing to address.
It’s hard to know whether there might have been more fentanyl coming in last year, or something like that could have occurred alongside Covid-19. But Covid-19 definitely exacerbated this problem.
I guess another question on that would be, does it matter whether Covid caused these numbers or not? Does it change the way people are responding to that increase?
Emma Cotton: That’s a really interesting question. I think in some ways, it doesn’t, because a lot of the solutions need to happen anyway — at least this is what I’m hearing from a lot of advocates that I’ve spoken with. It’s exacerbating an existing problem that we still are working to address in many ways.
9,271 Vermonters were receiving medication assisted treatment in 2020. There are between 15,000 to 20,000 people who need treatment. And that includes people who are already receiving it — but, only half of the people who need that treatment are currently receiving it. So it looks like there needs to be an expansion of the programs that can help these people find recovery. And I think that expansion probably needs to occur, whether or not Covid-19 is here. I think this issue is here to stay until we address it.
You’ve been looking at how some of these programs work. What have you seen on the ground?
Emma Cotton: The state has set up what’s called a hub and spoke system. So a hub is a treatment facility that focuses specifically on opioids. And then a spoke is a physician practice. That could be like a psychiatrist, or a primary care physician, or an OB/GYN. And those are people who can sort of tangentially help with recovery.
This is the model that’s been in place for a while.
Emma Cotton: It has. Some people might be referred to a hub when they have an overdose and are in the emergency room. So the Turning Point Center, for example, responds to those and can set people up with treatment then and there. People can also decide that they’re ready to try to achieve recovery, and they can reach out specifically to a program like the Turning Point.
I spent a lot of time with the Turning Point in Rutland, and they’re doing some really interesting things. They have cookouts on Thursdays right now. People will drive by, and they’re holding out signs that are just saying, you know, come grab a burger or come talk to us. They’re really trying to invite people in and just start the conversation.
While I was there, I’m sort of hearing their conversations, and just being really grateful that people are calling in to try to achieve help. One of the things I’ve heard over and over again is, recovery coaches just being open and saying, ‘Hey, I’ve been through this before. It’s okay. You don’t have to feel ashamed. Let’s work through this together.’ And showing that lack of stigma and compassion is really important. So that is what they are definitely prioritizing.
Medication assisted treatment is also something that, I think, has been incredibly important for people to be able to access as they’re starting recovery.
And what exactly does medication assisted treatment look like? You know, if somebody is able to access that program, what is their treatment plan actually like?
Emma Cotton: There are a few different medications. One is buprenorphine. That’s coming from a pharmacy in most cases, and it doesn’t have the potential to be laced with fentanyl. And it is not really giving people a euphoric sensation, but it is curbing their cravings, and it is preventing them from entering withdrawal, which is obviously a really painful and difficult process. It’s been hailed by many advocates as really a great way to enter recovery.
The other drug is methadone.
There’s a bill that’s been moving through the legislature this session that would legalize small amounts of non-prescribed buprenorphine, like that people haven’t gotten through a medication assisted treatment program. From the advocates that you’ve been talking to, how significant a step would that be? What do they think would actually change on the ground if this bill goes all the way?
Emma Cotton: The number one thing that it would do would help people access buprenorphine immediately. I think one of the biggest challenges to folks entering recovery is, they’ll show up in a treatment center ready to take on recovery, which is a difficult process for them. They may be told, once they arrive, ‘well, come back in a week.’ That person may have just lost their chance to enter recovery.
I think what I’ve heard over and over is that it’s really important to capitalize on the moment when someone feels ready. So for people to be able to access this away from a doctor’s office, or before they’re ready to officially come forward and make an appointment with a physician to access buprenorphine, I think that is another gateway to recovery, and an important one. I think there are quite a few people who have entered recovery in Vermont who did it through non-prescribed buprenorphine. And the testimony on this bill, I think showed that to legislators who it seemed really, really came around in the end.
I wonder what other solutions are on the table to get at what seems to be a worsening crisis?
Emma Cotton: There is definitely funding coming in from Covid-19 that is going to help with this. I think there’s around $12 million that will be funneled to these treatment and prevention centers. The Turning Point Centers will likely receive some of that money. I’m not sure it’s entirely decided where that’s going to go and how. But I think that will really help.
I think what I’ve heard from, you know, people who are close to the situation is that it’s, it’s about harm reduction. It’s about trying to get people who are going through this, to feel ready to access recovery. And, you know, I think as much as Vermont has addressed stigma since 2014, when Governor Shumlin gave his state of a state state of the state address on this, you know, some stigma still definitely does exist. And, you know, it sounds sort of like a lofty goal to try to reduce stigma, but I think that is one of the number one barriers that prevents people from seeking treatment. So, you know, that’s a constant work in progress also.
But it sounds like getting into one of these recovery programs for a lot of people really is the only way.
Emma Cotton: Yeah, I think I think it is, and improving access and expanding and then locations where people can seek that kind of treatment is going to be vital to this. I think in Burlington, there are low barrier recovery centers where people can go, but in the more rural areas, you know, in Southern Vermont, and maybe in the Northeast Kingdom and the further reaches of the state, that kind of treatment isn’t necessarily available. And it’s it’s really difficult for people to, to access. So an expansion of those systems is really important.
And that’s, that’s where this federal money is likely to head.
Emma Cotton: That’s right.
In terms of big picture solutions, what do you see as the way out of this?
Kyle Burditt: I wish I knew. If I had that answer, I’d have a much different job, I guess.
I like what I’m seeing. Just speaking of addiction and substance use disorder, the conversation is being had in the light of day. People are talking about it. Active steps are being taken to reduce stigma, to increase programming, to increase connection. That’s ultimately the way out of it.
I think it’s unreasonable to assume that we can make addiction a thing of the past. But there’s certainly a lot we could do to improve the state of how we’re treating addiction and substance use disorder.
