This commentary is by Mike Selick, associate director of capacity building at the National Harm Reduction Coalition, and Scott Pavek, a policy analyst and recovery advocate.
For the first time in our history, Vermont has surpassed 200 opioid overdose deaths in a single year. The 210 fatal opioid overdoses in 2021 mark a nearly 33% increase over the then-record 158 deaths observed in 2020.
Opioid overdose deaths are preventable, but the war on drugs and outdated treatment programs put people who use drugs at higher risk of overdose and death.
Following the national Sackler-Purdue opioid settlement, Vermont is due to receive $36 million — a sum that could be used to end our ongoing overdose crisis. However, if these funds are not allocated with a clear understanding of both changes in substance use trends and gaps within our state’s network of treatment, harm reduction and prevention systems, we cannot hope to end this public health emergency.
H.711, a bill detailing composition of an advisory board tasked with allocating this settlement, is currently receiving consideration in Senate Health and Welfare; we offer recommendations here both for the legislators designing this board and those individuals who will ultimately serve on it.
Vermont is home to a network of organizations dedicated to substance use disorder prevention, treatment, recovery, and harm reduction. While programs within each area of focus must be maintained through targeted investment, we call attention to the needs of our state’s syringe service programs — SSPs for short.
SSP staff members provide care to our friends and neighbors experiencing the highest risk of overdose, regularly fulfilling roles spanning case management, wound care, drug education and, too often, fundraising and grant writing. Despite the critical importance of SSPs — often a source of drug checking and harm reduction supplies, including fentanyl test strips and naloxone — these organizations are often the last to receive consideration when drafting budgets.
Settlement funds should not only bolster existing syringe service programs, but they should also be used to help establish new SSPs for underserved areas such as Windham and Windsor counties. No Vermonter should have to drive more than an hour to acquire the supplies required to keep themselves safe and healthy.
While many of us are painfully familiar with the opioid overdose crisis that began decades ago, general awareness of stimulant use is only catching up to the reality of drug use in Vermont today. Well before years of data were compiled to affirm our ongoing need for new stimulant-specific substance use treatment, SSP staff were highlighting this trend and forecasting the failures of public health strategies that focus narrowly on opioids.
Policymakers scramble to address programs and policies that fail to target stimulants today, but this need not be the case for future public health crises. By increasing the capacity of SSP staff and other harm reductionists to curb overdose deaths, such as through purchase of mass spectrometers and new drug checking equipment, we can also inform prevention and treatment programs by identifying emerging trends in the drug supply in real time.
Still, we can do better than giving people more information about the drugs they use; we can ensure no more Vermonters are lost to overdose and other harms of the war on drugs through implementation of overdose prevention centers. New York City has launched multiple overdose prevention centers with great success; there is no reason for our state to not do the same.
When considering which programs ought to receive support via settlement funding, we must support efforts to treat substance use disorder that will also address housing insecurity. Behavior change is already very difficult, and it is so much harder when you do not have a safe place to exist.
While housing is an important support for people struggling with their drug use, it is not a panacea. We must invest in “housing first” treatment, recovery and harm reduction programs that recognize the efficacy of medications for opioid use disorder, particularly agonist treatments such as methadone and buprenorphine.
“Medication first” program models recognize the most effective means of preventing drug poisoning is providing safe drugs in conjunction with social support, in contrast to traditional programs that place barriers between individuals and medications for opioid use disorder. No treatment program or protocol should pose any obstacles to individuals seeking to transition from illicit drug use to medications for opioid use disorder.
While we understand no single path from treatment to recovery exists, we have no reservations in calling for an end of all support to programs that demand abstinence or otherwise restrict individuals from pursuing the evidence-based treatment of their choosing.
The overdose crisis is dynamic; we will not effect change with static solutions. The knowledge, skills and experience of those policymakers finalizing settlement allocations ought to receive the same close scrutiny to which spending is subjected.
The investments and reforms discussed here have long been championed by individuals who use drugs, are in recovery, or have lost loved ones to overdose. It is past time to elevate individuals advocating for bold action to positions of leadership. Should new leaders embrace advice detailed here, we may finally make progress toward ending a crisis that continues to claim the lives of our friends and neighbors.
