In America, we are still in the early phases of what some have termed a heroin epidemic. But in Vermont, where heroin use has been growing by leaps and bounds, there is nothing theoretical about the arrival of a truly dire situation. Previously known for its bucolic hamlets and delicious maple syrup, Vermont is becoming famous for a different reason. Heroin abuse has gotten so out of control in the Green Mountain State that tackling the problem has become public health priority No 1. In fact, Vermont Gov. Peter Shumlin devoted his 2014 State of the State address to this topic, promising bold and aggressive action to fight this scourge. Two factors appear to be driving Vermont\u2019s surge in heroin use. First, the popularity of prescription opioid painkillers like OxyContin, Vicodin, Percocet and Lorcet has opened the door to heroin by addicting tens of thousands of people to this entire class of interchangeable drugs. Crackdowns on the availability of these addictive narcotics have sent increasing numbers of people fleeing into the arms of heroin, which is seen as a cheap and easy alternative for those looking to get their daily fix. The second reason for Vermont\u2019s problem originates on the supply side. Because the state\u2019s economy is relatively good and its citizens fairly prosperous, market forces are keeping heroin prices higher than in surrounding states. So while heroin goes for $10 a dose in New York, it costs $30 a bag in Vermont, and this has provided a powerful profit motive for illegal drug retailers eager to get in on the action. Drug dealers from neighboring states see Vermont as prime territory, and their arrival has made things difficult for local law enforcement officials not used to being at the center of so much nefarious illicit activity. Vermont\u2019s Comprehensive Approach to Combating Heroin Abuse The problem of heroin abuse and its effects on individuals and society is complex, multifaceted and resistant to easy solutions. But to their credit, policymakers in Vermont seem ready, willing and able to accept this reality. Consequently, their efforts to stop the spread of heroin use and addiction in their state are setting a standard in proactivity that other states would be wise to emulate. Vermont\u2019s anti-heroin, anti-addiction campaign includes some of the following initiatives: \tExpanded surveillance and criminal prosecutions: Aware as they are that outsiders are helping to flood the state with plentiful supplies of the drug, state and local police departments are working hard to crack down on the interstate drug dealing networks that have penetrated Vermont\u2019s borders. Thanks to these dedicated efforts, in federal courts heroin-related prosecutions increased from 31 in 2012 to 73 in 2013, while city and county district attorneys secured 220 heroin convictions in 2013 after successfully prosecuting just 106 individuals for those crimes in 2012. \tLaunching a \u201chub-and-spokes\u201d treatment program to expand drug rehabilitation availability: The \u201chubs\u201d are regional treatment centers where ailing addicts receive subsidized medical services, including detox and psychological therapy. The \u201cspokes\u201d are local doctors who agree to care for recovering heroin addicts after they complete the original stage of their rehabilitation program. \tSupplying police officers and EMTs with plentiful doses of Naloxone, which can counteract and negate the effects of an opioid overdose: Vermont overdose deaths attributable to heroin use jumped from nine in 2012 to 21 in 2013. Meanwhile, deaths caused by misuse of prescription opioids rose from 46 to 50 over the same two-year period. Naloxone can make a decisive difference if it is administered in time, and few doubt that widespread availability of this drug will have a positive and demonstrative impact on drug fatality statistics. \tThe opening of more drug courts: Vermont now has three drug courts. These alternative judiciary bodies sentence non-violent drug arrestees to rehabilitation instead of prison. Charges against the accused will be dismissed if they complete treatment programs and remain clean and sober. Studies show that about half of all drug court graduates do in fact meet these requirements, and relapse rates for this group are lower than for drug addicts punished with incarceration. \tLimiting the availability of Zohydro, the newest entrant in the prescription opioid painkiller class: This potent new hydrocodone drug has been compared to OxyContin, the most notoriously addictive of all the opioid medications. The FDA\u2019s decision to approve the drug has been controversial, and in response to its arrival on the market Gov. Shumlin issued an emergency edict restricting the ability of physicians to hand out Zohydro prescriptions until further studies can be carried out. On the Frontlines in the \u2018War on Heroin\u2019 While the War on Drugs as normally defined has largely been a failure, the fact remains that without public campaigns targeted at drug abuse, we would be left helpless in the face of an onslaught. Heroin has returned to these shores in full force, as a consequence of runaway prescription painkiller addiction, and if we bury our heads in the sand, the situation is guaranteed to get worse before it gets better. Left with no choice but to act, Vermont, in a sense, has declared \u201cwar\u201d on heroin. But officials are attacking the enemy intelligently, on multiple fronts, in a coordinated attempt to undermine all the factors that are supporting this dangerous new epidemic. Only time will tell if Vermont\u2019s approach is effective. But right now more than any other state, Vermont\u2019s officials have fully accepted responsibility for heroin\u2019s presence in their midst and are making a concerted effort to protect their citizens against its depredations. Vermont is to be congratulated for its efforts, and even the mistakes that are made will help guide policymakers in other states when they find themselves confronted by the same problem in the very near future.