Dangerous, ignorant leadership has no place in drug policy

Dangerous, ignorant leadership has no place in drug policy

The remarks of the Vermont commissioner of public safety were dangerous and, true to form, ignore evidence-based realities about opioid-use disorder in the state’s response to a deadly epidemic. It’s time for him to go.

NEWFANE — On April 16, a press conference addressed the major drug bust that happened in Brattleboro not long ago.

This media event was held, in part, to commend law enforcement for handling this enormous task and a job well done.

Commissioner of Public Safety Tom Anderson also wanted to put folks who are selling “on notice” - an effort that we know, from the failed war on drugs, is ineffective. The idea of going after the supply might make us feel safer, but it only holds false promise.

We have seen for many years that targeting of vulnerable people suffering from this disease causes great harm. The war on drugs is failing, and the problem with opioid-use disorder is growing. We now know that the threat of prison does not heal the people with this disease - and that, yes, this is a disease.

* * *

I found most concerning the comments from Commissioner Anderson. His statements were alarming and his direction the wrong one for our county and our state.

Most egregious was this statement: “The message that I want to send is an uncompromising one: you stop selling this drug whether you are addicted to it or not. You get into treatment, or you get arrested.”

He then went on to say: “whether you are the top-level dealer or the individuals selling this drug to sustain their own habit, you are part of the problem.”

With that, he created a stigmatizing and shaming narrative that will do the direct opposite of getting folks suffering from the disease “into treatment.” Those words will make it even harder for people to raise their hands and ask for help.

Furthermore, his message ignites stigma against folks with the disease in our community. With this message, he has now accused folks with the disease of killing their friends.

They didn't kill their friends.

This disease did. The Sackler family did. Purdue Pharma did. This state not moving quickly enough to embrace harm reduction did. The lack of access to low-barrier medically assisted treatment did. The lack of access to long-term treatment did. Their mental illness did. Their trauma did. Our country that is just allowing us to bury our children at alarming rates did.

No, they are not part of the problem, they are victims of the problem. Their friends were suffering from a disease and with or without the drugs that may have been sold to them in that moment, they would have used and they would have died.

* * *

These statements on the whole are extremely dangerous and, in true Tom Anderson form, ignore important realities about the science of the disease.

We hear time and time again from most officials, law enforcement, and even the governor that we can't arrest our way out of this problem. It strikes me that Anderson came to Windham County, the county struggling the most, to tell us that that is just what he plans to attempt.

All of the evidence before us says that we can go after the supply of drugs endlessly and doing so will be like playing whack-a-mole until we address the demand.

The commissioner also said: “We have done a tremendous job in this state of getting treatment to individuals that want treatment. [...] I think the health commissioner would say that we have treatment on demand, virtually across this state at this point. So, I think the excuse that you can't get into treatment [...] rings hollow to me.”

This is inaccurate.

Talk to any family member who has lost a loved one, to most people in recovery, to most people with active use: there are still wait times.

I will say that again: there are still wait times.

The barriers are still too high for many to get and stay on medically assisted treatment, and there is no true long-term residential treatment for you in this state. (The 21-day regimen covered by Medicaid is not true long-term residential treatment.)

Even when you meet the mark and you are ready, your job may conflict with access, your lack of transportation may conflict with access, your family obligations may conflict with access, or the requirements you may not be ready for may conflict with access.

And even if all of that is not true, in the recent testimony from Health Commissioner Mark Levine M.D., he said that you are waiting an average of 72 hours for your first appointment, and you might not be given treatment in that visit.

In 72 hours, someone in active opioid use disorder may use up to 15 times.

That means their life is at risk up to 15 times in that time frame.

This is not by any stretch of the imagination “treatment on demand.”

I have called for treatment on demand in my plan to heal the epidemic for the reasons above and, while I am glad that my language is catching on, it can't be used to create a false narrative about existing treatment availability.

* * *

Commissioner Anderson is outspoken, uncompromising, and constantly putting up roadblocks to us making progress on this disease. This is especially dangerous in Windham County, where our deaths have risen astronomically since 2016 - 60 percent in 2018 alone.

We are in the middle of a massive public-health crisis and he is partially responsible for the slow rate of progress and thus the death of many around our state.

If this were an isolated incident of Anderson being wrong, while unfortunate, it might be forgivable. If it were the only time that he dug his heels in on the war on drugs despite the strong evidence that it doesn't work, it might be forgivable. However, this is a trend.

In March of 2017, when overdose prevention sites (OPSes), formerly known as safe injection sites, came up as proposed legislation, he said it “sends the wrong message, at the wrong time, to the wrong people.“

In his own letter sent to the media later that year, he cited research that actually indicates a drop in hepatitis and HIV infections in places where there are OPSes. He warned of significant risks, but failed to list them at all - much less provide real peer-reviewed data.

This is also not uncommon for the commissioner, who claims a scientific basis for his approaches but cannot refer to any specific studies when pressed.

The reality is that all the research on this disease tells us that use is not encouraged by providing harm-reduction alternatives. It is reduced.

* * *

When Chittenden County State's Attorney Sarah George announced that she would no longer be prosecuting for misdemeanor amounts of buprenorphine, Commissioner Anderson came out against her policy change with a sky-is-falling warning.

The sky has not fallen in Chittenden County. In fact, in that county, the number of deaths decreased by 50 percent in 2018, while many other counties - including our own - saw their death rates skyrocket.

Arguably, this was the one major shift early enough in 2018 to have made a difference. This measure saved lives.

When this same measure was proposed in legislation this session, the commissioner, rather than reconsider his position, doubled down on his war on drugs and has made his voice heard to anyone who will listen.

He recently stated in an interview on Vermont Public Radio: “What I have serious concerns about is proponents equating effectiveness of buprenorphine usage as part of a treatment program with the unsupervised use of diverted buprenorphine.”

Since George took this measure in Chittenden County, we now have excellent data.

Several studies show that use of illicit buprenorphine is a strong indicator toward treatment.

Also, they show that the shame of the disease is often a huge barrier to accessing treatment and thus this measure can reduce that shame and provide a pathway to recovery.

The commissioner also likes to rest on one statistic: that across the country in a single year, 43 people died of an overdose that included buprenorphine.

This doesn't mean those people died from buprenorphine; it just means the drug was present.

But more importantly, in that same year 55 people died from a lightning strike.

Also in that same year, 70,000 people died from an opioid-related overdose.

Put another way: That year, the number of deaths from opioids - in the crisis that our families are facing every day in this state and across the country - was 1,628 times higher than the number of deaths from buprenorphine.

* * *

Finally, just the other day, I sat in on testimony that the commissioner was giving in the House Judiciary Committee regarding roadside saliva testing for cannabis.

He kept contradicting himself. “Why wouldn't you want the jury to have all of the evidence?” he asked, yet he also said that the test “would not be admissible in court.”

When pressed on the science, he claimed that the test was relevant, yet also said that it doesn't indicate that a driver is actually intoxicated at the time the test is administered.

At one point he said, “I don't have any studies in mind to refer to.”

There is overwhelming evidence that roadside testing proves nothing, is extremely expensive, inaccurate up to 13 percent of the time, and thus ultimately lands as not useful and prejudicial.

Once again, the commissioner was not able to follow the science.

Perhaps the most alarming part of this testimony was when he was pressed about the idea that this measure, if passed, could prove to be another way in which people of color are targeted disproportionately.

“I don't see how that is relevant to this conversation,” he said.

To the commissioner, I say: How this will impact marginalized communities is always relevant to the conversation.

* * *

Are we willing to accept that the commissioner of public safety in Vermont refuses to look at and utilize the up-to-date science on important public-health issues?

Is it OK with us that he has doubled down on the war on drugs despite the clear and concise evidence that informs us that this approach has failed?

Do we accept that he seemingly does not understand the issues of racial bias that put us in the top five in our country for racial inequity in our prisons?

I don't.

I think it is time for us to move forward. We must ensure that every public official understands the imperative to our citizens, to those suffering, to families dealing with loss, and to our communities to use best practices and up-to-date science and strongest-serving public-health measures - the ones that have proven successful in combatting this disease - in order to ensure the best outcome, reduce death, and make our communities safer.

I call on Governor Scott to remove Commissioner Anderson and replace him with a commissioner who understands the imperative. We cannot tolerate a public servant who would come to the county with the most deaths in the state from this crisis, a region where families are pleading for a way to help their loved ones, and give an “uncompromising message.”

Instead, we need compassion.

We need many more resources and tools.

We need public-health measures.

We need to follow the science.

Governor Scott, our families and friends who are suffering cannot continue to have to fight the war on drugs while we struggle to save our loved ones. Commissioner Anderson's recent words in Brattleboro amount to a war on people suffering from opioid-use disorder.

Enough lives have been lost. Please appoint a new commissioner and help us deal with this epidemic.

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