ST. ALBANS, Vt. — Fear has long been Stephanie Robtoy’s companion in her tiny rental home. Now, unexpectedly, hope is, too.
The 25-year-old single mother has been clean for six months, although the risk of relapse into opioid addiction is always with her as she struggles to make ends meet with a low-paying cleaning job.
Robtoy attends support meetings every day of the week. She feels better. She feels safer. But still she’s tempted by the carefree numbness and easy money that come from using and selling drugs.
Robtoy’s fear and her hope are Vermont’s as well. No other state has gone as hard at the opioid deluge, beginning when Governor Peter Shumlin last year devoted his State of the State address to what he called a “full-blown heroin crisis.” Since then, Vermont has emerged as a national leader on the issue.
But also since then, heroin use and its related deaths have continued to rise. And no one — not the governor, not health workers, and not recovering addicts — can say with certainty if the tide will turn for good.
“It’s probably how you Bostonians felt when the snow kept falling: When is this going to end? We can’t take it anymore,” said Ed Williamson, clinical director of the Howard Center, which treats substance abuse.
That “enough is enough” attitude, embodied by Shumlin’s speech in January 2014, led to a flurry of resources to fight the widespread abuse of heroin and prescription opioids. Funding for treatment nearly tripled this year; more clinic staff has meant smaller waiting lists; and naloxone, a drug used to reverse overdoses and save lives, is more widely available.
In the courts, a state program to divert nonviolent drug offenders to treatment instead of trial is being implemented.
And across Vermont, an interconnected string of outpatient treatment clinics, primary care physicians, and recovery centers has been praised as the only such state-supported system in the country.
“Vermont has emerged as the leading state in the country in addressing opioid overdose,” said Lindsay LaSalle, a California-based attorney with the Drug Policy Alliance, a national advocacy group.
Although heroin use has not abated, the state’s effort has had some positive effects. As resources increase in Vermont, the stigma surrounding addiction is crumbling. From Bennington in the south to St. Albans in the north, Vermonters appear to have moved beyond the hurdle of acknowledging the problem to brainstorming ways to reach and treat thousands of addicts and new users, health officials said.
“We’ve changed the conversation,” Shumlin said recently. “This isn’t an issue to be ashamed about any more than you should be ashamed of getting cancer or kidney disease.”
An example of ramped-up dialogue swept through the State House in Montpelier last month during the annual Recovery Day. Dedicated to addiction treatment and prevention, the event attracted hundreds of people who have been afflicted by the disease or are trying to help those who are.
“This is going to take courage from all of us,” Shumlin said to loud applause in a packed conference room.
The work, however, is seen only as a beginning in what could be a decades-long fight. “I don’t think in America we should ever underestimate how deeply opiate addiction is affecting all of us,” he said in an interview. “The question is, can we move fast enough to innovate our way out of this mess?”
Despite gains, the intractability of addiction makes for a grueling, patience-sapping challenge. As addiction to prescription opioids appears to be waning, heroin fills the void.
Deaths in Vermont from prescription opioids, which have become more difficult to obtain, dropped to 43 in 2014 from 53 the year before. But fatalities from heroin, which is cheaper and more readily available, rose to 35 from 21.
Numbers bear out the consumer shift in opioids. In 2014, the state treated 2,258 people for heroin use, a staggering 64 percent increase over 2013 and more than three times the 623 people treated in 2010.
More services have spurred more access to treatment, but resources have not kept up with the demand. To close that gap, state health officials are trying hard to enlist more physicians who are authorized to prescribe Suboxone, which is used to treat recovering addicts.
Finding enough doctors “has probably been the biggest challenge” in providing treatment to everyone who wants help, said Barbara Cimaglio, the state’s deputy health commissioner, who supervises substance-abuse programs.
Health workers estimate that for every person being treated, two or three more might be abusing opioids. “I think the issue going forward is, how do you pay for it?” asked Williamson, the clinic director.
Katie Tanner, a 28-year-old woman from St. Albans, has watched opioids devastate her life and that of many others in this small community of 7,000 people. A recovering morphine addict, Tanner nearly died from an overdose before becoming sober nine years ago.
Then, last April, she relapsed with the painkiller Vicodin during a panic attack. Tanner is seeking help once again at the Turning Point, a recovery center that helped her remain clean for nearly a decade.
So far, the reinforcement and peer support she receives there have helped keep the demons at bay. But still, temptation is never far away.
“There are little places in your brain where it’s always around,” Tanner said.
Karen Grenier, executive director of the Turning Point of Franklin County, tries to wall off those places. The recovery center she supervises in St. Albans sees 1,400 visitors a month, a number that has not changed in the last year.
The staff includes former addicts such as Melinda Lussier, who is Grenier’s top assistant, and Hal Porter, who helps clients navigate a sometimes confusing path to the recovery center, the treatment clinic, and other support services.
Robtoy, the young mother, is among the Turning Point’s clients. For the first time in her life, she is thinking about what she wants and who she is.
“I don’t know what I like to do,” said Robtoy, a high school dropout, with a bemused shrug. “I’ve been living this life of doing drugs for so long I don’t know who I was before.”
That life is changing.
“I wake up and go to work now, and that’s amazing to me,” Robtoy said. “I’m not afraid when a cop’s behind me. I’m not afraid that my door will be knocked in and I’ll be robbed, or that my daughter will be taken away from me.”
Robtoy wants a new, sober life for her 3-year-old daughter and herself. But she knows every good day — whether today, next month, next year — can come undone despite all the striving and good intentions.
Many Vermonters, after a year of headache and headway, feel that way, too.
Opioids have become too addictive, for too many, to be rolled back dramatically in the short term, said Mary Pickener, the state’s point-person here for substance-abuse programs.
Reducing them is possible, health officials said. Eradication? Probably impossible.
“I don’t think it will ever go away,” Pickener said.
Brian MacQuarrie can be reached at email@example.com.