America is in the throes of an addiction crisis. Last year, more than 70,000 Americans died of drug overdoses. Vermont saw the death of more than 100 people from opioid overdoses in 2017.
Beyond the astonishing number of overdose deaths in recent years, even more people suffer the agony of addiction. The harm spreads to family members, friends, neighbors and communities. The negative social and economic consequences wrought by our national drug epidemic are legion.
Our campaign to end this crisis must serve the two related goals of supply and demand reduction. We reduce the supply of drugs in our communities by aggressively prosecuting dealers who seek to profit in the addiction business. This deters drug traffickers from coming to Vermont and takes money out of their pockets, reducing the grave harm they inflict upon our state. Demand reduction involves educating youth about the perils of addiction to prevent first-time drug use.
We also reduce demand by providing addicted individuals with treatment. Specifically, we seek to increase access to evidence-based treatment, including medically assisted treatment programs. These programs rely, in part, on the prescription by federally qualified medical providers of buprenorphine and methadone — opioids that are approved by the FDA to help addicts quit using stronger opioids, such as heroin and fentanyl.
Participants in Vermont’s successful “Hub and Spokes” program often begin by receiving methadone in the “hub,” then transition to the care of a licensed practitioner, the “spoke,” where they can receive buprenorphine prescriptions, along with compliance monitoring and the comprehensive health services (such as counseling and behavior therapy) necessary for effective treatment. The Hub and Spokes approach addresses the grave risks associated with co-mingling opioids with other substances and also ensures buprenorphine doses are optimal to effectively treat opioid dependency. This program is a crucial component of the fight against opioid addiction in Vermont. There are around 8,000 people enrolled, with no waiting lists to speak of. That is 8,000 Vermonters on the path to freedom from the horror of addiction.
And this reduction in demand means fewer Vermonters putting money in the pockets of dangerous out-of-state dealers who exploit human suffering for profit. This is harm reduction. Demand reduction must be accompanied by vigorous enforcement of our drug laws to stem the flow of drugs into communities.
But some local law enforcement partners in Vermont are opting not to enforce the drug laws as they relate to buprenorphine possession. Unprescribed buprenorphine use is illegal under federal and state law for a reason: It is dangerous. Buprenorphine is a partial opioid agonist. It is abused because of its opioid-like effects. It can kill, as exemplified by the recent Seven Days article describing the overdose of two Vermont inmates on buprenorphine diverted in the prison setting. (Both were revived with naloxone.) Mixing buprenorphine with alcohol or other drugs — especially central nervous system depressants like benzodiazepines — creates a significant risk of overdose and death. For these reasons, users and drug dealers of buprenorphine can be prosecuted and imprisoned in state and federal court in Vermont. Failure to enforce drug laws will attract more black market dealers of buprenorphine to Vermont, put more money in the pockets of dangerous traffickers, and increase the use of unprescribed buprenorphine.
Decriminalization of unlawfully possessed buprenorphine encourages the ingestion of dangerous drugs without physician oversight and compliance monitoring. That is harmful. Those who advocate such policies speculate that illicit buprenorphine users do so because they are self-medicating, attempting to wean themselves off stronger opioids outside professional care. By that logic, why not decriminalize oxycodone because it is less potent than fentanyl?
Unprescribed buprenorphine is misused, not for treatment purposes, but to get high or stave off opioid cravings until stronger drugs become available. Given the absence of waiting lists in the statewide Hub and Spokes program (and the new, “low-barrier” availability of prescribed buprenorphine at Howard Center Safe Recovery and UVM Medical Center), decriminalization of buprenorphine undermines efforts at responsible addiction treatment, while ignoring the grave dangers associated with unmonitored buprenorphine use.
Policies that foster an environment where it is easier to use dangerous drugs without fear of prosecution send the wrong message to children, undermine our efforts to rescue addicts and increase profits for out-of-state drug dealers. In other words, they increase drug supply, drug demand — and harm. Let’s not give up. Let’s continue to make Vermont an unpleasant and unprofitable place for criminals to sell drugs. Let’s continue to strive to free individuals from addiction and transition them into healthy, drug-free lives.
Christina Nolan is the U.S. Attorney for the District of Vermont.