A new walk-in health clinic will open early next year in downtown Burlington to treat patients hooked on the increasingly dangerous drugs available in the city.

Caroline and Geoff Butler, a husband-and-wife team that operates a similar nonprofit health center in Johnson, are setting up shop at 117 Bank Street, formerly a Christian Science reading room located across from the CityPlace Burlington site. They are partnering with Vermonters for Criminal Justice Reform, a nonprofit in the building next door that serves people with substance-use disorder.

Twice a week, nurse practitioner Caroline will hold office hours to help patients manage their meds and connect with mental health services. She will treat persistent wounds caused by xylazine, an animal tranquilizer that's mixed in some of the drugs sold in Burlington. When she isn't in the office, a staffer at Vermonters for Criminal Justice Reform will connect her to patients via video.

The low-barrier clinic aims to fill a gap in Burlington, where a spike in crime, homelessness and drug overdoses has officials scrambling for solutions. By working with the criminal justice reform group that active drug users know and trust, the Butlers hope the clinic can steer some of the city's most vulnerable residents into treatment.

"We need these services now," Caroline said.

The supply of illegal drugs in Vermont has become particularly deadly since the pandemic. Between January and July of this year, the state tallied 140 overdose deaths involving opioids, up from 114 in all of 2019. Xylazine was detected in about one-third of this year's cases.

Burlington overdoses are also at an all-time high, with almost 400 on record through October, compared to 252 in all of 2022. Drug use has become more visible, with discarded needles frequently found in public places. To stem the tide of death, the Burlington Fire Department recently launched an overdose response team to treat patients with Narcan and hand out drug-testing supplies. The team also distributes wound kits — nearly 60 in the first two weeks, according to city data.

City officials have tried other ways to address the problem. Mayor Miro Weinberger has pressured the state to distribute its $23 million share of opioid settlement funds, which have been sitting in state coffers for months. He's also directed more than $300,000 in city funds to Vermonters for Criminal Justice Reform, which helps formerly incarcerated people and those facing criminal charges find housing and get drug treatment. The nonprofit opened a year ago and already has nearly 200 clients.

Other city efforts have been more symbolic. Last month, city councilors passed a resolution declaring the drug crisis to be Burlington's top public health and safety issue, but the vote has had little practical effect. The measure reiterated the council's support for overdose prevention centers and called for holding two public forums this month, but neither has been scheduled.

Meantime, the Butlers' Johnson Health Center has been a lifeline in Lamoille County. The center, which offers primary care and addiction treatment, opened in November 2022. Eight months later, the office was ravaged by the July flooding. The center quickly created a makeshift office and leaned on telehealth to keep serving patients. Demand for its services has only grown.

At about the same time, Jess Kirby, the director for client services at Vermonters for Criminal Justice Reform, noticed that more of her clients had wounds in places where they weren't injecting drugs. The gashes, a side effect of xylazine, can cut to the bone and lead to amputation.

Caroline Butler, who worked with Kirby years ago at another nonprofit, offered to help. For the past six months, she's met with Kirby's clients virtually and made weekly treks from Johnson to Burlington to see patients in person, treating them in a private room at Kirby's office. When the building next door came up for rent, the Butlers couldn't pass it up, though they were still rebuilding their Johnson clinic.

"It's a matter of need. The need is so great," Geoff Butler, the center's executive director, said. "Caroline's really passionate about a very low-low-barrier system and trying to get care to people who are extremely underserved."

The clinic — called the Johnson Health Center on Bank Street — will be open on Thursdays and Fridays, but Caroline will be reachable via telehealth almost anytime. While Kirby's office primarily works with people who have been incarcerated, anyone with substance-use disorder will be able to receive care at the clinic.

Kirby said the on-demand model addresses the unpredictable needs of her clients. On a recent Friday, for example, she picked up a man from the courthouse with no clothes to wear except his corrections-issued ones. He didn't have anywhere to stay and was out of buprenorphine, a drug used to treat opioid-use disorder. Kirby called Caroline, who got him a refill before the pharmacy closed for the weekend.

"She always answers the phone," Kirby said of Caroline. "If he would have relapsed on opiates that weekend, it is not far-fetched to say he may not be here right now. That's how contaminated and deadly the drugs are."

Weinberger agreed, saying in a statement that the more dangerous drug supply has made traditional treatment methods less effective. A partnership such as the one on Bank Street is a novel approach to a shifting problem, he said.

"The co-location of the VCJR recovery and re-entry center with a new primary care practice in the downtown is already proving to have a positive impact for the clients they serve," Weinberger said. He called it "an example of the urgent, innovative responses we need to meet this moment."

The emergent need for wound care has complicated drug treatment in Burlington. Kirby, who is in recovery herself, has seen abscesses develop at injection sites. But xylazine wounds are a different beast, she said, scrolling through photos on her cellphone. In one, a large swath of a person's shin was covered in an angry, scaly cut. Another, much smaller in diameter, looked like the person had been stabbed with a pencil.

"These would have been once-a-year wounds in the past," Caroline said, noting she's treated more than 20 in the past month. "It's everywhere."

The wounds need to be kept clean, a challenge if the patient is unhoused or living outside. Many people resort to covering their injuries with paper towels, which aren't sterile and can stick to the cuts.

The Butlers have already started handing out wound kits stocked with gauze, medical tape and antibiotics, but the supplies are expensive. Even Caroline's own stash, which she keeps in a red Craftsman toolbox, was running low last week. She said the clinic, once it opens, may hold a supply drive.

The office may also need financial support. The Butlers are stretching their existing budget to run the Burlington clinic but will look for other funding to cover costs that aren't reimbursed by insurance or Medicaid. The clinic will also offer services without charge if the patient can't pay.

Having a walk-in option avoids the need for appointments, which Kirby said are a struggle for some of her clients to keep. She also thinks people may prefer the clinic to a hospital visit because of the stigma associated with drug use and fear that their pain won't be taken seriously. Connecting the clinic to her office, which Kirby's clients know and trust, could encourage them to seek care, she said.

"People are really at risk of dying every day," she said. "We really want to make it work for people."

Before that can happen, the Butlers need to make the Bank Street office their own. The two main spaces will be transformed into patient rooms; the kitchen will become a small laboratory. The bathroom already has a shower that patients can use.

The new endeavor doesn't mean the Butlers will abandon their central Vermont patients, Caroline said: The couple reopened their Johnson health center last week. It's already as busy as ever.