by Bob Bick, Howard Center CEO Beginning last summer Vermonters seeking medication assisted treatment for opiate use could access treatment almost immediately. While there may still be a delay in first appointment scheduling, what had been long waiting lists at the treatment centers known as hubs were all but eliminated. Around the same time, Vermont instituted new policies that limit opiate prescribing and encourage doctors and their patients to explore alternative pain management solutions. The result has been a dramatic reduction in the number of prescriptions written for opiates in Vermont.
In spite of these achievements, the number of deaths attributed to opiates in Vermont once again increased in 2017, albeit at a slower rate than in previous years.
We are also seeing dramatic increases in the incidence of opiate-related harms other than overdose and death. One example is endocarditis, a serious infection of the lining of the heart that can be caused by injecting under unsanitary conditions. Between 2013 and 2017, the number of cases treated at the UVM Medical Center increased from nine to 59.
Vermont’s forceful response to opiates is recognized nationally as a model for other states to follow, yet increasing opiate-related deaths and incidents of other harms make it clear that more work lies ahead. Conversations are taking place around the state about how Vermont can further reduce the harm done by opiates.
One idea receiving attention is safe injection sites. These are facilities where users inject under clean, safe, and supervised conditions; where staff members are trained to respond to overdoses; and where people can access information and referrals to treatment.
Safe injection programs are an extension of the harm-reduction model, an approach that seeks to minimize the harmful effects of drug use and includes well-established and evidence-based strategies like syringe exchanges and overdose reversal medication distribution.
Howard Center’s own harm reduction program, Safe Recovery, provides clean injection supplies, HIV and hepatitis testing, overdose reversal kits, and referrals to recovery treatment. Safe Recovery staff work to keep people from all Vermont counties safe until they are ready for recovery and through the periods of relapse that are common among people in recovery from opiate use. This program has successfully referred more people to treatment than any other source in Vermont other than self-referrals.
Safe injection sites have operated in Europe, Australia and Canada for years. Now, with growing numbers of fatalities and increasing financial burdens associated with opiate use, American cities are hoping safe injection sites will alleviate some of the harm being done by these drugs. San Francisco is planning to open the first U.S. sites this summer, while Philadelphia, Seattle, Denver, Ithaca, and New York City are also considering sites.
As is happening in these cities, conversations around the potential value, impact, and placement of safe injection sites in Vermont are raising many concerns and questions. Would such sites send the wrong message and end up encouraging drug use? Would the resources necessary to build and operate a site save more lives if allocated to other substance-use reduction programs? Would Vermonters from rural communities be able to access a site? How would the federal government, which considers such sites illegal, react to safe injection sites in Vermont?
As part of its Community Education Series, Howard Center recently invited experts in substance use treatment, law enforcement, education, and public health to discuss safe injection sites and to answer questions from the public. Rather than organizing a debate, we offered a presentation of facts, perspectives, and information to allow community members to become better informed. A video of that discussion is available via our website at howardcenter.org, and I encourage you to watch and listen to the opinions and facts presented and to determine if you need more information in order to form your own opinion on the issue.
We’re also planning a one-day conference on opiates this May where national experts will present on related topics and perhaps challenge some of our assumptions about the nature of the opiate epidemic and the best strategies to address it.
Howard Center has been a leader providing treatment, harm reduction services, and other supports to thousands of Vermonters every year and welcomes any respectful discussion aimed at improving the health, well-being, and safety of the people we serve. With two Vermonters dying every week due to opiates and many others at risk, we need to do more to stop the damage caused by these drugs.
Whether that includes establishing safe injection sites is yet to be determined, but with open minds, a focus on evidence-based solutions, and a commitment to work together, I am confident we will find effective answers and continue to develop meaningful strategies to reduce the negative consequences of opiate abuse on Vermonters and our communities.
Last year Howard Center helped 16,000 people in over 60 locations and six counties with mental health, substance use, and developmental services. www.howardcenter.org. Help is here.