 Good morning. This is a joint meeting of the Senate Judiciary Committee and the Senate Health and Welfare Committee Coming to you on Thursday, April 29th, 2021 by Azum and U2. Today's topic is H-225, a bill that seeks to decriminalize possession of small amounts of euphonorphine or, as many people know it, suboxone. Michelle Childs is going to be late. She won't be here until probably nine o'clock. I'm going to briefly run through the House bill and then if you have questions, we can ask Michelle when she gets here. But the House bill, its intent is to decriminalize possession of 224 milligrams or less of euphonorphine, persons under the 21 years of age who possess it would be referred to court diversion for the purposes of enrollment and use substance abuse safety awareness. This is very similar to possession of other drugs by youth, marijuana, etc. Person under 16 would be treated as delinquency preceding in the family division as a superior court. Knowing an unlawful possession of more than 224 milligrams of euphonorphine would continue to be criminal and penalized in the same manner as other narcotics pursuant to 18 BSA 4234. Section 2 does what the bill says, except that as I read it, and this is a question for myself, it says shall not be punished in accordance with person knowingly and unlawfully possessing 224 milligrams or less of euphonorphine shall not be punished in accordance with Subdivision A of this subdivision. So I don't know what happens to they are caught with it. So it's sort of in my mind legalizes it as opposed to when we did the earlier versions of decriminalization of marijuana, we left it with a civil thing, if you all recall, for those over 21. In this case, it doesn't appear to be anything so for all intent and purposes it would be legalized in my view. Then it goes into the possession under 21 where they between under 21 would be committing a civil violation and subject to section 4230 of this title and a person under 16 would be committing a delay. And the bill takes effect on July 1, 2021. So our first witness this morning is State Attorney Sarah George of Chittenden County. Good morning, Sarah. Good morning, everyone. How are you? Joint meeting. Good. How are you? Good. Thank you so much for having me. I am going to try to keep this brief so that I can answer any questions that you all have. As most of you probably know, in 2018, I announced that I would no longer prosecute for misdemeanor possession of buprenorphine and related compounds such as Suboxone. These drugs are intended to be lifesaving. They are an integral part of medication assisted therapy. They block the craving for heroin or other street opioids and therefore minimize the chance of relapse. They help individuals reduce or abandon their use of heroin or other opioids. So in return, people who are using buprenorphine or who are prescribed buprenorphine are likely to commit less crimes and there is a drastic reduction in fatal overdoses and recidivism. In the year that followed the implementation of my policy, the overdose fatalities in Chittenden County dropped by over 50 percent. Although we were the first jurisdiction in the country to stop prosecuting this opioid, since then, other jurisdictions around the country have followed suit. Most notably District Attorney Larry Krasner in Philadelphia and District Attorney Ellie Savitt in Michigan, both specifically recognizing Chittenden County's policy in their own. So I say that just to point out that what Vermont does really does matter as small as we may be. Our decisions do have a big impact and they send a bigger message. And the message here really is that we as elected officials are tired of simply saying that substance use disorder is a public health issue and instead are implementing laws and policies that prove that we believe that. The bill is a modest step towards recognizing the harm that criminalizing substance use has had on individuals who use drugs. It tells people that use drugs that we care about them, that we want them to survive. And so when they're given an option of possessing heroin or possessing buprenorphine, not only do we want them but we encourage them to possess the buprenorphine. When we implemented this policy in Chittenden there was skepticism from some law enforcement community members and some legislators but over time as most things do those concerns really have not been validated and the positives that we hoped for have been more than realized. Our overdose numbers drastically reduced, the number of doctors who could prescribe went up. And as an aside I would just note that the previous barriers that were in the way of having more doctors be able to prescribe buprenorphine just this week were waived by the Secretary of Health and Human Services nationwide and they specifically stated in that mandate that these perceived barriers to buprenorphine are aggravating the overdose epidemic. So given our size Chittenden County was essentially a test study in using evidence-based research to make public health policies and decisions and it worked. It's my opinion that the state should follow suit especially now when Vermont's overdose fatalities are up 38% and nationally the overdose deaths have increased 26.8% and in 2020 88,000 people died from opioid overdoses and I don't mean to sound overly dramatic but waiting another year on this bill could quite literally cost lives. Since UVM Medical Center implemented their ER program to allow for quick prescriptions of buprenorphine hospitals around the state have started to implement similar programs and I applaud them but I have heard from some folks that we should be satisfied with that or that it negates the need to decriminalize buprenorphine. So for anyone that might be wondering why I don't believe that or why folks can't just go to their local hospital and get a prescription it's just not it's not that easy and it's not how addiction works. First you know I don't believe that every county has a participating hospital but even if they do many don't have the same access to a hospital given more rural communities and further not everyone has the same experience with ERs and they're very busy not everyone feels comfortable or safe especially now and especially folks with other health concerns. Going into emergency rooms is not an ideal circumstance for a lot of people many people have negative relationships or experiences with their local hospital transportation to hospitals is difficult but perhaps more importantly insurance a prescription does still require either a cash payment or insurance and many of the folks that we're attempting to save here don't have either. The reality in our communities is that it's easier for people to buy heroin than it is for them to even buy a diverted bup strip so it's certainly easier for them to buy a diverted bup strip than it is to fight through the red tape to get a valid prescription at a hospital and as elected officials who want to keep our constituents alive I believe we should be encouraging the possession regardless of how they came to possess it rather than thwarting it. I have heard since implementing our policy from countless people who are now in recovery who say they started their path to recovery through non-prescribed buprenorphine and that is what we want and that is harm reduction and that is in my opinion public safety. The last thing I would just mention is that this is not a charge that is brought very often. I don't know what other state's attorneys my understanding of from other state's attorneys as well is that this isn't something we charge very often and so some people might think well then why do we need to decriminalize it but from my perspective then why do we need it. We are we have a really hard time with giving up things giving up laws especially as prosecutors because we think it's a tool it's one more thing in our tool belt that we need to use and from my perspective that's not how crimes should be used that's not how laws should be used and if we aren't using it and we don't charge it very often then we should be getting rid of it because right now our laws treated the same as possessing heroin and it's not the same and we we want people to be possessing this over heroin and right now and given the choice people might pick heroin if the penalty is going to be the same so that's I'm going to try to keep questions to a minimum because we have a really packed you know this one I think the one question that I have for you is did the house get the amount right would you be not prosecuting cases and I have no idea how much the milligrams are cut for me like ounces and cups and smear and even a smidge is easier for me but did they get it right in terms of the amount that they you say decriminalized I say legalized I think so I believe the 224 or 225 milligrams is about a two week supply 10 day supply I think that that is reasonable I don't have any concerns about it I think more than that somebody could still have more than that I'm sure for a personal use but I have not seen that typically people either have a few strips or they have hundreds that they're selling that's helpful yeah do you have you um no mind I guess I'm gonna ask that question I just wondered if you prosecuted any large amounts yeah I have and even since my policy I have two cases in particular where people had it was there were there was a lot of other drugs that they possessed as well um hotel rooms that were full of drugs and and I did charge the possession of the buprenorphine strips because I think he had a hundred other questions for uh state's attorney George sir thanks so much for being with you with us thank you so much for having me our next witness is David excuse me Michelle you're here and thank you for for joining us again we appreciate it we know we're all in the zoom world we're all stuck with various duties um and uh so thanks for being with us I um I'm curious we did a brief walk through the bill and I'm not it's not clear to me we when we decriminalized marijuana we we gave civil tickets out instead of the criminal offense and in this case the house chose to um just leave it um no punishment which in my mind got illegalized is that a is that a apt term and do you know what they went through but you know did was there any discussion about civil tickets or any other method it my my recollection was that there there was a robust discussion um both in house judiciary in 2019 because the bill had originated the the predecessor to 225 had originated in house judiciary and passed out of house judiciary and then um it went to human services and so my recollection from last session was that there was a discussion about establishing civil penalties as opposed to the criminal penalties for that lower amount but um but they chose to eliminate um those penalties uh because I probably some of the the policy reasons that you're hearing from people who are advocating for taking away the penalties and so right now as the bill is structured is that there would be no penalty for 21 and over or possession of the smaller amount and then if it's under 21 then they are referred to diversion and the youth substance misuse awareness program that's run by the attorney general's office and that's mirrors what we do with underage possession of cannabis and alcohol any questions for michelle um a next witness is david sure from the attorney general he's an assistant attorney general and chief of the community justice division community justice division excuse me thank you i'll get this right eventually david a couple more years we'll get there yeah thank you senator thank you committees for taking up this bill the attorney general supports this bill thinks it's an important move forward towards arm reduction approach to people who are suffering from substance use disorder uh our office has worked hard in our own realms such as diversion and pretrial services and tamarack uh since uh 2017 or so to try to really make more robust the our connections with the treatment community through those programs tamarack thanks and back to the senate judiciary committee was uh created in 2017 excuse me in 2017 in order to create a section of diversion that was a version of diversion that was really directed towards treatment oriented approaches to individuals involved in the criminal system we do think that this is a important to move forward towards ensuring that uh we are not criminalizing people who are possessing small amounts of a drug that can be life saving and preventing them from using much more harmful much more dangerous drugs specifically heroin and uh related compounds and we are seeing right now a serious opiate uh problem again in our state and around the country we're not unique in this right now than the pandemic certainly we hope that as things open up again we can renew some of the supports that had been in place to ameliorate that problem but we think that this is an important move forward to make sure that people are not being punished for using an alternative that is much safer much less harmful than what might they might otherwise turn to uh i don't think that you know i agree with a lot of the reasons that state strength dorge named i think she did a great job summarizing some of the data and most recent input we've heard from national authorities on this as well so i won't go over that again i think that was very well stated and we agree with those points as well so with that i'm happy to take any questions and uh thanks again to the committees for considering this i guess my one question and my my understanding from some in criminal justice is that that somebody caught with a small amount of beef and morphine this is used as a tool to get them into treatment is there any concern that people won't seek treatment and just continue to use um and that they're not really um that they're still using um heroin and other but when they can't find it is there any concern on that that this will um lessen the treatment people might go to i certainly think that we need to make more robust our ways of getting people connected to treatment i don't think that we need to use the criminal system as the way to do that i think that we can um and do better in terms of making sure that public health resources are readily available for reference by police um and by others in the community who may be in contact with individuals who are in need of that treatment but i don't necessarily think uh hanging a criminal charge over somebody is the best or even most particularly effective way to have them enter treatment in a way that is really something that sticks and is lasting or at least is part of a process that is that is lasting we understand that these things take quite a long time or can take quite a long time so my answer is i don't think that we are using a tool that is particularly that is essential or particularly helpful i think there are other ways that we can and that i think agencies are already doing i want to give credit where it's due i do think that law enforcement agencies are aware of these issues and are already working to create in some places are working to create these connections but i think going in that direction is the right way to go and i i don't want to labor the point but where do you get it if it's not diverted from somebody else's prescription or it's not you know you didn't break into a pharmacy to get the the amount of that's now you have to get it from somebody it's still i assume still illegal from somebody to give this amount to somebody else to sell it never so how did they get it if they're not either diverting it or stealing it from somebody else well maybe that they've acquired it in some transaction with somebody else just paid for it i mean and i think what we're trying to do here is and that other person maybe somebody who's involved in some other activity that allowed them to get it i think what we're trying to do here by putting the this amount in place is to create a distinction between people who are not involved in larger enterprise commercial enterprises not trying to do this for commercial gain and prey on people who you know need something that that otherwise could be gotten through through legal means i think and so putting that cap on it tries to different create that differentiation between those two types of individuals those who are doing this for commercial gain and those who are doing this simply to help themselves and i have recognized that those sorts of numerical caps can be a rough way of making that distinction but it's a reasonable way for a legislature to make those distinctions and i think you know it'll be up to law enforcement as well to and prosecutors to take cases as they come and see what is what is appropriate for things above that cap but we do think that that is a way of making the distinction that's necessary between those two types of individuals who may be caught with it good questions for david david thanks so much thank you um our next witness john cambell has politely declined um so denise white i'm sorry denise the state attorney from madison county maybe senator hearty should introduce you and i'd get the name right that's all right senator thank you um it's actually last name is wigman's wigman's okay thank you viceman in the old country but here in america we call it wigman's um thank you for having me today i really appreciate the opportunity uh similarly to uh state's attorney george and adison county we declined to prosecute uh misdemeanor possession of buprenorphine back in 2019 i say declined to prosecute which is really uh not accurate um because in the four years that i've been a state's attorney we've only seen one incident um where someone was in possession of uh buprenorphine without prescription now there are a couple of conclusions that can be drawn i think from that and part of it is to understand how uh we come across people in possession of illicit substances in adison county most of our possessory offenses occur uh related to traffic stops we don't do a lot of um you know what you see the feds do or the drug task force do here in adison and that is put together uh you know buys and then execute search warrants and so on in this county we see plenty of crack cocaine we see plenty of heroin and fentanyl in those traffic stops but we don't see buprenorphine and i think the reason is two fold one is that a lot of people who are using uh this drug illicitly are doing so uh and otherwise leading lawful lives they're not engaging in illegal activity in fact they're attempting to put their lives back on track uh having suffered from an addiction one thing that many of you probably don't know is that i worked in the music industry for 18 years before even went to law school and i've lived and worked around addiction uh regularly uh many of the people that i worked with in that industry succumbed sense to those addictions and um when people are in recovery which comes and goes oftentimes um you know that is a large focus of their life and they're trying to do everything to keep themselves on that track i think the question should be what's a fair impediment to place in the way of somebody who's seeking to enter into recovery and i would say not and i'd be willing to trade you know one criminal prosecution to save at least one life and i can guarantee that this drug is saved more than that uh and the illicit marketplace essentially what we're asking people to do is to conform to our model or perhaps die and that's a terrible equation for someone to have to struggle with there are impediments uh to go into the emergency room one of which as sarah mentioned is the insurance impediment but there's a greater insurance impediment and that is the people that have insurance perhaps don't want their addiction to be documented in addition there are other issues that may be related to their employment and to of course the generalized shame that comes with having an addiction and a lot of these folks you got to remember studies have shown they ended up here not by any fault of their own but because they were over prescribed pain medications to begin with and they were seeking heroin or other opiates or opioids in the illicit marketplace when they were cut off by their doctors and so from my perspective it seems to be a public health win uh to decriminalize this particular possessory amount uh first it's not as widespread as some of us have concerns about second you haven't seen the proliferation that people are concerned about and look i get it i understand the trepidation associated with suddenly as senator sears says legalizing a substance that was previously not legal but we haven't seen the proliferation proliferation here in addison county we didn't see it in uh chitin county and you know we haven't seen it in the dui drug cases for example we see other otherwise uh prescriptive medicines such as um benzodiazepine and other xanax and other prescribed drugs but we don't see buprenofin in those persons uh blood flow nearly as often i think i've seen one case in the last two years so finally what i would say is that uh we should do everything we can to encourage people to engage in uh coming off of uh an otherwise extremely deadly drug and if part of that includes uh decriminalizing small amounts of buprenofin i'm all for it if the concern is how do we get people into treatment we can always uh you know pass a statute requiring law enforcement for example to refer people to treatment providers when they find them in possession of the amount but um in my experience it's not the best method of getting people to treatment by trying to cuddle them there they kind of have to come to that decision on their own thank you thank you um senator hardy and then senator white thank you senator sears um uh mr wigmans i saved my questions for you since you're my state's attorney um well it's good to hear that this is not a huge issue in our county um i'm curious if you think it sounds like you've seen people with higher amounts of other implicit drugs in their system or in their possession than buprenofin i'm i knew i was not going to be able to so do you think if we were to pass this bill that would switch and there would be more people who have decriminalized bup than have um heroin or crack or other illicit substances do you understand what i'm trying getting at i do know i do understand what you're getting at um i would say no and the reason i say that is because as you point out these other substances are are illegal they're illegal to possess and people are using them nonetheless uh just because it becomes lawful first off porter hospital here in our county does provide strips through the emergency room and a number of people are engaged in that program we have a very active medically assisted treatment program through the mountain health and we're going to be seeing i think another one coming up we have a walk-in program in virgines um so you know i think that that concern um you know i don't want to call it a false flag but i just don't see people turning to a bup when if they're looking for a kick uh they're not going to be looking there um there are a lot more uh hard drugs that people can turn to that are readily available in the illicit marketplace i guess i i didn't see my question quite clearly um because i'm wondering if it actually i meant it as would it be a good thing that we'd see lower amounts oh i see you're saying crack and coke and higher usage of bup which is trying is is helping people get off their addiction does that oh yes i see what you're saying but you know the only time it's really going to be coming into play where we uh in our office become aware of this type of use is probably in a DUI drug case where we've received a blood drop and as i said um we haven't been seeing buprenorphine that often we've seen you know crack methamphetamines we've seen cocaine methamphetamines you know opiates and opioids uh and other substances many of them are you know prescriptive medicines um but i don't see where i'm going to learn about that that's probably a better question for people um that are um administering your analysis for purposes of medically assisted treatment okay and i know that we're going to get testimony later on um about how this is unnecessary because um people can just go to treatment and you sort of alluded to that in your testimony and i'm wondering if you could expand on that that the sort of availability of treatment and how that um might interact with this change in the law well you know um one of the things that i have noticed about the testimony that's been provided a lot of it has been from people like me uh people like uh you know state's attorney martin she will be presented testimony later uh folks from uh the law enforcement and things what i haven't seen is a lot of people who have been out there um you know dealing with their addiction um you know i lived with someone who was going through this back in the 90s um you know he has since relapsed but then recovered each time uh he turned to street you first um you know it's really a lifesaving you know drug in that regard um and from my perspective as i said if the concern is whether or not people are going to engage i think majority are going to engage in a you know in a treatment program uh through the emergency room but there are some who the stakes are too high for them or they have other concerns where they're not going to feel comfortable and so placing that impediment in their way of saying hey you know what if you're caught with this you're going to be you know dragged into the court system um and that maybe leading them to not choosing this i think is a dangerous choice um one that we would be actually encouraging um not by uh you know decriminalizing and especially when the stakes are not particularly high as it stands right now we're not talking about a huge number of criminal cases statewide thank you thank you senator white i was just gonna thank you attorney wegman i was just going to um comment on your your suggestion that we could probably pass a law that says that law enforcement has to refer them to uh rehab and um for all the good that would do because we don't have the appropriate rehab facilities anyway so um we could pass the law we could do anything we could encourage people to go to rehab but until we have the appropriate uh resources for them it's not going to do any good so the only comment i would say you know related to that is if that's an ongoing problem now i don't see it changing either way um and i would agree with you that we you know don't have a lot of resources um and we do have limited access to for example emergency rooms where people can kind of start those first steps yep thank you i i've got a you know i'm i'm having a hard time with some of this conversation so i have to be honest with everyone um whether you support the bill or not and i'm trying to be open minded here but believing somebody at treatment is not a bad thing i spent about 40 years of my life with people who didn't want to get treated trying to treat them and they resist obviously i resist they resist but we keep going um you know finally in about half the cases they come along so i just i have a hard time with the idea that you know i always said you can take a horse to water but you can't make them drink it but at least if they're around the water they might decide to drink it and so i'm having a hard time with some of this conversation which sort of indicates that you know unless somebody is really motivated they won't seek treatment you know one of the biggest complaints i have from emergency responders is when they go to the scene of an overdose and they use the naloxone and the person comes back they refuse treatment and the next night they're back out you know in the same situation same person same situation so i just need to say that um you know again i'm open minded about this and also let's let's be honest we're legalizing it for people over 21 we're not decriminalizing it we if we um ask the house senators here's my comment on that sure you can lead a horse to water but you can't make him drink it but you've got to have enough water to begin with and that's that is a problem i think we don't have enough enough water meaning rehab services okay i'll i'll just chime in here and i look forward to the testimony that we have today on all of this and knowing that part of our some of our needs are actually helping people in these situations and having care management systems or case management systems in place uh whether we have sufficient um support out there through hub and spoke or our da's uh it is always problematic and especially now given the escalation of addiction that's going on but um but i i want to hear from folks who we're going to hear from some folks who are actually on the ground working in in some of these areas and i know that we're all we're all concerned about this the question about my question really goes to the under 21 and under 16 categories that are in the bill and how we're dealing with those two sets of of folks so under 16 going to uh juvenile uh court and then the other under 21 there's literally no penalty that that a question for the witness it is a question for the witness do you see any distinction or what kind of distinction do you see in your practice and thank you for for being here thanks so um well first you know we haven't seen a single case involving juvenile and and and adison county um we um you know i do have our largest high school year does have a school resource officer um and we've not seen a a single case um i don't have a lot of concerns in that area that we're going to suddenly see um you know because adults can have access to it um as i stated earlier i think the majority of people are going to you know continue uh to proceed through the emergency room or through a medically assisted treatment program elsewhere um and i didn't mean to uh imply in any way that i think that you know treatment is a bad thing or helping people to get to treatment is a bad thing our court and our um you know state attorney's office was one of the first ones to fully embrace the pre-trial um you know what was called then monitoring program which is now called the pre-trial coordinating program we refer a very large percentage of our cases to that program and have seen a lot of success out of it and so i applaud all efforts to help people to um you know head towards treatment i don't know um that the adversarial court processes the best means though at helping people find treatment where it is available um but as far as the question is concerned um as i stated we don't see it very or at all in our county and perhaps that's been a different experience i'll swear um you know i can't really speak to statewide what's been happening in other our other counties thank you thank you hardy thanks and i i just want to add to i think uh state attorney wigman's gave a good examples of why people would not or may not feel comfortable seeking treatment at an er or at another medical facility um for a variety of reasons um because of past experiences with the medical system because of um issues with employment because of health insurance because of um issues with a criminal record and so there are a lot of barriers um so just saying that we'd like people to get in treat into treatment um and that we have resources for it is is simply not enough for a lot of people and it's much more complicated than that no thank you it is complicated and it didn't mean to suggest that it wasn't um my first experience with an overdose was 20 years ago um person who died was 20 years ago on st patrick's day um this has been and not so if that's 20 years ago um things have only gotten worse they haven't gotten better um i will say i'm gonna try to talk a lot of things so i'll just leave it at that state attorney erica matzich bennington county and think you're part of the executive committee attorney's association yeah okay so uh this has always been a topic for me because i feel like you know state attorneys are not we are not addiction specialists um we do what you do we gather our information from people who are uh and then we see how some of these um statutes kind of play out in the community and uh and i am uh i'm part of the bennington county um opioid leadership team and we have received a number of federal grants community action grants to work on just this issue and i'm the chair of the law enforcement subcommittee of that group and we uh had a meeting a couple days ago so i had this conversation with the folks on that call which included um a nurse that actually does uh she's a in the medication assisted treatment program in bennington uh cam grandee the um lieutenant from the bennington police department uh and then a number of other treatment providers the case worker for turning point um it was on the call which is our uh um essentially they you know they're the sobriety group in bennington they help with uh resources and connecting people it's mostly volunteer we've been running um for probably a year now a project with them with turning point where uh if anyone does uh overdose um law enforcement or or EMTs so it's not always necessarily the police when they respond the uh turning point responds as well and uh that's been extremely helpful from my perspective uh with in and from hearing from law enforcement the police officers genuinely appreciate having someone from turning point there what i find interesting about this bill is uh there's been a lot of testimony about it being you know um and i think the word miracle was used i mean what i would say is we don't criminalize it now it's really not i've never prosecuted it even once um it comes in maybe uh as uh s a wagman said with a a d y case um as a secondary charge but clearly not something that the i think the community is deterred currently deterred by the criminality of it so um but again that's my experience i speak for uh myself and a handful of the um essays that are on the executive committee uh because we also talked about this uh in our meeting yesterday so for me it ultimately really comes down to um i completely agree with senator sears i in that we need to be getting individuals into uh treatment and i think that it is highlighted this does highlight the need for more treatment availability and more uh programs um however you know there are a number of other things going on the the federal government has approved telehealth you know and it's been this way for all of 2020 so for the entire calendar year of 2020 individuals were uh able to go through telehealth for uh medication assisted treatment and um turning point hands out information about that they assist we have multiple programs that assist people with getting uh insurance i spoke with the nurse that does medication assisted treatment and asked her how many of the people coming in new clients coming in for treatment have been using uh buprenorphine off the street essentially for their own treatment um the number was significant she's like it's probably like 80 of the people that come to her have already either used in the past or currently using non-prescribed buprenorphine um which i thought i was surprised uh she talked about the stigma around going in and getting evaluated uh obviously i don't think the stigma is attaching to the cases where folks are overdosing in the law enforcement community is responding multiple times in a week um you know we had one young lady who overdosed three times in a week and had to be uh they had to use narkan on her and each time she declined any kind of um follow-up with turning point so i think that for me this is a tough one because again i'm not an addiction an addiction specialist so what i come down to for me is i am a cost-benefit person at my very core i look at every decision in my life in that cost-benefit kind of evaluation when i spoke with and i think senator sears is familiar with some of the um mothers and in uh bennington county have you know created fed up or vermont and so the fed up ladies i reached out to them they're all mothers that have lost either lost a child to addiction or have a child uh that's addicted and uh of the four of them they have strong opinions about medication assisted treatment that they're not actually fans of um that process for uh to achieve sobriety however they look at it exactly like i do if we don't prosecute it it's not removing any tools from my toolbox kind of regardless of what you all do with it um but if it saves one life it could be worth it um and to me that one life outweighs any benefit that i might get um from having this tool in my toolbox now all that said i love uh essay weigman's idea about um not diversion i would not argue for diversion i would say um that it's more like a pre-trial or pre-charge situation you know i don't i i agree i don't think getting the state's attorney's office involved in these kinds of cases leads to um positive outcomes i just i don't we refer every every case unless you are dealing or trafficking in heroin we refer every single case to treatment diversion more than half of them uh fail out but the half that don't we're making those connections and anybody who's ever dealt what i do know about addiction is that it's cyclical right we're gonna go through periods of sobriety and relapse multiple multiple times over the course of someone's life uh that's the hardest thing when i look at someone who's 25 who was addicted even if they get uh into treatment in their sober i always think in the back of my head this is something that they're gonna struggle with for the rest of their lives it doesn't just go away all of a sudden it's not like you're cured from addiction so um i feel like this is a fill it really is a philosophical decision for the legislators that are making that are looking at this bill and the governor i mean it's uh is it and i can also completely agree that it's not decriminalizing it it's legalizing it there's a difference um i don't i think there were a lot of kind of speculative things what was going to happen when we legalized small amounts of marijuana uh i don't i don't see that the sky never fell but i also don't see that we got rich off that prospect so um you know i think it really is something that you all need to hear from the experts and uh we the state's attorneys are not the experts i'm not um i don't think it's our place to take a position on uh this type of legislation because it really is so tightly tied to uh addiction and and how people deal with it and i think the department of health is really the one that um should be looked to for any expert testimony about this i appreciate that i i have a couple of questions and then i'll go to center alliance erica thanks so much for being with us this morning um and i will point out one of the advantages of zoom if you don't have to drive from me and just right and i'm wearing jeans i'll tell you wow i'm wearing shorts if we're going to be honest um but anyway that wasn't what i was going to ask you about um one of the frustrations that i've had and we've talked about it as well as the opiate missed party uh substance misuse group that you spoke of i knew to several of those meetings that are very aggressive for bennington county there is no um more um methadone treatment available unless you go out of state either green or brow brow but you're in state in brow moment feels like out of state or greenfield mass or north atoms mass that is a huge void in our district um and while i've got the health and welfare committee here i i don't want to leave without letting you know how difficult that is um i had to work with the corrections department to allow basiners and people on other statuses to leave the state in order to get methadone treatment i mean it is ridiculous and here and here is i had to work with the dcf because we have so many folks that are in treatment that uh are involved in family court that don't have driver's licenses or they don't have uh transportation and getting to north atoms this was not something i knew about dcf for the longest time couldn't use vouchers to cross into another state so that to me is really ludicrous aside i just want to raise that as impediments to treatment in our area yeah okay uh senator alliance had a question for senator uh state's attorney marcia um thank you actually it's a question that i would ask of each of the state's attorneys and just knowing the you know the progression that we look at in investing in prevention or intervention treatment and then recovery and it sounds like you're the recovery piece for you uh in bennington through the turning point center is um is a very close link and i think having those links in with the designated agencies for treatment um are equally important but i think as we all understand the funding in each of those areas is uh could be improved to turning point uh senator turning point the the they trained probably 15 uh volunteers um last year just for this project and it's really been astounding julia larson is on the agenda she's from the local bennington right she's going to be coming in a little bit later so we'll you know we'll hear more about the program but i i you know and i and i understand that you've identified the time frame for recovery can be seven years and it's also the critical time for whether or not someone will commit suicide there's all of those terrible considerations so i guess my question for each of you is is how i hear from from you um attorney marthage about turning point center and i hear from uh mr wiggum's widman's that there isn't a huge problem in adison county at least for this particular drug uh but and also um our state's attorneys george and chitin county but what linkages do you have for treatment and recovery and in particular that you're seeing for folks who are have um are using the buprenorphine it's a pretty open question but i think it's an important one because yeah i i agree i and i don't i want to make sure that um the committee understands i it is a huge problem in bennington i it's a huge problem but we don't i don't prosecute it because i don't um police don't bring these cases to me they see people all the time i asked the lieutenant about this yesterday um but we don't prosecute them we hand them a card you know we have these cards for turning point that we hand out uh the the linkage so so as senator sears indicated he's been to a few of these meetings the the bennington uh opiate opioid leadership team has been probably the only group i've been on in the last 20 years i have one other in the back of my mind the juvenile working group that i'm on that we have really um done good work the linkages there have been honestly the hospital is the one that took the lead they organized um i'm not sure i think senator sears was at the um meeting that representative welch came to uh probably four years ago and they were like 30 of us there just pleading with him that we needed resources we needed um really to come together and the president of the hospital at the time um tom d just took that and ran with it like and i was very impressed to have to say because the hospitals um you know they're helpful obviously but they're not typically the leader on this kind of issue and i felt like it really made sense like they loaned us a grant writer they gave us a space they organized all of like they really went above and beyond um and i think that is what really started creating those linkages right we started the woman who runs our crj was on the was as always at these meetings she's actually on the law enforcement subcommittee the public defender is on the law enforcement subcommittee um the lieutenant and we really talk about it but the hospital facilitates all of these meetings and we talk about how do we make these connections and i'm sure that's what julie is going to have a lot to say about that because obviously they they've been really a key component of that um that connection but yeah that's it like how do you stave off uh an overdose death while we're trying to get people into recovery that's really what it comes down to uh do i think that legalizing buprenorphine is going to have some huge impact on that i don't actually but i also don't think it's going to hurt um just because i think if if we can do anything that's going to make it um easier for folks to uh not use heroin that that's where we need to know so sarah or dentist do you want to comment to the question i can i can just chime in really quickly i agree our hospital has definitely been a big part of the success um in terms of getting more doctors prescribed i'm very hopeful that with the new um national mandate of waving the the obstacles that doctors have is going to mean even more doctors can prescribe and so even more people can um get prescriptions safe recovery in our community our syringe exchange program has also been a huge part of that um dr blake you know who lost her son shon um to an overdose has been it has been huge and just making sure she can get as many people prescribed as possible um but one thing i just you know i don't want us to lose sight of the fact that there are so many people in our community that are not ready for that full um abstinence and or even a full uh use of mat there are a lot of people who are just in the middle there and a lot of them aren't quite ready for that because of the underlying trauma that has led to their use and so until we really get great mental health services and co-occurring services for people that are also um using because of extreme trauma people may just continue to use buprenorphine illicitly one day and use heroin the next and then use buprenorphine and we have to be okay with that we have to understand that that's part of getting into recovery and that not everybody is at that um end level or end you know place yet and in the meantime every single time that they pick suboxone even if it's not their prescription is a time they are not going to die from fentanyl so you know i am really sick of getting up on top to your reports in my inbox every day from people in my community dying from fentanyl um people are not dying from suboxone and that's frankly at the end of the day what this bill acknowledges and you know tells the community thank you um treatment options i'm sorry now go ahead i i'll ask my question after you've had an opportunity to respond sure uh treatment options in addison county um as i stated earlier uh porter hospital which is part of the udvm medical center um system um you know since they became part of that system has been providing uh walk-in through the emergency room valley vista has a walk-in uh in virgin's uh mountain health in bristol um is tied in with um within the community both both there but also they have a van uh and so they've been uh mobile um part of the problem is that as um senator lions mentioned we you know we don't have enough water in our community um there we have a at least two or three towns uh in addison county that are on the other side of the green mountains um and those towns um you know their access to services is very limited um you know uh and that's where we see part of the issue is that we have a lot of people that live very remotely that don't have a great deal of access turning point is under new leadership in our county and also partners with the mountain health folks but they've largely been focusing on um you know housing as a as a need that needs to be met in addison county in addition the counseling services of addison county just hired a street organizer to help reach out you know to homeless folks that are living in our county uh to provide them or to link them with services but also to get them into some of the you know limited housing opportunities uh that we have so did you have another question senator lion yeah it's really a quick question it's not something that you actually need to respond to right away but with all of the investment that you're making and in time working with your advisory groups working with your local uh treatment centers uh recovery centers and um you have recommendations to make both to judiciary as well as to health and welfare and i remember several years ago when we were hearing testimony from people driving every morning for two hours to get to the methadone clinic and then driving home going to work and then the next day doing exactly the same thing that at least has been improved but now i'm hearing that bennington county it's not a broken has a broken system so if the these kinds of recommendations that you can send to us will help us as we develop our policies as well as our budget i know that senator sears and i both were very invested in having recovery centers receive funding during the pandemic and that that's happened but these these issues don't end and the need for improvements don't end so any suggestions that you have i would certainly welcome those in my inbox so i will just say it's not it's not all the fault of the state that bennington doesn't have methadone several years ago myself and a few others tried to get methadone started and the local groups were so opposed to the idea that we'd have methadone in bennington county they shot it down it wasn't until um really the hospital changed hands to on d and others that was started to see an interest in having methadone available um actually north adams is not that far um from bennington it just happens to be in another state which makes the transportation all that more difficult um but it was it's not all the fault of the state that we don't have yes um and then when the turning when the state developed the hub and spoke we were part of ruttland but ruttland had such a demand for methadone that by the time bennington was able to get in all the slots were already filled and it's very far from bennington yeah and that's really further than but but at the time that the ruttland operation opened right our only other option was greenfield mass and the and the the other you know we talk about um working you know you have to get up and drive two hours and go to your treatment and then go to work there's another piece of it a lot of the folks that um that i do see are the ones that have concurrent criminal charges for you know maybe burglary or a driving offense something related in criminal court then they have a family court case where their children have been taken into dcf custody and they have a case plan that they have to meet and so it's it is not lost on me that there are a lot of days that in juvenile court listening to the social workers say well they only made this percentage of meetings but some of those days they've been on the bus all day riding over to brattleboro and coming home and they don't um they they just aren't enough hours in the day to meet your dcf case plan your doc requirements and your treatment so um but i mean senator sears is absolutely right i remember when we when that all happened with the methadone clinic and it was uh i think there was some fear that if we bring a methadone clinic it's somehow going to change the face of you know the population in bennington and it's going to bring addicts to us not like that we didn't already have them so i i thought that was really unfortunate so um yeah i was surprised i got reelected anyway um that thank you all three states attorneys very much um we really appreciate hearing from you you're on the front lines dealing with it day in day out um with it being a significant drug problem that the law faces and that other states face and that associated crime that goes with motion um thank you next and we can't forget law enforcement and we have the commissioner of public safety uh next um mike shirling um and good morning mike and welcome to this amazing hearing we appreciate it and we're being here um so i'm going to just kind of throw it open to you and your views on it as a form of cheaper police in the city of bennington i know you have expertise and as a law enforcement officer as well as thank you senator uh thanks for having me in this morning uh i agree with the many of the points made by the state's attorneys although uh we'll offer a bit of a different view on what we believe a more pragmatic path forward uh could look like to address this this issue and i know you have dr levine scheduled in an hour or so and uh he'll add um quite a bit of additional detail from the public health perspective that dovetails into uh uh the perspective that we're bringing from public safety and the actual conditions on the street and i would just remind folks that uh less than 10 percent of the day-to-day responses of public safety organizations whether that's law enforcement or fire ems service make it to um a prosecutor's desk so the the field of view is substantially different from street level first responders um that's not to diminish the prosecutor's view but just to flag for you that it is a at least a tenfold increase in the number of events that we have our eyes on in any uh any given time period whether that's a week a month or a year our shared goal of course is better outcomes reduction of overdoses getting more people into treatment enhancing access to treatment and for all those reasons this really at its core is a public health issue not a law enforcement or criminal justice issue but it's important to note from the outset that buprenorphine is not only a treatment drug but it also is a drug of abuse so unlike Narcan which is used to reverse overdoses buprenorphine can be used as a drug of abuse and uh equally important it can be used by those you know what creates the diversion market is diversion it's sale of buprenorphine often by people who it's been prescribed to uh to fuel the purchase of of other things so again I offer that as background for some of the things I'm going to talk about in a moment it's been noted already that what's contemplated here in terms of the number of milligrams is beyond a smidge as the as you mentioned senator it's a one to two week supply of buprenorphine which is substantive when you talk about or when you contemplate what that could look like relative to to diverting um that level of of possession um we believe that uh achieving a balance in ensuring access to those who need treatment and assuring accountability for those who are um doing nefarious things with uh with buprenorphine is um is also uh a key piece of this conversation um it it struck me as I was listening to to the discussion this morning that encouraging people to uh possess buprenorphine for treatment is an admirable goal encouraging them to purchase something on the street on an illicit market um is problematic from a number of uh perspectives first it is not uncommon for people to be purchasing street drugs and not get what they signed up for um or to have what they signed up for be cut or altered in some manner that makes it either more hazardous or less impactful as a treatment if that is the underlying goal um additionally uh state's attorney george gave an example of a prosecution in a hotel room with a myriad of drugs that were uh um seized simultaneously that is the norm um drug dealers don't typically deal in one drug at a time and by dealing in diverted buprenorphine it's something that creates uh cash flow that allows them to continue dealing in other substances as well so again I just provide that as uh as background um the to get to sort of the meat of this each time although the number of times we encounter people in possession of buprenorphine cases is not high um the uh each time we encounter someone it is an opportunity to uh try to lead that force to water to get treatment and in uh decriminalizing or legalizing it and foregoing that opportunity we do lose an opportunity to get people connected to treatment now we've talked a little bit or there's been testimony earlier this morning about programs to um sort of step into that void but unfortunately in vermont those are hit and miss and we don't have a statewide systemic approach to getting people into treatment um at all opportunities where they intersect um I'll say the public safety system not necessarily the criminal justice system when they're in the back of an ambulance when they're um at a fire scene when they're um interacting with law enforcement um not only in cases where they may be possessing or even dealing drugs to support a habit but also in that 90 plus percent of other responses that can be anything from a landlord-tenant dispute to a disorderly conduct to a retail theft where having immediate access to treatment would be uh significantly beneficial treatment on demand which I think is our overarching goal but one that has been elusive for the couple of decades that our our heroin problem has been burgeoning and problematic uh so we've all of that background together to say this that we believe that a better approach would be to continue to use the structure of the criminal justice system not the prosecutorial aspect of it but the structure of the system um to encourage people to get into treatment and to have an opportunity to unpack their underlying issues in a more robust way by doing something like diversion um whether it's true diversion or it's some other mechanism uh each one of these uh encounters if we don't take advantage of it as a lost opportunity uh to try to save a life to try to impact not only the person who subjects the addiction but all of their family friends um work etc um and you know distancing ourselves from that responsibility um is an easy policy approach but it strikes me as not the right one um we should be engaging more not engaging less so um yeah I have a number of additional notes but I think at some point it becomes a little little redundant um so I'll stop there and if there are um there are questions I'll just end with doing something like that rather than straight decriminalization um would enable better tracking of the issue it would enable a pipeline to treatment and it would allow us to assess outcomes and make treatment referrals in a way that's simply going hands off and and encouraging people to buy things on the black market which I believe is hazardous um just that approach does not allow for those kinds of things thank you um I don't know how many of you received uh suggested language uh or a change from commissioner shirling I I did um um senator lyon you did Peggy or nelly do we have a copy of that that posted or printed out yep it is on the website um but I can pull it up right now if you want both websites or it should be on health and welfare as well yes oh okay thank you nelly oh I'm seeing your email sorry I didn't mean to do that that's all right with us um but it is on the website do you want me to try and pull it up yeah could you please sure while Peggy's pulling it up um commissioner if we went in your direction why wouldn't we do that for people under over the age of 16 and under the age of 21 that's certainly be at your discretion senator um the the framing was originally designed around uh statutes entitled 33 that uh encourage or direct inversion for certain kinds of offenses so you know that that framing is malleable depending on the policy goals having a little trouble here sorry guys not a problem in the meantime are there questions for commissioner shirling senator hardy thank you mr chair um and thank you commissioner shirling for your testimony I'm curious I don't understand your sort of take on the bill that it is encouraging a hands-off kind of approach rather than an engagement approach um it doesn't I don't read it as that I just read it as as saying we're not we're not gonna criminalize the possession of something it doesn't mean we're not gonna help the person if we find out that they are possessing um buprenorphine it just means we're not going to arrest and prosecute them so I don't understand your take on the hands-off approach of it yeah that's a great question um thank you the so in the field um you come across someone who's in possession of buprenorphine um what do you do next there are system beyond the ability to refer someone in in this case what we're suggesting is into the system and then to diversion where the diversion board can um can uh both direct and then ultimately monitor uh treatment or some parallel version of that potentially although unfortunately those parallel versions don't exist statewide absolutely that um the first responders who are there are just walking away in most cases uh there are hit or miss programs a couple of them have been described to you earlier this morning where referrals can be made but by and large we do not have the ability and access to treatment on demands uh in Vermont so the it will be a lost opportunity and and do you think that putting the person in to diversion will help that I mean I don't understand how that's just sort of using the and I understand that the diversion program is not directly the criminal justice system but it is a part of the criminal justice system and and how is that more helpful than helping the person you know access treatment uh an MAT program or medical treatment it's an additional option of sort of connective tissue to programs that so the the diversion program has access to a variety of different mechanisms that they can leverage to uh to shuttle cases to successful fruition through the diversion program again it's it's the only statewide program that we've got to use as a model um there you know we could there are other ways to do this we just don't have um a statewide version of another way to do it right now I will take this opportunity to promote in our modernization uh plan that we put forth last january one section of it which is available on our website dps.vermont.gov forward slash modernization shows a construct for a criminal justice and public health system that is designed to do exactly what we're talking about here uh engage people with prevention and education first outreach and intervention treatment options second alternative sanctions and then finally courts and corrections the sooner we work toward a systemic approach like that the better outcomes we're going to have we continue to attack this piecemeal and look at decriminalizing this or a tiny treatment pilot program here we're going to continue to struggle with uh good outcomes and and I think each time the state this isn't anybody's fault it's the piecemeal approach to to the way we do business and state government typically and I've watched this now for almost three decades or more than three decades we keep taking steps back from engaging and and disinvesting instead of going in the opposite direction mr chair may I ask a question yep sure thanks commissioner um a couple things i i i do believe that when you um reference the modernization plan that um this in in my mind this really is um responding to steps one and two it is um it or it can be responding to steps one and two and one of the things that I remember that we heard in the testimony on whether or not we should decriminalize the penalty for marijuana was that many many many people told us that the biggest problem that people had was getting involved in the criminal justice system that the the um their use of marijuana was a problem and could be dealt with but the real problem came in when they got involved into the criminal justice system and it can it tends to spiral downward they get involved then they are on diversion or on probation or whatever they have a violation that escalates and it just continues to spiral downward and so it seems to me that that just even getting people involved in the criminal justice system in this case is um uh could lead to the uh downward spiral for that person yeah I don't just agree with that senator I think that is an an accurate representation of what happens to some people um let me back up a step and and sort of bifurcate my description here uh if our overarching goal is to get buprenorphine into the hands of people who need it for treatment uh through lawful means then we should expand the mechanisms available to us so that people can walk into a pharmacy and get buprenorphine on demand um through prescription or referral or whatever the case may be but not encourage them to go to the street drug dealer who is using those profits to do something even more illicit or potentially handing them something that isn't buprenorphine or has been altered in some fashion um the if the public policy is to get it in the hands of more people which we agree with then we should find a mechanism to do that this is not that mechanism on the other side of the of the uh equation what I'm suggesting is for those who then choose to go get it from an illicit source um getting them into some kind of program in this case again the only one we've got access to at the moment that statewide is diversion um to monitor and encourage them to get correct treatment rather than street treatment then that's that's the other lane of travel but first and foremost as I started my testimony this is a public health issue we should be developing a system that gets them on demand access to treatment and if the right treatment is buprenorphine gets that in their hand as swiftly as possible so they're not going to the local hotel to buy it I I agree with you I would expand this to say we should um have allow pharmacies to dispense um it but I don't think we're going to go there that's a pretty big step for most people to take but um and we did hear that it will allow that we are now allowing more doctors to prescribe so that's a step it doesn't have to be just on demand in pharmacies but um more and more people could could access it and and there are the issues about that um attorney wigman's pointed out about the um people not wanting it on their insurance policy they because of employment issues and all kinds of stuff so I yeah I understand your point I disagree with it but I understand it excuse me I excuse me that was an editorial comment but let me let me just go ahead and I'll have a can we take can we take the share screen down so we can see each other better um actually I wanted to have you take a I wanted to be able to take a look at that that's why I put it up there okay we ended up going somewhere else I was only with senator white was only you know we've been together for so many years on the judiciary committee that I'm used to the polite way she tells somebody she doesn't so commissioner if you could just briefly go through while we have the shared screen up and then we can take it uh unfortunately senator I'm on a phone so the shared screen is uh like this big so well your proposal all right so but anyway your proposal is that we treat we create a presumption of diversion for the possession of 224 milligrams or less and that someone who um is arrested for the possession of 224 milligrams or less would be referred directly to court diversion by a state's attorney and less state's attorney states on the record why our referral toward the American would not serve the ends of justice that's basically your proposal you got it that's correct so you're trying to get people into treatment then we get into the discussion of how to make morphine available on demand um and I was reminded of the days when the correct gum was only available by prescription and then miracles happen and now you didn't buy it without prescription without prescription I should be clear senator not advocating it to be over the counter because again it is a potential drug of abuse and it does have much more significant impacts than uh than um Nicorette but uh having the healthcare system able to do it more swiftly is what I'm advocating yeah and the other advantage to having it by prescription was your insurance paid for yes that's what I was going to mention all right um taking the fair screen down and Senator Hardy has a comment thank you mr chair it seems to me commissioner that this actually would go in the opposite direction and it would get more people into the criminal justice system um rather than fewer people into the criminal justice system and I I agree with Senator White that we want to be making it easier for people to access treatment not through the criminal justice system and I understand that you're trying to have a path because you don't feel like there's a path to treatment but this seems to go in the opposite direction and and what I heard from state's attorney George and I wanted to hear your comment about this is that there was recently some federal change in for physicians being able to uh prescribe buprenorphine and that that would actually do what you're suggesting is have many more legal options for getting the prescription she also said that when she announced publicly that she would stop prosecuting the possession of it many more physicians were available you know came forward to offer treatment and offer prescription so it seems to me that by decriminalizing it we're actually um encouraging more in the medical community to feel comfortable um prescribing and working with patients who are ready for treatment um and using the court diversion program is actually putting more people into the court system I understand the argument but as I'll use I'll paraphrase Senator White I don't agree with it I think the what I'm suggesting is we create a system where people can get access to it through the the healthcare system and not have to go to the black market but when they do go to the black market that then we step in and we have a system to shepherd them along in this case what's proposed is diversion I don't see that as increasing the number of cases especially hopefully we get the number of cases to zero if we can build the requisite healthcare access that I'm describing. Good night. No Senator White. I'm sorry Senator Elias wanted to speak and I um she's been anxiously awaiting. Yeah no listen this is what we're talking about is a medical condition addiction is a medical condition and it is a public health imperative to treat this medical condition so having resources available and links available when people are run into the public safety or judicial system having resources available to keep them out of that system I think are absolutely critical and important we've been trying to work on this for years with our prevention council and our prevention work in the department of public health that crosses the silos of state government and we've also been working on this with our social workers in our responsive social workers in our local communities uh and so the mobile crisis units and so on so there's a lot going on but I'm what we're hearing is that when one person is stopped in a traffic stop that there's not a direct link for that person to get medical support that's what we're hearing or to get to the DA's or to get to someone who can at least uh help that person and perhaps the person can then follow a path whether it's direct or indirect the the whole issue about prescribing you buprenorphine that's come down from the federal government I think is an improvement the other thing that we did recently in our legislation was during the COVID was to allow for prescription with re-prescription renewal without office visit and so that's that's can that's helping people but I think what um commissioner correct me if I'm wrong but what you're suggesting is simply having more linkages for people outside of the judicial system and I wholeheartedly agree with that so whether the bill as written is the way to go or whether there are whether it's a first step or whether your bill is the first step we need to continue to identify a additional resources and be those links so thank you senator I would also offer and dr levine would be the correct person to speak more to this but there are instances I imagine where the correct treatment profile for someone isn't buprenorphine and you need the medical provider to be able to assess that instead of um you know joe smith the drug dealer at the holiday center of white wants to stand up for holiday industry no but I was this might be getting too much into the ways but commissioner you uh suggested that um if people that if we had a better system for people to be able to get it um legally with a prescription through the health system that would be great but then when they get it from the from as a street drug that that's when we they should enter into the criminal justice system in some form and I this might be too much in the weeds but does that mean that the person would have to carry their prescription around with them all the time I mean how how would a law enforcement person finds out that somebody has and I think they're called strips of buprenorphine and how would they determine whether they should write the write a ticket for the guy arrest him when senator when uh it's a great question when um when people have prescriptions uh there's a prescription label on the container um nine times out of 10 99 times out of 100 probably more accurately or probably 999 out of a thousand when you find a drug uh whether it's oxycontin or buprenorphine or something that's outside its prescription container it's been obtained illicitly so it's a pretty straightforward equation in the field okay thank you um really appreciate the testimony and and your thoughts on how to deal with this problem I one of the problems we still face I think as a state as a nation is there are those who see medically assisted treatment as not being the ideal that's in the treatment world so we've had in some areas of the state we're turning point clubs for example we had the treatment programs which would not take somebody who was medic on Medicaid assisted treatment medical treatment um so you've got that also involved there um I'm um I don't know if there's any more questions for commissioner shirling um and we could think we're at a top point where we might want to take a short break and come back at 10 15 if we could show because we only got 40 we have to quit at 11 25 I would say so we get to the senate floor unfortunately they half an hour away from us are we coming back to this this um yeah I say would everybody agree to five minutes and come back at 10 15 and begin um taking more testimony um realize it short so we've got um I'm hoping that Dr. Richter and um Dr. Levine and I see Brenda Siegel is here so we'll begin with her so okay well you're gonna you're gonna handle the next half of the meeting senator alliance yeah okay thank you senator Sears thank you all