Harry Chen, state health commissioner, holds a dose of naloxone, a drug that can reverse the effects of a heroin or opiate overdose, during a news conference March 3, 2014, in Waterbury as Col. Tom L'Esperance, director of the Vermont State Police, and Gov. Peter Shumlin look on. / Sam Hemingway, The Burlington Free Press
BURLINGTON, Vt. - The two men from Brooklyn entered the federal courtroom in Burlington, Vt., one afternoon this spring wearing handcuffs and accompanied by federal marshals.
In quick order, Thomas Parker, 35, and Tyshawn Mack, 39, pleaded not guilty to heroin trafficking conspiracy charges and were escorted to jail, where they likely will remain until their cases are resolved.
Parker and Mack were following a path well worn over the past year by individuals suspected of peddling heroin in Vermont.
In the past 15 months, Vermont has been on a mission to quell a growing heroin addiction problem in the state.
The effort has involved busting up drug rings importing heroin to the state, vastly expanding opiate addiction treatment programs with collaboration of treatment hubs and local doctors and arming cops and ambulance workers with a drug that can reverse the effects of an opiate overdose.
In January, Vermont Gov. Peter Shumlin devoted his entire State of the State message to the Legislature to the heroin problem and what to do about it.
"In every corner of our state, heroin and opiate drug addiction threatens us," Shumlin told the lawmakers. "It requires all of us to take action before the quality of life that we cherish so much is compromised."
Shumlin won praise for his speech, but heroin remains a dark cloud hanging over the state's pristine environment and New England charm.
"I feel we're at midstream in this problem," says Tristram Coffin, the U.S. attorney for Vermont. "There's clearly more work to do. We're not looking for a complete solution. We're looking to get this back to a manageable level."
By raw statistics, the results of Vermont's first-year efforts are mixed.
â?¢ The state's per capita rate for people being treated for heroin and opiate addiction is the second highest in the country.
â?¢ The number of people federally indicted on heroin charges in 2013 more than doubled, from 31 to 73, a pace of prosecution that has slackened only slightly in 2014. Many, like Parker and Mack, are from elsewhere and suspected of bringing heroin into Vermont from places like New York City, Philadelphia and Chicago.
â?¢ In state courts, there were 220 convictions in 2013 involving heroin-related cases, up from 106 in 2012, according to the Vermont Center for Justice Research.
"We're working hard to limit supply," Coffin says of the sale of heroin. "The problem is, as long as there is demand there are people out there trying to fulfill it."
Vermont is a particularly attractive market for heroin traffickers. A bag of heroin costs $6 in New York City. In Vermont, the same bag can go for up to $30.
The state's new "hub-and-spokes" treatment program, a network of regional centers and local doctors providing medication-assisted care for recovering addicts, opened a new regional center in hard-hit Rutland and upgraded three other "hubs." The system has helped reduce the statewide waiting list for treatment, once well over 900, to 630 this spring.
"For every person who comes into treatment, there's someone else who is replacing them on the list," says Barbara Cimaglio, the state Health Department's deputy commissioner. "We're trying to figure out just how many people are out there needing treatment. At some point, we intend to meet that demand."
The state is struggling to find enough "spokes," or hometown primary care doctors, willing to take on care of patients who complete the "hub" phase of recovery. The number of "spokes" doctors increased by one in 2013, from 137 to 138.
"It's a tough population for doctors to take on who are already busy with their primary care patients," says Aaron French, deputy commissioner for the Department for Health Access. "You're talking about a very complex patient."
More than 100 people also are involved in the state's three, much-touted adult drug treatment courts. That's slightly less than a year ago, due to staffing problems at two of the courts, says Karen Gennett, the drug court's program manager.
The drug court allows addicts to get some non-violent drug charges dismissed if they successfully complete treatment and counseling requirements. Half of them do, Gennett says, and their relapse rate is lower than for those who don't go through the program.
Fatal heroin-related overdoses more than doubled from nine in 2012 to 21 in 2013, state data show. Fatal prescription opiate overdoses climbed from 46 to 50 during the same period. That overdose rate shows little sign of abating.
Fletcher Allen Health Care in Burlington, the state's largest hospital, announced in late April that nine people who had overdosed on heroin were brought in for treatment in one day. He said it typically takes two months for the hospital to treat that many overdoses.
All nine survived, but several needed multiple doses of the emergency naxolene treatment, says Stephen Leffler, the hospital's chief medical officer.
"They would wake up after a shot and then get sleepy again, because whatever was inside them was still affecting them," Leffler says.
Meanwhile, the impact of Shumlin's blunt speech about the state's heroin problem continues to be felt inside the state and beyond.
Reporters from as disparate media outlets as Rolling Stone and the Australian Broadcasting Corp. have weighed in on Vermont's heroin problem.
In its April edition, Rolling Stone magazine published a story accompanied by a picture of Vermont's iconic maple syrup can with its iconic wintry drawing altered to show a sugarmaker sitting on a tree stump injecting heroin into his arm.
Shumlin, in a statement, called the image "disappointing and hurtful."
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