Vermont’s efforts to confront ever-rising deaths from drug overdoses just got a little bit bolder.
A new addition to H.222, the House’s overdose prevention bill, would kick-start the statewide operation of drug-checking sites.
These are places, often co-located at syringe and needle exchanges, with staff and machinery able to test street drugs for potentially deadly concentrations of chemical additives.
The amendment, approved unanimously on Friday by the Senate Health and Welfare Committee, is crafted to create immunity from arrest and prosecution for people running the site and collecting samples, as well as for those who bring or offer up drug samples to be tested there.
Prior to now, the bill — approved unanimously by the House in late March — was focused on programs that would improve access to harm reduction supplies, such as the establishment of a syringe and needle disposal program and broader public distribution of the overdose-reversal drug Narcan.
It also made important technical changes to ease prior authorization requirements for medication-assisted treatment for opioid use disorder and to allow ongoing prescriptions via telehealth. It also requires state regulators to expand the number of locations where higher doses of buprenorphine can be prescribed.
But there had been no attempt to move toward more aggressive harm reduction measures such as safe consumption sites, which are locations where people can use illegal drugs under supervision so that overdoses can be reversed quickly. Action on the bill comes after the Vermont Department of Health reported 237 drug overdose deaths in 2022, the third record-setting year in a row.
“There is significant frustration, I think, in this building and in the community about what we can and what we can’t do, and about why we aren’t doing more, constantly,” said Chair Ginny Lyons, D-Chittenden Southeast, when the Senate Health and Welfare Committee began taking testimony on the bill on Tuesday.
Gov. Phil Scott vetoed a bill last year that would have required a feasibility study of developing overdose prevention sites in the state.
The language on immunity now included in H.222 was taken directly from S.119, a Senate bill that largely focuses on the decriminalization of personal-use amounts of illegal drugs and is unlikely to progress this year.
Advocates say that the section being adopted is narrower than other sections of that bill, focusing only on immunity related to the operation and use of drug-checking sites. They frame it as an extension of the state’s 2013 Good Samaritan Law, which provides wide-ranging legal protections for anyone who is actively seeking emergency medical help for a drug overdose.
That limited kind of immunity is an essential legal framework, they say, for making drug-checking available statewide and protecting people from potentially deadly doses.
“You can’t really move forward with community on-site drug-checking without immunity,” said Theresa Vezina, executive director of Vermont CARES. “Protection all the way around for everybody is really required.”
Vezina’s organization is one of several providing harm reduction services for street drug users across the state. Vermont CARES has office locations in Barre, Rutland and St. Johnsbury and also employs staff who use vans and cars to bring items like sterile syringes, fentanyl and xylazine test strips, Narcan doses and wound care kits upon request.
The approved amendment also allocates fiscal year 2023 spending from the Opioid Abatement Special Fund, which contains settlement money to be received over an 18-year period from the state’s involvement in several nationwide lawsuits against opioid manufacturers and distributors.
The language largely follows the funding recommendations from the Vermont Department of Health and the Opioid Settlement Advisory Committee. But it adds $700,000 for the department to award grants for setting up drug-checking services “in a harm reduction setting.” The department would authorize the locations, according to the bill.
The Department of Health presented drug-checking to the advisory committee as one of the programs it supports, but it did not make it into the final recommendations, David Englander, the department’s senior policy analyst, told the Senate committee in testimony this week.
Sen. Ruth Hardy, D-Addison, a member of the advisory committee and the Senate committee, said that her understanding is that the lack of immunity language in statute is the main reason drug-checking was not prioritized for funding.
The only current drug-checking program in the state is operated by the AIDS Project of Southern Vermont, launched as part of a research project based at Brandeis University. Before starting, the organization had to enter into non-prosecution agreements with the state’s attorneys offices in Windham and Bennington counties, Executive Director Samba Diallo told the House Human Services Committee in March.
The southern Vermont program tests small amounts of a drug on a printer-size spectrometry device kept in a special clean room in the organization’s Brattleboro office, said Dakota Roberts, an outreach worker who collects, logs and analyzes the samples.
The machine uses infrared light to identify the range of chemical compounds in each drug sample. They are then sent out to a more powerful mass spectrometer to determine the concentrations, he said.
The fact that the machine can pick out a wide variety of chemicals is what makes them different from test strips, which are typically focused on one type of chemical. New fillers or adulterants, some with deadly effects, can become part of the drug supply at any time. Proponents say that these types of machines are able to alert harm reduction programs and the people they serve more quickly.
“There’s always going to be a demand, and so a new chemical,” Vezina said.
People using black-market stimulants and opioids in the Bennington and Brattleboro areas have found the testing useful, Roberts said. In its first six months, the project has looked at around 40 samples. About two-thirds of the samples he collects during outreach visits and another third are brought in during the organization’s weekly syringe exchange hours.
Results are relayed to the individual who provided the sample either by text, email or in person. But they are also posted on a public website and mobile app called StreetCheck, developed at Brandeis. The website shows a picture of the source packaging, if available, and where and when the sample was collected.
Roberts has already seen how that information can spread quickly across a community and change behavior, leading users either to avoid a product or to take a smaller dose. Supporting similar projects around the state would provide even more shareable data.
“Generally, people want to be as safe as they possibly can, so it’s a really effective way to mitigate overdoses,” he said.