- File: Sean Metcalf
Melissa Bronson had just started a load of wash at King Street Laundry in Burlington one day in September when she saw a man fall down, unconscious. Bronson, who works as a personal care assistant, realized he was overdosing and called 911. By the time emergency responders arrived, Bronson feared the man had died.
"I can still hear him and see his face," Bronson told Seven Days. Since that day, she has witnessed two other people shooting up at local laundromats.
"This is becoming worse and worse as time goes on," she added.
Vermont has experienced a surge in fatal drug overdoses since the pandemic began, including a record-high death toll last year. Spurred on by the crisis, local drug treatment advocates are now pushing for a measure they hope can reverse the trend.
On December 20, Burlington city staff will give the city council a presentation about the possibility of opening an overdose-prevention site, including guidelines for determining where to put it and what it could look like. Also called safe-injection sites, the facilities are typically staffed by medical professionals who can refer people to treatment programs and intervene if someone has a bad reaction while using drugs.
"Death is something that opens people's minds ... to innovative measures," said Ed Baker of Burlington, who has been in recovery for 37 years and is behind the overdose-prevention site effort. "We're either going to do something or we're going to do nothing, and then we have to live with that."
Vermont was once seen as a national leader in combating the opioid crisis, managing in 2019 to reduce the number of fatal overdoses for the first time since 2014. But during the pandemic, the progress halted and reversed. The state tallied a record-high 157 overdose deaths last year and, through this August, had recorded another 129 deaths.
Chittenden County has been particularly hard hit, counting 26 opioid-related fatalities between January and August this year, up from 17 during the same period in 2020, according to the most recent data available from the Vermont Department of Health.
Fatalities haven't increased in Burlington, but other signs indicate a worsening drug problem. To date this year, Burlington police have administered the opioid-reversal drug naloxone nearly 30 times more than during all of 2020. The city's code enforcement office has received 262 reports of found needles and syringes this year, 200 more than last.
Concerns about the legality of overdose-prevention sites have hampered previous discussions about them in Vermont. In 2017, Chittenden County State's Attorney Sarah George garnered support from a commission of law enforcement, medical and social service professionals who endorsed the concept as a public health measure. In response, then-U.S. attorney Christina Nolan, an appointee of former president Donald Trump, announced that she would prosecute any organization that operated a prevention site.
Members of Gov. Phil Scott's Opioid Coordination Council were spooked by Nolan's threats, issuing a report in 2018 that said the legal liability alone made opening a site "virtually impossible." That year, the Burlington City Council approved an initiative that expanded access to buprenorphine, a drug that treats opioid addiction. But at the same meeting, councilors watered down a resolution that would have taken concrete steps to open an overdose-prevention site. Some opposed the measure in part because of Nolan's stance.
The issue resurfaced in fall 2020, when councilors asked then-city attorney Eileen Blackwood to analyze the legal barriers to opening a prevention site in Burlington. Her report noted a major red flag: In 2019, Trump's Justice Department had sued a Philadelphia nonprofit that was planning to open a site called Safehouse; the case is still pending in federal court. But Blackwood also noted that "potential leadership changes" at the White House could usher in a more accepting stance toward the sites.
Indeed, political winds have shifted under President Joe Biden's administration. Last month, the federal Department for Health &Human Services issued a report concluding that overdose-prevention sites could "represent a novel way" of addressing the nation's opioid epidemic.
And last week, New York City opened the nation's first sites, where nine overdoses were reversed during their first few days of operating. Four of the city's five district attorneys support the sites, and Mayor Bill de Blasio has promised "not to take enforcement action" against their operators, the New York Times reported.
Vermont advocates still have George, the Chittenden County state's attorney, in their corner. But the stance of Nikolas Kerest, the new U.S. Attorney for Vermont, is unknown. Kerest declined an interview with Seven Days about his position on overdose-prevention sites pending his confirmation in the U.S. Senate, which happened Tuesday night. George is optimistic that Biden's administration wouldn't go after Vermont, but she said she doesn't personally know Kerest.
"I would hope that our state would scream from the rafters if that was happening," George said of federal criminal charges. "It's certainly a fight I would take on with any ounce of power I have to do that. I would defend [overdose-prevention sites] with all it took, and I would hope the mayor would, too."
The mayor in question, Miro Weinberger, agreed that the recent step in New York City has made prevention sites a viable option in Burlington.
"Now is the time to pursue this," Weinberger said, adding that overdose-prevention sites are "getting to the top of the list of strategies that make sense."
Unanswered questions remain, however, such as where to put a site, and how to fund and staff it. Some proponents have suggested Howard Center, the Burlington nonprofit that has operated the Safe Recovery needle-exchange program for more than two decades, as the most sensible partner to operate the center. Baker, the Burlington advocate, has proposed using the state's $60 million from a legal settlement with opioid manufacturers Cardinal Health and McKesson — with more anticipated from OxyContin makers Purdue Pharma — for the as-yet-unknown operating costs.
Councilors first asked for a report examining the feasibility of opening an overdose-prevention site more than a year ago, but the process was delayed when its lead researcher left for a new job. The task has fallen to Marielle Matthews, the city's public health equity manager, who was hired in February. Scott Pavek, a Burlington resident and former Vermont House candidate who is in recovery, has joined Matthews in his new role as the city's substance use policy analyst.
In an interview last week, both Matthews and Pavek declined to share their research. Pavek has advocated for an overdose-prevention site in Burlington for several years but said the city's report will be an objective review of how one might operate in Burlington. Matthews agreed that the prospects are much brighter than just a year ago.
"There's really nothing for communities to fear besides the loss of life by not implementing a robust harm-reduction strategy," Matthews said. "I think the landscape is getting better and better for this kind of intervention to come to fruition."
There's seemingly no partisan divide on the issue among local elected officials. Democratic Councilor Karen Paul (Ward 6) and Progressive Council President Max Tracy (Ward 2) have both been vocal proponents and agree that Burlington should move forward. Paul, who introduced the topic in 2018, thinks that Burlington could open a site by 2022, as long as there's support from the community.
"People should have the opportunity to understand what it is, where it's going to be and what are the advantages of having this," she said.
Still, the proposal is likely to garner criticism. Opponents often argue that the sites legitimize drug use and increase crime, despite evidence to the contrary, and residents would almost certainly speak out against a site in their neighborhood. Law enforcement officials aren't always keen on the idea, though it's unclear how Burlington's acting police chief, Jon Murad, feels about prevention sites. Murad, a finalist for the permanent top cop job, didn't respond to multiple Seven Days' interview requests and hasn't spoken to the newspaper since June.
The state health department isn't necessarily an ally, either. Health Commissioner Mark Levine served on the governor's opioid council that recommended against overdose-prevention sites in 2018. The department is reviewing new research in light of Burlington's plans, but officials are still concerned about the sites' legality, deputy commissioner Kelly Dougherty said. She added that Vermont has limited drug prevention funds, and health officials wouldn't want to undercut other treatment programs to pay for prevention sites.
"I don't think I can say our position has necessarily changed. I think that we are reexamining at this point," Dougherty said. "We are open to any intervention that could help decrease overdose deaths. We look forward to seeing how this progresses in Burlington."
Grace Keller, coordinator for Howard Center's Safe Recovery program, said it's impossible to know how many lives an overdose prevention site would have saved last year, but she's confident that people died because they used alone. In 1986, Switzerland opened the first overdose-prevention site, and more than 100 have since opened around the world. No one has died at one in the 35 years since.
Keller, who is serving on a city committee that supports prevention sites in Burlington, is heartened by New York City's early success.
"We're seeing that the sky didn't fall," Keller said. "That's really what everybody needed, is somebody to go first, somebody to lead the way."
Baker thinks that his city is ready to carry the torch. A retired therapist, Baker said that when he began practicing, insurance companies would deny the claims he submitted for his patients' drug and alcohol counseling. Society was equally unaccepting of methadone clinics and syringe service programs when they first started. Every step to help people in addiction has been a fight, Baker said, but he thinks that if the city backs an overdose-prevention site, it has a good chance of succeeding.
"I'm an advocate, so I don't stop trying," he said. "I believe that Burlington will come through."