 Welcome. Thank you for joining us in Burlington City Hall and for this really I think unusual opportunity to have a screening of this film, Swallow This. We are really fortunate to be joined tonight by the film makers there. For some reason sitting in the back row we're gonna drag them up to the front soon but we have Helen Redman and Mary Elena Marchetti who have created this. Why don't you guys stand up just make sure you recognize. Thank you for being here. And you know you guys have come for the film and the discussion afterwards and we're gonna get to that in a moment. I would like to take just a moment kicking things off to reflect on why I think this is a really important and timely event for what we're facing. From my perspective we are in very troubling times with respect to the opioid crisis. It is not where I hoped or thought we would be in 2023 several years ago. Since 2016 fighting the overdose crisis the opioid crisis has really been one of the city's top priorities and we for several years had a real sense of momentum and progress in thinking that we were figuring out this terrible challenge and turning it around and we actually saw that in in the numbers. We we tracked very closely the number of people that die of drug overdoses on an annual basis and after being at 34 in 2017 we saw that number drop to 17 in 2018 it stayed there in 2019 and that was accompanied by what I do think was one of the most robust local kind of regional multi-party responses to the opioid epidemic of any region in the country. We were changing our prescribing practices dramatically we saw the hospital reduced its prescribing by about 70% by some measures we eliminated after years of having waiting lists to get into medically assisted treatment we saw those waiting lists go away. We opened up new ways because we found that just having no waiting list wasn't enough we opened up new we called the nodes to enter into the our hub and spoke system in the in the prisons with the state's partnership really leading that effort but this region advocated hard for that we saw our needle exchange safe recovery and we have a number of people who have worked in the past for safe recovery if I'm not sure if we have the current safe recovery people here or not we do great welcome thank you for being such a key partner the needle exchange added to their services inducting people in the medical assisted treatment the emergency room did the same thing it really seemed like we were you we were expanding access to the the main solution we had to this challenge which is medically assisted treatment and then 2020 hit the pandemic arrived and really I think in addition to that fentanyl arrived in this area in a way that we had been spared previously and we've really seen all of that dramatically reverse itself to the point where now in in 2022 we saw over 50 people in Chittenden County die of opioid related overdoses statewide I believe the figure was 237 which as a frame of reference is well more than double the number of total deaths that happened in 2013 statewide in 2014 was the year that the governor started the the the the year by devoting his entire state of the state address to what he you know called the heroine crisis that time so I really have this sense now that we have have lost our way and we have it's really quite heartbreaking and we need a massive effort to once again turn this around and get back on the right path I think that that reversal starts by an acknowledgement which I frankly I don't think we've heard clearly enough from our state leaders that our current system is not working we have a lot of rightful pride about Vermont's hub and spoke system and it and it play it and it still helps many people but it is it is by the state's numbers and maybe there's some questions about whether this will prove to be accurate but by the state's numbers my understanding is of the people who died in 2022 only 25% of them were in the the treatment system or had ever been in the treatment system at any point which means you know we're missing a large majority of the people that we need to be helping and that really I think should shake our sense of confidence that that what we're doing is working I think we need clarity again that this is our top public health crisis we had clarity about that back in 20 from 2014 through through 2020 we had to shift our focus a lot of public health focus to the pandemic in 2020 it's time for that focus to come squarely back on this on this crisis and I'm hoping events like tonight help help do that we also have to recognize that fentanyl has really dramatically directly undermined the effectiveness of the medic the this what previously was kind of our our silver bullet in this the medically assisted treatment suboxone buprenorphine is not it's not nearly as effective as it was prior to 2020 which means we really have to think hard about new strategies and that's that's also what I'm so appreciative about this film which is it squarely focuses attention on the drug the treatment medicine that has remained effective in the in the fentanyl age methadone and it also my senses I haven't seen the whole film yet myself I've seen some clips but I think it shows us a really shining example of the kind of dramatic paradigm shifting new interventions that we need to be considering at this desperate moment when when we really need new ideas in a new direction so again we're really appreciative to have this opportunity to watch this together I think we're gonna go right into this now and then I'll be part of a panel that comes up to kind of just try to discuss this together and its local implications on the other side so thank you all for being here tonight let me out let me out for being a minute late two hours just to get to have a drink some liquid in the cup and then go back two hours and then that's the way to start the day off that's abnormal have to come every day until we until we get to a certain amount never in my life would I think that this could happen in America our patients are with us for a long time you really never graduate from this the whole thing needs to go until we have a system that makes fucking sense separate and unequal system of care and I'm using the civil rights language deliberately because this is an artifact of stigma against addiction thank you so much everyone for being here watching the film with us and being part of this conversation huge shout out to Scott Pavek and Mayor Weinberger for championing this and really wanting it to be a dialogue with folks about this issue because we know that y'all are in here for a reason and we definitely after we hear from our panelists want to hear from you be it in the form of comments to share your own expertise around this issue questions but we definitely invite everyone to participate if you connected to this or have something to say yeah so anyway I skip the first part my name is Marilena Marquette I'm one of the filmmakers and what we're gonna do first is start with Heidi I'm gonna ask Heidi to introduce yourself and say why you're here and give the two three minute reflection and then we'll just come down the row and then move into comments questions so let's go ahead Heidi good evening everyone my name is Heidi Melvistad I'm the director of the Chitney Clinic here in Burlington it is the methadone clinic for our county it is the only clinic how about now okay it's the only clinic for methadone in Chinden County I am very grateful to be here I think it's important for me to be here Dr. John Brooklyn is also here who's the medical director of the clinic I appreciated one of the patients reflected on how different methadone clinics can be in our country and even though they are federally regulated especially in the midst of COVID clinic responses was very different so there's certainly things that were captured in the documentary that do happen at our clinic and there's also a lot of ways that we are not similar to a lot of what you saw tonight and I think that's really important so I'm here tonight to be able to expand all of your knowledge about what it's like for people in our community to be in treatment I'm here to build relationships with people and ultimately we want to be advocating for our patients we want our patients to be able to live their best lives and especially as the mayor commented earlier the overdoses keep happening in our community and we're focused so much right now on how to reduce barriers to care and so that is why I'm here this evening so thank you well let me echo the thanks for Scott Pavek for being the city's opioid policy manager and for for doing a lot of heavy lifting to make it Scott's in the back and appreciate the work he did to make tonight possible and work on this issue day in day out I feel very fortunate that we do have such a well-established and effective methadone clinic here in Chinton County thankful for Dr. Brooklyn and his decades of leadership on this issue very thankful for Heidi and her she's new leadership in this role and really bringing a fresh look to what can be done to reduce barriers to this life-saving medicine and we've done a lot already and I'm conscious that many people have dedicated their lives to doing a lot to move us in this direction and I am taken by the notion that we are awash with just vast volumes of fentanyl right now at a level that is unprecedented and that makes access to fentanyl extremely easy and immediate for many people and I think we need my sense is if we're going to turn this around it's going to require us changing the way we offer people and support people into getting into medically assisted treatment and I have for years of going with many of you having conversations about what keeps people from accessing treatment I continue to believe that we still have a challenge with the barriers that exist between people staying in treatment and that we have to be working on those barriers and I think I'm not completely expert to fully understand the implications of you know whether there are downsides of what's being advocated for here that we need to consider and grapple with but I welcome really as I said at the top I think this is a moment we need pretty dramatic paradigm shifting thinking if we're going to get back to if we're you know much lower levels of this kind of tragedy than what we've seen in recent years thanks mayor hi everyone my name is Jess Kirby I'm here tonight I was asked to be here tonight this is really important to me thinking about how it to reduce overdose deaths and thinking about how to reduce barriers to methadone treatment is one of the most important things that I think we need to be focusing on right now probably the most important thing we need to be focusing on and thinking about reducing overdose deaths and keeping people alive I am a person with lived experience methadone was a really important part of my journey in helping me get where I am today I'm also I work with people who are at risk of dying every day I'm the director of client services at Vermont sure criminal justice reform and we work with really high risk people who are experiencing overdoses who are at risk of overdose people who have passed away many of them and methadone is as this film you know is talking to us about the best tool that we have to keep people alive and not enough people have access to it that need it if I who have been in recovery for many years and have a vehicle and a place to live and a job and I have barriers you know to being a lot of barriers related to being in treatment then people who have no place to stay and who don't have a car and who don't have a phone have a lot of barriers and I work with a lot of those people there are people who try to go to the clinic for years and either just because they've been there before and they know what it entails or because it's just too hard to you know get yourself there with the way that our clinic model you know and I mean all clinic models are set up right now you know go years without treatment and those are people that are at risk of dying every day and many who do so I think if there's anything we can be putting our effort towards and working together and about and talking about and finding ways to push and advocate it's expanding access to methadone you know buprenorphine like the mayor has touched on is not working in the same way with the fentanyl crisis that we have going on right now the potency of the drugs has changed the culture of using drugs has changed and we have changed a lot we have done a lot and in Vermont and in Chittenden County we have done a lot to reduce barriers we have made buprenorphine so much more accessible like the mayor was talking about you know on-demand access to treatment same day you know harm reduction model like you can have your medication of course even if you're struggling and there's use involved and it didn't used to be that way we've virtual treatment you can have a phone conversation with your provider and be able to get access to buprenorphine but we have not it does not work that way on the methadone side and so that's a really big problem that's the medication that people are really needing more right now a lot of people are not able to take buprenorphine and have success with it even get on it let alone have continued success with it that people often do have with methadone so I just you know want to use my voice my experience as somebody who has you know been kept alive by you know utilizing this treatment and working with a lot of people who really need it and don't have it I want to use my voice to you know push for that and I also want to say that you know our clinic is I think pretty decent you know compared to a lot of clinics in our country you know Heidi and others at the clinic Dr. Brooklyn have it is very harm reduction focused and we have come a really long way and I'm very happy and proud of that and you know to be a small part of that and we have a client advisory board and we're working closely with leadership to like have our voices heard and you know talk about the things that are impacting you know treatment and so you know I do want to say that you know we have people at the table that care a lot about that there are a lot of federal things that are really difficult with methadone too that we need to work on and we need to push on so you know happy to be here thanks don't take my picture Kim my name is Helen Redman and I'm a licensed clinical social worker and I've worked in healthcare for well over a decade and I worked mainly with people who use drugs and one of my jobs was to try to get them into treatment and methadone treatment and that was my first eye-opener trying to help people do that and then them telling me what the clinic experience was like I'm also a journalist at filter and I write a lot about methadone that's sort of I'm on the methadone train so that is my specialty and I'm also a filmmaker and this is our second film about methadone our first film is called liquid handcuffs a documentary to free methadone and we went around the world to see how other countries deliver methadone and some were very similar and some were very different which will hopefully have time to talk about the reason I'm here is I want to free methadone I want to free the people who take methadone because with the methadone clinic system in existence you cannot be free you cannot be free because you're not in constant possession of your medication in fact it's just the opposite it's behind a plexiglass wall in a massive safe and a nurse doles out a certain amount to you either on a daily basis or if you can earn the privilege of take-homes you can get more so foundationally you're not a free person if you're not in possession of your medication and I think a lot of people in this room probably take medication I count myself among them and the thought of a clinic system controlling access and I get more and then the bottle recall and they're taken away you cannot be free when you have a clinic system the other thing about not being free is you're not free to move about as Samantha said you go to New York there's a bottle recall you lose your medication you want to go to another state for a wedding or a funeral you have to ask the clinic to get more take-homes they have to approve time away from the clinic you're not free when you have to ask a clinic system if you can leave the state or go to another town and get more take-homes and you know Zach Talbot who's featured in the film he's the president of the National Alliance for medication assisted recovery they have a grievance process and they have received a ton of grievances around this very issue of the bottle recall I was out of state I lost all my take-homes my business I have to travel I can't get back right so you're not free to move about the country your your movement is restricted that's wrong in my opinion in the last way you're not free and I've noticed this especially in my journalism and talking to a lot of people who take methadone from across the country they don't feel that they can speak out because they're afraid of retaliation you know the people in our film are brave they just said to hell with it I don't care if my clinic retaliates against me for criticizing them so the first amendment right to free speech people are afraid to speak out they won't go on the record with me for filter a lot of people webinars we want to have they're like the camera can't be turned on so you're not free and that's what we have to do and order to do that we have to end the clinic system and move to prescription parity which means you go and pick it up at the pharmacy all right thank you so much everyone so we want to hear from you comments questions anyone who wants to break the ice I won't call on anyone don't worry well yeah thank you yeah just picking up on your mention of international examples of doing things differently Helen and returning to what the mayor said about being unsure whether what's being advocated for has downsides it's worth noting isn't it that the the system that the biz was advocating for a pharmacy pickup does to a large degree exist in other countries like the UK and Australia for example and there you don't have methadone segregated from the rest of the healthcare system you don't have mandatory counseling etc and while those systems themselves could improve the result of those systems is not diversion and methadone involved overdoses so it is it is actually happening and working in practice in other places thank you well maybe we'll take some more don't have to come back on everything so let's see if some more folks thank you for coming here I just wonder because people are able to receive methadone prescriptions just not for opiate use disorder so I'm wondering if you can speak a little bit about you know depending on your diagnosis you have access to this thank you Heidi would you want to would you want to address that you can say no I can try I think so I think that it's a good point and I think at the clinic I think what you're talking about Heather is if somebody has pain issues right or other issues and it is different there is no doubt about that that if somebody is treated for pain they're gonna get a prescription from their provider and they don't necessarily have to come to the clinic and I think it speaks to the discrimination that we know historically has existed when it comes to people that are in treatment for substance use disorders I'll just say quickly that I wanted to touch on this when I was talking that you know yes we need to get closer I think to a model like you were talking about about being able to pick it up at a pharmacy like any other medication but it's also like we're not even close to that at all like there's never a point where you can get to that point like people that are in recovery for many many many years that whose lives are very stable they have not had substance use in sometimes decades can never get to the point where they can do that be prescribed by a doctor or you know pick it up at a pharmacy like you know even if some people don't agree that everyone should be doing that it's like you can never get to that point when it feels like trust you can never get to the point of earning trust that I lose a model I should be able to tell somebody you know what's going on or you know and that it should be okay and that's not anything on our our Chittenden Clinic specifically that's the model of methadone that you never get to that point and it's just 100% based on stigma and I just wanted to say that part that for people that don't really understand how this really works like it's like I think some people think like well you get there and you get stabilized and everything like that and you know but that's not how it is for people on methadone it's a forever thing the whole time that you're on methadone you're at the clinic on that level of supervision and it's really harmful and really deters people from wanting to be on it and stay on it who really need it you know many people get off methadone or don't get on methadone not because they don't want it and the medication part doesn't work but because they can't or won't understandably because they don't feel free do the rest of the stuff that comes with it so I just wanted to say that before so thanks Jess and I would add here in this county there's only one clinic so there is no choice that the patient has they have one place to go to receive methadone we have another comment or question some clarification on is your name Lisa I can barely see me yeah Jess Jess okay some clarification on what you were just discussing on what recovery looks like are you saying that methadone is a forever it's a it's a lifetime it's a lifestyle or does there ever come a point for those patients in opiate recovery where they don't have to go to the clinic and that is what their recovery looks like I don't exactly I I see where you're going but I'm not seeing the total endgame yeah um so I'm not saying that methadone is definitely a lifetime thing for people some people it is that's very individual like you know that depends on the person how long they stay on methadone in for a lot of people it is for a lifetime um I'm more saying that with a lot of treatment models for drug treatment you know they have this model that's like a step in a stage and you move towards you know more flexibility and that kind of thing but in a clinic model maybe you are on methadone and even if you're very stable there's a lot of reasons to stay on methadone you know like it's a medication you take a once a day and why not stay on a medication that you take once a day that's working for you and things are going well in your life and you're healthy and all these things but that you can never get to the point where you don't have to do everything that comes with the clinic you know so that's more the part that I'm speaking to that maybe things are really stable and you it would work much better for your life and you might be more comfortable being on methadone longer term if it's working for you if you didn't have to continue to go to a clinic and have that level of of supervision and restriction and lack of freedom but you you don't have an option to like eventually go to a lower level of care you know and be treated by a medical provider at a at your primary care which you could do for buprenorphine so am I answering your question let me let me add something here it's what Carlos said in the film you never really graduate from this as long as you need methadone to treat your addiction you cannot get out of the clinic system there's no way out and that's why people call it liquid handcuffs that's why people call it parole in perpetuity they use carceral terms because it's a carceral system so no you can never get out of the system as long as you're going to need to take methadone for addiction if you need methadone for pain you can pick it up at the pharmacy they've really put in a lot of restrictions now because they're cracking down on pain patients doctors are dumping pain patients the rate of suicide has gone up we have a crisis in this country around pain medication and the clinic system is not helping us to end the overdose crisis so you can never get out of the clinic system does that ants answer it yes yes yeah yeah some people sure I think that opioid use disordered why are you saying why would someone stay on you're saying why wouldn't people get off the medication is that kind of what you're saying is that if they're stable and why are they doing well and they're doing well does anyone at the clinic really believe that folks don't need the prescription for methadone at some point like that's recovery for them and they no longer have the urgency to take opiates even for pain or is it that everybody is under their thumb and somebody actually I don't remember the exact reference but somebody said that they they couldn't tell if the practitioners were trying to help them or harm them do you see what I'm saying like being under the thumb of the clinic can I take it like maybe some people don't realize that they could recover and they wouldn't have the urgency to use opiates so I think you're I think your question is speaks to what is treatment for opioid use disorder look like and for many people medication is a part of the treatment for opioid use disorder but that is not the only treatment for opioid use disorder and there are people that have an opioid use disorder that don't receive medication and so that conversation is with the provider of what does treatment look like for you and what makes the most sense for for the patient so at our clinic there's conversations with the medical provider because some people don't want to be on medication anymore and they decide not to be and then there's a protocol to like safely reduce the medication so that ultimately they stop taking it and they have other supports in place for their recovery and then they're no longer our patient because all of our patients take medication for opioid use disorder so they get treatment from other places in the community if they want it there is another part I feel like I have to say as a person that has done on methadone for a really long time is that people are on methadone that don't have an urge to use opioids like just because you're still on methadone doesn't mean that you're still having an urge to use opioids I'm not for many many many years but it also is you still are opioid dependent you know so it is rocking the bow and really messing with your life and causing you pain and suffering to come off of a medication that is really challenging to come off there are protocols but it is very very hard and so you're back again to the this is a treatment for a medical illness that I have it's a medication that I take once a day I am not craving opioids but because I will have these impacts if I come off of this I'm gonna stay on and take a medication that I take once a day and keep my life moving you know and that's you know what it is but just people that are often on and still very stable and not having a craving for opioids but yeah I think really the answer is that it looks different for everyone you know some people use this protocol and come off and and and that's totally fine and some people don't and they're and they're on you know and that's how they treat their opioids so we've got a bunch of questions but before we move forward I just want to say for the record Carlos the counselor calls people addicts but that is a very harmful way to describe people and we never want to call people addicts we can say people who use drugs people with substance use disorder I believe but this these terms are all changing but at the end of the day it's people centered first the person and then the thing but what Carlos said we're we don't endorse but that's your counselor for you so y'all got to see that so we had some questions over here maybe we'll take a group of questions and then I want to get you mayor you're coming back you're next and then everyone here is going to talk and yeah this is just a quick one what federally what's the least restrictive level you can be at at the clinic is it monthly take-homes yes okay but not every state allows that just a question about fentanyl does does methadone work equally well for people who are using fentanyl or is fentanyl in some way a barrier to the state of mind that would allow someone to approach treatment let's put a pin in that one and here's some more questions and what we're gonna do a bulk answering thank you guys for coming this has been awesome my partner and I are both prescribers and but one of us had to put the baby to bed how could we film that can we purchase this film can we stream it I would love that information before we all go tonight I have a quick question I often hear suboxone and bupenefren and methadone I personally don't know what the difference is and I think you made some reference to the efficacy of those different treatments so could you say more about that these are great questions we're gonna break it all down I can get the folks over here yeah and then we'll come thank you so much awesome film thank you all for being here question for the filmmakers how did you get awesome stories how did you get people to talk that I imagine develops all the time and trust and I thank you for capturing those stories because we wouldn't hear them otherwise anyone else over here okay yeah thanks so much for being here and putting on this this movie and I really appreciated the shout out to other models in other countries and then also following with that there isn't actually there's data around that not contributing to diversion right so I think something that we have seen in the state that we are so terrified of is diversion and this comes you know talking about methadone but also buprenorphine suboxone so why and maybe I'm preaching to the choir here but like why are we so afraid of diversion I would much rather have methadone and buprenorphine out there than people accessing fentanyl there's no argument in my opinion that can be made but I would love to be I mean I don't want to be convinced otherwise but I would love to hear why two more and then okay well do you you over there and then we're gonna go back yeah I just wanted to get a better sense for someone trying to access methadone at one of the clinics in Vermont just what are the the the nature of the requirements you know to create these barriers in terms of the frequency of testing the frequency of counseling the types of things that someone has to go through on a daily weekly basis as part of the red tape or barriers in order to access at a clinic so I heard somebody talked to them refer themselves as an owner of a clinic in your film and that kind of surprised me that people own these clinics and so I'm curious to know is that a predominant method or you know a ownership of these clinics or my sense was that they were more publicly nonprofit supported etc and that leads me to my my real question is what are the barriers and hurdles to changing the system you present a tremendous argument for change in this country and listening to an owner makes me curious are there vested interests that are standing in the way of evolution and change I can tell you growing up in the 70s I was very familiar with the methadone clinic in the town I grew up in and it doesn't seem like it's a lot different than than the things you presented here today so I'd be curious to learn more if I could thank you similar to the last question I'm just curious what is the path forward to create options for methadone to be available through pharmacies for people beautiful thank you do you want me to review any themes that we heard or you guys got it you're ready mayor should we go let's try in some ways I feel like maybe the least qualified person up here although I've been listening these conversations for many years about the differences between the different medications and why they're really significant right now I could take a stab at but I'm wondering do you think Heidi could you I think kind of to establish kind of baseline I want to come back to the diversion I do want to weigh in on diversion but before that maybe speaking about why fentanyl has so undercut undercut the effectiveness of buprenorphine whereas we don't feel that way about methadone so I think to your question so fentanyl is fifty to a hundred times more potent than other opioids such as heroin or even methadone so we have two main medications buprenorphine and methadone they function they're both opioids but they function a little bit differently at the opioid receptor in the brain so methadone is occupies the entire part of the receptor it's a full agonist buprenorphine only occupies part of the receptor so that means that other opioids can kick it out of the receptor if that makes sense so what you're talking about mayor is the reason why there's been such a decrease in recent years for the interest in buprenorphine is because if you are still using opioids when you take those opioids and then you take buprenorphine the other opioids will kick the buprenorphine out of the receptor and you will experience withdrawal symptoms so I think a lot of things kind of happened in concert so with the rise in fentanyl with the rise I think in our communities of like more destabilization and COVID more and more people continue to take opioids as they enter treatment and so because of that the interest and the use of methadone increased because that withdrawal that happens with buprenorphine if you continue to use doesn't occur with methadone In suboxone is the trade name for buprenorphine? Correct well since we're focusing on that it's a little more than that too right and that suboxone is buprenorphine in in a combination form with naloxone and there's a whole nother debate that maybe is sort of beyond maybe we should avoid getting into today but there's there's an interesting debate there too whether many people do not have a positive experience with that combined drug and I think there's an argument for why we should be moving away from suboxone which has been I think it's fair to say the state's preferred form of buprenorphine to to kind of separate and just have buprenorphine available so to try to keep sort of moving along the questions that were asked here the I think at a basic level the answer to the question in the back about what would be necessary to achieve this kind of change to go to go to this pharmacy model as the film advocates would require federal action is my understanding that that basically the the rules that regulate the hubs are that regulate the methadone clinics which we call hubs here are our federal rules and you would need congressional action or at least presidential action to to make a change there I do think it's important to note that there is support for kind of a step along that trajectory something that Heidi and I have been working on and that the legislature just passed a significant appropriation for using some of the new settlement money that is coming into the system that is basically putting money into the system statewide two and a half million dollars two million dollars explicitly to try to ease acts to respond to this conversation to expand access to methadone I don't think we've reached the conclusion exactly what that's gonna look like here in Chittenden County but one of it could be and maybe I should let you speak to what you are thinking the best way to make those investments are currently and so there's active work going on there that that we think we can do without federal action and so we'll have Heidi speak to that a moment I turn over for that let me just say I feel like what I said before maybe came out a little wish you're washing it then I attended and that I really am largely in agreement with the sentiment noted that too much of our policy with our opioid medications is driven by fear of diversion it is it is continues to be you know from my for my take on on the data you know I'm with you we are a wash and ethanol and we we need to step away from having so much of our state policy driven by that that fear of diversion I think that we've had a lot of debate about that with respect to to buprenorphine and I feel really quite confident that we we need to make substantial changes to our policy there this discussion of diversion you know methanone has been in this is really one of the first discussions I've been in where we've been talking about such a dramatic change to the way methadone is dispensed and so I am interested and I know I know there are people in the room that I think have real concerns about what opening up the system in this way might cost so I do think it's a little bit of a new discussion be talking about really just abolishing the clinics entirely so I would like to hear more about that but I got my sentiment is strongly in the camp that there are very few kind of opioid naive people who are being in do who are starting down the road of addiction based on methadone or buprenorphine consumption and that really is fun a million the fear and I think that that fear is has has way way too much weight and in our policy decisions we got to move away from it so with that maybe could you speak a little bit about what you think we should be doing on the on the on the methadone side Heidi and I might need your help more late others I've all these are all really great questions maybe just sort of organized so I think maybe I'll start with your question in the back so in the state of Vermont we have eight hubs or methadone clinics throughout the state in our county it's run by Howard Center which is a community mental health organization in other counties the clinic is run by a private organization so that question about there there are private entities that own clinics they're here in our county there are private organizations for profit organizations that provide buprenorphine so it just depends there's a lot of variability I think one of the silver linings from COVID was the leniency that occurred because of the federal mandates and the emergency declaration like the folks in them the movie talked about people who weren't eligible for take-homes in the past to be able to have medication once a week every other week a month were suddenly eligible and I think that provided this really nice insight to like almost experiment that the diversion that people were so afraid of didn't occur that hundreds of thousands of children weren't suddenly dying because they got a hold of methadone or buprenorphine so I always take that is a silver lining I think that's what we needed because SAMHSA are the federal entity the substance abuse and mental health organization for our country is looking at the data and they are the ones that have the power to change these regulations we are federally regulated so I agree that these medications are what we need to save lives but as a clinic we still need to have diversion control policies and that is that's law and so Dr. Brooklyn and I and the rest of the leadership staff since COVID the May 11th just happened and that's when the emergency declaration ended SAMHSA very surprisingly removed all the restrictions that we thought we were going to go back to and has put a lot of the power and authority into the local clinics and to the medical providers being able to assess risk for patients and so that's a really good thing for us that means that many many more people are getting medication weekly every other week monthly I think to the mayor's point to this so pure the opioid abatement money part of where some of that money might be designated as we might open what called medication units so for instance in our county the Howard Center and the Chittenden Clinic would still ultimately operate these facilities but they would essentially exist as pharmacies so that people wouldn't have to come to the clinic every time to get their medication they could go to another location that I think is important because we have a lot of folks that travel a long way to get to Burlington we're a really big county and transportation is a really big barrier to care thank you so much for all that you just said and kind of transitioning us into the end of our program so we had a really great conversation that kind of started with understanding okay what exactly is this medication what does it look like in our locale and there seem to be some sentiment that this has to go how do we change it what's the path forward so I want to hear from Helen and Jess to give us some final remarks but before that if you want to watch this film we have a website you can see it online pick up a little postcard at the table over there it has all the info and obviously this was the beginning of a conversation it seems like it could go go on a lot longer I wish we had more time we have just under 10 minutes so maybe we'll hear from Jess or Helen y'all can jump in every now and then but you guys bring us home yeah okay who's first you go well good because I think you probably have important stuff about what we need to do and can do about this you know I'll just say you know I agree with everything everyone has said you know I really hope that we can get to a place where we can help people access medication better I think I love you know the idea and an advocate is strongly for you know us to have like satellite locations and other places for people access methods I really hope that people in our community are gonna be able to access method on that way and that that helps more people get it I really hope that we can expand ours that's one of the main things with clinics that is a huge barrier to people all across the country is very strict hours that are in early morning and that's really hard for a lot of people so I think if we can move towards that I know for sure you know I work with a lot of people who miss doses you know daily weekly because they know they're gonna be late and and they won't be able to be dosed so I think that that's another huge way that we could be helping people do that and I just you know as a person that's in a position to tell people about this medication is hope people you know can understand that you know it takes a lot to be in treatment it's a huge step to take for people it saves a lot of lives we still have a lot of stigma it's hard to talk about the stuff for people like they were saying for me but it is way you know understanding more about it and being a part of helping people have medication they need is directly saving lives and you know stigma kills people in that way and so I hope that people can try to you know open their minds this idea learn more about it understand that you know this is a medication that sometimes people need for a lifetime and sometimes they don't and that's totally individual but we this is the biggest public health emergency we have and we really need to do better with helping people access this comfortably and easily and be supported by our community I think that we have to stop talking about diversion and overdose when we talk about methadone because those are DEA talking points the Drug Enforcement Administration is a police organization that's carrying out a worldwide war on drugs and that's a war on people and this is what the DEA has been saying for 40 or 50 years diversion overdose diversion overdose and for me we didn't even need a pandemic to know that that is not what is going on people who take methadone they want to take methadone it makes their lives possible and better there's lots of other drugs people don't want to take but methadone is not one of them so I will I don't even want to talk about diversion and overdose and especially because the DEA is actually responsible for the fentanyl apocalypse that we're living through right now people are dying because they're overdosing on fentanyl not methadone so we have to stop we have to stop those DEA talking points and unfortunately the DEA is centrally involved in regulating methadone clinics they regulate them they terrorize doctors people who doctors who medical directors of clinics have told me they're afraid of the DEA you know the DEA creates of an atmosphere of fear and control and then that they kick down onto the patients so we have to get the DEA out of drug treatment what is a police agency doing it involved in in methadone or buprenorphine or anything else they're they're carrying out the war on drugs so we have to get them out the other thing I want to say is you know people should know in other countries they do things differently and it actually works so in Vancouver it's a small pilot program but they're doing fentanyl maintenance give people the fentanyl if that's what they need to stay safe and not overdose and die in lots of countries in Europe there's heroin prescription you go and get your heroin right why can't we do that here the DEA is one of the major reasons now the next point I'm gonna make is very depressing but it's true the DEA has always had the power to change methadone regulations so they could have said 40 years ago any any doctor any healthcare provider can provide can prescribe methadone they have the power to do that so recently researchers at Washington State University did a study funded by Pew Trust and they looked at all the regs and so they found the DEA and SAMHSA they've had the power for decades to change these onerous regulations and they've chosen not to but they can so the DEA can change the regulation to say any healthcare provider can prescribe methadone this is what we know now and in the pandemic helped uncover a lot of this it's just regulatory insanity it's like it's the most regulated drug in the pharmacopoeia why because of discrimination against people who use opioids and so it's gonna be a fight to move to prescription parody there's no question about it because the DEA is involved and there are for-profit methadone clinics like Baymark who make a lot of profit and you know the way they make the profit is people coming every day so there's a financial disincentive to say oh we'll see you once a month well that's not gonna make them any money and this is where profit comes in and I'm not okay with that when a hundred thousand people died last year and God knows how many gonna die this year that is not okay but we already know these for-profit methadone chains they're gonna fight any kind of progressive change so we have to wage a fight against them and we're working to put together a national coalition who wants prescription parody you know there's 60,000 plus pharmacies in the United States guess how many methadone clinics there are about 1900 and to build a methadone clinic and to go through the DEA you know they have to license it and all that forget about it that's not gonna happen and so for me big problems need big solutions but in a way this isn't a heavy lift we have 60,000 pharmacies methadone is already there for folks who have pain so that's what we have to do we have to fight we have to fight to free methadone to free people on methadone. Alright thank you everyone thank you so much for coming pick up a postcard over there hope to see you around