Dan Simon, Senior Writer for the Gate, sat down with Vermont’s Governor Peter Shumlin to discuss combating opiate abuse in his home state, what makes Vermont unique and what’s ahead for this three-term governor.
Gate: I’ll start off with an anecdote. My local police department was the first in my county to provide officers with naloxone (Narcan), a fast acting anti-opiate used to reverse overdoses. And it’s been used twice successfully. But, the problem is that both times were with the same person. How do you make sure that person doesn’t need it twice? There is a free will issue. You can’t institutionalize somebody who has overdosed. You can’t imprison them, because that doesn’t help them. So, what do you do when you have to do this two or three times to a person that doesn’t seem to want to help themselves. How do you extend that arm and help with a strong enough voice that you don’t have to go back and keep rescuing them?
Gov. Peter Shumlin: The nature of this disease is so debilitating that it’s highly unlikely anyone in recovery will not relapse. So, we should change our attitude about the disease and really treat it as we would any other disease. We think nothing of doing a second round of chemo for a cancer patient. We think nothing of doing dialysis on a kidney patient sometimes twice and sometimes three times, sometimes everyday for months. I always ask the question: why do we think this disease will be any different from other diseases? We have to accept that no one suffering from this disease is likely to have a smooth and seamless transition to recovery. It’s going to involve relapses, it’s going to involve disappointments, it’s going to involve more heartbreak. So, accept it when you join up in a treatment system that works.
Gate: Is there a particular method of treatment that you find to be most effective? Either a halfway house program or inpatient treatment?
Shumlin: First of all, I’m no doctor and I don’t pretend to be an expert on this disease. I’m a governor. I’ve got to run all kinds of other things. I’m not the person to answer that. What I can tell you that is that I’ve been told treatment success varies from patient to patient. In other words, what might work for you might well not work for the person that’s addicted next to you. The good news is that medical technology is going to help us find more success in recovery. Here’s an example: Right now buprenorphine (Buprenex), the method of providing placebos to opiate users,requires you to show up once or twice a day to get their dose. The manufacturers are now developing implants that will only require you to check in every 20-30 days. That will be huge for quality of life for people who are back in the work force. Right now,they have to show up at the same place every single day to get their dose. There’s also real hope for naltrexone (Vivitrol), which is a new drug that we’re experimenting with in Vermont, which—unlike Bupe and the other placebos—is not a replacement drug. In other words, the drugs used to treat heroin right now are often treated in the streets; they also give you a high. I shouldn’t say give you a high; they are deeply desired by people who are addicted. After you go through withdrawal, Vivitrol actually changes the synapses in your brain so that you feel lousy if you use drugs. That has huge potential to change the face of recovery treatment. I’m sure other things will come along, but the point is that you’ve got to throw all the resources—all the research and all the technology at this disease—just as you would any disease. Over time, treatment options will improve.
Gate: In your talk you mentioned you are opposed to Dr. Robert Califf’s nomination to be the head of the Food and Drug Administration. If not him, then who? And not just specific people, but why? Are you opposed to people from pharma being involved in that process because it seems sort of like a good idea that somebody that’s familiar with one side of the operation should switch over to the other side. Sort of the revolving door type of situation that you see in a lot of government departments. Why in particular do you think that Dr. Califf or people in a similar situation pose a risk to this problem generally and also the drug regulatory scheme at large?
Shumlin: I think the FDA needs someone who can really determine what drugs work and what drugs don’t work. But who is objective and not a partner with the companies that are profiting from the approval of the drugs? Oxycontin literally made $11 billion in 2010 off of painkillers. The question we’ve got to ask ourselves is: do we want a head of the FDA who has been a part of Big Pharma’s system? I would argue that it is not in our best interest.
Gate: What methods do states have to restrict prescription drugs within their own borders?
Shumlin: Almost none.
Gate: Is that something you would push for at the federal level? More state control?
Shumlin: No, because I think that states neither have the expertise nor should they . We’ve got to fix the FDA so that it works for every state and so that they are partners in fighting addiction, not promoters of drugs that are prescribed in ways that make the problem worse. Let’s not give up in the model.Instead, let’s try to educate the folks who are leading us into this mess and say we need you to partner with us to fix it. This isn’t rocket science. We know that opiate addiction challenges grew exponentially when we approved Oxycontin in the 1990s. We’ve got to be able to back up to that moment and ask, “Okay, we can put someone on the moon, we can develop weapons that are the best money can buy in the world, we seem to be able to be innovators on technology for the world, can we figure out the root cause of this problem that we created?”.
Gate: There’s another border other than the one the US shares with Mexico. You are particularly close to the Canadian border. Does Canada have similar problems? Do you see heroin coming over the northern border as well as through the states from the south? Is that an area where you have a little more control or a little more expertise than other states by virtue of geography?
Shumlin: Canada also has a challenge, and we have a challenge. Anyone who has a border with Canada has this challenge. When we made Oxycontin tamper-resistant, the Canadians didn’t. A number of governors are working very hard with our friends, Canadian Premiers, to get the federal government in Canada to join us in the tamper-resistant efforts. But, ultimately, American prescription drug policy affects Canada, so we should work with them.
Gate: Do you think there is something inherent about the United States as a result of geography that makes drugs particularly challenging for us? because we do have such a long border and extensive coastline that we are going to perpetually face problems of novel forms of narcotics coming in, new methods, new technologies. Because, like you said, the drug cartels are sophisticated and intelligent people. They’re evil, but they’re sophisticated. How do we try and work against our own geography that has given us a lot but now is creating a lot of problems for use as a country.
Shumlin: We do have huge challenges with drug addiction and the ability to get illegal drugs in America. That’s probably going to be a problem as long as we’re on the face of this Earth. What’s different about this problem is that we can trace it right back to legal drugs—not illegal drugs—approved by the FDA and handed out in our drug stores like candy. That’s the part that we need to fix.
Gate: Bernie Sanders caught flack from Hillary Clinton during the debate for his stance on guns. You are from Vermont. You are a hunter and a fisherman. Is there something different about Vermont’s culture and the rurality of the state that makes guns a different situation than it is, say out in Montana, where gun control is a different conversation than it is in Chicago, which has a very different gun control position?
Shumlin: Yes. Bernie Sanders comes from a state where we all, where many Vermonters hunt, where we manage our natural resources. We have some of the most beautiful natural resources in the world because we manage our herds of white tail deer, bear and other species. There’s a culture in Vermont that treats weapons with respect, with dignity, with safety and with common sense. Bernie comes from a state where you don’t have hundreds and hundreds of people dying from gun violence every single month or week. So, it really is the tale of two worlds. Inner cities in Chicago, New York, and Los Angeles have very different gun challenges than Vermont. That’s why I’ve always said that a 50-state solution to this problem is absolutely critical because if you have one state that has one law and the state next door doesn’t, we all know that people that abuse guns are going to. That is, the ones that abuse the privilege of having a gun are going to the states that allow someone to get those guns. But, Bernie definitely comes from a world where the gun discussion is different than what most voters face.
Gate: One of the first challenges you faced as governor was Hurricane Irene and infrastructural damage. That’s also a big, bipartisan rallying point right now—along with criminal justice reform—for increasing the gas tax and things like that. What can states do to either ameliorate the situation on their own, sort of say: “we don’t need you, Washington, we’ve got to figure this out on our own,” or put a lot of pressure on the federal government in the coming months to fix this problem? It is a serious problem in my home state of Pennsylvania. Former Governor Rendell is really passionate about this issue. What can you do as the governor of a smaller state, but a governor nonetheless, to help apply pressure?
Shumlin: Governors have huge power to address climate change. You know I’ve dealt with three major climate change-induced storms and hundreds of millions of dollars worth of damages, We’ve lost lives, we’ve lost businesses, we’ve lost homes, and we’ve lost farmland. We’re facing real challenges like every other state. I’ve made energy efficiency, building out renewables and changing the business model for our utilities a top priority as governor and we’ve made extraordinary progress. We have ten times the number of solar panels we had in our state when I became governor. We’ve built up wind, too. We have one of the most energy-efficient programs in the country. The most exciting development for us is that we have, through legislation and a partnership with our utilities, changed the business model of utilities in Vermont...It used to be, a very short time ago, their business model was, “Sign up [for] as much power generation as you can. Bring it in across poles and wires, thousands of miles away...and sell as much of it as you can to customers.” Now, their business model [uses] on-bill financing. Meaning, for what you used to pay for your electric and oil bill combined, they’ll come into your home, your older home—and we have a lot of older homes in Vermont—they’ll rip out your door and windows and replace them with energy efficient doors and windows. They’ll blow your house so tight that you’ll have to open up your windows in the wintertime...They’ll put solar panels on your roof or in your yard or in your field to share with your neighbors. They’ll put a heat pump in your basement and rip out your oil burner. They’ll put storage in your house and literally you are energy independent and selling your excess power at low rates to your neighbors. And it’s changing the business model. That is allowing us to [improve] energy efficiency, get off of oil and coal, and move to a renewable future. It’s creating jobs. We have 4.7% of all jobs in Vermont being driven by this green economy that we’ve created.
Gate: You said you’re not running again in 2016. What’s next for you? Are you hoping to continue policy work in this area of heroin? Are you looking to move to DC and help work on problems there, perhaps in government or outside of government? Do you have any idea what’s next?
Shumlin: My view of being governor is that you should come in, do everything that you can to make a difference... and get out of the way. And that’s what public service used to be in this country. So, I’m deeply committed to continuing to be involved in policy and make a difference for my state. I’m a Vermonter and those of us that are born and raised in Vermont tend to want to sleep in Vermont. So, my idea of hell would be living in Washington DC.