By Michael Turton
“You’re never going to get anyone into treatment if they’re dead.”
That message was at the core of a talk by Brandon del Pozo at the Garrison School on Monday (April 23) to address how communities can combat opioid addiction. The former Nelsonville resident was appointed the police chief of Burlington, Vermont, in 2015 after serving 19 years with the NYPD.
Del Pozo said that on his first day on the job in Burlington, which does not have a health department, the mayor assigned him to lead the fight. And he wanted a plan, pronto.
“I told him I could come up with a plan but it wouldn’t include a lot of policing,” del Pozo said. “It was going to be a public health plan.”
Like every other state, Vermont faces an escalating addiction crisis. Nearly 68,000 Americans died from opioid overdoses in 2017, a 13 percent increase over the previous year, according to federal estimates. That included 128 fatal overdoses in Vermont, or a per-capita rate nearly twice that of New York’s.
A different approach
Del Pozo’s said his policing strategy in Burlington is to jail dealers who come into town while getting local users into treatment. He has added an epidemiologist to his staff, hired an opioid policy coordinator and partnered with the Johns Hopkins School of Public Health and the University of Pennsylvania.
“It’s going to be medicine-assisted treatment that solves opioids,” he said, citing a study that found treatment in Vermont prisons had reduced opioid fatalities by 62 percent among inmates after their release. “In the short or midterm, medicines get you at least 80 percent of the way” to recovery.
Del Pozo says Narcan, a drug that counteracts opioid overdoses, should be more widely available. “We want to keep people alive, to get them into treatment,” he said. “I carry it, all my officers, sheriff’s deputies and EMS carry it.”
Narcan must be administered quickly, and the introduction of a powerful painkiller, fentanyl, to street drugs has greatly reduced that window, he said. With heroin, the window can be minutes or even hours; fentanyl reduces that to seconds.
Users often misjudge the power of a dose because they don’t know it includes fentanyl. The drug is cheaper and less bulky than heroin, making it attractive to dealers, who are sometimes less than careful in dispensing it. “They don’t want to get people killed,” del Pozo said. “But they’re not chemists.”
A social contagion
Del Pozo said doctors and the pharmaceutical industry must be held accountable for the early stages of the opioid crisis. Pain pills were big business, were overprescribed, often leading to heroin addiction. “But there are fewer and fewer pills being prescribed across the country now,” he said.
He describes the current epidemic as “a social contagion.” A local drug user may host an out-of-town drug dealer, then sells drugs to a friend. “Then it’s not just one person shop lifting or robbing to get drugs,” he said. “Now it’s two, then three, then four.” Typically it’s not young people who are active in sports or school or in healthy relationships who are likely to become addicted. The dealers “find weak and vulnerable people,” he said.
Non-medicine based treatments
Treatment strategies that don’t include medicine, such as abstinence and prevention, have not proven widely effective, he said.
“Prevention is generational and it takes time. It’s easy to implement but the hardest to show if it’s working or not,” he said. “If there was a way to talk to kids, or a video to scare them straight, we would be doing it, demanding it of our schools and communities.”
He cited the Drug Abuse Resistance Education (DARE) program as an example of a prevention program that was never shown to reduce drug use. “It did not work,” he said. “It was well-intentioned but it just didn’t reach kids in the right way.”
Abstinence, quitting cold turkey, is limited. “Clinically it is effective only about 10 percent of the time,” Del Pozo said. “You have to be a certain type of person for it to be effective.”
He feels that users need to see a clear path to treatment, whether they seek help from a prison doctor, the police, the emergency room or an internist. Hospitals, he noted, have protocols for routing people to treatment for many maladies but not addiction.
He urged organizations in Putnam County to have a “keen awareness” of what treatments are available and their relative effectiveness and insurance implications, not just in adjoining counties but all the way to New York City. That, he said, will help those dealing with addiction to make good decisions.
Del Pozo advised avoiding lengthy, complex strategies to deal with the crisis, citing Rhode Island’s 2016 plan to reduce opioid overdose deaths by a third in three years as one of the best.
While the evening focused on opioids, del Pozo also commented on marijuana, pointing out that THC levels are many times higher than in the 1970s and 80s.
“There is absolute correlation between frequency of marijuana use and frequency of use of other drugs,” he said. “Brain science on adolescent marijuana use is also unequivocal. It messes up kids’ brains.”
Vermont, he said, had the highest rate of adolescent marijuana use in the country until Colorado took the top spot after legalizing pot. “We have to see where this goes. We’re in the infancy of legalized marijuana.”
He said childhood trauma appears to accelerate drug use, an issue that one mother in the audience said is not being addressed. “I knew my son was having difficulties,” she said. “I asked for assistance from the school and the court system and no one could help me. I had to go bankrupt, fight tooth and nail, to save my son’s life. There is no system in place.”