HomeMy WebLinkAboutAgenda - 04-18-2023; 6-c - Opioid Advisory Committee Settlement Use Recommendations and Approval of Budget Amendment #8-A 1
ORD-2023-018
ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: April 18, 2023
Action Agenda
Item No. 6-c
SUBJECT: Opioid Advisory Committee Settlement Use Recommendations and Approval of
Budget Amendment #8-A
DEPARTMENT: County Commissioners
ATTACHMENT(S): INFORMATION CONTACT:
Quintana Stewart, Orange County
Project Lantern Proposal Health Director, 919-245-2412
Freedom House Proposal
NC FIT Program Proposal
MOA Spending Authorization Resolution
Year-to-Date Budget Summary
PURPOSE: To:
1) receive an update on the Opioid Advisory Committee and the Committee's
recommendations regarding the use of Opioid Settlement Funds that support Option A of
the Memorandum of Agreement (MOA) on the Allocation and Use of Opioid Settlement
Funds in North Carolina;
2) approve the attached resolution regarding the expenditure of Opioid Settlement Funds;
and
3) approve Budget Amendment #8-A.
BACKGROUND: In July 2021, a bipartisan coalition of state attorneys general announced the
National Opioid Settlement — a historic $26 billion agreement that will help bring desperately
needed help to communities harmed by the opioid epidemic. The State of North Carolina and all
100 counties, including Orange County, joined the agreement. Orange County is expected to
receive $6,799,780 over an 18-year period.
In September 2022, the BOCC approved the appointment of the Orange County Opioid Advisory
Committee with the following charge:
• Discuss opioid-related health concerns and issues impacting the residents of Orange
County;
• Advise the Board of Commissioners on options to expend funds to prevent opioid abuse
and remedy opioid impacts;
• Plan and host an annual meeting open to the public to receive input on proposed uses of
the settlement funds and to encourage collaboration between local governments.
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The Board also voted in support of Option A for the use of the settlement funds per the NC
Memorandum of Agreement Opioid Settlement.
In January 2023, Orange County received an additional payment of $44,629 from the National
Opioid Abatement Trust II (NOAT II). NOAT II is separate and distinct from the National
Distributors/Janssen settlements.
The Opioid Advisory Committee met on March 21, 2023 and heard proposals from Community
Partners and County Staff who shared proposals/requests for consideration to use Opioid
Settlement Funds to continue program funding. These Partners included:
• The Lantern Project ($164,862)
• Freedom House ($122,188)
• NC FIT Program ($70,000)
All these efforts are currently funded via grants through June 30, 2023. Partners shared impact
data to show how these programs are helping community members experiencing substance use
disorder. The Committee unanimously voted to approve these funding requests for a two-year
period with a 5% increase in the second year to account for inflation and nominal salary increases.
In addition to funding for the aforementioned programs, the group requested $14,500 to order
additional narcan/naloxone and fentanyl strips for the community vending machines.
These four programs are authorized with the signing of the attached MOA Spending Authorization
Resolution, which also authorizes Budget Amendment #8-A for the County. This approves the
authorization of the new Opioid Settlement Fund, and creates the following grant ordinance for
the fund:
Opioid Settlement Fund($881,554) - Fund # 27
Revenues for this project:
Current FY 2022-23 FY 2022-23
FY 2022-23 Amendment Revised
Opioid Settlement Funds $0 $881,554 $881,554
Total Project Funding $0 $881,554 $881,554
Appropriated for this project:
Current FY 2022-23 FY 2022-23
FY 2022-23 Amendment Revised
Evidence-based Addiction Treatment (Lantern Project) $0 $164,862 $164,862
Recovery Support Services (Freedom House) $0 $122,188 $122,188
Reentry Program (NC FIT) $0 $70,000 $70,000
Naloxone Distribution $0 $14,500 $14,500
Unallocated $0 $510,004 $510,004
Total Costs $0 $881,554 $881,554
This also extends the two time limited reentry positions that manage the Lantern Project, and one
time limited community health aide that works in the NC FIT program through June 30, 2025.
FINANCIAL IMPACT: The budget amendment authorizes funding of the Opioid Settlement Fund
and increases the authorization to $881,554.
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SOCIAL JUSTICE IMPACT: The following Orange County Social Justice Goals are applicable
to this item:
• GOAL: CREATE A SAFE COMMUNITY
The reduction of risks from vehicle/traffic accidents, childhood and senior injuries, gang
activity, substance abuse and domestic violence.
• GOAL: ENSURE ECONOMIC SELF-SUFFICIENCY
The creation and preservation of infrastructure, policies, programs and funding necessary
for residents to provide shelter, food, clothing and medical care for themselves and their
dependents.
ENVIRONMENTAL IMPACT: There is no Orange County Environmental Responsibility Goal
impact associated with this update.
RECOMMENDATION(S): The Manager recommends the Board:
1) receive the information update;
2) approve and authorize the Chair to sign the resolution regarding the expenditure of Opioid
Settlement Funds; and
3) approve Budget Amendment #8-A.
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Proposal to Orange County Opioid Advisory Committee
The Lantern Project has been funded by the a grant titled "Opioids and COVID: Supporting Justice
Involved Individuals with SUD (Substance Use Disorder) during COVID"from the NC Department of
Health and Human Services, Division of Mental Health, Developmental Disabilities and Substance Abuse
Services since September of 2021.The Criminal Justice Resource Department's grant ends June 30,
2023.
The Lantern Project is a collaboration between the Criminal Justice Resource Department and
subcontractor Freedom House Recovery Center.The mission is to support justice-impacted individuals
with substance use disorder through evidence-based strategies, interventions and programming
designed to reduce their vulnerability to overdose, death, COVID-19 infection and recidivism. The
mission is to light the path to recovery through harm reduction, diversion, reentry support and
treatment.
CJRD staff includes Diversion Coordinator Megan Pickard and Reentry Coordinator Tauheedah White.
Freedom House staff includes clinician Ashley Machado and a peer support specialist.
Two tracks/strategies—SUD Treatment and Reentry support from Jail and Diversion from the criminal
legal system. Reentry clients are referred from jail and diversion clients are referred from law
enforcement, attorneys,judges, community members, and other CJRD programs.
CJRD does intake and case management and refers to Freedom House or other treatment services,
locally and across the state. Freedom House provides dedicated treatment services like CCAs, MAT
induction and continuation, MRT, peer support, individual and group therapy.The work is client-
centered and individualized for the participant's needs.
Lantern Project funding provides for critical participant needs such as basic supplies via gift cards, cell
phones, medications,transportation, mental health services, and referrals for social service providers to
assist with housing, employment and benefits.
Lantern Project provides harm reduction information and supplies including Naloxone kits,fentanyl test
strips, COVID tests, educational materials and resources. A critical component is the collection of data
and outcomes so that we are able to measure success, recidivism and equity.
Harm reduction "meets people where they are" and recognizes that not everyone is ready or able to
abstain from all substance use.The purpose of harm reduction is to decrease risk and provide non-
judgmental care to people who use substances.
Harm reduction is a key component in North Carolina's Opioid Action Plan and to the Lantern Project.
Some components of harm reduction include safe syringes, naloxone, fentanyl test strips,
compassionate care, and education about resources for treatment.
The Lantern Project Provides:
• Narcan to reverse the effects of opioid overdose
• Free Narcan vending machine at the Orange County Detention Center
• Naloxone kits to all program participants
• Fentanyl test strips to test all substances
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Outcome Measures
Activity Outcome Measure
Intake and screening,including CCA Make Increase in clients screened and referred to Number of referrals to Freedom House,and referrals to
referrals to treatment providers residential treatment/recovery other residential treatment
Provide harm reduction and COVID Increase awareness of COVID safety precautions Number of clients who have been given COVID and/or harm
education and harm reduction in this community reduction education
Increase number of naloxone kits in community of
Distributing naloxone kits need Number of naloxone kits distributed,
Advocate in court Reduce#of people with substance use issues
facing incarceration NumberStrategyA referrals by month
Increase in incarcerated clients connected to
Facilitating transition from incarceration to services while incarcerated and immediately upon Number grant services or referrals to services of any kind for
community release from incarceration Re-entry clients
Providing education on COVID risk
management/Providing education on harm Increase awareness of COVID safety precautions Number of clients who have been given COVID and/or harm
reduction and overdose prevention and harm reduction in this community reduction education
OUTCOMES:ONG TERM
ImproveReduce racial disparities in the criminal legal system
public health outcomes in Orange County
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Total Number of Lantern Clients
Percent
Quantity of total
Re-entry and Diversion Total 306 100.0%
Diversion 100 32.7%
Re-entry 206 67.3%
Start Date of 9/21 to 1/23
Total Naloxone kits distributed 450
Total Treatment Connections 604
Recovery Support connections 378
Total overdoses 25
Total overdoses reversed 25
Demographics of All Clients
(Diversion and Re-entry)
Percent of
Quantity total
AGE,under 18 0 0.0%
AGE,18-25 37 12.1%
AGE,26-35 93 30.4%
AGE,36-45 85 27 8%
AGE,46-55 60 19.6%
AGE,56-65 23 7.5%
AGE,66+ 8 2.6%
GENDER ID, Male 225 73.5%
GENDER ID, Female 76 24.8%
GENDER ID,Transgender 2 0.7%
GENDER ID, Non-Binary or other 3 1.0%
ETHNICITY,Non-Hispanic 281 91.8%
ETHNICITY, Hispanic 24 7.8%
RACE,Black 131 42.8%
RACE,White 140 45.8%
RACE,Asian 1 0.3%
RACE,Latino/a 13 4.2%
RACE,Native American 2 0.7%
RACE,Biracial or Multiracial 17 5.6%
RACE,Other 0 0.0%
RACE,Unknown 1 0.3%
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Diversion Cases(9/21 to 3/8/23)
Percent of
Quantity total
Active and Closed 100 100.0%
Active 48 48.0%
Closed 52 52.0%
Demographics of All Diversion Cases
(Active and Closed)
Percent
Quantity of total
AGE,under 18 0 0.0%
AGE,18-25 21 21.0%
AGE,26-35 23 23.0%
AGE,36-45 27 27.0%
AGE,46-55 19 19.0%
AGE,56-65 7 7.0%
AGE,66+ 3 3.0%
GENDER ID,Male 59 59.0%
GENDER ID,Female 39 39.0%
GENDER ID,Transgender 0 0.0%
GENDER ID, Non-Binary or other 2 2•0%
0.0%
ETHNICITY,Non-Hispanic 96 96.0%
ETHNICITY,Hispanic 4 4.0%
RACE,Black 43 43.0%
RACE,White 45 45.0%
RACE,Asian or Pacific Islander 0 0.0%
RACE,Latino/a 2 2.0%
RACE,Native American 0 0.0%
RACE,Biracial 0 0.0%
RACE,Other 0 0.0%
Number of Clinical Case Assessments completed by Freedom House Clinician — 200
Number of Clients Connected to Peer Support - 150
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Outcome of Diversion Closed Cases
Number of Percent of
Category individuals total closed
cases
Total Diversion Closed Cases 52 100.0%
Avoided incarceration sentence 5.8%
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Charges dismissed 16 30.8%
Charges reduced 8 15.4%
Other 7 13.5%
Pled as charged 2 3.8%
Successful deflection 3 5.8%
Unsuccessful engagement 13 25.0%
Demographic of Diversion Closed Cases
Percent
Quantity of total
7AGE,under 18 0 0.0%
AGE,18-25 13 25.0%
AGE,26-35 8 15.4%
AGE,36-45 16 30.8%
AGE,46-55 8 15.4%
AGE,56-65 5 9.6%
AGE,66+ 2 3.8%
GENDER ID,Male 36 69.2%
GENDER ID, Female 16 30.8%
GENDER ID,Transgender 0 0.0%
GENDER ID, Non-Binary or other 0 0.0%
ETHNICITY,Non-Hispanic 50 96.2%
ETHNICITY, Hispanic 2 3.8%
RACE,Black 20 38.5%
RACE,White 25 48.1%
RACE,Asian or Pacific Islander 0 0.0%
RACE,Latino/a 1 1.9%
RACE,Native American 0 0.0%
RACE,Biracial or Multiracial 6 11.5%
RACE,Other 0 0.0%
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FY 23-24 Budget Request
CJRD Full Time Position Costs:
Reentry Coordinator—Salary $48,410 Benefits $21,910
Diversion Coordinator—Salary $51,000 Benefits $22,432
Cell Phone Service - $600 (x2) - $1200
Participant Needs - $20,000 (Harm reduction materials, incentives for engagement, cell phones,
basic needs help, transportation, medication assistance
*No Start Up Costs Needed*
*County/CJRD In-Kind Support for office space, admin support and supervision*
Total CJRD Funding Request: $164,862.00
Option A of N.C. MOA - National Settlement Agreement
The Lantern Project addresses several of the high-impact opioid abatement strategies listed in
Option A:
• Evidence-based Addiction Treatment
• Recovery Support Services
• Naloxone Distribution
• Criminal Justice Diversion Programs
• Addiction Treatment for Incarcerated Individuals
• Reentry Programs
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Freedom House Recovery Center
The Freedom House team consists of a licensed clinician, a Certified Peer Support Specialist,
and a clinical supervisor to oversee the work. A Psychiatric Mental Health Practitioner is on
staff at Freedom House to assist with medication management and medication assisted
treatment. Freedom House connects with individuals screened in the Orange County Detention
Center who have a history of Opioid Use Disorder. The licensed clinician will conduct a
Comprehensive Clinical Assessment to ascertain the best treatment options for the individual
prior to or upon release from incarceration.
Freedom House will utilize a Peer Support Specialist post incarceration to assist individuals with
connecting to the recommended treatment. The Peer will work with the individual as long as
needed to connect them with treatment, community resources, court appearances and to
support the individual in recovery to curb recidivism. The clinician will reevaluation as needed
when and if life circumstances change prior to engaging in treatment.
FY 23-24 Freedom House Budget Request
Full Time Position Costs:
Licensed Clinician —Salary$46,500 Benefits $7,928
Peer Support Specialist—Salary $36,500 Benefits $6,226
Cell Phone Service - $1,000
Mileage for Staff(x2) - $11,880 (Reimbursed at the current IRS mileage rate of .65.5 cents per
mile. Staff travel to support individuals recently released from incarceration attempting to
engage in treatment and reestablish stable living/working opportunities)
Staff Training - $1,000
Indirect Costs - $11,154 --Indirect cost cover office supplies and space, clinical supervision,financial
oversight, assessment software licensing, insurance.
Total Freedom House Funding Request: $122,188.00
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Proposal to Orange County Opioid Settlement Committee
The NC FIT Program is a comprehensive reentry program that focuses on unmet health needs
for people released from incarceration. NC FIT provides connections to primary care, behavioral
health and substance use disorder treatment. All NC FIT Community Health Workers have
personal histories of incarceration. The NC FIT Program is based on the Transitions Clinic
Network Model which is an evidence-based program that complies with Strategy A in the
settlement MOU.
• FIT worked with the Sheriff and CJRD to establish the Detention Center's MAT program
• Focused on people impacted by the criminal legal system
• Addresses Racial Health Disparities
• Linkages to evidence-based treatment for opioid use disorder
• Established program since 2018, supported by the Orange County Health Department
• FIT Provided grant funding to start the program in Orange County and to hire both the
CHW positions through the Health Department.
• Collaborates with Sheriff's Office, Piedmont Health Services, CJRD Lantern Project, Local
Reentry Council, State Prison System, Parole and Probation, Public Defender's office,
Reentry House Plus, IFC, Wounded Healers, UNC Chapel Hill Dept of Family Medicine
• Currently provides care at PHS for over 60 clients
Request Funding for FIT Program Community Health Worker:
We request funding to continue a grant funded position for 1 FTE CHW that has been
hired by the OC Health Department.
CHW position will focus on assisting people being released from the Detention center
with a diagnosis of Opioid Use Disorder. This FIT CHW position will work closely with efforts
supported by the Lantern Project run through the CJRD.
The NC FIT Program will continue to provide regular support and technical assistance to
Orange County supporting the Orange County FIT Program, Jail-based MAT at the Detention
center, collaboration with the CJRD and linkages to Piedmont Health Services.
Budget:
Salary and Fringe $65,000
Travel, Training, Mileage, Supplies $5,000
Total: $70,000
Annual Reporting:
• Number of referrals for people with Opioid Use Disorder, from both the
Detention Center and the community.
• Number of people enrolled in FIT Program with OUD
• Number of referrals connected to treatment for OUD and Substance Use
Disorder
• Number of know Overdose Deaths in referrals that are connected to treatment
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RES-2023-029
A RESOLUTION BY THE COUNTY OF ORANGE, NORTH CAROLINA
TO DIRECT THE EXPENDITURE OF OPIOID SETTLEMENT FUNDS
WHEREAS Orange County,North Carolina has joined national settlement agreements
with companies engaged in the manufacturing, distribution, and dispensing of opioids, including
settlements with drug distributors Cardinal, McKesson, and AmerisourceBergen, and the drug
maker Johnson& Johnson and its subsidiary Janssen Pharmaceuticals;
WHEREAS the allocation,use, and reporting of funds stemming from these national
settlement agreements and certain bankruptcy resolutions ("Opioid Settlement Funds") are
governed by the Memorandum of Agreement Between the State of North Carolina and Local
Governments on Proceeds Relating to the Settlement of Opioid Litigation("MOA");
WHEREAS Orange County has received Opioid Settlement Funds pursuant to these
national settlement agreements and deposited the Opioid Settlement Funds in a separate special
revenue fund as required by section D of the MOA;
WHEREAS section E.6 of the MOA states:
E.6. Process for drawing from special revenue funds.
a. Budget item or resolution required. Opioid Settlement Funds can be used for a purpose
when the Governing Body includes in its budget or passes a separate resolution
authorizing the expenditure of a stated amount of Opioid Settlement Funds for that
purpose or those purposes during a specified period of time.
b. Budget item or resolution details. The budget or resolution should (i) indicate that it is an
authorization for expenditure of opioid settlement funds; (ii) state the specific strategy or
strategies the county or municipality intends to fund pursuant to Option A or Option B,
using the item letter and/or number in Exhibit A or Exhibit B to identify each funded
strategy, and(iii) state the amount dedicated to each strategy for a stated period of time.
NOW, THEREFORE BE IT RESOLVED, in alignment with the NC MOA, Orange County,
authorizes the expenditure of opioid settlement funds as follows:
1. First strategy authorized
a. Name of strategy: _Recovery Support Services
b. Strategy is included in Exhibit Exhibit A (Exhibit A, Exhibit B)
c. Item letter and/or number in Exhibit A or Exhibit B to the MOA: _Exhibit A
Strategy 3
d. Amounted authorized for this strategy: $ $164 862.00
e. Period of time during which expenditure may take place:
Start date July 1 2023 through End date_June 30, 2025
f. Description of the program, project, or activity:
The Lantern Project is a collaboration between the Criminal Justice Resource Department
and subcontractor Freedom House Recovery Center. The mission is to support justice-
impacted individuals with substance use disorder through evidence-based strategies,
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interventions and programming designed to reduce their vulnerability to overdose, death,
COVID-19 infection and recidivism. The mission is to light the path to recovery through
harm reduction, diversion, reentry support and treatment.
g. Provider: Criminal Justice Resource Department
2. Second strategy authorized
a. Name of strategy: _Evidence-based addiction treatment
b. Strategy is included in Exhibit Exhibit A (Exhibit A, Exhibit B)
c. Item letter and/or number in Exhibit A or Exhibit B to the MOA: Strategy 2
d. Amounted authorized for this strategy: $ 122 188.00
e. Period of time during which expenditure may take place:
Start date Jul 1 2023 through End date June 30, 2025
f. Description of the program, project, or activity:
Freedom House connects with individuals screened in the Orange County Detention
Center who have a history of Opioid Use Disorder. The licensed clinician will conduct a
Comprehensive Clinical Assessment to ascertain the best treatment options for the
individual prior to or upon release from incarceration.
Freedom House will utilize a Peer Support Specialist post incarceration to assist
individuals with connecting to the recommended treatment. The Peer will work with the
individual as long as needed to connect them with treatment, community resources, court
appearances and to support the individual in recovery to curb recidivism. The clinician
will reevaluation as needed when and if life circumstances change prior to engaging in
treatment.
g. Provider: Freedom House
3. Third authorized strategy
a. Name of strategy: _Reen Pro_ram
b. Strategy is included in Exhibit Exhibit A (Exhibit A, Exhibit B)
c. Item letter and/or number in Exhibit A or Exhibit B to the MOA: _Strategy 12
d. Amounted authorized for this strategy: $ 70 000
e. Period of time during which expenditure may take place:
Start date__July 1 2023 through End date June 30, 2025
f. Description of the program, project, or activity: _
The NC FIT Program is a comprehensive reentry program that focuses on unmet health
needs for people released from incarceration. NC FIT provides connections to primary
care, behavioral health and substance use disorder treatment. All NC FIT Community
Health Workers have personal histories of incarceration. The NC FIT Program is based
on the Transitions Clinic Network Model which is an evidence-based program that
complies with Strategy A in the settlement MOU.
We request funding to continue a grant funded position for 1 FTE CHW that has been
hired by the OC Health Department. CHW position will focus on assisting people being
released from the Detention center with a diagnosis of Opioid Use Disorder. This FIT
CHW position will work closely with efforts supported by the Lantern Project run
through the CJRD.
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The NC FIT Program will continue to provide regular support and technical assistance to
Orange County supporting the Orange County FIT Program, Jail-based MAT at the
Detention center, collaboration with the CJRD and linkages to Piedmont Health Services.
g. Provider: NC FIT
4. Fourth authorized strategy
a. Name of strategy: Naloxone Distribution
b. Strategy is included in Exhibit Exhibit A (Exhibit A, Exhibit B)
c. Item letter and/or number in Exhibit A or Exhibit B to the MOA: _Strategy 7
d. Amounted authorized for this strategy: $J14,500.00
e. Period of time during which expenditure may take place:
Start date Jul 1 2023 through End date_June 30, 2024
f. Description of the program, project, or activity:
Funds needed to purchase narcan and naloxone for County First Responders and to
keep community vending machines stocked.
g. Provider: JCRJD and EMS ]
The total dollar amount of Opioid Settlement Funds appropriated across the above named and
authorized strategies is $881,553.55.
Adopted this the 18th day of April, 2023.
Jamezetta Bedford, Chair
Orange County Board of Commissioners
ATTEST:
Laura Jensen, Clerk to the Board
COUNTY SEAL
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Year-To-Date Budget Summary
Fiscal Year 2022-23
Opioid
Fund Budget Summary Settlement
Funds
Original Budget Revenue $0
Interfund Transfer Revenue
Fund Balance Appropiation
Total Original Budget $0
Additional Revenue Received Through
Budget Amendment#8-a (April 18, 2023)
Grant Funds $881,554
Non Grant Funds
Additional Interfund Transfer Revenue
Additional Fund Balance Appropriation
Total Amended Budget $881,554
Dollar Change in 2022-23 Approved Budget $881,554
Change in 2022-23 Approved Budget 100.00%
Authorized Full Time Equivalent Positions
Original Approved Full Time Equivalent Positions (includes
Permanent and Time Limited)
Changes to Full Time Equivalent Positions 3.000
Amended Approved General Fund Full Time Equivalent
Positions 0.000
Total Approved Full-Time-Equivalent Positions for Fiscal
Year 2022-23 3.000