Seventeen Vermonters died of an accidental opioid overdose in January, four more than in the same period last year — a year that brought the most fatal opioid overdoses in the state’s history.
Amid this rising death rate, the Vermont Department of Health said sites that distribute the opioid-overdose antidote Narcan can temporarily stop asking recipients to fill out a form. The form, which some distributors have described as “intrusive and demeaning,” is undergoing revisions while providers seek to clarify the data collection policy.
The state health department released the form in 2016 to assess the effectiveness of its Narcan program. Officials wanted to collect data such as whether the brand of nasal spray — generically known as naloxone — is being distributed in the areas that are seeing the most overdoses and if recipients have previously used it, health department Deputy Commissioner Kelly Dougherty said.
“Where are our distribution efforts most successful, where are there gaps, and the only way we can know that is if we collect some data,” she said in an interview.
Dougherty emphasized that people who seek Narcan from community distribution sites are not required to fill out the two-page form. Among the questions: the person’s substance use status, if they’ve ever experienced or witnessed an overdose and what drugs led to the overdose.
Dougherty said the health department has instructed distributors to give out the Narcan canisters before asking the recipient if they’re willing to answer some questions.
“The person already has it in their hand. They’re free to say, ‘no, thank you’ and walk out the door,” she said. “Our priority is getting Narcan into the hands of as many people as possible.”
Last year, the program provided almost $738,000 worth of Narcan to Vermont’s 115 community distribution sites, said department spokesperson Ben Truman. The data collection, he said, also helps the agency provide accountability for how it spends public funding.
The health department said it’s in the process of revising the form, with input from the Agency of Human Services’ trauma and resilience coordinator, to remove questions that could potentially traumatize respondents. The new form is expected to be released in May or June, Dougherty said.
Paul Dragon, director of the Champlain Valley Office of Economic Opportunity, one of the state’s largest anti-poverty organizations, believes the form should be eliminated.
“We don’t think there should be another form in its place,” he told VTDigger. “We are advocating for distribution without fear or judgment.” The organization serves some 22,000 people a year.
In early March, six of his office’s staffers underwent training with the state health department on becoming an official Narcan distribution site. The message they received was that filling out the first portion of the Narcan form was a “requirement” for people wanting the spray, said staff member Abbey Jermyn, who participated in the training.
Since they began using the form six weeks ago, Jermyn said they’ve averaged one person a week asking for three canisters of Narcan. Previously, clients would pick up two to four canisters a day.
She worried that some clients might not speak English well or have the literacy skills to fill out the form, yet be embarrassed to ask staffers for help.
Dragon, who wrote a recent VTDigger commentary describing the form as intrusive and demeaning, said the paperwork would stand in the way of providing equal access to the life-saving drug. He specifically cited people who are traditionally mistrustful of authority, such as people of color, people experiencing homelessness and those with criminal records.
Meanwhile, the state’s latest opioid fatality report shows that of the 17 Vermonters who died of an accidental opioid overdose in January, 13 had used fentanyl and seven had taken heroin. Users often ingest a mixture of drugs.
Fentanyl has dominated opioid deaths in Vermont since 2016. Some users seek the powerful synthetic opioid, while other users don’t know that it’s being mixed in with the substances they purchase, according to information from public health experts, law enforcement officials and addiction recovery counselors.
The county with the highest death rate in January was Orleans County, with 11.1 deaths per 100,000 residents, compared with the statewide rate of 2.7. Second was Lamoille County, at 7.9, and Addison County, at 5.4.
Health officials have repeatedly advised users and their companions to always carry Narcan. Distribution sites can be found on the state health department’s website.
The department also distributes Narcan through other local partners. They include recovery centers that give out “harm-reduction kits” and emergency responders who carry “leave-behind kits” if they encounter people in an emergency call who show signs of opioid misuse. The kits are given without the optional Narcan form, the department said.
Since 2016, pharmacies in the state have also been under instructions to dispense Narcan even when people don’t have a prescription for it. The standing order enables insurers and Medicaid to cover the Narcan’s cost so people don’t have to pay out of pocket, said Truman, the health department spokesperson.