Editorial: Opiate Addiction; Public Health Crisis in Vermont

If Vermont has been suffering from a quiet crisis of opiate drug addiction “bubbling just beneath the surface,” as Gov. Peter Shumlin put it last week in his State of the State Address, that part of the problem has been solved. The governor devoted nearly his entire 34-minute speech to the subject, to the exclusion of many important issues such as how he proposes to move the state down the road to a single-payer health care system.

Whether previously invisible or now highly visible, the dimensions of the drug addiction problem outlined by Shumlin are, if not shocking, certainly grave. The governor reported that since 2000, Vermont has seen a 770 percent increase in treatment for opiate addiction, up to 4,300 people in 2012, and a 250 percent increase in the number of people receiving treatment for heroin addiction; that 80 percent of the state’s prison inmates are either addicted or incarcerated because of their addiction; that the number of overdose deaths due to heroin almost doubled in the past year; and that law enforcement authorities estimate that drug trafficking brings $2 million worth of heroin and other opiates into the state each week.

Shumlin’s response is a sensible one, the key insight being the need to stop regarding drug abuse as solely, or even primarily, a law enforcement issue and begin dealing with it as the public health crisis that it is. To this end, Shumlin proposes to devote more money to treatment, by appropriating $200,000 immediately so treatment centers can begin to reduce backlogs of up to 500 addicts who are waiting for help and, in total, by adding $1 million to the $8 million the state already spends on treatment and recovery programs.

Shumlin also wants to give the 14 independently elected state’s attorneys the resources to establish early intervention and diversion programs in each county, so that addicts accused of committing crimes related to their drug abuse could choose to receive immediate treatment for their illness and, if they successfully complete that treatment, avoid prosecution. This is both a humane and cost-effective approach, given that, according to Shumlin, it costs $1,120 to keep somebody in prison for a week in Vermont, compared with $123 to get a week of treatment for heroin addiction at a state-funded center.

This approach would be coupled with stiffer penalties for high-volume drug dealers who make the quick and highly profitable trip up the interstates from urban areas to Vermont, as well as for those who use a weapon in the course of a home invasion.

Less detailed and less impressive was Shumlin’s treatment of what after all are the main questions: Why are so many Vermonters becoming drug addicts and what can be done to prevent addiction in the first place? The governor promised to convene a community forum at the Statehouse to solicit ideas — “we need all of us thinking big together” — but beyond that he had little to offer except to allude to the need to combat the ill effects of poverty and to create more economic opportunity for Vermonters.

Certainly conventional wisdom would agree with this proposed remedy. We assume that mental anguish derived from economic distress plays a large role in making people turn to drugs, much as physical pain does. But we can’t help but wonder if something more is not involved here, a sense of hopelessness more widespread, more profound and more deeply rooted than material circumstance would admit of. If so, the task is even more difficult than Shumlin imagines.