 Hi everyone, welcome to the addiction recovery channel. I'm Ed Baker. I'm your host I'm very happy today to have as our guest Representative Taylor Small. Thank you so much for having me on. Thank you. Thank you so much for being here I know that your your day is busy to say the least. You are right about that one Taylor is in her second term as a member of the Vermont House of Representatives and really representing Chittenden County and very well versed in this public health Emergency catastrophic emergency that we face in Vermont today and that will be the topic of our discussion Taylor just in your own words could you I mean describe what you feel about what's going on what you see Going on you've been watching this for a number of years now. What what do you make of it? What do we make of this? I mean simply put out its heartbreaking It's heartbreaking to know that when these conversations first started we were talking about an opioid crisis We were talking about recognizing that pharmaceutical companies were to blame for a lot of addiction that we were seeing in our communities And we were starting to talk about getting folks into treatment and what recovery would look like and now Because we haven't been as aggressive as the drugs that are coming out onto the streets We are now having to talk about an overdose death crisis We have to talk about addressing overdoses instead of just addressing substance use disorder at its core And that is is what's most devastating. I think back to my first year in office when we were working on this We had the very poignant message said to us that a hundred and eighty people had died of overdoses in that year and To think as elected representatives in the state of Vermont. There are a hundred and eighty of us that occupy those seats There was a moment taken where representative Dane Whitman presented this bill and said For every seat that we occupy that is one person that has died in the state And I said I don't want to see that again And I came back the next year and Vermont once again set a record with over 200 deaths What year was that first year? The first year so I came in in 2021 So I believe 2022 is when we first tried to pass H728 focused on overdose prevention and that was simply to study overdose prevention sites and that was vetoed and then It really showed that that work was needed when we set another record the next year and again this coming year And we're about to set another record of overdose deaths, and that's not what I want to see for Vermont I think we're really backtracking in what is addressing this issue and really focusing on the fact that we have a hub-and-spoke model Which yes is helpful in getting folks into treatment, but it's not the panacea of what the current What is currently happening on the streets? You know, I mean you describe it so poignantly that in the year that you Began your service in the Vermont House of Representatives There was exactly the number of overdose deaths as there are seats in the house. That's mind-boggling it is since then The Centers for Disease Control has a little bit of a different estimate of death in Vermont their estimate for Vermont in 2022 Was 264 beloved Vermonters taken from us 264 do you Do you have figures at hand for Chinden County for 2022 or going into 2023? I don't know those figures Right off hand, but I know that the rate of overdose in Chinden County is escalating to the point that Unlikely characters are coming out of the works to say hey what we are doing is not working I think in particular what is really highlighted for me is our emergency medical services As well as our fire department who is saying we are spending more of our time Responding to and addressing overdoses in communities than we are to doing our regular jobs we're being held up by addressing substance use disorder in our communities and Because of us not taking action on the state level We're putting it back on communities and local fire departments and EMS agencies to try to figure out new solutions So in Burlington, we saw that the fire department was seeing this increase in calls And so they started having just a rapid response for overdoses alone Yeah, I think that is so commendable of what we are seeing in Burlington And yet that is not what I want to be seeing I want us to be addressing this as a state issue and thinking more broadly than a case-by-case or municipality idea I understand and I do have the figure for 2022 because because I've spoken with Sarah George lately it was 54 54 people in Chinden County Mm-hmm Just in our county and the majority of them are concentrated in downtown Burlington and just to highlight your point about the police department and the fire department Chief LaChance recently saw him speak and he quoted that This year 2023 the number of overdose responses is going to be two point five times higher than the national average than the City average for the past three years so two hundred and fifty percent more These these people are back on their heels and like you say Their response is commendable To have fire department personnel working overtime not taking out fire engines, but in a van Reversing overdoses. I I couldn't agree with you more, but it it shouldn't be that way right, we should have services that are more medically based more science-based more available to us that we don't have and It's the same thing when you look at we look at the citizenship of Vermont Every place I go people are are in a deep grief about what's happening here They have a tremendous motivation to do something about what's happening here, but there's sort of almost being stopped by The status quo and I'd like you to speak a little bit about that that kind of Momentum we have To do what's best, but the fact that we're not being allowed to Yeah, I think in recognition that this has been at minimum Seven-year conversation in Vermont about hosting an overdose prevention center and really thinking about evidence-based Just interventions that Might not be popular at the time, but are actually lifesaving and so when we think of how the trajectory of overdose prevention centers especially from the state legislative perspective In 2018 was the first time that this really came up as a potential option and where we studied it and at that time We looked at biased research that came together to say that there would be no buy-in here in Vermont Within our communities to put overdose prevention centers forward that there was no researcher data into the rural efficacy of these Centers and that it just wasn't needed that's simply what the report said I remember that and we came back and We decided no we want to really focus on folks who are doing this research We want to look at the feasibility right here in Vermont based on data that we can look right above us up in Canada where there are rural interventions there are mobile interventions and When we tried to pass that legislation it was vetoed in the last biennium and the governor and his veto letter very vehemently opposed safe injection sites and that is not the language that we're using in any of our legislation because we Recognize that not only does using the language of safe injection sites or safe injection facilities Increase this idea of stigma as you and I have talked many times it creates this image of what is happening within those facilities. It's simply For myself it conjures this image of someone who is just going in to use drugs and then they're going to leave and yet When we talk about overdose prevention centers, they are so much more than that and so as we're having these conversations We're talking about yes It is a place for folks to use pre-obtained drugs in a safer manner under the supervision of medical or trained professionals and It also is not just about injection because when we're talking about safer consumption We're not saying that it is safe to consume drugs if it was safe to consume drugs We wouldn't be putting overdose prevention centers in place But what we are saying is that there are other ways that folks can consume drugs that would reduce their likelihood of overdose and reduce Their likelihood of death and that's what these facilities are. They're educational their prevention And when we look at the data as to where other overdose prevention centers are We know that about 80% of folks within a two-year time period are going to get connected to treatment or additional services where they are on that path way to recovery and so To be constantly going head-to-head with an administration that is not looking at the science Even though they are saying that they are looking for data and they are looking at the research But they are neglecting the science that is right here in the United States Neglecting the research of other health departments such as Rhode Island or most recently Massachusetts saying that these are not only evidence-based, but necessary interventions It makes it really hard for the average for mantra to truly understand what an overdose prevention center is and why we would move forward with such an Intervention and instead what we hear is more stigma about who is using drugs where they are using drugs currently and What those activities look like in our communities, especially in the realm of public safety, you know, I couldn't I couldn't Agree with you more and it's such a pleasure to To talk to someone and have someone on the show Who has actually done their homework who has reviewed the literature listened to experts more than once and And and integrated the information in a way You know that that's Not biased to open yourself and be changed by science be changed by your experience I was abstinence based abstinence centric for a very very long time What happened to me in my career was I began to see people dying when we tried to offer them services Based on Accomplishments, they couldn't meet like don't take drugs and we'll help you yeah the people that are dying on our streets most frequently are the people that are most difficult to engage and They are taking drugs in overdose prevention center just to Highlight what you're saying is a place that says come to us while you're taking drugs We care about you so much that we're not going to place unrealistic demands on you and we're going to help you to stay alive because Tragically the drugs you are taking are are lethal You know Kalen C. I know Kalen C for the viewers Kalen C is the Special project director at on point New York City the first overdose prevention center in America and and what she says is the actual observing of The self-administration of drugs at the overdose prevention center is that's the least time they spend With a participant They talk to them. They get to know them. They engage them. They help them with their needs They refer them for health supporting services 85 90% of the time spent with these people is really in a harm reduction and Health support so to call a Center like that an Injection facility is clearly the intentional use of Stigmatized language to miseducate the public would you agree on that? I would absolutely agree and I think To your point and really recognizing what is happening on our streets and when we look at our drug supply We need new interventions when there is new data being presented And so just it is staggering to think about and I didn't think Vermont would get to this point but when we were receiving testimony from the Overdose prevention centers up in Canada and the researchers doing this work. They talked about how the drug supply up there moved from being Pharmaceutical prescription opioids to heroin to just fentanyl where they're not even seeing heroin come Across their toxicology reports Yeah, and I think what was most staggering in the most in the recent Comstant meeting for Burlington was to see that The majority the vast majority of overdoses are fentanyl base and only about three of them if I'm remembering correctly We're heroin. Yeah, and then we're mixing these drugs of Extremely fatal fentanyl with xylazine So we have these overdose reversal agents in community And yet that is not going to combat the xylazine that is also in the drug supply And I think that's just one variation of the mixtures that we're seeing that is increasing this likelihood of overdose death And so if we were talking about the same Issue if we were talking about the same problem of the pharmaceutical industry and folks being overprescribed or being addicted to prescription opiates then the the Hub and spoke model actually works it works in that very limited capacity And now we have to be looking at the hub and spoke model as just one Tool in our tool belt. I think there are also many improvements I need to be made to our hub and spoke model because of the impact of fentanyl We know that buprenorphine is not necessarily the panacea in getting folks connected to medication as a treatment And yet methadone is so much more difficult for folks to access on a regular and consistent basis gosh one story that always sticks with me is When we were had the ability to go Vin and Visit Jenna's promise up in Johnson, Vermont And one of their employees there was saying how he has successfully been on methadone for the last year and When we asked about it like how is this working? How is it helping with you in getting into employment? He said well the most challenging thing for me is to get to work on time Because right now while I'm here in Johnson I have to drive an hour an hour and a half to Newport, Vermont to get methadone Before my shift starts and I have to make sure that it is within the hours that the hub is even open And so there are just so many barriers for folks to consistently maintain on treatment That it feels like we are setting folks up for failure if we are not actually looking at how we bring services back To the people who need it most I I hear you I hear you loud and clear and I know that Our wonderful mayor Weinberger is pressing now for low barrier access to methadone for exactly those reasons it works with people who have fentanyl addiction and I want to highlight the fact that There's money Been allocated by the legislature That was allocated from the opioid abatement settlement committee For exactly that But the money is lying there because of red tape and it may lie there for 16 months Because of red tape So I want to I want to just for the viewing audience. I want to say that We will be convening a panel at the end of the show with with Taylor Tanya Vahovsky representative Taylor Senator Vahovsky Mayor Weinberger and they're all they're all Weinberger and our state's attorney Sarah George And we're going to be looking at this but to just summarize for for today Tell her I think what correct me if I'm wrong, but I think there are basically three points one that there is an ever accelerating velocity of accidental overdose death in Vermont and this will continue and We're not doing everything we can about it very true to that the governor and And and and forces that align with the governor are actively Discouraging us from implementing overdose prevention centers, which are a science-based medically necessary service that will help this the same population that's dying Three that that there is money available Specifically opioid Settlement money and also we have tremendous reserves in the state coffers $264 million I read somewhere. I do not have that information Yeah, I read that I read that today somewhere. There's there's a reserve that that money That's available is not being released in an urgent timely fashion. Would you agree with those three points? Absolutely, and I think You know to the third point. I think It is Unintentional that the money is being held up. I will give them that but the unintentionality is due to Maintaining a lean government and that is something anyone a lean government and Governor Scott has been very adamant about this of not having a robust State government and instead what this means is that when we don't have positions filled within state government it takes longer and longer for us to have the solutions come to fruition so it is one thing for us to pass legislation and for us to Allocate funding from our state budget to various nonprofits or to the folks who are actually going to be doing this work in our communities It is another to have Follow-through and implementation from the executive branch on what has been done within the legislature And so my hope is that we can move in a direction where our state agencies are fully Brought up to staffing where we're not running into these workforce issues and where we're having grants that are going out in a Timely manner so that we can be responsive to these issues because not only are we not seeing money being addressed for methadone But I think another important component is drug checking That folks do not even know the drugs that they are using because it is an unregulated supply and With that unregulated supply We need to be able to know if we're not going to have overdose prevention centers How we can address or at least let folks Reduce the harm or use more safely the substances that are already going to be consuming Thank you. Thank you so so so well said and I'm so grateful to have you as a leader in our in our beloved state well, I'm grateful to be doing it and Truly honored to be having this conversation with you because I think we don't talk about it enough I think we can address that there is an issue and that it is heartbreaking and devastating for all of us in our Communities, but it is so often that we don't get to the point of what are the actual solutions that we can put in place Yeah, so thank you and we will continue with solutions at the end of the program