On Tuesday, Vermont became the first state in the nation to legalize possession of buprenorphine, a prescription drug used to treat opioid use disorder.
This week, Gov. Phil Scott signed H.225, a bill that will allow people to possess up to 224 milligrams of the drug — roughly a two-week prescription of the substance — even if they don’t have permission from a doctor. Previously, that qualified as a misdemeanor.
Before it became law, the measure was debated in the Legislature for three years and hit a delay when the Covid-19 pandemic struck last year. Since then, drug overdoses in the state have spiked, which lawmakers said gave the bill new urgency.
Supporters of the policy say it will prevent overdoses and save lives by encouraging people with substance use disorders to choose buprenorphine over heroin.
Brenda Siegel, a drug policy advocate who pushed for the buprenorphine policy for years, said passing the bill “really seemed like an immovable mountain for a long time.”
“I am so relieved that people will have this tool for survival,” Siegel said.
While possessing buprenorphine is no longer a crime in Oregon — where limited possession of all drugs has been decriminalized — Vermont is the only state that has specifically legalized small amounts of the substance, which is commonly prescribed as Suboxone and Subutex.
But the bill Scott signed Tuesday won’t make buprenorphine permanently legal. Instead, the measure will expire after two years, giving state officials time to see if the policy is a success and determine whether it should be renewed.
Through an executive order, Scott has also established a task force to use metrics and data “to assess the effectiveness of decriminalizing buprenorphine.”
“This seems like a reasonable, thoughtful approach to the challenge of addiction and overdose in Vermont,” said Joshua Sharfstein, a vice dean and professor at the Johns Hopkins Bloomberg School of Public Health, who testified in favor of the policy during the 2019 Vermont legislative session.
“It’s based on a foundation of evidence, but also recognizes that it’s going to be very important to study the implementation,” he said.
Chittenden County State’s Attorney Sarah George, who also advocated for the legislation, said she was grateful Scott signed the bill and “acknowledged the importance of dealing with substance use disorder in a different way than we have been.”
“My hope is that this will send a message to folks who are using drugs, specifically using opioids, that the Legislature and the state, and leaders in the state, care about their survival, and want them to stay alive,” George said.
Under George, prosecutors in Chittenden County decided in 2018 that they would no longer file criminal charges for possession of the buprenorphine — becoming the first jurisdiction in the U.S to do so.
That year, opioid overdose deaths dropped by 50% — an outcome that some have attributed, in part, to the policy shift.
George said she hopes the new policy will “have the impact statewide” that officials believe it had in Chittenden County, so that “more people will be using buprenorphine instead of heroin, and so our overdose fatalities will drop.”
Kellen Russionello, a senior staff attorney with the Drug Policy Alliance, a national organization that advocates for decriminalization of all substances, said he isn’t aware of any other states looking to legalize buprenorphine possession, but he’s “very hopeful that this type of legislation can be replicated in other states.”
However, he also noted that some states are contemplating decriminalizing all substances.
“The system that we have in place makes it so difficult to get medication that people will do so not through the legal means, and they shouldn’t be punished for trying to do that,” Russionello said.
“I think it’s a great example and something that hopefully will be exported,” he said.
While Scott decided to sign the buprenorphine bill into law, he noted that he is still skeptical of the policy.
“I am concerned about the lack of data on decriminalizing buprenorphine, and its effectiveness in reducing opiate overdoses is unproven,” Scott wrote. “The impact of diverted medication and its use outside of treatment is also a concern, given the critical support the hub-and-spoke system provides, and with the difficulty prescribers may face in their work to ensure successful treatment.”
Vermont’s health commissioner, Mark Levine, also opposed the policy.
George said Scott’s comments ignore the facts, asserting “there isn’t any data when we did this in Chittenden County and the fatalities dropped over 50%. To completely ignore that, and by ignoring that, sort of give this impression that criminalizing it does something beneficial, I think is disingenuous and inaccurate.”
But Scott ultimately opted to sign the buprenorphine bill in part because it will expire in two years, “providing experts the opportunity to assess the effectiveness of this initiative.”
“Although I remain skeptical, I signed this bill because it is well-intentioned and offers another potential approach to reduce the impacts of substance use disorder,” Scott said.
Sharfstein said multiple studies show that people who use unprescribed buprenorphine are more likely to seek treatment for substance abuse disorder.
But, while there’s “certainly evidence to support taking a step like this,” Sharfstein said, it’s also “completely appropriate” to study buprenorphine legalization carefully and “assess what happens.”
“I don’t begrudge the governor for saying that he is a little wary, because I think it’s appropriate when you’re doing something that has evidence, but it’s still new, to be careful and thoughtful,” Sharfstein said.
Read the story on VTDigger here: Vermont becomes first state to legalize limited possession of buprenorphine.