Gov. Phil Scott signed seven bills into law on Thursday, most notably omnibus overdose prevention legislation.
The bill, H.222, was designed by lawmakers and state health officials to make investments and policy changes that would have an immediate and lasting impact on reducing deaths from opioid overdoses statewide.
The Vermont Health Department reported 237 deaths from opioid overdoses last year, the third record-breaking year in a row.
“As we continue to lose far too many Vermonters — mothers, fathers, children, siblings and friends — to the crisis of opioid addiction, we know we must continue to do more,” Scott said in a statement Thursday.
“We must keep building on what we know works and address barriers to treatment, housing, and other supports, with a focus on saving lives,” he said.
The overdose prevention law contains more than a dozen policy changes and more than $8 million in new funding allocated from major settlements with opioid manufacturers and distributors.
The additional resources are important, one of the bill’s primary authors said, but so is what is symbolized by the legislation’s emphasis on addressing drug addiction first and foremost as a public health crisis.
“This is just an issue that’s really prone to stigma, really prone to mistrust from so many people, including our leaders,” said Rep. Dane Whitman, D-Bennington. “To send a message that substance use disorder is not a crime. It is an epidemic, and that we recognize that and help is on the way. That is just huge for me.”
Some measures in the law work to reduce the risk of death from overdose for people who use illegal street drugs, such as the needed liability protection and funding to launch drug-checking services around the state.
Others are intended to break down barriers to receiving treatment for substance use disorder, such as wait times related to preauthorization for medication-assisted treatment, and to expand the availability of proven supports, such as recovery or sober-living residences.
All but a few of the measures in the bill, noted below, take effect immediately upon passage.
The signing won praise from service providers such as Vermont CARES and Vermonters for Criminal Justice Reform, as well as legislators and advocates who have been pushing for broader measures.
“These provisions will save lives, lower the overall rate of substance use and allow people to seek treatment when they are ready because they have built the trust and connections to access treatment,” Sen. Tanya Vyhovsky, P/D-Chittenden Central, said in a statement released by the Decriminalize Vermont Coalition.
Other bills that Scott signed Thursday are H.53, which eliminates the suspension of a driver’s license based on the non-payment of civil penalties; H.110, which extends the sunset on applications to site new telecommunications facilities for an additional three years; H.161, which clarifies the authority of the commissioner of forests, park and recreation to direct town fire wardens not to issue burn permits during periods of increased fire hazard; H.495, which approves amendments to Middlebury’s charter; and H.506 and H.507, which approve amendments related to elections and polling in Burlington.
The illicit opioids market in Vermont and across the country, previously dominated by heroin, has been overtaken by synthetic fentanyl in recent years. The strength of the drug can vary widely and be mixed with other contaminating substances, which has made street drugs more deadly.
Indeed, the Department of Health reports that fentanyl was involved in 93% of overdose deaths last year. Xylazine, an animal tranquilizer that can cause skin lesions and wounds, was present in 28% of those cases. A new drug contaminant, the anti-seizure prescription medication gabapentin, found in 13% of the cases, contributes to the slow-down in breathing and heart rate that leads to overdose deaths.
The harm reduction measures in the bill are largely aimed at making overdose reversal drugs more widely available and giving people who use illicit drugs, both opioids and stimulants, more information about what chemicals are in them and at what strength.
“That is just so critical because of the increased lethality of the drug supply that we are seeing,” Whitman said.
The legislation makes a number of allocations and policy changes to support harm reduction strategies.
- $1.98 million from the Opioid Abatement Special Fund to pay the salaries of 26 new outreach and case management staff positions to engage with individuals with substance use disorder in a variety of community settings including police barracks, shelters and social service organizations.
- $1.98 million from the same special fund for broader distribution of naloxone, also known by the brand name Narcan, an opioid overdose reversal drug. The Department of Health is directed to establish kiosks or vending machines in accessible locations across the state and increase the medication’s availability for home delivery, mail order and “leave-behind” kits.
- Naloxone joins needles and syringes on the list of harm reduction items that are not considered “drug paraphernalia” for criminal purposes.
- $400,000 from the special fund to support the state’s four existing syringe and needle exchange providers. The Department of Health is directed to establish and maintain a disposal program for syringes and needles developed in conjunction with communities and providers, and from that process report on where disposal sites and exchange services should be located. A separate $150,000 will fund organizations involved in the study.
- $700,000 from the special fund for the development of drug-checking services across the state, including planning or the purchase of spectroscopy equipment. The law also creates liability and other legal protections for people operating and providing samples of drugs for checking.
Access to treatment
Two years ago, Vermont became the first state in the country to decriminalize the possession of buprenorphine, a prescription drug widely known by the brand name Suboxone and used in the treatment of opioid use disorder. The 2021 law made it legal to possess up to 224 milligrams of the drug without a prescription, which had been a misdemeanor, with a caveat. The change would be repealed in two years without further legislative action.
In the meantime, a survey of almost 500 users of illicit opioid drugs in Vermont by researchers at Johns Hopkins Bloomberg School of Public Health found that three-quarters of them had used buprenorphine not prescribed to them, in the large majority of cases in order to prevent withdrawal symptoms. People who had used non-prescribed buprenorphine were more likely to also report participation in formal treatment.
Those results were enough to convince legislators to make the change permanent.
Transportation to a distant clinic, lack of insurance or waiting for pre-approval can all pose barriers to getting a legal prescription. Buying buprenorphine off the street or getting it from a friend or family member could be someone’s first step toward trying to manage their opioid use, Whitman said.
“We don’t want that to be a criminal activity,” he said. “Our preference would be that they engage in treatment, but we do not want to further marginalize somebody who’s trying to take those steps.”
Also included in the legislation:
- $2 million from the special fund to add satellite opioid treatment sites, one in Chittenden county, one in Addison county, one in eastern or southern Vermont and one in a facility run by the Department of Corrections.
- Allow office-based satellite providers of medication-assisted treatment to begin prescribing up to 24 milligrams of buprenorphine. The previous limit was 16 milligrams for these locations. This change will go into effect on January 1, 2024.
- Allows the ongoing prescription of controlled substances for opioid use disorder via telehealth. This pandemic-era allowance would have otherwise expired.
- Requires Medicaid to allow prescription of one medication in each medication-assisted treatment class — methadone, buprenorphine and naltrexone — without prior authorization. This requirement will take effect in September.
- Forbids “fail-first” policies by private and public insurers that require prescribers to document an allergy or other poor reaction to a particular opioid use disorder medication before prescribing another.
- $840,000 to expand a pilot “contingency management” treatment program for people addicted to using stimulants such as cocaine and methamphetamine. Vermonters for Criminal Justice Reform in Burlington operates the only such program now.
Zoning reprieve for recovery residences
For many people with substance use disorder, the road to recovery requires a change in location.
“When you’re in recovery, to have an opportunity to escape the environment that might be feeding that addiction is incredibly important,” said Jeff Moreau, executive director of the Vermont Alliance for Recovery Residences, which certifies residences according to national standards developed by the National Alliance for Recovery Residences.
That is where sober living or recovery residences come in. Whether the addiction is to opioids or alcohol, for some, it is especially helpful to live in a community with people facing a similar challenge, where a commitment to sobriety is shared.
A final provision in the new law makes it clear to all local zoning boards that any residence certified by that program, or another one approved by the Vermont Department of Health, must be permitted in any area where single-family residences are allowed.
A 2019 analysis of Vermont’s population estimated that the state at that time needed around 300 more beds in recovery residences to meet the need. Current demand is likely much greater as several locations around the state closed during the pandemic.
Operating a recovery residence is usually a labor of love, not a money-making venture. So costly zoning challenges can, and have, become stumbling blocks for projects in different communities around the state, Moreau said.
“I think it’s fair to say that with volunteers on zoning boards, they just didn’t know how to handle it,” said Moreau. “So to have some consistent guidance, this really will help.”