How can we move forward and eliminate the continuing death tolls?
There are some immediate steps we can take to help now.
One, we need overdose prevention sites. While we are dealing with fentanyl we need to act now to ensure people can use without the risk of death. Sean had fentanyl in his system, 100% fentanyl, no heroin. This is the case with many deaths. Overdose prevention sites are needed as part of a harmreduction approach. Harm reduction is allowing people to use substances by lessening the risk of harm (death and disease). We have many people who desperately want recovery. They will never have the opportunity to find sobriety if they die.
We need to ensure access to treatment. Treatment facilities are lacking in Vermont. There is little availability of long term residential ie. 90 days or more. Especially treatment for co-occuring mental health conditions, like the bi-polar disorder Sean suffered from. Sean needed to go out of state for treatment. It was heart wrenching to not be able to support him, or be with him at holidays.
We need to decriminalize substance use disorder. Portugal has done this and the response has been overwhelmingly positive. Oregon has just begun this process. Mass incarceration is not going to solve this issue. Especially incarceration without treatment or rehabilitation. Forced treatment is harmful. The harm reduction services need to support people while they are considering. Drug and mental health courts that don’t support people through a relapse just, end up incarcerating them. This happened with Sean. Going to jail for misdemeanor charges (nonviolent charges) is not helping anyone.
We need to retain folks in treatment. When I was at Howard Center from 2018 to 2020 (until the OBGYN office needed me back fulltime), I had a 90% retention in treatment, very few of my patients didn’t make it (thankfully). Many are engaged in treatment and sober today. Many are now at Affiliates (currently a spoke in the hub and spoke) Why? we used a harm reduction approach. Warm, encouraging, reinforcing any positive change. You didn’t lose your medication for a relapse. Appointments were flexible and supportive. Judgement free treatment.
We need better access to medication assisted treatment. Vermont has long been lax with prescribing for opiates for pain but, tough on buprenorphine providers. It should be the opposite. My husband received over 200 pills for a fractured ankle in 2012, he used 2 tabs and we had a hard time getting rid of the rest. However, the Vermont guidelines for buprenorphine prescribing are rigid and harsh. Obviously, diversion is a concern with any controlled substance. However, less than 2 % of overdose deaths have buprenorphine in their bloodstream. People are not dying of buprenorphine use, nor is it a gate way drug. Buprenorphine protects against overdose deaths. With many people on fentanyl, the suboxone film (buprenorphine-naloxone) is difficult to transition to. It is easier to transition to subutex (buprenorphine only). However, the prior authorization process is cumbersome and time consuming. We need to eliminate prior authorization for buprenorphine. We need better coverage for medication assisted treatment. Medication should be free. Getting people coverage was a barrier to treatment.
Finally, we need prevention strategies. We need to need to address bullying in schools. We need a culture that supports healthy mental health. Sean endured bullying and the stress to fit in was a big factor in his substance use. I have been dismayed at the amount of shame people with substance use disorder endure. No other health condition, which is so deadly, produces so much counterproductive shame. Mental health should be promoted as health. Iceland has done an amazing job promoting health amongst it’s youth, we can do the same here. As evidence that overdose deaths and suicide are leading causes of death for our young people, we need a massive public health response.
HOW CAN YOU HELP?
Write your legislators!! We need a massive response yesterday!! We need Overdose Prevention Sites and decriminalization ASAP. This can be accomplished at the state level, with national response to follow.
Need to read more?
I recommend “Fentanyl, Inc” by Ben Westoff. “Dopesick” by Beth Macy. “Dreamland” by Sam Quinones.
“She Spent more than 110,000 on drug rehab. Her son still died” by German
Lopez, Vox September 3, 2019