 Hi everyone, welcome to the Addiction Recovery Channel. I'm Ed Baker and I'm your host and I'm very happy to be with you here today. Today we're going to address a topic that is both complex and controversial, namely overdose prevention sites. We have four distinguished guests with us today and it's my privilege to introduce them. We have Dr. Jun Young Park. Dr. Park is an assistant professor of medicine and epidemiology at Brown University and she is a faculty member at the Center on Biomedical Research Excellence on Opioids and Overdose. Dr. Park's research focuses on promoting the health and well-being of people who use drugs through harm reduction. Thank you so much Dr. Park for being with us today. Thank you for having me Ed. Yes, we have with us today Michelle McKenzie. Michelle is director of community engagement with the Center on Biomedical Research Excellence on Opioids and Overdose at Rhode Island Hospital. Michelle is a research associate with the Brown Alpert Medical School and has been conducting harm reduction and overdose prevention research for more than 15 years. Michelle is also a person in long-term recovery. Thank you Michelle so much for being with us here today. Thank you, it's a pleasure. Yeah, we have with us today Sarah George. Sarah George is currently serving as the Chittenden County State's Attorney in Burlington, Vermont. Sarah was appointed by Governor Scott in 2017 and elected again in November 2018. Sarah is a mighty advocate for social justice. She describes her role as just doing my part to overhaul a racist and classist legal system and replaced it with healthy and vibrant communities. Thank you Sarah for your service and thank you for being with us here today. Thank you for having me. We also have Grace Keller. Grace Keller is the program coordinator at Howard Center's Safe Recovery right here in Burlington. Safe Recovery is our harm reduction center. Grace has worked on the front lines in our community for going on 14 years now. She and her team meet people who use drugs where they are and they offer them a wide array of innovative and lifesaving supportive services. Thank you Grace for being here with us today and mostly thank you for your service. Thank you so much for having me in. I'd like to begin the show by focusing on the very it's difficult to focus on because it's so tragic but I'd like to begin the show and focusing on the reality that we're facing today specifically in Vermont and then we'll branch out to a little bit later. But Sarah could you begin by just giving the audience an idea of what it is you face every day regarding this. People who inject drugs, people who use drugs and drug overdose fatalities. Sure so I really only have a great indication or a great perspective on Chittenden County but luckily I guess luckily Chittenden County has over a third of the state's population so I imagine we might be a little different from the rest of the state but we do overly represent a lot of the communities. Every year since I've been a prosecutor this has been something that is on my mind part of our jobs as as deputy state's attorneys and state's attorneys is that we have to go to the scene of every untimely death and as a brand new deputy state's attorney straight out of law school going to the scenes of overdose deaths was something that really struck me and hit me very hard especially the younger people who had you know a sports injury like I had many times and started out with a valid prescription that turned to heroin and died. When I became state's attorney that's when I really started looking at the work we were doing or more importantly not doing in our communities to help people who use drugs. As a prosecutor like many things we've become the role that has become part of our role is to essentially try to treat people who use drugs and what I have learned is that that doesn't work that we're not very good at it and that forcing people into those situations is actually more harmful for them and the community. So right now we were doing really great our numbers were still tragic and horrific but we really were I think tackling it in a really good and harm reduction way but with COVID our numbers are pretty dismal. In Chittenden County we've lost 32 people this year to overdose and most of those individuals at least 26 were alone either in their residences or in bathrooms one was you know on a park bench but all 26 of the 32 were alone. So that you know I think in a pandemic where people are isolating themselves or are losing their jobs or losing access to healthcare all of those all of those barriers are making our communities incredibly unsafe and people who use drugs are in really dire circumstances. I do you know would obviously always give a shout out to Grace and the folks at safe recovery and they are really doing incredible work for some of our most vulnerable people in the community who use drugs but I do think there is another population of people that are not taking those opportunities and are isolating themselves in a way that is really scary and is leading to death. Thank you thank you Sarah and painful as it may be this is we need to focus directly on this. In Vermont in 2020 if you see me glancing over to my left it's because my notes are there 2020 death rose in Vermont by almost 58 percent. We were we had the highest increase in the rate of death from overdose fatality in America in Vermont. Grace do you want to shed some light on that you want to talk a little bit about what your experience has been here in Chinden County. Sure and I also like to give a shout out to Sarah because you know we have a strong partnership between harm reduction and our prosecutor's office which is quite unique. Sarah actually started this conversation a couple years ago and got a commission of us together people from the hospital law enforcement all walks of life and we all agreed that this was a path forward that we really should be exploring so I I always want to highlight that because in Vermont we may take it for granted it's not all that common that we have prosecutors that are such champions for this so I want to say that first and foremost what I can say is that overdoses effect so safe recovery has 5,000 members we are Vermont's oldest and largest syringe service program we're the only full time program in the state so sometimes as high as 33 percent of our clients come from outside of Chinden County but the you know the two-thirds come from inside of Chinden County and I've been in my job for 14 years we are we've been open for 20 years and so when we're talking about these overdose deaths here these are very often people we know people we've worried about for years people we have access to people who have access to our services that we could be offering services to and in in better ways to keep them safer and when we did Sarah's commission we actually asked them and and 91 percent of our clients said they wanted a safer consumption site that they would use it and that they wanted a safer option so when we talk about fentanyl and that's what's really driving the overdose crisis in in Vermont right now for about 18 years we surveyed our clients and about on intake about whether they've witnessed an overdose and for those 18 years or 17 about they was 23 to 26 percent would identify having witnessed an overdose and in one year in 2017 that number jumped up to 81 percent we're now at 86 percent of our clients reporting having witnessed an overdose and 57 percent of clients at that time were reporting that they'd overdose themselves so we are really in a in a crisis our clients are afraid they're looking for support and every time when we lose a client one of the hardest things for my staff is we sit down we talk about things we could have done differently but we oftentimes look at things that we don't have access to and I think in this country we've really started with the pandemic one of the things that's been heartening is hearing stories of people making sure the front lines have what they need and you know that really came into our our homes this year people seeing that frontline workers and hospitals didn't have what they need and when we look at opiate overdose and we look at this this epidemic that we're going through this crisis that we're going through our frontline workers don't always have what we need and it's the one area well when when frontline workers are saying what they need stigma comes into play and we really talk you know continue to not be able to access things that we know would work so for my staff and for me and on behalf of my staff we are really struggling we are dealing with a lot of trauma a lot of loss of clients and oftentimes we know them very well we know their dreams their aspirations oftentimes we know their family members and children parents and partners so we really want to keep looking at ways to improve things and out of those 5000 members we did not have a client death to covid we had one covid hospitalization um but that we know of um but we our numbers for overdose are really um we're really climbing and and sometimes in a weekly in a weekly reoccurrence so thank you for bringing this us all together to talk about this i'm really excited to have people from outside of vermont to talk about this too today so thank you yeah thank you thank you grace for your contribution and your and your life's work thank you um you know in vermont i i don't want us to be misperceived as somehow you know saying oh you're not doing enough for vermont you're not trying hard or there's there's no criticism coming from the panel there's no criticism coming from the show you know we know that vermont is a leader in america we have a wide um low barrier access to buprenorphine we have a treatment system a hub and spoke treatment system that is second to none we have no waiting list we have uh thanks to sarah george uh grace caller and a number of other people we have uh successfully decriminalized possession of small amounts of buprenorphine we have a number of harm reduction sites we have our recovery centers we have our recovery center sensitive communities but but with all this the the the numbers keep mounting the deaths keep mounting and i'd like to cite a quote from one of dr park's recent um papers as she says unfortunately interventions fail to fully address the current wave of the opioid epidemic and often omit the voices of people with lived experiences regarding drug use every overdose death is a combination of a long series of policy failures and the lost and lost opportunities for harm reduction so i'd like to move into into this now with all we're doing dr park's of dr park what what do you what do you see as the next um scientifically based step in in helping this population thanks ed for having me here and starting this important conversation uh so scientifically i think um we're kind of at a crossroads um we have invested as a country tremendous amount of resources into um both uh public health prevention treatment and law enforcement and um although we have seen some progress um obviously there are as sara mentioned um many people who are still using drugs alone and um people you know a lot of people that i've talked to over the years in um bolton war and other places around the country um you know talk about uh feeling isolated you know dealing with mental health issues dealing with trauma and i think that we have a real opportunity right now to um extend a lot of the great work that has already been done whether it's peer outreach recovery programs emergency department programs um harm reduction centers syringe exchange um naloxone programs like the list is very extensive especially in vermont which really is a um leader in the country um to incorporate the reality that a lot of people are using drugs alone and in um different unsafe unhygienic spaces so for example um for people who are stably housed and you know they have a good support system um if they are you know battling addiction or choosing to use drugs you know in the safety of their home um and there's somebody around to revive them with naloxone then you know an overdose prevention site would probably not be of as much interest but the people that i've talked to and i know michelle has too um who are unstably housed who are moving between places um who are living under bridges um there are many people out there who you know are dependent on drugs such as opioids and fentanyl and heroin and um don't really have anywhere to go and um juxtaposed with that reality they are also um in an environment where um what they are engaging in is inherently illegal and so um balancing the need to stay hidden from law enforcement from getting into trouble versus um dealing with a you know addiction or dependence um and um engaging in drug use it's a it's a tricky situation and so overdose prevention sites are evidence-based spaces where people that hygienic um there are trained people on site who can supervise and intervene if something happens something were to happen most of the time nothing actually happens um nothing negative i should say um but in case there is an overdose um someone is there to respond with napkin or oxygen or even call EMS and the reason why these interventions have been um implemented across the world over 100 locations and um supported by science and evidence is that at the heart of heart of these spaces is that they connect people they connect people to um services they connect people to other harm reduction programs and just help to build relationships and re-engage people in the health system and so i think that they have a lot of value there are different models um there isn't a one size fits all there are multiple models that we can talk about um but i think they are really promising intervention thank you thank you very much uh michelle would you like to care to elaborate a little bit on the same uh the same topic um i i would i i thank you um jew for that backdrop with um what uh how um harm reduction centers or overdose prevention sites there's actually a number of names for them really are evidence-based practice and certainly our neighbors to the north have um have really invested in or in harm reduction centers considerably and honestly really so there's like 30 in 37 cities and towns throughout canada and um many proliferated only in the last few years in the last they started of course several years ago with vancouver and uh insight in vancouver but really proliferated proliferated in response to fentanyl and recognizing that this was a very good um a very important step to save lives um and here in red island you know um ed you talked about how there we saw some gains we saw a reduction in overdose deaths certainly that was the case in red island between uh between 2016 and 2019 but then um and but the before actually before covid hit in december of 2019 red island started seeing increase increases in overdose so we we were really left with the reality that while covid made things worse for all of the reasons that you that sarah and grace talked about with regard to what you know the isolation and loss of employment and i mean the on and on cascade of things that would cause people to use um for us in red island it started before that and in part i think that we are you know we have done really important steps as you talk about making naloxone available um increasing access to medications for opioid use disorder both methadone and buprenorphine and then now treksone to a lesser degree um but what we are now really focusing on is is addressing the problem in more and in embracing even more uh even more a harm reduction approach and so that was um evidence of this sort of really embrace of harm reduction was the legislative um measures that passed this year so we actually had three really big uh laws that passed that i think go are very important in recognizing the um failure of our drug policy that has focused on the criminalization of drug use and and seeing that substance use drug use is a human behavior and that um a more public health response is going to be uh be better so the three pieces of legislation were um the harm reduction center passing a pilot harm reduction center which we'll be talking about more obviously in the show the other another piece of legislation was um decriminalizing buprenorphine which of course you guys they beat us to the punch you did it in vermont which is wonderful um and also reclassifying possession of any substance 10 grams are under as a misdemeanor possession rather than a felony possession um and with the idea you know and that is you know there was a lot of conversation when we were passing that legislation because possession prior to this was our felony possession was 28 grams are under people many people advocated for a larger you know more higher number of grams uh because we recognized that uh that you you really want if you're moving away from a criminal justice approach you want to make cast the net as wide as possible but we started with 10 grams which is a wonderful step in the right direction and um and we will be looking at that and seeing what are the repercussions of the fact that people are not going to have to worry about criminal penalties for possession and in fact when you look at the barriers to engaging in treatment in barriers to um getting the help that you need there's no question that the criminal is that this is a criminalized activity comes in the play thank you thank you michelle i can't even express how um encouraging it is to to understand that the legislatures and people with power are finally beginning to understand the dynamics of addiction and what what people with addiction are all about and and are beginning to move away from punishment i think it was the obama administration in 2013 that abandoned officially the war on drugs and began to take on a public education posture about disease but it seems like the culture itself is just way lagging behind in understanding what is going on with addiction so so hearing hearing uh you know your your comments is is very encouraging i'd like to make a comment this is another one of dr park's quotes so we know that overdose prevention sites save lives but in addition uh she states that there are more than 110 overdose prevention sites in 66 cities worldwide evidence on the impact of overdose prevention sites demonstrates their significant association with reducing overdose fatalities hiv and hcv transmission so hiv and hepatitis c transmission syringe sharing public injection it reduces all these ambulance usage and crime this is profound furthermore overdose prevention sites increase entry into drug treatment have never housed a fatal overdose have never housed a fatal overdose and have been found to be cost effective so i'll just throw that out to the to the panel for for comments we have we know what's happening outside overdose prevention sites the death rate is skyrocketing and this is what's happening inside overdose prevention sites so i'll throw that out to the to the panel who would like to comment on that grace i pick you well i knew that was coming um which is good because i was thinking about it well what i can say is i have been to vancouver and i've been to in sight i know sarah has to maybe others on the call have um and what was um stark to me and uh pretty emotional is talking to them about what happens when an overdose happens on site and having immediate access to people that can help who are right there who are witnessing it within seconds um and what happens at safe recovery we've had 20 overdoses um or 21 all but one was were people that overdosed other places and were brought to our office in a car blew not breathing and unconscious um and overdosed and when that person when when those people were brought to us people with them are terrified they have no idea how long it's been if you've ever been in a situation like that and i have you know there's no accurate way for you to say whether it's been a minute or 10 um and every time we've been able to reverse the overdose um but only because that metrics of getting the person to us just happened in enough time so what we need is time and um and any of those times a lot of these people were not breathing or at least from what we could tell so that's time that oxygen is being um the brain's being robbed of oxygen so seconds count here and i every time we've reversed somebody i think you know all of us go through what would have happened if it had just been more seconds and i think at this point that's really what what we're talking about in the practicality of overdose prevention sites is that um their staff is prepared their staff is ready they are there people around that are watching there are people around that that know the people that are with the person also have the comfort of knowing that they're safe that there's somebody there that can help them um where the the amount of trauma also that goes through even when somebody has an overdose that's reversed um the person the people that are with them are terrified our staff is terrified you know the person who overdosed is terrified and we've been just plain lucky that we've been able to reverse these overdoses and so i think what we need to do is really focus on a science-based approach that really gets that time down um and that really doesn't rely on luck it relies on practical approaches that we know have worked in other areas yeah well said well said thank you grace sarah yeah i'll just speak specifically to what you were saying about all of the reasons um all of the evidence-based reasons around the support for um a safe consumption space versus what we have continued to do regardless of what obama has said we are still fighting a quote-unquote war on drugs and um and i think a lot of the problems with our criminal legal system in general is that we have a ton of evidence says it doesn't work and we continue to do it because that's how we make money um you know we make a lot of money on policing prosecuting and incarcerating folks for public health issues and there is a great desire to ignore the evidence um in place of listening to data and it happens with drugs it happens with incarceration in general incarceration makes communities and people less safe and we continue to do it um so i think that having a lot more if if we really want to talk about the obama administration or the biden administration ending the war on drugs then they should be decriminalizing drugs um and that we're so far from that at this point um even within chitin and counting we don't we really don't prosecute them but we get so much pushback from law enforcement and their their quote-unquote reasoning is how else will this person get treatment and you know i think that that's such a that's so telling that one that law enforcement think that's the best way to get somebody treatment is to put handcuffs on them and send them into a courthouse um and some of the reality of that is that it's true and that's the really unfortunate part is that most people are getting connected to services through policing and prosecution instead of having more direct access to those services in our communities we're a little bit more lucky in that sense in chitin and county but when you talk about more rural communities and communities that even if they had a safe consumption site people don't have cars they don't have an ability to get to those sites or get to counseling um you know i i do think that there is a part of that is that we don't resource we over resource the police and prosecutors and we under resource that the folks that we actually want to do this work for the people that need it thank you sarah you know i think maybe at this point we should begin to talk a little bit about stigma we're doing we're doing well with time uh the who the world health organization did a study a number of years ago global study and they found that um addiction was the number one condition uh that received the most and the most intense types of stigma number four was alcoholism so it just it makes you think that there's there's some sort of hierarchy of a stigma or a totem pole of stigma and and people who inject drugs on the very bottom of it and i do believe that you know this is one of the things and i know we all agree that this is one of the things that's preventing us from moving forward so dr park and michelle do you have any um you know through your research have you what have you learned about about stigma toward people who inject drugs and and what do you think we can we can do about that um one of the things that has come up repeatedly um and work that i'm currently working with the red island department of health and talking to folks who use in order to learn about what what people's experiences are with our current policies right so what are people's experiences with accessing treatment harm reduction services etc and one of the things that comes up repeatedly um are people talking about their experience in in um health care settings very many health care settings sadly but very particularly in emergency rooms um and sort of the emergency response system and i think that the part of the really unfortunate treatment that people receive is very much rooted in stigma it's also rooted in a system that's inadequate to the task of treating people's needs so people end up you know getting um a 911 call police arrive um EMTs arrive and and then the and folks get um transported to an emergency room and particularly whenever you're looking at you know during health crises in general so you've got COVID going on you've got really a terrible impact um because of the pan of because of COVID um on our health care systems and then you sort of add this layer of stigma so people are being sort of forced into the system that people that emergency emergency room folks do not know how to treat really their needs well and so it really builds a lot of medical mistrust among people who uh people who use drugs um and it builds up you know a lot of resentment and contributes to stigma and i think that the harm reduction centers actually will have a really important role to play in this because when you were talking about responding to overdoses when overdoses are responded to in an overdose in a harm reduction center people don't go to the emergency room they are able to have the overdoses adequately responded to right there because you can see exactly what went on you know when the person went out you know the applying oxygen and naloxone that can all happen safely at a harm reduction center which means that all of the folks who would be utilizing the 911 system in a well that kind of ideally would would have and without a harm reduction center that the 911 would get called um they don't end up in the system so they don't experience all of the sequel eye of being caught up in this system and it also so that means that not only do they not have to go through it it means there's actually less of a burden on the system overall i actually think we need to make a lot of changes with it um we've actually found here in Rhode Island there's been a decrease in calling 911 because of all the things that i just talked about um so but i i think that the that just the fact that you're going to have less of a burden of having people calling 911 once we get harm reduction centers open will make a big difference thank you thank you dr park yes um so i think michelle you're like talking a lot about healthcare stigma and and it reminds me of um the you know discussion around how institutions and laws can really shape stigma there is a kind of bi-directional relationship and so earlier we talked about you know drug use being illegal and even when i was growing up you know that was the message i got at school and in college and so if you don't necessarily have lived experience with substance use then you might grow up and think all your life that anyone who uses drugs is bad for um people you know you might believe that people who are using drugs should be arrested and so one i have two examples actually of this um one is that um and this is you know in addition to the barriers to education housing employment um out when we talk about institutions i think about the universities that i've worked at um even places like universities that hire people like me who do harm reduction research can continue to perpetuate stigma and that can be in the form of people not feeling comfortable disclosing about their recovery process um people not wanting to disclose their use of drugs um and even when we are hiring other students and research assistants and community outreach workers um our institutions can stigmatize them by uh mandating for example random drug checking drug testing and um these programs um for some jobs it kind of it makes sense um but for other jobs it's just the remnant of um these prohibition drug prohibition laws and it's everywhere everywhere you look every institution you look at um you can see remnants of it and um and i wanted to also mention uh just follow up on what michelle said earlier you reminded me michelle of a time where i haven't even had a chance to tell you this but um i was a doctoral student conducting survey based research in baltimore and um there we were heading home actually you know driving our van back to the hospital and on the way we saw an overdose on the street and when we got out of the car somebody like a bystander who didn't know this person luckily was there and had called 911 so we were like okay great so we run to the van we get out on a lot zone we're going to respond but then the ambulance arrives and so well like great the ambulance in addition to naloxone has oxygen has like healthcare professionals this person's going to be okay i have never seen such a slow response to a emergency situation the you know ems workers they walked there they joked about the person who was clearly in distress and i almost like pushed them out of the way to administer the napkin because um this person was you know seconds away as grace said earlier seconds away from you know having cognitive damage or death and it was an extremely scary situation it was the first overdose that i saw as a young student and that really stuck with me and so when we talk about stigma um it's in our health care system it's in the institutions that we work at and it's a something that we definitely need to tackle alongside providing these harm reduction programs well said and i go ahead one of the things that i see a lot is um is where this danger most dangerous too is um internalized stigma uh you know i've been here long enough to have experienced a two-year waiting list for most of our clients to get access to medication assisted treatment and i was also the program that got to start a program that got to start having immediate access to buprenorphine at our office and um the one of the first few days um what happens with the in our population that you still see remnants of is um is a scarcity mentality when we had no resources for people in this situation they had to survive by taking care of themselves and each other um and so one of the first days of low barrier of buprenorphine we were ready to get you know we had people ready to go get people into treatment one of the first women was somebody i knew for a long time she'd been trying to get into treatment and i talked to her i'm like you we can get you in today right now we can get you in front of our provider and she had come in to see me because she had um overdosed and been sexually assaulted that weekend and when i said or we can get you into treatment right now the first thing she said is i bet there's somebody who needs it more than i do and i don't want to take up a spot and that's the system that we've sort of created when we didn't have treatment for somebody is there's always this perfect individual who's going to take that spot and do everything that what you know um somebody thinks is going to happen if you're in a waiting list there's always somebody behind you that might deserve it more or might be more successful and i think that that's what we're still up against um and unfortunately one of the things that plagues my staff and i is when when we've had overdose deaths there are conversations about stigma that ring in our heads people talking about how they were afraid of medication assisted treatment or ashamed of certain things or especially when you talk about relapse that's the one of the most dangerous times but it's one of the most highly stigmatized and shamed times um so that's where i think also um overdose prevention sites or whatever term we're using can really help people to work through that that's where syringe exchange side shines is helping people through relapse it's relapse is not an area that you can talk to a lot of people about not even in our systems not with our providers not in some of the support groups that people are in so i think that's another area what we need to talk about is like this internalized stigma that that exists that we're always going to be up against but that systems create and reinforce all the time in the in the minds of patients that just need compassion exponentially in 2020 we have according to research done at grace's site a willingness on like 90 percent of the people who use our site would use an overdose prevention site we have i think we have coming into the state significant amounts of resources settlements with whole cell opioid distributors and in the near future settlements with the secular family so millions of dollars per year coming into the state so we have the need we have the willingness we have the research and we will have the funds what what you know what what can i say about this you know the the table is set and dr park i think i'm going to pick on you because during your last presentation at comstat in response to a question that i posed to you your last four words were the time is now so what do we do now what's the next step for us in vermont who have our constituent has no voice people who inject drugs have no voice we are their voice how do we use our voice to move forward for them how do we do this well what kind of suggestions does the panel have yeah so i'm really fortunate to have recently moved to road island where the it is the first state in the whole country that has legalized a pilot program to implement and evaluate a harm reduction center or multiple harm reduction centers in fact and so i think that legislation is one area that you know vermont could organize around there are also many community advocates who are working to get community support in road island so that's an ongoing process and michelle can speak to that aspect but it is the time is definitely now i think that we have the evidence we just need to get the right investments and get the right people on board to move this forward in vermont yeah thank you and we'll be i think we'll be looking to you for you and michelle and others in road island for guidance thank you michelle do you want to comment on that and expand on that i will just on the idea of a coalition i think that one of there were a couple of reasons that the legislation passed this year i'm not going to lie that one of the reasons is that we had a change of leadership in the state house and that made a big difference and we actually had in the last couple of years got uh have a new attorney general um and that those changes in leadership at the state level really helped us um but the other thing is that we have had folks doing the advocacy and legislative lobbying for several years developing relationships and really calling and putting together a wide coalition so the people who were at the state house just um testifying were of course um uh people who were involved in harm reduction work um and researchers but also medical providers um substance use uh disorder treatment providers um uh folks in recovery and recovery advocates um people from different uh really many different disciplines and people people who are do like for instance generally do more work sort of around criminal justice issues they were there um pulling those folks into the mix and i think oh and actually and this is critically important um people with lived experience so that the because facts and figures obviously have to be part of it and this is evidence-based practice but what i think that talking from the heart um makes a really uh big impression on you know in these committee hearings because they're in hours and hours of committee hearing so really talking from the heart so a large coalition um and really letting people tell their stories thank you thank you well said and heard um i know that sarah put together a commission a number of years ago that had a wide array of um allies sarah do you want to talk about who was on that commission and who you see as in support of this kind of movement or activity in brumont sure so this was very early on in my um after being appointed state's attorney and i really didn't know a lot about it um i didn't know a lot about harm reduction in general or um safe consumption spaces and so i i had the commission made up of um folks from safe recovery um including somebody in recovery and um law enforcement i had two law enforcement officials on it a i had a program coordinator on it um somebody from another syringe exchange program um within the state that was mostly outside of this county their work was which was helpful for the more rural areas um i think that was an interestingly coming into it you know especially for the law enforcement and and frankly even myself really not knowing a lot about it my initial response was like most people that i was a little skeptical of it and whether or not that was actually the right way to be going and um everybody by the end was including law enforcement was like this is clearly an option that we need to be looking to support the the one hesitation from law enforcement specifically was they really wanted legislation around it just i think frankly for liability purposes more than anything but um there was never a hesitation around towards the end about like whether it was when and how was really how the conversation quickly turned when you start looking at the evidence and research it's hard not to mean you say all those things that you were saying before ed you know when we started doing all of the research and laying that out for folks it's like it's really hard not to appreciate how much better off it could all be if they were in place beautiful and uh thank you and and thank you dr park and michelle and um uh grace you know i just like to add over the past couple of weeks i was in touch with uh tom dalton who is the executive uh director of vermont just for criminal justice reform his organization or or he specifically is very much in in favor of this kind of effort in brahman i'm uh i was a clinical social worker so i was in touch with the n as w vermont chapter they don't have a decision yet they're bored but they supported this kind of activity over those prevention sites in california so it looks like they'll be supporting us in vermont i was in touch with um the vermont recovery network board which is uh composed of directors of recovery centers in vermont we have 12 of them so people out there right you know grassroots right on the front line their board is in favor of overdose prevention sites and i've been in touch with the vermont um addiction professionals associations so these are all the providers these are the clinical providers their board voted unanimously to support this idea so it's this growing support in vermont i i will pledge to um dedicate a number of shows uh the end of this year and over next year specifically focused on on this topic and will be disseminating them as widely as possible uh to see if we can maximize support um the will of the people is is important and i do believe that if the people are educated if if if their consciousness is expanded if they can open their minds their hearts open and and we will have their support and therefore we'll have the the legislature so i want to i want to thank you um well and also um i think michelle mentioned uh people with lived experience i've i've got um a couple of things going on now where i've got some people reaching out to people who are injecting drugs and i'm going to invite them on the show with safeguards to their confidentiality and uh we're going to try to get you know their lived experience out into the public what it's like and what would help them so it's a very exciting time i want to i want to thank my panel from the bottom of my heart thank you so much uh for being uh with us here today any any closing comments uh from any of you thank you for um bringing us all together yeah that's great yes thank you i'm sad all right all right thank you and audience just you know keep tuning in all right for for some great information from some great people thank you thank you