Act No. 22 Page 1 of 3
2023
This act summary is provided for the convenience of the public and members of the General Assembly. It
is intended to provide a general summary of the act and may not be exhaustive. It has been prepared by the
staff of the Office of Legislative Counsel without input from members of the General Assembly. It is not
intended to aid in the interpretation of legislation or to serve as a source of legislative intent.
Act No. 22 (H. 222). An act relating to reducing overdoses
Subjects: Human services; opioid use disorder; crisis response; overdose
Sec. 1 of this act updates the Unused Prescription Drug Disposal Program to include
needles and syringes. Sec. 2 of this act requires the Department of Health and the
Blueprint for Health to facilitate regional stakeholder meetings regarding public needle
and syringe disposal programs. By January 15, 2024, the Department shall present
information to various committees of the General Assembly regarding the progress of the
regional stakeholder meetings. Sec. 3 of this act appropriates $150,000.00 in fiscal year
2024 from the Evidence-Based Education and Advertising Fund to the Department to
provide grants and consultations for municipalities, hospitals, community health centers,
and other publicly available community needle and syringe disposal programs that
participated in the stakeholder meetings required pursuant to Sec. 2. Sec. 3b of this act
requires the Department of Health to present information to various committees of the
General Assembly on unmet needle and syringe service needs, resources required to
ensure equitable access to needle and syringe services, and who is best positioned to
provide needle and syringe services.
Sec. 4 of this act amends 18 V.S.A. § 4240 pertaining to opioid antagonists, including
requiring the Department of Health to include the status of legal possession of substances
and harm reduction supplies to any education or trainings provided, to distribute opioid
antagonists to assist those at risk of experiencing an opioid-related overdose, and to
establish opioid antagonist dispensing kiosks in locations accessible to those at risk of
experiencing an overdose. This section also removes the requirements that a health care
professional may only prescribe, dispense, and distribute an opioid antagonist to
individuals who have received education in a manner approved by the Department of
Health and that an individual call for emergency medical services after administering an
opioid antagonist.
Sec. 5 of this act exempts “other harm reduction supplies” from the definition of
“drug paraphernalia” so as to exempt harm reduction supplies from penalties related to
selling drug paraphernalia to a minor.
Sec. 6 of this act prohibits a health insurer or other health benefit plan offered by an
insurer or pharmacy benefit manager on behalf of a health insurer covering prescription
drugs from using step-therapy, “fail first,” or other protocols requiring documented trials
of medication before approving a prescription for the treatment of substance use disorder.
Sec. 6a of this act updates the phrase “medication-assisted treatment” to be “medication
for opioid use disorder.” Sec. 6b of this act amends existing rulemaking authority to
provide the Departments of Health and Vermont Health Access (DVHA) greater
flexibility in maintaining a regional system of opioid use disorder treatment. It further
adds subsection (d) to allow controlled substances for use in opioid use disorder
treatment to be prescribed via telehealth in accordance with federal requirements and
subsection (e) to prohibit DVHA, or DVHA’s pharmacy benefits manager, from
VT LEG #370992 v.2
Act No. 22 Page 2 of 3
2023
requiring a health care provider to document a patient’s adverse reaction to a medication
prior to prescribing an alternative medication for opioid use disorder to the patient. Sec.
6c replaces the term “medication-assisted treatment” with “medication for opioid use
disorder.”
Secs. 7–8b of this act pertain to prior authorization. Sec. 7 adds 33 V.S.A. § 1901l to
(1) require the Agency of Human Services (AHS) to provide coverage to Medicaid
beneficiaries for medically necessary medication for opioid use disorder when prescribed
by a health care professional practicing within the scope of the professional’s license and
participating in the Medicaid program and (2) pending approval from the Drug
Utilization Review Board, requires AHS to cover at least one medication in each
therapeutic class for methadone, buprenorphine, and naltrexone as listed on Medicaid’s
preferred drug list without requiring prior authorization. Sec. 8 requires the Joint
Legislative Justice Oversight Committee to provide recommendations to various
committees of the General Assembly regarding legislative action needed to ensure
continuity of treatment for individuals reentering the community after discharge from a
correctional setting, including eliminating prior authorization for medication for opioid
use disorder. Sec. 8a requires DVHA, in consultation with individuals representing
diverse professional perspectives, to research the feasibility and costs of administering a
gold card program for substance use disorder treatment in which AHS shall not require a
health care provider to obtain prior authorization for substance use disorder treatment if,
in the most recent evaluation period, AHS approved or would have approved not less
than 90 percent of the prior authorization requests submitted by the health care
provider for the medication. DVHA’s research must be submitted to the Drug and
Clinical Utilization Review Boards for review. Sec. 8b directs DVHA to amend its
rules to enable health care providers in office-based treatment programs to prescribe
24 milligrams or less of the preferred medication for buprenorphine without prior
authorization in accordance with 33 V.S.A. § 1901l.
Sec. 9 of this act adds a definition of “recovery residence” and requires that in all
municipalities, a recovery residence serving not more than eight individuals be
considered by right to constitute a permitted single-family residential use of property.
Sec. 10 of this act removes the future repeal of the buprenorphine exemption,
meaning this section would be a continuation of existing law in that there would not be
criminal penalties for possession of 224 milligrams or less of buprenorphine, except that
(1) persons under 21 years of age in possession of 224 milligrams or less of
buprenorphine would be referred to the Court Diversion Program for the purpose of
enrollment in the Youth Substance Awareness Safety Program and (2) persons under
16 years of age in possession of 224 milligrams or less of buprenorphine shall be subject
to delinquency proceedings in the Family Division of the Superior Court.
Sec. 11 of this act amends 18 V.S.A. § 4201 to add definitions of “approved drug-
checking service provider” and “drug checking.” Sec. 12 of this act provides immunity
protections for individuals obtaining or providing drug-checking services.
Sec. 13 of this act amends 18 V.S.A. § 4774 to clarify the process by which funds are
appropriated from the Opioid Abatement Special Fund. Sec. 14 of this act makes
numerous appropriations from the Fund, including for outreach and case management
VT LEG #370992 v.2
Act No. 22 Page 3 of 3
2023
staff, distribution of fentanyl test strips, and implementing a wound care telehealth
consultation pilot program.
Effective Date: Multiple effective dates, beginning on May 25, 2023
VT LEG #370992 v.2


Statutes affected:
As Introduced: 18-4224, 18-4240, 18-4475, 18-4752, 24-4412
As Passed By the House -- Official: 18-4224, 18-4240, 18-4475, 18-4752, 24-4412, 33-2004, 8-4089i, 18-4750, 18-4753
As Passed By the House -- Unofficial: 18-4224, 33-2004, 18-4240, 18-4475, 8-4089i, 18-4750, 18-4752, 18-4753, 24-4412
As Passed by Both House and Senate -- Official: 18-4224, 18-4240, 18-4475, 18-4752, 24-4412, 33-2004, 8-4089i, 18-4750, 18-4753, 18-4201, 18-4774
As Passed by Both House and Senate -- Unofficial: 18-4224, 18-4240, 18-4475, 8-4089i, 18-4750, 18-4752, 18-4753, 24-4412, 18-4201, 18-4774
As Enacted: 18-4224, 18-4240, 18-4475, 8-4089i, 18-4750, 18-4752, 18-4753, 24-4412, 18-4201, 18-4774
House proposal of amendment to Senate proposal of amendment Official: 18-4201
House proposal of amendment to Senate proposal of amendment Unofficial: 18-4201