The Fentanyl Plague in the US: How Vermont is Fighting Back

Fentanyl has now become the opiate of America.  It is not just Fentanyl itself, although it is bad enough on its own, but its negative effects are exacerbated by the other substances being substituted for it: ‘cut’ in the street argot.

These are poison and the most commonly used is Xylazine which is used in veterinary surgery as a horse and other animal tranquiliser, which kills and also causes hideous sores and lesions when it is used.  As an example of how widespread it is 80% of drug equipment tested in Maryland found not only Fentanyl but also contained xylazine. We also talked about how Fentanyl is found in the air on a majority of public transport in Oregon, where you can even find open air drug markets.

Oregon attorney general spoke about the growing Fentanyl crisis just over a week ago.

The US Center for Disease Control and Prevention estimated that 100,000 people died of drug overdose deaths in the US in the year to April 2023, of which around 75% involve Fentanyl and other synthetic opioids. The state of Vermont has experienced a great spike in the use of such drugs recently, but it is fighting back with a pioneering approach to rehabilitation.

Fentanyl is now considered to be worse than heroin in in terms of the addiction and deaths it has caused and is causing.  Vermont itself has seen a huge increase in deaths during the 12 months to April 2023 and it is now believed that Fentanyl is implicated in almost 100% of overdose deaths.  In addition, the US State Department of Health thinks that one in three opiate overdose deaths this year involved Xylazine when cut with Fentanyl.  Xylazine is known locally ‘on the street’ as ‘horse tranq’ due to it use by vets.

What Vermont has pioneered is a new approach to helping addicts rid themselves of this pernicious drug – which it calls ‘Hub and Spoke’ and which puts prescription medicines at the very center of the treatment strategy. This approach is part of the statewide ‘Blueprint for Health’.  Hubs have been established in the more populous areas of Vermont with the spokes in the outlying, more remote, areas.  It often also involves people to assist the addicts – as a ‘mentor’ – often former addicts – who can not only give help and guidance – but have shared the pain of ridding themselves of the addiction.

This style of treatment offers serious treatment at regional ‘Hub’ sites for those with the worst addiction – usually using Methadone to ‘get them off’ the drug; whilst the smaller community offices, which are the ‘Spokes’, provide local care by giving the addicts who are not quite so bad, the opiod withdrawal drug Buprenorphine (Suboxone).   The effects of the initiative are that Vermont now prescribes more medication for opioid use disorder per capita than any other state in the USA around half of all addicts.  This is considered by many experts to be a very effective approach and the Vermont ‘Hub’ and ‘spoke’ initiative is now being imitated across the USA in several states for example California.

The modus operandi is that a patient is assessed and if required is checked into one of the nine ‘Hubs’ across Vermont.  Then once they are considered to be in a stable position they are transferred out to a spoke for local care.  Provision is made that, in the case of a relapse, the addict can be transferred back to a Hub.  The ‘Spokes’ can only offer a mild substitute drug as they are not allowed to offer methadone due to its stringent regulation.   The Director of Clinical Operations in Vermont believes that what is needed is that methadone, which is the drug of choice to reduce Fentanyl addiction, needs to be slightly deregulated, so as to be made more accessible to addicts, under authorised control.   A further issue is that neither Suboxone nor Methadone were designed to treat Xylazine or Fentanyl addiction and are not as effective against these new drugs as they are against, say, heroin.

This new approach attacks those using Fentanyl – but there is another issue with Fentanyl and that is that it is actually coming from overseas.  Basically, the chemicals to create it are supplied from Chinese factories and then shipped to Mexico and brought into the US by drug cartels according to the US Commission for Combating Synthetic Opioids.  The DEA described Fentanyl which is 50 times more powerful as heroin – and as the deadliest drug problem facing the US.  Most of the drugs are produced in secret factories in Mexico, by the Sinaloa and Jalisco drug cartels.  China and Mexico, of course, are not subject to US control and thus bilateral agreements need to be reached – which have proved difficult – especially as China does not recognise a Fentanyl issue and Mexico sees it as unwarranted interference.

The US Federal Drug Agency last year intercepted enough Fentanyl to kill every single American – that is 379 million potentially deadly doses – and a deadly dose is just 2 mg stop.  It’s so powerful that a legal dose is small enough to fit on the tip of the pencil when this is cut with the tranquiliser, it becomes an absolutely deadly poison.  Recently President Biden declared that xylazine-laced fentanyl is an officially emerging national drug threat. Rahul Gupta, the Director of the Office of National Drug Control Policy (ONDCP), said Xylazine is the deadliest drug threat the United States has ever faced, and the Administration has allocated huge sums of money to combat it – but more is needed.