For advocates in the treatment of opioid use disorder, making buprenorphine more readily available to people who need it, and decriminalizing possession of small amounts, has been a matter of life and death.
A bill that passed the House of Representatives overwhelmingly last week would decriminalize the possession of 224 milligrams or less of buprenorphine for persons 21 and older, if it meets with support in the Senate and with Gov. Phil Scott.
The effort on the bill was not brand-new: the House Human Services Committee heard testimony on a similar bill last year, but that proposal was shuttled to the back burner last March and never returned for a floor vote.
This time, the bill, H. 225, passed the House by a 126-19 vote on second reading Thursday, and third reading on a voice vote Friday.
The bill’s next hurdle is whether it will be granted consideration by Senate leadership, as it passed the House after crossover. That’s up to the Senate Rules Committee.
“I hope to get it out of Rules, but we’ve not discussed it yet,” Senate President Pro Tem Becca Balint said Monday. “I think it’s a very important bill that could save lives. I’m going to try to make that case to my colleagues.”
Buprenorphine is one of two active ingredients in Suboxone, a prescription medication used to treat opioid use disorder.
Medical assisted treatment for substance use disorder has support because it allows users who are not ready for recovery, or not able to reach the state’s “hub and spoke” treatment system, to use a prescribed medication that is safer than street alternatives.
Former gubernatorial candidate and drug treatment advocate Brenda Siegel of Newfane was pleased to see the bill pass.
“When you look at our increase in [overdose] deaths being 38 percent higher this year, I felt like we really desperately needed it more than ever,” Siegel said. “I was really, really heartened to see it move quickly. And I think the hope is that there’ll be an exception [in the Senate], and we’ll get it out this year.”
While the state says its hub and spoke model provides for drug treatment for anyone who wants it, only three in 10 people are accessing that system, for a number of reasons, Siegel said. “And so we still want to reach those other seven,” she said.
“We want to send a strong and clear public health harm reduction message to people who are using ... That if you have the choice between buprenorphine and heroin, please choose buprenorphine,” Siegel said. “That you have value and that you deserve to survive. And, and that we are going to do what it takes to make sure that you have the tools you need to survive.”
The Substance Abuse and Mental Health Services Administration of the U.S. Department of Health describes buprenorphine as an opioid that produces the euphoric effects of other opioids, but at much weaker levels than methadone and heroin. It’s prescribed to lessen opioid withdrawal symptoms and cravings. As the prescription drug Suboxone, it’s mixed with naloxone to counter the risk of misuse.
Buprenorphine activates the same receptors in the brain as other opioids, Dr. Kimberly Blake, a Burlington doctor, told the House Human Services Committee on April 2. That means if a person on the drug takes heroin with buprenorphine in their system, they won’t get the euphoric heroin high — making heroin use even less attractive, while fending off heroin’s withdrawal symptoms.
Distributing buprenorphine to people who would otherwise be using heroin is “the harm reduction model of meeting people where they are,” Blake said. “They may be in a phase of pre-contemplation, or thinking about going into recovery, and using Suboxone to stave off withdrawal symptoms.”
MEETING PEOPLE WHERE THEY ARE
Julea Larson, the supervisor of the opioid response team program at Turning Point Center in Bennington, told the Human Services Committee on April 2 that an outreach program, providing the drug in locations throughout greater Bennington where opioids are being used, is working.
“We’ve seen great success in Bennington in going to people and saying, ‘Hey, you know, this is an option, we have a position available for you at a physician, should you choose to take it.’ The response has been really, really good,” Larson told the committee. “Almost everyone we talk to says ‘If I did not feel the withdrawal, I would stop.’ “
Larson also said some of her clients, aware that they have trouble saying no, prefer buying Suboxone on the street, or getting it from a friend or family member, rather than risk encountering someone in a clinical setting who is still using.
“I … would much rather see somebody have a couple of doses of buprenorphine versus a couple of bags of heroin,” Larson said. “Overdose from opiates is completely preventable. And buprenorphine is not something ... we need to worry about people overdosing on.”.
“So, you know, I think that having buprenorphine decriminalized would provide some safety nets, and also it would decrease the street value,” Larson said.
The bill is one of a suite of legislative initiatives that a group of lawmakers, prosecutors and activists including Siegel pushed for in February. It’s the first of those proposals to pass out of committee and win approval on the House floor.
Readers: This story was updated at 8:45 a.m. on April 13.