Two states, same problem, different responses

MILTON, Vt. — On a cold morning last month, as Rusty Beaupre was walking his daughters to the bus stop, he spotted something gleaming on the ground: two syringes on a bed of thawing dirt and pine needles.

“Everyplace you turn, it’s there,” Beaupre said.

The heroin scourge — exemplified by this town of roughly 10,000 people stretched out over 61 square miles just north of Burlington — has spread to all corners of Vermont, so much so that Gov. Peter Shumlin dedicated his entire State of the State address in January to what he called the state’s “full-blown heroin crisis.”

And that unprecedented move — which has attracted an onslaught of national, and even international, attention to this bucolic state with fewer residents than Bergen County, N.J. — has galvanized public health officials and law enforcement in an ambitious, if still unproven, effort to fix the drug problem from the ground up.

Whether Vermont’s efforts will work, and whether they might be a model for other states, including New Jersey, remains to be seen.

The two states face similar challenges. Both have reported an eightfold increase in demand for opiate-addiction treatment at state-licensed facilities in the past decade, along with a doubling in overdose deaths involving heroin and a rise in crime and gang activity.

But their approaches differ. Vermont has put in place a broad, coordinated law enforcement and public health response. New Jersey so far has focused largely on drug arrests and acute emergency care.

Under Gov. Chris Christie, the state has expanded drug courts — already considered among the nation’s most ambitious — and inmate addiction care and passed a good Samaritan law protecting those who assist people experiencing a drug overdose. The governor approved a $2.5 million pilot program in 2012 to require court-supervised rehabilitation of low-level offenders who would otherwise serve time in prison. And he made addiction treatment a focal point of his own State of the State address this year, praising current programs and acknowledging the need for more action.

“New Jersey’s approach to reclaiming lives is working,” he said.

Those initiatives pale in comparison to Vermont’s, however. Unlike Vermont, for example, New Jersey has not had a general expansion of treatment programs, and doctors are not required to register with the state’s prescription monitoring program.

“I had hoped New Jersey would be a leader on the opiate epidemic, the problem with pills,” said Frank Greenagel Jr., who led a state task force on heroin and opiate addiction. “I think we will be a middle-of-the-pack state.”

The two states’ heroin problems are reflections of their population and geography. In New Jersey, a densely packed state with a population approaching 9 million, users ranging from wealthy suburban youth to lifelong addicts seek out heroin in cities. In Paterson, the destination for North Jersey addicts, officials say millions of dollars’ worth of highly pure, cheap heroin is packaged and sold in open-air markets each week.

Vermont, a rural state with a population of fewer than 630,000, is at least one step removed from the source: Dealers bring backpacks of heroin up the I-87 and I-91 corridors from North Jersey and New York City by bus, rental car and train, moving in and out of rental properties in small cities and towns, and dispense to waiting customers, often at a steep markup — up to $30 a bag, compared with $4 or $5 in Paterson.

“It was never this bad, growing up,” Beaupre said. “It’s coming out of the big cities. They’re coming to Vermont.”

Officials in Vermont say that while the most visible addicts are unemployed residents on public assistance, the epidemic has touched families at every socio-economic level.

“I don’t think there’s a town that would say it’s not a problem,” said Barbara Cimaglio, Vermont’s deputy health commissioner for alcohol- and drug-abuse programs. “But I think in Vermont, where everybody values the quality of life, to see this kind of thing happening, people are saying: ‘We don’t want to become this kind of state. We have to do something about this.’ “

To be sure, there is increased public awareness of the problem in New Jersey, with communitywide forums and statewide reports. But the lack of sustained engagement has led to complaints from some families and professionals that Christie, a Republican, and the state Legislature, which is dominated by Democrats, have not been more ambitious.

“Racing around and arresting people who are addicted to the drugs — we spend a ton of money, and we’ve almost in some perverse way institutionalized this crisis,” said state Sen. Joseph Vitale, D-Woodbridge, chairman of the Health and Human Services Committee. “It’s exploded. There has got to be a comprehensive approach.”

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The state budgets in both New Jersey and Vermont set aside increased financing for addiction treatment this year, but the money would be used differently.

Vermont’s $5.6 billion budget increases support for substance abuse and mental health funding, along with affordable housing, needle exchanges and child care. It also moves to fold addiction programs and primary care into a single health organization.

In his January address, Shumlin said his policies “are designed to reframe the way we solve drug addiction and drug crime in Vermont, attacking it first as the health crisis that it is, while simultaneously retooling our criminal justice system and strengthening law enforcement.”

Christie’s proposed $33 billion budget dedicates $4.5 million in increased funding for the drug courts — partly to expand capacity in addiction-care facilities — and $1 million toward employment services in the program. Community Mental Health and Addiction Services were budgeted a total of $406 million, roughly level with last year.

“The latest thing we’ve seen is politicians saying they really care about the issue, but they’re not putting money into services,” Greenagel said.

“Governor Christie is saying the right things, but it seems like his hands are tied because of the budget,” Greenagel said.

Vermont has a unified Democratic Legislature and a Democratic governor, and it is the only state in the union that does not require a balanced budget.

Last year, a report by Vermont Blueprint for Health — which administers the state’s health care reform — identified a “collective sense of crisis” about prescription drug and heroin abuse, compounded by a “lack of access to treatment services.”

The report also identified “extraordinarily high public spending on Vermonters with opioid addiction.” In 2011, the state reported $45 million in Medicaid bills for 3,415 people who received treatment for opiate dependence — nearly three times the average per capita cost for other Medicaid recipients. They were also less likely to be employed and more likely to be incarcerated.

Vermont authorities have designed what they call a “hub and spoke” system that links primary care, treatment providers and local health teams offering Medicaid services. The state also has expanded medication-assisted treatment, such as methadone and buprenorphine.

It is looking into extending the required length of coverage of inpatient substance-abuse treatment for Medicaid patients, and its prescription drug monitoring program is now required of all physicians. The program is run through the Department of Health — not the Attorney General’s Office, as in New Jersey. Cimaglio says this reflects a recognition that addiction is a health crisis.

Shumlin has asked the Department of Public Safety to gather data about problem spots in Vermont. An online database tracks incidents by drug type for every police department in the state.

Despite these efforts, some Vermonters say their towns continue to be damaged by drugs and crime.

In Rutland, a city of 16,000 below the Killington slopes, Michael Moran, a 65-year-old Vietnam veteran, watched authorities descend on his street one night last fall. “It sounded like a tank,” he said: A helicopter thumped overhead as federal agents moved in with semiautomatic rifles and scopes.

“After the big bust, this neighborhood was wonderful,” said Moran’s wife, Faye. “It was like what it was when we moved in 20 years ago.”

But a few weeks later, she said, new dealers were back.

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In New Jersey, two state reports focusing on the opiate addiction crisis have been released within the last year, but to date no bills have been passed on any of their major recommendations. The first report, issued in July by the State Commission of Investigation, called for tightened prescribing practices and regulations for clinicians. The second, released by Greenagel’s task force in March, focused on addiction prevention, education and treatment.

Several bills have been introduced aimed at increasing penalties for heroin traffickers and unscrupulous prescribers, but none has moved far. And large-scale insurance reform, as well as mandating participation in the state’s prescription monitoring program, have been elusive. An administration spokesperson could not be reached for comment on the issue.

Sen. Loretta Weinberg said she expected progress on a bid to compel all prescribers to join the prescription monitoring fund.

“Whether we are ahead or behind the curve, the fact is we need to do it,” she said.

Vitale also said last month he was working on a package to expand treatment capacity and increase prescribing oversight. But he and others expressed hesitation about strict regulation of the health care industry — doctors have objected to prescription monitoring and patients’ advocates push back against over-regulation.

“There’s a fine line between being strict on prescriptions and denying people pain medication they legitimately need on a day-to-day basis,” Vitale said.

The Governor’s Council on Alcoholism and Drug Abuse, which sponsored the task force, is working on an advertising campaign to raise awareness about addiction.

Although Vermont is often ranked among the healthiest states in the country, it has long had some of the highest rates of drug use and binge drinking by adolescents and young adults.

As in New Jersey, Vermont’s latest wave of heroin addiction has its roots in the arrival of prescription painkillers, like OxyContin in the late 1990s, which opened up a market for opiates and paved the way for heroin’s resurgence across the Northeast. Recent measures to clamp down on prescription pill abuse may have pushed more users toward heroin, officials say.

In 2013, 21 people died of heroin-related overdoses in Vermont, compared with more than 400 in New Jersey, similar rates given the states’ populations.

More disturbing, for many, has been the accompanying crime. Trisha Conti of Vermont Forensics Laboratory said the office has seen more cases of people driving under the influence of drugs; her own family’s house was broken into by an addict last fall.

Milton police Detective Paul Locke said nearly all of his cases involved drugs, including break-ins and thefts, which have increased sharply.

Locke recalled a recent series of burglaries in which guns, including an AR-15 rifle, were taken and traded in Burlington and New York for drugs. Vermont’s high rate of gun ownership and its growing demand for drugs has created a regional cycle of supply and demand, Locke said.

After Shumlin’s address, reporters from around the world poured into Vermont. The images of junkies amid the ski slopes and maple farms shocked Americans and rankled many Vermont residents, who saw in these jarring exposes the same outsider meddling that brought the drugs there in the first place.

Few places received more attention than Rutland.

“When I arrived, things were really blowing up here — prescription drugs, heroin, opiate addiction was just going nuts,” said Police Officer Jon Dickerson. He said he moved to the city in 2010 after working for more than a decade in a Houston neighborhood, where violence and drugs were “a way of life.”

“Here, it’s smaller, it hits close to home,” Dickerson said. “People actually care.” He said the department was “consumed” with phone calls about thefts, overdoses, suspicions of drug-related activity in neighbors’ homes.

Rutland authorities have hope in Project Vision, a new coalition of law enforcement, social services and local developers that state officials have hailed as a model.

Arrests now lead to interventions, Tucker said. Team members work with families to provide long-term housing, employment and sobriety support. One Project Vision unit is studying burglaries and foreclosures as part of an effort to rehabilitate the area.

Shumlin has directed money to Rutland for an intervention program; the city’s lone methadone clinic is expanding to accommodate hundreds more people.

Still, addicts face innumerable “hurdles and barriers” to sobriety — and, for that matter, gainful employment and staying out of jail, said Prudence Pease, a case manager for Project Vision. She described her work with families as a constant uphill battle. And there are many more addicts than she can help.

“Maybe it’s just because I’m looking for it,” Pease said, “but I see it everywhere.”