[00:02:37] Good afternoon. Welcome to Research Live.

[00:02:42] Every Wednesday, we talk to a researcher, a Vermont researcher, who's done some really interesting work in Vermont. I'm Richard Watts, the director of the Center for Research on Vermont Broadcasting live from my home in Ames for four months.

[00:02:58] And today we have a very special guest. I just graduated senior student Lucia Purcell, who's going to talk about a project that she's been working on for almost 18 months called Landscape of Care in the Opioid Crisis.

[00:03:19] So welcome, Lucia. Hi. Thanks for having me.

[00:03:24] Yeah. Nice to see you and I know that school ended well for you.

[00:03:28] You won so many awards, including the Center for Research on Vermont's Andrew E. Newquist award for top yearlong paper in the paper and project.

[00:03:41] You're going to talk to us about was also your honors thesis.

[00:03:46] And last summer, you won another center award, the Green Mountain Award, that helped pay for some of this.

[00:03:51] Yeah. Thank you for that. Appreciate it.

[00:03:56] You're doing OK. Wherever you are.

[00:03:58] Yeah. I'm in Minneapolis, Minnesota, with my family and we're not sure exactly when I'll come back to Vermont, but I'm happy to be home right now. Spring is happening. Summer is here. Yeah.

[00:04:12] Yeah. Yeah. Summer came here today with a bang. It's 90 plus degrees.

[00:04:16] I can hear the birds.

[00:04:21] We're really like. So this is a project that I know you've done some oral histories here and talk to us about.

[00:04:30] About this terrific, horrific crisis that swept through the country around opioid use and abuse.

[00:04:38] And then what, Vermont, how Vermont, some of the stories that have come out of your mind.

[00:04:43] Mm hmm. Yeah. And today I'm going to focus mostly on the geographic themes like not the individuals, but we don't have that time today. So maybe another time, I should say.

[00:04:57] You can tell us, but I think your paper is probably publicly available through scholar works.

[00:05:02] Yeah, it's usually are in that, you know, in addition to winning these these a variety of awards. You are a geography. Student.

[00:05:14] And there's a really nice award, the geography department gives him the name of a professor, Glen Elder, for social research and social justice.

[00:05:23] And that's another one that you accomplished along your time here. Who shot it? I'm going to turn it over to you.

[00:05:32] You're going to talk for fifteen or so minutes. Show us some of the research that you did, and then we'll open it up to anybody who has questions or comments or things that you'd like to ask Lucia about this research or related, please. You can just post them here on the Facebook page.

[00:05:48] All right, Lucia. We're going to turn it over to you now.

[00:05:52] Take a look.

[00:05:58] OK, so like Richard said, this is a project I've been working on for about since last January, and I'm really privileged to have spent this time researching in Vermont. And for all the folks who've really helped me with this project and the individuals who have narrated these stories. And I'll talk about them a little bit in a moment. But I'm just gonna start with a graph which is here on the next slide to kind of get us all on the same page about what the opioid crisis looks like in Vermont. So in twenty eighteen alone in the United States, forty seven thousand Americans died from opioid overdose deaths. And between nineteen ninety nine and twenty eighteen, that was nearly four hundred thousand people.

[00:06:50] And so we're here in this really interesting moment of a global pandemic. But it's also important to continue to think about the opioid epidemic that we are still experiencing amidst all of this. And so this graph, I just think is really important for us to understand where Vermont fits within the larger crisis in the United States. So the gray line. Oh, sorry, go back to the gray line. There is per capita, the average opioid death rate in the United States and the red is Vermont. And so what we can see here is starting from two thousand all the way until our contemporary moment. Vermont has exceeded that per capita rate, which is just really important to think about. So it's not just that I was doing this research because I lived and was studying in Vermont, but it's also Vermont is an incredibly unique community and landscape to study this epidemic. So you can go to the next slide, please. Thanks. So my question when I started this research was, so what is what do these numbers look like in such an idyllic landscape like this? Right. We have the rolling Green Mountain, these beautiful fall foliage. And then we're met by really intense numbers, like in twenty eighteen. One hundred and thirty Vermonters died from opioid ovary dose deaths. And already in the first two months of twenty twenty in January and February there, there's a suspected 20 overdose deaths as well. So this is continuing even in this idealistic landscape. And what I what I want to mention, too, is that although there's these really high rates of overdose deaths and use, there is also a contrasting, extraordinarily high rate of medication, assisted treatment for opiate use disorder. So in Vermont, eight thousand seven hundred Vermonters are on medication assisted treatment. And that's one point seven percent of the Vermont population. So per capita is the highest in the US. And I think it's only second to France. So Vermont is really leading the fight for access to medication, assisted treatment in order to combat this crisis. So if you can click next. What we see here. I want to use this image because I think it's so interesting and kind of contradictory. This is the image that's used on public health, the Vermont public health Web site, to explain and talk about opioids and quote unquote, the challenge of opioid addiction. And then we see this like really peaceful landscape with no people. That's really idyllic and quaint. And so I think that I'm going to talk about more about the Vermont ideal. But that was a really large part of this research is kind of deconstructing what the realities of the opioid epidemic in Vermont look like in comparison to this really idyllic landscape. So I use a couple of different methods for this research, and I'm just going to touch briefly on my archival work. So based around a book, a cup and a couple of articles by Gary Shaddock, a Vermont researcher and historian, about early opioid use in Vermont. And from my own archival research, I'm looking through old newspapers and engaging with the resources of the University of Vermont. My biggest takeaway that I just want to really express to everyone is that this is nothing new. So on the left there, you can see the Bennington Evening Banner in 1912. Their headline was Morphine Fiends in roughly in Rutland. And then a hundred years later. Right. We see a similar story by The New York Times about Rutland struggle with the contemporary opioid epidemic. So, again, I could talk for a really long time. About the history, and I think it's really important for Vermonters to really grapple with that a little bit and understand that this didn't just come out of nowhere. This isn't totally new. Maybe the death rate that we are seeing because of synthetic opioids is new. But this long generational use and addiction and really complex history is really alive and well in Vermont. So the most important method that I used for this project was oral histories. And these are the faces of the twelve individuals who I had the pleasure and privilege to speak with last fall and summer, who really helped create this narrative that this thesis provides. And they are harm reduction practitioners. They are doctors. They are advocates. They are our representatives. And they're all individuals who somehow have dedicated their lives to fighting for people with opioid use disorder or helping them or caring for them. And I chose to use oral histories because they're really kind of a bottom up approach of putting power in the people who have the experience rather than relying on traditional sources or what like larger news media has to say or even the data that I just talked about. Right. It's really important to engage in an individual conversation and understand how these places and experiences are constructed. So all talk really briefly about a couple of them, but I just wanted to put their faces up there and have everyone be able to recognize and thank them and someone. So I'm going to today just talk about three of the major geographic themes that I took away from this research. I don't have enough time to touch on everything that I learned, obviously. But so today I'm going to talk about the opioid epidemics, disruption, the Vermont ideal, and secondly, how rural geography produced a new treatment model which is now used around the United States. And then finally, the evolving imagined geography's of opioids in Vermont. And that's a very human geography term. And I'll explain that a little bit more later. So we're going to start with the first one. And I just want to start by saying that every single narrator that I met with talked about this address that I'm going to talk about. So I thought it would be really important to start here. So in 2014, Governor Pete Shumlin dedicated his entire State of the state address to the opioid crisis that was facing Vermonters. And he really made national and, of course, local headlines through his political courage to really speak about kind of this like dark underbelly that was largely ignored for a really long time and to really bring it to light. And in his speech, he said, quote, We are lucky to live in the best State of the Union where people work hard.

[00:14:10] Trust and care for each other. And strive to keep Vermont a place where our children and grandchildren will grow up and thrive. He continued by saying, in every corner of our state, heroin and opiate drug addiction addiction threatens us. It threatens the safety that has always lost our state. And so what we see here is this really like strong political moment and a lot of courage and a call to action, but also still using language that kind of romanticizes Vermont. Right. And we see this like sturdy Vermont or strong community in this place that's so safe. And this shouldn't be happening here. And so it's this interesting moment. And I'm going to talk about a couple of articles that came after it to really explain why this disrupted the Vermont ideal.

[00:14:58] So after Sherman's address, articles like this started to arise. This is an article by Gina Truong.

[00:15:08] She's a Vermonter and it said, How did I do, like Vermont, become America's heroin capital? So we're like I do like quaint, bucolic. We're used in these headlines really questioning. Well, what's happening is that the governor is going to really declare this like emergency. What's really happening in this place that we see is so safe and soft and comfortable. And I do like and she ended her article by saying it's time for Vermonters and for the rest of the country to recognize that heroin is now nearly as much a part of our state's identity as our beloved maple sirup and covered bridges. So you can go to the next slide here. And what we're going to see is this like here's an image that just completely flips that ideal on its head. So this was from the Rolling Stone a couple months later with the title New The New Face of Heroin. And they described Vermont as the least likely corners of America and a full blown crisis that they had just woken up to. And here this image has really like carried with me throughout this project because. Right. So Shumilin talks about strength and community and safety. And here we see like a young Vermonter who we would expect to be chopping down trees to heat his home or to tap for maple sugar in this idyllic landscape. He's probably community minded, right. But here he is sitting in this picturesque northeast landscape, injecting heroin and really being like this is the product of the state and how we we market ourselves that we really need to be talking about. So someone's addressing these subsequent articles really marked a moment of this complete disruption of thinking about how Vermont is constructed and how its identity is constructed in the face of such a profound crisis. So the second theme I'm going to talk about is how world geography and the rural geography specifically of Vermont created a new opioid use disorder treatment model. This man here is Dr. John Brooklyn. He was the first narrator that I had the pleasure of meeting with. He is cited as one of the architects of the hub and spoke model, which is Vermont's model for treatment. And I'll just kind of briefly explain what that is. So there are hubs which are larger, more regional centers that deal with more complex substance use disorders and people who need more services and kind of like a constant source. And then there are spokes which are localized clinics. So that could be like a primary care clinic or elsewhere where it's in a community you don't need to drive as far and where you can get your medication, assisted treatment every day and it doesn't have to disrupt your life. And so before this model, Vermonters had to drive to New York, to Massachusetts every single day if they wanted to be on medication, assisted treatment, which is the proven treatment to help recovery for people with opioid use disorder. And so what John Brooklyn did and other state officials was create this model that really was based around the challenges of the rural geography of Vermont writes, We have a lack of transportation infrastructure, long travel times, communities that don't have a lot of resources or medical personnel to really create a system that was localized and that put money and resources in communities that were struggling so that everyone could get adequate access to treatment. And like I said earlier, PROMOTE has the highest per capita opioid use to sort of treatment in the entire United States. So this next map that I'm going to show is just to kind of illustrate that we have rural information sharing going to an urban space. Right. And that's pretty unusual in these kinds of things. We usually see urban centers and big think takes thinking of things and then putting them on rural communities. But instead, these barriers to care that we saw created this really integrated health care system that is now being replicated in the states highlighted on the screen. And most of which have enormous populations compared to the six hundred thousand people in Vermont. Right. It's a California, the most populous state in the union. So I just that is something that's really important to highlight here, is that Vermont's kind of innovation and ability to create a model and execute a model that is now replicated across the country is very impressive.

[00:20:07] And then finally, I want to kind of talk about the evolving narrative of care that will lead into my final geographic themes.

[00:20:16] I'm just gonna tell a quick story here, and then we're going to hear a quick audio clip from Kate O'Neill. This is Kate. She's in the black shirt. I met with Kate in October of twenty nineteen. And Kate is a Vermonter. She currently lives in Philadelphia. And a year ago, from when we met her sister, Maddie, who is pictured there with her son, passed away from opioid related, opioid related fatality and neglect by officers to help her. And Kate wrote an obituary, that of her sister, that was profoundly honest and humanizing. And it went viral. And four million people within a span of a few months had listened and read the story of her sister. And after that, Kate decided to work with seven days, the local Vermont newspaper, to every month showcase a different story and do some reporting about some aspect of Vermont in relation to the opioid epidemic. So if that's trafficking, if that's harm reduction. And she did this year long project and I was sitting there in her living room with her and I. It dawned on me that it was a year, almost to the week of when her sister had passed away unexpectedly. And I asked her I was I said, Kate, like, how do you have the strength to do this work? Because it's really intense to be working on this topic. Do you have any kind of a personal connection and experience and so close to her sisters, the loss of her sister? And this was her response.

[00:22:16] Well, we might not be able to hear it, but I can kind of summarize what she said. Instead, she said that this can be our time machine.

[00:22:26] She said that the work that her family is doing and the journalism and reporting and all that time and all of those communitywide talks and radio shows. She said this can be our time machine so that other people don't have to think, what if what if I would have known about harm reduction? What if I could have helped my sister? What if I knew about the resources that were out there for her so that her her story is really impactful for me and really was a great example of the evolving narrative of care that exists in Vermont that has really created the model of care and system of care that we see today. If you go to the next slide. Those stories and bringing the individual and personalized level of the opioid crisis into the forefront of media and communities really changed the imagined geographies of opioids in Vermont. And what I mean by that is that previously from my research, I found that opioids were seen as something that happens somewhere else. Like people, people use opioids elsewhere. That's an urban problem. That's a suburban problem that doesn't exist really in Vermont. And if it did, it existed in little pockets that were highly stigmatized and not talked about. And what we've seen is that this has been a continuation of a problem. This hasn't gone anywhere. But what's really changed is that individuals have been able to share their stories and projects like these. And journalism and all of these different storytelling mechanisms have really worked to destigmatize how we see opioids and also claim it as something that is from Vermont. And so I just want to show this picture here. It says, No one chooses addiction. They suffer suffer from substance use disorder. And this is in the Burlington International Airport where anyone who is coming to go skiing and Stowe or Leaf peeping at camel's hump or local Vermonters, when they get off the plane and they look to the green mountains, they see that substance use disorders here in this landscape. And I think that that is just a really profound example of the changing narrative of care and how Vermonters have imagined themselves within this larger epidemic.

[00:24:55] And then the next slide here, I just want to end with this, because I was thinking about this profoundly strange and challenging moment that we're in right now. And this is Bess O'Brien. She's a Vermont filmmaker based out of the northeast kingdom. And she made a film in 2014 called The Hungry Heart that documented a bunch of youth in Franklin County who were struggling with opioid use disorder.

[00:25:20] And their pediatrician, Fred Holmes, had the pleasure to speak with kind of their experience of the epidemic and the challenges that they were facing. And she said I asked her again. How do you do this work? How do you constantly engage? And why do you think this is important? And she said, I think storytelling is the basic bottom line. If you're not telling your story and you're not getting the word out there, you're not expressing yourself. I don't think change is possible. Everything starts with a story. And so I hope that this project and this archive of oral histories and we'll really be changing story. And if anyone has any questions, I would appreciate them. And thanks for listening.

[00:26:02] Thank you, Lucia. That was really, really, really interesting. So many levels. So, yes, please, people, if you want to pose the question. But I when asked to show up. You think so? To me, one of the enormous turning points that you talk about is Governor Shumlin, state of the state where the entire address and turned it over to just talking about this issue and among all the things that you talk about that it did in a way, it made it to your last point, really made it clear that people who were addicted were not criminals.

[00:26:44] It's a health issue, right, to speak to them.

[00:26:50] Yeah, and I think that also it's important with the history of addiction medicine is where addiction turned rather from a personal choice into a health issue.

[00:27:06] And really what we see as a medical model of addiction medicine is about criminalizing it started going away and seeing this as a disease.

[00:27:17] Because the other thing I noticed about how Vermont has pivoted to be one of the leaders, as you point out, by allowing regular doctors' offices to be places of treatment. It's instead of criminalizing the people who are addicted, it's just this is another disease that you get treated at your doctor's office.

[00:27:40] Right. And I think that that's also a component of standing in line, waiting for methadone with a bunch of other individuals continues to be stigmatizing rather than just going to your normal like you would every for asthma or diabetes or for anything.

[00:27:59] And along those same lines, there have been some.

[00:28:05] Public policies, in addition to the hub and spoke the you mentioned. So I think Vermont has also been a leader in reducing the number of pills the doctors can prescribe, you know, to.

[00:28:16] Yeah. And in addition to now, also, there's been a lot of criminal justice reform that has also been really important.

[00:28:23] And getting medication, assisted treatment into the prison system so that people who are experiencing incarceration aren't in withdrawal and overdose. And so that's a real leader, not kind policy as well.

[00:28:39] And since you're so close, this issue in so many ways that chair of the geography department has posed to the question, asking if you know of other public policy measures that have come out of, you know, most recently ways if Vermont has moved to handle this.

[00:28:55] You talked about how it spoke. We just mentioned the reader. Any others that you know or other ways of Vermont has positioned itself to address this? Crisis, really?

[00:29:06] Well, from Beverly's question about any feedback on Wolesi makers. I don't know if it is referencing my project itself. You haven't gotten feedback from them. I'm waiting first from some of my narrator. But to Meghan's question about Kofman 19 affecting for her neighbors with substance use disorder. I really want to help because I've been thinking about that recently and realizing that this epidemic that we're seeing with opioid and this larger pandemic with Kofman is just intensifying the isolation and the mental health crises and unemployment. And a really unstable crown for a lot of people who don't. And so I just want to mention, like, freaked out people, you know, if they're struggling. I think that we're gonna see an uptick in overdose deaths. I think kind of on just a couple weeks ago, her daughter overdosed. And it's just a really tragic situation with Kofman and not. And so I think that we're going to see kind of an intensified landscape of substance in Bali because the care.

[00:30:34] The attention has been diverted.

[00:30:38] Yeah, it's definitely possible. But I also know that folks who work in medication, assisted treatment clinics and folks who are doing this work. That is their number one priority. And we see that even in Vermont. Right.

[00:30:52] Like people who work at that clinic, they're there every day, no matter what is happening, because they are there to help treat them with and especially folks on the ground like crime reduction centers. People like Aubrey will work right now as well as the her, and they continue to show up every day. And I'm grateful for them and all the work that we're doing.

[00:31:19] And I don't know if you saw, but Dr. Morse asked you a question, too, if you had additional funding.

[00:31:25] What would be the next step in this research? Where would you go next?

[00:31:30] I would really like to expand the network of individuals who I have had the pleasure to speak with, working with UVM and I, Arby's and things like that. I.

[00:31:43] I thought that this would be most appropriate for this project to talk to.

[00:31:48] Only harm reduction practitioners or doctors or people who are more on the professional level of things. I would really like to do is do oral histories with figures that are more formal. Right. So mothers who want kids or people who are in recovery or even in active use and how they see all people caring for what. What I know this is, you know, people who do harm reduction, work who work, people who are inactive and folks who are dual policy, they have a very different understanding of how things work. Right. So, you know, we have this great rate of medication treatment, but that doesn't mean that it's accessible to everybody. Right. And so people with different perspectives and different experiences with a really different take on that. And so I really want to be able to open this project up for them.

[00:32:40] I think that they are perhaps the most important person in this year long process with with the group that I speak with you. I hope you get the chance to do a slight detour.

[00:32:55] But just mentioned what your mother's right now, what she's working on.

[00:32:59] Yeah, my mom is an oral historian here in Minneapolis and she works Macassar College and she is working on the final draft of a book that she's writing called When Rockbottom Means Death, about the opioid epidemic in Minnesota because Minnesota is known as the land of 10000 rehabs in the Minnesota model.

[00:33:21] It's really what all traditional AA end treatment programs are built to London to really incredible work. I'm kind of being her bibliography research assistant right now and putting everything together for her.

[00:33:36] So I'm very grateful for her work. And this project will be able to be what it is today without her guidance and support to help her with her project.

[00:33:46] But she's pretty glad to have helped.

[00:33:51] It's like day two or maybe not cauda your research. But one of the things that's always I work with Peter Shoman. A couple of things. And I know another initiative here that he really, really cared about on this issue was.

[00:34:05] Some penalties are. Criminal indictments and jail time for some of the executives that we know a lot about now who know quite a lot about how addictive their substance is, where I don't.

[00:34:22] Do you think about that at all? Nobody has gone to jail yet. Some have settled or are close to settling.

[00:34:29] Yeah, I should be absolutely held accountable.

[00:34:34] And like Oklahoma is a really interesting example where they won a lawsuit and were given funds to help kind of combat the crisis that they were seeing for harm reduction, resources and treatment. And I think executive actions like that should be held accountable for paying for Pumphrey treatment system in the US. And I think that that's a really large hurdle that we're going to have to get to. But it's very clear, especially in the Arctic, for research. I go. But even 100, 100 years ago, towns and whales in Burma were being enriched by opium fall or not, because it was built on the sale of, if you like.

[00:35:23] Right. And so it's important to recognize is not and how important it is that people are involved as well because it wasn't anything new to you. They knew that know ravaging.

[00:35:37] And that's why I'm hopeful that Hebner is on that work and that people continue to. It's that. Yeah.

[00:35:48] I always just wondered morally at some level, these people know, you know, the pain and agony that this drug that they are voting in. You know, we know in some of these cases, like Purdue, they just spent hundreds, literally hundreds of millions of dollars to promote these products.

[00:36:07] Yeah.

[00:36:09] Just you know, I just can't get my head around how you could do that and know that the pain and destruction that you're causing.

[00:36:16] Yeah, well, you can see it like that first slide that I showed in my presentation, that graph Purdue Pharma put out oxy cotton in nineteen ninety five. So four years before that graph started and you can see that that is partly responsible for that extreme. There's no if but you know anything about it. But I also think it's important, one, to recognize the role of Big Pharma, but also to recognize the role of mental health in the United States and are kind of lacking system with that. And so our recovery system in the United States, proper opioid epidemic is based around abstinence. And I think with what are in your ear, we're different than when you bring them to safely recover from them.

[00:37:11] This is a proven one thing.

[00:37:16] So there's a lot to work on.

[00:37:18] Yes. I do feel, though, as you said a few times, the accessibility of Vermont.

[00:37:24] I mean, to me, you interviewed every important stakeholder. Just quickly look in John, Brooklyn, Kay. You know, all these people who are so core to every conversation.

[00:37:35] Was there something about doing this research in Vermont that made it particularly. I don't know, telling or compelling for you or. Yeah.

[00:37:45] I asked every one of the narrators about what they thought about Vermont. And if Vermont was unique in this. A lot of people had worked in other communities or were well versed in problems that were happening elsewhere. And most of what they said was that the community in Vermont and the smallness and the activity really allowed for these conversations to happen and or actually feel like different legislation to go through and to really like advocate for people in which it's a little bit harder and a bigger place with many more bureaucratic barriers. Now, kind of the biggest takeaway about Vermont specifically, that people had to say more like, you know, Vermont is not alone in this crisis and not as unique in its response. And I think that also sometimes goes along with the truck of like, oh, Vermont so unique and we can do it and things like that. But really, I do we do this. That's one example Vermont has done. And there's still a lot of work to be done. They are good people in our government and people on the ground are really trying to hit this that every point to provide access to.

[00:39:04] Nicely said Lucia. Yeah, we think of ourselves as exceptional in some ways. There's something about the scale of stability that in this case, you combine that with a leader who is really for a variety of reasons. At the top, really pushiness, and then you had a whole lot of progressive people in the medical establishment who were ready, I think, to.

[00:39:30] Just a lot of things came together. We should thank you so much for having me.

[00:39:36] And thank you for all your, you know, good work that you did in her years at UVM.

[00:39:42] We're gonna miss you.

[00:39:43] I can see a bunch of your faculty members have all chimed in here anyway.

[00:39:49] So good luck to you in so many ways. This thesis is publicly available on scholar works. And we'll post the link here and hopefully we'll be in touch in some other ways. I'm going to say goodbye, goodbye to Lucia and goodbye. And Brianna is going to come in and tell us what next Wednesday is.

[00:40:06] Research Live may or may not be all about all right. Until the Baelish, Brianna.

[00:40:15] That's all you. Hello, everyone. So I'm here to announce next week's speaker, and I'm actually not the one.

[00:40:26] That's it. It's a mystery speaker. So tune in next Wednesday at 12:00.

[00:40:30] We want to hear more about who's speaking and we may or may not make an announcement early next week.

[00:40:37] So it is for. But we'll let you know. So thank you for tuning in.