again and welcome to the governor's community forum on opiate addiction. I'm Barbara Somoglio. I'm the deputy commissioner for alcohol and drug abuse programs at the Department of Health and I'll be your host for today and trying to keep you on track and make sure we get everybody to the right place at the right time. I just want to give you a little bit of opening before we get right to the governor and remind you that the purpose of today's forum is to share community solutions. We've been talking a lot about the problem and we're going to hear a little more about that this morning. But the bulk of the day is really to hear about what you are doing in community to address the issues of opiate dependence, opiate trafficking, and all the things that go with that in your local community. We're going to be providing education on the issues and information about what we know works and we're going to be promoting community team action planning so you'll actually come away from today with some next steps that will help you go home and continue your good work. We also want to connect communities to resources that are available to you on a statewide, regional, and local basis. We have a few housekeeping things to go through but I know that everyone's very excited to hear from the governor so what I'm going to do is get us right started with the governor and then we'll go through some of the more mundane details after we get fired up by hearing him talk to us. We are very fortunate here in Vermont to have a governor who is not afraid to talk about some of the more challenging things that are going on in our state and also to be willing to take the leadership to spur the national folks to pay attention to this, to look at what they can do to help us, and to be part of the solution along with the leadership that he's taking. So without further ado, I would like to welcome and introduce to you this morning our governor, Peter Shulman. First lesson when we're doing something that has this many moving parts, we know that some things are going to happen out of order. So while we're waiting for the next part, I think I will go ahead and do the housekeeping. First of all, and most importantly, this day is about many people working together and I want to particularly thank the governor's office, Sue Allen and Carolyn Wesley for their leadership and their support of doing an event that has been quite complicated to pull together. Also, I would like to thank everyone that served on the planning committee and I am going to name them because each and every one of them did a great job and was instrumental to helping this day be a success. First of all, my staff who helped with this, Marsha LaPlante and Patty Baroudi in particular who were part of the planning committee couldn't have done this without them. Bess O'Brien for her vision, passion and ability to engage the broad community and her commitment to people in recovery, to Bob Bick, Joellen Turalo Falk from the Center for Health and Learning, her and her staff have done all the logistics out there that you see and we could not have done this without her and her team. Marsha Maxim and the United Way for their great support, both resource and personal, we could not have done this without the United Way and we've learned so much from them about how to engage community. That is the core of our planning committee, so will you please help me give them a round of thanks. In addition to that smaller planning committee, we had a larger group that came together and gave us feedback on the agenda and helped us flesh out the content of the workshops. So I'd also like to thank those people, Colonel Tom Lesperance of the State Police, Lisa Ventress, the Vermont Business Roundtable, Sean McMahonen, Representative Joan Lennis, Dr. Mark Deppmann, Pat Martin, Laurie Augustiniak, Hannah Rose, Rayna Lowell, Paul Bankston and Steve Klein. Please help me thank them. I'd also like to introduce a special guest that we have with us today. This is a person that I work a lot with in Washington and he was so excited to hear about what was going on in Vermont. He agreed to come and be with us for the day. So I'd like to introduce Rob Morrison, who's the Executive Director of the National Association of State Alcohol and Drug Directors. We say hi, Rob. So now I'll just walk through our plan for the day so everybody can understand what the order of the festivities are. So you have an agenda that should be in your packet. I also want to point out, in your packet, there are many things. Hopefully everyone got one of these packets. You have an agenda, but also in there, you have a little card looking thing that's got in plastic in the inner pocket. And if you're like me, you're saying, what is this thing? This thing is all the resources that we chose not to print out in paper, but to put on this flash drive. If you take that little thing out, you will see that if you open the little flap that will go into your computer and you will be able to pull up all of these things that are listed on this yellow sheet. So if you want to refer to regional maps, contact lists, website resources on many, many topics, the Youth Risk Behavior Survey, information on prescription medication disposal guidelines, and many, many more things. It's all on that little card looking thing. So don't lose that because it's got lots of good information on it. Also in your packet are some new fact sheets that the Health Department has produced. There are four of them. On opioid addiction, what communities can do, prevention, and treating opioid addiction. So these are also up on our website and can be reproduced as you would like to reproduce them. On the other side, you've got a map so you can find where all the rooms are. There are lists of the regional contact people and also lists of the regional teams and the panelists for the workshops this morning. So we've tried to make sure you have all the follow up information that you might want to take home with you. Okay. So quick review of the day. We're going following the governor. We're going to hear from a panel of speakers who will help us frame our discussion. We want everybody to be on the same page as we open our dialogue today. And so we've chosen our speakers carefully to give you some important background. Following the panel, we'll have an opportunity to hear very brief presentations from people who are doing work at the individual and community level in various sectors, medical schools, family, etc. Those are what we call affectionately our popcorn speakers.  So if you like what you hear from these people who are going to give you just a couple of minutes overview, then you can go to the workshop later on and hear more in depth from them and others who are working in these areas. Then we will have lunch and the morning presenters will be joining other panelists and facilitated breakout sessions to further discuss their topics. And that's what I said. All your room assignments for the breakout and community planning sessions are indicated on your agenda and all the rooms are labeled. And there are people out in the hallway that have a sign that name tag that says ask me. So if you see the people that say ask me, they can point you in the right direction if you're not sure where you're going. We'll be eating lunch in regional community groups from 12 to one in the cafeteria. In your packets and at the registration table is a list of the district Vermont Department of Health Office regions. Please select one to join. It's basically where you know the area where you live you'll be we'll be asking you to have lunch together with with people from your area. Also during lunch, you might want to talk amongst your groups so that you split up where you're going to go in the workshops so that you're not all going to the same one.  You will meet again by community groups at 230 and that will be local planning. You'll have a facilitator and we'll be asking you to answer some questions and put together some next steps that make sense for your community because at the end of the day, this really is about taking action and it's going to be important for you to come away with a couple of follow up steps. We all each of your communities also has a follow up meeting plan and we encourage you and we'll be inviting others to join you for that follow up meeting. So this event really is just kicking off what you're going to go home and work on when you get back to where you live. Then at the end of the day, we're going to come back here for a little debrief and a few short closing remarks and a recoup of our next steps for our effort. We ask you to please move quickly. We're going to try to keep on schedule. It's pretty tough with as many moving parts as we have, but we're going to do our best. If you have any thoughts throughout the day, please feel free to share those. There is an evaluation that we'll ask you to do at the end of the day and to put back at the registration table. I'll just say a little bit now. You have some cards also in your packet. When we get to our morning speakers, we ask you if you do have questions, write them down and we'll have people collecting the cards that you can pass your cards to so that we'll have a few minutes for questions and we can do that an efficient way if you write those down on the cards and make sure you pass them in. So he is he the governor hasn't arrived yet. So we will go ahead and begin with our panel and when he arrives, we'll just move from the panel to to his comments. So okay. Thank you for being patient. You can tell I'm not used to being a moderator. So I've got a lot of pieces of paper up here. So our panel, we thought that one of the things that was important for you as as participants in this forum is to make sure that everyone has some grounding in the issues that we're talking about. We know we all have strong feelings and we all have our personal experiences we bring. But we want to give you a chance to learn a little bit about the problem as we look at the data about what our state is experiencing. A little bit about prevention and why prevention is so critically important as the foundation of keeping our communities healthy and well. We also want to learn more about the science of addiction. Why is this such an intractable problem at the human individual level? What happens to our brains when we use powerful opiates that makes it so hard to control our behaviors when we take these substances? What are communities doing? And we have a wonderful example of a community that is taking action across the whole spectrum. And then we want to end up by hearing from a brave lady who has agreed to share her story with us of recovery so that we can see what is possible. We do everything we do because recovery is possible and community wellness is is so critically important. So with that I'm going to introduce our first speaker and he's a very special speaker for me to introduce because he's my boss, Commissioner Harry Chen of the health department who has been exceptional in his leadership as a former emergency room physician at Rutland Hospital. He knows this problem first hand. Not only does he know it, he believes that it's important to take leadership and to ensure that we are doing community action across the board. So without further ado I'll introduce Dr. Harry Chen. Well thank you Barbara and I have to at least give you one story which is the last time I remember being interrupted by the governor who was at a press conference at the airport in Barperia and he was landing in a helicopter so this won't be the last time I'll be interrupted by him. So I do want to thank all of you for being here and your commitment to work together with each other and with us at the state level to meet the challenge of opiate addiction. Opiates are powerful drugs. They slow the breathing and heartbeat. They act on the brain to relieve pain and increase feelings of pleasure. Opioids can be powerfully addicting and that's why we're all here today. We have a crisis in our state but let's start with some hopeful news. Some of the numbers are going in the right direction. Percentage of Vermonters who are using prescription painkillers for non-medical reasons has declined or stayed about the same since 2002-2003. For the 12 to 17 year olds those in middle school and high school the blue line in the middle there's been a significant change since 2002 and 2003 from 9% to 6%. Overall Vermont has a similar prevalence of pain, believe or misuse compared to the U.S. and there are no regional differences within the state. So we're essentially the same as the rest of the country and there's no difference in Vermont where you live. It's the young adults, the 18 to 25 year olds, the top green line that we are most concerned about. Heron use among Vermonters has been low compared to the U.S. as a whole and hasn't changed much over the years. It's 2% of high schoolers according to the youth risk behavior survey or less than 1% of those Vermonters 12 and older. But just the same even though it's significantly lower than the rest of the U.S. there are troubling trends that really speak to our crisis. Research is showing in common sense tells us that the use of opioid painkillers is related to the use of the opiate heroin. Heroin is now cheaper and easier to get than prescription painkillers. I remember in the emergency department seeing a patient who I didn't want to give opiate painkillers for the 10th time for their tooth or their back and them just storming out of the emergency department saying well I'm just going to get some heroin on the street. Many users report that crushing prescription opioid pills to snort or inject was the start of their drug use. We know that 60% of them get them from their friends and family. We need to work on the misconception that they're safer just because they're prescribed. Vermonters brought the problem of addiction and heroin and other opioid drugs national attention this year. It's a problem that was shared with the rest of the nation. It's not a political one but a public health issue. And the numbers that quantify addiction as a public health crisis are startling for our small states. More than 50 Vermonters die from opioid drug poisoning every year and the rate is increased from 2012 to 2013. Between 2012 and 2013 deaths from heroin doubled. And so why do we call this a crisis given some of the numbers that I've shown you? It's clear. We call it a crisis, a public health crisis. Addiction is a life threatening and lifelong chronic disease. And death and overdose is always a threat. Addiction affects us all. The costs are high for treatment, healthcare, law enforcement corrections, human services support. These are costs that are borne by all of us. But the costs of young lives shattered, families and communities torn apart. These costs are unquantifiable and unacceptable. Addiction requires effective treatment often with medication assisted therapy. So in a way, it's good news that more than 4,000 Vermonters were in state funded treatment for opioid abuse in 2013, up from 399 in the year 2000. Because of this, it reflects the state's greatly expanded access to treatment. Facilities opened in 2004, 6, 8, 12 and 13. Opiates surpassed alcohol for the first time in 2013 as the primary drug for people in treatment. And you can see that on this graph. I actually never thought I'd actually see that, but it's here. The Health Department administers both the federal SAMHSA block grant and the state Medicaid funds along with other dollars that support intensive outpatient residential and medication assisted treatment. Our goal is to ensure that anyone who needs treatment can get it, get the right treatment as soon as possible. With the opening of Westbridge in November and March, Behavior Health Services in the Northeast Kingdom in January, the state is implementing the Care Alliance for Opioid Addiction. The Care Alliance is a partnership of treatment centers and clinicians around the state using a hub and spoke model to offer medication assisted therapy for minors in need. Simply put, the treatment centers or hubs will serve patients with complex needs. Hubs offer comprehensive assessment, especially treatment with methadone or buprenorphine, providing treatment much closer to home for many. Connected with the hubs are the smokes, the blueprint for health, primary care, and other physician practices that treat patients using buprenorphine. Each patient's care is coordinated and supported by nurses and counselors who work to connect with community support services. This is the same model we use for Vermont's chronic diseases like diabetes and heart disease. People admitted to treatment are asked when they started using. The age opiates of first use 21 is somewhat older than the first use of alcohol 15. They start later. We know that the demographics of heroin addiction and overdose in users is changing nationwide and in Vermont. It's no longer a minority inner city disease, no surprise given our recent experience, much closer to home. We also know that people seek treatment for opioid addiction sooner. The difference between the age of first use and the age at which a person seeks treatment is much shorter for opiates, roughly eight years than for alcohol, nearly 25 years. So people who use opiates end up in treatment in the treatment system much sooner than those having problems with alcohol. That is partially to explain why we're experiencing such a crisis. The problem is compressed. They start younger and seek treatment sooner. It takes a comprehensive approach sustained over time to make a difference. We know that any single strategy approach may solve part of the problem but won't hold up for the long term. We know, for example, that we can't arrest our way out of the problem. And so the move to get offenders who are not dangerous quickly into the treatment is a good one and proven by the data. And we know that treatment community support and recovery services are critically important for people who are addicted to manage their disease. But that is not prevention. And that's why we're here today. Years of research show that effective interventions require that we take many actions, actions such as working way upstream to prevent problems that lead to addiction in the first place. This includes everything from promoting mental health and resiliency in our youth, implementing policies known to reduce access to unused prescription drug medications, actions such as supporting screening, brief intervention, and referral to treatment in our traditional health care settings to prevent risky substance use from becoming addiction. Actions such as promoting recovery through individual supports and community-wide education to reduce the stigma that is associated with addiction. We can't solve this problem without both owning it and embracing it. The good news is that we can do this. Everyone here has a part to play. And that's why we're all gathered today. We can do this. I'm confident that we can. Opioid abuse and addiction is a complex and tough problem. And we know the consequences. With the reminders working together in our communities, we can make progress. Truly, I thank you all for being here today and look forward to the rest of the day and the results of your efforts. Thank you. Thank you, Dr. Chen. OK, we're going to go on to write. No. OK. Didn't know what you were saying there for a minute. We're going to go on to our next speaker. And I'm very excited to introduce Dr. Mark McGovern to you. I got to know Mark. I don't even know. It was back when I was in Oregon. I've known him for a long time. And I've always been impressed with his research. And he is, in fact, one of the researchers in our field of addiction that has been doing this work over the years. And we've learned so much from what he's found out by working with people in treatment. Dr. McGovern is a professor of psychiatry and of community and family medicine at the Geisel School of Medicine at Dartmouth in Lebanon, New Hampshire. But he lives in Vermont. So that's why we invited him. He practices at the Dartmouth Hitchcock Medical Center. And his research program is based at the Dartmouth Psychiatric Research Center. His clinical and research focus is integrated treatment for persons with co-occurring substance use and psychiatric disorders. Dr. McGovern has received a NIDA Career Development Award and grant funding to translate evidence-based therapies for co-occurring disorders into routine clinical settings. He's also received awards from Robert Wood Johnson Foundation and Substance Abuse and Mental Health Services Administration to advance a series of organizational measures of integrated service capacity. These measures, the dual diagnosis capability in addiction treatment and dual diagnosis capability in mental health treatment and dual diagnosis capability in health settings have been widely adopted and are being used to implement evidence-based treatments in community settings throughout the United States. These DD cats and the related, what they really do is help people in one setting learn how to integrate their work. So if you're a mental health clinician, how do you make your program more integrated with addiction and vice versa? So these have been tools we've actually used on the ground here in Vermont quite successfully. Dr. McGovern has also been actively involved in the education of medical students, psychiatric residents and fellows and clinical psychology interns at Dartmouth and previously at Northwestern University Medical School in Chicago. Since 2009, he's also been editor-in-chief for the Journal of Substance Abuse Treatment, the leading scientific journal dedicated to addiction treatment research and implementation. He's also working with us with our hub and spoke system of care and leading the learning collaboratives that are helping our practitioners learn how to implement evidence-based practice. So on many, many levels, we are very grateful to Dr. Mark McGovern and today we're very grateful to have him here to talk about, oops, the governor's here. Well, Mark, you got a good introduction. Now I'll have to wait. So remember all of that. So in a few minutes, when you hear Mark, you'll know. Mark, we need to say one more thing. Carolyn and Alistair are going to be on either side to collect cards. There he is. If you have questions. So Carolyn, Alistair, pass them your cards when you have a question. Thank you. Take it away. Hey, thank you so much, Barbara.  And of course, my team, all of you. Thank you. And I'm sorry I'm late. As you know, you're going to hear from a lot of great folks. And we got a lot of people to thank. But obviously to the United Way for helping with my health department, we've got the commissioner here. You know, Barbara's here. The team's here. You're going to hear from Mayor Loris from Rutland later. I think his wife and mother are here. Is that true? Yes. They don't usually admit to knowing him. So that's a big deal. I think Mayor Tom Loson is here, too. Is the mayor here? Did he couldn't get out of that usual? Where is he? Hey, thanks for your good work. He was working in a yard this weekend. So that's where he got that tan. But thanks for all your great work. Thanks to Lisa Ventress, the business roundtable. Most importantly to all of you, law enforcement, judiciary, folks that are working hard in our schools, parents, folks in recovery, the treatment community, and anyone else I'm missing. Thank you from the bottom of my heart. Listen, I don't think there's a discussion more central to preserving our quality of life than the one that we're having today. And I want to first thank you all for giving me the information and the strength to help us collectively raise our voices to talk about an issue that nobody wants to talk about. And we know that folks don't want to talk for lots of reasons. Addicts often feel shame, so they won't talk. Family members feel shame, so they won't talk. Politicians don't like to talk about it. Politicians don't like to talk about it because we recognize that we have to change in order to move more people from addiction to a productive life. And when we talk about making change, we talk about risks, and we all know that people who are elected tend to be risk adverse. So from our public servants to the folks that are working so hard to deliver the services, most importantly to the folks, Vermonters who are addicted, the fact that we're raising our voices, that we're coming together collectively to figure out how we can get this right, recognizing that none of us have the answers, but all of us are trying, and some models are working perfectly in their region, but aren't being deployed. The really the question today is, how do we collectively take an issue that's so critical to Vermont, so critical to our quality of life, and turn it in to the most innovative practices possible to solve a growing challenge? You know, when I first told my staff that I thought I should devote my state of the state address to what I was hearing out on the streets from Vermonters, you know, you can kind of imagine their reaction. And I just gotta say this, since we had that conversation, I think we've accomplished one thing for sure, and that is, we have made it possible to talk about addiction and recovery, to talk about what we're doing well, and we're not doing well, and most importantly, to have a collective conversation about how Vermont leads in getting this right. Let's talk about the roads that we've traveled a little bit. I started talking about this because I had many, many Vermonters coming up to me every day as I circle this state, and I'm late today because I'm on the circle, and that's what I do seven days a week. And I had so many Vermonters from all walks of life, all walks of life, saying to me, you know, my son, and I've lost my son, we've lost our family to addiction, lost my daughter, lost my niece, lost my mom or my dad, or folks would say, you know, my store's getting ripped off or my car's been getting ripped off or my house's been getting ripped off, things have been happening that didn't used to happen like this in Vermont. And they said, how come nobody's doing anything? When we look at the statistics, you know, statistics can put you to sleep, but they really matter in this case. Since 2000, more than a 770% increase in treatment for all opiates, all opiates. People often ask me, and I bet they ask the mayors and they ask Chief Baker and so many people here, how do we get into this mess? And I think we're all too hesitant to say, you know, it really isn't that puzzling when the FDA approved OxyContin and we started passing it out with what only could be described as irrational exuberance, a lot of people got addicted. You know that we passed out enough OxyContin in the second year that was on the market to keep everybody in America high for a month. That's right. When my own dad passed away six weeks ago, my mom and my sister started going through the medicines that they'd given them as somebody who's just growing old in Vermont, you know, had various elements that people were 89, 90 year olds get.  We're still doing it. Not much has changed. You all know that the FDA's own advisory committee voted, I believe eight to two, do not approve Zohydro because Zohydro is OxyContin on steroids. And it's not even tamper resistant. You know, you can crush it, you can shoot it, you can snort it, the FDA proves it. Go ahead. Like we didn't learn anything. Not a thing from our battle with OxyContin. So when people ask, how do we get into this mess? And then people say, and how come Vermont? I say, wait a minute. It's not a puzzle how we got into this mess. The FDA sells opiate heroin in pill form, proves it, we passed it out. It's all 50 states. Vermont is no better or worse than the other 50. The difference is Vermont has a quality of life that binds us together, that holds us together, that defines us and therefore we feel it more intensely here because we don't have much robbery. We don't have much crime and we don't have people on the streets who will do almost anything to feed a habit. That's what's different. Since 2000, we've seen a 250% increase in heroin treatment. It's more than 40%. Five times as many convictions in 2013 for heroin is in 2010. Why? Because we all know that the street value of OxyContin is higher than the street value of heroin and people who are addicted will do anything to feed their habits so they move to heroin. So no one should be puzzled about why Vermont and no one should really be puzzled about why America. So here's what we've learned and here's the work that we're asking you to do not only today, but every day go forward. This is what I think we're getting right. When you see Bessel Bryant's film, one of the things that struck me was the story of the young farmer up in Addison County who, you know, 10th grade gets offered some OxyContin during exam time, takes some, finds out that he's never felt better, becomes an addict hard and fast, spends five years struggling with addiction.  And when he was ready for treatment, when he was ready, his mom calls up and says to my folks, hey, you know, my son's addicted and he needs treatment. And the person in the other line says, is he suicidal? She says, no, he's not suicidal, he's addicted. Say, well, sorry, we can't help you. We got waiting lists. We can only help those who are suicidal.  So what do we learn from that? Since we know that the hardest, most difficult thing for people who are suffering from this disease is to move them to treatment. That they'll do almost anything to deny their addiction. We ought to have a system when someone calls up and says, I need treatment. We say, how can we get you that treatment right now? So, we're investing a lot of money. We're doing some right things in the hub and spoke program that we're all putting together collectively. As Mayor Loris will tell you, we've just opened a beautiful center in Rutland. We got to do a little work in Bennington. We've just over the center of the kingdom. We want to make sure that when the money we're invested in its big money, $12 million this year, that nobody who calls up ready for treatment has to stand in line. That's what we've learned, I think, collectively on a bipartisan basis. We've agreed in Vermont, if you're suffering from a disease like this, you should get treatment just like you should get treatment from any disease that you're suffering from. So that's progress, and I'm convinced that sometime early next year, even as we talk about this and have forums like we are today, and therefore sign up more people for treatment because it gets easier to talk about, easier to acknowledge a problem and therefore easier to get treatment for it, we're still gonna be able to keep up. That's important. Second, tomorrow I'll sign a bill that really changes what we've been asking law enforcement and judiciary to do, and I think the most profound way of anyone that's thought about this across America. We've said to law enforcement and judiciary for years, not only do we want to avert our eyes to addiction on Main Street, while we scream and holler about treatment in our backyards, but we also don't wanna deal with us.  And that's what's failed so miserably across America. So this bill I'll sign tomorrow changes the system statewide. So that the minute you're charged, when you bottom out, when you're most likely to be ready for treatment, we say to that individual, we're gonna get a third party assessment done, right now. And that third party assessment will say, listen, this is something that you should be scared of or mad at, scared of and go through the normal judicial process that we've asked the judiciary and law enforcement to do for years, or this is someone that is suffering from a disease. Somebody you should be disappointed in perhaps, mad at maybe, dreams didn't work out, but someone who we can move to treatment and back into a productive life. And at that point we will say to them, guess what, you have two choices. One is to go through the judicial process that many of your friends have gone through that'll end you up in a jail and you're likely to come out frankly in worse shape than the way you went in. Or the other is you can go into treatment, we'll give you the wraparound services, we'll move you from addiction to recovery, we hope. And if you succeed, you will never have a criminal charge filed against you and you'll never go through the court system. Now that's just common sense, that's just common sense. Third, we now, the most successful state in having law enforcement and everybody else that we can give it to carry Narcan to save lives of people who are ordained. That too is just basic common sense. Do you know that we have saved dozens and dozens of lives since we've implemented that policy? We have. And we've got other governors in the Northeast to think that's a huge mistake. All I can tell you is we're getting that right too and that's because of the conversation that we've been having statewide. Finally, where we need to go. Listen, it's easy to get discouraged because I don't think anybody has figured out effectively how we do the prevention piece, how we avoid addiction in the first place. But what I do know is that in talking to people in different communities around Vermont, Rutland's a great example. What the mayor and the chief baker and the entire community is doing there. Hey, maybe it won't work for Rattleboro or maybe it's not right for Winooski. But I can tell you it's right for Rutland. And if we can learn from each other what we don't know how to do so well, which is prevention and more proactive moving people on the treatment, I'm convinced that we can develop a statewide model that will work not only well for Vermont, but for the rest of the country. So listen, that's really what today is about. It's not long speeches, it's already been too long from the governor. It's not about long speeches from folks who wanna say everything that we're doing so well. It's really about how do we take some of the community models that are working and help spread them where they're working and help kill off things that we're not doing so well? How do we assess that going forward? That's what we're hoping you come out of today with a blueprint for figuring out how we take things that are working well and put them on steroids and things that aren't working so well and put them where they belong on the back bench. So I pledge to you this. I will continue to be a voice of a governor for rational policies that move people from addiction to recovery. Tomorrow I'll be down in Boston. I'm grateful to Governor DeVall Patrick and my fellow New England governors talking collectively about how we can deal better with some cross-border issues and how we can deal better as a region where the problem that's plaguing us all. You know, I can tell you as a kid who grew up born and brought about raised in Putney, raised my daughters there, when Western Massachusetts has a challenge it's our problem too. And yet we tend to talk about this as if Vermont is over here and Massachusetts is down there and the two shall never meet. So I'm optimistic about what might come out of that. On Thursday I'm down in Washington DC at the White House where the president has pulled together a national conversation about how we take some of things that we're figuring out in Vermont and other parts of the country and get this right. The National Governors Association. Because of the conversation that we're having here in other parts of the country, but largely what's happened here is now asking the question, how do we bring together governors to deal with not just a regional approach but a national approach? And in a time when Washington seems incapable of getting much done, you know, how do we do it here? And I'll tell you, I sat on a panel this winter with some of the most progressive governors and some of the most conservative governors in America. Next to me was Dr. Governor Bentley from Kentucky who is a, you know, a leader on this. I mean, he absolutely sees it the way we see it. I was with Governor Sandoval from Nevada who sees it the way we see it. All I'm saying is all of a sudden as we move from a policy that was kind of blind to the connection between what the FDA approves, what we pass out in our prescribing practices and what happens on our streets to a policy where we say collectively, we're in this all together. The people that are addicted are all of us. It isn't the, what I mean by that is it isn't the folks from one particular socioeconomic group. It isn't folks from one particular race. We have poor addicts and we have wealthy addicts. We have addicts from the North end of Burlington. We got addicts from Spear Street. We got addicts in Brattleboro from Canal Street and we got them from Chestnut Hill. It's all of us. We're in this together collectively. We can do much better than we've been doing. With your collective wisdom, your experience and your imaginations, let's let Vermont continue to be the place where we maintain our quality of life because we confront this head on, not because we turn our heads and pretend that it's not happening. So thank you from the bottom of my heart for the work that you're about to do. I wanna thank Raina Lowell for being willing to talk about her story. That's huge. To best, to Mary Alice McKenzie, Boys and Grows Club. Is Mary Alice here? She's gotta be. Mary Alice, thank you. There's an example again of how you get in early and try find ways to confront a head on with our kids. But to all of us, thank you from the bottom of my heart. I have high hopes for today. I have high hopes for not getting this right. I have high hopes that no Vermonter who suffers from addiction won't have a system in place that gives them the opportunity to move back to a productive life and a productive future. Thank you from the bottom of my heart. Thank you, Governor. As you can see, for those of you who may not have had a chance to hear the governor speak personally, this is a very important and personal issue. And I think as it is to many of us, this is what keeps us energized to find better solutions. So we're gonna get back to our agenda. And I've already given you an introduction for Dr. Mark McGovern. So I'm gonna just turn it over to Mark and ask him to come and do his presentation. I was starting to think I was off the hook. Really, I actually feel inspired. I've been fighting the fight professionally against addiction since 1978 at my first job at a detox program in North Philadelphia. And it feels to me, I say inspired because it feels to me like the Calvary, the reinforcements have arrived. So thank you all for being here. I really also appreciate Governor Shumlin's leadership. I've only ever seen Governor Shumlin on television. And I really appreciate his leadership in not hiding the problem, a courage to call attention to it, which is really the only way it can get better. I really also wanna thank Barbara Somagwio for inviting me to be here today. Thanks for having me. Really thanks again to all of you. It's really nice to see this many people involved in this issue. I don't think, as someone said earlier, Dr. Chen, we can arrest our way out of the problem. We can't treat our way out of the problem. We can't educate our way out of the problem. We have to do a lot of different things for it to work. I was asked to talk about the science of addiction. Which I think in terms of a pie chart, maybe it's Vermont's choice, I should say a cheese chart. What we know about addiction is really a very, very small slice of that overall piece of cheese. Maybe just a sliver. So I was asked to talk about 20 minutes about the science of addiction and we have a two-year fellowship at Dartmouth on the science of addiction. So I'll try to squeeze it in and maybe I don't have 20 minutes anymore. I have 15 minutes now. So it's a primer, which is the thing you put on the wall first before you try the second coat. It's another way of thinking about what I'll be doing here really just to start. But a simple definition of addiction is continued use despite consequences. It's the most elegant definition I've ever heard. Addictions also misunderstood and it was really refreshing to hear the governor speak to this issue. It's really involving fundamental brain changes at kind of the electric level, the chemical level and the structural level. The changes in function really affect things like judgment, like memory, like impulse control and will. Kind of things we do every day to kind of what mobilized us to get here this morning involved all of those different executive brain functions. We have pretty good data from functional MRIs, positron emission tomographies, other types of new brain scans, but I think the best data actually comes from animals. We're vermonters so we kind of like our animals don't we? So we're actually able to introduce addictive substances to animals and develop addiction in animals. Mostly the studies are done with rodents and monkey type animals. And essentially what happens is that the animals will work for the substance that they've become addicted to. They'll prefer the substance they've become addicted to, to food, to water, to sex, to sleep. Do the animals have character defects? Are they bad animals or are they addicted animals? So the idea here, and I think it was elegantly said by the governor that it affects anyone who's addicted. It doesn't affect poor people, rich people, black people, white people, people from Vermont, people from New Hampshire, people from Massachusetts really differentially. Our current diagnostic procedures are very, very primitive. The science is, I think this is one of these things in 20 years we'll be scratching our heads and saying can you believe what we did to assess addiction in 2014? We actually asked people about 10 questions to determine if they were addicted or not versus slide them into a technological device and measure something that's happened to their brain. I predict, I'll go out on a limb here, I predict that that's what we'll be doing in about 10 years. Essentially what we notice is it's a range and a loss of control, bio-behavioral control, control of judgment, memory, impulse control and will. I don't know that you can see this, but this basically is a state of the science on trying to link the substances that we commonly see in addiction treatment with their corresponding brain chemistry. So we're talking about opiates today, so opioids affect strangely termed opioid receptors. Dr. Chen mentioned the statistic I hadn't heard before this morning. It's really kind of an interesting statistic. It's not a good statistic, but it from age of onset of using the substance to getting into treatment, it takes eight years, eight years. Things aren't improving in those eight years, things are probably getting worse in those eight years. So the other idea with opiates and benzodiazepines is that the age of onset to the early symptoms of addiction can take days. Little less so with these other substances, but there's a very rapid course from use to disorder, use to symptoms to disorder. What about treatment? Treatment doesn't work, right? We hear all the time about people being readmitted, about people relapsing. Well, it turns out a very excellent paper, a landmark paper by Tom McClellan, colleague at the University of Pennsylvania and colleagues published in the Journal of American Medical Association in 2000, compared the treatment course of addiction with other kind of more acceptable chronic diseases. And there's an Inheritability column, an Outcome column and a Relapse column, and you can see the bands of percentages in terms of what the cause is, what the outcomes are and what the relapse rates are. They compare favorably with high blood pressure, that's what HBP is, diabetes, asthma, and there's addiction at the bottom. The outcomes though vary by things like the stage of the disease from early to advance. So if it takes eight years for you to get into treatment, you're probably at the advanced stage. Socioeconomics also have played an empirical and predictive role. If you have insurance that covers it, that turns out that you get different kind of care and more care. Family and social support matters. If you have a mental health condition, severe depression, post-traumatic stress disorder, severe mental illness, your chances for getting better with any of those diseases are less than average. The motivational stage of the patient, how ready are they for the treatment? How interested are they in complying with the recommendations of the provider? And this bottom one is really kind of interesting, isn't it? The quality of the treatment matters. We'd like to think that all we have to do is get into treatment and the rest will take care of itself. Turns out the quality of the treatment, the quality of the provider, the quality of the program, is a large degree of variability and variation. Also, we don't just stick people into a dryer and turn the dial on to 45 or 50 minutes or have that magical thing that detects moisture and stops the dryer at that point. And they're done. Treatment's over. It's a chronic disease. Treatment continues for the foreseeable future. Perhaps a person is at risk lifelong. So this is a fairly educated audience and the treatment of opioid use disorders is a little different. We actually have two FDA approved medications, methadone and buprenorphine. You're familiar with probably both of them. The medications, the medicines target those opioid receptors to restore normal functioning so the person does not have to continue to take oxycodone, hydrocodone, heroin, et cetera. Methadone is an agonist. Buprenorphine is a partial agonist. There's really two views and my very good colleague, Dr. Ben Nordstrom, and I actually debate this constantly where some professionals believe that medications are important for long-term maintenance, almost like insulin is for a type one diabetic. And other people believe that the medications are really for shorter term stabilization. What do I mean by shorter term stabilization six months to a year? So there's not a good deal of science on being able to predict yet. Who's like a type one person with addictive disorder or who's a type two person with addictive disorder if they'll require the medication for the foreseeable future if not for lifelong or if they can benefit from it for a relatively short period of time, i.e. up to a year. By the way, the information we have on depression, treatment of depression with medicines is still at that stage as well. Opioid used to disorder treatment in Vermont, well, we're the poster state for the problem worldwide. I can't tell you how often I get to a conference. I was in Navajo Nation last week in Shiprock, New Mexico, and people said to me, Navajo people said, you have big problems with opioids in Vermont, don't you? We don't have that here. And I'd like to think that we can be the poster state for the solution. Governor Shumlin talked about the hub and spoke model for opioid use disorders. It's really an innovative model. The rest of the country is watching us. I have a colleague at Office of National Drug Control Policy, ONDCP, Cecilia McNamara, who's pestering me to explain the hub and spoke model so that other states can use it. Hub and spoke model really has its origins. I think with the alcohol and drug abuse program office here, the Department of Health, the Department of Vermont Health Access, DIVA as it's affectionately known as, and I'd like to say that the folks from DIVA have a tremendous healthcare intelligence and have really led, I think, a lot of the innovation around the hub and spoke model and provided, talk about reinforcements, provided the extra personnel and nurses and behavioral health specialists to operate within these programs. We have a great Vermont prescription drug monitoring system. I work in New Hampshire, I live in Vermont, I'm a Vermonter. New Hampshire doesn't have an equivalent system. Of course, a lot of folks know that they can get the prescription in Vermont and cross the river to fill the prescription in New Hampshire so that it can't be tracked. We'd really like to see, hope that's on the governor's agenda and I hope the governor of New Hampshire's part of that discussion would really be great to see all of the Northern New England states have a similar system that we do. We have the best system. As also as reference, we've been part of practice improvement collaboratives, learning collaboratives, and I see many people from Candace Collins, from Cold Hollow, Enesburg, to Dr. Peter Park, from Deerfield Valley, to the Northeast, to the Southwest part of the state, and a lot of practices in between. Really brought 27 practices, physician practices together, to get that kind of quality level that will result in more favorable outcomes. Reduce variation, improve quality, increase the access for people with opioid use disorder so they can get medication as quickly as possible. That window of opportunity closes very fast, as you know. The other really cool thing about the learning collaboratives is that we've treated addiction as the physician practices have treated other chronic diseases. So pediatric asthma was a learning collaborative topic before addiction. So it's, talk about stigma, shame, and discrimination, marginalization, we've not really experienced that with this problem so much in Vermont. What are the challenges, and this is probably from a scientific, as much as possible point of view, the challenges to treatment in Vermont. Well, you heard that mention, and I'm sure everyone here can probably identify a family member, a loved one, a friend, a colleague, yourself that knows about the access to care. In my own view of this is that there's probably enough care, but I don't know that we've mastered the efficient way of getting people in as quickly as possible. So we need to work on that. We probably have enough providers. Probably have enough methadone clinics, hubs. Actually probably have enough spokes. Have enough physicians who can prescribe the medication. We haven't mastered the flow. How to get people in, how to get people seen, how to get people treated, how to monitor, how to follow. There's a lot of practice variation. A lot of different ways of approaching this issue. Many traditional addiction providers are still unsure about addiction medications. If that's like a full-fledged kind of recovery or is it a compromised recovery. Mark Ames and his group that helped that recovery centers across Vermont have done a lot to change the culture of recovery centers. I think you'll be hearing from Mark at some point today. We also haven't mastered being able to get good outcome data. Data that we could actually use, it's kind of like we're driving a car and we can't see the dashboard and at time, I'm not even sure, we can look out the window and we're still trying to navigate roads and streets and turns and U-turns and so forth. We can look out the rear view mirror so we can see where we've been but we can't quite get close to real-time data to see how we're doing, which is really important. I think the kind of Dr. Chen data that was presented is excellent but still retrospective. Still probably a year or two behind where we are today. I also think that we need to do better and hopefully today will be the start of it. Mayor Loris from Rutland drove over the mountain a couple of weeks ago to meet with me in person to talk about the importance of aligning treatment and law enforcement, treatment and child welfare, law enforcement and child welfare, all the different kind of all hands on deck that it's gonna take to address this problem. Need to come together in this kind of way by community. It's gonna take all of us with all of our various levels of expertise. The knowledge of all for one and that one is the person with the opioid use disorder. So I think time's up, thank you. Remember if you have any cards with questions, pass them up to the folks who are collecting the cards. Great, thank you very much Mark. I think it's critically important that those of us who are not scientists or medical experts remember that the intractability of this as a brain disorder makes it very difficult for someone to walk away as is often expected. Why don't people just walk away from this? Hopefully you've got a little better insight into the complexity of the brain function that's affected. But as Dr. McGovern said, we are not gonna solve this problem alone and we've heard that from everyone this morning. It's going to take everybody working together. And we think that we have a pretty good example here in Vermont of a community that is doing that and is beginning to see some great results. What this exemplifies is the importance of one ingredient that has to be there. And that is leadership. And we now are gonna hear from Mayor Chris Loris from Rutland and we thank him for his leadership in showing that a community can work together and can come together. And he's gonna share a little bit with us about how they're doing that. Mayor Loris. I appreciate those remarks. However, I think they're a little bit misplaced. There are a number of leaders in Rutland who I hold in much greater esteem than myself. So don't look at me thinking I've got the answers, especially that screen will not be changing.  I'm a little bit of a Luddite. Before I move on to community solutions, you need to, when you go back home at the end of the day today and start your hard work over the next several months, are rest assured you've got to deal with one premise that you need to have honest conversations. Feelings are gonna get heard. There will be a divergence of opinion. And I will exemplify and demonstrate that probably within these remarks today. The crisis, the epidemic of opiate addiction in the state is not a public health issue. It is no more a public health issue or a public health crisis than it is a law enforcement issue. It is not a law enforcement issue or a healthcare issue any more than it is an issue of poverty, than it's an issue of jobs creation and economic development or an issue of destabilized neighborhoods and chaotic households. It is all those things. Opiate addiction, the crisis, the epidemic of opiate addiction is a community and societal issue. And unless you're willing to accept that, you're doomed to failure. It all has to start from there. The disparate sectors must be working towards the same solution. And it demands collaboration and partnership, demands it. Anything less will not work. And each community, as the governor said, I'm here to talk about the story, but each community is going to have to find their own comprehensive and holistic strategy because we're all a little bit different even throughout the state. But you will need to work collaboratively and that's really the takeaway from Rutland's story, frankly. It's a very challenging problem. And as I said, you're just starting. When you leave here today with an action plan, you're not done. You are just barely scratching the surface. And it'll take months of planning and outreach to disparate groups and partners and not without some pushback because frankly, there are many groups in this room that compete for the same dollars. And as I said earlier also, there will be feelings to get her and a little bit of pushback as different organizations look to fulfill their missions. And frankly, you may find some folks, as we did in Rutland, that may be unwilling for either personal or professional reasons to support the work of others. That's a challenge. Those are obstacles to overcome. We did. And when you go home, you can too. For the last six months since the governor's state of the state, and some people have heard me say this before, you know, you frankly can't swing a dead cat without hitting somebody, saying all hands on deck. But the reality is, there are still people below playing pinnacle in the galley. And we need to get them on deck. As I said, you know, I may say a few things to hurt some feelings here, but I know Marilow's on from Barry, will appreciate the next one. And he may be the only one in this room that does. However, last year, one of the governor's initiatives was to build on the prescription drug database we have in Vermont and expand law enforcement's use of it. And within this chamber, they chose not to go the way the Senate or the governor did. And individuals like Marilow's on and me would contend that they got that one wrong. Likewise, doctors, we need, even though the opiate epidemic has been transitioning to heroin, we still need the docs with us. And we're working on that in the Rutland area to ensure that they follow the best practices for prescribing prescription opiates. And we need them because frankly, 10 years ago, a lot of the docs were asleep at the wheel. Business community, we've got a very, very robust business community in Rutland that, and I'll speak to them, two minutes left. Okay, I'll move it along. And the business community has got to be key to the solution as well. And frankly, politicians as well. Neanderthals like I used to be that thought it was all about enforcement and it was the law enforcement community that made me recognize treatment and prevention are every bit as important as law enforcement. So we all own a piece of this one as a community and we recognize that we individual individually we must work together collaboratively or we'll be doomed to failure. Real quick, I was hoping I had a little more time but I screwed up in my messaging here. Vision, viable initiatives and solutions through involvement of neighborhoods. That's the name of vision when you hear project vision. It is a collaboration of over 100 individual groups and organizations in Rutland that meet on a regular basis and it's across all the sectors. We have made some investments of our own and did not look for the, didn't look for the cavalry to come in and save us. We sent Captain Scott Tucker upstairs to run the vision team internally where we are working with law enforcement and non-traditional partners on a bi-weekly basis, on a daily basis where crisis workers, mental health individual, mental health workers, family practitioners, not practitioners, family crisis workers are embedded in our police department and are getting out into the neighborhoods in order to solve our problems. And that's collaboration that frankly needs to be replicated throughout the state because law enforcement can't do it alone, healthcare can't do it alone. And it needs to be everyone in the community working, the term we've coined it in Rutland is the death by 1,000 cuts. Last thing I wanna speak to is academia. We're very fortunate in Rutland, we have an individual named Kareen Rodriguez, a researcher from University of Miami who has drilled it into us and we get it that without academia to measure the outcomes. That's why I called Doc a couple of weeks ago and I saw he was on the panel with me because we need to validate our processes and need to validate our outcomes using academia and that's what we're doing in Rutland as well because evidence-based, I'll give Doc credit with this one, evidence-based is like the word organic, what does it mean? So those guys, the folks who live and die by research, they get what that means and we've gotta work on the evidence-based models in order to succeed. So no action is too small. When you go home today, build coalitions, avoid ego, keep your eye on the ball, play the long game. Community and collaboration are key and no single sector frankly can go it alone and that's the lesson of Rutland, so thank you. Thank you, Mayor Loris. Our final speaker this morning exemplifies the reason we're here and that is to help those who still suffer from addiction to enter and maintain long-term recovery. Reina's one of the people, for those of you who saw the Bessel Bryant's film, The Hungry Heart, Reina's one of the people who told her story of addiction and recovery. She has been clean from opiates for three years. She's a mother of two and most importantly now and how she's helping us, she's an activist for change. So let's welcome Reina. Thank you so much. My gosh. I feel so honored to be here today and I really hope that you do too. This is a really special opportunity that we've been given and I just wanna take a moment to recognize that Governor Shumlin's State of the State address this past January brought me to my knees. I had never been so proud to be a Vermonter as I did that day. Sorry, I'm a little emotional, so I hope you'll bear with me. I felt proud to live in a state where our governor cares more about the health and wellbeing of our families than he does about being a target for judgment and criticism and so we've become trailblazers. We will lead the way for the rest of this country as we fight back against this disease that is destroying families and taking lives in epidemic proportions. And so on behalf of myself, my mom and my dad, my two sisters, my crazy and wonderful aunt, my beautiful new baby niece, my son, Miles and my daughter Zeta, I'd like to thank the governor for giving us that gift. Preparing for this speech was difficult. I couldn't decide which topic was the most important to focus on. Did I wanna talk about recovery and how I got sober and what worked for me and what didn't work? Did I wanna focus on the power of perseverance? Should I address what is and is not working with how we approach recovery in America today? Do I talk about the limited resources available to us and what that means and what that looks like and what I believe we can do to change that? Addiction is so complex. There are so many layers to it. I imagine there are at least a few of you out there that are hoping I might be able to stand here and tell you how to get someone sober or at least how to get them willing to try. But I have no idea how to do that. I wish that I had a secret formula, but I don't. I mean, I know what worked for me and certainly there's some wisdom there, but what worked for me might not work for someone else. Ultimately, what I realized is that as an addict in active addiction, my needs are so great. They are so complex and I require so much from others many of my needs are not easy to meet either. It's not easy to love an addict.  It can seem pointless. It can seem like all we do is manipulate others to get what we want and that we only ever care about ourselves. It is not always easy to draw hard lines or to do something that feels like turning your back on someone who you know is very sick, someone who perhaps you love even more than you love yourself. But I realize that one of our greatest challenges is understanding each other. How can someone who has never been trapped in the world of addiction understand why an addict does what he or she does? I believe that the better we understand each other, the easier it is to connect and we need connection. I believe the more others learn about us, the more they understand us, the easier it is to erase the prejudices, the stigma that attaches itself to addiction. The truth is I talk to people all the time, people with great big hearts and the very best of intentions who have prejudices about addicts that they don't even know they have. And I get it. I was terribly prejudiced before I experienced this myself. I had no idea the extent of my ignorance. But I would say things like, why on earth would she do something like that? Or he's making poor choices right now. I believed that addicts were weak and that they were selfish. So I've decided the best approach to this speech, though maybe not the easiest, is to open myself up. To be honest, to share a piece of myself with you. And through that, create an opportunity for us to understand each other a little better. To make it a little bit easier for all of us to find the human being stuck inside the shell of an addict. And this is how we will create change. The first time my mother heard me say, hi, my name is Reina, and I'm a drug addict, it upset her deeply. She almost seemed offended by it. As it turns out, it didn't upset her because I was admitting to being an addict. It upset her because she felt that statement was too encompassing. But you're so much more than that, Reina. Being an addict doesn't define you, she said. Why can't you say something more like, hi, my name is Reina, and I have an addiction? I liked the sound of that, but the truth is, being an addict does define me. And being an addict in recovery tells you pretty much everything you need to know about me.  It has changed every single thing about me. And I'm not just talking about your run of the mill, losing everything, herring the people I love, compromising my values. I mean, I did all that too, but I'm talking about something so much bigger than that, something so much deeper than that. Addiction changed the very core of my being. I'm talking about the nature part of me versus the nurture. When I was deep in my addiction, my mother would look in my eyes and she wouldn't recognize me. This is my mother I'm talking about, the person who brought me into this world, the person who knows me better than I will probably ever know myself. She would look in my eyes and see a stranger. I would look in my eyes and see a stranger. Sometimes I would stare at myself in the mirror, searching for even a trace of me. I didn't understand who I was anymore, and I was afraid that I might be lost forever. My addiction owned me mind, body, and soul. My addiction became my survival. We all know that humans will go to extraordinary lengths and do extraordinary things to survive. When drugs took over my life, addiction moved into the driver's seat, and I became powerless. I felt like I was stuck in a never ending cycle of a catch 22. I would wake in the morning filled with fear and anxiety. Everything was fueled by my overwhelming need for a fix. I was afraid, I was angry, I was raw, I was determined, I was confused and heartbroken, and everything about me was saturated in shame. But I wouldn't acknowledge, I couldn't acknowledge the true state of my life and where I was headed. Everyone else around me could see it, but I couldn't. If I did, I would be forced to acknowledge how bad things had gotten, and I would be forced to acknowledge that I needed help. And I would be forced to acknowledge that the only thing in the entire world that made me feel good was killing me. How can something that feels so right be so wrong? When I hit my bottom, I was an Ivy heroin user, a crack addict, and an alcoholic. It was winter, and my children and I were living in our home without heat. Sometimes I would sneak over to our neighbor's house and steal firewood in the middle of the night to keep warm. Sometimes I would turn the oven on in the kitchen. Eventually I began burning pieces of our furniture to keep us warm. My kids and I were all living in one room in our house, the living room. They were sleeping on a pull-out couch, and not just because the house was freezing, but because their bedrooms were unlivable. It's not easy for me to stand here and say these things, to revisit that time in my life is very painful. I could never properly articulate the kind of shame that I feel, the regret I struggle with, and the sadness that fills my heart when I do. So why do I share these details with you today?  I do it for every addict out there that is still suffering today. I do it for my son, who is not allowed to play with his best friend because his parents found out that I'm a recovering addict. I do it for every person that struggles, that feels anxiety, that experiences depression, that finds themselves in a vulnerable state of mind that feels like they can barely breathe and someone hands them a painkiller. I do it because I need to feel that this journey I'm on has purpose. Now, my day has passed since my son was born and then my daughter that I wouldn't have sacrificed my own life to save either of theirs. I love my children and I always have just as much as any parent out there. Nothing has ever been more important to me than their happiness. But three years, 137 days ago, you would not have believed that to be true. I believe in being honest and sincere. But three years, 131 days ago, you would not have believed that to be true. I believe lying and stealing are wrong. In three years, 131 days ago, you would not have believed that to be true. Addiction is not a reflection of a person's character. It does not in any way demonstrate the hopes and dreams I have for my future or the love I feel for my children. It does not in any way demonstrate the kind of person I someday hope to be. The way I behave when I'm in my active addiction has absolutely nothing to do with the person I am when you take drugs out of the equation. What it does tell you is that I am a very sick human being. It tells you that I believe I deserve every bad thing that happens to me. It tells you that I am living without hope. It tells you that I believe every terrible thing anyone has ever said about me.  It tells you that when I'm in my active addiction and you take my drugs away from me, I have no idea how to be. When I'm in my active addiction and you take my drugs away from me, nothing makes sense. When you take my drugs away from me, every cell of my being believes that I will never feel good again. When you take them away, everything hurts. Everything. It hurts so badly. And when everything about me is saying that there's only one way to remove this pain, I believe it. When I'm in my active addiction, I believe that no one knows what it's like to be me. I believe others have been given a gift that I did not receive. I believe that I am different than everyone else and that I do not have what it takes to get better. So when I say that being an addict defines me, I mean it. Being an addict in recovery is a miracle. Some days I have no idea how I got here. When I introduce myself as an addict in recovery, it tells you everything you need to know about me.  Thank you very much. Because we're running short on time, I have a conflict. We have some questions and we wanna move on to the next part of our program. So I think what I'm going to do is respectfully ask that we hold the questions and try to make sure we're getting information followed up with you so that you get the answers. A couple of them are informational, more information about the prescription monitoring system and more information about how we define successful treatment. So hopefully some of our workshops this afternoon might touch more on those, but we will make sure we get information out to people. And then there are several that have come together to ask that we make sure that we put a focus on the support that families need and peer support and encourage that those elements be a part of the follow up in a meaningful way. So I'm just wanting you to know that we're acknowledging your input and we'll think about how best to go forward. There are other topics and again, we'll go through those and make sure we have a way to incorporate them into our follow up. So I wanna thank again all of our morning speakers, the governor and our panel. I think we got a lot of insight into both what we're doing and the emotional aspects of what we're facing. So I thank you all again for sharing with us this morning. So we're moving on to our next phase about what's working in communities. And again, these are going to be little previews of the topics of the workshops this afternoon. To take us through this next section, I'd like to introduce someone who has been one of our guiding forces for this forum and for the whole topic of how communities deal with opiate addiction. There's a very trite phrase that says, a picture is worth a thousand words. But I think in the case of Bess O'Brien in her films, in particular, the film The Hungry Heart about opiate addiction, it is so true. I think we could talk to you the data, the medical, the law enforcement, but seeing the stories as we've had the privilege to hear from Reina and seeing how addiction affects lives, families, and communities really is worth any words that we could bring to it. So I'd like to introduce Bess O'Brien.  This is an important part of the day because one of the things we wanted to do is to give you guys an idea of what is working around the state, okay, because you're all here and we tend to sort of be in our own worlds and we don't know what the northern part of the state is doing or the southern part of the state is doing. So these are called our popcorns, okay? They're five minutes each, if you can do it in less than five, I'll give you two points, okay? So we're gonna have 10 people randomly get up each five minutes and just say a few words working in their community and what they're doing that is making a difference, so that you guys can go back to your community and say, wow, that person in Morrisville is doing this really cool thing, let's duplicate it in our community, okay? So the first person is Cindy Hayford and she's gonna talk about communities making a difference, go Cindy, where are you? All right, put that microphone right up there, oh, the little switch, okay, there you go. Okay, so I'm Cindy Hayford, I'm from the Deerfer Valley Community Partnership in the Wilmington, Whitingham area and we've had a community coalition down there for over 17 years. Before we started doing prevention work, we were a community where the use of drugs and alcohol were extremely high among our youth. We were always above state levels and we continued to increase every single year. Just to give you some brief statistics, 71% of our high school kids were drinking, 48% of our middle school kids were drinking, 48% marijuana, half of our high school kids were smoking marijuana and a quarter of our middle school kids were smoking marijuana. We had a local advisory board that was school-based and they were really concerned about these statistics. But they really didn't have a background in prevention. What they thought was if we do enough alternative activities and we keep kids busy, we're gonna keep them off drugs and alcohol. We all know that's not the case. As we found out, and these statistics continued to increase, it was time to learn what does work and what we found out, as the mayor said, it takes a community. It's not a school issue, it's not a law enforcement issue, it's not a family issue, it's an issue for the whole community that you all have to come together and work on. You have to partner with one mission and the mission is reducing drug and alcohol use among the youth. We brought all these community members together and we formed a coalition and our focus was creating a safe and healthy community. Our mission became identifying what are the risk factors in our community, what are the things that are going on that's contributing to the use of substances and what are the protective factors, what are the things that are going on that are preventing some kids from starting substances. We did this and we came up with initiatives to address the risk factors and increase the protective factors. What we learned was availability and easy access to substances is a risk factor. We found out the perception of harm and perception of use is a risk factor. And if kids think that a substance is harmless and that everybody's doing it, they're more likely to try it. We also found out that parental disapproval, lack of parental disapproval and lack of monitoring were contributing factors and through our assessment we found out we had every one of these risk factors. The key to making the difference in our community was getting these partners together at the table to address this. And as the mayor mentioned, all of the sectors of the community. The most important partners though were the youth and the parents. The quote that says not for them without them is key. We had to have them at the table. So we recruited youth and they looked at the data and they determined what were the root causes of our problems and they helped come up with some of the solutions and we supported them in implementing those solutions. When the parents looked at the data, they looked at the monitoring, was it monitoring and lack of education about the teenage brain was an issue. So we implemented programs that addressed those issues and supported them in doing parent chats, hosting a discussion in their home with their friends, inviting parents of their kids friends to have a discussion and start talking about the issue. To be honest in the beginning, we had no clue what we were doing. We didn't have staff to do it, it was all volunteers. So we worked together to get some funding from the Vermont Department of Health and every training that we could go to, we did. And then we brought that information back to our community so we did know what we were doing and we started implementing best practices and things that are known to work and we've been doing that for 17 years now. The main focus of our prevention work is delaying the early onset of substances, preventing kids from starting to use any kind of drug. Opiates are obviously an issue in our town and every town. But it's clear that kids don't start using opiates in heroin, they start with other substances. So our work is to implement a comprehensive program that works on things like making our parks smoke-free, changing our environment to reduce access, implementing alcohol-free family events, supporting student assistance programs. This comprehensive programs, these type of comprehensive programs prevent youth from using any substances and we know if we can prevent them from using any substances until they're 21, they're most likely not to have addiction issues with alcohol, marijuana or opiates in their lives. So how we made a difference was bringing the community members together, identifying risk and protective factors, implementing promising and research-based programs. We became a community that's seen as a successful model for youth, substance abuse prevention. Our success was we saw dramatic drops in youths and we were recognized nationally for it. We still have much work to do, but we feel like we're on the right track. If you'd like to learn more about our work and the work of others, please join us at Communities Making a Difference. Thank you. We're gonna hear from Margo Austin and a student about what's working in their school. Margo. So my name is Noah Smith. I am a student at BHS. I'm part of a prevention group called START, which is an acronym for students taking actions and risk together. So our goal is to try to educate people in awareness if they're aware of it, unaware of it. We do many different prevention from drugs, alcohol, marijuana, stuff like that. So we meet every Wednesday, weekly. And one of my favorite activities that we do yearly is a leadership retreat, which is always a blast, lots of fun. Am I there? Oh yes, now I am. Hi everyone, I'm Margo Austin High School as the Student Assistance Program Counselor and I am really vying for those two points you mentioned, so I'm gonna talk really fast. My job at the school is to provide prevention and early intervention services. And really, when I go to a party and someone doesn't know what we do, I say, I do sales.  I said, yeah, we sell the concept of healthy choices to middle school and high school students. Sometimes that seems like an undoable job, but having people on the front lines to do this work in schools is so critical. It's key. And so unlike a guidance counselor, I can see any student who walks through the door. They don't need a diagnosis, they don't need a label, they just need to know that we're there. When this school year just ended at Burlington High School, I will have connected 40 students to drug and alcohol treatment or mental health services in the community, 40 students. Now for people who wanna know what a referral looks like, it's the follow-up, it's the transportation, it's the do you have insurance? Do you have a ride? Who can drive you? And all that work is done by student assistants, professionals in the schools, as well as going to health classes, getting to staff, awesome leadership retreats where we made six public service announcements with 20 high school students, and that's the work. The important thing that you know here in the audience is my role in schools does not exist in every school. So there are a lot of people in school communities that don't have an SAP counselor or a prevention person. Burlington High School is fortunate and lucky enough to have that, but when you get back to your communities, you may find that our resources don't exist, as well as we're usually grant funded and therefore it's year to year. So if we're looking at sustainable, effective prevention and early intervention, we need to make a commitment that in schools and communities these positions are as important as teachers, guidance counselors and other people in the school. We are not six toes, we're not nice to walk on and you can cut us off at any point. I actually learned that being in the profession because unfortunately that's the reality when you're grant funded and it's year to year. So as communities, we need to figure out how to make these positions sustainable so young people go to schools and say, oh yeah, we have a prevention person, we have an SAP counselor, and what I've heard from students more and more is we plant seeds and they will say, well, I don't wanna see somebody out in the community, but I'll talk to you. And if we're the person that introduces them to the concept that talking to people is safe and effective and positive, imagine the transference when they become adults out in the community. So thank you very much. In addition to having people in schools, which is really important, it's also really important to have youth services and mentoring out of schools. So for that, we have Victor Twiggs from the GIST program. Victor. My name is Victor Twiggs. I'm a coordinated director of a youth group by the name of GIST. We work in Morrisville, Vermont, Lamora County. GIST is a group that we created there because when I moved in the area, I realized there was a lot of suicides going on in the area. And me and my co-founder by the name of Terry Keller, who works for Behavioral Wellness, we came together real briefly and we said we need to try to do something. He's, we got together and we sat down and I was going to all these meetings and meetings and we said to ourselves, it's gotta be something we can do. I mean, we hearing about these youth killing themselves from addiction, just all types of things.  We had no clue what we were doing either at the time. So we figured, how can we engage these guys between the ages of 16 and 26? So through a couple of grants through ROS, Behavioral Wellness, the North Central Monterey Recovery Center, we teamed up together and we decided to get a forum set for these young men, a safe environment where they can come and talk about what's really going on in their lives. The way we did it was with pizza. We've got pizza, we gave them some gear. They wanted to belong to something. So me and Terry Keller, each day we just tried to figure out what can we do to engage this group of people who seem to be falling between the cracks. They come out of rehab, they were like just there. It was like nobody was there to sustain them, put it that way. What I realized from our greatest successes that I realized working with these young men has been since 2012 that we started this youth group up. And over that, we had over maybe 100 young youth in that age bracket come through outdoors. And what I realized is that a lot of them just need someone to really listen to them. They really need that love, you know. Sometimes it's days where we sit there, me and Terry, we scratch our heads and say, wow, you know, why is this working? You know, people come to us and say, why are these guys engaging with y'all? I think the piece of play is a part of it, but I think more so is that we have other men which we would call mentors. We call them elders in our group.  And they feel that these guys would be honest in telling the truth about where they was at in their life and where they can head to. And from what I see, it just seems that just being there for them, just being there and being consistent and knowing that on every Tuesday at four o'clock, the doors will be open, they'll be a hot piece, and we can talk about what's really going on in their lives. A lot of these kids have abandonment issues. They have no role models, young men, they have no role models in their home. So we, as the elders of the group, try to be there and give these guys some type of guidance and some direction. What I see is a lot of fear, you know, a lot of them feel like their life is done because they may have gotten in trouble with the law. So what we try to do is step in the gap and point them in the direction to talk with the right people. And most of all, what I see is that it's just a light to come on in their eyes, you know, when they realize that somebody really listening to what they're trying to say. So far, I think JIS has made a big difference in our community in Lamar County and Morrisville. Each day I go to this group, I'm amazed to see the young men come through and I see them coming hopeless. I see them coming with fear. I see them coming with a lot of doubt about their future and slowly I see them begin to grow. And the beautiful thing about is that when they start to grow, now they're looking for direction. So we team up with all these other organizations and we try to point them, like I said, in these directions to where they can have an opportunity to believe that they can step back and become a productive member of society and not give up and think that this is who I'm gonna be for the rest of my life because it's just not addiction. We have all kind of pathways of recovery there. We don't preach spirituality too much. We don't preach religion too much to them. We just try to preach real life situations to these young men who just don't have a clue. They don't have a clue, you know? And I don't know if I'm getting down to what I'm supposed to say. I wanna keep it as brief as possible, but basically they need love. That's what I see. Yeah, I can say we should start a GIST program in our community and call Victor and he can come down and help you or any of these other people who you're hearing about. Okay, the next person is Paul Bankston and this is Health and Medical Centers and what innovative stuff they're doing. Paul? Yes, my name is Paul Bankston. I'm CEO at Northeastern Vermont Regional Hospital in St. John'sbury, Vermont and St. John'sbury for 27 plus years raised with my wife, my three daughters there and it's a wonderful community but we've been struggling with these challenges all my life, there and probably even before that. Speaking from a medical or a hospital perspective, hospitals can express love too. I mean, not maybe individually but certainly in terms of making themselves more available to the community. So our mission is to improve the health of the populations we serve and so what that means to me is the whole population not just the people who walk through our doors so be a resource, a facilitator, a team player and a solutions oriented leader and some of the things we're involved in doing is making sure that we're building a context in which we together with our community can achieve success. Some of the practical, concrete things that we've done over the years in the past what does in our 15 years we employed, the hospital employed a community connections team and their sole job is to connect our patients and other people using other services in the community with each other. Basically their health access facilitator so that community connections team has also built the community health team which comprises a coalition much like the coalitions that you've heard previously in the popcorns here. So we've been through a lot of interesting time shall I say we had, I think it was the first methanol maintenance clinic in the state. We took a lot of slings and arrows. You take a lot of heat for introducing some of these programs into your communities like the methanol maintenance programs and the needle exchange programs and other harm reduction programs. So we have a lot of experience dealing with the anger, confusion, ignorance and love basically. So we also purchased what we call the Dr. Bob House and it used to be a farm bureau along what we did is we changed that into a kingdom recovery center which is led by several people here in this room. So it's not like the hospital did these things on its own because it can't. We have wonderful people that you'll hear from later like Steve Klein right here and others who have just, and Nancy Bassett back here have just done incredible jobs putting these organizations together. Most recently a coalition called Dark 2.0. It's the regeneration of an effort that was called the Drug Abuse Resistance Team. We call it Dark 2.0 because it's a resistance team smarter dart for new challenges and we're working on things like practical metrics. Get the waiting list for treatment down to zero. BART is the hub in our area that's the Bay Area treatment programs and they're doing a wonderful job working with this coalition to do that. So we also have prescription monitoring systems in place and that sort of thing but we're along the border so we have some of the problems that people heard about but we're here certainly to learn a lot today and I appreciate this, thank you. One of the most important things certainly when I tour my movie all through the state is family members. We forget about them many times. They're so embroiled in their childs or their family members addiction. They need support so the next person we have talking is Pat Martin from Whitsend. This is something anybody can do in their community and you should do because you've got family members in your community that need help. Pat, where are you? Right here. Okay. Good morning. Can you stand up? I can't today. Okay, that's fine. My name is Pat Martin and I'm married to Kathy. Beautiful wife. We had three wonderful children, daughters that we raised in the city of Rutland and life was good for a long time. I had a good job with the government and we thought we were on easy street so to speak. So we got a knock on the door March 25th, 1999. It was that knock you never wanna have as a parent. There was an officer from the local Rutland city police department that said that he had reason to believe that our daughter was at the local ER and would we come and identify her body? She is deceased. It was our first born, Sarah. She was just 19 years old and in Rowlington College she had her whole life ahead of her. Extremely brilliant and just the model child that any parent would wanna have. She had gone out with some friends the night before and didn't come home. Her 100 pound body that was also full of juvenile rheumatoid arthritis could not survive the 82% pure heroin mixed with benzos that she was given to snore. Kathy and I, we fell to our knees and we were numb for days and weeks and months and we realized after considerable time that in order to survive we had to do something about this. We didn't know where to go. We felt lost and alone. We were ashamed. We were shunned by some and when we felt we were guilty of everything that had happened. Who could we turn to for answers and support? When did this problem begin? Why didn't we see the signs? What were the signs? How could we survive and save our marriage and our family? Could we do to keep others from suffering the same tragedy? We were at our wits end and so the seed was sown. After trying to find a support group that filled our needs and failing at that, we made a want list and we decided to start our own group called Wits End to fill the needs of education and support to families of addiction in a free, open and confidential setting with a professional counselor present for the questions that may arise needing a greater level of expertise than what we had. We brought our plan to the Rullin County Heroin Committee as concerned parents who wanted our voice to be heard and considered considering our kid's future. With some initial support from the Vermont Department of Health ADAP unit, we started meetings on September 24th, 2001 and we've been meeting every Tuesday night since. Despite losing our funding several years ago, we still have managed to find a way to keep a counselor in the room because we feel it is so important to have that professional input for the folks that come through the door. We've steadily grown in the numbers of families attending and in the scope of the problems addressed. We educate the folks about signs and symptoms of use and abuse, about the appropriate responses that could be taken, about the treatment services that are available, about the glossary of addiction and mental health. We have 12 pages here, there's a partial list. So, understand that people that are not in the system do not know how to speak that language so we try to help them in that way. We network what works and what doesn't in our own collective experience. We support families in their chosen response to addiction, treatment, relapse and recovery and we recognize that the family needs to be educated about addiction and also healed from the enabling behavior to help the addict returning from treatment to come home to a healthier environment. After 14 years and hundreds of meetings, hundreds of parents have been coming together over these years and the families are healthier, stronger and more open to helping the others just coming through the door, just entering into the abyss of addiction. We're not face based, we're not 12 step although we fully support anything that helps. The main message is that parents and families are not alone and that they have the power to make a change and to have a voice. It is their right. More to come this afternoon in room 34. And just as everyone has said before, everyone needs to be around the table so we have next Chief James Baker from Rutland City Police Department talking about what they've done in Rutland. Good morning, thank you.  First, I wanna recognize the fact that I represent Rutland but there's many people in this room and other people that are back home in the city of Rutland who have worked very hard over the last two years to build a structure in Rutland that is starting to make a difference. It builds on the strength of Rutland and what's great about the city of Rutland. I am the police chief but that should not be seen as an indication that this issue is seen as a law enforcement issue in Rutland. It's no more a police issue than it is a public health issue or an issue of education or prevention. This is a community issue and you're gonna hear me use a few terms that the mayor used and other people have used because it's become part of our vocabulary in Rutland. It's all hands on deck. It requires that approach in order to be successful. We have based our strategy on the concept of all hands on deck. A word of advice that actually comes from some of the research partners that we've worked with to try to do it any other way, to try to do it from a narrow perspective is gonna be a sure path to failure. I wanna touch on three areas in my time now and please stop by room 11 this afternoon where there'll be further discussion. Two years ago the police department was demoralized and absolutely no trust in the community for a police department. Why do I say that in an opiate form? Because the issue of opiates played into that. There was an unrealistic expectation in the city of Rutland that the police department would solve the opiate problem. Every issue that occurred in the city that was related to a drug abuse situation was laid at the doorstep of the police department. Every time it was laid at the door of the police department the police department became more aggressive in its enforcement actions in the city. It led to a huge mistrust among citizens and the problem was the history of enforcement in the city was indicative that enforcement wasn't gonna resolve the issue. Not one of the underlying issues in Rutland or anywhere else that account for addiction has anything to do with the police department. It became apparent to us in Rutland in order to move the ball down the field we're gonna have to take a different approach. As we began that conversation with non-traditional law enforcement partners in the city of Rutland we also had a situation on the streets of Rutland where we had shots fired on a regular basis. We had a culture on the street where our community values were not being respected by individuals who chose to do harm to our community and it required us to take aggressive enforcement actions. Our first operation in the summer of 2012 resulted in the seizure of almost 8,000 bags of heroin and $90,000 in cash.  I was shocked that we could seize the first operation, 8,000 bags of heroin. It left us wondering to understand the depth of the addiction in the city of Rutland and the area that surrounded it. We realized that this was our first awakening and we can no longer do business as usual. Our second awakening came on September 26th, 2012 at about 6 p.m. on Cleveland Avenue in the city of Rutland. It was on that day that we lost one of our rising stars in the city. Carly Farrell was struck by a vehicle and killed as she exited her store, leaving work. Carly is one of our stars in our city. On her student high school, all-star golf player, worked several jobs, in fact worked the job in this neighborhood because she felt like she wanted to give back to that neighborhood. The individuals in the car, all three of them, were on some type of conditions of release for prior drug offenses. One of them in federal court, one of them in state court in Vermont, and one of them in state court in the state of New York. This caused the community to become laser focused. We started meeting more often. We started bringing non-traditional partners to the table and we started to develop a strategy championed by Chief Mike Sherling of the Burlington Police Department, known as the Community Intervention Team. The vision was to make all resources available and force multiply those resources in our community to raise the quality of life. Some of the folks that we brought to the table early on were social services agency, elected officials, police departments, domestic violence advocacy community, drug courts, corrections, prosecutors, business community, faith community, mediation service, neighbor citizens, and many others. Working collectively as a group, we sought out the assistance of Senator Leahy's office and we applied for a federal grant to make a long story short. We didn't receive the grant, but it gave birth to project vision that the mayor described earlier. The process demonstrated to us the importance of research and staying faithful to evidence-based modeling that produces results. We have engaged criminologists from Harvard, John Jay College, Michigan State University as the mayor talked earlier to University of Miami. We have stayed faithful to the concept of utilizing research to validate our processes. Today project vision is alive and well and the mayor mentioned it earlier. Over 100 people meet on a monthly basis. We have subcommittees looking at crime and safety, substance abuse, prevention treatment, neighborhoods and housing. They're working on strategies that are outcome-based. The result of that collaboration of resources, Royal City Police Department is now home to a variety of non-traditional partners that operate on the guiding principle that we face a very complicated issue that requires a complicated response. Inside the police department is two social workers from the Rutland County Family and Children's Center, a domestic violent advocate from the Rutland County Women's Network, an assistant attorney general, an emergency crisis intervention worker for Rutland County Mental Health, a representative from the Vermont Department of Corrections, Community Corrections Officer, our school resource officer, an animal control officer, a crime analysis and a representative from the city of Rutland Building Inspectors. And those resources are now coordinated by Captain Scott Tucker, the newly appointed executive director of Project Vision. It's important to know that one of those organizations I've mentioned did not have to change their culture, their structure and their operating principles in order to do for the better good of the city of Rutland. And we believe that we can no longer do business as usual as we've done in the past. Let me end by just touching on the Royal City Police Department for a minute. In the police department, we are embracing data and technology to identify how to apply these resources, never missing an opportunity to do a case review, create a system of better communication and providing focused prosecution for those who decide to do great harm to our community. Based on the data, we have developed integrated solutions that address those locations in the cities that do the most harm and the individuals who do the most harm. Never forgetting that addiction is an illness and that we have services that we can provide to intervene for those who are in need. It's important to note that we still support and apply aggressive law enforcement to deal with those who choose not to meet our community norms and do harm to our community. We see it as an important effort as our role is providing public safety. That's why we still maintain partnerships with the Vermont Drug Task Force, the Vermont State Police and our federal law enforcement partners. Let me close by just talking about a couple things that we've learned. There needs to be a clearly stated and accepted strategy that is based on an interdisciplinary cooperation and is based on the concept of force multiplying. There has to be research partners that understand outcome based modeling and assist with the research of best practices. Best practices need to be multi-disciplined. I as the police chief need to understand public health issues. Public health issue has to understand law enforcement issues. Make evidence-based thinking part of the dialogue. Embrace data. We have a long way to go. Some of the conversation I heard earlier, the inability for us to share data across multiple disciplines has been a hindrance. And there needs to be in your community a focused leader that can provide the support and the leadership to bring together the disparate organizations that work on this issue. Thank you. I think this is really important is when people get out of treatment and they come back into the community they need to get a job. They need to make money. And so the next panelist is Mickey Wiles. He's from Burlington Labs and he's gonna talk about hiring people for recovery, Mickey. Thanks. My name is Mickey Wiles. I'm the chief financial officer at Burlington Labs. We're a clinical toxicology lab that provides drug testing for the substance abuse treatment community. We're a Vermont-based business that provides drug testing in Vermont as well as states up and down the East Coast. We have approximately 75 employees mostly employed in Vermont. Burlington Labs is a strong mission and culture. We believe that our work contributes to saving lives, building community and living healthier lives. We do this largely by seeking employees that have a strong affinity towards the belief that substance abuse can happen to anyone and that treatment and recovery are possible. It is important to us that our employees believe in the concept that substance abuse is a disease and that it can happen to anyone and we'll not judge people based on what addictions they may have. Along the same lines we hire people who deserve a second chance as well. We have many examples of employees that have had difficulties in life including substance abuse. The president and founder of our company, Michael Casarico and myself are both in long-term recovery. I personally struggled with untreated addictive behaviors that landed me in prison for two years. Today I'll have the opportunity to work in my field of expertise as well as work in a company that is fully supportive of my own recovery needs. After all recovery is a lifelong process for those of us who are afflicted with substance abuse addictions. We have a couple of great examples of success stories at Burlington Labs. Just a little over a year ago I met a young man at a 12-step meeting who heard my story. He was fresh out of Maple Leaf a residential treatment center recovering from an opioid addiction that started in college and then he continued to have that while he worked for two years at J.P. Morgan Chase as a financial planning and analysis person. He approached me, asked me how he could reestablish himself in the business community. We hired him as a medical biller. Just over a year later he's a financial analyst for us and he is secure in his recovery and is an enthused participant in our culture. Another woman who was highlighted in the hungry heart was also a very successful business woman at City Financial. Her opioid addiction led to a loss of employment and ultimately prison. After being released she came to work for Burlington Labs and again two years later she is an exemplary employee who is working hard at her recovery. Although not all our employees we hire work out many more do than don't. For the ones that do we have incredible loyal and motivated employees that are grateful to work for a company such as ours. Further we believe that obtaining and holding a job is an important component of recovery. A job builds self-esteem and reduces the chance of relapse. I'd like to end with the message that any business can do this not just Burlington Labs. As employers we can hire people in recovery and provide a second chance that allows us to help people to become productive and contributing members of society. And the last thing I like to do is end with a question, Reina. Do you need a job? For yourselves, how many businesses in our community hire people who are in recovery and do a little chart and see if there is anybody and if there isn't try to include them in your community meeting and get them on board just like Burlington Labs is doing, fantastic. Okay, the other thing that people need when they come out of recovery is housing and many times we don't have housing for them. So we've got somebody here who's gonna talk to us, Elizabeth Reedy, about how important housing is for people in recovery. Thank you very much and we're really happy. I think Burlington Labs is coming to Addison County, right? Is that right? Yeah. So the people who are coming out of treatment are often coming to live in shelters. And each of us, I think, had a heart's break when we read in the paper or hear a story on TV about some of the children, another child dying just recently in a shelter. And I think of those parents, I think of those people that are running the shelter. We are all asking ourselves, how did this happen? Who is to blame? Where is it gonna end? But I think the most important thing and the mayor touched on it and I think many of the speakers have touched on it, the causes and conditions that go into that situation are so many and it's very difficult to point any finger at any one place. So our work is to begin to wind back some of the causes and conditions that cause these situations and to try to plant some new seeds that we can help water while they are in our housing. I'm gonna name five things. I hope one of those five things is something everybody here can try to do. First and foremost, housing comes first. You cannot undertake this kind of intention that people like Reina have undertaken and others have spoken about unless you are safe, you have a place to live and you're free from fear. Imagine that family huddled around that oven. It just doesn't work well for people. People use more when they're outside. It's very difficult to raise a family from the back seat of a car. So housing comes first and it has to be unconditioned on worthiness. The people, we don't say who's worthy. If they want to work on recovery, they deserve a place to live. So housing comes first. Secondly, comes services. I think that was it, I can't remember exactly who said, it was Victor who said. No, it was Reina who said there's a person inside here. And a lot of the work we do is to help recognize that person to let that person know that we see them, that we believe that they can have what it takes to make the next step. So we really stress person-centered services. The one thing I wanna disagree with the governor about is we aren't moving people from addiction to recovery. They are moving themselves. So that's one of the things that we really try to identify in the kind of services in every single interaction with somebody. I see you, I see that you can do it. Number three, and it's been mentioned before, is peer support is really key to recovery. It's not very difficult to see who the most powerful people in this room are. They are the people who have the experience who speak from that strength. And I would include their Pat and other people that have spoken about their families and Reina and other people. I wish we had more. Peer support is key to successful housing. It's key to successful services. And it's key to the credibility of your organization. So people need to be on the boards. They need to be helping to manage in the units. Number four, clinical services including medication assisted treatments are accessible and once again person centered. We are not coming in with a program. We are not the experts. People are gonna have to move deeply within themselves to make the changes. We're really lucky. We have a lot of our team members here from Addison County. We have a contract with the counseling service of Addison County. They're in the shelter every week. We have clinicians that are on our staff. And so the whole notion of peer assisted and strong clinical supports that are person centered are not two separate ideas. The last thing I wanted to bring up is I think Dr. mentioned it. Relapse happens, don't give up. I think that more than 80% of people are not gonna make it the first time. And if we really can keep touch with them, let them know that we're out there. I'm hoping that the hungry heart will eventually become the open heart and we can begin to change the situation. Thank you very much. Briefly, when we were looking at this topic of housing it was very difficult for us to actually find a lot of places around the state that took in folks who were in recovery. And Addison County is lucky to be doing this through the John Graham shelter and working with different folks who rent apartments. But once again, go back to your communities, find out who is renting, who is letting people in recovery live in their apartments and bring them to your community meeting and encourage them and tell them that they can connect and get resources but they're not alone. Next, we have holistic approaches to prevention and healing. The reason we have this is that we need to look at the fact once again that there are all kinds of different ways that people get well and go into recovery. And we wanna talk about not just a box, a box on tools and a toolbox, but we wanna talk about things like yoga and meditation and acupuncture and the arts. So for a brief overview of that, we've got Steve, Steve, go ahead. I'm Steve Klein from Community Connections at NBRH, Kingdom Recovery Center and Warren Rainbow EFT, and he is missing. And we try to fill the emptyness with substance abuse. We become addicted because the substance works to numb the anxiety until it becomes a more powerful anxiety in itself. We then exist in a state of nearly constant flight, flight distresses, complex, strongly believed that Medicaid meditation, yoga, acupuncture, EFT practices are optimal for people who become successful in substituting healthy behaviors for addictive ones. And we're based on prescriptions for other drugs with some counsel. For my three years as a first bar medically assisted treatment counseling model is in an extremely effective intermediate step. And there are so many success stories of Warren's heart shows much promise. It will work so much better when mid-level providers such as nurse practitioners can prescribe and take on patients. This is an issue that needs quick attention. Through personal experience, I've come to believe that treatment for addiction should be followed by and was a willing to discuss anything except for dosage levels. She and many of her friends have died over the recently buried another lovely soul, 14 year battle lost. It's time to choose more effective routes to real long-term recovery to a satisfying and fulfilling community life, not just ending illegal substance use and wasting the rate of psychotropic fraud. I want people to be enabled, not disabled. So we have been on the course for 15 years to find things that can compliment and be at least as effective as peer supportive recovery and counseling. And these are what we have found. Yoga continues to combine well with breath and posture that can carry over the daily life and reduce dependency on things outside of oneself. The emotional freedom techniques also known as meridian tapping, DFT or simply tapping address two levels of addiction. The immediate and returning cravings and the underlying emotional distress causing the anxiety which is stuck in our memory system and physical body trauma, physical illness or deeply felt core issue. EFT encompasses all the issues related to the addiction and the added contribute to and accelerate the recovery by continuing to tap into the whole body self-healing mechanism. Oricular detoxification involves disposable stainless steel into specific sites of each year. People who are struggling with addiction reports significant decreases in cravings, physical withdrawal symptoms, relapses, inpatient admissions, insomnia, and agitation. The practice of somatic mind-body integration helps the client discover those deep emotional conditions that can cause destructive feelings and behaviors. The important outcomes that the person encounters is emotional background noise as internal. This discovery reduces the sense of disconnection from self. Through light pressure and contact points the addict becomes conscious in your body of your immediate compulsive feelings and behaviors. This process of integration reveals the deep roots of pain and self-denial and releases somatic attraction. The nervous system quiets, addictive behaviors recognized and released and consciousness expands. Using the arts to raise voice and tell stories is critical in the healing process. By having people who regress themselves through writing, film, and visual arts, folks are able to share their struggles and give back to their communities. Instead of feeling ashamed of their past lives, they can use their experience to create change. When we toured the film here today, best as first film about opioid addiction, to over 100 locations, those who told this story would recover, and we changed the face of how our state addresses addiction. I firmly believe that addiction ends through an empty heart, so we need to continue the hard-to-hard conversation that's starting here today. Sometimes it's a good thing to be literally out of our minds and into our hearts and express both the pain and the beauty found there. The practice is mentioned here can and should be tools that will assist us in effectively preventing and treating addiction and fostering long-term we owe ourselves, our children, and our state that much we need to add to our toolbox. A list of practitioners is available. Communities doing good work, bring them to the table, get them involved, get them helping people in recovery. All right, our last person, we're almost there. Lunch is coming around the bend. Community recovery support, do we have Susie Walker? Where are you? Okay, there you are, good. So here we go, recovery center in Bradbroke, which serves all 11 re-centers in the state. So you probably have a wondering near you. I'm also a person in long-term recovery, and for me that means I haven't had a drink in 16 years. I know from my own personal experience and from the guests I see each day how critical peer support is for this like lunch. We can choose recovery and become happy and healthy by drawing strength from other people in recovery. I'm a grateful witness each day to the miracle of recovery. I see the light return to people's eyes as they experience renewed hope and reunited and men and women able to take their places as productive members of society, helping others and agree on the workforce. The rooms echo with laughter and conversation and profound connection. Our center is primarily run by volunteers and volunteering is a strong part of our peer recovery program. We have people in recovery who want to get back. We have people who are on work experience programs or internships. And these opportunities help people who have maybe spotty work histories have an achievement that they can put on their resumes. It also allows them the opportunity to build confidence and to have social interaction with people who are not in an active addiction. There are many of them are leaving those circles behind. One of my favorite jobs as a director is getting to write letters of referral for people. I get to say, you know, Jeff is us and he shows up by time and he does a wonderful thanks for us. I'll tell you about just a few of them. We had a single working mom who spent several years getting her college degree and did her internship at our center. She recently graduated and started a job in her field, this field, a young man in recovery, just volunteered for 25 to 30 hours a week because he was trying to figure out what he wanted to do as a person in recovery. He became an essential part of our team and now is a staff member, time showing up on time or at all. And she eventually became more felt so isolated by his addiction and his criminal past that it took him a really long time to come out of his shell and begin to trust people in the community. Over time he gained the confidence to come here on recovery day and speak in front of a group this big about his experiences as a person in recovery and how the recovery center in particular had helped him. Our guests are all the people that you've heard about today, the people who've had trouble in their lives and they know that there's hope because they hear from people who've been there. They come out and by interacting with peers and volunteers at our center, they learn that they can look people in the eye and they don't need to be reluctant about sharing their stories because their stories have value.  We say you're in recovery if you say you're in recovery. We've had several people and I remember one man in particular who came into the center for several weeks before he ever made eye contact with anyone. And then he did and then he eventually grunted hello and over time and it took a long time he finally told us his name and he became a volunteer and that really started to turn things around for him. We know that people find us, they may be very frightened. We know that people sometimes have pure communities, they may have a 12-step community or a church community or a family community or something, but many don't. But even the people who do say, well what do I do for all those hours of the day between meetings and the recovery centers in your community provide a place where people can go and simply have a safe place to be first and foremost and then they have a place where they connect with peer recovery supports such as recovery coaching. If you come to this afternoon we'll talk more about that. But through recovery coaching and the peers at the center, they learn how to make connections so that they can find stable housing so that they can find a training or a job to get to so that they can restore the broken relationships in their lives and learn how to look at themselves in the mirror. I know before I got sober I couldn't look at myself in the mirror. I wasn't looking for myself, I didn't wanna see myself. So we learn how it's okay for you to see me and it's okay for me to have people see me at the center. There's a lot of powerful work going on at all the 11 centers and potentially a new one coming up soon. We have a couple of SAMHSA grants that are allowing us to have more staffing so that we can do more of our important work. And I hope you'll come and join us this afternoon and learn what else is going on. Thank you. Thank you. Once again, if you go back to your communities and you don't have a recovery center, you should talk to Mark Game as in get one. Sorry Mark. Recovery centers are awesome. When we tour our film Beyond Vermont there's nothing like that in most of the rest of New England and they're so important. They're a safe place for people to go in your community who are in recovery. So thank you so much for listening to everybody. Barbara? Okay, you've all been so patient and attentive all morning. So I know that all of our speakers really appreciate how everyone stuck with us. We've never really done anything like this before so the planning committee tried to figure out how to cram a lot of good information in for you. But now it is in fact time for the long awaited lunch. So you're gonna go to the cafeteria and if you don't know where that is just follow the crowd and you'll get there. There are things to pick up for lunch and then we ask that you sit at your community table and all of the tables are labeled so you'll know where to sit. And then at one o'clock look through the work or the agenda and you'll see where the workshops are. So pick the topic that you're interested in split it up amongst your team and go to that room at one o'clock. Following that you'll have a facilitator who will then tell you about moving on to the next group which in many ways the final group which starts at 2.30 is the most important for you because it's the place where you sit with your community colleagues that are here today and you talk about what you've got, what you heard that you'd like to do, where the gaps are and how you can work together to make things happen. And we really encourage you to come away from the day with a couple of action steps that you commit to each other that you're going to go home and do and we're gonna be following up with everybody so that we can pull the information together and be able to share what is happening as a result of this forum. So the final thing then you're gonna come back here at the end of the day at 3.45 and we're gonna do a short wrap up and get you on the way. So if you have any questions again there's folks with the ask me tags you can ask them and they can help you out. So have a great lunch and a great afternoon and see you back here at 3.45.