Shortly after receiving her federal stimulus check, a Rutland County woman fatally overdosed. Another woman, in Chittenden County, relapsed and died after more than a year of sobriety. In Orange County, prosecutors allege that two people sold fentanyl-laced heroin to a 29-year-old man who'd been battling addiction for many years. He, too, died.
These are just a few of the dozens of Vermonters lost to the opioid epidemic through the first seven months of 2020, a worrisome toll that appears to be a collateral consequence of the COVID-19 pandemic.
Between March, when the virus reached Vermont, and July, the most recent month for which preliminary data is available, 61 people died from accidental or undetermined opioid overdoses, most involving fentanyl. That's 27 more than during the same five-month period in 2019, Vermont Department of Health data show.
The increase mirrors a national trend but is particularly disheartening in Vermont, which managed to reduce fatal overdoses in 2019 for the first time since 2014. The state is on track to see as many as 140 such deaths in 2020, health department Deputy Commissioner Kelly Dougherty said, a milestone that would make 2020 the deadliest year on record for overdoses.
The initial figures appear to confirm what state health officials and providers spanning the state's "hub and spoke" treatment system feared as the pandemic arrived: that social isolation, service limitations and economic hardships might worsen the existing opioid epidemic.
"When the shutdown happened, all of the people who work in the substance-use division of the Department of Health, that was where their minds immediately went," Dougherty said.
The case surge has not been confined to any one corner of the state. Through July, Rutland County had already matched its 2019 death toll of 11; Windsor surpassed last year's 13 deaths. Orange County had no deaths in 2019 but has four so far this year. Chittenden County, with 14 deaths, has nearly topped last year's total, prompting Burlington city councilors to revive an effort to open an overdose prevention facility.
On Monday, the council unanimously passed a measure to study whether it's possible to create such a site. The resolution directs the city attorney to conduct a legal analysis and the city opioid policy manager to draft a project plan. Their reports are due back in November and December, respectively.
"There was a period where we were seeing declines in fatalities — significant ones," Council President Max Tracy (P-Ward 2) said before the meeting. "But that trend has, unfortunately, reversed in very troubling ways."
Multiple factors have likely contributed to the spike, providers say. Users who inject heroin alone are at higher risk because now it's even less likely a loved one or someone else might be around to administer the overdose-reversal drug naloxone, branded as Narcan. Officials suspect the dangerous practice of using alone may have increased during monthslong lockdowns.
It's not just deaths that have increased, either. The proportion of nonfatal overdoses among all emergency room visits was twice as high in June as in the same month in 2019, according to the health department.
Additionally, there are signs that fewer people sought treatment, either because it wasn't available or the individual chose to stop going. Similarly, providers say more people in recovery seem to be relapsing. Some of those found it difficult to take advantage of recovery services in the age of social distancing.
"Everything is still kind of limited," said Tracie Hauck, executive director of Turning Point Center of Rutland, which provides recovery coaching. "It's going to wear on people that are maybe in the early stages of recovery."
The Rutland County woman who died was well known to Hauck's center. She had struggled with her recovery, Hauck said, and may have spent some of her federal COVID-19 stimulus check on drugs but seemed to be "in a good place" before fatally overdosing in the spring.
Throughout the spring and summer, the center struggled to maintain relationships with clients and help them keep their recovery on track. Hauck canceled in-person group sessions but determined that virtual substitutes weren't effective in many circumstances. The center does a lot of work with prisoners, for example, who couldn't convene for a group Zoom meeting. Instead, a recovery coach began writing letters to incarcerated clients.
"Some people I was doing coaching for prior to COVID-19, they didn't want to continue coaching because they didn't want to do it over the phone; they didn't want to do it by Zoom," Hauck said. "You feel like your hands are tied and there's no other way to help them."
The needle exchange in Rutland, one of three operated by Vermont CARES, has given out many more clean syringes, naloxone doses and fentanyl testing strips in the last 12 months than during the prior year, according to data the nonprofit provided. The amount of naloxone distributed at the Rutland site has more than doubled. Yet the number of clients and site visits has dipped slightly.
Associate director Theresa Vezina said the numbers suggest that clients are taking extra supplies to give to friends, a practice known as secondary distribution. The organization was able to continue reaching most clients largely by using its mobile van program, which accounted for more than half of its 739 client interactions in Rutland County over the last year.
Still, those pandemic-era interactions were brief and physically distanced, which provided less opportunity to reinforce tips about safe practices or to strengthen personal relationships.
"For the first couple of months, we didn't let people in the office," Vezina said. "They had to call from outside the door. The privacy and confidentiality piece was totally gone."
During that time, drug users may have been especially vulnerable to predatory dealers. The same anxieties that have driven up alcohol sales across the state during the pandemic can prompt those with substance-use disorder to relapse.
Meanwhile, the criminal justice system slowed, meaning dealers caught for distributing heroin were sometimes given citations with distant court dates, said Jackie Corbally, the outgoing opioid policy manager for the City of Burlington.
"If you're dealing, this is paradise for you," she said.
Some hotels that were repurposed as emergency housing have become treacherous environments for residents battling addiction. The close proximity to other users can make it hard to abstain and provides a particularly convenient market for dealers. The state now pays providers, including Turning Point, to distribute harm-reduction bags containing naloxone and resource brochures to the hotels. Hauck's team drops off 250 bags each month in Rutland County, she said.
In this destabilized situation, fewer people have sought help from a University of Vermont Medical Center program that invites emergency department walk-ins to enroll in medication-assisted treatment. The grant-funded, low-barrier program was regularly seeing a dozen or more new enrollees every month before COVID-19 struck. Only one person signed up in all of April, May and June — and that person did not follow up, a hospital spokesperson said.
Roz Bidad, program manager for emergency medicine research, noted that overall emergency room visits have also dropped significantly and that an "overabundance of caution" about the virus could be dissuading some from seeking treatment.
The program saw a slight improvement in the last two months: six new sign-ups.
Another promising sign: Overdose deaths in June and July were actually down slightly from 2019 levels, according to the health department.
At Monday night's city council meeting, Burlington Mayor Miro Weinberger said he sees policing as another underutilized gateway to treatment. He recently proposed hiring two social workers for the embattled Burlington Police Department, a pitch he tied to the epidemic. Those workers' duties, the mayor said, could include contacting people whom responding officers screen for opioid-use disorder.
"If we expanded the number of social workers at the police department, we might be able to follow up with more of these people and get more of them into life-saving treatment," he explained.