State of the state addresses—like the State of the Union—tend to cover a wide range of topics from the economy to health care to education. Vermont Governor Peter Shumlin broke the mold when he devoted his entire 2014 State of the State address to the state’s drug addiction crisis. The rising tide of drug addiction and drug-related crime spreading across Vermont is “more complicated, controversial, and difficult to talk about” than any other crisis the state confronts, he said.
“We have lost the war on drugs,” he said. ” The notion that we can arrest our way out of this problem is yesterday’s theory.” Even though Vermont is the second smallest state in the union (pop. 626,600), more than $2 million of heroin and other opiates are being trafficked into the state every week. Shumlin expressed alarm over the increase in the deaths from heroin overdose that doubled in 2013 from the year before and the 770 percent increase in treatment for opiates.
Shumlin told emotional stories of young Vermonters becoming addicted to prescription opiates and heroin — one recovered, one died from an overdose. While stories of young and promising individuals dying from heroin overdoses may grab headlines, data from the Centers for Disease Control and Prevention (CDC) show that deaths from prescription opioid pain relievers — such as codeine, methadone, and oxycodone — between 1999-2008 now exceed deaths involving heroin and cocaine combined.
CDC reports that in 2008, 36,450 deaths were attributed to drug overdoses in the U.S. Opioid pain relievers were involved in 14,800 deaths (73.8%) of the 20,044 prescription overdose deaths. The drug overdose death rate of 11.9 per 100,000 (Vermont’s rate was 10.9 per 100,000) was roughly three times the rate in 1991. Prescription drugs accounted for most the increase. An April 12, 2012 statement from the Office of National Drug Control Policy reported that death from unintentional drug overdoses is greater than car accidents, the leading cause of injury in the U.S.
Shumlin acknowledged the need for changes in the state’s judicial system and law enforcement – to intervene with users when they are most receptive to treatment options (when the police cruiser’s blue lights are flashing) and to impose swift and severe punishment for high-volume dealers and individuals who use firearms in robberies. He also spoke of the need for expanding treatment options and his support for legislation and funding “to bring evidence-based assessment and intervention programs statewide as quickly as we possibly can.”
But Shumlin identified preventing addiction as the toughest and most important task. It is a challenge, he said, “without a clear national model or consensus on what works best.” He proposed several different strategies including education efforts geared to high school students (using a film “The Hungry Heart” about addiction in Vermont) and programs to equip medical providers to intervene and educate patients about how to avoid addiction. He also noted that the Affordable Care Act (ACA) requires coverage for the treatment of substance abuse disorders.
Shumlin made the case for a greater role for schools. “We know that risky behavior develops early in life and too often accompanies family difficulties and dysfunction,” he explained. “When parents struggle, children suffer, and we all pay the price for years to come. This is why we must continue our focus on the earliest years.” He also promised to sign a bill for all Vermont children to have access to quality universal pre-kindergarten “to set them on the right path.” Universal pre-K programs in Oklahoma, Georgia, and Florida are often identified as models.
The national heroin addiction crisis, according to a January 8 New York Times article, is similar to the crisis in Vermont and the rest of New England in scope and severity: “While it may be acute in Vermont, it is not isolated. In the past few years, officials have reported a surge in the use of heroin in New England, with a sharp rise in overdoses and deaths, as well as robberies and other crimes common among addicts. Those same statistics are being replicated across the country. Lawmakers in virtually every state are introducing legislation in response to what is rapidly being perceived as a public health crisis.” These legislative proposals are detailed in the National Conference of State Legislatures’ report “Prevention of Prescription Drug Overdose and Abuse.”
PBS News Hour anchor Judy Woodruff interviewed Shumlin and Ryan Grimm, author of the book This is Your Country on Drugs: The Secret History of Getting High in America. In the set-up to the conversation, Woodruff noted that the White House Office of National Drug Control Policy reported that the number of deaths involving heroin surged 45 percent between 1999-2010. Grimm noted that some states, such as Kentucky, are starting to treat the drug problem more humanely.
There are hopeful signs that drug addiction is increasingly being treated as a public health crisis as well as a law enforcement matter at all levels of government. True, the cost of confinement is a driver but so is the evidence that treatment works. Shumlin asked his fellow Vermonters “to listen to this math”: A week in a Vermont prison costs about $1,120, but $123 will buy a week of treatment for a heroin addict at a state-funded center.
What makes more sense for a better future for our children: building more prisons or investing in addiction prevention and treatment? Or better yet, preventing ACEs and building resiliency against them?