Jay Diaz and Ed Baker
Vermont is experiencing a full-blown overdose crisis. A record 210 Vermonters died of preventable-related overdoses in 2021, marking 33.7 overdose deaths per 100,000 people. That’s a 500 percent increase since 2010.
For context, Portugal, which has committed to handling addiction with a public health approach since the early 2000s, saw less than 1 overdose death per 100,000 people from 2008–18.
The extent of this crisis is shocking, not least because Vermont has a relatively robust addiction treatment infrastructure. But accessible treatment is insufficient if we don’t keep our friends and neighbors alive long enough to access treatment when they are ready. Clearly, what we’re doing isn’t working.
Sadly, state leaders are still ignoring commonsense strategies that would save lives. One such necessary and proven step would be the opening of overdose prevention sites, medicalized facilities that allow people to use opioids in a safe, non-judgmental space where they can receive vital medical services if necessary.
Opioid users at an overdose prevention site have access to sterilized syringes, fentanyl test strips, overdose reversal medications and other life-saving tools. They also have an opportunity to connect to long-term treatment services that can be essential to recovery.
These facilities not only save lives — they also make our communities healthier and safer. They help reduce the transmission of HIV, hepatitis C and other blood-borne pathogens, while reducing the incidence of endocarditis, a deadly heart infection resulting from unclean syringes.
In addition, overdose prevention sites can lower costs in our public health and safety systems. Because they provide on-site medical care for people experiencing overdose, local emergency rooms, law enforcement, EMTs, fire departments and ambulances can focus attention elsewhere. Providing safe places to use also results in less public drug use and fewer discarded syringes in public spaces.
A review of the scientific literature shows that overdose prevention sites save lives, contribute to lower rates of crime and drug use, and help to alleviate the other myriad harms that drug criminalization has done to our neighbors and loved ones.
There are currently more than 120 overdose prevention sites around the globe. They exist throughout Canada, Australia and Europe. Every country that has implemented these sites has seen substantial reductions in overdose deaths. New York City just opened the first official sites in the United States, and Rhode Island recently became the first state to statutorily authorize overdose prevention sites. To this day, there has never been an onsite overdose fatality in an overdose prevention site.
The Senate Health and Welfare Committee is considering a bill, H. 728, that would create a working group on overdose prevention sites, but the working group’s report wouldn’t be due until late 2023. In the meantime, Vermonters will continue to die preventable deaths. We need to act with far more urgency.
Of course, overdose prevention sites are only one piece of the harm reduction puzzle. The overdose crisis requires a multi-pronged approach, and that includes making naloxone and fentanyl test strips more widely and easily accessible; expanding access to sterile safe injection devices and disposal boxes; improving good Samaritan protections for seeking emergency health care for overdoses; and providing mobile treatment, mobile overdose prevention, and greater access to transportation for people seeking treatment. Every one of these proposals should be on the table right now.
Without these kinds of public health strategies and science-based innovations that are succeeding in countries around the globe, we can expect more of the same grim outcomes. For many Vermonters struggling with substance use disorder and the families who love them, time is running out.
Vermont has a choice to make. Will we continue to allow Vermonters to die of preventable drug overdoses — wasting tens of millions of dollars from opioid settlement funds on failed and incomplete strategies? Or will we implement bolder and more effective policies to save lives?
Before the Legislature adjourns in May, Vermonters should call on Governor Scott and legislators to see this crisis for what it is and take decisive action to respond. That includes the immediate authorization of overdose prevention sites in Vermont.
Ed Baker, a retired licensed alcohol/drug counselor of 30 years, lives in Burlington and has been in recovery from addiction for more than 37 years. Jay Diaz is general counsel for the ACLU of Vermont and lives in Williston.