 Hello and welcome to Under the Dome from Town Meeting TV. My name is Bobby Lucia, and I'll be your host for today's program. Under the Dome is Town Meeting TV's coverage of the Vermont legislative session. So in this program we interview and speak with legislators, advocates, about the bills that are moving through the legislature this year and what they might mean for you and your neighbors. Today on today's program we'll be focusing on legislation that aims to prevent overdose deaths and advance substance use recovery efforts in Vermont. And we're joined to talk about that today by Senator Tanja Wichowski. Thank you so much for joining us, Senator, as well as advocate Ed Baker. Thank you so much for coming in today. So we'll just start with some introductions. If you both don't mind just sharing a bit about your role obviously in the Senate and what you're up to, Ed, and what brings you to overdose prevention and harm reduction work, and maybe we'll start with you, Ed. Okay, I'm Ed Baker. I'm very pleased to be here. And I guess I can best be characterized as an activist in favor of harm reduction to save the lives of fellow Vermonters who are dying one every 33 hours as we speak in Vermont. I have a history. I couldn't introduce myself for a long time. Probably the most important thing that I'd like the viewing audience to know is that I am a person with lived experience of severe poly-drug use disorder characterized by injection drug use. I understand what it means to inject drugs in public places. I understand what it means to be incarcerated, to be subjected to mandatory treatment. And I fortunately, by luck, know what it means to survive. And there are too many of us today not surviving, so that's why I'm here. Thanks, Ed. And Senator Vihovsky, what brings you to this work? Absolutely. So I'm Senator Tanya Vihovsky. I represent the Chittin Central District where we know that we've seen an incredible rise in overdose deaths all across the state. But when I'm not in the legislature, I'm also a licensed clinical social worker. And so I've had a fair amount of work supporting people who are struggling with substance use. Actually, in my second internship when I was in graduate school, I sat on the task force that Sarah George convened to talk about overdose prevention sites and to really think about what it might look like to invest in harm reduction in a really different way than we have before. So you mentioned harm reduction before we jump into some of the legislative work that is happening around this work. I would like to first kind of back up and just ask one or both of you to just define what we mean when we say harm reduction. What does that mean in this context? Well, to me, it means meeting people where they are. And what that means is people with addiction, people injecting drugs, people self-administering drugs are just fine the way they are. I don't expect any kind of, I don't demand change from them. I don't see them with a punitive lens. I want to meet them where they are. I've been a psychotherapist for 30 years in this field and I have listened to people constantly for 30 years. I understand them. The way systems operate today in America are based in stigma. Have no doubt about that. We've changed our language, but we haven't changed our inner worlds. These people are still persecuted, prosecuted, incarcerated and driven away from the treatment they need. We need to meet them where they are. We need to let them know that they are worthwhile and we are here for them. How do you want to change? How can I help you? What are you ready to do? Can I be here for you? And that's harm reduction. Do I want you to stay alive? Yes. Am I going to put restrictions on you that cause you to stay away from treatment if you refuse to abstain from drugs? No. I'm going to treat you and be here for you. That's what overdose prevention centers are all about. We meet people while they're injecting drugs. Yeah, so I think the core tenet for me, or at its very basic level it's about keeping people alive and it's about understanding that people are going to do what they're going to do and we have the ability and the capacity to provide tools and resources to make that less harmful than it would be without them. And a lot of examples of that overdose prevention sites are one of them. Needle and syringe exchange is another giving people access to safe sterile supplies. Naloxone is another helping to prevent overdose but really it's fundamentally about looking at whatever someone is engaging in because harm reduction, I think we most often talk about it in substance use but it's applicable in a lot of different places. It's looking at where are the systemic harms that we can mitigate so that someone is safer than they would have been and is able to stay alive. Right. So you mentioned a couple of those efforts and those efforts that we're taking to support folks that are using drugs. Taking sort of an inventory on where we're at in the overdose crisis in Vermont in 2010, Vermont had 42 recorded fatal overdoses in 2022 that number rose to 264. So what has changed in that time that would cause such a huge increase from just in the past 10 or 15 years? I mean, I think a lot has changed in that time. One of the things is the increasingly volatile and unpredictable drug supply. So frequently people don't know what is in what they are using and without knowledge of what they're using, they can't use safely and I think furthermore we're seeing more and more despair in our communities which drives people to be more engaged in drug use as a way of coping with that. So I think there's multiple systems here that are really at play creating and it ends up failure on our part to protect people and to make sure that we are not helping drive those overdose deaths up and they just keep going up year after year and this year we're well on track to blow last year's record out of the water so I know that there's a lot more we need to be doing. That's really scary. Just along those lines if I might continue on that point a little bit because I think it's really crucial. There's been a quintupling of deaths, as you've mentioned, since 2010. 2022 was the worst year ever. It seems like every year is the worst year ever. You'll hear 237 accidental poly drug overdose deaths cited in 2022. Well the real figure is more like 261. There are some that are unconfirmed. 2023, this year, right now, and we're not hearing a lot about it yet is on course to eclipse 2022 in Burlington. Burlington is like the epicenter of death in Vermont. I was at a meeting last week, a Comstat meeting. Sarah George, the state's attorney who's come out in favor of overdose prevention sites, stated recent statistics. In the first three and a half, almost four months of 2023, we've seen it should be around 25 overdose deaths in the Burlington County area alone. That's almost double what it was last year. We don't have figures yet for Vermont and I'm wondering why we don't. We should be having reports from Vermont. But if you look at this, and I think we have a graph that we can show it. If you can show, please, the slide with the... Is that it up there? No, there's another one that shows just the overdose deaths in Burlington. It's the next one, or the one before this. Show it, please. That one. That dark black graph shows overdose deaths in Burlington, overdose incidents in Burlington this year. There's been 104 of them. Those reported incidents. And that translates to around 50 deaths. It's the same thing happening statewide. I mean, when I look at this, and I know that Senator Bajowski has the same opinion, when we look at this, the acceleration, the velocity of death in Vermont, it boggles my mind that we have not declared a state of public health emergency. I just can't understand why this is. If this was anything else, if we found out that a dam in Waterbury had a structural flaw and was about to burst and we were going to lose 300 Vermonters in 2023, we wouldn't be calling a task force to convene in January of 24 to deal with it. We would be dealing with it now. We would be freeing up funds to deal with it now. That's my question. Why in Vermont are we, the opioid abatement committee is sitting on $3 million, $3 million lying idly while a Vermonter dies every 33 hours. This is my, I don't understand this. Yeah. So maybe this is a good time to just take also some inventory on what we are doing as a state to prevent overdose and also what we could be doing better. But I know that there are some resources available right now, and I don't know if either of you are, Senator, if you want to talk to speak to the things that we are currently doing as a state to serve those folks. Absolutely. And I can't agree with Ed enough that we're not doing enough and we're not acting fast enough. And one of the things I really saw in this biennium was a real shift from the administration in a prevention only response to really starting to consider harm reduction and really starting to consider the many different ways that we can treat and support people who are struggling with substance use disorder. And so there is, there was a pot of about $10.3 million from the Opiate Abatement Settlement Fund and about 8.2, I think about 8.2 of that was spent. And the vehicle for that was H-222. That bill ends the sunset on decriminalizing small personal use amounts of buprenorphine. So that was a bill that was passed in the last biennium but in order to make the governor comfortable with it, it had a sunset in it. And this bill will get rid of the sunset. So that will, those personal use amounts of buprenorphine without a prescription will continue to be decriminalized. Can you just share what buprenorphine is? Yeah, buprenorphine is one of the treatment options for medically assisted treatment. It can help people not use other opiates and helps prevent overdose. Yeah, absolutely. I forget because I talk about it so frequently that not everybody actually knows what that is. And some of the other things that are done in H-222 is an expansion of syringe services trying to make it easier for people to get access to sterile syringes and equipment as well as dispose of used syringes and equipment. It also invests in narcan or naloxone which are opiate antagonists. They can help reduce an overdose. We're looking at putting those in places where people can really easily access them whether or not the local designated agency or local Substance Use Treatment Center is open. We're looking at an expansion of test strips for fentanyl and when they come on the market for xylazine so people can test their own supply. And one of the things that I worked really hard on in the Senate was to get $700,000 put into that bill for physical sites where people can go and get their drugs tested on a carefully calibrated machine as well as immunity for both the people who are operating those sites and the people who are utilizing those sites to test to find out not only if there are any fatal contaminants in their drugs but the potency of their drugs. And that is really important because the test strips can only test for a high enough quantity of these contaminants whereas these machines can test for much lower quantities as well as other contaminants. So it can help really inform someone what is in their drug supply so that they can use it safely. And some of the things we're not doing that we really need to be doing are investments in things like overdose prevention sites, a site where someone can go and be provided medical guidance and medical care if they do suffer an overdose in those spaces. Overdose prevention centers have been set up across the world and have been very, very successful in preventing people from dying and connecting people to services. Someone who's connected through an overdose prevention center is much more likely to eventually engage in substance use treatment as well as to get the resources they need to have a healthier life. And most importantly, they're alive to do those things. So I think that's a really critical next step for us is investing in overdose prevention centers and granting the immunity to operate those overdose prevention centers. And frankly, I think what we really need to do is move towards a full decriminalization of personal use amounts of drugs. Thank you, Senator. Ed? I mean, I would disagree. I mean, I would agree strongly with everything that Senator Bahasky has said. Where I tend to focus, though, is that, you know, I mean, you expressed a litany of, like, progressive measures that we've taken in Vermont. And I would add that with each one of these measures there has been a battle fought by advocates dragging the health department forward every step of the way. And we're at another point now, a pivotal point in Vermont with this one I would call it a robust response. We have the envy of many states in America. Look at Vermont. And we say that. Look at us. And I say that, too. Look at us. With this robust response, we have a velocity of death that is the worst public health crisis Vermont has ever seen in its history. And we screech to a halt when it comes to overdose prevention centers. And that has to be my focus. Why is it that we are screeching to a halt? Rhode Island. The legislature has set in motion a process to establish two of these centers. Rhode Island. The opioid abatement committee has earmarked 2.35 million dollars to set up overdose prevention centers. New York State on point New York City has two locations in New York. They've been established for, it'll be two years in November, so a year and a half. They've seen, they have thousands of participants. They've reversed literally at 800, or over 800 overdoses. They've saved the city. The estimate to the savings to New York City is 15 million dollars. When you look at Burlington's police responses to overdose crises over the first three and a half months of 2023, there's been 104 responses. There's been emergency service responses, hospital responses, law enforcement investigations. All of these things are replaced by an overdose prevention center in New York. There's incredible cost savings to the city. Sanitation, you know, publicly disposed of syringes. Why are we screeching to a halt? I'll tell you why, because of Governor Scott. He vetoed H728. H728 was a bill that had a provision to study overdose prevention centers. He vetoed it. It was an overdose response bill. The will of the people expressed through the House and the Senate and the Governor, while Vermonters are dying at an unprecedented rate. What did he do instead? Let me tell you what he did instead. What he did instead was proclaim a day where parents could mourn their dead children. August 31st, over those awareness day. He vetoed it as a bill that can save lives and then gives parents formal permission to mourn their dead children. Something is wrong here. We'll look at what is motivating that resistance toward public health programs saving the lives of Vermonters. Right. Well, I would ask both of you that, you know, what do you think is behind the Governors and other Vermonters' skepticism or disapproval of these programs? I think there's a lot of things at play. I think there is a lot of stigma still involved. And I think the criminalization of this public health issue has allowed us for a long time to really force this into the criminal justice system rather than dealing with it as a health issue. And so I think there's a lot of underlying assumptions and beliefs about substance use disorder that really need to be unpacked. And I think there's fear. You know, I was at a press conference a couple of weeks ago talking about decriminalization in overdose prevention sites. And one of the questions I was asked is, you know, aren't you afraid that this will make it easier for people to use? And the statistics across the world simply don't bear that out. They actually show that when you move in the directions of overdose prevention centers and even full decriminalization that actually fewer people use. And the people who are using are able to use more safely. It does save money. I mean, I know I was talking to a city counselor in Burlington and the emergency services budget for this fiscal year is gone. It's already running in the red and in large part because of the many, many responses to overdose issues. And so I think there's a lot sort of grounded in our societal beliefs about both substance use disorder and the people who suffer from substance use disorder that allow us to both stand idle and actively in opposition to the policies that we know would save their lives. We live in a very punitive, retributive society and we really need to move more towards restoration and saving lives if we're going to make these changes. So H-222 is the bill that's been passed by both the House and the Senate at this point. Is that correct? Yes. And it's on the Governor's desk right now. It's not on the Governor's desk. It's not on the Governor's desk. So it was passed by the House. It was amended in the Senate. So it actually had to go back to the House. So the House is now looking over the Senate amendments making sure that they agree with them. I do think they're making some small changes. It will then, if they'll concur with further proposal of amendment, it'll come back to the Senate. Hopefully we will concur and then we'll send it to the Governor's desk. But right now it's sort of making its way through the legislative process. And those amendments, is that the creating immunity from prosecution to operate? Or what was in those? In the Senate amendments. That was one of the Senate amendments was creating the immunity to operate the drug checking facilities as well as the appropriation for that. It's also the vehicle that we used to put all of the opiate abatement settlement funds in along with all of the programs that it would fund. So when H-222 came to us, it was, there was no appropriation and it really was an expansion of syringe services and expansion of access to opiate antagonists or naloxone and the end of the sunset on buprenorphine. And what we utilized that bill to do was take all of the opiate settlement, abatement settlement funds and all of the programs associated with it and put it into that. And so the House wanted a chance to kind of look over the work and make sure that it was in line with what they wanted to do. And I believe they're going to make a few small language changes, not really substantive changes, but some small language changes. I hope that the Senate will then just concur and we can send it to the governor. Do you expect that the governor will sign this bill? Have you heard anything from him about that? I do expect the governor to sign this bill, although I certainly don't want to speak for the governor or my crystal ball is not working today. But the opiate settlement committee worked really closely with the administration to make sure that we were putting forward things that they felt like they could agree with in really trying to act in the expediency of what this crisis deserves. And certainly it's not everything that we would have wanted. It's not as grounded in harm reduction. And part of the reason that we made that compromise was trying to get something the governor would sign now so that we can continue the work on some of the things that he's deemed more controversial. Right, okay. And has it passed just in case the governor doesn't sign it? Has it passed with a veto-proof majority? In both the House and the Senate. There was one no vote in the Senate. So it passed 29 to one. 29 to one. I wanted to just better understand for a second. I know we only have maybe five or so, maybe 10 minutes left. But what these safe injection sites will kind of look like? Are they, you know, where will they be in a place like, for example, Burlington? And what, yeah, what kind of services will be available? What does it look like when you walk into one? How does it, how is it staffed? I don't know if this is the kind of question that can be answered, but it's something that I'm curious, you know, I just, to understand is it, you know, is it built into our existing infrastructure, city infrastructure and state infrastructure, or is it kind of a pop-up sort of, sort of a site? I had a conversation this morning along these lines because one of the impediments that Commissioner Levine continues to offer is that we don't have any place to put these, we don't have any sites. And people that I'm speaking with in the field with lots of experience on the front lines all the time are telling me that the safe syringe programs are the logical place where an overdose prevention center would be located. We already have safe syringe programs. We have safe recovery in Burlington. We have Vermont Cares in Montpelia and with mobile units. We have two safe syringe programs in the southern end of the state. So these places are where people come to get syringes. They come for wound care. They come for naloxone. They're known to this population that's using drugs. It's the logical place for an overdose prevention center to be. Now, what happens is, I mean, people are welcomed there. They feel welcomed there. They know they're not going to get arrested there. They know they're not going to get seen through a lens of stigma there. They feel safe. This is the place to have them come, inject drugs safely. We can save their lives if they overdose. But it's so much more than that. In Governor Scott's veto of 728, he uses the term injection sites. This is a pejorative stigmatized term, and he knows it. They're not injection sites. They're overdose prevention sites. Some people are beginning to call them comprehensive user engagement sites, where people are engaged through many, many different types of behaviors. They're met where they are, and then they're helped to move forward if they so choose, in a way that they're motivated to move forward. It can be buprenorphine, that can be methadone, that can be housing, that can be medical attention, that can be psychotherapy. It can be any one of a number of things. But the trick is engaging this population. This population is the most difficult to engage population. Childhood trauma, the wounds of drug addiction, persecution, arrest, stigma. They stay away from services. We have to meet them where they are. This is what overdose prevention centers will do. This is what they've been doing. Since late 80s, early 90s, all over the world, they're not happening here. The war on drugs is why they're not happening here. Make no mistake about it, we are still fighting the war on drugs and the war on people who use drugs. Thanks, Ed. In terms of what it might look like, it depends. It could be a mobile site that goes to people. I think it was you that told me that there are even virtual options now for people to be supported virtually. It could be a fixed site. I agree that our existing syringe services centers make the most logical sense. They already have established safe trusting relationships with the people we're trying to keep alive. It can be a suite of services. It can be all of the syringe centers already offer as well as counseling and medical care. That's really how these sites work best is by providing the service in the moment that the person is looking for. If that is not dying of an overdose, that's the service that is provided, but through that process, you develop these safe trusting relationships and people are able to ask about counseling or people are able to ask about food or housing or medical care or testing for who knows, all of the various things that might come along from when they were using before they had access to safe services. It builds this relationship that ultimately allows people to engage more and more and more over time. Again, I can't state the most important part. They're alive to do it. Thank you both for joining us. I think we have a couple minutes left. If there's anything that we didn't touch on that you'd like your community members to know about overdose prevention, feel free to take the extra. Actually, I just remembered one final thing which is just to clarify that the bill that you mentioned, Senator, that is in the House and then is being ironed out a couple of those amendments, if that is passed and signed by the governor, do you expect that these overdose prevention sites, does it include funding for these prevention sites or no, it doesn't? It does not include funding for the overdose prevention sites. There are two other bills, one in the Senate that would have provided immunity for operating overdose prevention sites, but unfortunately, neither one of them moved and they didn't come with funding. That was sort of compromise language that we thought might be more palatable to some of the more conservative members of the General Assembly who were really uncomfortable with the idea of funding an overdose prevention site. This bill does include funding for the drug checking that I talked about. It does include the $700,000 to stand up seven of these sites across the state. There is a pilot of that program currently operating in Brattleboro. Got you. Thank you, Senator. Anything else that you wanted to add before we end here, Ed? Just that I think silence is being broken and people are developing the courage to talk and I think people should just, for the viewing audience, talk amongst yourselves, talk to your legislators, talk to your mayor, talk to people you know. We need to get this, this idea of don't talk, you know, don't trust, don't feel. There's a structure in place that's supporting the status quo and that structure has to be broken and the only way it's going to be broken is if people like us and regular Vermonters start speaking the truth about what they see and what they want to happen. Vermonters don't leave Vermonters behind. Vermonters are being forced to leave Vermonters behind by the structure, by the status quo and it's unacceptable. And Baker, Senator Wieckowski, did you want to just add? Yeah, I think the last thing that I would add is just the critical importance of recognizing that every one of these data points we've talked about was a person. It was someone's child, someone's neighbor, someone's friend, someone's family member and their lives mattered and the more people are dying, the more family members are lost. And I also just want to remind people that if you or someone you know are struggling, that you can access resources. The Vermont Department of Health will give you Narcan. I carry it in my car, not because I personally am aware of someone struggling, but you just never know and you can really access any of the resources either on the Vermont Department of Health's website. They can direct you to the different resources that you need. I just want to make sure that we keep as many people safe while the legislative process grinds far too slowly because we haven't declared the state of emergency that we should. And if I could just add support for that, that the 2-1-1, I've called them a number of times with a test call just to see if I pick up any stigma coming my way and there's none. The 2-1-1 line is really, really very, very productive. Thank you both so much, and thank you for joining us today. Thank you for tuning in. Under the Dome, we'll continue through the end of the legislative session connecting you with your representatives and advocates in Montpelier. You can find this program and others on our website, ch17.tv or on our town meeting TV YouTube channel. Thanks so much for joining us and have a great day.