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Home My WebLink AboutORD-2023-018-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. 2 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. 3 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. 4 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 5 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 6 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% 7 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 8 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% 3 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% 9 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 10 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 11 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 12 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, 13 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. 14 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 15 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