June 29, 2105
By Kathleen Phalen Tomaselli
Heroin starts with a seed planted in rich mountain soil.
With the right combination of sun and rain, flowers bloom and the delicately violet, purple and red poppies hidden on small plots in Colombia’s Andes Mountains give birth to one of the world’s most damaging drugs.
And one that in recent years has torn apart Vermont families and communities.
Diaphanous poppy petals surround an interior bulb that holds the tar-like substance used to make heroin in small home-grown Colombian labs.
First, the grower must slice the bulb several times with a curved knife to extract a sticky poppy oil.
“Colombia decided there was more money in heroin from the poppy plants,” said Vermont State Police Detective Lt. John Merrigan, commander of the narcotics investigation unit. “They decided to knock out all their coca plants (grown for cocaine) and start producing heroin.”
From there, the heroin is shipped to Mexican cartels in preparation for distribution to large cities like Chicago, New York and Philadelphia.
“This heroin is three times more effective (than what was previously available),” Merrigan said, explaining that the purity of the drug makes it even more addictive.
“(Many of) Vermont’s opiate addicts started with pills, but it is much easier to get and sell heroin.”
By early 2000, the Department of Justice began noticing an increase in heroin seizures in Vermont, and in a Drug Threat Assessment report from the National Intelligence Center, researchers said that heroin was the biggest threat to the state.
Since that time, there has been a 770 percent increase in opiate treatment in Vermont, said Gov. Peter Shumlin in his 2014 State of the State address. “What started as an Oxycontin and prescription drug addiction has now grown into a full blown heroin crisis.”
Addicts describe their first heroin high with a whispered love, as if reading from scripture or sacred tomes.
And chasing that feeling — though it is never re-captured — becomes a daily and all-consuming occupation.
The initial euphoria transforms into a sickness, and now the addict will do anything for a single $40 dose, which lasts about six hours before the cycle starts again. They will do anything to keep the sweats, chills and diarrhea produced by withdrawal at bay.
“A young man told me that you don’t worry about feeding your kids. You worry about chasing that high,” Shumlin said. “The disease is a relentless, relapsing illness.”
The toll is high for everyone.
Used syringes litter living room floors, parks, sidewalks. Some addicts lose jobs, family, homes. Some go to jail. Some prostitute for drugs.
“Over 20 kids I know died because of a little bit of dope,” Vergennes Police Chief George Merkel said. “A girl cut the tip of her finger off to get pain meds; a young lady was injecting heroin into her neck; a house I went into was so loaded with needles, I wouldn’t take my dog inside; a kid told me his habit cost him $80,000 to $90,000 a year.”
As the state tries to keep pace, arresting drug dealers and treating addicts are primary goals.
Shumlin promised more money for treatment, and from 2014 to 2015, budgeted treatment dollars more than doubled, from $5,254,144 to $13,254,144. The treatment budget for 2016 is $18,179,578.00.
Vermont’s innovative approach to heroin treatment has other states watching. “Vermont is actually the national leader,” said Dr. Thomas Simpatico, chief medical officer and professor of psychiatry, University of Vermont College of Medicine. “Vermont is the nation’s petri dish. If successful, we will have an explainable model.”
Dr. Simpatico is referring to the Hub and Spoke model of treatment created at the college of medicine.
Addicts are evaluated and then treated in the hub, a central clinic that dispenses medication-assisted treatment of methodone or suboxone. These drugs trick the brain into thinking opiates like oxycodone or heroin have been used, and this suppresses the withdrawal symptoms and cravings associated with the drug.
Once stabilized, they can be referred into the spoke, a family physician approved to prescribe suboxone. The catch is, the family physician can only have 30 suboxone patients at one time during the first year. After one year, with special approval, that is expandable to a maximum of 100 patients.
That means some must wait for treatment — and for a heroin addict, if treatment is not immediate, they may never get the help they need.
“We still have a way to go,” said Vermont Deputy Commissioner of Health Barbara Cimaglio. “We still have waiting lists. The hubs are going well, but we need more primary care doctors to help.”
Some question the practice of treating addiction with another form of opiate. But Dr. Simpatico and other treatment professionals say it is like treating any disease with medication.
It’s no different than treating diabetes or heart disease, he said.
Once the addict is stabilized they no longer have to chase that illegal high.
“Studies have shown a precipitous decline in crime,” Simpatico said. “We have to change our thinking from seeing it as a criminal activity punishable by incarceration to clinical activity.”
And others still believe that inpatient detox is critical. Cimaglio says inpatient detox is rarely necessary for heroin withdrawal.
“Many people do not need residential care,” she said. “Detoxing, while unplesant, is not life threatening. Alcohol is a much more serious detox.”
Cimaglio said they follow the American Society of Addiction treatment guidelines, which say that each patient must be assessed and placed into an appropriate level of care. But for the most part, outpatient, medically-assisted treatment is appropriate, she said.
The hub and spoke has been evolving, according to Cimaglio.
“In 2001 we opened our first clinic in Burlington,” she said. “When the problem ramped up, we said let’s work on a whole system. We identified gaps in places like Rutland and then we developed a statewide network.”
Cimaglio said they are in the process of collecting data about success of patients. “The preliminary analysis is showing good results,” she said. “They are sticking with treatment and we are seeing positive results. They are using less ER services.”
As of April 2015, more than 2,504 people were in treatment in the hubs, up from 1,704 in January 2014.
West Ridge Center for Addiction Recovery in Rutland, which opened in November 2013, is treating nearly 425 patients.
BAART Behavioral Health Services, with locations in Newport and St. Johnsbury, opened in January and is treating 516 patients.
Central Vermont Addiction Medicine/BAART in Berlin now has 307 patients.
Brattleboro Retreat opened in July 2013 and has 506 patients.
The Howard Center and Chittenden Clinic in Burlington and South Burlington have 902 patients.
“I would say that like most other communities in Vermont and across the country, opiate abuse continues to be a genuine concern in Rutland City,” Rutland City Police Acting Chief David Covell said. “Although no community will ever be able to totally stop opiate abuse, our goal is to approach the issue from every angle so those who sell drugs are arrested and held accountable and those battling with addiction get treatment to improve lives and reduce demand.”