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Vermont Senate Panel Previews Amendment Narrowing House-Passed Safe Drug Consumption Site Bill To Single Facility

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A Vermont Senate panel this week discussed planned changes to a House-passed bill that would, in its current form, create and fund two overdose prevention centers in the state, where people could use currently prohibited substances in a medically supervised environment—part of a pilot program aimed at quelling the ongoing epidemic of drug-related deaths.

The Senate Health and Welfare Committee plans to vote next week on an amendment that would make broad adjustments to the proposal, including narrowing the pilot program to a single site in the city of Burlington, where officials have expressed interest in hosting a facility. As passed by the House, the legislation would create and fund two over dose prevention centers (OPCs) in yet-undeclared parts of the state.

State grant funding for the would also be cut under the revised language to $1.1 million for the single-site program, down from $2 million in the earlier version of the bill.

Provisions in the committee’s striking amendment came at the request of various stakeholders, including Burlington’s mayor and fire department and the Vermont Medical Society, as well as the Senate panel’s chair, Sen. Ginny Lyons (D), whose district lies south of Burlington.

Another change would add that the OPC would need to provide drug-testing services—a request from Lyons—which presumably refers to positively identifying drugs and testing for adulterants.

A revision added at the request of the Burlington Fire Department, meanwhile, would require on-site professionals with training in CPR, overdose interventions, first aid and wound care, as well as the performance of medical assessments to determine the need for further emergency care.

The amendment retains the full $300,000 that was in the House-passed bill to study the impact of the pilot project. That money would come from the state’s opioid abatement special fund.

Panel revisions would also restructure the bill’s language to separate its OPC provisions into one section and provisions around the bill’s proposed syringe services expansion into another.

At a hearing on Wednesday, Lyons pointed out that the proposed amendment lacked language conceiving of more OPCs in the future.

“In a way we’re limiting it to one site in Burlington,” she said. “Going forward…there’s nothing in here that allows for expansion, should there be funds available.”

As the committee returned to the bill on Friday, however, Lyons also noted that the new language “doesn’t preclude” other OPCs from being authorized later on.

The revised bill also includes adjusted language on criminal immunity for OPC staff, property holders and others, to ensure they aren’t subject to arrest or prosecution as the result of good-faith overdose prevention efforts.

Lyons initially said at Friday’s hearing that she’d like to act the bill and others by the end of the day, although the panel ultimately decided to push action into next week.

One issue raised during the latest discussion on the proposal was how OPCs would deal with possible smoking of opioids at facilities, which could create more problems for those nearby than injecting drugs does. Members seemed to agree, however, that the matter is one that the state Health Department could address when creating program guidelines.

Other areas of discussion among lawmakers during the roughly 40-minute debate on Friday included whether municipal approval would be necessary to OK an overdose prevention center, whether people would have their drugs tested and then sell them to others, the state–federal conflict on controlled substances and whether Vermont itself could be liable if it’s seen as condoning drug use.

Lyons urged the panel not to endlessly debate those issues, which she said previously came up during invited testimony and public comment in several hearings this week and last week. “We’ve looked at all of that,” she said. “We had the answers in our testimony.”

Before concluding the Friday’s hearing, Lyons said the panel would return to discuss remaining issues, such as questions about state liability.

“We have to solidify this thing,” she said. “We’re gonna finish the bill on Wednesday…but we may vote on Thursday.”

If it becomes law, Vermont would join Rhode Island and Minnesota in authorizing the facilities, where people can use illicit drugs with medical professionals present and be connected to various support services, including treatment.

Sponsored by Rep. Taylor Small (P/D) and 28 House colleagues, the bill is another attempt by lawmakers to allow overdose prevention centers following Gov. Phil Scott’s (R) veto of a 2022 measure that would have established a task force to create a plan to open the sites.

Even if the overdose prevention center legislation passes the Senate this session it still faces a possible veto from the governor.

“I just don’t think that a government entity should be in the business of enabling those who are addicted to these drugs that are illegal,” the governor said of the current measure at the time it passed the House earlier this year.

Scott wrote in his 2022 veto message on the earlier legislation that “it seems counterintuitive to divert resources from proven harm reduction strategies to plan injection sites without clear data on the effectiveness of this approach.”

Ahead of the Senate committee vote, members took testimony and received written comments from a number of officials and organizations over the course of multiple hearings.

At one of the most recent meetings, the new mayor of Burlington, Emma Mulvaney-Stanak, who took office earlier this month, said that—like outgoing mayor, Miro Weinberger—”I also strongly support H. 72 and the pathway it provides our city of Burlington to pilot an overdose prevention center in our community.”

Weinberger, who himself addressed the panel at an earlier hearing, said addressing the opioid crisis has been a top priority in the city since 2015.

“I have long supported overdose prevention sites as a strategy,” he said. “I have become increasingly focused and increasingly believe that this is something that we urgently need to pursue.”

The proposal has support from advocacy groups such as the Drug Policy Alliance, Law Enforcement Action Partnership, National Harm Reduction Coalition, the American Diabetes Association, Planned Parenthood of Northern New England, Johnson Health Center, Broken No More, Recovery Vermont, the Vermont Association for Mental Health Addiction and Recovery as well as various individual public commenters.

The National Harm Reduction Center, for example, called overdose prevention centers “a vital part of a comprehensive public health approach to reducing the harms of drug use.”

“They cannot prevent all risky drug use or related harms,” the group said in its testimony. “However, evidence demonstrates that they can be remarkably effective and cost-saving and improve the lives of people who use drugs and the safety and health of our communities.”

Some state officials, however, told the committee that overdose prevention centers (OPCs) aren’t the right fit for Vermont.

“My position is that while I acknowledge OPCs can have many potential benefits and be part of a multipronged approach to the opioid epidemic, they ultimately may not represent the best option for a state such as Vermont at this time,” Mark Levine, commissioner of the Vermont Department of Health, said in submitted testimony, arguing that the facilities work best “where people who need these centers can access them easily and quickly—typically these tend to be larger population areas, neighborhoods where injection drug use is more prevalent.”

New York City, he pointed out, has located its two overdose prevention sites in areas that fit that description.

Levine also pointed out that people shouldn’t drive to and from overdose prevention sites, which they may have to do in many rural Vermont locations.

“VT doesn’t have the population density of people who use drugs and sufficient public transportation to facilitate people consistently using the sites,” he wrote. “That gives people who don’t live within walking distance the option of lingering near or in the site, having a designated driver, driving after use (completely unacceptable), setting up shuttles to transport people (apparently RI is planning to do this) or not using the OPC.”

“If people attend a site and then drive,” he added, “who has liability?”

Rep. Eric Maguire (R), who also opposed the bill, argued that while OPCs might be an acceptable option for Vermont in the future, the state currently lacks the infrastructure to make the project worthwhile. He also emphasized that the sites could violate federal law.

“Currently at this time, the state of Vermont does not have the infrastructure or continuum of care to support this harm reduction model,” he told the panel. “It’s not sanctioned by SAMHSA… It’s against the law under the Controlled Substances Act.”

“There may come a time when they are sanctioned by our national health organizations and sanctioned within the harm-reduction model laws,” he added, “and then we can look at crossing that bridge.”

Weinberger, the former Burlington mayor, told panel members that not only do OPCs prevent overdose deaths, they also connect drug users with treatment and other services, often reaching individuals who are missed by other outreach.

“One often under-appreciated in the discussion is that studies are showing that these facilities reduce—not only do they not increase, they reduce—crime and disorder in the area immediately around the facilities,” he said. “I think that surprises many people.”

Weinberger acknowledged that the sites may not work in every part of Vermont, especially more rural areas, but said that wasn’t a reason to deny facilities in denser areas such as Burlington.

Scott Pavek, meanwhile—a substance use policy analyst for the city of Burlington and a member of the state’s Opioid Settlement Advisory Committee and Substance Misuse Prevention Council—urged lawmakers not to be complacent about the ongoing overdose crisis.

“Recently, this committee heard testimony that suggested the state’s overdose deaths have plateaued,” he said, warning against the “eagerness to point to a still unacceptable number of Vermonters lost to preventable overdose deaths as proof that our harm reduction and treatment strategies are sufficient.”

A saying he often heard during his own recovery, Pavek added, is that “half measures avail us nothing.”

“I encourage the legislature to consider that proverb when assessing our state’s system of harm reduction and treatment services,” he said. “You have heard about new, promising approaches to address the overdose crisis that seem to me to be half-measures relative to the utility of overdose prevention centers.”

Separately this month, Vermont’s Senate passed a measure that would establish a working group to study whether and how to allow therapeutic access to psychedelics in the state. If the bill is enacted, a report from the working group would be due to the legislature in November with recommendations on how to regulate the substances. As originally introduced, that bill would have also legalized use and possession of psilocybin, but lawmakers on the Senate Health and Welfare Committee nixed that section last week to focus instead on the working group.

Though Rhode Island and Minnesota have state laws on the books allowing safe drug consumption sites, New York City became the first U.S. jurisdiction to open locally sanctioned harm reduction centers in November 2021, and officials have reported positive results saving lives.

An early study published by the American Medical Association (AMA) found that the facilities had decreased the risk of overdose, steered people away from using drugs in public and provided other ancillary health services to people who use illicit substances. And separate research published by AMA late last year found that the centers have not led to increased crime despite a significant decrease in arrests.

Meanwhile the federal government has fought an effort to open an overdose prevention center in Philadelphia, with the Biden administration arguing that the facilities violate federal law. Earlier this month, the court in that case granted the Justice Department’s motion to dismiss a challenge from organizers.

The Supreme Court rejected a request to that hear that case in October 2021.

DOJ first blocked the Philadelphia nonprofit from opening the overdose prevention center under the Trump administration. Supporters hoped the department would cede the issue under President Joe Biden, who has promoted harm reduction policies as an alternative to criminalization, but the parties could not reach an agreement to allow the facility to open despite months of “good faith” negotiations.

Congressional researchers have highlighted the “uncertainty” of the federal government’s position on such facilities, pointing out last November that lawmakers could temporarily resolve the issue by advancing an amendment modeled after the one that has allowed medical marijuana laws to be implemented without Justice Department interference.

Meanwhile, National Institute on Drug Abuse (NIDA) Director Nora Volkow has tacitly endorsed the idea of authorizing safe consumption sites, arguing that evidence has effectively demonstrated that the facilities can prevent overdose deaths.

Volkow declined to say specifically what she believes should happen with the ongoing lawsuit, but she said safe consumption sites that have been the subject of research “have shown that it has saved a significant [percentage of] patients from overdosing.”

Rahul Gupta, the White House drug czar, has said the Biden administration is reviewing broader drug policy harm reduction proposals, including the authorization of supervised consumption sites, and he went so far as to suggest possible decriminalization.

The National Institutes of Health (NIH) put out a pair of requests for applications in December 2021 to investigate how safe consumption sites and other harm reduction policies could help address the drug crisis.

Gupta, the director of the White House Office of National Drug Control Policy (ONDCP), has said it’s critical to explore “any and every option” to reduce overdose deaths, which could include allowing safe consumption sites for illegal substances if the evidence supports their efficacy.

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Image courtesy of Dima Solomin.

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