“Don’t let others do for you what you can do for yourself.”
Growing up in Vermont, this was a saying I learned in one form or another from an early age. It is rare to hire strangers to mow your lawn, or ask anyone other than a neighbor’s kid to babysit. Even Vermont’s most iconic international businesses, like Ben & Jerry’s and Green Mountain Coffee, have maintained local management. So, when earlier this year, a sensational media blitz descended on Vermont to expose the dramatic rise in opiate and opioid abuse, many Vermonters felt our story had been told wrongly, because it had not been told in our voice.
Full disclaimer: I am a proud Vermonter, and like many others, I have been frustrated by the tabloid-style journalism that has nicknamed Vermont “The Brown Mountain State.” The New York Times, Rolling Stone, and other publications have sought to fit Vermont too neatly into the bleak post-Recession box that applies to many corners of our country. Despite these accounts, the images of high school hallways strewn with heroin baggies and controversy surrounding recovery centers just don’t jive with the Vermont I grew up in, and many friends back home feel the same way. This is not to say that locals are denying the existence of a crisis, but rather that an issue as pressing as this deserves honest, de-stigmatized dialogue to foster recovery.
Following Vermont Governor Peter Shumlin’s State-of-the-State Address dedicated to the issue of heroin abuse on Jan. 8 of this year, what Vermonters had known to be an issue for years suddenly rose to the forefront of national media. Of the startling statistics Gov. Shumlin shared, one in particular stands out: “In Vermont, since 2000, we have seen a more than 770% increase in treatment for all opiates.”
He did not posit a reason as to why Vermont had been hit so hard, nor why many other parts of the country have seen a recent upswing in heroin abuse after years of declining numbers. Neither he, nor anyone I interviewed, could explain why Vermont has been vulnerable to this upsurge in abuse. And perhaps not knowing is what makes the situation so frightening.
Bob Bick is the Director of Mental Health and Substance Abuse Services at the Howard Center, a multi-service organization that provides, amongst other services, treatment and counseling for substance abuse and mental health. He thinks Gov. Shumlin’s speech helped to reveal some of the stigmas surrounding opiate and opioid abuse that his team works tirelessly to dispel. “I think it has encouraged people to shine a light on a somewhat dark corner of the Vermont experience,” Bick told the Observer. “Vermont is still a wonderful place to live, and the quality of life is great, but we have the same kinds of problems and challenges as any urban area in the country.”
The Howard Center provides many high-demand services to opiate and opioid abusers as well as those in recovery. Says Bick, “We were the first methadone program in the state when we opened in 2002 with 70 clients. We currently have 750 active clients with a waiting list of around 220 as of mid-March. These clients represent the full socioeconomic spectrum—we have folks that are homeless, students, homemakers, unemployed, who work in a range of employment situations, from unskilled labor all the way up to professionals.”
Besides actively treating recovering addicts, Bick recognizes that education and prevention are important challenges as well. “More than half of the patients we see began their addiction with a legitimate painkiller prescription from a doctor, dentist, or the ER. Over the last several years we’ve seen a bubble as a result of some of the marketing strategies of select pharmaceutical companies, which involved aggressively promoting their products as less addictive.” Over-prescribing by physicians has also been problematic. “We have patients who went in for a root canal and were given a prescription for 30 OxyContins, so you end up with 27 or 28 left over. These can be consumed as an abused substance, or sold down the street where they can earn $50-$70 per pill,” which is $1 per milligram.
Because the opioids in heroin are chemically indistinguishable from the opioids in painkillers, but heroin carries a street price of $30-$40 per 100mg bag in Vermont, it is common for individuals introduced to opiate and opioid abuse through prescriptions to transition to heroin for economic reasons.
Sarah*, a 25-year-old from Vergennes, Vermont, can speak to this transition. “I was introduced to Vicodin and Percocet by my friends. I fell in love with the way they made me feel.” After a court-ordered stint in rehab, Sarah learned from other residents that heroin was less expensive and provided a more powerful high than synthetic opiates. “I instantly wanted to try it even though it had ruined everyone’s lives. Being an addict, I always just wanted more.”
Although her friends and family knew she was using, they didn’t know how to get her help. “At my worst I was jobless, had no friends, and my family wasn’t talking to me. I was lying and stealing from everyone. I weighed 75 pounds and was drinking a fifth of vodka a day, shooting bag after bag of heroin just to not get sick from withdrawals. I was surviving.”
Once Sarah was arrested a second time for a DUI, she realized she would die without help. After a long stint in rehab and a painful detox, Sarah now attends regular AA meetings and sponsors other women in recovery. She is a year and a half sober.
When asked why she thinks Vermont has seen a rise in heroin abuse, Sarah pointed to the economic boon for out-of-state dealers. “They make money here… and it’s easier to get away with it.” A bag of heroin that would cost $5 in Philadelphia can sell for as much as $30 in Vermont, says Rutland’s police chief James Baker.
Dr. Stacey Sigmon, Professor at the University of Vermont College of Medicine and Director of the Chittenden Center’s Methadone Maintenance Program, researches how to predict who is most likely to abuse prescription opiates and opioids. “The strongest predictor of who was likely to abuse medically prescribed prescription opiates were patients with alcohol abuse problems. But it’s a complex picture.” It is also often difficult to determine which users are more likely to progress to heroin abuse rather than prescription opiates. “In Vermont, quite a lot of opioid-dependent patients are using prescription opioids as their primary drug, not heroin. Often it’s more a matter of availability or cost rather than clear preference.”
When discussing the stigmas surrounding opioid abuse, Dr. Sigmon sees an association between increased availability of prescription opioids and the lower mean age of opioid abusers. “Over the past 5-8 years, we’ve seen an increase in prescription opioids as the primary drug, and a big increase in intranasal (snorting) as the primary route rather than IV. We also now regularly see patients who are young adults as well as those in their 30s or 40s. I think this is likely associated with the concurrent increase in the availability of prescription opioids. Opioids are simply more available, and generic versions have increased availability and reduced cost.”
Because prescription opioids have clearly marked dosages and are regulated, “some of the stigma has been removed. Younger folks who wouldn’t have been willing to buy heroin from a dealer, then dissolve and inject it, can instead take a pharmaceutical product from their parents’ medicine cabinet.”
This portrait of opioid abuse is a far cry from the homelessness, crime, and illness associated with the drug in the 1980s. This suggests that the shock of the national media is not so much that heroin has made a resurgence, but that opioids have become so popular in a small, bucolic state with not a single city with residency over 45,000 and a population that is 96% white. It is less newsworthy that prescription opioids and heroin are being abused in inner cities. We, as a culture, have acclimated to that image. As the media blitz continues to unfold with features in Rolling Stone and the continuing series in the New York Times, a higher standard must be met to address the very real and very painful reality of opioid abuse in Vermont, and to arm readers with the necessary facts, resources, and knowledge to better address this crisis.
Bick shared a poignant story that illustrates the strides made in stigma reduction surrounding opiate and opioid abuse, and the many challenges that remain. “I recently spoke to two moms, both of whom were professionals, both of whom had sons who had died from heroin overdose. What they talked about was a sense of loss and pain, but also a sense of shame they felt when the family and friends knew that their sons had died from opiates. When it became clear that it was heroin rather than a prescription, it was an even more distant reaction. So even within sympathetic communities affected by this problem, there continue to be negative associations that need to be addressed. If lives haven’t been touched by addiction, perceptions may be based on fear or lack of knowledge.”
*Name has been changed to protect the identity of this source.