While methamphetamines are the most-abused illegal drugs in many states, fentanyl remains the most popular in Vermont. Source: US DEA NDTA report

Fentanyl, cocaine, xylazine top 3 drugs of choice

Burlington community health center offers gift card incentives to stay clean

By Guy Page

Data published during Vermont Overdose Prevention Week last week show that 183 Vermonters died of a fatal drug overdose last year – just slightly more than one OD every two days. 

That figure is down from 2023, when 236 Vermonters OD’d. 2025 YTD totals aren’t available, but this April, a total of 31 Vermonters perished from fatal overdose. Those Health Dept. statistics don’t include other drug-related deaths, such as drug-trafficking violence, suicide by other means, drug-related domestic violence or death by drug-abuse related health conditions. 

Vermont’s OD decline reflects a national trend.

According to a U.S. DEA report issued this spring, In the 12-month period ending in October 2024, 84,076 Americans died from a drug overdose, according to the most recent available provisional statistics from the Centers for Disease Control and Prevention (CDC), underscoring the devastating effect these cartels have on our country. Although these numbers show a 25 percent decline since the same 12-month period last year – when the country lost 112,910 people to drug poisonings – demonstrating positive momentum in the fight against these drugs and the organizations trafficking them, the threat remains grave. The trend is hopeful, however. October 2024 was the eleventh  consecutive month in which CDC reported a reduction, and the current statistics represent the largest 12-month reduction in drug overdose deaths ever recorded.

Services provided to reduce overdoses

With fentanyl implicated in most of Vermont’s 183 fatal overdoses last year, Community Health Centers (CHC) of Burlington is rolling out a new program that rewards people in recovery for meeting treatment goals.

The initiative uses contingency management (CM), an evidence-based approach that provides small incentives — such as gift cards — to patients who attend counseling, stay engaged in treatment, and maintain clean toxicology screenings. Research has shown that CM increases treatment participation and reduces relapse rates.

At the state level, the VT Department of Health conducts several anti-opioid abuse initiatives (much of content below republished verbatim):

Overdose Outreach – Syringe service programs (SSPs) through a VDH program active reach people who are not connected to services to provide harm reduction education and tools, information on treatment, and recovery services. 

Mobile syringe service exchanges are available through all of Vermont’s Syringe Service Programs (SSPs): Vermont CARES, AIDS Project of Southern Vermont, the HIV/HCV Resource Center (H2RC), and Howard Center Safe Recovery. These mobile exchanges help to meet the needs of Vermonters who are unable to access services through a fixed site location. The mobile exchanges provide sterile injection equipment, HIV/HCV tests, case management and naloxone to people either at their homes or in a public location (such as a parking lot) that is easily accessible. 

Naloxone distribution is provided by first responders, health care facilities, and community organizations including libraries. Agency of Human Services employees are being trained to administer naloxone. 

KnowOD is an opioid overdose prevention campaign reaching two primary audiences: people at riskof an overdose, and their family and friends. Key messaging for people at risk of an overdose focuses on six overdose prevention and harm reduction tips: 

1. Never use alone—if you OD while alone, you can die 

2. Go slow—start with a small amount to test drug strength 

3. Call 911—in case of an overdose 

4. Use new syringes—to reduce risk of infections and help to protect vein health 

5. Test for fentanyl—fentanyl can be dangerous, so test with easy-to-use strips 

6. Carry naloxone—Narcan® nasal spray can reverse an overdose 

Medication by Hub & Spoke – Vermont uses a system of nine regional Hubs and over 100 Spokes, including Vermont’s six correctional facilities, to provide Medication for Opioid Use Disorder (MOUD). Hubs provide a higher intensity of support to their clients and work closely with their region’s spoke providers which are office-based treatment locations, often embedded within primary care and family medicine offices. Patients who need a higher level of support in their treatment and recovery experience are treated by Hubs, while those who might have more stability in their treatment and recovery are treated by Spokes. Patients who are prescribed buprenorphine or naltrexone can be moved between Hubs and Spokes depending on their support needs. 

As VDC readers know, state, local and federal police routinely arrest suspected drug criminals, including many from out-of-state gangs targeting Vermont due to its perceived weak criminal justice response to drug crime, especially juvenile drug crime. The State of Vermont has been unable to site a replacement for the Woodside juvenile detention and treatment facility that closed years ago, and therefore often has no place to put suspected juvenile drug criminals. 

The Legislature has taken some steps in recent years to make Vermont less hospitable for drug traffickers. But no-one – least of all state authorities – are claiming the state has turned the corner in the struggle against drug crime. 

Vermont ranks among the lowest states for federal seizures of drug-related cash, with less than $500,000 in 2024. Texas, NY and California were the top-ranked, with more than $20 million in seizures each of the total $280 million. 

This last data point reflects the fact that Vermont is a tiny battlefield in the illegal drug trafficking war between organized international cartels and their American gang henchmen vs. state, local, and federal governments. 

The 2025 U.S. DEA National Drug Threat Assessment offers a sobering look at drug crime and the success – or lack thereof – of fighting it at the national level. It includes the following data points (much of the information below re-published verbatim):

Fentanyl purity declined throughout 2024, consistent with indicators that many Mexico-based fentanyl cooks are having difficulty obtaining some key precursor chemicals. DEA reporting indicates that some China-based chemical suppliers are wary of supplying controlled precursors to its international customers, demonstrating an awareness on their part that the government of China is controlling more fentanyl precursors to comply with recent updates to the United Nations counter- narcotics treaty. 

The downward trend in fentanyl purity does not mean that street-level fentanyl is less dangerous. Drug dealers in the United States continue to adulterate fentanyl with various animal tranquilizers (such as xylazine), anesthetics (such as ketamine), and other synthetic opioids (such as nitazenes). 

In addition to the synthetic drug threat from Mexico, elevated synthetic drug production in Canada—particularly from sophisticated fentanyl “super laboratories” such as the type seized by the Royal Canadian Mounted Police in October 2024—presents a growing concern for the United States. Currently, estimated flows of fentanyl from Canada are  substantially lower than flows from Mexico. As of Spring 2025, 22.7 kilograms of Canada- sourced fentanyl were seized at the U.S.-Canada border in 2024, compared to 9,354  kilograms seized at the U.S.-Mexico border. 

In an effort to reduce cash seizures, Cryptocurrency has emerged as another tool that is increasingly being adopted by TCOs because of the ability to swiftly and securely transfer funds internationally through an encrypted blockchain, significantly limiting access to transaction information.

Psychostimulant (mostly methamphetamine) fatal overdoses peaked at a record 36,251 in 2023. Most meth consumed in the U.S. is produced and trafficked across the southern border by Mexican cartels.

Heroin continues to be replaced by fentanyl – The prevalence of fentanyl and other synthetic opioids in the U.S. illicit drug market amplifies the downward trend since 2020 in plant-based opiates such as heroin. Mexico-based cartels supply most of the heroin destined for the United States, the majority of which is smuggled through the SWB. 

From a production standpoint, fentanyl possesses several distinct advantages for these cartels that heroin does not: fentanyl is less expensive and time-consuming to produce; clandestine fentanyl laboratories are not affected by weather or agricultural hazards; and fentanyl can be produced both quickly and year-round. 

Xylazine, the #3 drug of choice in Vermont after fentanyl and cocaine, continues to be on the rise nationally. Xylazine is added to fentanyl by street-level drug traffickers – a mixture known as “tranq” – increasing the risk of death from fentanyl poisoning. Because xylazine is not an opioid, naloxone does not reverse its effects. 

China-sourced Nitazenes are synthetic opioids similar to fentanyl butcan match or surpass the potency of fentanyl. They were first developed in the 1950s for pharmaceutical research and were never approved for use in the United States or any other country. Chemical suppliers, mainly located in China, introducenew nitazenes when the ones currently on the market become riskier to produce due to regulatory actions and drug scheduling, or as users seek novel opioids that are not yet illegal. 

‘Lost’ prescription drugs up nationwide – The DEA Theft/Loss Reporting Database (TLR) reveals that the number of unaccounted-for (“lost”) narcotic prescription drugs (opioids) increased by 1.6 million in 2024. The loss of CPDs can be through employee theft, natural disaster, in-transit damage to or hijacking of transport vehicles, accidental breakage/spillage, robberies, break-ins/burglaries, and other causes.

This increase of legitimate pharmaceutical opioids lost to theft or diversion might be linked to distrust of fentanyl-laced street-level pills creating a renewed demand for licit medications, the DEA said. 

Illicit use of ketamine, an anesthesia, was up in 2024. Use of synthetic stimulant ‘bath salts’ was down, DEA said. 

Chinese dominate domestic marijuana production: Over the past 10 years, Chinese TCOs (trans national criminal organizations) have come to dominate the cultivation and distribution of marijuana throughout the United States, a phenomenon noted from California to Maine. 

The purchase of real estate for both indoor and outdoor grows, and for the storage of needed equipment, is often initially funded through family and community connections, both in China and in the United States, as many seek to skirt restrictions on the movement of currency from Chinese banks to foreign countries. 

Undocumented Chinese immigrants, many of whom spent years in Mexico and were lured to the United States with offers of legal employment, staff many of the grow sites alongside undocumented Mexican immigrants in similar circumstances. The undocumented migrants are closely monitored by the Chinese TCO members who own and manage the grows. 

Most of the grow sites are located in states where the cannabis industry is “legal,” though most do not follow the established licensure process or have obtained their licenses through falsified means. They face little prison time, if any, when caught, and often move to a new location in the same state or to another “legal” state once discovered. 

VDC has been unable to determine whether any Chinese-owned marijuana grows are operating in Vermont, similar to the extensive operations reported by The Maine Wire and republished in VDC.

The Chinese TCOs are producing the most potent form of marijuana in the history of drug trafficking, with a THC content averaging 25 to 30 percent, compared to a national average of 16 percent. The grow sites use pesticides and fertilizers shipped from China, including many chemicals banned in the United States for decades because of adverse health and environmental consequences. Not only are these chemicals entering the water, soil, and air around the grow sites, some quantity of these chemicals also remains on the processed marijuana that is ingested by users. 

Drug cartels smuggling black market petroleum into U.S. – TCOs are obtaining or stealing, then smuggling, Mexican PEMEX (Petróleos Mexicanos, Mexico’s state-owned petroleum corporation) crude oil into the United States for sale to U.S. oil and gas companies, in a sophisticated trade-based money laundering scheme. The investigation has determined that this black-market petroleum smuggling operation is the primary means by which the TCO funds its networks. It is estimated that Mexico is losing tens of billions in tax revenue annually, while simultaneously costing the U.S. oil and gas companies billions of dollars annually due to a decline in petroleum imports and exports during this same period. 

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Meanwhile, in Vermont, the Community Health Center (and other state and local substance abuse recovery groups) are trying to stop addiction one person at a time.

“Every step forward in recovery is a victory,” said Dr. Heather Stein, CHC’s Chief Medical Officer. “This program recognizes those steps that often go unnoticed and gives patients an extra boost to keep moving forward.”

The 183 OD deaths in 2024 figure represents a 22 percent drop from 236 deaths in 2023 and marks the state’s lowest overdose toll in four years. It was also the second consecutive year of decline.

Still, fentanyl remains the dominant driver of deaths, appearing in 93 percent of cases last year. Health officials also report a troubling rise in overdoses involving cocaine and the animal sedative xylazine.

Public health leaders say the downward trend in overdose fatalities shows progress, but sustaining and accelerating that progress requires innovative recovery supports. CHC says its gift card program adds one such tool.

Funded through state grants, the program provides participants with tangible rewards for meeting recovery goals and actively engaging in treatment planning. The aim, CHC says, is to strengthen motivation, reinforce positive behaviors, and help people sustain momentum in their recovery journey.