This commentary is by Beach Conger, a physician who works at the Johnson Health Center in Burlington, a clinic that provides medical care to homeless people and those with substance use disorders. “Human kind cannot bear very much reality.” So wrote T.S. Eliot in “Burnt Norton,” the firs t of his “Four Quartets.” I have been reminded of this line by several opinion pieces and letters to the editor in recent weeks about the public visibility of opioid use. The common theme among these pieces is that those who use drugs in public should be held accountable for their actions. It is not the drug use itself that is disquieting, but the fact that the writers can see it. What form this accountability should take includes increased police presence, increased incarceration for public drug use and involuntary treatment. Although the term “rehabilitation” is used, it’s not specified what this means. It raises the question: Is the individual sick? Or is it society? If it is the individual, then the increase in public drug use would be due to an increase in the number of opioid users. Although it is hard to find precise data on this question, two observations suggest it’s not the case. The first is that the annual survey of drug use conducted by the Substance Abuse and Mental Health Services Administration reports that in the past three years, opioid misuse in Vermont has declined from an estimated 18,000 people to 13,000. In addition, overdose numbers have declined even more, from a high of 269 in 2022 to a projected 130 this year, extrapolating from the first four months of data from the Vermont Department of Health. This suggests that the more likely explanation for the increase in public outdoor drug use is not that there are more drug users, but that they have nowhere to go. Support for this hypothesis is that the homeless population in Chittenden County has more than tripled from 260 in 2020 to an estimated 834 this year. READ MORE I work in a facility in downtown Burlington that provides medical services to this population. Most of the people I see were successfully in recovery until Covid-19 disrupted their lives. Like the children who were socially isolated during Covid, they have struggled to regain their footing. Many have given up. They have been in and out of jail and in and out of rehabilitation facilities, after which they are released back to the streets. We do our best to provide treatment, but our efforts, like those of law enforcement, have only a transitory effect. A permanent solution will require both a bigger commitment to long-term treatment in supportive facilities and permanent housing upon release. It is not a commitment our society is willing to make at this time. I don’t know how to solve this problem. But I do know this: None of the people using drugs on Church Street or in the garages or in City Hall Park or on the waterfront are there because they want to be. Whenever possible, I eat my lunch in City Hall Park. There are people stumbling around in a daze. There are people transacting drug business. There are people zonked out on the benches. There are people screaming and gesticulating. Some are wild. A few look frightening. It is not a pretty sight, and it is disturbing to watch. I understand how distressing it is for people to witness, especially if they have children with them. But when I sit there, I am not outraged. I am not angry.  I am sad. Read the story on VTDigger here: Out of sight isn’t a policy. ...read more read less