Just a few weeks ago, Governor Peter Shumlin invited people to a forum on opiate addiction that drew together people affected by the impact of the regional crisis.
This first-ever statewide forum on opiate addiction on June 16 provided an opportunity for people from law enforcement and justice, treatment, prevention and recovery centers, as well as chamber members, business and property owners to learn from one another what is working around the state.
Collectively, Shumlin said, “We can figure out where we need to go.”
“It's easy to get discouraged,” he told the attendees. “I don't think anybody has figured out effectively how to do the prevention piece; but we can learn from each other about prevention and proactive treatment.”
And, the governor said, the state can “not only create a statewide model that works well for Vermont, but for the rest of the country as well.”
The forum's intention, he said, was to figure out how to “take some of the community models that are working” and spread them where they work. And to create a “blueprint for figuring how we take things that are working and put them on steroids, and things that aren't working and put them on a back burner.”
He pledged to work for “rational policies that move people from addiction to recovery” so that “no Vermonter who suffers from addiction won't have a place to move back to a productive life and a productive youth.”
“It's going to take all of us together,” Shumlin said.
As a result of the day-long forum, follow-up discussions have been scheduled regionally. A Windham Regional Opiate Addiction Forum will take place on Tuesday, Sept. 16 from 3:30 to 5 p.m. at the Marlboro College campus in Marlboro.
A difficult cycle to break
Shumlin addressed nearly 100 participants, noting that everyone there “knows there is a problem” and that there are gaps in the state's response to it.
He emphasized that to arrive at a model that works, it will take not just law enforcement, or just treatment and recovery, or just prevention, or just community efforts. It will take all of those separate measures together to resolve the problem.
And medical experts, while pointing out the issues with opiate and heroin addiction and why its such a hard cycle to break, also emphasized that treatment options have improved.
Dr. Mark McGovern, professor of psychology from the Geisel School of Medicine at Dartmouth College and Dr. Harry Chen, the commissioner of the state Department of Health (VDOH), agreed that treatment alone will not work.
Chen noted that last year, for the first time, the number of Vermonters entering opiate-abuse treatment rose above those undergoing alcohol-abuse treatment, and admissions for treatment of heroin addiction doubled between 2012 and 2013.
Discharges for overdoses of opioids rose sharply in 2012, he said. And total opioid deaths rose by 36 percent between 2012 and 2013, while death related to heroin doubled in the same time period.
Prescription-related opioid deaths have declined somewhat over the past six years, Chen noted.
How to overcome the shame of addiction?
One of the first challenges to creating an effective community response to the problem is removing the stigma attached to addiction, forum participants stressed.
Removing stigma requires understanding the addict instead of turning and looking away. It requires removing prejudices that respond to addiction with reactions like How could she ever do that to herself? or He made poor choices, or believing addicts are simply weak and selfish.
The last speaker on the floor that morning was Raina Lowell, an addict who, as of that date, had been clean for “three years, 137 days.”
Blonde, tall, pretty, and a Vermonter somewhere in her early 30s, Lowell did not look like an addict as she stood at the podium addressing the forum.
“The truth is, being an addict does define me,” Lowell said. “Being an addict in recovery tells you everything you need to know about me.”
Addiction has “affected every single aspect of my life” and “changed the very core of [her] being,” she said.
In the deepest days of her addiction, Lowell was living in two rooms of her house, her two children sleeping on a pull-out sofa. She would burn her furniture for firewood or would walk over to a neighbor's at night and steal theirs to keep warm.
She told the gathering that they kept to those two rooms, “not because it was hard to heat, but because the childrens' rooms were unlivable. They were filled with filth.”
Noting that she was “undergoing the challenge of “talk[ing] about the most shameful and painful thing in my life to a roomful of strangers,” she said she was doing so for all the addicts who are seeking treatment. For her son and daughter. For the mothers, sisters, aunts, and brothers of an addict.
Lowell described not recognizing herself, her self-loathing, the fear and anger of and for the addiction. She said she didn't know where to start toward recovery, let alone how to understand that what “made me feel so good was so wrong” - and killing her.
But she does not claim to know what the magic bullet is for all addicts in all cases. And what “worked for me may not work for another addict,” she warned.
“To open myself up, to be honest and share a piece of myself with you, to create an opportunity to understand addiction, and to find the human being stuck inside the shell of an addict - this is how we work through change,” Lowell said.
What is working in communities?
From public information, to coordinated health initiatives, to family education and support, Vermont is one of the leading states in creating successful models for dealing with heroin addiction.
But communities have been so involved in addressing their local substance-abuse problems that most have not had the opportunity to share what is working.
Success stories came from youth groups and youth mentoring. They come from holistic approaches to prevention and healing from addictions. They come from businesses that have hired recovering addicts. They come from housing managers for people coming out of treatment into recovery.
“A lot of the groups talked about how they were not aware of things going on in their own community, and are talking about working in a more integrated way,” Barbara Camiglia, the deputy commissioner of the VDOH division of alcohol and drug abuse programs told The Commons.
That was what leaders of the state agency “hoped would come out of it,” she said, echoing the need for cooperation and collaboration.
“It's probably an ongoing process,” she said.
Shumlin is talking with the other members of the Coalition of Northeastern Governors, comprised of the chief executives of Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont. There, he hopes to gather information, and “we are going to be looking at what the key themes are, and working regionally,” he said.
Shumlin noted in his address that state borders mean nothing when it comes to such problems.
“A problem in western Massachusetts is a problem in Vermont” as well, he said.
Camiglia noted that when “something comes up, every community can't do things on their own.” Referring to the Hub and Spoke system [see sidebar], she said specialty treatments cannot be located in every community but can be coordinated regionally.
“Whether we are talking about housing or jobs,” it needs to be “approached systemically,” she said.
“We were hoping that one of the main takeaways from the forum is people have a greater understanding about how complex addiction is, and that there is not just one solution,” Camiglia said. “It's not just about treatment, prevention, or law enforcement. It's going to take coming together to institute more permanent solutions.”
“It's really important that it happens at the grassroots with individuals reaching out to friends and colleagues, and coming to an event that somebody invites them to,” she added.
“We see our role as supporting this - helping to design activities,” Camiglia explained. And, she said, local health departments need to know about events and meetings, and how to contact regional support groups.
Investing in prevention saves money
Substance-abuse prevention, including preventing opioid abuse, “takes a comprehensive, long-term approach that includes information, education, early intervention, and referral to treatment, community communication and mobilization, and policy setting,” according to the VDOH.
To work, prevention initiatives in schools and communities must be sustained over time. They must target increasingly younger populations and groups of people at risk.
Community coalitions and regional partnerships for success, coordinated school health initiatives, and family support and education are some of the VDOH-funded strategies in place.
For every prevention dollar spent, $3 to $8 costs of healthcare, criminal justice and lost productivity costs are saved, according to the U.S. Substance Abuse & Mental Health Services Administration.
On the day after the forum, Shumlin signed into law a bill earmarking $12 million for third-party assessment and a door into recovery for addicts who have been arrested.
But at the regional level, prevention organizations rely on an inconsistent network of financial support to deliver services and fill in those gaps.
And there is a lot of competition for those dollars.
Greater Falls Prevention Coalition (GFPC), which serves the Bellows Falls region and the Brattleboro Area Prevention Coalition (BAPC) were both informed last month that they would not continue receiving two grants.
At the GFPC, those grants currently fund salaries for two of their community outreach and prevention education staff. As a result, Director Fran Waldren and Media Coordinator Chad Simmons are scheduled to depart later this summer.
Despite the statewide inter-agency interest in addressing the heroin and opiate addiction problem in the state, Simmons said there is a lot of competition and “not a lot of money.”
Neither agency will be able to apply again for these grants until 2017. The grants are administered regionally.
Waldren said “only time will tell” what impact the loss of these two staffing positions will have in the long run.
In the meantime, locally, Simmons said, forums hosted by GFPC in Grafton and Bellows Falls have resulted in connections and conversations that will make it easier for the organization to go forward with less staffing.
The positive results, Simmons said, are in “starting the conversations that needs to happen.” And, he said, keeping the conversation going helps tackle the complicated picture of opiate and heroin addiction in Vermont communities.
Talking about the problem locally
Corbelly, who has worked in addiction for more than 30 years, said community forums are being held all over Vermont to help communities understand not just what opiate and heroin addiction is and why it is happening now, but also how communities can help and how to implement ideas that have worked elsewhere.
Calling the discussions “an incredibly exciting community step,” she said she was excited about the level of community involvement in these conversations.
Addiction is “shame-based so its easy to not talk about it,” but the governor is making it easier, she said. “The disease is nothing to be ashamed about.”
“With the governor making this a priority for Vermont, it gives communities permission to talk,” she said.