This commentary is by Kenneth A. Feder, Ph.D, an assistant scientist in the Department of Mental Health at Johns Hopkins Bloomberg School of Public Health. The views expressed here are his own.
As part of its efforts to address Vermont’s ongoing drug overdose crisis, Vermont’s General Assembly has sent to the governor a bill (H.222) that would permanently eliminate penalties for possessing small amounts of nonprescribed buprenorphine — an essential medication prescribed for treating opioid addiction.
Research led by my team at Johns Hopkins Bloomberg School of Public Health shows that eliminating criminal penalties for buprenorphine possession may help improve the health of Vermont residents who use opioid drugs, while also reducing unnecessary criminal justice involvement.
However, this policy change will be most effective if it is accompanied by proactive public health outreach by organizations serving people who use drugs, to make sure people who use drugs understand, and can take advantage of, their new rights.
In 2018, to “correct the error of criminalizing a person struggling with opioid addiction for possessing an effective means to treat it,” the city of Burlington adopted a de facto policy of neither arresting nor prosecuting residents in possession of nonprescribed buprenorphine. In 2021, the state followed suit by repealing, for a two-year trial period, all criminal penalties for possessing 224 milligrams or less of buprenorphine. Bill H.222, which is now in the governor’s hands, would reaffirm the elimination of criminal penalties for buprenorphine possession going forward. (Selling, giving, or trading away a buprenorphine prescription would still be illegal. Criminal penalties for possession of other drugs remain unchanged.)
Vermont was the first state in the country to remove criminal penalties for buprenorphine possession, so the state’s experience in the first two years offers important lessons for the future. To better understand the potential impact of removing criminal penalties for buprenorphine possession, my colleagues and I surveyed almost 500 Vermonters who had recently used opioid drugs illicitly to assess their use of nonprescribed buprenorphine and their beliefs about criminal penalties for buprenorphine possession.
We found that about three-quarters of respondents to our survey had taken buprenorphine that was not prescribed to them at least once in their lives. Similar to past studies from other states, participants described to us how they used nonprescribed buprenorphine to prevent the symptoms of withdrawal when they could not access formal treatment or experienced gaps in their care.
For example, participants took nonprescribed buprenorphine after leaving inpatient programs, hospitals, or jails and discovering their appointments to obtain a buprenorphine prescription had been suddenly canceled.
Participants also stated that when they took buprenorphine that was not prescribed to them, this mostly had a positive impact on their lives: helping participants to alleviate withdrawal, avoid overdose-causing drugs fentanyl and heroin, hold down jobs, and improve the relationships with friends and family that opioid abuse had worsened.
There was also evidence that, before criminal penalties were eliminated in 2021, respondents to our survey had faced legal punishment related to their buprenorphine possession. One in five survey respondents had been arrested at least once while in possession of buprenorphine. One in 10 had been punished for violating the terms of their parole or probation because of buprenorphine possession. Both punishments were more common among respondents to the survey who were not white.
Finally, eight in 10 respondents said Vermont should not impose criminal penalties for buprenorphine possession. However, only a third of respondents were aware that Vermont had already eliminated criminal penalties for buprenorphine possession.
Our research suggests that permanently eliminating penalties for buprenorphine possession could benefit people who use drugs in Vermont. These benefits include reducing unnecessary and racially disparate criminal justice involvement, and possibly facilitating a harm reduction strategy that people who use drugs in Vermont say has helped them avoid fentanyl.
However, for this change to achieve its full public health potential, it is important key constituents are actually aware of the law. As our study showed, most people who use drugs were unaware that nonprescribed buprenorphine possession is no longer a crime. Public health agencies should partner with organizations that interact with and serve people who use drugs — including harm reduction programs, health care providers, social service agencies, and law enforcement officers — to disseminate information about the new law.
Vermont has for years been a national leader in helping residents with an opioid addiction obtain buprenorphine treatment and prevent overdose. Permanently eliminating criminal penalties for nonprescribed buprenorphine is an innovative approach to further promote harm reduction.
Health officials and professionals should embrace and promote the policy so those who stand to benefit — people who use opioid drugs — know their new rights and can act accordingly to protect themselves from overdose.