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Lawmakers in Vermont have formally adopted changes to narrow the scope of a House-passed overdose prevention site bill, which in its amended form would create and fund a facility in Burlington where people could use currently prohibited substances in a medically supervised environment—part of a pilot program aimed at quelling the ongoing epidemic of drug-related deaths.
After approving a panel amendment last Thursday, the Senate Health and Welfare Committee voted 3–2 to advance the bill, H.72. On Friday, the Finance Committee also voted 4–2 to approve it. It next proceeds to the Senate floor where consideration is scheduled to begin this week.
“H.72 is one we’ve worked on quite a bit,” Sen. Ginny Lyons (D), the Senate Health and Welfare Committee, noted at a hearing ahead of her panel’s vote.
As passed by the House in January, the legislation would have created two overdose prevention centers (OPCs) in undeclared parts of the state, with $2 million set aside in funding for the facilities, plus another $300,000 to study the study the impact of the pilot project.
In its amended form, $1.1 million would go toward the single-site Burlington project, though the full $300,000 would be retained to study the program.
The Department of Health would need to establish operating guidelines for the new program, which would include staffing levels and qualifications, by September 15 of this year.
Many of the new provisions in the Health and Welfare Committee’s striking amendment came at the request of various stakeholders, including Burlington’s mayor and fire department and the Vermont Medical Society, as well as Chair Lyons, whose district lies south of Burlington.
After discussing the bill at past hearings, the panel a day before the vote went over final changes to the legislation, which included restoring a clarification in the House version that OPCs could be either fixed or mobile services, adding a requirement that grant applications receive approval from the city council as well more minor, technical amendments.
Panel revisions broadly restructured the bill’s language to separate its OPC provisions into one section and provisions around the bill’s proposed syringe services expansion into another.
As for the syringe services section, that would provide $1.45 million to fund programs for HIV and harm reduction services through grants by September 1. That money would come from the state’s Opioid Settlement Fund. The latest committee draft also removed an additional $400,000 that would have come from the state’s general despite pushback on Thursday from Sens. Ruth Hardy (D) and Martine Larocque Gulick (D). Lyons, the chair, said that money could still be set aside during the state’s budget process.
“I don’t feel comfortable abdicating those decisions to down the hall, because this committee has done the work, and I in particular have done a ton of work on this issue, and I don’t have confidence in the decisions made down the hall, frankly,” Hardy said.
“We’ll see what happens,” replied Lyons. “Everybody’s trying to do the best they can.”
Another change adds that the OPC would need to provide drug-checking services—a request from Lyons—to positively identifying drugs and test for adulterants.
A revision added at the request of the Burlington Fire Department, meanwhile, requires on-site professionals with training in CPR, overdose interventions, first aid and wound care, as well as the performance of medical assessments to determine the need for further emergency care.
At a hearing earlier this month, Lyons pointed out that the amendment lacked language conceiving of more OPCs in the future.
“In a way we’re limiting it to one site in Burlington,” she said. “Going forward…there’s nothing in here that allows for expansion, should there be funds available.”
As the Health and Welfare Committee returned to the bill on April 12, however, Lyons also noted that the new language “doesn’t preclude” other OPCs from being authorized later on.
The revised bill also includes adjusted language on criminal immunity for OPC staff, property holders and others, to ensure they aren’t subject to arrest or prosecution as the result of good-faith overdose prevention efforts.
If it becomes law, Vermont would join Rhode Island and Minnesota in authorizing the facilities, where people can use illicit drugs with medical professionals present and be connected to various support services, including treatment.
Sponsored by Rep. Taylor Small (P/D) and 28 House colleagues, the bill is another attempt by lawmakers to allow overdose prevention centers following Gov. Phil Scott’s (R) veto of a 2022 measure that would have established a task force to create a plan to open the sites.
Even if the overdose prevention center legislation passes the Senate this session it still faces a possible veto from the governor.
“I just don’t think that a government entity should be in the business of enabling those who are addicted to these drugs that are illegal,” the governor said of the current measure at the time it passed the House earlier this year.
Scott wrote in his 2022 veto message on the earlier legislation that “it seems counterintuitive to divert resources from proven harm reduction strategies to plan injection sites without clear data on the effectiveness of this approach.”
Ahead of the Senate committee vote, members took testimony and received written comments from a number of officials and organizations over the course of multiple hearings.
At one of the more recent meetings, the new mayor of Burlington, Emma Mulvaney-Stanak, who took office earlier this month, said that—like outgoing mayor, Miro Weinberger—”I also strongly support H. 72 and the pathway it provides our city of Burlington to pilot an overdose prevention center in our community.”
Weinberger, who himself addressed the panel at an earlier hearing, said addressing the opioid crisis has been a top priority in the city since 2015.
“I have long supported overdose prevention sites as a strategy,” he said. “I have become increasingly focused and increasingly believe that this is something that we urgently need to pursue.”
The proposal has support from advocacy groups such as the Drug Policy Alliance, Law Enforcement Action Partnership, National Harm Reduction Coalition, the American Diabetes Association, Planned Parenthood of Northern New England, Johnson Health Center, Broken No More, Recovery Vermont, the Vermont Association for Mental Health Addiction and Recovery as well as various individual public commenters.
The National Harm Reduction Center, for example, called overdose prevention centers “a vital part of a comprehensive public health approach to reducing the harms of drug use.”
“They cannot prevent all risky drug use or related harms,” the group said in its testimony. “However, evidence demonstrates that they can be remarkably effective and cost-saving and improve the lives of people who use drugs and the safety and health of our communities.”
Prior to the amendments, some state officials told the committee that overdose prevention centers (OPCs) aren’t the right fit for Vermont’s rural areas.
“My position is that while I acknowledge OPCs can have many potential benefits and be part of a multipronged approach to the opioid epidemic, they ultimately may not represent the best option for a state such as Vermont at this time,” Mark Levine, commissioner of the Vermont Department of Health, said in submitted testimony ahead of the committee changes, arguing that the facilities work best “where people who need these centers can access them easily and quickly—typically these tend to be larger population areas, neighborhoods where injection drug use is more prevalent.”
New York City, he pointed out, has located its two overdose prevention sites in areas that fit that description.
Rep. Eric Maguire (R), who also opposed the bill, argued at the earlier hearing that while OPCs might be an acceptable option for Vermont in the future, the state currently lacks the infrastructure to make the project worthwhile. He also emphasized that the sites could violate federal law.
“Currently at this time, the state of Vermont does not have the infrastructure or continuum of care to support this harm reduction model,” he told the panel. “It’s not sanctioned by SAMHSA… It’s against the law under the Controlled Substances Act.”
“There may come a time when they are sanctioned by our national health organizations and sanctioned within the harm-reduction model laws,” he added, “and then we can look at crossing that bridge.”
Weinberger, the former Burlington mayor, told panel members that not only do OPCs prevent overdose deaths, they also connect drug users with treatment and other services, often reaching individuals who are missed by other outreach.
“One often under-appreciated in the discussion is that studies are showing that these facilities reduce—not only do they not increase, they reduce—crime and disorder in the area immediately around the facilities,” he said. “I think that surprises many people.”
Weinberger acknowledged that the sites may not work in every part of Vermont, especially more rural areas, but said that wasn’t a reason to deny facilities in denser areas such as Burlington.
Scott Pavek, meanwhile—a substance use policy analyst for the city of Burlington and a member of the state’s Opioid Settlement Advisory Committee and Substance Misuse Prevention Council—urged lawmakers not to be complacent about the ongoing overdose crisis.
“Recently, this committee heard testimony that suggested the state’s overdose deaths have plateaued,” he said, warning against the “eagerness to point to a still unacceptable number of Vermonters lost to preventable overdose deaths as proof that our harm reduction and treatment strategies are sufficient.”
A saying he often heard during his own recovery, Pavek added, is that “half measures avail us nothing.”
Separately this month, Vermont’s Senate passed a measure that would establish a working group to study whether and how to allow therapeutic access to psychedelics in the state. If the bill is enacted, a report from the working group would be due to the legislature in November with recommendations on how to regulate the substances. As originally introduced, that bill would have also legalized use and possession of psilocybin, but lawmakers on the Senate Health and Welfare Committee nixed that section to focus instead on the working group.
Though Rhode Island and Minnesota have state laws on the books allowing safe drug consumption sites, New York City became the first U.S. jurisdiction to open locally sanctioned harm reduction centers in November 2021, and officials have reported positive results saving lives.
An early study published by the American Medical Association (AMA) found that the facilities had decreased the risk of overdose, steered people away from using drugs in public and provided other ancillary health services to people who use illicit substances. And separate research published by AMA late last year found that the centers have not led to increased crime despite a significant decrease in arrests.
Meanwhile the federal government has fought an effort to open an overdose prevention center in Philadelphia, with the Biden administration arguing that the facilities violate federal law. Earlier this month, the court in that case granted the Justice Department’s motion to dismiss a challenge from organizers.
The Supreme Court rejected a request to that hear that case in October 2021.
DOJ first blocked the Philadelphia nonprofit from opening the overdose prevention center under the Trump administration. Supporters hoped the department would cede the issue under President Joe Biden, who has promoted harm reduction policies as an alternative to criminalization, but the parties could not reach an agreement to allow the facility to open despite months of “good faith” negotiations.
Congressional researchers have highlighted the “uncertainty” of the federal government’s position on such facilities, pointing out last November that lawmakers could temporarily resolve the issue by advancing an amendment modeled after the one that has allowed medical marijuana laws to be implemented without Justice Department interference.
Meanwhile, National Institute on Drug Abuse (NIDA) Director Nora Volkow has tacitly endorsed the idea of authorizing safe consumption sites, arguing that evidence has effectively demonstrated that the facilities can prevent overdose deaths.
Volkow declined to say specifically what she believes should happen with the ongoing lawsuit, but she said safe consumption sites that have been the subject of research “have shown that it has saved a significant [percentage of] patients from overdosing.”
Rahul Gupta, the White House drug czar, has said the Biden administration is reviewing broader drug policy harm reduction proposals, including the authorization of supervised consumption sites, and he went so far as to suggest possible decriminalization.
The National Institutes of Health (NIH) put out a pair of requests for applications in December 2021 to investigate how safe consumption sites and other harm reduction policies could help address the drug crisis.
Gupta, the director of the White House Office of National Drug Control Policy (ONDCP), has said it’s critical to explore “any and every option” to reduce overdose deaths, which could include allowing safe consumption sites for illegal substances if the evidence supports their efficacy.
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