Op-Ed: Public safety and substance use needs a comprehensive approach

April 2, 2025  |  By Jenney Samuelson

Vermont has long been a leader in treatment for addiction and substance use, particularly through its Hub and Spoke model which was launched nearly a decade ago to address the opioid epidemic. 

This approach brought treatment into the mainstream, integrating it into doctor’s offices and expanding access to services through regional hubs. It made Vermont one of the top states for accessing care and significantly reduced the stigma around seeking help.  

However, the landscape of the substances in use has evolved over the past 10 years. What we are seeing now is an increasingly complex drug supply in Vermont that mixes the potent opioid fentanyl with stimulants like methamphetamines and cocaine and adulterants like xylazine, leading to complex addictions and complex treatment. 

The tools and treatment systems we developed to address opioid addiction are no longer enough to tackle this emerging crisis. The medication-assisted treatment model that once worked for opioids does not translate effectively to stimulant use. Not surprisingly, that creates significant gaps in care. This shifting landscape presents new challenges in reducing addiction, improving public safety, and ensuring long-term recovery. 

To break the cycle, we must adapt. In addition to supporting recovery efforts, we need to address the broader public safety implications tied to addiction and drug trafficking. The criminal activity associated with drug distribution, as well as the violence and disorder it breeds, disproportionately impacts the health and safety of our communities. These are not isolated issues; they are inextricably linked to the lack of comprehensive care and support for those struggling with substance use disorder and the need for further treatment options that our judicial system can offer. 

One of the most pressing gaps in our system is the treatment of complex substance use, particularly in light of the rising prevalence of stimulants. Traditional medication-based treatments used for opioid addiction do not work in the same way for stimulant use. That means that people suffering from addiction to multiple substances often face longer recovery times and higher relapse rates. There are also significant gaps in how we provide treatment for people entering residential care, making it difficult to get into care at the moment when someone is ready to take that step and difficult to get back into treatment when they are relapsing.  

Vermont’s housing crisis is another critical issue that exacerbates these challenges. Stable housing is a fundamental pillar of recovery, yet the shortage of affordable housing makes it incredibly difficult for individuals in recovery to maintain long-term sobriety. The lack of housing units also makes it nearly impossible for recovery housing programs to expand.  

The lack of stability and continuity in treatment further compounds the challenges and can play out publicly in communities across the state. Too many transitions in the residential treatment and recovery system create risks for disruption, particularly early in recovery when individuals are most vulnerable. Each time a person moves from one level of care to another, the chances of relapse increase, threatening their progress and, by extension, their potential to reintegrate into society. 

Vermont’s residential treatment programs need to offer a full range of treatment options, allow for longer residential treatment stays, and provide better support for individuals during transitions from residential treatment programs back to home or to recovery housing options. 

Substance use is a major factor in our justice system in Vermont. More than 70% of individuals in corrections are being treated for substance use disorder. This presents a key opportunity to address the issue, but we must go beyond offering medication-assisted treatment during incarceration. The real challenge lies in equipping individuals with the tools they need to stay sober once they are released. Without comprehensive residential treatment during incarceration and continued support through the transition back into the community, many individuals will find themselves trapped in a cycle of reoffending, which perpetuates the broader public safety issues we face. 

The administration’s recent proposal takes significant steps to address these gaps in care. It aims to ensure that residential treatment providers offer a full spectrum of services, equipping them to treat the evolving drug landscape effectively. Additionally, the proposal calls for stays of adequate and meaningful duration in additional high-intensity recovery housing -- integrating housing, treatment, and critical skills-building programs for individuals in recovery and struggling with the most complex challenges. Finally, offering residential recovery services in corrections and enhancing pre-trial supervision, this plan will help bridge the gap between incarceration and successful reintegration into communities. 

Ultimately, by filling the gaps in our current system and smoothing out the transitions in care, we can improve care for those struggling with addiction and address the behaviors that disrupt the safety and health of our communities. We will see a reduction in substance-use-related crime, improved public safety, and a stronger, more resilient state overall. 

Healthy individuals are the foundation of healthy communities, and by investing in comprehensive, integrated care, Vermonters can break free from the cycle of addiction and rebuild their lives. 

The time to act is now, and with the right tools and policies in place, Vermont can continue to lead the way. 

Jenney Samuelson is Vermont’s Secretary of the Agency of Human Services.