 Welcome back everybody and welcome to our new witnesses. We're going to be taking a look at H644 and act relating to decriminalization of a personal use supply of a regulated drug. And it looks like our first witness is Andrew Siemen, Vermont Medical Director, Better Life Partners. Hi, thank you members of the committee and I really appreciate you all taking the time to talk about this this year. So I am Andrew Siemen. I'm a medical director of a harm reduction framework opioid treatment organization called Better Life Partners here in Vermont. I'm also an assistant professor of medicine at Oregon Health and Sciences University and a researcher in harm reduction and treatment of opioid use disorder. And I also was a lead proponent of the Oregon decriminalization measure in the past last year. So I urge you all to strongly consider moving this forward this year whenever we can. We are in the middle of an overdose crisis as you all are aware. And I believe in decriminalization for many reasons as a scientist and also just as a human. I've been taking care of people who use drugs for almost 10 years. And my experience of this is that criminalizing people who have a health condition, people who have a learned condition of addiction has no positive impacts and has deep societal and personal harms to those who use drugs. I encourage you, there's a lot of data we could talk about but I really encourage you just to think about some of the stories that we know. I've taken care of so many people who've been adversely affected by criminalization. One woman in particular is someone who always sticks with me when I talk about this and think about this. It was a woman who had young children, used heroin but was very stable in her life, had a job, had relationships, kept her drug use away from her children in every situation. And her children didn't live with her when she used. And she was arrested on a drug charge. She went to jail. She went through withdrawal, was deeply retraumatized. She had a strong history of trauma, was discharged to the street six days later and proceeded to overdose. She lived, thankfully. She lived to have a crime on her record now. She lost her job. She had a lot of trouble finding a new job. She ultimately lost her housing and became homeless and really struggled to gain access to treatment and struggled to regain relationships with her family. So this is a really common story. When we arrest people for drug use, we destabilize them. We take away the very things that provide support to people who are seeking recovery, whatever that means for people. Recovery may or may not be stopping drug use. But the things that help people thrive in life are social connectedness, our family, employment, feelings of self-worth, ability to manage their own mental health and societal trauma. And when we arrest people for drug use, we really take away people's ability to manage that. On top of that, I think a lot of people have put forth, well, what about the drug courts and what about these other ways we have of using the criminal justice system to address addiction? And I would just say, one, first, I think Vermont has done a lot of really good work to make those systems better. And I applaud the state of Vermont for that. Having said that, the evidence is just not behind mandated treatment. If you look at systematic reviews of court mandated treatment, they are systematic reviews are kind of combinations of data that we use in healthcare. They are at best neutral at these studies and at worst, they do harm. And the reason for that is that when people decide not to use drugs, it needs to be an internal decision. This is a very, very complex illness slash learned state. And if someone else is telling you you have to stop but you don't yourself see it that this is the right thing for you in this moment, it just doesn't change and the evidence supports that. And so, I think that there are many, many reasons to support decriminalization. In addition to healthcare reasons, one of those is a huge equity concern. I think as stated in the measure, people of color, indigenous people are far more likely than white counterparts to be arrested for drug use. They're more likely to be approached and targeted to be arrested, even if that arrest doesn't occur. And we all know the potential implications of that too for people of color. And if they are arrested, they're more likely to go to jail. And then so all of these negative societal harms associated with incarceration and with arrests in general are amplified for people of color. And so I think in this time of an overdose crisis, in this time of a civil rights renewal and all of our efforts in anti-racism, I would encourage you to see this both as a health bill and also an anti-racism bill. There are a lot of things that we've learned from Oregon so far. One of which is that a lot less people get arrested and a lot less people of color who would have been disproportionately arrested have had that outcome happen. There's a lot that we don't know yet in Oregon. The short-term impacts of decriminalization are largely just prevention of harm. The long-term impacts, what does it do for how we think about people who use drugs? What does it do for how we care for them, how we show up to treat them with dignity and kindness? What does it do when we don't give people criminal records and cause them to lose their housing and cause them to lose their employment? Those are going to take decades to realize. And so we really can't judge the Oregon situation fully right now. We certainly can't judge it in the middle of an overdose crisis in COVID-19, but I can only see better things coming to Oregon and I hope the same can happen in Vermont. And I'd be happy to answer any questions as well as find data or literature that might support some of these claims if the committee would like in the future. So thank you so much for your time and I'll put myself on mute. Yes, hi, Amy, thanks for being here. I guess you had mentioned Oregon and I have learned that a lot of this is being based on studies or statistics or something from the state of Oregon. And I also believe that maybe from Portugal, I believe or what else. And if so, do we have access to those studies? I just something that a couple of people know about or are they on our committee web page or where can we find those? So I think I'll just very briefly answer that and then I'll defer to Representative Colburn. I think that the most of these studies are ongoing. We don't have a lot of early data. The data that we do have are really preliminary. There was a report showing that I kind of semi-cited that thousands of people were not arrested who would have been last year for possession. We don't have very refined data. Some of the initial report included people who were arrested for a felony charge which now would have been arrested for a misdemeanor charge. So we don't have much of that. And the other thing that is slightly different from the Oregon bill that they did use cannabis funds to provide more access to treatment for substance use disorders in that bill. And so a lot of the research and outcomes that we have are associated with new avenues for treatment associated with it. I'm happy to look into more specific bills if there are targeted questions about certain outcomes people are interested in. But as for right now, I think most of these studies are ongoing. And I thank you, but it seems most of the time that data and surveys are brought up within our committee. And we rely heavily upon them. So I guess that's why I was looking for that, Andy. Thank you. But I'm happy to, or Representative Norris, I'm happy to try to get some of that research posted to our committee page. And I know also that a few years ago as part of some prior legislation this committee did commission, just a study from legislative council on how different jurisdictions were handling drug penalties that included kind of a deep dive into what had happened in Portugal. This was prior to Oregon's ballot referendum and maybe we can repost that as well. So I'm happy to work with Andy and others to pull together some good research and make it available to this committee. Thank you. Any other questions for Andy? Yeah, Martin. Let me devils advocate a little bit here from what you're suggesting. So one question that I'd have is our healthcare system really up the challenge of treating this solely as a healthcare issue. Cause I understand in Portugal, for instance, they have made substantial investments to be able to deal with addiction and drugs in the communities through other than criminal justice. Yeah, so a couple of things on that. I would say that the entire US healthcare system has a lot of work to do with this. I think of anywhere in the country that can handle this, starting off without additional resources. I think Vermont is probably one of the best candidates to do that. I think the hub and spoke system, which has a lot of press there, there is good access to buprenorphine in Vermont. I think methadone access is not as good. I think we at Better Life Partners are really trying to fulfill in some of the gaps there where we think more of a harm reduction approach and based out of syringe service programs and elsewhere. I think we can fill in some of those gaps. I think by and large that, yes, I think we can handle this. I think also though, what I would argue is devil advocacy, that I think this is kind of relying on this assumption that the criminal justice system is actually providing a lot of benefit and that they are managing this. And I would just make the argument that if we were to treat addiction and treat people with drugs as not criminals, that there would be a lot less harm done by the criminal justice system. Even if there's some incremental benefit that is done through drug courts, the amount of harm that's done, often they usually outweighs that benefit. So maybe actually takes away some of the benefits that the health system could be providing to people who use drugs. So I don't know if I had another question, but if Representative Colburn had something to add. Okay, I guess the other question that I'm sure that we would have to confront is won't this lead to more drug use if there is not that penalty out there? You know, I think we will follow that. You know, certainly in Oregon, I think that so far that is not clear that there's a direct relationship between that in Portugal. If I remember the data correctly and we can maybe pull some of these studies that there was some slight overall lifetime increase use in drugs. Most of that though was cannabis in Portugal when they went back and looked at the data in more detail, but the harmful drug use, the drug use that related to increased harms and overdoses and all the other complications and drug use did not increase. And that actual participation in society, employment and all of these other positive things did increase. If you look at the Portugal data from when they implemented decriminalization and then you compare that in those trajectories to other surrounding countries, that it's really stark the curves and harmful drug use and some of the harms associated with drug use that Portugal did dramatically better than surrounding countries. If that answers your question. No, no, that's helpful. And just a couple other questions on this line is if we've decriminalized possession in such, does that send the wrong signal to kids as far as that it's not so bad to try out these drugs and thus get on that road in addiction? Yeah, I guess that I don't really feel that it's the criminalization of drug use that ends up leading to people thinking it is a good or not good thing to do. I think that people see the harms associated with drugs and criminalization has been around for ever in this country and it has never done any good and it hasn't really discouraged people from using. I think we have mountains of data that suggests that the drug war is failing in a lot of different ways. So I don't know. I just don't see that as the reason people don't use. And I also would just say that the reason people do use is completely unrelated to whether or not it's criminalized. They use because they're traumatized and they need something to self-medicate. They use because they're struggling because this culture isn't taking care of them. So I don't see that as being something that's likely to be a major impact on this bill. I think the other thing though, now that you bring that up though, is that it is true that as a society, when we say that something is illegal, we're saying inherently it's morally wrong. And as an addiction researcher, I get so tired of going to these conferences where people talk about how do we destigmatize drugs? How do we stop stigmatizing people? Well, we're telling them they're morally wrong by doing it, by taking drugs. And then we say, well, we don't wanna stigmatize you. But I think the first step is let's make it so we're not making this a moral issue. This is about health. This is about how do we support people? And so I really think that decriminalization is a step towards rethinking how we think about drug use in a positive way, rather than a way that will lead to more use in general. If I may just ask a couple more questions. I don't mean to be hogging this, but these are all questions I think we've, that at least Representative Colburn and I are quite familiar with having worked on decriminalizing usage of marijuana. So I'm just throwing some of those out so we can kind of get an answer on the record on some of these concerns that we're likely to hear. So a couple of questions as far as the drug trade and sales. I don't take that you're suggesting that we are legalizing sale of drugs or trafficking and such, is that right? That is correct. Yeah, and I guess the question is, how do you sort out where you have many users who are also selling to fuel their addiction? How does that get sorted out? Well, as I understand it in this bill and Representative Colburn, please weigh in if it's incorrect, but is that the part, one of the things written into the bill is that there's a committee that sets up that establishes what is a personal use amount, which I think is actually a really positive way of addressing this. I think that actually even the Portugal law and the Oregon law didn't address this as well as this bill does in Portugal, they had for instance, one gram of heroin was the limit, whereas many people might use two or three grams of heroin and so those people might still be criminalized. And at the same time, so you don't want it to be, you don't want that personal limit limit to be too low because then the measure doesn't work very well. At the same time, you still have to set a level that makes sense for personal use. Will there still be some possibility of someone having, you know, amount of drug within the personal use that might sell a small amount to someone else? I think that's possible. I think that in the big picture though, this is happening no matter what we do. And I think criminalization or not criminalization will not have a significant impact on that activity. But where I think we're worried about more on the big scale is people who are larger scale suppliers of substances and all of the things associated with that. But will this, with this, if we're doing this and not the surrounding states, do we become a heroin or cocaine vacation destination? This is something we heard on the marijuana stuff as well. Yeah. So, and I don't think that we've seen that, but we haven't had the same such, these are all questions that would come up for this. And just to make clear, I'm supportive of this effort and hope to someday get there. But these are the objections we've heard before. Yeah, I really appreciate that. And I think it's really good to have these out early and in the open. I think I just don't see, I don't see criminalization or decriminalization as having a really big impact on, I think if you were to legalize it and sell it, that's when you see these drug destinations, you're talking about Amsterdam and then some states in the US, the early legalized cannabis. But that has to do with lower access and being able to use publicly in large quantities. And I think I don't know that that's going to dramatically change with this bill. We're just talking about not throwing Vermonters in jail for something that is related to something far beyond a moral issue and really focused on a health related issue. Thank you, I really appreciate your testimony. Yeah, thank you. Selena? Well, I think Martin posed my question in, well, I'll offer just a couple pieces of information and then I'll pose my question, although I think it's really kind of a variation of some of the questions that Martin posed and Martin really appreciate getting, you getting all those questions on the record and the opportunity to hear Andy's response because you're absolutely right that those are the kinds of questions that I think people really have around this issue. So I will just say in terms of the treatment access, the landscape of treatment access in Vermont, we do have a health department who's repeatedly told us in the legislature that treatment is essentially available on demand in the straight state of Vermont, at least for opioid use disorder. I think there are some of us who'd like to continue to figure out how to make that as true as we possibly, as it possibly can be, but that's certainly the view of the health department is that treatment is quite accessible. I'll also note that we do have $10 million of the cannabis recreational market that's kind of already devoted to prevention and hopefully to treatment. And then we have a significant amount of opioid settlement funds coming into the state that have some prescribed uses that really are around kind of restorative work. So really treatment and a harm reduction approaches seems to be the focus that the Attorney General is bringing to those. So in addition to any ongoing general fund dollars we could allocate to this, we have some sources of revenue that will allow us in the near future to enhance the landscape of treatment, harm reduction and prevention in the state of Vermont. The question, the thing that I hear a lot, whether we're talking about decriminalizing, defelonizing, changing, just even reducing drug penalties by changing thresholds as in the previous bill we discussed law enforcement. And I am well, so I've heard many times from law enforcement, like this is the only tool we have to intervene and get people help. And I think you've shared very articulately and with a lot of evidence behind it why that just might not be how things play out. But I'm wondering if you wanna comment anymore on that and what other kinds of tools law enforcement might use to get people help other than arrest and sort of putting someone through that justice system as well, man. Yeah, so I think this is, that's a hard question to answer. And I will be really honest, I've been in Vermont now for six months and so I'm still learning some of that treatment landscape. I think one of the issues is that because of the legacy of our approach to treatment of substance use or really even not to treatment but to kind of management or approach to substance use in general, that we have these silos, we have these criminal justice system silos and we have these health system silos. And it's your point of contact that determines where you go, not necessarily underlying things that have to do with you as a person. And so I think that this could be an opportunity to help merge these systems better and better assess if someone comes into contact from the criminal justice system where the person who uses drugs better assess how do we plug them into the health system? And that is gonna come in a lot of different ways. That could be plugging someone into an existing treatment program and or into a housing assistance program. Clearly we need more housing assistance in Vermont and we need more residential beds as well. So I do think there is a need for more inpatient treatment. And I think that is still we have to ask this question if someone goes into jail, are we helping them? If someone's arrested, are we helping them, plugging them into the drug courts? There's no reason why those same things couldn't happen in conjunction with the healthcare system if we had better communication and collaboration between the systems. So I don't think I fully answered your question because I don't think I fully understand all of the different ways these two systems interface currently in Vermont. And I think that we just have this legacy that has historically separated us in a lot of ways. And I think there are a lot of ways that we can use these various ways of being engaged with our overall community to better link people to the sort of services they need. Thank you, I appreciate that. Barbara? Thank you. So your testimony is so greatly appreciated. So I am a social worker and in my observations, it seems like we still make people as long as some drugs are illegal or drugs are illegal and there are serious consequences. I have witnessed people be afraid to seek help because the stakes are just so high and they're not never sure who they can trust or when they're gonna get in trouble. So in hearing representative of the law's questions about like, well, what impact might this have on society? I wanna say, and I don't know if we know enough from Portugal or Oregon yet, to see if people feel safer and more comfortable seeking help in addition to your great point about it having to be self-motivated and not imposed. Yeah, thanks. Any other questions? Andy, thank you very much. Yeah, thank you so much. And thank you, Representative Rachel Sim as well for that comment. It really resonates with me how much of the harms of substance use has to do actually with pushing people into the shadows. So thank you all. Oh, I'm sorry, I actually did, I wasn't trying to make a statement. I wondered if you did have the same thoughts or any research on driving people, just driving people away and yeah, how we can. Absolutely, and not just away from treatment. So yes, I think that if someone thinks that by coming forward in their community and identifying their need for treatment might wind them up with a criminal justice record, they will absolutely be less likely to engage with treatment. But also it's all of the other things, right? It's if I am in some ways identified with as having a substance use disorder that I'm less likely to engage in health treatment. I won't go in to get my abscess drained until it becomes endocarditis and now you're in the hospital for six months and have $200,000 medical bill. I won't go to a harm reduction center because it's right across the street from the police station, which is true in some places here. And so maybe I'll be identified as this drug user and then targeted by the police. Whether or not the police are doing it, that the experience of people who use drugs is that they are highly kind of monitored. And so it drives them away from help. And I think we all know that just being able to be vulnerable in our society and being open with what we're struggling with is just it's a healing thing, driving us into the shadows, injecting alone when the first rule of harm reduction is never inject alone is steeply harmful. Great, thank you. And next we will hear from Cassandra Frederic. Thank you for your patience, Cassandra. No worries at all. This is actually way faster than I've ever experienced being called up during legislature. So I'm very excited. Good afternoon, my name is Cassandra Frederic and I'm the executive director of Drug Policy Alliance. DPA is the leading organization in the US promoting alternatives to the war on drugs. We envision a just society in which the use and regulation of drugs are grounded in science, compassion, health and human rights. I really thank you so much for having us here today and allowing me to offer comments in support of H644, a bill which would decriminalize personal use amounts of drugs in Vermont. I'd like to first say that I'm very excited and heartened by the introduction of this bill in Vermont. And congratulations with over 40 sponsors. This bill has more support than any other piece of decriminalization legislation in the country currently. And there have been bills introduced in many states. Part of my job is to know that part. Your efforts here reflect a nationwide conversation that is quickly emerging about how we as a society choose to address the issues of drugs and drug use and whether we choose to look through the failed lenses of criminalization or through a new lens of human dignity, harm reduction and public health. As you know, criminalization is the foundation of the drug war. It has resulted in astounding rates of arrest, prosecution and incarceration with black Latinx and indigenous people and other people of color as its primary target. Drug possession continues to be the leading offense. People are arrested for in the United States over 1.1 million arrests in 2020. Within those numbers live the continued stain of the racist drug war policies demonstrated by the fact that black people make up 24% of drug arrests, almost double their demographic percentage and are nationally three times more likely to be arrested for drugs than white folks despite using and selling at the same rates. In Vermont, as you've heard previously when you were presented data from the council on state governments, black people were 14 times more likely than white people to do B defendants in a felony drug case each year. And black people are 1.3 times more likely to face conviction for misdemeanor drug offenses. We see the same types of statistics in all the other states that DPA works in. I understand that you are also considering a defilminization legislation, which is a worthy endeavor. I would caution, however, to not choose one over the other, defilminization and decriminalization are efforts that need to work hand in hand. While reduced sentencing will have some positive impacts on some people, the continued criminalization of personal drug use with the continuation of remonters being ensnared in a criminal legal system that will increase harm to individuals and communities and not reduce harm. In fact, in 2017, as we previously heard from Andy, or again, defilminized drug possession, but later last year, well actually two years ago, voted to decriminalize possession to reduce the harms and also provide much needed social and other services. What I'll say about Oregon, in addition to them while there's a lot of data that is still out, what we do know is that there was an exorbitant infusion of funding into the healthcare infrastructure. So you have service providers that are getting money that they never would have gotten before. The money has moved out way faster than they anticipated and has really been focused on funding black and indigenous service providers to deal with the often hard to reach communities in Oregon. So also in rural communities and especially in the tribal nations. I think for us, it's been 50 years since Nixon declared the war on drugs and our biggest thing right now is imagining a world in which we rely, we do not rely on criminalization in effective outdated racist system, but that would create a system of care for people which is based on evidence and is really focusing on preventing disease and fostering a sense of belonging and hope. Representative Barbara, I'm also a social worker and we know that the part of the reasons for addiction is because people are looking for connection and a lot of people are consistently alienated and ostracized, we've already talked about Portugal so I won't even read that part of my testimony. I think what's incredibly important and I think something that Andy really laid out here is how well positioned Vermont is to take the stance in the kind of thinking that the elected officials that you all have already taken into consideration the direction that you've been consistently moving and the last couple of years. And just that H644 takes an innovative approach which allows Vermont to stand out and be shaping the conversation. Andy mentioned this before, creating the benchmark board, having people that are going to be most impacted by this policy really set the standards so that they can create a policy that they know will actually work because I think one of the things that people miss is that people who use drugs actually want the policies to work and we need to talk to them because they know what's going to work for them. And that this is also about sharing the governance. This moment, this great experimentation is about co-governance so that people can actually create the policies and institutions that are going to best accommodate the lives that they're living. And doing that together with decision makers is going to make all of our jobs a lot easier and make our families and communities a lot safer. And I think one of the things that's super important for the work of the board would be helpful for both the reclassification and decriminalization effect efforts, the extent that thresholds are contemplated. And we really support the effort of individuals to waive civil penalties if they show that they have been diagnosed by substance use disorder and if they make contact with treatment services. This is crucial as we know, again, as social workers, we know that sometimes when we try to help people and then we put barriers up that continue to rely on criminalization, we don't actually get the help. And people are less likely to ask for the help. And fines and fees are another way that people are ensnared in the criminal justice system and just delay the criminalization and stigmatization that we're all trying to move through. Finally, I would say that it's no coincidence that we are in an overdose crisis right now. It is our policy choices that have put us here. It is the role of prohibition that has made our drug supply more poisonous and therefore increase the incidence of overdose fatalities over 100,000 overdose deaths in the last year. All of these things were preventable. And so I am incredibly grateful that you all are having this conversation and really hope to stand as a resource to give you those stats around Oregon. We have a lot of that in our vantage point. We've also been doing a lot of the decriminalization, evaluation metrics that we can share with the legislature to see like, what are we trying to track? And then also talk about the ways that how we can move to remove criminalization but also recognize that decriminalization alone will not be enough and that it is a part of a menu of things, a tapestry so that we can wrap our family and loved ones together to provide support and care as opposed to criminalization and stigma. Thank you. Thank you. Any questions? Bob, then Kate. Thank you. Hi, Cassandra. Thanks for being here. You had made a statement about in looking at the bill where you appreciate the fact that they're gonna waive the civil penalty if in fact someone is found to have a substance abuse problem. And I guess my question is that that was somewhat ironic to me in listening to that was, have you ever had someone using drugs who was not a substance abuse fixture, shall we say? So as social worker, what I can say is that there are a lot of people that use drugs that do not meet the criteria for substance use disorder. And so it's important for us to not conflate the two. So not everyone that uses drugs has a substance use disorder. Some people just use drugs and some people use drugs and have a problem. And so that's important to acknowledge. Thank you. Just a quick follow up. So not percentage wise, but say for instance out of 50 people that you've come into contact with and you put them through this process, roughly how many adults 50 people would be, I guess recreational users, they don't have a substance abuse problem. So I won't, and I probably won't give you a question, answer that will satisfy your question just because I think the criteria, and I see Barbara shaking her head, the criteria can be different. What I can say is that most research shows that between, for people that use drugs between 80 and 90% of people that use drugs would not categorize as having a problem with drugs or chaotic. So if I use that stat, it would be like five people. But that is really hard to say out of the 50 because it depends on location, the community, family history, role of criminalization. So those 50 people might have a higher incidence than a different group of 50 people. Thank you. I might get started on this for mom obviously, but thank you. I just had to make my Columbia statistics teacher proud and making sure I didn't answer that incorrectly. Yeah, Kate. Thank you, sorry. First of all, I am also a social worker and so I just want to recognize this moment of having three social workers on this call and so getting me really excited right now. So thanks for being here. Are you a poacher? I'm so sorry. This is a good moment, it's a good moment. So my question I guess this is for either Andy or Cassandra. So one of the things that I think really marks our society's approach to substance use and substance dependence is this what I would call very sort of outdated idea of the importance of hitting bottom in order to facilitate movement in the direction of healing and recovery. And when I think about our investment in the criminal justice system as a method of addressing substance use, I feel like it's really tied in with that. This idea that like, well, if we don't have the ability to adequately punish people, then we won't have the tools we need in order to like motivate people towards healing. And when I say it's outdated, it's not outdated in the way we approach substance use in our society that's still very current, but I think in research and the healthcare communities, it's very outdated in the sense that in my understanding is research indicates that that is not actually an effective strategy at moving people towards healing, but I'm not, I guess that's, I'm intending to bring that more as a question to you guys. I'm wondering if you can speak a little bit to that and sort of the idea of hitting bottom as a way of facilitating healing. Andy, do you want to start off? Cassandra, why don't you take the mic and then I'll follow up. Okay, awesome. So I think rock bottom has been a theory that has been really important for a lot of people in recovery. And I think for the people for whom that theory works, I can respect it. As someone who is navigating this in my own family and in my friend group, rock bottom can mean death, right? And that is the thing that I am most focused on is keeping people alive in order for them to be able to make different choices for themselves and to be able to have access to the resources. And one of the things that harm reductionists say is you can't recover if you're dead. And I think there is this, in this country, I would say there is a commitment to corporal punishment and that punishment can create the foundation on how we respond to complicated situations. And one of the things that we have learned, gratefully, is that the conversation around addiction and chaotic drug use is way more complicated than whether or not someone wants to stop using or not. But there are multiple factors, there are multiple circumstances that create the conditions that make someone's drug use chaotic. And therefore our responses have to be multifaceted and have a lot more texture to give people different opportunities and entry points to make different choices. I think it is critical for us to understand that we are in a point where this conversation, for me, is about love. And as a social worker, as someone who has worked in schools and as someone who has worked in domestic violence places as well, love is not supposed to hurt. And so we have to make this decision. Do we wanna love our community members? If we do, then we need to understand that love is not supposed to hurt. And therefore punishment should not be a part of our responses. Can we create different incentives for people to make different choices? Yes, but if those incentives are rooted in punishment, then we're cutting our nose off in spite of our face. And I think it gets confusing if we're telling people, come into this place because we want to help you and that place is also a place of punishment. We have to make a decision, which is why I think it is crucial for us to decouple help from criminalization. The idea that you have to be criminalized in order to get treatment. Or if you don't do well in a treatment society, in a treatment center, then you will be recriminalized. We have to decouple them because once we decouple them and remove ourselves from punishment, we create more spaciousness for people to have more options and figure out what is the plan that will work for them. Thank you, Cassandra. This is why I wanted you to talk for us. I think that was just- Anthony, did you wanna add something? I would love to. Thank you. That was so beautifully said. And I think, I couldn't agree more with everything you said. A couple of other things just really briefly. I think some of this comes back to why people use, right? In my experience in working with the healthcare for the houseless organization for many years and treating people with drugs is so much of it is about trauma, not for everyone, but for people who do have chaotic use. Like you said, Cassandra earlier, not everyone who uses drugs, misuses drugs or uses drugs in a way that's harmful or chaotic, but people who have chaotic drug use and harmful drug use tend to have underlying trauma and that oftentimes using drugs is a way that they self-medicate that trauma. And so this whole idea, this kind of older moralistic way of thinking about drug use treatment as being rooted in sort of hitting rock bottom and once you have hit rock bottom, then you'll find your way back up again, which is kind of rooted in these old 12 step models which can have a lot of benefit for some people, but externalizing all those benefits to everyone who comes in is really a mistake. I think that when we take a traumatized person and we re-traumatize them, it just exacerbates the underlying reason that people are using to begin with. If you take someone who's traumatized and you put them in a cold jail cell with hard services and people yelling at them and pushing them around and making their trauma worse and you kick them back out into society again, they might be feeling even worse than before, but is this a therapeutic thing that's helping them build up towards a safety in love and recovery and meaning in their life, a reason to get up and not use again? I would say absolutely not. The things that support you in doing so are being interconnected with your community, having meaningful things in their life to get up and not just disappear. Again, so much of drug use is about disappearing and retracting from these harmful situations. Totally agree. I think rock bottom is an old idea based on moralism and not in what we currently know about addiction treatment. Great, thank you. Martin, then Barbara, and then Selena. Yeah, this is kind of maybe, it's a lot of lines of what we've been talking about right now. It's maybe a little bit more subtle or nuanced that looking at our diversion program, I don't think we're at a minimum trying to avoid what Andy just talked about as far as individuals spending time in jail. But we hear the argument that it's a path to get individuals into treatment that they may not otherwise go into treatment. Yes, it may not work, but it is one way that with the misdemeanor crimes, those crimes are automatically diverted to treatment in these situations. I guess the question is, if you could critique that system a little bit perhaps, but also if I could understand, what are the other paths in lieu of this path that we do have in Vermont, where if somebody has a misdemeanor possession, they are automatically diverted to treatment? And then I had one other question. And that's for either Cassandra or maybe start with Cassandra, but if Andy wants to, since Cassandra's on the hot sheet right now. I was gonna be like, the Vermonter should go first. So what I would say about diversion is that, again, I think that it has been a pathway for people to get access to resources. And I think that if we want to give people resources and we don't want to criminalize them, because the idea is we are diverting them from the criminal justice system, we think that if you have a misdemeanor, you shouldn't be involved in the criminal justice system, we should put you into a pathway to treatment. Let's get rid of the middleman. There's no reason that the criminal justice system has to be the purveyor of health. And I recognize that we are in a process of getting to that place. And that sometimes a diversion program is a reasonable middle step for us to get there. What I would offer is, I think budgets are moral documents. And so oftentimes we put the money into diversion. And then when we do something that is outside of the criminal justice system, it is not as robustly funded, right? And then it doesn't have the outcomes that we would want. And then we say, well, this doesn't happen. We have to use the criminal justice system. But part of it is that we're not, that we have to make the decision fully that we do not believe that criminalization is an appropriate pathway for people to get help. And I think that this moment is about us figuring out what are the different ways that people access care? Who are the different people people go to for care? How can we work with those people to figure out what are different alternative structures for us to do it? Because in some instances, and it is my belief for like drug courts, for example, it is the criminal justice system by a different name. And there is no way to do criminalization gentler or kinder because it will consistently be an institution that strips the dignity away from people. So I think to your earlier question, Wale can and has been a pathway for people. I think we're very much at a cross worlds where we need to at least fund the alternatives as strongly as we do the offshoot of the criminalization. And then I will caution us to recognize that if we want to give people care, let's just give them care. And let's not have them hop through the hoop that is still connected to the system that we're trying to move away from. So I guess the question would be how what are those best alternative pathways? And it seems to me, I haven't had a chance to spend a lot of time with the H644 unfortunately, I've skimmed it, but it seems to me almost that we need to, for that endeavor, we need to spell out the funding and the alternative path because that is going to be one of the main arguments that we're going to hear from law enforcement, states attorneys, some states attorneys. But if we have that alternative spelled out for that replacement of people think that this is an important pathway, that's important. I guess that wasn't a question for you. That was a comment before I forgot it as much for Representative Colburn as anything. The other question is, and I'm almost loathe to ask this question, I think it has to be put out there, is the concept which has pretty clearly not worked for the past 50 years of why we, maybe it's not so much a moral. I'm going to take this as not a moral choice as far as punishing those who are in possession or criminalizing that. Though I think obviously that's a big part of it, but the other argument you hear is that that's trying to address the demand side of the drug market. And we're also trying to address people trafficking and selling. If you have any comments on that concept because I have also heard that argument made for instance, why are large amounts of possession when somebody's possessing a significant amount that leads to a felony. One of the arguments is, well, we're looking at the demand side as well. I mean, I've heard that even with respect to the other bill that would 505. If you could comment on that, I'd appreciate it. Thanks. That's for me again. Either. Andy, I'm going to tag you in, Andy. I just. Well, I think with regards to the whole supply versus demand, you know, sphere. I think actually Cassandra made some really nice comments about this earlier, is that I just think we have, we basically have no control on supply side. That's what I've sort of settled on to at this point in doing this work is that on supply side, all we can do is make it a little harder to get a drug somewhere. And if we do that, we make the drugs more dangerous and more potent so that they're smaller and easier to traffic. And you shut down one aspect of a supply chain. We find another aspect of the supply chain that makes it more dangerous, et cetera, like it's happening with methamphetamines right now. And so I think, I just think for me, we need to focus on the human beings in our culture who are hurting, who are, you know, screaming out for help, sometimes silently and alone because they're criminalized, but they need help and that we are focusing on, you know, just like, and I love Cassandra, you know, budgets are immoral, our moral documents and this really applies to the supply side thing as well, that if we were to put energy from the supply side into the human side and taking care of people with trauma, preventing trauma, taking care of treating addiction in those individuals with evidence-based practices, that that is the only thing we truly have control over. And that we, from my perspective, are fooling ourselves into thinking we have any control at all over supply. So I'm not sure if that answered your question exactly. I think I did, but if I could just, as I apologize, Tom, if they just ask a follow-up question on that, isn't the answer partly the answer that, well, we can deal with the demand side by putting people in jail, which isn't very effective, or we can deal with the demand side by buttressing our treatment opportunities? Hey, isn't that part of the answer, is that not really that too simple? Yeah, well, I would say that I just don't know that even putting people in jail addresses demand either. Certainly in prison, you can get drugs in prison, but in general, it's a very temporary fix if it is a demand fix, and I would make the argument because of the harm done towards someone's long-term ability to have recovery or meaning in their life or whatever it is you're defining, that probably in the big picture, all of this criminalization has made demand go up rather than down. But I guess the question though is, is treatment making sure that we are really offering treatment, is that another way to address the demand side of the drug problem? What was that? Yes, absolutely, and also providing access to harm reduction services, helping people, if the demand is there, that the demand is less harmful, but I would say certainly treatment, if that is something that people are desiring and can do at this point in their life, that's certainly part of the demand side of things. And what I would also offer is that treatment recognizes the demand, right? And deals with the situations that arise with high demand, and I wouldn't make the direct thing like if we increase treatment, it will make demand to go down, because I think it's important to recognize that treatment is about making people whole and people can leave treatment and still use drugs, but in a way that is less chaotic or problematic. I think treatment creates, treatment availability, it deals with the reality that people are using drugs and some people might get in trouble, right? I think the conversation around demand goes to the question of why people choose to use drugs and what are the things that make someone drug use go from recreational or experimental to something that's chaotic and problematic that makes it hard for them to live. And a lot of those things, a lot of those answers are less about drugs and more about the circumstances around the drug use, right? Like basic universal, basic income, healthcare, food security, housing. So I think part of the thing, and all the social workers are like, yes, part of that is making sure that people are making rational choices around drugs based on the circumstances that they're navigating. So if we're talking about demand, you can't just talk about demand and not talk about housing insecurity or talk about people's ability to take care of their family members because there are some people that use drugs and have no problems, but the people that we're navigating right now that are consistently in the criminal justice system that are filling up hospital beds have other things going on in their lives that make it difficult for drugs to be a part of their lives. And to navigate that demand, we have to have conversations that are not about drugs but are about what are the things that we are giving our Vermonters to live their lives successfully. And the conversation about supply is that Decrim alone will not deal with supply, the supply side issues. That is a larger conversation on another hearing about what it means for us to actually tackle prohibition because prohibition has set up the situation where our drug supply is now poisoned. We are now dealing with different synthetic substances because people are moving to synthetic substances from plant-based substances that we have so much research on, cocaine, heroin. Like we know what these things are because we've been able to research them for so long. People are moving to these synthetic substances in labs because they are trying to deal with our prohibitionist set of laws. So they're making substances that are not yet illegal. And so it is making the demand more dangerous and the supply more dangerous because we have less and less information. And this is why we say like a lot of the issues that we're navigating are preventable if we move away from punitive responses and punishment as an underlying factor on how we navigate complicated human behaviors. Great, thank you very much. Barbara? Thank you. I've got to say it's so uplifting to meet and hear from both you, Cassandra and you, Andy. Like I feel like it's wonderful having and knowing that you two are in the world doing the work that you're doing. So thank you. I'm wondering because it does seem to me like certain systems that we have created including our current system of punishing and locking up people who use drugs or certain drugs like makes no sense. Like I think about, Cassandra, you're just talking about prohibition. It's like go to, for those of us that live in Vermont go to Pearl Street beverage on a Saturday night and see the cases of liquor that people buy. We don't, thank goodness, we no longer lock people up for alcohol and hold people accountable for the behaviors that they do to harm people. So it's true. It's like we are paying X amount of dollars to send every person to prison. They're not getting treatment, they're a much treatment. And then we're sending them back out and they should have learned their lesson until we stop. So here's what I guess I wanna say is what if we treated, if we were looking at our society with Martian's eyes, I was a sociologist as an undergrad or a sociology major, why wouldn't we say, what if we did that with people who suffered with obesity and shamed and locked them up for their addiction to food? Like it just, I think we need to step back and I think you two have pointed out like why people use and not getting hung up in trying to control things or be paternalistic. And I'd like to say that I'm concerned because even when Martin's asking about diversion, anything that still smacks of this amount is illegal, we're gonna catch everybody. There's, I just wanna share, there's a woman that I had worked with years ago who was a very smart woman who was in recovery. She was a licensed electrician. And she suffered from horrible postpartum depression she could not get into a psychiatrist who took Medicaid. She happened to be at a party when somebody offered her heroin and she got very addicted. And again, I think these kinds of vivid examples are showing us that we need to have lots of different options and pathways for people to get health when they need it. And yeah, I'm just grateful for what you're both doing. Thank you Barbara. Selena? Yes, second, I second that Barbara. I like Martin, so thank you both so much for being here and for your testimony. It's just been really powerful and really helpful and educational. Like Martin, I'm thinking a little bit about, you know, some of the questions that we're, and that have come up historically that are gonna continue to come up as we navigate discussion on both of these bills in the coming weeks. So, well, first of all, I was gonna ask some of those similar questions that Martin asked about just diversion and some of those things. So I'll just make a quick comment before my question, which is I think one of the things that I've come to find really challenging around the treatment court model and even the diversion model. And I will say in Vermont, we have really inequitable access to treatment courts. So there's only a couple counties where folks can have that option. But, you know, those models still rely on the stick of sentencing. And we know that for substance folks experiencing substance use disorder relapse is really the statistical norm. It's part of the path to recovery. It's like 70%. I think of folks with a diagnosis of substance use disorder will experience relapse. And if we're talking about opioid use disorder, that number jumps to like in some studies, like over 90% of people will experience relapse. And so it offers people maybe a pathway to connecting with some kinds of resources, but it also like in light of some of the work we've been doing on just the kind of revolving door of incarceration or sentencing. You know, it doesn't necessarily set, people aren't necessarily set up for success in that model. So that's really more of a commentary and just a response. But related to that, I think one of the things we're gonna hear as we talk about these issues and I've certainly heard in the past as someone who works on these issues, because we have a really robust system of diversion in Vermont because we do have some treatment courts that operate perhaps with a more harm reduction focus than some of the other treatment courts nationwide. Like I've actually read a study of one of our treatment courts that said, you need to, you know, like you need more stick, less harm reduction, which I thought was wild. We often hear from folks like, oh, nobody's gonna get incarcerated for drug possession. I'm not sure the data that I've been digging into in Vermont totally bears that out, but, you know, they'll just end up with a misdemeanor charge. So I'm wondering if you can talk about some of the collateral consequences of justice system involvement, even for misdemeanors or maybe even when the charges are dismissed, but someone's, you know, been detained in jail, which there's lots of studies about the effects of even just a handful of days of detention on people's income and, you know, just all kinds of things long-term. So are there collateral consequences for lower level charges or even justice system involvement that doesn't ultimately result in a criminal sentence? Sure, I'll take this one first. Thank you. So the short answer, I think, is certainly yes. The two things I'll comment on. So if you have a misdemeanor, it's a criminal offense. It's still on your record. Every job you have to apply for, you'll have to get court records. You'll have to explain what happened. And in doing so, if it's specifically a possession charge, then you are now highlighting yourself as someone who either does or did, use drugs and then now come in, enter all of the societal stigma around addiction and your chances of getting that job just fell dramatically in most situations. So that's one thing. And again, how important is it that people have a way to support themselves? How is it, especially if you are a woman, if you are, you know, a BIPOC, if you have other things that are also making it more difficult already for you to maybe have independence in some situations, then what is the impact of that? So that's one thing. The other piece, and this is a statistic I didn't say earlier, but I think is really important. So that patient that I had who overdosed, but didn't die, coming out of jail is the norm, not an exception. So in one study in Washington, in the first one week or two weeks out of upon reentry for people, all comers leaving prison in the first two weeks after upon reentry, you have 129 times the risk of overdose from the community comparison. I have never in any area of medicine ever heard a statistic that rivals that, not even remotely close, 129 times the risk. So it just highlights all of the complex, nuanced, destabilizing factors that happen when you are incarcerated. All of the gaps in our system to support people coming out of incarceration. So again, this is an incarcerated population, but this is still just a dramatically important thing to highlight that I didn't before. I would also add when we're talking about folks that are incarcerated, it is actually the prison policy institute put out a report which looked at some of the reasons why people die in custody. And one of the leading causes of that is drug overdose inside of prisons and jails, right? And so I think it's really important for us to also highlight part of the reason why decriminalization is so important is like, if we are trying to deter people from using drugs, criminalization has not been an effective tool for that. If we're trying to save people to make sure people don't die by incarcerating them, they are also dying of drug overdose when they are incarcerated and then also more likely to die when they leave incarceration. And so criminalization kills, right? And so it's really important for us to just hear that and understand how the different mechanisms for that to happen. To your question, Representative Colburn, there are a multitude of ways that people are harmed even just in the arrest. I think about parents losing custody of their kids through child welfare situations. We know that this is a, one of the leading causes of people losing custody of their kids or having child welfare cases to the social worker's on the call has to do with the neglect cases that come from drug involvement. The role of immigration with drug arrests in particular in the ways that people are either detained or deported or unable to come back into the country if they have legal permanent residency because of arrest. If we're looking at the way that people get access to public benefits, these are things that are often cut off for people. For instance, I know you asked about misdemeanors but drug felonies is one of the reasons why people will not be able to get access to food stamps. If we look at the role for housing instability, these are also things that we've been looking at studies and algorithms from housing providers that look at drug arrests as reasons as to not rent to people for housing. And so when I was answering the question from Mr. Ladon about the different kinds of things that make people use drugs or the kinds of circumstances that make it more difficult for people to live lives that they are proud of and are less chaotic, we go drug arrests can lead to all these exacerbating factors that make someone more likely to be living in a chaotic state because we take away the access to food support. We take the access away from public benefits. We rip apart their families through the child welfare system. We make it harder for them to be able to get housing. If the person is a non-citizen, they're dealing with a multitude of different kinds of risks. And what it shows for us is that incarceration or death is like at the end of the spectrum but there's a whole lot of stuff that happens before you even get there, right? And that is another reason why it is so crucial for us to decriminalize because there's a lot of conversation about how we have to get people out of jails and prisons and that is super, super important but there are way more people that are being arrested, the cases are being dismissed, they're playing down, they're getting forced into treatment, they're getting diverted and they also still have a host of drug war impacts that they still have to navigate and that we are woefully ill-equipped to help them navigate and we are woefully uneducated about all the different ways that near arrest can harm and change their trajectory of someone's life. Thank you, that is upsetting but really helpful information, thank you. Any other questions? Thank you Cassandra and Andy for your testimony today. Thank you. Thank you all.