Johnson clinic gets Narcan vending machine

The number of annual opioid-related overdose deaths has steadily gone up in Lamoille County since 2015, reflecting a general increase statewide.

In comparison, Chittenden County saw 55 opioid-related overdose deaths in 2022, or a rate of 32 per 100,000 residents, while Rutland County saw 40 such deaths, or a rate of 66 per 100,000 residents.

Since 2014, 1,379 Vermonters have died from opioid-related overdoses, 450 more than the number of Vermonters who died from the COVID-19 virus since 2020.

The report also highlighted a concerning new wave of chemicals playing into accidental opioid-related overdoses. Though fentanyl remains king — responsible for 93 percent of deaths in 2022 — new drugs like gabapentin was involved in 13 percent of fatal opioid overdoses in 2022 — up from 2 percent in 2021 — and xylazine was involved in 28 percent of fatal opioid overdoses — up from 13 percent in 2021, according to state data.

To Caroline Butler, a nurse practitioner who heads the Johnson Health Center, the rising prevalence of these new drugs could be a harbinger of a new wave of overdose risk, complicating the already dangerous drug cocktails that lead to accidental overdose deaths in the first place.

From her vantage point working with individuals in recovery and seeking treatment for any number of other issues, Butler also warned that opioid-related overdose deaths recorded by the state only scratches the surface.

“It’s been a rough few years, and we’re losing people,” Butler said. “It’s not just overdoses. There are so many other related causes that are playing into it.”

Free Narcan

The Johnson Health Center opened late last year as a low-barrier health clinic serving the Lamoille County community’s general needs with a focus on providing services within the Jenna’s Promise opioid recovery nonprofit.

Butler worked in addiction-stricken communities throughout Vermont before coming to Johnson, an experience that has only strengthened her belief that people should have access to and be educated about naloxone and buprenorphine, drugs that stop opioid overdoses and reduce opioid dependence, respectively.

To this end, the medical center will soon install a vending machine filled with Narcan, a brand-name for naloxone, outside of its facility. The first of its kind in the state and paid for by a grant from the University of Vermont’s Center on Rural Addiction, the machine will ensure access to potentially life-saving intervention drugs will be easier than grabbing a candy bar.

Jenna’s Promise, which was founded in 2019 following Jenna Tatro’s accidental overdose death, sought out the vending machine after a Johnson resident became one of the eight Lamoille County overdose deaths recorded in 2022.

“Fentanyl, it’s just like a sniper and the variability of the strength and the way it really does just take people out, it doesn’t matter if somebody’s an experienced user, or it’s somebody that’s doing it for the first time, it’s taking out anybody and everybody,” Butler said.

Having naloxone on hand and knowing how to use it can mean the difference between life and death, and Butler recommended that even those who don’t think they’ll ever be in a situation that will require such an intervention should familiarize themselves with its use and carry the drug with them. The nasal spray bottles are convenient to carry in one’s purse, Butler said.

“One of the things that we’re really working hard to do is just normalize that this happens,” Butler said. “When we put the defibrillators in malls and supermarkets and things like that, everybody was like, ‘Well, we’re not going to use that.’ And now, what’s the first thing you do if someone’s having a heart attack in public? You run for the defibrillator.”

Problems ahead

As new chemicals contribute to the already dangerous conditions created by fentanyl spread, advocates and medical experts like those at Jenna’s Promise are urging creativity and further action from lawmakers when it comes to stemming the growing stream of opioid-related deaths in Vermont.

Daniel Franklin, who was brought in as the Jenna’s Promise chief operating officer last July after leadership roles with the North Central Vermont Recovery Center and the Vermont Association for Mental Health and Addiction Recovery, pointed out that the growing prevalence of xylazine in opioid-related deaths was particularly troubling, as it affects breathing and isn’t counteracted by naloxone.

Another related crisis is also brewing. Despite protest from the progressive wing of the Legislature’s Democratic supermajority, funding for a pandemic-era expansion of the state’s emergency hotel housing program will expire in July and is expected to see approximately 2,500 people newly homeless across Vermont, including 600 children, according to VTDigger.

In Lamoille County, 105 adults and 42 children are currently homeless or at risk of homelessness, according to Lamoille Community House director Kim Anetsberger, and to complicate local matters further, a new expanded homeless shelter in Hyde Park has been delayed by a zoning appeal.

Franklin pointed out that many of those currently in the hotel housing program are struggling with addiction to opioids.

“Regardless of what you believe about the value of that program, the fact is, we’re going to have many people affected by mental health challenges and substance use and abuse and human trafficking that are out in our communities, so we’re going to have to react and adjust what may be coming ahead of us,” he said.

During the recently concluded legislative session, lawmakers passed a bill establishing legal immunity for those who operate drug-checking sites, but declined to do so for safe injection sites, also known as overdose prevention centers, where opioid consumption is conducted in a safe and supervised environment, and other resources for drug users are provided.

Gov. Phil Scott vetoed a bill that would have commissioned a study of such sites in 2022.

Still, Butler hopes to eventually see an overdose prevention center in Burlington, which she believes would be the perfect place to see a pilot program. As lawmakers take what he sees as “small steps,” Franklin said recovery programs are already doing the work on the ground.

“Our state likes to study things and do pilots to see what’s going to work, but in many ways, we know what’s going to work,” Franklin said. “I think we’re continuing to make headway here in Lamoille County. We don’t let studies get in the way of action, we are being aggressive about getting Narcan and harm reduction packs out widely.”

Franklin would also like to see greater collaboration and less siloed separation between mental health and support programs and the recovery community, including more involvement in prisons, where a large majority of the incarcerated are also addicted to opioids.

Promises kept

Coming into its fourth year, Jenna’s Promise uniquely exemplifies the kind of un-siloing that Franklin is calling for in its “recovery village” format, establishing a web of interconnected health and social services and businesses that employ people in recovery from addiction throughout Johnson by occupying and, in some cases, rehabilitating buildings that had fallen into disuse.

“The reality is that there are communities who have not supported addiction services, they’re afraid of what, in our field, we call the bad element,” Franklin said. “They think that if you have the services for people (in recovery) that it will invite people into the community who are going to do bad things, who are going to commit crimes or use drugs out on the street or whatever, and we, I think, have shown that quite the opposite is true.”

Politicians from across the political divide have touted Jenna’s Promise as a model for effectively combating the opioid epidemic, though the organization has been fueled by the uniquely personal grief of one family with the social and political relationships to secure private as well as government funding for its programs.

This, along with the rare local willingness to embrace the reshaping of the town’s business community by the nonprofit, makes the Jenna’s Promise experiment, despite its success, appear perhaps too singular to be replicated.

“I think the Tatros have built something that is incredibly special, so it would be hard to imagine being able to find similar leadership, as amazing as they are, but I do think that this model works, and I think there are pieces we can put together in a replicable package,” Butler said.

The key to the recovery village model of care for Franklin is the sustained relationship it creates between those addicted to opiates and support services.

“Quite simply, we often don’t give up on people that the system does give up on,” Franklin said. “We’ve managed to help people finally find recovery who really had had so much closed off to them. We bring in the community into these environments, whether it’s our cafe or our community center, and we’ve shown that when you mix people, when you put people in a position to interact with each other, whether they have an addiction or not, it breaks down the stigma, it helps people realize that we’re all affected by this.”