State, community efforts attempting to deal with impact of opioid crisis

VERMONT- The state’s opioid crisis was first brought sharply into focus - to Vermonters and to the nation - when Gov. Peter Shumlin took the unusual step of devoting his January 2014 state of the state address to the rising tide of addiction, crime, and overdose. “In every corner of our state, heroin and opiate drug addiction threatens us.  It threatens the safety that has always blessed our state.  It is a crisis bubbling just below the surface that may be invisible to many, but is already highly visible to law enforcement, medical personnel, social service and addiction treatment providers, and too many Vermont families.”  Shumlin called on the state to recognize the opioid crisis as a threat to public health.
The opioid crisis has had a deep impact locally. In the Deerfield Valley, last summer, a grassroots effort formed to assist people who are addicted to opioids and to support their families. 
At the group’s first meeting, Pettee Memorial Library assistant librarian Jennifer Razee said she worried about how to help and provide safety for people who she knew were using drugs in the library’s bathroom. She said the library had recently made the decision to put literature about recovery and install a sharps container in the bathroom to foster the safe discarding of needles. 
At that first meeting, Razee and several other attendees said they were inspired to come to the meeting by their grief over the June 2018 overdose death of local Connor Rusin. Rusin was 25 years old.
Last week, the group was trained on how to administer Narcan, a drug that temporarily blocks the effects of an overdose. The same week, Wilmington police reported that an unresponsive man had been found in the bathroom of a local business. According to the police report, the man was given two doses of Narcan. A third was later administered by Deerfield Valley Rescue, after which the man began to revive. He was transported to Southwestern Vermont Medical Center for treatment.  According to Wilmington Town Manager Scott Tucker, it’s the second time the same man has been revived 
According to a report recently released by the Vermont Department of Health, there were 110 opioid-related deaths in Vermont in 2018. Of those, 24 of the deaths occurred in Windham County, and 21 of the victims were residents of Windham County. Those numbers were the highest in the state and accounted for 21% and 18%, respectively, of all opioid-related deaths statewide. 
In Windham County, 21 resident deaths translates to 58 deaths per 100,000 residents. By comparison, in Rutland County, which had the second highest number of opioid-related deaths in the state, there were 16 opioid-related fatalities of residents, which translates to 27.1 deaths per 100,000 residents. In other words, when comparing the proportion of the population that was affected, the rate of opioid-related deaths in Windham County is more than double the rate in the county with the second highest number of opioid-related deaths in 2018.
Historical data shows that deaths have risen significantly over time. According to the same report, from 2013 to 2016, there were well under 10 opioid-related deaths of residents of Windham County each year, with most years hovering between two and three deaths. In 2017, there were 13. By 2018, that number rose to 21.
Reports available from the Vermont Department of Health illustrate the connection between opioid-related deaths and prescriptions of analgesic opioids. In a 2015 report, using information from the Vermont Prescription Monitoring System (VPMS), the state analyzed the prescription histories of 68 of the 75 opioid-related accidental deaths (ORAD) that occurred that year. Of those 68 people, 81% had, in the five years preceding their deaths, received an analgesic opioid prescription totaling 90 morphine milligram equivalents (MME) per day. 
Prescribing practices have changed, which data supports. According to a 2017 state report titled “Windham County Profile, Regional Prevention Partnerships Grant,” in 2015, 28% of Windham County’s residents received prescriptions for a controlled substance (opioid, sedative or stimulant). Of those, 19% were prescriptions for opioids. Quarterly VMPS reports for 2018 show that analgesic opioid prescriptions were given to approximately 5% of Windham County’s population in 2018. Meanwhile, 0.6% of its population received medically assisted treatment (MAT) for opioid use disorder. That number rose to 0.7% in the fourth quarter of 2018.
That the rate of prescriptions has gone down while the rate of deaths has gone up is not unique. A state report about opioid misuse reads: “The general pattern for Vermont is a lot like the national trend: prescription drug misuse has slowly gone down, access to treatment for those dependent on opioids has widened, and there has been an increase in disease and death associated with heroin use.” While the rate of deaths from prescribed opioids has remained fairly stable throughout the years, the rate of deaths due to heroin and fentanyl has risen. In 2010, there were zero fentanyl-related  deaths in Windham County. That number never rose above three until 2017 when it was nine. In 2018, it doubled to 18.