Politics

02.19.14

Heroin Threatens Vermont’s Rural Paradise

Despite low unemployment and near universal health insurance, Vermont is facing an epidemic of heroin addiction.

The fairy tale of Vermont—that it’s all small towns, ice cream, maple syrup and smuggler’s notches—has stubbornly persisted in the national imagination, even if Ben and Jerry have long since cashed in and moved on. There’s never been enough concentrated wealth for gross inequality or the massive urban centers that tend to serve as laboratories for crippling social problems. Certainly, vice as it is commonly understood reared its head in the past, most notably during what was essentially a local flirtation with organized crime in the prohibition era when alcohol flowed through resort towns from across the Canadian border. And yet that just contributed to the local lore of the state as a repository for rugged Americana.

But after Governor Peter Shumlin’s State of the State address last month, one he took the unusual step of devoting entirely to the local surge in heroin addiction, there was little left to anyone’s imagination. Heroin addiction in Vermont is up 770 percent since 2000, for 4300 cases in 2012. Now the state’s political class is working feverishly not just to deal with the health issues presented by what some are calling an epidemic (Shumlin prefers ‘crisis’), but also to protect the Vermont brand and buttress a legendary tourism industry, one that brings in over a billion dollars to local breweries, restaurants, and ski lodges every year. The idyllic escape of many a childhood memory has apparently been compromised by the same poison that recently claimed one of America’s great acting talents, and now the question is whether the rural state can cope with a drug epidemic that has overwhelmed once-thriving metropolises like Baltimore.

“The governor deserves some credit for being willing to shine a light on that corner of the Vermont experience,” says Bob Bick, director of mental health and substance abuse services at the Howard Center in Burlington. He praises a pilot program the state launched even before the governor’s speech to make Naloxone, the best treatment for those experiencing an opiate overdose, much more widely available, including at Bick’s facility and other nonprofits, where he claims it has already saved a handful of lives.

Once thought by local pols to be a more serious problem in neighboring Connecticut, with its depleted cities, or New Hampshire, which does, after all, encourage residents to Live Free or Die (and is also much closer to Boston), heroin is now the chief issue confronting the Green Mountain State. And in interviews with politicians, lobbyists, law enforcement officials and treatment experts, there was a certain shellshock that addiction could ever become so widespread in a place where almost everyone has health insurance and long-term unemployment is seventh-lowest in the country.

“If you drive through the state, you don't see the poverty,” says Richard Sears, chairman of the Senate Judiciary Committee and chief architect of S.295, the bill making its way through the legislature in response to Shumlin’s battlecry. Vermont, with a population of about 625,000 people (roughly equivalent to that of Washington, D.C.), has seen an explosion of Oxycontin habits (and subsequent efforts  to control that drug’s abuse) lead to a jump in heroin use over the past decade, after a previous spike in opiate activity raised eyebrows under then-Governor Howard Dean 15 years ago. So having health insurance is no silver bullet, and may even perversely be part of the problem, with doctors over-prescribing painkillers and setting their patients on the path to destruction.

“It's kind of a perfect storm,” explains Lt. Matthew Birmingham, commander of the Vermont State Police drug task force. “You had the reformulation of Oxycontin [in 2010] which basically took that out of the market [by making it turn to gel when crushed], and then you had the widespread availability of heroin in the northeast, where it was extremely cheap and blew up. This latest heroin surge has been a shock. Over the past 15 years I've seen cyclical surges with different drugs but nothing of this magnitude.”

Heroin addiction in Vermont is up 770 percent since 2000

Heroin isn’t just vexing Vermont law enforcement, though; it’s also causing problems for drug reform advocates across the country. Shumlin, going before a national audience on Sunday talk shows like This Week to make his case, wants the American conversation about curbing the War on Drugs to include the hard stuff and not just marijuana. Voters are increasingly open to the idea of liberalizing pot policy—Shumlin signed a law decriminalizing possession just last year, and Colorado and Washington recently began to permit recreational use—with ambitious politicians from Rand Paul to Andrew Cuomo seizing the reform mantle. But few are willing to wade into the nitty-gritty of heroin laws, even in 2014, in large part because there is zero prospect of financial windfall (tax revenues that can be dangled in front of skeptical constituents) for those elected officials who get on the bandwagon. On the contrary, heroin decriminalization, or any kind of national rethink of how we treat those addicted to it, is likely to be both complicated and expensive.

“There are so many challenges with opiate addiction, and one of them is no one wants to talk about it,” Shumlin told me in an interview. “Addicts don’t like to talk about it for obvious reasons. Their family members don’t like to talk about it because they feel ashamed. And politicians don’t like to talk about it because there’s risk in change.”

To its credit, the state has been working on this problem for some time, last year passing a 911 Good Samaritan law to protect those who get medical help for friends experiencing overdose. Vermont is also generally more willing than most states to invest in preventive care, and local prosecutors have successfully petitioned legislators to look at heroin through the lens of harm reduction and treatment rather than punishment alone.

“We think this is a really comprehensive bill because it deals with getting the best information we can to judges before they make a decision,” Sears tells me, ticking off plans to screen addicts who have not committed a violent crime when they are first arrested and to impose increased penalties on those caught possessing significant amounts of heroin with intent to distribute. Of course, proposed thresholds for what constitutes a large quantity have some reform advocates wary, since one need not be a drug dealer to have dozens of bags of heroin in tow. And waiting-lists for addiction treatment across the state are already backed up, raising doubts that the mental health infrastructure will be sufficient to meet demand. To that end, Shumlin has proposed $10 million in spending between more money for pre-existing programs and the new legislation. That’s no problem in Vermont, which essentially remains a Swedish-style social democracy. But if one of the long-term concerns ahead of Obamacare implementation was that it would test the supply of available doctors in America, it’s worth noting that any kind of boost in heroin prevention and treatment is likely to create staffing quandaries of its own.

So as encouraging as the holistic response on part of law enforcement, political leaders, and the medical community in Vermont has been, it should also be a bit terrifying as well. After all, one of the least dysfunctional political subcultures in America is still struggling to meet this challenge. And if Vermont can’t cope with its drug epidemic, is there any hope left for the meth ravaged hills of Appalachia or the inner cities long synonymous with heroin addiction?