- Thomas James
On Phil Scott's first day as governor in 2017, he signed an executive order creating the Opioid Coordination Council to tackle Vermont's drug crisis. At a Statehouse press conference this January, he touted 22 strategies the group had proposed, ranging from school prevention programs to expanded drug treatment for inmates. The Republican governor also mentioned the drug fight in his State of the State address last month, pledging, "We will not slow our progress or our search for answers."
Nearly three weeks later, Scott proposed a 2019 state budget with no new funding for opioid addiction services.
"That's shocking, given the moment in time that we're in with the opioid crisis," said Rep. Selene Colburn (P-Burlington). "Where's the urgency?"
Health Commissioner Mark Levine told the House Human Services Committee about the level-funded budget in early February and tried to provide a positive spin. "The good news in this is, there is nothing proposed to be cut," he said.
Rep. Ann Pugh (D-South Burlington), the committee chair, sounded as if she were struggling to understand what Levine had just revealed. "We have an opiate crisis. We have a need for providers. We have a need for prevention. And there's no increase to address that," she said.
Levine went on with his budget presentation without attempting to address Pugh's observation.
Days earlier, he'd told the committee that fewer than 8,000 of the estimated 20,000 to 30,000 Vermonters addicted to opioids are receiving treatment. The Vermont Department of Health hasn't released the 2017 overdose death tally yet, but Levine suggested that it would be similar to 2016, when a record 106 people died. That's an average of two Vermonters dying each week from an overdose.
When Seven Days sought to confirm that the budget contained no additional money for programs addressing opioid abuse, Levine had a ready reply. "That's an easy question to answer," he said. "The answer is no, but there's no decreases — no cuts."
How can the administration justify that when, by Levine's own estimate, as many as 22,000 Vermonters are going without treatment?
Levine said he didn't see a contradiction. "You heard me talk about all the funding that we think the federal government should be [giving to] states," he noted.
He and Scott recently testified at a congressional hearing to describe Vermont's efforts to address opioid addiction and to make a pitch for more money. But back in Vermont, the commissioner didn't sound especially optimistic about help from Washington, D.C.
"We have this — I won't use the word 'fantasy' — I'll just use the word 'aspiration' that the federal government will listen," Levine told the Human Services Committee. "Obviously, none of us are holding our breath," he added.
Extra dollars are equally hard to come by in Vermont, where Scott has made clear he'll reject any proposal that includes new taxes or fees.
"That's a big reason" the state level-funded the opioid programs, Levine said in an interview.
While Scott's health commissioner acknowledged the budget situation, his communications director, Rebecca Kelley, argued that it was incorrect to say the budget includes no new funding for opioid addiction services.
She pointed to three initiatives in Scott's 2019 budget: a $400,000 pilot program to send nurses into homes in two communities to provide services for mothers and infants; a $500,000 investment in the Department for Children and Families to "facilitate parent-child contact" during child protection court cases; and investments in mental health care, which, Kelley claimed, "will have some overlap in supporting those with both mental health and substance use disorder challenges."
A policy paper on what's been billed as a "universal" home-visiting program suggests that the families of newborns exposed to drugs would be eligible for up to a year of services. Other families are limited to three visits within a 16-week period. Kelley said physician referrals would help the state identify families with drug problems.
Either way, Pugh didn't sound impressed. "Having 'universal' home-visiting in two communities, of which maybe they'll go to a few of the homes of newborns [exposed to opioids], is not a way of really tackling this," she said in an interview. Her committee has chosen not to endorse the proposal, noting in a memo that the state already operates several home-visiting programs.
Making the case that "new spending is not the only way to take action or demonstrate commitment to an issue," Kelley also cited three actions Scott has undertaken without additional dollars.
A tobacco-prevention position at the Agency of Education has been repurposed to become a substance-use-prevention coordinator. This spring, the Department of Labor will start offering career counseling in recovery centers, drug-free locations that serve people getting back on their feet after addiction. And the administration is working to streamline the licensing process for mental health counselors.
Some of these efforts overlap with the Opioid Coordination Council's 22 recommendations. Most of the others conveniently call for more research, not money.
The state, meanwhile, spent approximately $275,000 on salaries and benefits for two council staff members.
"The nice thing about the OCC is, it came out with a lot of recommendations — most of them didn't have a budget on them, and many of them have a working group or study group associated with them," Levine said.
To be exact, none of the recommendations came with a price tag, and nine of them call for further study by new work groups — committees that are often synonymous with delay.
"Oh yeah, yeah, yeah," said Levine, acknowledging such a reputation. "But in this case, it's not a delay."
The commissioner made the case that the administration needs more time to analyze where to make investments. That process shouldn't take long, Levine said, noting that a number of the work groups have been given deadlines of six months or less.
Some legislators have lost patience with study groups. "I've seen a lot of approaches that are about bringing the right people around the table, gathering their knowledge, needing more time to reflect on it and study it and understand it before moving forward," Colburn said. "Meanwhile, people are dying, you know?"
The Burlington rep thinks the state could be doing more to expand treatment services. While waiting lists at clinics have shrunk significantly, some people are still waiting or traveling long distances to get their addiction meds.
It's not yet clear how hard the legislature will push to get more resources into the budget. Pugh said her committee's top priority is advocating for an additional $165,000 to bolster recovery centers. Several other committees have been working with the Scott administration to try to expand opioid treatment for inmates.
Beyond that, lawmakers don't appear poised to undertake major new efforts to tackle opioid addiction.
"To put forth a package that would not see the light of day is not a good use of our time," Pugh concluded.
Such modest proposals create challenges for those working on the front lines.
"To not have resources behind [the council's report], I think, is really unfortunate," said Catherine Simonson, chief client services officer at the Howard Center in Burlington. Her boss, CEO Bob Bick, serves on the council.
The Howard Center is the largest of Vermont's designated agencies — the organizations the state funds to provide mental health and substance abuse services.
One of the greatest impediments to providing substance abuse treatment, according to Simonson, is recruiting and retaining the clinicians who make it possible. Better wages, education loan repayment programs and other incentives would help address the shortage of drug counselors and nurses, she suggested.
The Opioid Coordination Council's report acknowledges a need to expand the workforce. But rather than new spending, it recommends forming a subcommittee to find strategies to address the issue.
"It puts us in a really tough predicament," Simonson said. "We need to look at reducing services in order to find dollars to increase compensation. That's not a place where we want to be."
Another urgent need: ensuring that addicts have access to syringe exchanges. In addition to distributing clean needles and the overdose-reversing drug Narcan, the exchanges serve as a conduit to treatment. Without more money, some exchanges may cut back on services.
Safe Recovery, the Burlington exchange run by the Howard Center, referred 854 clients to treatment last year and safely disposed of 300,812 syringes, according to Simonson. But when a private grant expires at the end of June, Safe Recovery will have to cut its staff from three full-time employees to one and a half.
The shortage of staff means the Howard Center will struggle to keep the needle exchange open, she said.
Simonson also noted that a number of Safe Recovery clients travel to Burlington from other counties, where exchanges are understaffed, have limited hours or simply don't exist. The state's seven other syringe exchanges are open only 3.4 hours a week on average, according to the council's report.
Simonson said the report "showed great attention to the importance of this work, and yet there were no new dollars allocated." Instead, it calls for a working group to come up with a plan to expand syringe exchange programs by June.
Members of the Human Services Committee also expressed concern for the state's 12 recovery centers, which Levine described as operating on a "shoestring budget."
Pugh asked whether Scott's budget directed more money to them.
"So, nothing in the budget to actually support each center," Levine responded, "but that's part of the study process."
Scott did take action last week, signing a proclamation that declares February 14 "Recovery Day."
"Partners in Vermont's public and private sectors are working tirelessly to find solutions to curb this epidemic, and many from around the country and the world are turning to our state as a resource," the governor said in a press release.