Last year, for the first time in five years, the number of Vermonters who died from opioid overdoses fell. Preliminary data from the Vermont Department of Health show 231 Vermonters died from opioid overdoses in 2023. That marks a 5% decrease from the record-breaking prior year.
Health Commissioner Dr. Mark Levine joined Vermont Public's Mary Williams Engisch to talk through the latest data. This interview was produced for the ear. We highly recommend listening to the audio. We’ve also provided a transcript, which has been edited for length and clarity.
Mary Williams Engisch: This is a rare bit of good news about a public health crisis. It's really roiled substance users and advocates, and lawmakers, local officials. But the health department was quick to caution — it's not, statistically, a big decrease. How are you personally thinking about this latest data?
Mark Levine: It's important to note, and we say this at the beginning of the report, that each data point that we're going to be talking about is someone who lost their life due to substance use. So, I'd like everyone to really examine these data in the context of that humanity.
As you point out, even though it's not a statistically large decrease, this certainly does mean that fewer families have lost a loved one. In the numbers, there are still plenty of families who have lost a loved one. The fact that we see this decrease is encouraging, though, especially knowing what's been going on with the toxicity of the drug supply and with the increasing number of adulterants, and other substances being found at the time of overdose. So we're in a very complex time period.
I think now we are a couple of years out of the pandemic, which certainly is helpful, but at the same time, certainly, there's been a lot going on in trying to contribute to this decrease in overdose deaths.
Mary Williams Engisch: You just mentioned being a couple of years past the pandemic. Do we know the reasons why these numbers dropped last year?
Mark Levine: Yeah, it's really going to be hard to specifically state a single or even multiple number of causes. But we know there is a lot that's been going on.
Mary Williams Engisch: Can you talk about what the health department's doing to try to drive these numbers down even more, like in terms of community level prevention, harm reduction?
Mark Levine: I kind of look at things like, very simply, we often know that people who have succumbed to an overdose death never had any connection with our treatment system, often used alone and often were at home.
So, we need to be able to find people ahead of time. We need to connect people, especially with trusted communities, whether that be within our treatment system, whether that be in the recovery system, whether that be with our syringe service programs.
We need to support people with opioid use disorder and especially support their families and friends who might be in a position to help intervene. And we need to educate the public. We have certainly done our job in providing Naloxone across the state — about 20,000 more doses than in 2022 — which is well over 72,000 doses in 2023.
Finding unique ways to distribute Naloxone. We have a lot of programs that began with opioid settlement money in the previous year, and that we are now going to start seeing become much more active.
Mary Williams Engisch: At the risk of asking a dumb question, Dr. Levine, why are these numbers still so high relative to Vermont's historical averages? Why is this just such a difficult problem to get our arms around?
Mark Levine: So, 2019 marked the first year that we actually had a decrease in the numbers. We were very hopeful that this was going to be the beginning of a trend. But then, as we all know, this new entity called COVID came upon the scenes, which markedly exacerbated the situation.
And since 2019, you know, there's been essentially a doubling of the overdose death rate. Now we're kind of out of that, which may account for part of the reason why the increasing trend has stopped.
Obviously, we're in a situation where the drug supply is now very different than it was in the late teens of the 2000s.
The final point to make is the sequela to the pandemic. The pandemic left the population in a much different place. We've seen significantly increased rates of substance misuse, increased rates of mental health distress, increased rates of chronic disease exacerbation, and an alteration in people's lifestyles, where they might have lived a healthier lifestyle pre-pandemic and haven't quite returned to that yet.
As we come out of that, we can hope we will also see some improvements in all of these statistics.
Mary Williams Engisch: One more question for you — safe injection sites are places where people can use illegal drugs under medical supervision, and have overdose reversing medications nearby. Lawmakers approved legislation to open one in Burlington. Now, you've spoken in support of safe injection sites, but Gov. Phil Scott has indicated he does not support these. What would you say to him as he considers whether to veto that bill or let it become law?
Mark Levine: Well, he has pretty much made up his mind. From a public health point of view, this is a really very challenging, challenging topic for me. Because I can review the literature in a very enlightened way, but also understand why, for Vermont, this might not be the ideal situation for us.
From a public health perspective, issues of geographic equity in a state where we don't have a lot of urban areas, and we are predominantly rural, and our highest overdose death rates are in rural areas, where it would be very challenging to site these abundantly enough.
Most of the data comes from traditionally neighborhood-based enterprises. Yes, you may actually help in that area of the neighborhood of a larger metropolis in Vermont. But, you may not be helping on a very population-level case. And that raises some equity concerns to me as well.
After this interview was recorded, Gov. Scott said at a weekly press conference that he plans to veto legislation creating a pilot safe injection center in Burlington. Scott said he believed the $1 million dedicated to the center should be redirected to strengthening existing treatment programs.
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