 Hi everybody, I'm Ed Baker and welcome to ARC. ARC is the Addiction Recovery Channel. The Addiction Recovery Channel is dedicated to bringing information to the general public. Information that's both current and accurate. And I'm very pleased today to welcome my guest, Sarah George. Thank you so much. By way of introduction, I'd like to read a quote from Rebecca Kelly. Rebecca Kelly is the spokeswoman for Governor Scott's office. This quote is regarding Sarah's appointment, which was just about exactly one year ago. Rebecca Kelly says, Sarah demonstrated strong character and a commitment to public service and justice that made the governor exceedingly confident in her ability to serve the people of Chittenden County and to be a steadfast advocate for the rights of victims. That's quite a recommendation, Sarah. You know, I cannot believe you're right that tomorrow is a year. It does not seem possible. But thank you, it was. And that's a perfect lead into my first question for you, is basically what has this first year been like for you? What has been your experience and what's shaped your initiatives heading into your second year, Sarah? So, before I became appointed, I was a prosecutor in the same office. So, TJ Donovan was my boss. I was there for about six and a half years before I was appointed as the state's attorney. So, in terms of the everyday office experience, it hasn't changed a whole lot other than being in court a little less and being kind of out in the community a lot more. But I've been trying since day one really to shape my priorities as a state's attorney and then find ways within the community and within the courthouse to really implement those goals and focus on those priorities. All right. For me, would you maybe choose one of your top priorities going forward? Yeah, I mean, the clear one for me is the opioid crisis. That's definitely been something that's been very important to me and one of the reasons, obviously, that I'm here. Law enforcement is a big priority for me supporting our law enforcement and, you know, it may seem like a small thing but I'm doing everything I can to really highlight all of the positive things that our law enforcement is doing in this community because I feel like we're in a day and age where all of their negatives are really being exploited and their positives are, and I see the positives every day. So, I'm working on that as well. And my office, my office is a priority. My deputy is making sure that they're paid what they should be to the extent I have that ability and making sure that they're getting what they need for resources. Absolutely. Along the lines of law enforcement, I have gotten to know a little chief del pozo a little bit and certainly Jackie Corbally has, you know, lay us on for issues regarding the opioid epidemic. And I just remain completely impressed with the ability of officials in Burlington and Chinden County to familiarize themselves deeply with the elements that are contributing to the opioid crisis in Vermont. You have T.J. Donovan, you have Brandon Del Pozo. You have many, many people on almost vertical learning curves, certainly Miro, Weinberger. People every day facing death, you know, the crime related to the opioid epidemic and struggling every day for solutions. So I would join you in that. We're very, very fortunate to have the leaders that we have in Vermont. The governor certainly with his opioid commission, Jolinda LeClaire heading up, you know, what appears to be an overarching, very dedicated push to do something about this issue. What is it that's risen to the surface in your awareness and your daily practice of your job regarding the opioid crisis? What is it that's gotten your attention? Well, I mean, personally as a prosecutor, I've known since the start that we can't incarcerate our way out of this problem. That's been very clear to me and it's frankly one of the reasons I became a prosecutor because I, you know, I wanted to be a defense attorney for the longest time and then kind of realized that as a prosecutor you can do a lot more good in the actual system if you're the one with that, you know, power for lack of a better word. But personally, my experience has been kind of sculpted by the fact that we, as state's attorneys and as deputies, respond to every untimely death in the county which a lot of people don't realize. And so when I first, you know, fresh out of law school thought I'd be in court every day I had no idea I'd be going to the scenes of people who have just died and I thought that that would probably be elderly individuals who are dying in their sleep but what it ended up being was a overwhelming amount of suicides that I didn't expect and an overwhelming amount of overdose fatalities. And, you know, as a young prosecutor fresh out of law school at three in the morning going to the home and telling a family that, you know, you're sorry for their loss it just really struck me as like what is happening? Why is this happening all the time when we're responding to scenes like that every week for young people, older people, people with full-time jobs, people with good families and good relationships and people with no homes and no families and no relationships? It just, it occurred to me that this was a serious issue that is not, it wasn't from my perspective being talked about. I hear you and that resonates deeply with me that this is a disease. We call it an addiction but it is very much a brain disease. It's not a choice. People don't develop it on purpose. It develops innocently and it can develop in anyone. Now, I think the statistics for 2016 were 106 deaths specifically attributable to opioid overdose but we do believe that it's more than that. Is that your impression? Absolutely. I'm sure that it's more than that the official numbers yet for 17 but my understanding is that it'll be around 135 but even that I don't believe is the full amount. I think that we're missing a lot of people that, not only do I just believe that they maybe died from endocarditis for example but they're really dying due to their substance use disorder and even more so people that maybe are dying in communities like Upper Valley where I'm from who are dying in New Hampshire because they're dying at Dartmouth-Hitchcock or they're dying in Littleton from St. John'sbury. All of those numbers aren't being counted in our Vermont numbers because they're not dying here but there are people, they're Vermonters and so I think the numbers are higher than we are seeing. It's very hard to track with accuracy the number of fatalities and when you add into that naloxone, the statistics for 2016 were 423 layperson administrations of naloxone 416 of them were successful, seven people died but so you have 413 people overdosing on opioids where the overdose is reversed without naloxone the fatalities would be markedly higher. So it's interesting, you know we have naloxone, we have hub and spoke, we have safe needle exchanges we have a lot of activities in Vermont that are very progressive to deal with the opioid crisis but at the same time as you're noting the fatality rate is increasing So what's next? What do we do next? Well I think we have a lot to do. I think that we need more treatment options, we need more inpatient rehabilitation beds we need more doctors prescribing, we need naloxone, our can in more hands and we need that to be available to more people and one of the things that I've talked about a lot lately is the potential for a safe injection site, supervised consumption whatever you want to call it. That's a courageous dialogue to open in Vermont. I think most of the people that I know over the course of the last two decades methadone treatment in Vermont was a stretch that was very very difficult for people to accept buprenorphine treatment or some commonly known as suboxone was a stretch people really had to open their minds to that and see that it was a medication it simply wasn't a replacement. Safe needle exchanges, another issue and now we have safe injection facilities or there's lots of names for it but safe injection sites What is it? I know you've researched this fully I just would like to give you the opportunity to open this dialogue a little further to talk a little bit about it What is it about safe injection facilities that you find works in terms of saving lives? Well the one thing I would say to start is that this is a new idea in Vermont and somewhat of a new idea in the US but it's a very old idea they have been implemented in other countries there's over a hundred of them worldwide for over 30 years so the idea is actually very simple it's just a space where people who are actively injecting heroin or really any unsafe practice in drug use can go and use their drugs with clean and sterile product in a clean space have the ability even to clean such a small thing as cleaning their arm or wherever they're injecting before injecting that some of these individuals just don't even have access to that most basic need and they're supervised while they do it so that if they do overdose somebody is there to help them they then have a kind of safe space after to you know chill out is what a lot of them are called the chill out zone and even more important if one of those many times they go to use the facility they find themselves at a place where they're ready for further help for treatment or whatever that might mean for them to get into recovery that is also there that services there that resources there and you know for me the important part of it is that we're not getting to everybody right now and they might not be at a place where they're ready for that service or resource but that doesn't mean we shouldn't care about them or we shouldn't be making sure they're alive in the meantime until they are and you know the the kind of quote of you know you dead people can't recover and that's what I feel like safe consumption sites do there's like I said over a hundred worldwide and there has never been a single death never been a single death not one single fatality in any of the sites worldwide well that's pretty impressive yes I took the liberty of reviewing your commission's report and they take a look at two needle exchange programs in Vermont one being right here in Chittenden County the safe recovery now they conducted the commission conducted a fairly extensive survey and they found that 90% of the people that use safe recovery a needle exchange said they would be willing to use a safe injection facility now we know now that the majority of people who overdose with a fatality resulting are injecting opioids alone correct so it seems that it seems then that a safe injection facility as you're saying would prevent every one of those overdoses where someone overdoses because they're alone and there's no one available to administer naloxone do you agree with that I do if if every one of those individuals was using a facility every one of those lives would in theory be saved the research I think also shows that just to be specific about it 34% of the respondents there were 85 respondents to the survey correct reported contracting hepatitis C 3% of the survey reported contracting HIV if those individuals had been using a safe injection facility 0% would have contracted hepatitis C and 0% would have contracted HIV if they had been following the instructions at the safe injection facility right so what happens then is I think there's this kind of a it's a hard distinction to make between the value of harm reduction and the value of use reduction most people value use reduction right the number of people injecting heroin or opioids would decrease harm reduction is something different the number of people inject injecting opioids can remain exactly the same but the harm associated with the injection is decreased would you like to talk about that for a minute yeah I mean I absolutely agree I think that those two things too often get seen as the same and I think a lot of the reason that people initially might have a visceral reaction to the idea of safe consumption sites and to be honest I did too before I did any research is that you do have this idea that if you really want to help you'll get more people into treatment which I of course agree with that I think we would all love for that to happen and for every person we come into contact with who has substance use disorder we'd get into treatment but it's not realistic you know the and I see that all the time with individuals that are unfortunately also committing crimes but not everybody is at that place and so you need to focus on how you can keep those people alive while they are in that throw of addiction sorry try not to use that word that's something that's getting used to but substance use disorder until they're ready until they're at this place where they can and in the meantime I mean harm reduction literally is reducing the harm to each person while they are actively injecting absolutely and I think you bring up quite a few very important points this idea of brain addiction or substance use disorder I think that the general public sometimes really doesn't understand exactly what it means so you have people that are injecting a drug I have never met anyone and I was a therapist for 30 years dealing with this population I've never met anyone who began using drugs by injecting them the disease itself pushes the person toward injection if they're using opioids because injection is the most efficient way to deliver the drug molecule to the receptors in the brain by way of the blood it's just simply efficient and people are driven to the desperation of injecting drugs by the disease itself they overcome their sensibility toward what's safe and what's not safe because of the desperation of leading to self-administer the drugs it's a symptom of the disease it's a symptom of the diseased mind it's not a choice have you ever met anyone that wasn't afraid of needles? not many I've never met anybody I mean people go for flu shots and they can't watch who wants to inject a drug? no one but it's the desperation of the disease that pushes people toward that I really appreciate your compassion for this particular population when you look at the, I mean Vermonter is a wonderful no Vermonter wants to abandon another Vermonter but again this is a stretch this is a very very hard thing for the general public to get their mind around what do you see as facing your advocacy for this in the future what do you see as obstacles moving forward or more better than obstacles areas where the general public would need to be educated? I think that the first the education needs to come in what these facilities are actually for and the real truth behind harm reduction and the idea that even if harm reduction is our goal there is a lot of research that these facilities get more people into recovery so that is still happening but in the meantime getting over this idea that we're enabling drugs or drug use and when in fact we're enabling safe use and we're enabling people to stay alive but beyond that I think that the real education needs to come in the reality of resources being spent because you know I've had a lot of people say I don't think our tax money should be going towards this or we have limited resources and so we should be spending it on prevention or education or treatment or you know like we have to do one or the other when from my perspective I don't think most people in Vermont realize how much money we're already spending on this crisis in ways that they don't think about and not just in incarceration costs which I see are super origin costs because of the crimes some individuals are committing but Medicaid costs for endocarditis and blood infections and site infections HIV, hepatitis all of these things that we're already spending a lot of money on so it really I understand that we have limited resources I'm a state employee I know that I'm well aware of how limited our resources are but we need to really be transparent about our resources that we're already spending because I think that most people would be pretty appalled at how much we're having to spend on the other end of this crisis and from my perspective mostly in medical costs that we could if we're putting more money into preventing unsafe use and dirty needles or discarded needles in the park and public restrooms and putting more into facilities like this and safe recovery in general not just if they had a safe consumption site but just safe recovery in what they do now putting more resources into places like that we'd actually end up saving money I agree with you and I think this is a long battle going forward that will the duration will be decades, generations one of the areas that I think we're beginning to look at is adverse childhood experiences or ACEs that the children who are exposed to five or six adverse childhood experiences in their lifetime are 40 or 50 times more likely to become addicted to opioids so when you look at the resources that we are going to need as a culture, as a state, as a society to spend really absolutely doing something about this that's going to make this a pivotal moment in our history it's staggering really to look at there's prevention, there's education, there's treatment, there's harm reduction, there's recovery support services but now more than ever before and I think in American history the attention is being paid to this and I think we've got traction you have the president's commission on opioids and drug addiction in America if you read those recommendations, there's over 50 recommendations if those recommendations were followed we would really be doing something about this epidemic when you read Governor Scott's recommendations, if those recommendations were followed we would really be doing something about this epidemic in America where do you see us going with that? where do you see us as far as the funds being allocated going forward to adequately deal with these problems? that's a good question and this is, I think I've said this to you before I'm very new to politics and really funding in general as a deputy I always was just worried about how much can I get paid more because I was, you know, I feel like the deputies in this state every deputies state's turning public defenders do not get paid enough money for all the work they do but beyond that I didn't really have a lot of concept either with how much we're spending I really don't know, I think that the numbers really need to be shown I know that the Medical Center is working now on prescriber numbers UVM Medical Center as well as they are starting to give us information on endocarditis costs so I think now that those numbers are really starting to show themselves I do think that the resources can be spent the way that they should be in terms of a safe consumption site I don't know where we're at with that I think that if it was to be done in a place like Safe Recovery where so much of these services are already being the cost really wouldn't be that high and so if we can really start to figure out whether without the legislation just figure out how much would something like this cost and can we project how much we might save by having it I think there really is a likelihood for it in Chittenden County Alright, thank you Thank you for your courage and thank you for your efforts Bertha Madras was the lead author of the President's Commission on opioids and drug addiction and I had the pleasure of attending a webinar with her recently and the way she closed the webinar was with an appeal to the general public noting that this effort has the only way it can really succeed is if the general public educates itself and becomes as involved as possible from everybody according to their ability people who want to volunteer, certainly AANA, the volunteer programs out there and regular citizens to just get more involved in this and learn whatever they can do to support these kinds of initiatives I'd like to give you the opportunity to close the show and really to make a statement to the general public What are you feeling about the general public's role in this? I wish I could have heard what she said because that is something that I try to tell people all the time ever since I announced my support for this legislation I've gotten a lot of really great feedback from people people that know nothing about safe consumption sites but are just excited to have this really open dialogue and have more conversations like this where maybe the opening of a facility isn't the end result but in the meantime this really great dialogue is happening about substance use disorder and the opioid crisis and the reality of it, not just people talking about there being a crisis but really delving into it but I would echo that I've also had a lot of people that have emailed me or called me saying pretty horrible things that have clearly not done any research they have made this opinion about it about safe consumption facilities specifically without doing any research and I've developed a thick skin in this job and it doesn't bother me but I just would hope or I'd ask that people do five minutes of research about the topic that they want to have an opinion about before engaging in a conversation I disagree with people all the time I'm a lawyer, that's what I do but I do my very best to make sure that I know what I'm talking about and have a basis for my opinion before I do it I'm in court every day asking a jury to believe my version of an event and that's based on what I think the evidence is or what I think the facts are so I would just ask the same of anybody else who wants to engage in a conversation about something like this and if you don't do that, step back from it and just listen to the conversations that are happening before you decide to engage well hopefully your appearance on this show today will help the general public to educate themselves and maybe spark some interest so people can go out there individually do their own research and of course reach their own conclusion about something as important as this and just an additional question to you one more opportunity for you so really what would you say to the person out there with opioid use disorder or heroin use disorder who's injecting potentially lethal drugs what would you say to them Sarah? if you are in Chittenden County I would encourage them to go to Safe Recovery or any place where they feel safe to talk to somebody talk to if they have insurance and can talk to a provider about safe practices if they're not ready for services or resources or recovery and just know that I'm the top prosecutor in Chittenden County and I would talk to anybody about it I want people to feel I don't want to just say that I want to support these individuals I truly want to support these individuals I'm in a public office and if somebody feels like they are ready for that and they don't know how to do it I encourage them to go anywhere they feel safe and if that means coming to my office then they can come to my office and if that means going to the Burlington Police Department which I know might sound weird but they do have an incredible worker there that this is her passion and this is her job Jackie Corbilly will absolutely help get them into services I have a coordinator in my office Emmett Hellrick who is absolutely incredible at getting people the help that they need but anybody and don't use a loan if you are injecting with the I mean they're already this likelihood is already there but with the fentanyl and car fentanyl that is in the heroin now it's just terrifying how many people are dying so don't use a loan use with somebody have Narcan available if you have family members make sure they have Narcan friends that are around you and your cars in traffic use in safe places with people around you very well said Sarah and thank you so much for joining me today yeah absolutely thanks for having me Ed