Reps. Pugh & Whitman: How to save a life — the true intentions of H.728

This commentary is by state Rep. Ann Pugh of South Burlington, chair of the House Human Services Committee, and Rep. Dane Whitman of Bennington, a member of that committee.

Vermont needs to have conversations about substance use. Year after year, hundreds of lives — young and old — are lost to preventable death. We know that Vermonters are dying at record-breaking numbers from opioids, and one death is far too much for somebody who has lost a loved one to fatal overdose. 

We are facing a public health crisis that warrants our full attention and active engagement. Unfortunately, the veto of H.728 hinders this forward momentum. 

Over the past two years, the Covid-19 pandemic has shown Vermont how to respond to a public health crisis: Allow for flexibility, adapt to the latest evidence, be both innovative and practical. We can reflect on our willingness to ensure access to vaccines: free of cost and available in diverse locations. 

Are we as a society adopting that same sense of urgency for the opioid overdose crisis? 

H.728, an act related to opioid overdose response services, was a collaborative effort to strengthen our state’s strategies toward overdose prevention. Sponsored by the entire House Human Services Committee, H.728 was supported across party lines: Republican, Democrat, independent and Progressive. It was an omnibus bill, with various policy proposals to expand access to services for opioid use disorder. 

For example, one of the initiatives within H.728 sought to remove barriers to treatment for Vermonters on Medicaid. Vermont Medicaid (insurance for low-income Vermonters) requires patients and providers to jump through hoops that private health insurance companies cannot impose by law. 

Studies suggest that removing this administrative barrier used by Medicaid, called “prior authorization,” may encourage participation in treatment and improve health outcomes. H.728 would have tasked our state’s pharmaceutical and clinical utilization review boards to hold public hearings and propose changes to our prior authorization policies. 

Another vetoed initiative would have expanded access to services provided by syringe exchange programs. According to the Centers for Disease Control and Prevention, syringe exchange services reduce transmission of disease and can greatly increase a participant’s likelihood to engage in treatment and long-term recovery. 

Current Vermont law, which was enacted in 1999, excludes many organizations from providing needle exchange. H.728 would have granted the Department of Health increased flexibility in designating organizations as syringe exchange providers. 

The June 7 veto message ignores these two initiatives, and instead rejects the proposal for an Overdose Prevention Site Working Group. This working group would have tasked the Department of Health and various stakeholders to investigate the feasibility, liability and costs of overdose prevention sites (facilities where individuals can use drugs under medical supervision). 

While we heard from various people on the front lines that overdose prevention sites are worth pursuing, the committee agreed that we needed more information before taking action. We proposed research and planning — which the governor vetoed due to insufficient information. But isn’t the purpose of research to gain information? 

The veto message reads, “This bill proposes to shift state policy and financial resources away from prevention and toward unproven strategies such as overdose prevention sites.” This statement is misleading. The facts are that there is no obligation in H.728 to fund overdose prevention sites. Furthermore, the Legislature has already funded prevention efforts at the governor’s request, and in addition strengthened resources to our substance use treatment providers, recovery centers, and syringe exchange programs in this year’s budget. Fortunately, the veto of H.728 will not affect these funding increases. 

We know that stigma is one of the greatest barriers to overcoming substance use disorder, and we would be disheartened if certain conversations were off-limits for our executive branch. 

While it is frustrating to postpone policy progress for another year, we are optimistic that the Legislature and the administration will be able to return to the table, hear from Vermonters, and find solutions. If the pandemic has taught us anything, public health should not be political.