Republican Gov. Phil Scott has made it clear to Democratic lawmakers that he’s opposed to overdose prevention centers, but his top public health appointee said this week that Vermont would benefit from the creation of facilities where people can consume opioids under medical supervision.
Asked Thursday whether it’s fair to say he thinks the time has come for Vermont to include overdose prevention centers as part of a broader harm-reduction strategy, Commissioner of Health Dr. Mark Levine said, “Yes.”
“A better way to frame it would be: I am in support of the Opioid Settlement Advisory Committee’s recommendation that overdose prevention centers become part of Vermont’s multi-pronged strategy,” Levine said.
The committee’s recommendation calls for $2.6 million in funding for two fixed locations in Vermont. The proposal includes appropriations for medically trained staff, case managers, safer-use supplies like syringes and legal compliance.
Levine said Vermonters should not be under the impression that overdose prevention centers are a “panacea.” He pointed out that the rate of overdose deaths in Vermont, where there are currently no overdose prevention centers, is lower than it is British Columbia, where they have 44 overdose prevention sites.
“They do save lives. They save lives within the facility, and some of the literature is now indicating within the neighborhood that the facility is located in.”Mark Levine, Vermont commissioner of health
Levine said the state may also face challenges finding willing partners in prospective host communities. But he said that, on balance, Vermont would benefit from the introduction of overdose prevention centers.
“They do save lives,” he said. “They save lives within the facility, and some of the literature is now indicating within the neighborhood that the facility is located in.”
Levine said the scientific literature is also beginning to show that overdose prevention sites lead to an improvement in some of the quality-of-life issues associated with drug use.
“There may be reduced crime in the area and reduced needle disposal on the streets, and indeed some of the most recent literature is indicating that indeed does happen,” he said.
Scott, who appointed Levine to the commissioner’s post in 2017, has consistently opposed overdose prevention centers. He vetoed a bill passed by the Legislature in 2022 that would have cleared the path for the facilities.
He said in his veto message to lawmakers that the proposal was “counterintuitive.”
“Unfortunately, this bill proposes to shift state policy and financial resources away from prevention and toward unproven strategies such as overdose prevention sites,” Scott wrote. “It's important to note that what little data exists on this approach is for sites located in large cities, so it's not applicable to the vast majority of Vermont.”
Levine himself has urged caution on moving forward with the facilities as recently at last year. In written testimony submitted to the Legislature in April of 2023, Levine expressed “concerns with the way outcomes of the studies in the literature are being portrayed.”
“My conclusion is we need a little more information,” he wrote.
In addition to doubts about the efficacy of overdose prevention centers, Levine also questioned their “generalizability to Vermont.”
Those concerns included workforce availability, siting, and “the whole issue of geographic equity in a state with some of the highest OD death rates in rural areas.”
While Levine said he’s ready to embrace overdose prevention centers in Vermont, he understands why some people aren’t.
“I completely understand why those who oppose them oppose them,” he said. “And I do respect their points of view, and I know that there’s challenges.”
Levine came under fire from the Vermont chapter of the American Civil Liberties Union earlier this month after he submitted a funding proposal to lawmakers related to overdose prevention centers.
That recommendation was nominally on behalf of the Vermont Opioid Settlement Advisory Committee, a 16-member panel created by the Legislature in 2022 to advise lawmakers and the governor on how to spend Vermont’s share of cash settlements reached with the makers and distributors of addictive drugs like oxycodone.
The advisory committee recommended using $2.6 million in settlement money to fund two overdose prevention sites. Levine’s final recommendation to lawmakers noted the committee’s preference, but did not include the funding. Levine said he stripped settlement funding from the proposal because pending legislation in Montpelier already contemplates a different source of funding.
That bill, called H.72, passed the House of Representatives earlier this year and is now in the Senate Committee on Health and Welfare. The legislation would use fees on pharmaceutical companies to fund the measure.
“It is clear that the legislature plans to fund these centers from a non-settlement source,” Levine wrote to lawmakers. “Therefore … we have excluded this from the current set of recommendations for use of settlement funds so as to maximize our ability to support a broad array of initiatives.
The ACLU alleged that Levine had, in violation of open meeting law, unilaterally bypassed the committee’s will in favor of his own. Harrison Stark, an ACLU staff attorney, speculated that Levine had done so at the urging of the governor.
“The most reasonable inference is that [overdose prevention centers] do not enjoy the support of the governor’s team, and they want to affect this process in some way,” Stark said.
Levine said Thursday the scenario Stark suggested “did not happen at all.”
“And from my standpoint, it directly impugns my integrity, my transparency, all of the positive characteristics that I’ve really built with the population of Vermont,” he said.
Levine said he realizes that some overdose prevention center advocates felt his recommendations to lawmakers undermined “the initiative they had dedicated literally years of their life to,” and that the proposal “was somehow now on fragile ground.”
Levine said the opposite is true.
“The irony, of course, in the assertion in the ACLU letter is the failure to recognize that on literally any harm-reduction strategy, and certainly on this harm-reduction strategy, that I am an ally and not an enemy,” he said.
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