 Hi everyone, I'm Ed Baker. Welcome to the Addiction Recovery Channel. I'm your host today We're honored to have three distinguished guests with us experts in harm reduction and Experts in caring about people who use drugs Teresa the Zena is the executive director at Vermont Cares The state's largest longest-running AIDS service organization Providing harm reduction services in 11 of the 14 counties here in Vermont Teresa is a leader in our state a person with lived and living experience of drug use and proud of it Her journey away from a life of self-destructive use and chaos began close to 20 years ago She has devoted her life to working with and for people who use drugs She has been in the harm reduction field for more than a decade and comes with a deep respect and love of her work Thank you, Teresa for being here with us. Thank you for having me Ed Joe McGee is a harm reduction advocate and person in recovery Working to break down stigma around addiction and mental health He is also a Burlington City counselor Working to bring harm reduction practices into municipal policymaking. Thank you, Joe for being here with us Thanks for having me And Mike Selick is the associate director of capacity building at National Harm Reduction Coalition He has been a community organizer and advocate for human rights focusing on police accountability inequality drug use sex work homelessness HIV and hepatitis C for more than 15 years Prior to joining the organization seven years ago He worked at New York City harm reduction programs First with a focus on public policy and peer training and then as director of services at a South Bronx syringe service program Mike earned his master's of social work with a concentration in public policy from Columbia University In New York City, Mike is currently based out of Burlington, Vermont. We're lucky to have Mike here. Thank you, Mike for being with us You know, I guess what I'd like to do Before we begin our conversation is provide a little backdrop a little context for our discussion today Accidental drug overdose in Vermont has more than quadrupled since 2010 quadrupled There's been a steady increase in the number of deaths in Vermont every year besides one 2019 For 2020 and 2021 the rate of increase in overdose mortality in Vermont was over 30 percent both years in 2020 we were ranked first in America or worst in America the rate of increase in Vermont was the highest in America Followed by West Virginia and Kentucky 2021 was the worst year on record with 217 loved Vermonters lost to drug overdose death This is one Vermonter dead every 40 hours in Chittenden County, there were 51 deaths one virtual death every week At this point it appears certain that 2022 will be even worse as of the latest Department of Health statistics From January through October 2022 there were 190 accidental overdose deaths as Compared to 176 for the same period in 2021 We are clearly being overwhelmed and That's what the show is about today The show today is about what we're not doing in Vermont Some would say we have a robust response to drug overdose death in Vermont and we do compared to other states But what are we not doing? To that I'd like to turn to my experts. We have three experts on harm reduction first I'd like to have Mike if you could begin by defining harm reduction What is harm reduction and how is it set aside from other traditional types of approaches to drug overdose and drug overdose death? Thanks, Ted at National Harm Reduction Coalition We have two definitions one with the little H little R one with the capital H capital R So the more classic little H will our definition is it's a public health intervention That respects the dignity and rights of people who use drugs we give people syringes Pipes to smoke out of things to keep them safe from getting soft tissue infections Transmitting viruses and a lot of some things to keep people alive And that's the general concept of it and that gets adopted by a lot of places But with the capital H capital R we think of it as a human rights Movement to respect the rights of people who use drugs people who engage in sex with their autonomy And can really be all about the principles of harm reduction So we try to really focus on that spirit because you can be a pharmacist who gives us a wrench to somebody But you're not necessarily practicing harm reduction if you are completely mean and disrespectful That's why we think it remain harm reduction is best done by people who actually care about people who just use drugs Who practice harm reduction and really use the spirit of it rather than just a simple public health intervention? People don't build trust with people who are being mean to them harm reduction is a trust building tool and engagement tool People's behaviors isn't going to change if we're mean to them and coercion never makes any changes You know all the all three of my guests today and myself included we are all members of the Vermont overdose Prevention Network and the Vermont overdose prevention Network is very focused upon harm reduction Theresa for the audience Could you just describe the VO PN and its membership? I'll do my best to add. Yeah. Yeah, so the the Vermont overdose prevention Network That's the that's what VO PN stands for for folks that may not know what that acronym means and back in 2021, you know as we really were at was saying earlier, you know that we were really seeing the rise of fatal overdoses really impacting Vermonters and felt that it was time to gather up a group of stakeholders community members from all sectors to really address and look at the Opioid overdose death rates and what can we do? How can we advocate for people who use drugs? How can we advocate for better drug policy? How can we as a group of of individuals and both from the community and from? within our sectors our social and public health sectors can come together Because we all had the same goal and that was just to save lives And you know so as it started out as a grassroots organization really looking at how can we help through the? 2021 legislative session right to really highlight overdose prevention sites and expansion of syringe service programming and you know Access to naloxone and all of these things that we know are so important lower barrier buprenorphine programs and and these types of things and Vermont cares and myself have Been a member of the VOPN since the start But I've really been able to see that grow over the last couple of years and the one thing that I really love and having been in harm reduction now for more than a decade one of the things that I've noticed and I think the VOPN is a really great example of is When I first started doing this work and many people from decades ago We'll remember when harm reduction wasn't called harm reduction It was not well accepted and we were fighting all of the time And so I now see people at this table who a decade two decades ago weren't quite there yet, and so it's really really heartening and Amazing to see the different folks that are at the table now who are genuinely beginning to embrace harm reduction embrace the Public health policies that Mike was just talking about but also really embracing the philosophy of Harm reduction and understanding that it is more than the public health Interventions and strategies that it's more than that and it's just it just brings me a lot of joy And so we're all working together as a great big team because it takes a village to save Lives really quite honestly, so to me that's what the VOPN means to me as a member But I'd love to Mike and Joe to share with their experience. Yeah. Yeah, well, thank you. Thank you for sharing that And do you want to contribute to that? Comments about the OPM. I think what What Teresa said it was exactly right, you know, and it's hardening in the face of a lot of suffering and such a substantial increase and overdose deaths to be working with a group of people that Understand some of the steps we need to take to begin to save lives and to be have that space to share in the challenges and the joy experience in that work I think is Can't be understated how important that is Thank you. Thank you You know from from from my perspective of the the wide range of representation is Remarkable City government state government law enforcement Medicine recovery harm reduction people with lived experience. I mean it seems to be very well represented and and has kind of a momentum to it that that that that people like yourselves are You know kind of fueling and I do believe that That Vermont Will be changed or the way we approach people who use drugs in Vermont will be changed over time, you know, Joe I think I think one of the interesting things for us to begin with is the the Burlington City Council's Repeated position on on overdose Prevention centers and then maybe we can go into a discussion of that So would you want to begin there, please? Sure. Yeah, so I I Began working on that resolution with Council President Karen Paul and members of the VOPN and It is very similar to a resolution that was passed by the council I believe in 2018 2020 And this one uses more forceful language in terms of Being explicit in our endorsement of establishing an overdose prevention site in Burlington Because we we've seen the studies that show that Overdose prevention sites help save lives in Exactly the sort of environment that we're seeing in Burlington right now you can look at a Map of where we're seeing the most overdoses and fatalities in Burlington and See a direct correlation to studies of overdose prevention sites around the world They show that that would be an effective tool for us to implement here to help save lives and So this resolution called for a number of things I called for the mayor to begin engaging with community partners to Figure out what resources are needed to stand up an overdose prevention site in Burlington to make sure that They have the resources that they would need to be successful And also advocating for the state Settlement advisory committee To Dedicate resources to overdose prevention sites as well So, you know, I think this was a big endorsement from the city council I think we need to see more action from The state legislature to bring back the bills that were vetoed by the governor Last year because you know Burlington can't do this by ourselves And so I think really having those state partners Come to the table and recognize that this is something that we need to do and we need to do now Is very important. Thank you. Thank you. You know, Mike I know you've done a lot of research on overdose prevention centers Do you do care to comment on, you know, what exactly happens at an overdose prevention center, you know, there's a lot of misunderstanding Governor Scott in his veto of h7 a h7 to 8 which Had put in had attempted to put in place a study group looking at overdose prevention centers characterized it as in an injection Site so there's there's this a lot of misinformation about what exactly happens a Lot more happens at an overdose prevention center. Would you care to care to comment on that, please? What exactly happens at an overdose prevention center? The most part the same thing that happens at any other syringe exchange program in the entire country When I was running a program people were regularly injecting in the bathroom and we called them an uninvited Unsupervised injection center. We would time people we would go in and check on people reverse overdoses in real time However, an overdose can happen very quickly, especially when we're talking about fentanyl It can happen in less than a minute, which was not the case. We would just regular heroin And what we can do differently in the supervised versus unsupervised is we can give people directions at that moment Normally I'd ask people please walk me through your injection process to try to help figure out where things are going wrong Especially people are telling me that they're getting abscesses or other skin infections I can actually watch a person do it while they're doing it and give them advice in real time Which is much more helpful to prevent endocarditis Which is that serial infection of the heart which is very expensive to take care of can require heart transplant months in the hospital There's something you don't talk about nearly as much with Drug use we're often talking about HIV and overdose which are both bad things that have happened But there are lots of other outcomes that supervised injection facilities or overdose prevention centers can help to prevent But really it's just one service Which is why we like overdose prevention services as a name because we also are giving out syringes connecting people to drug treatment Whether that be methadone buprenorphine or other kinds of counseling, which is often available there. We run groups We have food showers laundry tons of different medical Services available or referrals and connections to them Supervised injections is just one thing we are able to provide in the array of other services However, it is the one that we can tell you in over 200 facilities in 14 countries for decades across the world No one has died in not a single person has died in one of these facilities It is not the magic bullet that ends overdose across the whole state It isn't even the magic bullet that would end overdose in Burlington But it would have a significant impact specifically in the area surrounding it Which is where in our case of Burlington most of the problems are happening is in the general downtown area It's a small enough downtown that one center can probably serve that entire area and people can walk 10 blocks to get to it So we don't need more research to show this because we know it doesn't increase crime We know that it reduces the amount of times people are injecting a day We know nobody's gonna die. You know, they're gonna get connected to treatment to detox and other services that they need to stabilize their life And stay alive Basically when somebody says they oppose this I would like to hear them always say and that's why I want to see this person Overdose and die in a public bathroom on Church Street because that's what they're essentially saying when they're against this They're not saying that this doesn't enable anything There's no negative consequences the consequences are people aren't dying at that moment So they have an opportunity to do something different tomorrow whether that be engaging health care get on to buprenorphine Or you know keep working towards trying to get housing But that doesn't happen when people overdose and that is what people are saying when they're saying they're against this service I couldn't agree more with you and I think about that a lot I think it's interesting that you put it that way because sometimes I think about crimes of omission and crimes of commission And and it seems to be that the mentality is as long as we don't do something to harm people Who are dying of drug overdose? We're safe But it should be as if we refuse to do something that can save People dying from drug overdose then we're responsible. It's like a crime of a blatant crime of omission that the Administration in Vermont and the health department in Vermont are not actively seeking and pursuing ways to Open an overdose prevention center in Chittenden County where there's a death a week a Death a week that and many of them can be prevented as Joe has said there's a heat map Showing the concentration of death. There's on superimposed onto that heat map. There's a public transportation system There's a location. That's ideal. We know everything we know and and I want you to comment on this a little bit Mike if you would begin the money is Available through opioid abatements. There's millions of dollars Flowing into the state that are not going into the most efficacious way to save lives now Do you care to comment on that? Yeah, and we know overdose prevention services safe lives It also saves money prevents people from me to call the police on public injecting prevents people from me to go to hospital as much But the thing is I don't blame people for getting this one wrong. Everything we've learned about drugs was incorrect I didn't know any of this stuff before I started working in this world even when I was using drugs myself I didn't know any of this stuff to be be true. We have this weird idea about rock bottom rock bottom is dead on the street We aren't making drugs more harmful is not making anybody recover faster It's like the idea that if somebody's going to be drinking and we don't give them a glass to drink out of they're gonna stop drinking That is a ridiculous comment. People are gonna drink out of a broken whiskey bottle. That's all they have available So we give them syringes that they're not injecting with use syringes all of a sudden the HIV rates go from Huge amount people injecting drugs down to basically nothing. It's the same thing here People think we're enabling drugs use all enabling is people to not die on the street And it's what most people in the community who are complained about truly They say they would like to not see people injecting in public They say don't want to have to deal or see these overdoses This service gets people behind closed doors where they can get support and where nobody in the community has anything to complain about anymore But it's literally a win-win for every and we see this in places where they've been opened. It takes a few years We still see some opposition happening in New York to what's happening in that neighborhood Same thing was happening in Vancouver when that place first opened wait a few years It was almost 10 years later when the federal government tried to shut down inside in Vancouver the police the neighborhood the community The mayor all came out in support of it. People see how this helps their community It just takes time for it to really work. You can't decide tomorrow We're gonna open the center if magically everyone is gonna start using it every single time It needs to be available for everyone as far as the money goes. There's plenty of money I know Vermont doesn't have the biggest budget in the country. We're also one of the smallest states in the country There's plenty of money to the opioid settlement dollars and this doesn't have to be set up the way we see in Vancouver in New York City It should be similarly sized. That's appropriate for people here You might not have 30 injections happening simultaneously Maybe we only need a couple boots to make sure people have access to it without having to wait too long So I don't think looking at a budget for what a center in New York or San Francisco wants to charge is Reasonable for looking at what things in Burlington cost when it's a very different town with a very different scale of the problem But I'm quite confident that with the millions of dollars that are available for the decade plus We have enough money to get this project started and it should be funded by our government because we're putting money into policing We're putting money into programs that aren't working for people and when we put people into a course of abstinence based programs they end up coming out overdosing and dying so we need programs that are supportive for people Overdose prevention services Range access programs harm prevention increases people engagement in abstinence based treatments and makes them more likely to stay in it And also let them know that when they exit this if they're going to use again We're not mad at them. They should come back and talk to us getting a lot of them and be safe When people relapse I want them to come back to an overdose prevention center So that they have a chance to go back to treatment if that's what they choose not dying because their tolerance is lower And they've internalized the idea that they're only success if they don't ever use drugs again Thank you. Thank you. Well said And this is one of the main Platforms of the Vermont overdose prevention network this year is to see that An overdose prevention center is open in Vermont. I'd like to switch the focus now to number two. Oh, yeah I'm sorry. I'm sorry chime in one thing on the overdose prevention site and Just a kind of the way that the way that I kind of look at overdose prevention site Is it's just the natural progression of what our existing syringe service program network is anyway? It's kind of like the the natural next step to the work that we're already doing and have been doing for decades and doing You know the best we could with what we had and in following best practices And so I just really like what Mike was saying like it's it's an overdose prevention center Is everything that happens at a syringe service program or we could look at it as it's a syringe service program Adding one more service to the to the already existing Expans programming that we're offering and so that's why I really think you know safe recovery has All the tools that they need as far as knowing who Needs these services right now. They're already working with them. They have already built so many amazing trusting relationships with not only People who would be utilizing the service but with community members with community partners So I kind of just want to flip the switch and say yes Over those prevention site, but hey, maybe just adding on to our syringe service program So that's just sorry. That's right. No, no, that's exactly that's exactly where I was going because I wanted to ask you about expanding access to safe syringes lower barriers to Buprenorphine and the measures of that nature, which are also Priorities for the op and then I think you're already involved in what is it? What is it about? Providing of safe syringes to people. I mean what what what what is it about that that fosters health that that helps to prevent overdose death my goodness, there's probably so many there's the obvious right it Reduces the risk of transmission of infectious disease but way beyond that You know when I first started at the well It was called the needle exchange when I first started working at Cares And you know it was really about getting out those sterile syringes and sterile needles and and whatnot and what I've learned And what I've seen and I always like to put the things I say into terms of stories And and what I learned coming into this work is when someone comes in and they're making this decision To better their health and and to make this decision to use a sterile syringe Coming to a new exchange. They're saying so much more than can I get a sterile syringe, right? They're that that action speaks so many more volumes And then the services that were able to provide just the conversations Everything just leads to different pathways to health and wellness and keeping people alive And it's really determined by that person and what else they're coming in for they may be coming in to say They need a syringe, but after you sit down and chat for you know 20 30 minutes You find out that in addition, you know, they they also need several other of the things that we're offering and and I think that is Is also what an overdose prevention site could be like by expanding what we offer It's like, you know, not just giving out syringes, but also, you know We're we're giving out supplies for people who use in other ways whether it's you know, whether they're smoking which is You know, we all know is a lower risk of overdose If you are using different ways if you Are smoking or maybe it snorting instead of you know injecting and so just by offering different supplies to people outside of syringes We are also noticing we are connecting with a whole another group of people who use drugs that we weren't connecting with 20 years ago when the only thing we're giving out with syringes So for me, it's about a buffet of options and having those doors where people can walk into to get these services be More expansive, right because even though I have relationships with the people I serve another Organization who has the capacity to offer harm reduction services sterile syringes and other Services that we know help to save lives They may also already have an existing relationship with other folks that we may never have contact with and not be able to Build that same relationship with so I think this expansion of syringe service Programming sort of speaks to that, but I also have to say That I think it's extremely important as we look at that that the folks that are going to be offering those additional Services are coming from a true place of harm reduction I'm pointing to my heart because harm reduction to me This is where it starts and as long as that's where your start point is is Genuinely loving and caring about people who use drugs and it starts from there You know, I fully support The expansion of services Vermont such a rural state It is you we serve in 11 of the 14 counties and we have a very small staff to do to Reach all 11 of those counties And as you know, it takes at least 20 minutes to get anywhere when you're in Vermont So having little other spots with scattered throughout the state where these services are available Is critical and absolutely can go a long way towards not only saving lives, but just being there for more people Yeah, well, let's let's let's all stick with that for a second because I think I heard both Joe and and Mike allude allude to it this this idea of a war on drugs When when when someone comes to you and asks for a syringe and You they're asking for much more When you give them a syringe From the heart you're giving them much more Let's I want it. I want to talk about that a little bit like this population That's been persecuted prosecuted incarcerated judged punished Historically for decades What what is it? What is it like? When when when they come and they're met with compassion or love or a sense of dignity and respect What's what's their response to that? I mean, I think it varies Ed But I the the ones and of course these are the the things that kind of stick with you because Someone comes in and they it brings tears to their eyes and they literally will cry and say this is the first time you know, I've Got gone in somewhere and you know been treated like this and treated like this Just means we're just treating them like anybody else the way we would treat anyone else just With care and kindness and it just breaks my heart that it would bring someone to tears to To have this be one of the first times that they're experiencing that from a service provider You know other people are just like really bubbly and really excited and I've received so many hugs we were just talking recently with a community partner about when we opened the mobile program in Rutland and That community had been unserved For the hope for all the years that Vermont cares was in all the service programs There was no service program in Rutland County In Vermont cares said well, let's start a pilot. This is back in about 2014 2015 and the very first people that I saw when I went to Rutland Literally came up to me in tears. They were just hugging me so hard and saying. Oh my god We can't believe someone's finally here. We we've been standing six or seven people deep Taking turns sharing the same syringe for months. There's no more numbers on the syringe and and these People were just so genuinely Grateful but I also saw that the distress in them that they had been living this way when Services were available two hours away. Yeah, they didn't have services in their community and It really It makes you it makes you really stop and think When you have get to have opportunities to really connect with people in that way and see what they really needed I'd be able to bring that to them. I think everything that we're talking about on this platform with the VOP N Supports all of all of those types of of things and and really meeting the needs of people You don't really know what they are and to start getting out there really talking with people and seeing how much They're struggling where the where the gaps are and service. Yeah, and then stigma stigma and the war on drugs Certainly in our life or in my lifetime since the Nixon Administration declared the war on drugs, but certainly before that I think was 1915 the Harrison Act prohibited MDs doctors from prescribing Drugs to patients to provide comfort the idea being We're gonna make you uncomfortable and you're gonna get so uncomfortable that you're gonna be motivated to stop using drugs not we care about you and we want to help you and You know Mike you have any You know feelings or or or vignettes about about that in particular this idea of of people being met where they are and their response to that as opposed to people being punished and met with stigma and their response to that I am if Doctors and nurses were willing to go out to tent cities under bridges at two in the morning to provide public health services we wouldn't exist we've invented a Senate health system run by people who use drugs and people who love people who use drugs because the medical system and our society is Not set up to help people like that and you see this leg I'm for throwing people being brought to tears by getting their first an insurance program My personal experience has been very different a lot of times people are not truthful at the beginning And I was understandable when they've been Shamed and stigmatized and internalized at their entire life They've been kicked out of multiple programs before coming to us the amount of time people come up to me in the streets And they're like oh, you're giving out needles cool my grandma's diabetic And I'm like mm-hmm your grandma's totally diabetic and give them whatever they need and then they walk away my co-worker goes Why'd you give them needles if they're grandma's diabetic? I'm like first of all we're in a poor neighborhood if poor people of color need diabetic supplies They can't support can't afford. I'm happy to give them to them more importantly though that guy took cookers and ties There's no way that guy's grandma's diabetic and he's not ready to talk to me about the fact that he's shooting drugs But I'm gonna tell I told them I'll be here next week and we could talk next week Sometimes it takes a month or more for someone to finally go. Hey, so I have an access on my arm I don't know what to do about it. Let's talk about my drug use and that's fine So I'm sure there are people who like this is a totally eye-opening moment for them I personally just haven't experienced it I've seen way more people who are going to admit that they're using drums or unwilling to talk about it asking people Oh, how often are you injecting was one of the first questions we asked when you come to the program if they say 20 times And ask me for one syringe. I'm like see them out there isn't working out Can I give you more the numbers thing that Theresa mentioned? That's so real ever seen so many people opposed syringes out their stock with no numbers on it and they're like, it's fine It's fine. I'm still using it every time you inject the needle gets less and less sharp if you look under a microscope we give out these pamphlets for years of like Brand new needle one time injected five times and it's like a big hook at the end That's gonna cause damage to your veins It's gonna make you more likely to transmit viruses and get pains when this man wasn't willing to talk to me about his drug Use until he had an access that he couldn't deal with without talking to somebody and that's a shame But that comes from the war on drugs in the state when we're putting people under They people are told don't talk about my drug use even if they go to a place where we're trying to give you out Materials to use drugs people are still too scared to talk about their drug use until they really Work through it and really develop trust with people So I would often tell our outreach team look if somebody wants to come by and talk to you for baseball about baseball for 10 minutes Talk about baseball for 10 minutes after you give them the needles. That's the conversation That's gonna make them say hey, I having this medical problem. I'm too scared to ask anybody about I've been treated poorly by doctors my whole life Do you know any doctors will be nice to me and hopefully the answer is yes We got them back at the office if you're a well funded program, but it might be you know What I know one doctor one county over I could drive you over there It had really good experiences and I'll stay there and hold your hand the entire time If the medical system was set up to keep treat people who use drugs properly We wouldn't need to exist in the first place, but unfortunately, it's not and that's why these services are around They're mostly run by people who use drugs who didn't do these experiences and just want to care for their community the best they can So so we've discussed over those prevention centers we've discussed increasing access to safe syringes and the common theme seems to be connecting and engaging people who use drugs in a way that communicates compassion and You know and I think that's gonna be a theme in every every topic we discuss. Let's let's move on to making Bupren orphan more available by Eliminating prior authorization from Medicaid What what about that making a bupren orphan more available to people why and making a bupren orphan decriminalization Permanent why is that important and would somebody like to describe bupren orphan for the viewing audience? Sure, it's a partial agonist opioid. So it puts some foods on the receptors, but it has a ceiling effect That's just kind of technical neuroscience But the idea here is it's very very very difficult to overdose on buprenorphine making it incredibly safe If there was just a new study, I believe out of Indiana where they were looking at all the drugs people had on Born-worn a overdose and I'm pretty sure in five to ten years There was 2.5 percent of the overdoses had buprenorphine at all That isn't saying it caused the overdose that saying if you're on buprenorphine, you're probably not going to overdose It is less regulated than methadone and slightly safer than methadone because of the ceiling effect So essentially it's the best easiest to administer medication we have available to us Methadone should be more easily Available to people, but unfortunately they're pretty serious federal Rules to how you can dispense it as far as buprenorphine They've actually just reduced the rules they xvx waiver from the federal government, which means now anyone who has Got a training from the DEA to dispense medication can also dispense buprenorphine They got rid of the patient caps So one doctor can now prescribe to as many people as they need and we need to make buprenorphine easier to get Than heroin or fentanyl on the street. We needed to people want it It works well for them and they should be able to access it when we decriminalized buprenorphine We did this because we found Most people who are giving buprenorphine weren't selling it to make money They were giving some of their personal usage to their friends so that they could try to avoid withdrawal and protect themselves when they couldn't find Drugs people make risky decisions about sharing syringes about potentially overdosing when they're in withdrawal and their risk calculus Has changed you're not feeling well And you want to do anything you can to feel better And that's when you're more likely to make a mistake and do something that you might not normally think is safe Buprenorphine helps interrupt that cycle gives you time and you can go use that later if you need to or you can choose never to use again And just stay on buprenorphine because it's giving you what you need to not feel sick all the time while protecting you from overdose There are multiple different formulations on it. What's working for people is what they should be available to them unfortunately Vermont has structured a deal with a big pharma company and we're gonna get one formulation cheap for Medicaid Which is only the good idea but has made them unwilling to give affordable buprenorphine to people who use different formulations of it and that's what this whole Prior authorization is about for private insurance. You don't have to deal prior authorization Which means the doctor tell you you need it they send the prescription to the pharmacy It's very you pick it up prior authorization is another step That is for insurance companies can throttle back care to save money and try to say oh You don't need this medication or maybe you need it but you should wait a week or you need it But I want you to take a different kind of it and we've already eliminated that for private insurance but when we try to eliminate it for Public insurance the governor vetoed it which is actually him saying it's not worth the money to make sure we keep people safe and alive We need to solve that problem. I will commend the legislature of Vermont We have passed a supervised consumption bill in this state We have passed a Decrim which is on this verge of sunsetting we have passed the parodies to make sure there's no prior authorization for buprenorphine Our problem is the governor was completely consistently vetoed these bills And the deaths are at his door It's his fault that people are overdosing when they don't have access to bup or a safe place to use drugs So that they don't overdo it. I think that the study show that the death rate drops by 50 percent When people are prescribed buprenorphine so half the number of people will die if everyone is prescribed buprenorphine correct 50 percent It's better in some studies, but it is the gold standard methadone and beep are the only thing that cut the death rate in half I wish I could tell you it was going to cure 95 percent of people and that nobody was going to die But there is literally no intervention that we have that is better than buprenorphine or methadone They are the things that works the best that are FDA available There are other full opioid agonists that people have used around the world and even in the u.s. That are super successful But the two treatments we have that are FDA approved at this point in time our methadone and buprenorphine And they are the most effective treatment available for people It should be the first thing we offer them before counseling Before anything else and we should offer them syringes and stuff But when we talk about drug treatment low threshold buprenorphine, which is happening That's the syringe programs and will continue to be happening if we open an overdose prevention center is the first line treatment It is the best thing we should be offering people and there should be zero barriers to it So when we create artificial barriers, we're making people more likely to be dead and less likely to be in treatment Thank you. Thank you Mike. I think I'm glad that you mentioned the governor's veto because that was an overdose a bill focused on overdose responses and clearly the legislature was was United about it expressing the will of The population of the will of the people and the governor vetoed it. We had it would address safe syringe programs prior authorization guidelines for medication for opioid use disorder Mobile medication assisted treatment, which I think Teresa was alluding to a little bit earlier substance use support for justice-involved remonters and other overdose emergency responses and the bill was just The will of the people was negated with that veto Maybe we could we could move into this Substance use support for a justice-involved of remonters to do I mean, it's my understanding that people Who are incarcerated and released from incarceration have like an incredibly high Rate of drug overdose death. Is that correct? Anybody who is forced in or has decided to have a short period of abstinence whether that be from prison jail A treatment center detox bed has a significantly higher rate of overdose Jail and prison is pretty high on that list of over month is better than some places of connecting people To community-based treatments and initiating treatment while they are incarcerated There's still definitely a huge link between coming out of any absence based requirements Based into the regular world where overdose happens because when your tolerance goes down, which happens only after a few days The same amount of drugs you use beforehand will cause an overdose And that's one of the one of the platforms that we need to be looking at is, you know Advocating for for more services for people who are incarcerated or or released From prison. It's one more way to save lives Teresa, I think that you began to talk a little bit about Decriminalizing possession of all harm or reduction Paraphanalia because you want you want to Maybe elaborate on that a little bit I you know, I will elaborate on that. I think that the general consensus has been that the Interventions that the that we use Supplies that we're giving out are constantly changing because we're going with the flow of like current drug trends also what? The folks that we're serving are needing and so right now the paraphernalia law only covers syringes This paraphernalia law well Great and has been in place for many many many many years just needs some updating it just needs a little Little addition to it and that is just to include all harm reduction supplies this way Whatever the supply is that people are needing harm reduction is is For us anyway is led by the by by participants by people who use drugs so people are coming and say gosh We really need X you know to stay safer we're gonna do all we can to make sure that that supply is available to them and so I think there's Very purposely to keep it broad and open and to trust that the harm reduction providers in Vermont are providing the Supplies that people need right now today no matter what that day is to help to keep them safer whether that be you know to reduce infection or reduce Overdose or you know, whatever that might be that we're that we're there to provide that so we just don't want it to be just syringes Really looking at the expanseness and we talked about the buffet of options So we want to make sure that buffet of option is available, but also that people have protection as we're looking at You know the drug-checking and different technologies coming out and you know just just to be thoughtful that To create things that to that move that that move along with change like as change comes and it's things need to to Innovate right so so so basically it looks like you know what we're trying to do is keep people alive It's what we're saying to the public who uses drugs It's more important for you to stay alive than it is for you to stop using drugs We'll meet you where you are will help you use drugs safely Will help you to stay alive will protect you From from using an unregulated drug supply that's contaminated with poison and While we're doing that will engage you Will let you know we love you. We care about you. We understand you We're studying addiction science so we can better meet your needs Because you deserve it. You're worth it and in the meantime if we can help you with something else We'll do our best to do that too Do you need transportation? You know do you need a place to live? Do you need clothes? Do you need health care? Do you need help navigating a system that's very complex? Do you need help? You know feeding your dog and your cat Do you need a shower? Do you need a haircut? Do you need somebody to talk to? Do you need any any basic human need met? While we're meeting you where you are if there's something that you decide you want help with Will be there for you and that's the beginning of a path that could lead anywhere Certainly in my case and in your case. I know you're in recovery and I'm in recovery. It's led to recovery you know This is what it's about. Why why we're hesitating as we are in Vermont to really take that final step and embrace harm reduction is I understand it, but it's unacceptable and it's it's beyond me and I Like to go into the last part of the show Talking a little bit about the decriminalization of drug possession Because I think this is one of the major factors that drives people into the shadows where they die Because they've been criminalized They're afraid to come out for help because they fear Rightly so they may be arrested and thrown in jail. So let's talk a little bit about that Who wants to start on that decry the decriminalization of drug possession? And we talked about earlier jails in prison lead to overdose deaths. So avoiding them is Preferable um, I believe in bodily autonomy We can have conversations about how we feel about like drug trafficking, but that's not who we're arresting for drugs ever We're arresting either people who are using them Which means they're people who are making their own choices about what they do with their bodies And I personally think that is none of our legislative business Or we're arresting people who sell drugs which are mostly just people who use drugs who drugs are expensive You want to help people who have no money for them without stealing stuff They sell drugs to their friends and then they keep the extra for themselves so that they can get what they need When we criminalize this people are less likely to get the support they need in the future You become ineligible for federal grants for college a lot of housing becomes Available to you lots of benefits become unavailable to you you get background searches when you're looking for simple jobs We're basically telling people we want you to change your entire life And we're going to make it as absolutely challenging as physically possible for you because guess what most jobs are going to do? Background checks and not hire you because you got picked up on heroin possession while you were unhoused and using drugs in public That doesn't really seem like a solution to anything to me And as you're kind of alluding to and sense the wrong message It says you're a criminal for using drugs as opposed to you're a human being who is using drugs as a You know probably now adaptive book coping mechanism Drug use is rational choice in a society that leaves people out You're homeless and hungry you have ten dollars in your pocket You're cold Aaron will solve those problems for tonight. No other ten dollars is getting you house fed warm and feeling safe and getting some sleep So if we can't accept that that's the reality of the society we built then we're putting sick people in jail because they're trying to cope with a sick society and It's really not the people who are sick if the society that's throwing them away like that Thank you Thank you. Joe. Yeah, Joe Yeah, if I could add to that and You know, I I think it's important for us to also look at that the war on drugs Disproportionately impacts black communities and communities of color And here in Vermont we spend fifty seven thousand dollars a year to keep somebody incarcerated What if we I think as a policymaker what I'm the question that I'm Call to ask is what if we dedicated those resources towards community care towards investing in treatment investing in harm reduction and helping folks get the support that they need to Deal with the trauma that they've experienced in their life. I think, you know, when we start to reframe Issues of drug use as public health crises rather than criminalizing Discussion and use that's when we start to Really get at addressing the root causes that we're seeing Investing in housing for folks investing in mental health support Making sure folks have access to the health care. So I think everything that we've talked about here today is is working towards that goal of Expanding access to just basic health support that folks need that our current system does not provide Good point Teresa I just was taking a moment to to take in what mike just said and that is it is so true You know, I look at The decriminalization piece, you know, has so many layers worked. We worked with a student group out of Larner College of Medicine at UVM medical center You know helped us do a research project pulling Vermonters and physicians medical providers across vermont to just kind of gauge what their Readiness was to see decriminalization and vermont and the numbers, you know spoke volumes that people not only Community members and citizens but also medical providers were really ready to see this happen in my strong belief is as to why is because Because so many people that stigma that we talk about like if this were to be decriminalized and you could actually Well before you maybe even had a significant maybe problem where where whatever Drug it was that you're using whether it be alcohol or heroin or or crystal meth or whatever it might be if You know if these things were not decriminalized as the stigma was removed and we could talk to Our our doctor about it or talk to our our boss about it or talk to our, you know Our neighbor about if we could just have open conversations. I also think it really falls into that like Um that sort of prevention zone that people want to talk about too like how do we prevent it from getting so far for people? Um, and I think there's a real opportunity here in decriminalization Uh to really just be able to have those conversations without so much fear attached to it I think about my kids there in their early 20s and mid 20s And thank goodness, um, you know, I was able to have open conversations with them But I've also talked to many families. You know, they're kids. It's still it still is illegal and when you grow up with something criminalized Um, you know for I'm thinking also for our next generations. I have a grandbaby coming You know, it's like like how do we want how do we want our current? Um members of society to be uh treated and how do them to feel but also what do we want for the generations to come And um, I think this could have far reaching Um effects and on in on so many levels and so the the what we learned from our study was that more people would feel comfortable From a public health point, uh to talk to their um medical providers if it if if it were decriminalized Um, hopefully then fending off any particular life-threatening issues Sooner I hear you and thank you and thank you for that study. That's that's important I hope we can help to to publicize Then information Where we're just about out of time. I thank you. I thank you all for your expertise your work Your generosity and coming to the show and sharing your experience. Um I wanted to give everybody just like a like a a a brief opportunity to speak to people Speak directly to people using drugs. What do you have to say to people using drugs? Maybe Trisha, would you like to begin that? Um Gosh ed what would I say to people using drugs like I I'm a person that uses drugs So those are what would I say to myself? Um, you know, I just think it's Just be yourself You know, it's it's it's actually just okay because we are so much more than people who use drugs Like I don't even know that I even like that label anymore, right? It's like we're actually just people Right a person that might choose to do drugs or not choose to do drugs or choose to drink or not drink Or choose to watch netflix or not watch netflix or choose to shop or not shop We're all just people first and I guess that's what I would say We're all people first and the activities we engage in the behaviors that we Take part in all that stuff is a piece of who we are But it's just a piece and we have the choice every single day every single moment to choose something different Um, I I personally have always, you know Uh Been an every day glass of wine drinker. I've I've a few months ago saw that hey, you know what I'm gonna choose I'm not gonna be drinking wine every day Doesn't Meaning the particular just means that I chose something different and I think you know We just all have that opportunity and we're all people and we're all people that deserve to have our own Our own choice like not to have that our choices taken away from us Also as a woman with everything that's just happened like like Our bodies are our bodies and what we choose to do with them and put into them It should always be our choices and we should never be judged for those choices Thank you never be judged. Thank you um Mike About 10 years ago when I still worked in services. I made a series of pamphlets That we gave out on our program safer sex work safer drug use overdose prevention They also different things on the front but every single one of them said you matter So I want that to be the message that people who use drugs always hear from us Uh, the whole world tries to tell people they don't matter people internalize that stigma and start to feel like they're worthless That makes people use drugs more if you think you're worthless. You don't feel like doing anything different You're just gonna keep using drugs. So I hope everybody who uses drugs knows you matter There are people in the state who care about you their programs here Who can treat you with that kind of respect and dignity and help you understand That you're not a bad person just because of your drug use um, and You know, that's that's what we all need to do is to stop making people feel bad about themselves The more we do the more people will use drugs not just people who use drugs people who use drugs in particular Let's just try to be nicer to each other Thank you. Thank you. Thank you. Joe Well, Mike and Teresa, I think uh It said most of what I I would say I think I'll just close it out by saying simply, you know, you are loved You have value to our community and your story matters as a policymaker folks with lived experience sharing stories about how Uh, our systems have failed Uh, it's how we begin to make them work better for folks and so I would just uh, encourage folks if they feel comfortable if they're If they're able to share their story and myself for Find a way to have your voice heard Thank you. Thank you That's it. Uh for for this show. I want to thank the three of you for Joining me today for for coming on to the addiction recovery Channel for for the viewing audience for the general public You know, we're in this together And we are being overwhelmed by it As a culture as a state as a society as a group of communities We're back on our heels and um We need to to really search ourselves Search ourselves And figure out what what is it that each one of us can do as an individual first To be compassionate toward people who use drugs or develop problems as a result of using drugs to communicate To them to actively communicate to them That we love you. You're okay. Just the way you are and secondly I do believe this that this is a democratic society We vote And we have influence with our votes We have voices and we have influence with our voices We need to research People running for a state senate research People running for the house of representatives research People running for local positions people running for the governor the gubernatorial position We need to research that and we need to vote for people that are in line with our values And if we care about people and we care about people who use drugs we can find out what people Running for positions of power think Along those lines and vote for the ones that we identify with We can also if we're dissatisfied with the way someone is Behaving with the decisions that they're making We can we can protest We can call them we can write emails. We can write commentaries letters to the editor We can be more vocal about this I know everyone is overwhelmed with life life itself We're all struggling to meet the demands we meet every day But each one of us each one of us can make a little bit of a difference And that can make a very big difference and we need to make a very big difference In what is happening in vermont. So so thank you and i'll look forward to seeing you next time