In January 2014, Vermont Gov. Peter Shumlin devoted his entire State of the State address to the opiate drug scourge ravaging his state. While Vermont is not the only state to experience the growing addiction problem, it arguably has been the most aggressive in tackling one aspect of it — offering treatment to residents who agree to participate.
Within six months of his speech, Shumlin, a Democrat, signed bills and executive orders that included $6.7 million for a “hub and spoke” treatment program of central facilities and small treatment outposts, a medication-assisted addiction therapy program, tougher sentences for drug traffickers and new regulations for prescribing and monitoring prescription drugs. One of biggest changes is giving people who are picked up by police the choice of treatment instead of criminal prosecution.
In January 2015, the state reported that medically assisted drug treatment had increased by 40 percent. Of those who completed treatment plans, 75 percent showed improved functioning. But the report also said more treatment opportunities are needed, citing the difficulty in hiring and retaining clinicians and other health care providers as a major obstacle.
A year and a half after his groundbreaking speech, Stateline checked in with Shumlin to talk about his progress and what remains to be done.
Why did you take on this issue and devote an entire speech to it?
When I became governor, I kept having moms grab my jacket, or dads, or sons or daughters, saying addiction is going on in our families. So I went into the prisons, talked to addicts, recovery folks, I talked to law enforcement, to the judiciary, everybody I could talk to. And what I learned was that we were doing almost everything wrong.
We seized the opportunity to change the system to one that deals with this as a disease, like cancer or kidney disease, or any other health challenge. We did three things.
Denial is the biggest challenge to recovery. Opiate addicts will lie. They will cheat. They will deceive. They will desert their children. They will do anything to get this drug. The window of opportunity to move folks from denial to recovery is when they are most in crisis — when the blue lights are flashing and the handcuffs are on. But we used to have a system that took months. And by the time you got to the judge, you are back abusing, back dealing and back denying. So, we changed the system. We said if you go to treatment, if you move to recovery, you will never see a judge or have a criminal record. And we do that while the blue lights are flashing. This happens immediately. We move non-violent offenders into recovery.
The second thing I found is there were folks who were ready to go into treatment. But there was a waiting list. So we’ve been building treatment centers like mad to treat the folks who are ready and able to go into treatment.
And finally, we distributed heroin overdose rescue kits to everyone we could find — State Police, firefighters, law enforcement at every level, EMS folks. And we’re saving hundreds of lives.
Vermont has seen a drop in young adult drug and alcohol abuse. Does that mean the supply of drugs is lessening?
I believe that use numbers go up and down. But with all of our extraordinary efforts to treat opiate addiction as a disease, change attitudes about the disease, get rid of waiting lines for treatment and stop letting people die of overdoses, I’m not sure that any of us have truly choked off the supply of addicts signing up for this disease.
Why do we have so many people addicted to opiates and heroin? It is directly related to the day the U.S. Food and Drug Administration (FDA) approved OxyContin and we started passing it out like candy. Until we have a real conversation about painkillers in America, and how we deal with pain, I believe we are going to see more people signing up for addiction.
Has the federal government been a good partner in your state’s fight?
I think that the federal government and the FDA are partners with the pharmaceutical industry in creating the opiate crisis. Let’s just look at history, because that’s quite a charge. We all thought we learned about abuse of OxyContin, and there was huge pressure on industry to make it tamper-resistant. If the drug is tamper-resistant, it turns to gel when you crush it. When it isn’t, you can shoot it, you can snort it, and that leads to pure heroin.
Just a year and a half ago, the FDA advisory board recommended that the next drug, what I call OxyContin on steroids, Zohydro, not be approved. The FDA not only ignored them and approved it, they didn’t make it tamper-resistant so you can snort it and you can shoot it. So, I’m unconvinced that the FDA is partnering with us to try and solve this epidemic.
[In response, the FDA said it concluded the benefits of Zohydro ER outweigh its risks when used according to the instructions on its labeling. It said available data supports that Zohydro ER is safe and effective for treating pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatments are inadequate.]
How do you stay a step ahead of the opiate drug addiction epidemic?
You can’t. We’re losing the battle in every single state right now.
Here’s how the economics of it work: Americans have access to FDA-approved opiates at levels that are unprecedented. Those pills become very expensive on the street because we make them tamper-resistant. In Vermont, they are $80 a pill. So Americans turn to the much cheaper and more pure form of opiates, which is heroin. To buy a bag of very pure heroin from South America, it costs $5. That same bag can be sold in a small, rural community in Vermont for $20 to $30. There is no business model like that in America that gets you such an extraordinary profit so quickly.
There’s huge pressure on governors, law enforcement and health care providers who are fighting a tide of dealers who do almost anything to supply their demand and enrich themselves. That’s our challenge. We have totally reinvented how we deal with this disease once they have it. But none of us has figured out how to choke off the disease, and the economics alone are daunting.
Opponents of your effort say treatment programs hamper law enforcement efforts. Is that true?
Law enforcement is a critical partner in solving this problem. The mistake politicians have made in the past is by saying to law enforcement, ‘Go and fix it, it’s your problem.’ What we have learned in Vermont is that it is a partnership between law enforcement, the judiciary, health care, recovery and treatment folks. It takes a community to help people recover from addiction.
Did you have to raise taxes to do this?
I had to raise some taxes. I resisted raising income tax rates, sale tax rates, and rooms and meal tax rates because they are too high in Vermont. [The tax hikes came primarily from limiting itemized income tax deductions such as mortgage interest, which is capped at 2.5 times the standard deduction.]
What surprised you about the program’s results?
I think the biggest surprise is the more we change attitudes about the disease, the more we have people coming forward confessing that they have it. The secrecy, shame and grief that accompany opiate addiction stand in the way of recovery. I underestimated that when we changed the debate. One of my state cops stopped a car — it was clear that the woman in back was either on OxyContin or having opiate-related symptoms. The officer said, ‘We’ve got to get you into a system here to deal with addiction.’ She said, ‘Wait a minute, don’t take me to jail, Governor Shumlin has a plan that I can deal with my disease as the health care disease that it is, and that’s what I’m ready to do.’ We have succeeded in removing some of the shame and that has resulted in more folks signing up for recovery treatment.
There is a move to legalize marijuana use for adults in Vermont. Can you legalize marijuana and treat opiate addiction — or is that working at cross purposes?
I don’t think it’s prudent for a small state like Vermont to spend precious law enforcement dollars chasing down small amounts of marijuana. I would ask a simple question: If marijuana is a gateway drug to heroin, what are the FDA-approved opiates that we hand out like candy?
Not everyone, including some other governors, agree with your treatment approach. What do you say to them?
You need leaders who are willing to help change attitudes. That means governors speaking up and saying these are our sons, these are our daughters, these are our moms, these are our dads, these are our neighbors — and they are suffering from a terrible disease, one of the hardest to recover from. And we need to treat it as such. A backward approach will only promote more misery and more addiction, and more loss of life.