Vermont holds the dubious distinction as being the state with the highest rates of drug abuse and addiction in the country. In fact, it is often cited as the center of an addiction and overdose problem, often due to heroin use, that has struck all of New England. It is an occurrence that no one could have predicted. World-renowned for its country charm and beautiful vistas, a green landscaped dotted with tiny towns and expansive farms, it seems like the most unlikely place in the country to struggle with such an ugly epidemic.
But Vermont is struggling. Individuals and families are being torn apart by substance abuse and addiction. It is clear to all, including government authorities, that it is an epidemic that requires immediate and extensive attention.
According to the National Survey on Drug Use and Health: Comparison of 2009-2010 and 2010-2011, about 15.29 percent of people over the age of 12 in Vermont reported past-month use of an illicit substance in 2010-2011, up from 13.73 percent in 2009-2010. This was the single highest rate in the country.
Opiates specifically are the most commonly cited drugs of abuse among entrants into Vermont treatment programs. Since 2000, there has been a 250 percent increase in the number of people seeking treatment for heroin abuse and addiction across the state, according to Vermont Governor Peter Shumlin in his January 2014 State of the State address cited by The New York Times.
Governor Shumlin also said that the greatest increase up to that point had occurred in the year prior to his address, noting a 40 percent increase in people seeking treatment in 2013. Additionally, there were two times as many federal indictments handed down against dealers of heroin than in the two years prior and more than five times the number handed down in 2010. As a result of these increased rates of opiate use across the state, more people are dying as well: about two times as many people died due to heroin overdose in Vermont in 2013 than in 2012.
The good news is that the opiate addiction problem in Vermont is gaining attention and there are multiple programs in the works to prevent people from developing a heroin problem as well as to assist those who are currently facing addiction to connect with treatment that will help them heal.
Vermont Overdose Deaths: Stats and Facts
Death due to overdose across substances is a huge problem for Vermont and despite increased attention to the problem in recent years, thanks in large part to Governor Shumlin, according to the Vermont Department of Health Vital Statistics System report, Data Brief: Vermont Drug-Related Fatalities 2010-2015. They note that:
- Fatalities due to drug overdose rose from 75 in 2010 to 108 in 2015.
- Overdose deaths more frequently strike males as compared to females every year. For example, in 2015, 72 men and 36 women in Vermont passed due to drug overdose. This ratio was similar in 2014 as well.
- Most drug overdose deaths were deemed accidental, but a fair percentage were cited as an act of suicide or “undetermined.” For example, in 2015, 88 overdose deaths were termed accidental, 14 were undetermined, and six were suicides.
- Fentanyl has increasingly become the cause of overdose death in Vermont. Rates of death rose steadily from zero in 2010 to 29 in 2015.
Additionally, the Vermont Department of Health’s June 2014 report, The Challenge of Opiate Addiction, provides some of the most recent and in-depth statistics concerning the state of opiate use and abuse specifically in Vermont:
- More than 50 people in Vermont die due to opiate overdose every year on average, but rates have been increasing, and the drug of choice has been shifting as well.
- Heroin use in Vermont is on the rise but opiate painkiller use is not decreasing, indicating an increased use of opiates in general among residents. In 2010, 38 people passed due to prescription painkiller overdose and one passed due to heroin overdose. In 2013, 50 people lost their lives due to painkiller abuse and 20 people died of heroin overdose.
- In 2012, the number of emergency room admissions due to opiate-related issues increased significantly from years prior. Between 2010 and 2012, rates of discharge due to opiate overdose increased by more than 60 percent.
- Rates of nonmedical use of opiate painkillers is a significant problem as well, maintaining 3-4 percent from 2002 to 2012 in people aged 26 and over, down to 6 percent from 9 percent in that same time period among people between the ages of 12 and 17, and maintaining a relatively constant high between 12 percent and 15 percent among young adults aged 18 through 25.
So why are so many people in beautiful Vermont developing a drug abuse and addiction problem and dying as a result? There are a number of potential reasons.
Barbara Cimaglio is the deputy commissioner of Vermont Department of Health. She told Business Insider: “You have everything from the colder climate, which tends to be a reason some people give, to more liberal attitudes, to higher income levels, to people having more access, but I don’t think anyone knows for sure.”
There is no way around it: Vermont is cold. According to US Climate Data, the cold weather in Vermont begins during October, and things do not really begin to heat up until May, with temperatures dropping down into the low teens in January and February. Roads are icy, daylight hours are scarce, and people are cooped up inside. For many, this can contribute to boredom, which can translate into drug use and abuse if healthier options do not immediately present themselves.
Vermont is right in between Montreal, New York, Philadelphia, and Boston, with highways threading through the state going to each of those locales. As a result, many drug traffickers pass through the state on their way to the big cities where drug use is an ongoing problem. Cimaglio noted that there had been a recent uptick in burglaries across Vermont as well as drug-related arrests of people who were not residents of the state.
Because Vermont is more rural and access to these substances is limited, dealers are happy to drop off packages along the way to would-be dealers that sell the goods at higher cost knowing that there is no other option or possibility of competition in the black market, according to Seven Days, an independent Vermont newspaper. They say that the drugs, especially heroin, originate in Boston, Chicago, NYC, Detroit, and Philadelphia. The newspaper also noted that a bag of heroin that might cost only $5 in a large city might sell for anywhere from $10 to $30 in Vermont, depending on the supply at the time and other factors.
Some suggest that because many in Vermont have higher income levels as compared to other parts of the country that the increased disposable income may factor in to high rates of drug use. But people with lower levels of income in Vermont also struggle with the problem, so just as in other parts of the country, it may be that income plays only a modest role in the development of a substance use disorder and may contribute more to the choice in initial drug use.
It has been suggested that Vermont’s liberal political stance may have contributed to the current rates of drug use and abuse across the state, particularly the widespread use of marijuana. According to Slate.com, in addition to high rates of opiate use, Vermont ranked highest in the country for use of marijuana in recent studies as well, with an estimated 13 percent of those surveyed reporting past-month use of the drug.
Says Cimaglio: “I think what drives this up tends to be the higher use of marijuana, and if you look at the states [with high illicit drug use], they tend to be the states that have decriminalized or have more favorable attitudes toward use of marijuana.”
State of the State
The epidemic of drug use and abuse and opiate addiction in particular has been a growing problem for almost a decade in Vermont, but in January 2014, Governor Peter Shumlin made an unprecedented choice to focus the bulk of his 34-minute State of the State address on the problem of opiate use and abuse infecting the state. He called the problem “a full-blown crisis” and an issue which is more “complicated, controversial, and difficult to talk about” than other issues facing the state at that time.
Among the statistics and facts Governor Shumlin shared to demonstrate his point:
- People in Vermont seeking treatment for opiate drugs had increased by 770 percent between 2000 and 2013.
- OxyContin prescriptions were likely the starting point for today’s current opiate addiction problem in Vermont. Today, it has evolved into a heroin epidemic.
- In 2013, Vermont saw a huge increase in overdose deaths caused by heroin from 2012.
- Federal indictments against heroin dealers and traffickers in Vermont have steadily and significantly increased between 2010 and 2013.
By using this moment in the spotlight to discuss the problem of drug abuse and addiction across the state of Vermont, he not only helped his own constituents but also turned the country’s attention to a problem that people all across the United States are facing.
From OxyContin to Heroin
Lieutenant Matthew Birmingham is the commander of the Drug Task Force for Vermont and points solidly at OxyContin when people ask why and how the heroin epidemic started in the state, according to the Burlington Free Press.
A report on the use of narcotics from the International Narcotics Control Board supports Lieutenant Birmingham’s theory. They note that in 2011, though the United States is home to only 4.5 percent of the world’s population, the country consumed about 81 percent of the world’s OxyContin.
Once it became clear that widespread use of these drugs was causing the untimely deaths of so many Americans, government, state, and medical groups all took action. The result was that it was far more difficult to come by OxyContin legally; thus, the supply was lower on the black market where prices for the pills skyrocketed. Additionally, a new abuse-resistant version of OxyContin hit the market in 2010, reports the Wall Street Journal, creating a version of the drug that turns into a gel if crushed and mixed with water for injection, making it even less of an option for those living with extreme opiate addiction.
Lieutenant Birmingham told the Daily Beast:
“It’s kind of a perfect storm. You had the reformulation of OxyContin which basically took that out of the market, and then you had the widespread availability of heroin in the Northeast, where it was extremely cheap and blew up. This latest heroin surge has been a shock. Over the past 15 years, I’ve seen cyclical surges with different drugs but nothing of this magnitude.”
According to Birmingham, a drug bust that resulted in a seizure of 10-20 bags of heroin used to be significant but now they are seeing seizures of anywhere from 400 bags to 1,000 bags in a single bust. This kind of supply has resulted in a steady decrease in price – as low as $8 a bag, which was previously unheard of in rural Vermont. The lowered cost in addition to the rising supply means that the epidemic has constant fuel to grow.
For many in Vermont, it is not just the problem of substance abuse but also mental health problems that is making it more difficult to transition out of active addiction and into treatment.
Per the Data Brief out of the Vermont Department of Health, updated in July 2016, a significant percentage of overdose deaths between 2010 and 2015 were marked as either a suicide or undetermined.
- 2010: 12 of 74 overdose deaths were deemed a suicide and 21 were undetermined.
- 2011: 10 of 96 overdose deaths were cited as suicide and 21 were undetermined.
- 2012: 9 of 81 overdose deaths were suicides and 15 were undetermined.
- 2013: 18 of 109 overdose deaths were suicides and 20 were undetermined.
- 2014: 15 of 96 overdose deaths were deemed a suicide and 16 were undetermined.
- 2015: 6 of 108 overdose deaths were suicides and 14 were undetermined.
It is clear that mental health issues such as depression may be playing a significant role in the continuation of drug use and addiction for many people in Vermont. While it is impossible to know whether or not the use of drugs predated the development of depression or the other way around, this fact provides some insight and demonstrates that comprehensive treatment for co-occurring disorders is needed in many cases.
Towns in Crisis
According to data on drug-related deaths by county published by the Vermont Department of Health, one of the counties hardest hit by the epidemic of drug use and addiction in the state is Chittendon County. Since 2010, the number of deaths due to drug overdose have far and away been higher in Chittendon with Rutland County running a distant second.
Between 2010 and 2015, overdose deaths in Chittendon County numbered between 20 and 30, with 30 being the preliminary number for 2015, indicating that the problem is not abating. Comparatively, during that same time period, overdose deaths in Rutland County, the county with the second highest rates of overdose across the state, ranged from five to 16, with 16 occurring in 2015.
Close behind Rutland County is Windham County, with 5-11 overdose deaths per year between 2010 and 2015 – but in 2015, there was a relatively low number of six lives lost. On the other hand, Franklin County was also high ranking in overdose deaths, but lost five people a year from 2010 through 2012, then lost 11 in 2013 and 10 in both 2014 and 2015, showing a huge jump in rates of drug use.
It is in Franklin County that the documentary, Hungry Heart, is set, specifically in St. Albans, Vermont, a town that is home to about 7,000 people. This tiny town is the setting for some of the worst of the state’s problem with illicit substances, especially heroin. Filmmaker Bess O’Brien follows Dr. Fred Holmes, a 72-year-old pediatrician who ran a practice in St. Albans for 35 years when one of his patients, a 19-year-old man named Kyle, came in asking for help breaking an opiate addiction. In order to help Kyle, Dr. Holmes learned about addiction and became certified to prescribe Suboxone, a medication that is often used in opiate detox and the only drug that can be legally prescribed in a doctor’s office setting. The documentary follows him as he unexpectedly treats 150 people for addition in his small town.
In little towns across the state, there are other clear signs of the drug problem that is rampant in Vermont. Vermont Public Radio reports drug raids in Chester, Rutland, Milton, and Bristol. They note the death of a 17-year-old individual from Rutland in a car crash caused by a driver who had been huffing fumes before the crash. They also share the frustrations of neighborhood residents in Rutland who have seen their property values fall because drug dealers inhabit the parks and sidewalks in front of their homes. They note the large increases in people in need of help for addiction in Bennington and Grand Isle Counties.
In fact, it is difficult to find an area of Vermont that has not been hit hard by the problem of drug use and abuse.
Drug Use among Vermont Teens and Young Adults
The US Department of Health and Human Services notes that substance abuse of all kinds is prevalent among Vermont’s adolescents and teens. Their report, Vermont Adolescent Substance Abuse Facts from July 2013, notes that:
- Eight percent of kids in high school reported having used inhalants in their lifetime.
- Five percent of young men in high school reported using cocaine in the month prior to the survey, higher than the national average.
- Six percent of young people between the ages of 12 and 17 in Vermont reported using painkillers nonmedically in the year prior to the survey.
- Five percent of kids between 12 and 17 needed treatment for substance use treatment but didn’t get it, a number that’s higher than the national average.
- More than 50 percent of people in Vermont between 18 and 25 engaged in binge drinking in the previous month.
- More than 33 percent of young adults in this age group used marijuana in the previous month.
- Vermont residents between 18 and 25 were far more likely to have driven after using marijuana than drinking alcohol in the past month: 15.4 percent and 3.7 percent, respectively.
- More than 17 percent of young adults in Vermont reported using prescription drugs nonmedically in the last year, yet the most popular type of prescription drug of abuse was not painkillers but stimulants, very different from the national average in which young people are more than twice as likely to abuse prescription painkillers than prescription stimulants.
- Young men in Vermont were more likely than young women to use and abuse all substances and more likely to drive after use of any drug or alcohol.
Vermont: Moving Forward
Vermont is working hard to address the problem of opiate addiction, but the epidemic did not develop overnight and it will not be reversed quickly either. This is not stopping government agencies, treatment programs, and a number of nonprofit and medical organizations from doing everything possible to move forward.
Governor Shumlin told the Daily Beast: “There are so many challenges with opiate addiction, and one of them is no one wants to talk about it. Addicts don’t like to talk about it for obvious reasons. Their family members don’t like to talk about it because they feel ashamed. And politicians don’t like to talk about it because there’s risk in change.”
One way in which positive change has been implemented comes in the form of some of the most comprehensive Good Samaritan Laws in the country. According to a DrugPolicy.org press release, Vermont’s H.65 allows for anyone to call 911 in the event of an overdose with legal immunity. That is, callers will not be arrested, prosecuted, or convicted of drug-related charges, nor will they be subject to the seizure of personal property. Even those who are on parole or probation will not have a violation in the event that they call 911 for an overdose victim. Vermont is the third state to implement such a stipulation. Vermont is also the first state to protect those who are in violation of a restraining order from prosecution should they call 911 on behalf of someone in a state of overdose.
The press release also states that H.522 is legislation that provides for the prescription of naloxone, an opiate “antidote” medication, to concerned friends and family members who may be on hand to witness an opiate overdose in a loved one. The law also protects healthcare professionals and those who administer the drug from any liability related to those prescriptions.
Drug and alcohol prevention education is a heavy focus in Vermont schools, according to the Vermont Agency of Education, which provides education for school personnel on the nature of drug and alcohol abuse as well as legal consequences for having and using those substances, especially on school campuses. Trainings will include how to choose outside speakers to address students, training modules for teachers including an electronic format, education on family support when drug abuse and addiction is an issue for a student (especially when another family member is struggling with addiction), strategies for prevention of drug use in schools, and support to students.
Additionally, Governor Shumlin gave Beth O’Brien, director and filmmaker behind The Hungry Heart, a grant that would allow her to show the film at every high school in the state.
The Division of Alcohol and Drug Abuse Programs (ADAP) is responsible for providing funding for substance use disorder treatment services in Vermont. Additionally, the Vermont Mental Health Services contributes some funds to provide treatment for up to 1,500 people in need of adult outpatient treatment services who require treatment for mental health disorders as well as substance use disorders. New services, especially for those who are living with co-occurring disorders, are being developed across the state; the Vermont Integrated Services Initiative (VISI) is a program focused on helping to assist this specific population in connecting with appropriate and timely treatment.
The Vermont Department of Health’s One Year’s Progress report from January 2015 reports that more and more people in Vermont are seeking treatment at the five treatment programs serving the different regions of the state. Though this is a sign that the problem is serious and growing, many more are getting treatment that is needed. As of November 2014, they report that 2,517 people were in treatment for addiction, up from 1,704 at the beginning of the year. Unfortunately, more than 500 people were still on the waiting list for treatment programs funded by the state, more than half of which are awaiting an opening in a treatment program in the Burlington area. Grants from the Substance Abuse and Mental Health Services Administration (SAMHSA) will go toward increasing part-time staff to oversee the development of a peer support and recovery program.
According to the progress report cited above, Vermont has expanded the pretrial assessment program to help more nonviolent offenders with drug-related charges to connect with treatment rather than be incarcerated.
The report also states that more than 800 naloxone opioid rescue kits have been distributed through the health department at six sites across the state, and more than 80 have been used to reverse suspected opiate overdoses.
Vermont is also working with four neighboring state governments in New England to create a regional strategy to address the problem of heroin addiction, according to The New York Times. The governors of these states, including Governor Shumlin, have agreed to share data related to painkiller prescriptions as well as work to create a treatment agreement that works for all their state Medicaid programs.