This is the first story in a two-part series examining the opioid crisis in Vermont’s largest city. The second story, “Burlington struggles to find solutions to a fentanyl-fueled crisis,” can be found here.
About two years ago, Kevin Donaldson started seeing a new drug mix on the streets of Burlington.
“Philly dope,” as it was called, combined fentanyl, an opioid, and xylazine, a sedative. It was cheap, plentiful and up to 100 times more potent than heroin.
The 43-year-old Burlington resident has contended with substance use for much of his life. When fentanyl arrived in the city, he initially steered clear, he said — and tried to help others do the same.
“I’m not saying I was selling drugs, what I’m saying is, I helped friends get stuff that wasn’t killing them,” Donaldson said.
But then his girlfriend, who has also battled substance use disorder, became sick. She had a cyst in her stomach and a possible brain tumor, among other ailments. At one point, Donaldson recalled, she had sepsis and was vomiting every hour.
When the couple discovered that fentanyl could ease her suffering, Donaldson reluctantly started buying bags of it.
“It was cheaper, it was more dangerous, but it also took her pain away,” Donaldson said. “And when you love somebody, that’s what you do.”
The U.S. Centers for Disease Control and Prevention have declared fentanyl the “third wave” of the opioid crisis after earlier phases driven first by prescription opioids then heroin. The drug’s now ubiquitous presence has sent the opioid crisis into uncharted territory — across the country, and in Vermont.
Statewide, overdose deaths have been on a sustained rise since 2020. Chittenden County has seen the biggest numbers over that time, with 150 fatal overdoses from January 2020 through July 2023, according to a state Department of Health report.
The problem is particularly glaring in Vermont’s largest city, where, as of Oct. 31, the fire department has responded to 422 reported overdoses so far this year.
“I’ve spoken to my fellow chiefs around the county,” said Burlington Police Chief Jon Murad. “They are not seeing the same spike in overdoses that Burlington is seeing.”
The crisis goes beyond overdoses: the Queen City is also contending with open-air drug dealing and suspected drug-related crime, including multiple homicides, a rise in fentanyl-laced stimulants and an overlapping homelessness crisis.
Public health experts and local officials agree that the escalation of overdoses can be traced to the arrival of fentanyl and similarly potent substances. That coincided with the Covid-19 outbreak, which increased social isolation and consumed state and local resources that could have otherwise been deployed to respond to the opioid crisis.
As the threats of the pandemic have faded, leaders are again turning their sights to the growing drug crisis, and in October the Burlington City Council declared this its top priority in a resolution. But key officials and advocates say progress isn’t happening nearly fast enough.
“What we’re doing isn’t working,” said City Councilor and mayoral candidate Joan Shannon, D-South District at the October meeting. “We need to recognize that we can’t solve a problem without recognizing our problems.”
‘We had no idea what was in store’
Just a few years ago, there were glimmers of hope in Burlington’s efforts to combat opioid use.
In early 2019, Burlington Mayor Miro Weinberger sent a press release touting a 50% drop in opioid overdose deaths in Chittenden County, which had fallen from 35 in 2017 to 17 in 2018.
“While it is difficult to pinpoint (the) precise cause of this reduction, the City believes the strongest contributors to this decline is likely to be the embrace of the life-saving potential of addiction medicines,” the press release read.
A year later, when 2019 data was released by the Vermont Department of Health, total overdose deaths in Chittenden County remained consistent at 17.
During an interview on Oct. 13, Weinberger said he still believes that expanded access to the medication buprenorphine had played a key role in reducing overdoses. Public health experts hailed the city’s decision in 2018 to make the medication readily accessible — and the county prosecutor’s decision to refrain from prosecuting those who possessed it without a prescription.
“If someone wanted to stop using illicit opioids and start treatment, they just needed to get a prescription of buprenorphine and start taking it and they can make that transition in a day,” Weinberger said. “They could start on a new path immediately.”
Burlington also focused in those years on reducing wait times for other forms of treatment, the mayor said.
“We were making progress during those years,” he said. “We were making dramatic progress.”
Among the people involved in that work was Ed Baker, a licensed clinical social worker in Burlington who has spent more than 30 years helping people with substance use disorder. He’s also in recovery himself and has been formerly homeless, incarcerated and forced into treatment.
“I like to say sometimes that I’ve been beaten nearly to death by the war on drugs,” Baker said. “And I’m lucky. I’m a survivor.”
Baker remembered seeing the first mention of fentanyl sometime around 2015 in a Centers for Disease Control and Prevention report.
“Fentanyl was a footnote,” he recalled.
According to data from the Department of Health on overdose deaths, the percentage of deaths that involved fentanyl stayed below 20% from 2010 to 2014. In 2014, that number jumped to 27% and climbed steadily each year. In 2022, 93% of overdoses in the state involved fentanyl.
Kyle Blake and Jeremy Raymond, two lieutenants with the Burlington Fire Department, both said that when they first began in the fire service overdoses were less common. When someone could be revived by Narcan, they’d often be surprised by the fact that they’d overdosed.
“It’s not a surprise, really, for a majority of the people we’re going to anymore,” Blake said.
Blake and Raymond said that the way those calls usually go — with an increasing number of people who don’t go to the hospital and become repeat patients of the fire department — can be demoralizing.
“It’s just like, are we doing the right thing? Are we truly helping this? Are we making it better? Are we the right tool for the problem? And it’s starting to feel like we’re not,” Blake said.
As for how fentanyl took over, Baker pointed to simple economics: It was an “absolute miracle” for drug cartels, he said. Unlike heroin, which requires the cultivation of acres of poppy fields, the synthetic opioid could be produced in small warehouses for much cheaper.
“This whole phenomenon did not occur because people with opioid use disorder said, ‘I want fentanyl,’” Baker said. “It occurred because the manufacturers and the cartels and distributors discovered that they could raise their profits exponentially by switching from heroin to fentanyl.”
Profit margins weren’t the only thing that changed. The drug’s effects were faster-acting and wore off sooner, leading people to take it more often. This facilitated the rise of xylazine, a sedative originally developed for use in animals, which is often combined with fentanyl in an effort to increase the duration of fentanyl’s effects, Baker explained.
“I used to think that heroin and prescription opioids was a major tragedy,” Baker said. “We had no idea what was in store for us. Now we see and we’re not responding to it the way America should respond to it.”
And as fentanyl was becoming increasingly pervasive, the pandemic arrived in March 2020.
Kelly Dougherty, deputy commissioner of the Vermont Department of Health, said that from 2018 to 2019, the state as a whole had started “bending the curve” in the opioid crisis. The isolation forced by the pandemic interrupted that progress.
The health department sometimes runs a “social autopsy” report to review the lead-up to an overdose death, examining, among other questions, what treatment the person received and which state systems they interacted with. The hope is those analyses can help policymakers and service providers do better the next time. Since the arrival of Covid-19, Dougherty said, social autopsies have concluded that most overdoses deaths happen because people use drugs alone.
The state’s data shows that beginning in 2020, overdose deaths in Chittenden County spiked to 26. The grim trend continued in 2022, when there were 48 deaths.
The Burlington Fire Department’s own data mirrors the trend. According to a report created by Chief Michael LaChance, in 2019 the department was responding to an average of 13 overdose incidents per month. That figure counts all reported overdoses, not only fatalities. This year, that monthly average is up to 42.
“One of our messages is that if you’re going to use, don’t use alone because you can’t administer naloxone to yourself,” Dougherty said.
Another factor, she said, was the increasing “toxicity” of the drug supply. Since the arrival of fentanyl, stimulants such as cocaine and methamphetamine have become a significant driver of recent overdose numbers.
Fat, sugar and salt
State data shows that fentanyl hasn’t only infiltrated the opioids coming into the state, but is also increasingly being added to stimulant drugs.
In 2010, overdoses were driven mostly by prescription medications, with the top share being opioids and benzodiazepines — 22% of fatal overdoses that year, according to the Department of Health. In 2022, the top drug mix in fatal overdoses was fentanyl and cocaine at 47%.
Dr. Richard Rawson is a professor with the University of Vermont and a national authority on substance use and behavioral health. He said he has been trying to raise awareness of the involvement of stimulants in the overdose crisis.
“Vermont’s had a cocaine problem for 30 years and there’s no treatment for people with cocaine use disorder,” Rawson said.
Rawson compared the public’s lower level of concern on stimulants to that of cannabis. Previously, deaths from cocaine overdoses were rare and the public remained focused on opioid use.
“Well, now that cocaine has fentanyl in it,” Rawson said. “It is overdose relevant. It’s driving a lot of the overdoses.”
Dr. John Brooklyn is the medical director at the Howard Center’s Chittenden Clinic in South Burlington, a medication-assisted treatment facility. He said the reason that fentanyl has ended up in so many other substances is because drug dealers know it increases the addictiveness of stimulants.
“It’s kind of like the way the food industry uses fat and sugar and salt,” Brooklyn said. “You know, if you put enough of it in certain foods, people are just going to keep eating it and I think it’s a similar method — a similar reason why fentanyl is added to all this stuff. They just want to get people addicted so they just keep buying that product.”
Those who use opioids have the option to use medications like methadone or buprenorphine to help their recovery, but those who use stimulants have no such medication.
Recently, Rawson and a post-doctorate colleague from UVM conducted a survey at the Howard Center’s Safe Recovery, which runs a needle exchange program. Rawson’s team asked those getting needles which drugs they were going to buy. The most common response was cocaine.
“There’s an awareness growing that — okay, fentanyl — we need to focus on fentanyl,” Rawson said. “But we can’t ignore the stimulant thing because people who are using cocaine and meth, a lot of them are dying and are part of overdose death statistics. And we have no treatment for them.”
Pointing fingers
On Oct. 11, the Burlington City Council had three items on its meeting agenda related to the drug crisis: the fire department’s new community response team pilot which changes how firefighters respond to overdoses, an update from the Burlington Police Department’s drug unit and finally a broad resolution declaring the crisis the city’s top priority.
City councilor and mayoral candidate Karen Paul introduced the October resolution and framed it in the spirit of collaboration and common ground.
“We must act now and we must act together,” Paul said. “We need to speak with one voice, one call to action.”
But that plea from Paul hasn’t stopped some local advocates and politicians from pointing fingers, particularly toward the state government.
Covid-19 understandably occupied the focus of policy leaders for years, they’ve said, but state officials have been too slow to re-prioritize the opioid crisis.
Tom Dalton, executive director of Vermonters for Criminal Justice Reform, has extensive experience in substance use treatment programs and has advocated for policy reforms on the issue. He said that since the pandemic, the actions the state has taken have been insufficient.
“They haven’t happened at the scale they need to and they’ve been delayed for years at a time,” Dalton said. “And that’s allowed a lot more death and destruction to happen and for the crisis to worsen.”
In particular, Dalton said the state must do more to expand methadone treatment, a medication for opioid use disorder which reduces cravings. Methadone can be effective against fentanyl use where other medication treatments can fall short. Dalton also said there should be more housing for people in recovery, which could help address circumstances in which substance use and homelessness collide.
Rawson agreed that more could be done at the state level. He recalled in 2014 when former Gov. Peter Shumlin, having declared the opioid crisis the state’s top priority in his annual state of the state address, brought together state leaders, clinicians and national experts to push for a treatment model called “hub and spoke,” which provides intensive services such as in-patient care followed by ongoing treatment at smaller, office-based facilities.
Rawson, the UVM professor, said that following Covid-19, he didn’t think that state efforts to address the opioid crisis have operated at the same level of focus and intensity as during the years when the hub and spoke clinic system was being stood up. He would like to see the state lead an effort similar to Burlington’s Community Stat meetings, which are monthly meetings covering the subject of the drug crisis facilitated by the city.
“That seems to be much more of the sort of main leadership event than anything the state is doing as far as I know,” Rawson said.
Following the Burlington City Council’s resolution on the drug crisis, Gov. Phil Scott said during a press conference that the state would be a “willing partner” in fighting the issue.
In response to that, Weinberger said he thinks the state should declare the crisis its “top priority,” arguing that the state has “public health authorities that municipalities and others simply don’t have.”
“They have access to information and data that is by law restricted from municipalities and others. The state must lead this and I don’t see that right now,” said Weinberger, who is exploring a run for statewide office.
Dougherty pushed back strongly against the suggestion that the state hasn’t been doing enough and said officials never stopped focusing on the opioid crisis during the pandemic.
In fact, she said, the department actually stepped up its efforts. She said the substance use division of the department worried that the social isolation of the pandemic would exacerbate the drug crisis, so “a lot of that clinical team” wasn’t deployed to focus on Covid, she said.
‘One foot in front of the other’
Donaldson traces his struggles with serious substance use to the first time he was incarcerated. After a difficult childhood — he said both his father and stepfather were abusive toward his family — a theft charge landed him in prison as a teen.
“When I first went to jail, I was like any other teenager and I drank and smoked pot,” Donaldson said. During that first prison stint, he had done heroin for the first time and had learned to cook and smoke crack cocaine, he said.
“That’s what the (Department of Corrections) taught me,” he said. “And I hit the ground running.”
Years of crime — mostly burglary and theft to pay for drugs — led to more time in prison.
But seven years ago, Donaldson, recently released from prison, managed to get an apartment with his girlfriend. With the help of methadone, the pair pieced together about four years of sobriety.
Then, around the start of the pandemic, the couple was evicted. Not long after, Donaldson’s mother and his brother died. After the eviction and a time spent living in Swanton, Donaldson began using drugs again and returned to Burlington where he became homeless and fell heavier into heroin.
The onset of his girlfriend’s illness coincided with the emergence of fentanyl and xylazine. Donaldson began collecting cans as a means to finance the drugs. He watched as fentanyl took over the drug market and started to use it himself.
“And then finally, I noticed that just about everybody that’s using, is using that stuff,” he said.
Donaldson said the blame for fentanyl’s arrival should be shared. In addition to the dealers who seized on a more profitable but deadly product, “it’s our fault for choosing to do that stuff. It’s the government’s fault for not helping us out.”
When asked if he saw a road to getting off of substances, Donaldson said he had other concerns that come first.
“There’s so many other things that I’m worried about that, honestly, dope is not one of them,” he said.
His worries include the stresses of being homeless as the temperature drops, choosing whether to eat a meal or ease his girlfriend’s pain with drugs and taking care of his dog, Bingo, a 130-pound pitbull.
Still, there may be a path forward if his life feels more safe and settled.
“I learned a long time ago to never give up,” Donaldson said. “Always put one foot in front of the other and just keep moving forward and try to make today a little bit better than yesterday. And if I do that, then everything else will fall into place.”
Despite the small steps in his everyday life, Donaldson still spoke about future plans. He hopes to be “part of the solution,” to run a charitable online store, make a documentary about life on the street, and perhaps to return to a medication treatment like methadone.
Disclosure: Patrick Crowley was employed by the Burlington Fire Department in 2021 and 2022.
