HomeMy WebLinkAboutAgenda - 06-06-2023; 8-g - Opioid Advisory Committee Settlement Use Recommendation, and Approval of Budget Amendment #10-B 1
ORD-2023-028
ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: June 6, 2023
Action Agenda
Item No. 8-g
SUBJECT: Opioid Advisory Committee Settlement Use Recommendation, and Approval of
Budget Amendment #10-B
DEPARTMENT: County Commissioners
ATTACHMENT(S): INFORMATION CONTACT:
Quintana Stewart, Orange County
1. UNC SHAC Proposal Health Director, 919-245-2412
2. MOA Spending Authorization
Resolution
PURPOSE: To:
1) receive a recommendation/request from the Opioid Advisory Committee for use of Opioid
Settlement Funds that supports 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 #10-B.
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.
The Board also voted on Option A for the use of the settlement funds per the NC Memorandum
of Agreement Opioid Settlement.
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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 May 8, 2023 and heard a proposal from UNC Student
Health Action Coalition (SHAC) Syringe Service Program. The Student Health Action Coalition
Syringe Service Program (SHAC SSP) is a volunteer-based organization that seeks to improve
health outcomes for people who use substances and increase community knowledge around drug
safety. SHAC provides direct resource distribution and community education. The parent
organization, SHAC, is a 501(c)(3) nonprofit that is managed through the UNC Health Foundation
and is part of the National Association of Free Clinics (NAFC) and the North Carolina Association
of Free and Charitable Clinics (NCAFCC).
After discussion with the Advisory Committee, SHAC is requesting $64,200 for one year with plans
to reevaluate the program and the proposed budget for a potential request in year 2.
FINANCIAL IMPACT: Distribution of opioid settlement funds may support programs and services
that serve persons with Opioid Use Disorder or any co-occurring Substance Use Disorder (SUD)
or mental health condition in Orange County. The MOA amount totals $64,200.
The amount in the MOA is recommended to be funded with $64,200 with unallocated funds in the
Opioid Settlement Fund previously created with Budget Amendment #8-A. Budget Amendment
#10-B amends the following grant ordinance:
Opioid Settlement Fund($64,200) - Fund#27
Revenues for this project:
Current FY 2022-23 FY 2022-23
FY 2022-23 Amendment Revised
Opioid Settlement Funds $881,554 $0 $881,554
Total Project Funding $881,554 $0 $881,554
Appropriated for this project:
Current FY 2022-23 FY 2022-23
FY 2022-23 Amendment Revised
Evidence-based Addiction Treatment (Lantern Project) $164,862 $0 $164,862
Recovery Support Services (Freedom House) $122,188 $0 $122,188
Reentry Program (NC FIT) $70,000 $0 $70,000
Naloxone Distribution $14,500 $0 $14,500
Student Health Action Coalition (SHAC) Syringe Service $0 $64,200 $64,200
Program
Unallocated $510,004 ($64,200) $445,804
Total Costs $881,554 $0 $881,554
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.
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• 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 recommendation/request from the Opioid Advisory Committee for use of Opioid
Settlement Funds that supports Option A of the Memorandum of Agreement (MOA) on the
Allocation and Use of Opioid Settlement Funds in North Carolina;
2) approve and authorize the Chair to sign the attached resolution regarding the expenditure
of Opioid Settlement Funds; and
3) approve Budget Amendment #10-B.
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Student Health Action Coalition Syringe Service Program
Proposal to Orange County Opioid Advisory Committee
Who We Are
The Student Health Action Coalition Syringe Service Program(SHAC SSP) is a volunteer-based
organization that seeks to improve health outcomes for people who use substances and increase
community knowledge around drug safety. We are founded on the principles of harm reduction,
which seek to center the humanity of people who use substances while working to decrease risky
behavior through delivery of non judgmental care. People who are involved with an SSP are
more likely to stop injecting and enter treatment for substance use disorders than those who are
not affiliated with an SSp.1-4 By providing safe and convenient needle disposal sites, SSPs also
protect the public, first responders, and police by reducing syringe litter.`I Through this
evidence-based approach we aim to "meet people where they are" and rebuild trust between
people with substance use disorders and the medical community.
Our parent organization, Student Health Action Coalition (SHAC), is a 501(c)(3) nonprofit that
is managed through the UNC Health Foundation and is part of the National Association of Free
Clinics (NAFC) and the North Carolina Association of Free and Charitable Clinics (NCAFCC).
SHAC has been in continuous operation since 1967, with the mission of providing
"comprehensive health care and social needs support, completely free of cost to patients."
SHAC SSP serves a diverse clientele and, aside from the Orange County Health Department, is
the only SSP based in—and focused solely on—Orange County. SHAC is supervised by Dr. Karen
Halpert, professor in the department of Family Medicine at UNC. SHAC SSP benefits from
additional clinical oversight and mentorship by Dr. Robyn Jordan, a board-certified psychiatrist
and professor at UNC specializing in addiction medicine. Dr. Jordan is also the medical director
of the UNC Addiction Medicine Program. SHAC SSP registered with the North Carolina
Department of Health and Human Services as an SSP in Spring of 2022
What We Do
Over the past six months we have greatly expanded our supplies offered, our base of volunteers,
and our community education activities. Over the past year, we have provided safer use supplies
to over 45 SSP clients, including more than 200 doses of naloxone and more than 1,000 sterile
syringes. Our leadership team has received training in order to lead educational activities related
to naloxone administration, harm reduction principles, North Carolina Good Samaritan laws, and
fentanyl awareness. Our team has trained more than 20 active volunteers, and we have worked
with community partners on UNC's campus and at the Inter-Faith Council (IFC) in Carrboro to
provide training for the public.
Our work involves both direct resource distribution and community education. We currently
provide direct care weekly out of the Inter-Faith Council (IFC, and we are seeking to expand
both the number of days and the locations at which we provide services to reach the greatest
number of people who could benefit from our services. In our direct work we provide:
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1. safer use supplies (syringes, sterile water), wound care supplies, and overdose avoidance
and reversal supplies (fentanyl and xylazine test strips, naloxone).
2. one-on-one teaching to our patients on best practices for naloxone administration and
safer substance use.
3. expedited referrals to care providers through UNC hospital systems (e.g. substance use
disorder treatment, family medicine) and UNC-affiliated free clinics (e.g. SHAC medical
clinic).
4. educational materials in English and Spanish on a variety of subjects, including: local
substance use treatment and recovery services, harm reduction principles, health care
resources, naloxone administration, and North Carolina Good Samaritan Laws.
In our work in community education we provide:
1. overdose reversal education, including information on identifying signs of overdose,
appropriate Narcan and naloxone administration, and NC Good Samaritan laws.
2. accurate education on current substance adulterants, such as fentanyl and xylazine, and
explanation of how to use test strips for these substances.
New Initiatives for FY 2023-2024
Over the coming year we seek to
1. Expand SSP Service Locations: We have begun conversations with the Community
House Men's Shelter and Homestart Women's and Families Shelter in Chapel Hill
around expanding SSP service provision locations to include their sites. This would allow
us to reach a greater number of community members with our services. We are actively
seeking additional organizations to partner with for resource provision.
2. Grow and Strengthen Community Partnerships: We would like to grow and expand our
existing partnerships with organizations that may interact with our clients to strategize
how to best serve this population. Potential community partners include the Chapel Hill,
Carrboro, Hillsborough police departments, Orange County Sheriff's Office, UNC
campus security, and the Street Outreach, Harm Reduction and Deflection(SOHRAD)
program.
a. We plan to expand the services that we offer to address housing; instability
(through referrals to shelters and other residential options) and other social service
needs.
b. We have begun work to partner with the UNC Street Drug Analysis Lab 12 to offer
drug-checking services to our clients to reduce the risk of overdose and prevent
other harms in our community.
3. Develop Emergency Use Naloxone Boxes: We plan to expand access to free naloxone in
Orange County communities, specifically in those locations with a greater risk of opioid
overdoses (locations to be identified through a data-driven historical analysis and in close
consultation with area law enforcement). This initiative will include installing (and
maintaining) emergency naloxone boxes (similar in concept to public-use AEDs and
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EpiPens) in locations that were sites of overdose in 2020-2022, according to Chapel Hill,
Carrboro, and Orange County police reports. These efforts will initially focus on parking
garages and public spaces, with further locations being determined following consultation
with our current clients, as well as local police and EMS services.
4. Expand Community Education Efforts: We plan to increase our community harm
reduction and SSP education efforts both on the UNC campus and in the greater Carrboro
and Chapel Hill community. This initiative will include providing naloxone trainings to
campus fraternities (already in-progress, through partnerships with UNC fraternities in
response to the overdose death of a UNC student this academic year while attending a
fraternity party at Duke University), delivering harm reduction trainings to our partners at
the IFC, and increasing community awareness of the SSP in local community
organizations (e.g. the Chapel Hill Public Library and homeless shelters).
5. Develop an Online OrderingPortal: We plan to offer our clients a confidential online
portal where they can place orders for harm reduction supplies. These orders could be
fulfilled at any of our tabling events or spaces, and they would allow clients the
opportunity to determine an onsite location for discreet delivery. We anticipate that this
portal will encourage greater use of our services by providing greater ease and privacy.
a. This portal will also allow us to directly elicit feedback on the services and
resources that we provide, greatly improving our capacity to respond to the
evolving needs of our clients.
6. Expand Naloxone Provision in Piedmont Health Service (PHS) Free Clinics: We have
started conversations with SHAC medical clinics about managing the distribution of
naloxone and educational materials to their patients. In addition to naloxone distribution
management, we would provide them with our multilingual harm reduction and local
medication assisted treatment (MAT)resource materials.
7. Develop Post-Overdose Response Team: Following the model of GCSTOP, a
collaborative effort between Guilford County Emergency Services and UNC-Greensboro,
we plan to collaborate with Orange County Emergency Services to connect with
individuals who have recently experienced overdose and would like support. This
program would aim to prevent subsequent overdoses by connecting participants with
counseling, services, treatment (if desired), and harm reduction tools and resources.
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Proposed Budget and Funding Request:
We are presenting a 24-month budget. The budget for the first year is below.
One PTE (salary) $ 30,000
Community health worker providing program management and
support (educational materials development, volunteer management,
community partnership building,program expansion, direct care, etc)
Supplies (naloxone, syringes, test strips, etc.) $ 26,400
Educational Materials $ 2,000
Training, Travel, Mileage $ 1,300
Marketing and Provision of Educational Materials $ 3,700
Indirect Costs $ 800
Total $ 64,200
We thus are requesting a total budget of$128,400 for two fiscal years beginning July 1.
Outcome Measures and Annual Reporting
• # of new naloxone emergency box locations created
• # of new community partnerships formed
• # of harm reduction educational trainings delivered
• # of new SSP locations initiated
• # of SSP clients served
• # of referrals to substance use treatment/recovery services, housing services, and other
health care and social services needs
• # of overdose prevention supplies distributed(e.g. naloxone doses, fentanyl test strips)
• # of safer use supplies distributed(e.g. syringes, cookers, etc.)
• # of wound care supplies distributed
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Sources:
1. Wodak A,Cooney A. Do needle syringe programs reduce HIV infection among injecting drug users: a
comprehensive review of the international evidence. Subst Use Misuse.2006;41(6-7):777-813.
2. Hagan H,McGough JP,Thiede H,Hopkins S,Duchin J,Alexander ER. Reduced injection frequency and
increased entry and retention in drug treatment associated with needle-exchange participation in Seattle
drug injectors.J Subst Abuse Treat.2000;19(3):247-252.
3. Strathdee SA, Celentano DD, Shah N,et al.Needle-exchange attendance and health care utilization
promote entry into detoxification.J Urban Health. 1999;76(4):448-460.
4. Bluthenthal RN, Gogineni A,Longshore D, Stein M. (2001).Factors associated with readiness to change
drug use among needle-exchange users.Drug Alcohol Depend.2001;62(3):225-230.
5. Doherty MC,Junge B,Rathouz P,Garfein RS,Riley E,Vlahov D.The effect of a needle exchange
program on numbers of discarded needles: a 2-year follow-up. Am J Public Health.2000;90(6):936-939.
6. Tookes HE,Kral AH,Wenger LD,et al.A comparison of syringe disposal practices among injection drug
users in a city with versus a city without needle and syringe programs.Drug Alcohol Depend.2012;123(1-
3):255-259. doi:10.1016/j.drugalcdep.2011.12.001.
7. Riley ED,Kral AH, Stopka TJ,Garfein RS,Reuckhaus P,Bluthenthal RN.Access to sterile syringes
through San Francisco pharmacies and the association with HIV risk behavior among injection drug users.
J Urban Health. 2010;87(4):534-542. doi:10.1007/sl 1524-010-9468-y.
8. Klein SJ,Candelas AR,Cooper JG,et al. Increasing safe syringe collection sites in New York State. Public
Health Rep. 2008;123(4):433-440. doi:10.1177/003335490812300404.
9. de Montigny L,Vernez Moudon A,Leigh B,Kim SY. Assessing a drop box programme: a spatial analysis
of discarded needles. Int J Drug Policy.2010;21(3):208-214. doi:10.1016/j.drugpo.2009.07.003.
10. Doherty MC,Junge B,Rathouz P,Garfein RS,Riley E,Vlahov D.The effect of a needle exchange
program on numbers of discarded needles: a 2-year follow-up. Am J Public Health.2000;90(6):936-939.
11. Bluthenthal RN,Anderson R, Flynn NM,Kral AH. Higher syringe coverage is associated with lower odds
of HIV risk and does not increase unsafe syringe disposal among syringe exchange program clients. Drug
Alcohol Depend.2007;89(2-3):214-222.
12. "UNC Street Drug Analysis Lab." UNC Street Drug Analysis Lab,www.streetsafe.supply.
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RES-2023-043 Attachment 2
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: _Syringe Service Program
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 9
d. Amounted authorized for this strategy: $_$64,200.00
e. Period of time during which expenditure may take place:
Start date July 1 2023 through End date_June 30, 2024
f. Description of the program, project, or activity: _
The Student Health Action Coalition Syringe Service Program (SHAC SSP) is a
volunteer-based organization that seeks to improve health outcomes for people who use
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substances and increase community knowledge around drug safety. SHAC provides
direct resource distribution and community education. The Student Health Action
Coalition Syringe Service Program(SHAC SSP) is a volunteer-based organization that
seeks to improve health outcomes for people who use substances and increase community
knowledge around drug safety. SHAC provides direct resource distribution and
community education._
g. Provider: _Student Health Action Coalition(SHAC)
The total dollar amount of Opioid Settlement Funds appropriated across the above named and
authorized strategies is $881,553.55.
Adopted this the 6th day of June, 2023.
Jamezetta Bedford, Chair
Orange County Board of Commissioners
ATTEST:
Laura Jensen, Clerk to the Board
COUNTY SEAL
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