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HomeMy WebLinkAbout18 - Acceptance of Opioid Settlement Funds for Community Outreach and Education and Distribution of NaloxoneQ �EwPpRT CITY OF s NEWPORT BEACH `q44:09 City Council Staff Report June 27, 2023 Agenda Item No. 18 TO: HONORABLE MAYOR AND MEMBERS OF THE CITY COUNCIL FROM: Joe Cartwright, Chief of Police - 949-644-3701, jartwright@nbpd.org PREPARED BY: Eric Little, Lieutenant, elittle@nbpd.org PHONE: 949-644-3740 TITLE: Acceptance of Opioid Settlement Funds for Community Outreach and Education and Distribution of Naloxone ABSTRACT - Overdose deaths involving opioids have increased by more than eight times since 1999, killing nearly 69,000 people in 2020. In 2021, a $26 billion settlement offer was made by opioid manufacturer Janssen Pharmaceuticals and three distributors to resolve their liabilities in over 3,000 opioid crisis -related lawsuits nationwide. It is estimated that California will receive approximately $2.05 billion from the Janssen and Distributors (J&D) Settlement Agreements over the next 18 years, with the majority of funds dedicated to the abatement of the opioid epidemic throughout the state. The City of Newport Beach will receive a portion of these funds annually; $395,765.84 has been received for FY 2022-23. The Newport Beach Police Department (NBPD) seeks acceptance of the funds from the Janssen & Distributors Settlement. The funding will be used to make naloxone more readily available in the community, and to launch a media and public relations campaign to educate the public on the use and availability of the naloxone as well as the dangers associated with the misuse of opioids. RECOMMENDATIONS: a) Determine this action is exempt from the California Environmental Quality Act (CEQA) pursuant to Sections 15060(c)(2) and 15060(c)(3) of the CEQA Guidelines because this action will not result in a physical change to the environment, directly or indirectly; b) Accept funds from the Janssen, Distributors and NOAT II Settlement Fund, totaling $395,765.84; and c) Approve Budget Amendment No. 23-071, increasing NBPD revenue estimates and expenditure appropriations by $395,765.84. 18-1 Acceptance of Opioid Settlement Funds for Community Outreach and Education and Distribution of Naloxone June 27, 2023 Page 2 DISCUSSION: BACKGROUND Opioids are substances that work in the nervous system of the body or in specific receptors in the brain to reduce the intensity of pain. Opioids include prescription drugs like morphine, oxycodone, fentanyl and illegal street drugs like heroin. In addition to reducing the intensity of pain, opioids can produce a euphoria ("high") for some people, which can lead to the misuse and abuse of the drug. When taken at a higher dose, opioids can restrict the ability to breathe and can lead to a fatal overdose. According to the Centers for Disease Control and Prevention (CDC), more than 932,000 people nationwide have died since 1999 from a drug overdose. Overdose deaths involving opioids have increased by more than eight times since 1999, killing nearly 69,000 people in 2020. The opioid epidemic has touched nearly every region of the United States, including Southern California. In Orange County, opioid-related overdose deaths increased from 251 in 2017 to 743 in 2021. During the course of the opioid overdose epidemic, state, local and tribal governments brought lawsuits against pharmaceutical and drug distribution companies to recover costs associated with the epidemic and to prevent future crises. On July 21, 2021, a $26 billion offer to settle was made by opioid manufacturer Janssen Pharmaceuticals (parent company of Johnson & Johnson) and the "big three" distributors, McKesson, AmerisourceBergen and Cardinal Health, to resolve their liabilities in over 3,000 opioid crisis -related lawsuits nationwide. It is estimated that California will receive approximately $2.05 billion from the Janssen and Distributors (J&D) Settlement Agreements over the next 18 years. The majority of this money will be provided for the abatement of the opioid epidemic throughout the state. The City of Newport Beach will receive a portion of these funds annually. By fiscal year end 2022-23, it will have received $395,765.84. The California Department of Health Care Services (DHCS) is responsible for overseeing the manner in which these funds are spent by participating jurisdictions. The DHCS published a list of allowable expenditures for the use of settlement funds. Allowable expenditures were divided into two sections. Section 1 stipulates that no less than 50 percent of the settlement funds be used for one or more of High Impact Abatement Activities (HIAA), such as addressing the needs of communities of color and vulnerable populations, and interventions to prevent drug addiction in vulnerable youth. Section 2 includes abatement strategies such as funding for media campaigns to prevent opioid misuse, funding for prevention programs in schools, increasing availability and distribution of naloxone (and other drugs that treat overdoses) in the community, and providing training and education regarding naloxone for first responders and members of the general public. Participating jurisdictions will be required to submit an annual report to the DHCS outlining how the settlement funds were used. In line with the criteria outlined in Sections 1 and 2 of the DHCS guidelines, the City of Newport Beach will use the funds in the following manner: 18-2 Acceptance of Opioid Settlement Funds for Community Outreach and Education and Distribution of Naloxone June 27, 2023 Page 3 Increase Availability of Naloxone in the Community to Prevent Overdose Deaths Naloxone is a life-saving medication used to reverse an opioid overdose, which includes overdoses of heroin, fentanyl and prescription opioid medications. It can restore normal breathing within two to three minutes in a person whose breath has slowed, or even stopped, as a result of opioid overdose. Naloxone is safe and easy to use, works almost immediately, and is not addictive. It has very few negative effects, but may cause opioid withdrawal symptoms like agitation, nausea, vomiting, tearing and a runny nose. There are no effects if opioids are not in a person's system, and no potential for abuse. Naloxone requires a prescription but is not a controlled substance. There are two U.S. Food and Drug Administration (FDA) approved forms of naloxone that can be used without medical training or authorization: injectable and prefilled nasal spray (commonly referred to by brand name Narcan). In order to increase the availability and use of naloxone in the state, the California Department of Public Health (CDPH) issued a statewide Naloxone Standing Order in 2017 (per California Civil Code Section 1714.22). The standing order permits community organizations to dispense naloxone to a person at risk or in a position to assist a person at risk without a prescription. Staff of community organizations and other entities distributing naloxone under the statewide standing order are required to receive opioid overdose prevention and treatment training, and are also required to train individuals who receive naloxone from them. Individuals administering naloxone in good faith in an emergency situation are protected from liability by California's Good Samaritan law. This law states in part, "no person who in good faith, and not for compensation, renders emergency medical or nonmedical care or assistance at the scene of an emergency shall be liable for civil damages resulting from any act or omission other than an act or omission constituting gross negligence or willful or wanton misconduct." The DHCS created the Naloxone Distribution Project (NDP) to provide free naloxone to organizations throughout California. NDP applicants must submit a prescription or standing order for naloxone, and must provide a brief plan on how the naloxone will be distributed. The NBPD receives free Narcan kits through the NDP, and maintains an inventory of approximately 240 kits. The kits are mostly distributed to uniformed field personnel, and additional kits are obtained through the NDP based on usage and expiration dates (the FDA recently extended the shelf life of Narcan from two to three years). If a sufficient amount of naloxone is not available through the NDP, Narcan kits can be purchased directly from the manufacturer for $47.50 per unit. The City will now be able to assist with increasing the availability and accessibility of naloxone in the Newport Beach community. Funds from the settlement agreement will be used to purchase any amount of naloxone greater than that which can be obtained through the NDP. Naloxone will first be made available to all City employees who have contact with members of the public. NBPD or Newport Beach Fire Department (NBFD) personnel will provide training on its use. The naloxone will be distributed during the training and records will be kept of its distribution. 18-3 Acceptance of Opioid Settlement Funds for Community Outreach and Education and Distribution of Naloxone June 27, 2023 Page 4 The City will further distribute naloxone kits directly in the community by providing them to staff members at bars, restaurants, hotels, gas stations, and any other common places someone might suffer an opioid overdose. The mass distribution of naloxone and the training of community members on how to correctly use it will be a large undertaking and will be handled by NBPD and NBFD personnel. The Newport -Mesa Unified School District (NMUSD) also maintains a supply of naloxone to utilize at each campus location. The City will look to partner with the NMUSD to increase the availability of naloxone in the local schools. Additionally, education will be provided to students on the dangers of opioids. Media and Advertisinq Campaign A media and advertising campaign to increase awareness of the dangers of opioid misuse and to educate the public about the availability and use of naloxone will satisfy requirements of Section 1 and Section 2 of the DHCS guidelines. The media campaign will include a video production in the form of a public awareness video, social media posts, and printed media like information fliers, door hangers, etc. The public awareness video will be an educational video, between two and three minutes long, focused on raising awareness of the opioid epidemic and providing useful information about available resources (including how to obtain free naloxone kits). The printed fliers and handouts will be designed to raise awareness of the opioid epidemic and to provide useful information about available resources (including how to obtain free naloxone kits). Instruction cards about the correct use of the naloxone kits can also be produced. Digital versions of these cards can be made available on the City website. To educate and engage City employees and community members in this undertaking, staff will draft a news release on the kick-off of the campaign. FISCAL IMPACT: The Budget Amendment records and appropriates $395,765.84 in additional revenue from the Opioid Settlement Agreements and increases expenditures by the same amount. The revenue will be posted to the Opioid Remediation Fund 2022-23 Account #1692041-431457-G2310 and the expenditure appropriations will be posted to the various expenditure accounts within the Opioid Fund, according to the following breakdown: Account Category Amount 1692041-841077-G2310 Disposable Medical Supplies $361,505.64 1692041-871002-G2310 Advertising & Public Relations $34,260.20 Total $395,765.84 18-4 Acceptance of Opioid Settlement Funds for Community Outreach and Education and Distribution of Naloxone June 27, 2023 Page 5 ENVIRONMENTAL REVIEW: Staff recommends the City Council find this action is not subject to the California Environmental Quality Act (CEQA) pursuant to Sections 15060(c)(2) (the activity will not result in a direct or reasonably foreseeable indirect physical change in the environment) and 15060(c)(3) (the activity is not a project as defined in Section 15378) of the CEQA Guidelines, California Code of Regulations, Title 14, Chapter 3, because it has no potential for resulting in physical change to the environment, directly or indirectly. NOTICING: The agenda item has been noticed according to the Brown Act (72 hours in advance of the meeting at which the City Council considers the item). ATTACHMENTS: Attachment A — Budget Amendment No. 23-071 Attachment B — Settlement Funds Allowable Expenditures 18-5 PoR @ ATTACHMENT A City of Newport Beach u, r BUDGET AMENDMENT cq<Foa�P 2022-23 BA#: 23-071 Department: Police ONETIME: ❑. Yes ❑ No Requestor: Eric Little Approvals ❑ CITY MANAGER'S APPROVAL ONLY Finance Director: NO 046W Date s/w-z5 0 COUNCIL APPROVAL REQUIRED City Clerk: Date EXPLANATION FOR REQUEST: Increase revenues and expenses related to a settlement received for opioid remediation. ❑ from existing budget appropriations ❑� from additional estimated revenues ❑ from unappropriated fund balance REVENUES Fund # Org Object Project Description Increase or (Decrease) $ 169 1692041 431457 G2310 OPIOID OUTREACH SERVICES - OTHER INTERGOVERNMENTA 395,765.84 -----.----_._._.---- Subtotal $ 395,765.84 EXPENDITURES Fund # Org Object Project Description Increase or (Decrease) $ 169 1692041 841077 G2310 OPIOID OUTREACH SERVICES - DISPOSABLE MEDICAL SUPPLI 361,505.64 169 1692041 871002 G2310 OPIOID OUTREACH SERVICES - ADVERT & PUB RELATIONS 34,260.20 Subtotal $ 395,765.84 FUND BALANCE Fund # Object Description Increase or (Decrease) $ 169 300000 OPIOID REMEDIATION FUND - FUND BALANCE CONTROL Subtotal $ No Change In Fund Balance 18-6 ATTACHMENT B CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES Janssen & Distributors Settlement Funds Allowable Expenditures On July 21, 2021, California Attorney General Rob Bonta announced the final settlement agreements with prescription opioid manufacturer Janssen Pharmaceuticals and pharmaceutical distributors McKesson, Cardinal Health, and AmerisourceBergen (the Janssen and Distributors, or J&D Settlement) that will provide substantial funds for the abatement of the opioid epidemic in California. This document is intended to provide guidance for California's cities and counties (Participating Subdivisions, listed in Appendix 1 of the California Janssen and Distributors Agreements) that receive funds from the J&D settlements. Allowable expenditures must include activities tied to the ending, reduction or lessening the effects of the opioid epidemic in communities and include prevention, intervention, harm reduction, treatment and recovery services. After reviewing the list, if you have questions about the applicability of your strategy to expend these funds, send questions to DHCS at OSF(a_dhcs.ca.gov. The following information is intended to provide Participating Subdivisions with a list of allowable expenditures for the J&D settlement funds and includes two sections: • Section 1: High Impact Abatement Areas (HIAA) • Section 2: List of Opioid Remediation Uses — Core Strategies and Approved Uses Section 1: High Impact Abatement Areas (HIAA) No less than fifty percent (50%) of the funds received by a California Participating Subdivision from the Abatement Accounts Fund in each calendar year, will be used for one or more of the High Impact Abatement Activities shown in Table 1. 1 18-7 Table 1: High Impact Abatement Activities (HIAA) Provision of matching funds or operating costs for substance use disorder 1 facilities with an approved project within the Behavioral Health Continuum Infrastructure Program (BHCIP) 2 Creating new or expanded substance use disorder (SUD) treatment infrastructure' Addressing the needs of communities of color and vulnerable populations 3 (including sheltered and unsheltered homeless populations) that are disproportionately impacted by SUD Diversion of people with SUD from the justice system into treatment, including 4 by providing training and resources to first and early responders (sworn and non -sworn) and implementing best practices for outreach, diversion and deflection, employability, restorative justice, and harm reduction 5 Interventions to prevent drug addiction in vulnerable youth Section 2: List of Opioid Remediation Uses — Core Strategies and Approved Uses Participating Subdivisions shall choose from among the abatement strategies listed in Schedule B of Exhibit E from the J&D Settlement Agreement and listed below in Approved Uses (Schedule B). However, priority should be given to the following core abatement strategies ("Core Strategies" Schedule A). Core Strategies (Schedule A) A. Naloxone or Other FDA -Approved Drug to Reverse Opioid Overdoses • Expand training for first responders, schools, community support groups and families • Increase distribution to individuals who are uninsured or whose insurance does not cover the needed service B. Medication -Assisted Treatment (MAT) Distribution and Other Opioid- Related Treatment • Increase distribution of MAT to individuals who are uninsured or whose insurance does not cover the needed service • Provide education to school -based and youth -focused programs that discourage or prevent misuse • Provide MAT education and awareness training to healthcare providers, EMTs, law enforcement, and other first responders • Provide treatment and recovery support services such as residential and inpatient treatment, intensive outpatient treatment, outpatient therapy or 1 May include cost overrun for BHCIP programs as needed. counseling, and recovery housing that allow or integrate medication and with other support services C. Pregnant and Postpartum Women • Expand Screening, Brief Intervention, and Referral to Treatment (SBIRT) services to non-Medi-Cal eligible or uninsured pregnant women • Expand comprehensive evidence -based treatment and recovery services, including MAT, for women with co-occurring Opioid Use Disorder (OUD) and other SUD/Mental Health disorders for uninsured individuals for up to 12 months postpartum • Provide comprehensive wrap -around services to individuals with OUD, including housing, transportation, job placement/training, and childcare D. Expanding Treatment for Neonatal Abstinence Syndrome (NAS) • Expand comprehensive evidence -based and recovery support for NAS babies • Expand services for better continuum of care with infant -need dyad • Expand long-term treatment and services for medical monitoring of NAS babies and their families E. Expansion Of Warm Hand -Off Programs and Recovery Services • Expand services such as navigators and on -call teams to begin MAT in hospital emergency departments • Expand warm hand-off services to transition to recovery services • Broaden scope of recovery services to include co-occurring SUD or mental health conditions • Provide comprehensive wrap -around services to individuals in recovery, including housing, transportation, job placement/training, and childcare • Hire additional social workers or other behavioral health workers to facilitate expansions above F. Treatment for Incarcerated Population • Provide evidence -based treatment and recovery support, including MAT for persons with OUD and co-occurring SUD/MH disorders within and transitioning out of the criminal justice system • Increase funding for jails to provide treatment to inmates with OUD G. Prevention Programs • Funding for media campaigns to prevent opioid use (similar to the FDA's "Real Cost" campaign to prevent youth from misusing tobacco) • Funding for evidence -based prevention programs in schools 3 I • Funding for medical provider education and outreach regarding best prescribing practices for opioids consistent with the 2016 CDC guidelines, including providers at hospitals (academic detailing) • Funding for community drug disposal programs • Funding and training for first responders to participate in pre -arrest diversion programs, post -overdose response teams, or similar strategies that connect at -risk individuals to behavioral health services and supports H. Expanding Syringe Service Programs • Provide comprehensive syringe services programs with more wrap -around services, including linkage to OUD treatment, access to sterile syringes and linkage to care and treatment of infectious diseases I. Evidence -Based Data Collection and Research Analyzing the Effectiveness of the Abatement Strategies Within the State Approved Uses (Schedule B) Participating Subdivisions shall choose from among the abatement strategies listed below which are from the Approved Uses (Schedule B) list in Exhibit E. Part I: Treatment A. TREAT OPIOID USE DISORDER (OUD) Support treatment of OUD and any co-occurring Substance Use Disorder or Mental Health (SUD/MH) conditions through evidence -based or evidence - informed programs or strategies that may include, but are not limited to, those that: • Expand availability of treatment for OUD and any co-occurring SUD/MH conditions, including all forms of MAT approved by the U.S. Food and Drug Administration. • Support and reimburse evidence -based services that adhere to the American Society of Addiction Medicine (ASAM) continuum of care for OUD and any co-occurring SUD/MH conditions. • Expand telehealth to increase access to treatment for OUD and any co- occurring SUD/MH conditions, including MAT, as well as counseling, psychiatric support, and other treatment and recovery support services. • Improve oversight of Opioid Treatment Programs (OTPs) to assure evidence- based or evidence -informed practices such as adequate methadone dosing and low threshold approaches to treatment. • Support mobile intervention, treatment, and recovery services, offered by qualified professionals and service providers, such as peer recovery C! 18-10 coaches, for persons with OUD and any co-occurring SUD/MH conditions and for persons who have experienced an opioid overdose. • Provide treatment of trauma for individuals with OUD (e.g., violence, sexual assault, human trafficking, or adverse childhood experiences) and family members (e.g., surviving family members after an overdose or overdose fatality), and training of health care personnel to identify and address such trauma. • Support evidence -based withdrawal management services for people with OUD and any co-occurring mental health conditions. • Provide training on MAT for health care providers, first responders, students, or other supporting professionals, such as peer recovery coaches or recovery outreach specialists, including tele-mentoring to assist community -based providers in rural or underserved areas. • Support workforce development for addiction professionals who work with persons with OUD and any co-occurring SUD/MH conditions. • Offer fellowships for addiction medicine specialists for direct patient care, instructors, and clinical research for treatments. • Offer scholarships and supports for behavioral health practitioners or workers involved in addressing OUD and any co-occurring SUD/MH or mental health conditions, including, but not limited to, training, scholarships, fellowships, loan repayment programs, or other incentives for providers to work in rural or underserved areas. • Provide funding and training for clinicians to obtain a waiver under the federal Drug Addiction Treatment Act of 2000 (DATA 2000) to prescribe MAT for OUD, and provide technical assistance and professional support to clinicians who have obtained a DATA 2000 waiver. • Disseminate of web -based training curricula, such as the American Academy of Addiction Psychiatry's Provider Clinical Support Service— Opioids web -based training curriculum and motivational interviewing. • Develop and disseminate new curricula, such as the American Academy of Addiction Psychiatry's Provider Clinical Support Service for Medication— Assisted Treatment. B. SUPPORT PEOPLE IN TREATMENT AND RECOVERY Support people in recovery from OUD and any co-occurring SUD/MH conditions through evidence -based or evidence -informed programs or strategies that may include, but are not limited to, the programs or strategies that: • Provide comprehensive wrap -around services to individuals with OUD and any co-occurring SUD/MH conditions, including housing, transportation, education, job placement, job training, or childcare. • Provide the full continuum of care of treatment and recovery services for OUD and any co-occurring SUD/MH conditions, including supportive housing, peer support services and counseling, community navigators, 5 18-11 case management, and connections to community -based services. • Provide counseling, peer -support, recovery case management and residential treatment with access to medications for those who need it to persons with OUD and any co-occurring SUD/MH conditions. • Provide access to housing for people with OUD and any co-occurring SUD/MH conditions, including supportive housing, recovery housing, housing assistance programs, training for housing providers, or recovery housing programs that allow or integrate FDA -approved mediation with other support services. • Provide community support services, including social and legal services, to assist in deinstitutionalizing persons with OUD and any co-occurring SUD/MH conditions. • Support or expand peer -recovery centers, which may include support groups, social events, computer access, or other services for persons with OUD and any co-occurring SUD/MH conditions. • Provide or support transportation to treatment or recovery programs or services for persons with OUD and any co-occurring SUD/MH conditions. • Provide employment training or educational services for persons in treatment for or recovery from OUD and any co-occurring SUD/MH conditions. • Identify successful recovery programs such as physician, pilot, and college recovery programs, and provide support and technical assistance to increase the number and capacity of high -quality programs to help those in recovery. • Engage non -profits, faith -based communities, and community coalitions to support people in treatment and recovery and to support family members in their efforts to support the person with OUD in the family. • Provide training and development of procedures for government staff to appropriately interact and provide social and other services to individuals with or in recovery from OUD, including reducing stigma. • Support stigma reduction efforts regarding treatment and support for persons with OUD, including reducing the stigma on effective treatment. • Create or support culturally appropriate services and programs for persons with OUD and any co-occurring SUD/MH conditions, including new Americans. • Create and/or support recovery high schools. • Hire or train behavioral health workers to provide or expand any of the services or supports listed above. C. CONNECT PEOPLE WHO NEED HELP TO THE HELP THEY NEED (CONNECTIONS TO CARE) Provide connections to care for people who have —or are at risk of developing—OUD and any co-occurring SUD/MH conditions through evidence - based or evidence -informed programs or strategies that may include, but are not limited to, those that: FT 18-12 • Ensure that health care providers are screening for OUD and other risk factors and know how to appropriately counsel and treat (or refer if necessary) a patient for OUD treatment. • Fund SBIRT programs to reduce the transition from use to disorders, including SBIRT services to pregnant women who are uninsured or not eligible for Medicaid. • Provide training and long-term implementation of SBIRT in key systems (health, schools, colleges, criminal justice, and probation), with a focus on youth and young adults when transition from misuse to opioid disorder is common. • Purchase automated versions of SBIRT and support ongoing costs of the technology. • Expand services such as navigators and on -call teams to begin MAT in hospital emergency departments. • Provide training for emergency room personnel treating opioid overdose patients on post -discharge planning, including community referrals for MAT, recovery case management or support services. • Support hospital programs that transition persons with OUD and any co- occurring SUD/MH conditions, or persons who have experienced an opioid overdose, into clinically appropriate follow-up care through a bridge clinic or similar approach. • Support crisis stabilization centers that serve as an alternative to hospital emergency departments for persons with OUD and any co- occurring SUD/MH conditions or persons that have experienced an opioid overdose. • Support the work of Emergency Medical Systems, including peer support specialists, to connect individuals to treatment or other appropriate services following an opioid overdose or other opioid- related adverse event. • Provide funding for peer support specialists or recovery coaches in emergency departments, detox facilities, recovery centers, recovery housing, or similar settings; offer services, supports, or connections to care to persons with OUD and any co-occurring SUD/MH conditions or to persons who have experienced an opioid overdose. • Expand warm hand-off services to transition to recovery services. • Create or support school -based contacts that parents can engage with to seek immediate treatment services for their child; and support prevention, intervention, treatment, and recovery programs focused on young people. • Develop and support best practices on addressing OUD in the workplace • Support assistance programs for health care providers with OUD. • Engage non -profits and the faith community as a system to support outreach for treatment. • Support centralized call centers that provide information and connections to appropriate services and supports for persons with F 18-13 OUD and any co-occurring SUD/MH conditions. D. ADDRESS THE NEEDS OF CRIMINAL JUSTICE -INVOLVED PERSONS Address the needs of persons with OUD and any co-occurring SUD/MH conditions who are involved in, are at risk of becoming involved in, or are transitioning out of the criminal justice system through evidence -based or evidence -informed programs or strategies that may include, but are not limited to, those that: • Support pre -arrest or pre -arraignment diversion and deflection strategies for persons with OUD and any co-occurring SUD/MH conditions, including established strategies such as: i. Self -referral strategies such as the Angel Programs or the Police Assisted Addiction Recovery Initiative (PAARI); ii. Active outreach strategies such as the Drug Abuse Response Team (DART) model; iii. "Naloxone Plus" strategies, which work to ensure that individuals who have received naloxone to reverse the effects of an overdose are then linked to treatment programs or other appropriate services; iv. Officer prevention strategies, such as the Law Enforcement Assisted Diversion (LEAD) model; v. Officer intervention strategies such as the Leon County, Florida Adult Civil Citation Network or the Chicago Westside Narcotics Diversion to Treatment Initiative; or vi. Co -responder and/or alternative responder models to address OUD-related 911 calls with greater SUD expertise. • Support pre-trial services that connect individuals with OUD and any co- occurring SUD/MH conditions to evidence -informed treatment, including MAT, and related services. • Support treatment and recovery courts that provide evidence -based options for persons with OUD and any co-occurring SUD/MH conditions. • Provide evidence -informed treatment, including MAT, recovery support, harm reduction, or other appropriate services to individuals with OUD and any co- occurring SUD/MH conditions who are incarcerated in jail or prison. • Provide evidence -informed treatment, including MAT, recovery support, harm reduction, or other appropriate services to individuals with OUD and any co- occurring SUD/MH conditions who are leaving jail or prison or have recently left jail or prison, are on probation or parole, are under community corrections supervision, or are in re-entry programs or facilities. • Support critical time interventions (CTI), particularly for individuals living with dual -diagnosis OUD/serious mental illness, and services for individuals who face immediate risks and service needs and risks upon 0 18-14 release from correctional settings. • Provide training on best practices for addressing the needs of criminal justice- involved persons with OUD and any co-occurring SUD/MH conditions to law enforcement, correctional, or judicial personnel or to providers of treatment, recovery, harm reduction, case management, or other services offered in connection with any of the strategies described in this section. E. ADDRESS THE NEEDS OF PREGNANT OR PARENTING WOMEN AND THEIR FAMILIES, INCLUDING BABIES WITH NEONATAL ABSTINENCE SYNDROME Address the needs of pregnant or parenting women with OUD and any co- occurring SUD/MH conditions, and the needs of their families, including babies with NAS, through evidence -based or evidence -informed programs or strategies that may include, but are not limited to, those that: • Support evidence -based or evidence -informed treatment, including MAT, recovery services and supports, and prevention services for pregnant women —or women who could become pregnant —who have OUD and any co-occurring SUD/MH conditions, and other measures to educate and provide support to families affected by Neonatal Abstinence Syndrome. • Expand comprehensive evidence -based treatment and recovery services, including MAT, for uninsured women with OUD and any co-occurring SUD/MH conditions for up to 12 months postpartum. • Provide training for obstetricians or other healthcare personnel who work with pregnant women and their families regarding treatment of OUD and any co- occurring SUD/MH conditions. • Expand comprehensive evidence -based treatment and recovery support for NAS babies; expand services for better continuum of care with infant - need dyad; and expand long-term treatment and services for medical monitoring of NAS babies and their families. • Provide training to health care providers who work with pregnant or parenting women on best practices for compliance with federal requirements that children born with NAS get referred to appropriate services and receive a plan of safe care. • Provide child and family supports for parenting women with OUD and any co- occurring SUD/MH conditions. • Provide enhanced family support and child care services for parents with OUD and any co-occurring SUD/MH conditions. • Provide enhanced support for children and family members suffering trauma as a result of addiction in the family; and offer trauma -informed behavioral health treatment for adverse childhood events. • Offer home -based wrap -around services to persons with OUD and any co- occurring SUD/MH conditions, including, but not limited to, parent skills training. pf 18-15 • Provide support for Children's Services —Fund additional positions and services, including supportive housing and other residential services, relating to children being removed from the home and/or placed in foster care due to custodial opioid use. Part II: Prevention F. PREVENT OVER -PRESCRIBING AND ENSURE APPROPRIATE PRESCRIBING AND DISPENSING OF OPIOIDS Support efforts to prevent over -prescribing and ensure appropriate prescribing and dispensing of opioids through evidence -based or evidence -informed programs or strategies that may include, but are not limited to, the following: • Funding medical provider education and outreach regarding best prescribing practices for opioids consistent with the Guidelines for Prescribing Opioids for Chronic Pain from the U.S. Centers for Disease Control and Prevention, including providers at hospitals (academic detailing). • Training for health care providers regarding safe and responsible opioid prescribing, dosing, and tapering patients off opioids. • Continuing Medical Education (CME) on appropriate prescribing of opioids. • Providing Support for non-opioid pain treatment alternatives, including training providers to offer or refer to multi -modal, evidence -informed treatment of pain. • Supporting enhancements or improvements to Prescription Drug Monitoring Programs (PDMPs), including, but not limited to, improvements that: i. Increase the number of prescribers using PDMPs; ii. Improve point -of -care decision -making by increasing the quantity, quality, or format of data available to prescribers using PDMPs, by improving the interface that prescribers use to access PDMP data, or both; or iii. Enable states to use PDMP data in support of surveillance or intervention strategies, including MAT referrals and follow-up for individuals identified within PDMP data as likely to experience OUD in a manner that complies with all relevant privacy and security laws and rules. • Ensuring PDMPs incorporate available overdose/naloxone deployment data, including the United States Department of Transportation's Emergency Medical Technician overdose database in a manner that complies with all relevant privacy and security laws and rules. 10 18-16 • Increasing electronic prescribing to prevent diversion or forgery. • Educating dispensers on appropriate opioid dispensing. G. PREVENT MISUSE OF OPIOIDS Support efforts to discourage or prevent misuse of opioids through evidence - based or evidence -informed programs or strategies that may include, but are not limited to, the following: • Funding media campaigns to prevent opioid misuse. • Corrective advertising or affirmative public education campaigns based on evidence. • Public education relating to drug disposal. • Drug take -back disposal or destruction programs. • Funding community anti -drug coalitions that engage in drug prevention efforts. • Supporting community coalitions in implementing evidence -informed prevention, such as reduced social access and physical access, stigma reduction —including staffing, educational campaigns, support for people in treatment or recovery, or training of coalitions in evidence -informed implementation, including the Strategic Prevention Framework developed by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). • Engaging non -profits and faith -based communities as systems to support prevention. • Funding evidence -based prevention programs in schools or evidence - informed school and community education programs and campaigns for students, families, school employees, school athletic programs, parent - teacher and student associations, and others. • School -based or youth -focused programs or strategies that have demonstrated effectiveness in preventing drug misuse and seem likely to be effective in preventing the uptake and use of opioids. • Create or support community -based education or intervention services for families, youth, and adolescents at risk for OUD and any co- occurring SUD/MH conditions. • Support evidence -informed programs or curricula to address mental health needs of young people who may be at risk of misusing opioids or other drugs, including emotional modulation and resilience skills. • Support greater access to mental health services and supports for young people, including services and supports provided by school nurses, behavioral health workers or other school staff, to address mental health needs in young people that (when not properly addressed) increase the risk of opioid or another drug misuse. H. PREVENT OVERDOSE DEATHS AND OTHER HARMS (HARM REDUCTION) Support efforts to prevent or reduce overdose deaths or other opioid-related harms through evidence -based or evidence -informed programs or strategies 11 18-17 that may include, but are not limited to, the following: • Increased availability and distribution of naloxone and other drugs that treat overdoses for first responders, overdose patients, individuals with OUD and their friends and family members, schools, community navigators and outreach workers, persons being released from jail or prison, or other members of the general public. • Public health entities providing free naloxone to anyone in the community. • Training and education regarding naloxone and other drugs that treat overdoses for first responders, overdose patients, patients taking opioids, families, schools, community support groups, and other members of the general public. • Enabling school nurses and other school staff to respond to opioid overdoses, and provide them with naloxone, training, and support. • Expanding, improving, or developing data tracking software and applications for overdoses/naloxone revivals. • Public education relating to emergency responses to overdoses. • Public education relating to immunity and Good Samaritan laws. • Educating first responders regarding the existence and operation of immunity and Good Samaritan laws. • Syringe service programs and other evidence -informed programs to reduce harms associated with intravenous drug use, including supplies, staffing, space, peer support services, referrals to treatment, fentanyl checking, connections to care, and the full range of harm reduction and treatment services provided by these programs. • Expanding access to testing and treatment for infectious diseases such as HIV and Hepatitis C resulting from intravenous opioid use. • Supporting mobile units that offer or provide referrals to harm reduction services, treatment, recovery supports, health care, or other appropriate services to persons that use opioids or persons with OUD and any co- occurring SUD/MH conditions. • Providing training in harm reduction strategies to health care providers, students, peer recovery coaches, recovery outreach specialists, or other professionals that provide care to persons who use opioids or persons with OUD and any co- occurring SUD/MH conditions. • Supporting screening for fentanyl in routine clinical toxicology testing. Part III: Other Strategies I. FIRST RESPONDERS In addition to items in section C, D and H relating to first responders, support the following: • Education of law enforcement or other first responders regarding appropriate practices and precautions when dealing with fentanyl or 12 18-18 other drugs. • Provision of wellness and support services for first responders and others who experience secondary trauma associated with opioid- related emergency events. J. LEADERSHIP, PLANNING AND COORDINATION Support efforts to provide leadership, planning, coordination, facilitations, training and technical assistance to abate the opioid epidemic through activities, programs, or strategies that may include, but are not limited to, the following: • Statewide, regional, local or community regional planning to identify root causes of addiction and overdose, goals for reducing harms related to the opioid epidemic, and areas and populations with the greatest needs for treatment intervention services, and to support training and technical assistance and other strategies to abate the opioid epidemic described in this opioid abatement strategy list. • A dashboard to (a) share reports, recommendations, or plans to spend opioid settlement funds; (b) to show how opioid settlement funds have been spent; (c) to report program or strategy outcomes; or (d) to track, share or visualize key opioid- or health -related indicators and supports as identified through collaborative statewide, regional, local or community processes. • Invest in infrastructure or staffing at government or not -for -profit agencies to support collaborative, cross -system coordination with the purpose of preventing overprescribing, opioid misuse, or opioid overdoses, treating those with OUD and any co-occurring SUD/MH conditions, supporting them in treatment or recovery, connecting them to care, or implementing other strategies to abate the opioid epidemic described in this opioid abatement strategy list. • Provide resources to staff government oversight and management of opioid abatement programs. K. TRAINING In addition to the training referred to throughout this document, support training to abate the opioid epidemic through activities, programs, or strategies that may include, but are not limited to, those that: • Provide funding for staff training or networking programs and services to improve the capability of government, community, and not -for -profit entities to abate the opioid crisis. • Support infrastructure and staffing for collaborative cross -system coordination to prevent opioid misuse, prevent overdoses, and treat those with OUD and any co- occurring SUD/MH conditions, or implement other strategies to abate the opioid epidemic described in this opioid abatement strategy list (e.g., health care, primary care, 13 18-19 pharmacies, PDMPs, etc.). L. RESEARCH Support opioid abatement research that may include, but is not limited to, the following: • Monitoring, surveillance, data collection and evaluation of programs and strategies described in this opioid abatement strategy list. • Research non-opioid treatment of chronic pain. • Research on improved service delivery for modalities such as SBIRT that demonstrate promising but mixed results in populations vulnerable to opioid use disorders. • Research on novel harm reduction and prevention efforts such as the provision of fentanyl test strips. • Research on innovative supply-side enforcement efforts such as improved detection of mail -based delivery of synthetic opioids. • Expanded research on swift/certain/fair models to reduce and deter opioid misuse within criminal justice populations that build upon promising approaches used to address other substances (e.g., Hawaii HOPE and Dakota 24/7). • Epidemiological surveillance of OUD-related behaviors in critical populations, including individuals entering the criminal justice system, including, but not limited to approaches modeled on the Arrestee Drug Abuse Monitoring (ADAM) system. • Qualitative and quantitative research regarding public health risks and harm reduction opportunities within illicit drug markets, including surveys of market participants who sell or distribute illicit opioids. • Geospatial analysis of access barriers to MAT and their association with treatment engagement and treatment outcomes. 14 18-20