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Home My WebLink AboutCOM 0661.001 2022-2024Matt Kfineali'i-Kleinfelder Hawai'i County Council District 5 Phone No.: (808) 961-8263 matt. kanealii-k-leinfelderghawaiicounty.gov Finance Committee Chair Policy Committee Health, Safety, Well -Being Vice Chair Hawai'i County Council County of Hawaii Hawaii County Building 25 A upuni Street, Suite 1402 - Hilo, Hawaii 96720 DATE: January 5, 2024 TO: Hawaii County Council Members FROM: Matt Kdneali'i-Kleinfelder, Council Member Council District 5, County of Hawaii SUBJECT: Bill No. 114/ Res. No. 402-24 Additional Information (Overview of 1�1"J Opioid Settlement Funds and the Hawaii Island Fentanyl Task Force) Executive Assistant to the Office of the Mayor, Tim Hansen, has submitted the following attachments as additional information for Bill No. 114 and Resolution No. 402-24, scheduled to be heard by the Committee on Finance on January 9, 2024. Please process accordingly. Should you have any questions or concerns, please do not hesitate to contact my office. Mahalo nui. Comm. No. Ref. To: 9 2 Ref. Date JA -02, Hawai'i County is an Equal Opportunity Provider and Employer I DI &N - we "T : a :4 1 ki Lei Oki HOLLY T. SHIKADA ATTORNEY GENERAL For Immediate Release February 28, 2022 News Release 2022-09 Drug Distributors and Johnson & Johnson Commit to $26 Billion Opioid Agreement with Hawaii Expected to Receive Over $73 Million to Fight the Opioid Crisis HONOLULU - Attorney General Holly T. Shikada, joined by the Mayors and Corporation Councils of the County of Hawaii, City and County of Honolulu, County of Kaua'i and the County of Maui, announced the final approval of the $26 billion opioid agreement with the nation's three major pharmaceutical distributors — Cardinal, McKesson, and AmerisourceBergen — and Johnson & Johnson. Following successful state sign -on and subdivision sign -on periods, the defendants will start releasing funds to a national administrator on April 2, 2022. Money will start flowing to state and local governments in the second quarter of 2022. "These settlements do not complete our fight against those who created and fostered the nationwide opioid problem," said Attorney General Shikada. "But with the assistance of our counties, these settlements are a major step forward in finding and funding better solutions." The agreement marks the culmination of three years of negotiations to resolve more than 4,000 claims of state and local governments across the country. It is the second largest multistate agreement in U.S. history, second only to the Tobacco Master Settlement Agreement. Fifty-two states and territories have signed on to the agreement as well as thousands of local governments across the country. In Hawaii, all four counties have signed on to the agreement. As a result, Hawaii will receive its full share of approximately $73 million, most of which will go to support treatment, recovery, harm reduction, and other strategies to address the opioid epidemic. The partnership between the counties and the State will result in the most effective use of the funds to address this epidemic in our State. "Hawai'i County thanks the Department of the Attorney General for taking the lead in settling this lawsuit and thank our outside counsel for their work representing the Department of the Attorney General News Release 2022-09 Page 2 interests of Hawai'i County. We look forward to continued collaboration with the State in addressing the opioid crisis for Hawai'i Island and the State," the Corporation Counsel for the County of Hawai'i shared. The Corporation Counsel for the City and County of Honolulu said, "We would like to thank the Department of the Attorney General for its leadership in this lawsuit and look forward to working with the State on the use of the settlement funds." Kaua'i Mayor Derek S.K. Kawakami said, "Addiction is a lifelong struggle for those affected. We still have an uphill battle ahead of us, but it's time these major pharmaceutical companies be held accountable and help to be part of the solution. We thank our attorneys, both past and present, for their work toward this resolution." The County of Maui said, "Maui is thankful to the Attorney General's Office for negotiating such a substantial settlement that will benefit our county and the State of Hawai'i." In addition to the funds, Cardinal, McKesson, and Amerisou rce Bergen will: • Establish a centralized independent clearinghouse to provide all three distributors and state regulators with aggregated data and analytics about where drugs are going and how often, eliminating blind spots in the current systems used by distributors. • Use data -driven systems to detect suspicious opioid orders from customer pharmacies. • Terminate customer pharmacies' ability to receive shipments, and report those companies to state regulators, when they show certain signs of diversion. • Prohibit shipping of and report suspicious opioid orders. • Prohibit sales staff from influencing decisions related to identifying suspicious opioid orders. • Require senior corporate officials to engage in regular oversight of anti -diversion efforts. Johnson & Johnson is required to: • Stop selling opioids. • Not fund or provide grants to third parties for promoting opioids. • Not lobby on activities related to opioids. • Share clinical trial data under the Yale University Open Data Access Project. Additional information about the opioid settlement is available at https://www.morepowerfulnc.orq/opioid-settlements/ For more information, contact: Gary H. Yamashiroya Special Assistant to the Attorney General Email: ATG.PIO@hawaii.gov Web: http://ag.hawaii.gov Twitter: @ATGHIgov By using the 15% figure for what will be allotted to counties and then the 18.2671692501% figure for what Hawaii County will be getting, I broadly estimated: $2,137,239 will come to our county over the 18 year distribution time frame. Further broken down according to proposed distribution annual schedule for money coming to Hawaii County: $400,555 in 2023 $ 78,023 +/- in 2024-2031 $ 70,000+/- in 2031-2038 Most up to date figures calculate Hawaii County available portion: County Percentage Currently Available Amount Hawaii 18.2671692501 $478,577.98 as of l/l/24 • There are other National Settlements still in process that could bring additional funds to our state and county. 0 Background 3 Introduction 3 HIFTF, Vision, & Mission 4 Dash -Board Measures 5 Priorities, Goals & Objectives 6 Appendix A: Organizations 13 Appendix B: Organizational Chart is Appendix C: Budget 16 Appendix D: Updated Activities 17 0 In 2017, the U.S. Department of Health and Human Services declared the opioid crisis a public health emergency. In 2022 the opioid epidemic was marked by a further increase in individuals with opiniduse disorder: over ten million people atrisk bymisusing prescription mpokdsand unknown millions of people intentionally or unknowingly using fentanyl. Fentanyl caused 72% of the record 110,000 US overdose death in 2022, Thirty-seven million Americans are using any illegal drug, which increases the risk ofunwittingly consuming fen{anyi For example, fentan\dhas caused deaths in Hawaii and the continent when the user thought they were smoking only marijuana, Now, in 2023, with no state or federal official reporting yet, anecdotal information from "boots on the ground" folks isthat the upward fmntany|trend continues. Hawaii and especially Hawaii Island are experiencing this deadly epidemic. Recent surges in2U12: 320 statewide overdose deaths statewide - one every 27 hours ; Hawaii Island, one overdose death every 1ldays have overwhelmed care providers and resulted in a growing impact of medical, social, judicial, and economic seque|ae Community advocates working together offer the most promising response tothe crisis, For this reason, the Hawaii Island Fentan\dTask was formed. Now inits second year, there |sanemergent need tnplan for the future. This document was prepared and vetted over the last 9months for discussion, planning, and for the action steps of funding and implementation. It outlines a comprehensive approach - used successfully elsewhere - to address and attenuate our Hawaii Island hentnny|epidemic. Fentanyl on Hawaii Island Itbestimated that fentanyl.was first recognized onHawaii Island in 2017-18. • kwas recovered inlaw enforcement seizures, and its use onthe island was confirmed in the single health care setting where patient point of contact fentanyl testing was performed. • Public Health, medical and judicial system knowledge regarding fentany|was, and is easily available through a multitude of State, Federal and other resources, ° Fentany| has become a leading cause ofU.S.deaths |nthe age groups 18-45. Federal data have indicated that there isnow anoverdose death every11 days mnHawaii Island. many oƒthese involve fentanyt For every fatal overdose, there are approximately 14non-fatal overdoses. Anon- fatal overdose increases the risk for a fatal overdose within a year. Hawaii Island EMS data indicate that Hawaii County first responders reverse 2overdoses aweek. Anunknown number offatal and ofnon-fatal overdoses occur without being reported. When reported officially, confirmation has taken as much as 9 months. Public reporting locally and nationally is not systemized to allow timely information on the epidemic. Demographic information on overdose victims is also not available, hindering messaging and preventive outreach to high risk groups: on Hawaii Island, high school students have died of fentanyl overdoses and we know only because family or friends speak out. Police cannot make a full report until an investigation is complete, and health care facilities and personnel have confidentiality restrictions, The Task Force began in November, 2021 in response to public concerns and outcry, when a14-yeap o(d girl died athome onHawaii Island ofofentanyloverdose. Although the cause ofdeath was not officially confirmed until August, 2022, community members and health professionals knew quickly. 4small group subsequently approached Major Mitch Roth, and the coalition now known asthe Hawaii Island Fentanyl Task Force (HIFTF) was formed. The HIFTF organization started as an unincorporated community coalition, and will soon come under the umbrella ofacommunity non- profit organbation. AsofDecember IL2O2Z: w there were over 30organizations, and over 7Dmembers (Appendix A)engaged inthis work. • Also, aforward-facing organizational chart can befound inAppendix B.Current leadership governance is through a loose, "Board of Directors", management is through volunteer and "in'Nnd"personnel. The "8OD°meets regularly, atleast quarterly, * Appendix includes aproposed Budget, and; • Appendix Dincludes task force activities completed through May 1A,2O23. Vision A community that is aware, informed, and empowered to prevent addiction, drug overdose,and other consequences of drug use on Hawaii Island, Mission Our mission btoreduce the demand and supply ofillicit drugs, especially feNaryl through education, prevention, treatment, harm reduction and recovery support activities, and wesupport law enforcement and judicial initiatives. Initial Efforts: Early Awareness Messaging /thought itwas safe, but it was lacedFentanyl Kills. 0 Other Messages Depending on Target Audience Be Kind to Your Mind Choose Not to Use One Pill can Kill Laced and Lethal Fake and Fatal Hugs not Drugs Dashboard Measures It is the intention of the Task Force that with the implementation of this strategic plan, there will be tracking of key performance and outcome impacts: ]L Decrease innpiom'nela1edfatal overdoses 2. Decrease innon-fatal opiuidoverdoses. 1 Decrease in emergency room services due to overdose. 4. Decrease inopimid-ne|atedcalls tothe Hawaii Poison Hotline. 5. Increase Training and Availability ofNanzn,Fentany| Test Strips and buprenorphine(Suboxona) 6. |ncreasedadmission ofpersons with Dp|oidUse Disorder into treatment programs. 5 recommendations below, the work of the Task Force and all efforts to improve the situation on Hawaii Island has and must continue to take into consideration two groups: our youth and persons with challenging social determinants of health. Addiction is a pediatric disease: 90% of adults with addiction started using addictive substances before turning 20 years old. Informing and supporting our island youth and their families and community contacts is imperative. Social determinants of health include factors like socioeconomic status, education, language agility, neighborhood and physical environment, employment, social support networks, as well as access to health care. Priority 1: Education and Prevention. Combating the Opioid Crisis through the (Ition expansion of education and prevention activities. Goal: To bring an awareness of the dangers of drug use and strategies to prevent addiction to everyone on the island above the age of 12. Objective 1: Education and prevention through in-person/zoom trainings, school presentations, community fairs, and annual conferences. Note. Identify how to better communicate with community organizations (i.e., sports clubs, churches) and letting them know about education opportunities through presentations, recovery group(s), doing talks, etc. Also, at the annual summit report on what is working, not working, and why. Obiective 2,: Education and prevention through the media (radio, news, TV, social media, and sign -waving) Note. Create own Facebook and Instagrarn pages with regular posts. Share stories of what we're doing. Share outside stories of what's happening elsewhere. Develop a newsletter. Obiec1ive 4:Education and prevention through awalk-in service and/or hotline. Education to key policy decision makers (legis|atures,mayor's office, etc.) Note, Engage with policy decision makers, legislators, mayor's office, and council members. Provide our newsletter to them to keep them informed. Early Intervention. Ensure there are systems hnplace for proper mcreen�ng and early intervention. Goal: Every point ofentry has protocols inplace (im, S8|RT- creening,8hef|ntervention,andRefena|0o Treatment) for addiction screening and early Determine the entry points ofwhere screening and early intervention would occur (ie, doctors office, prison entry orrelease, hospital etc.). Provide anavenue for providing awareness and/or training onscreening and brief intervention (SBIRT). O1iective fExpand the options ofSB|RTexpertise tofamilies, churches, sports advocates, and Note. 90RTbacomprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are atrisk ufdeveloping these disorders. Prmnaryca/cuence/n. hnspita|emn,�oncymoms'�rauma ren�eo'nndother�omnnunby�e:bn�sprovideoppion m|Uhat'�sk �yhs�ance usea �e'�s more�everz concequencesrccu, 7 Priority 3: Treatment Services. expansion of treatment options on island. Obiective 1: su000rt more treatment and treatment beds on island so that people can remain within their communities as they start to heal. Residential Treatment 8eds There is an ongoing shortage oftreatment beds for persons with substance use disorders, with wait times from 2weeks tomonths. This issue results inpatients wanting services being turned away when they are ready for help. Compounding the problem isfunding that isdependent onhee-fop service:this*/iUa|wmysbeinadequate\oPayforthestart-upandthentheactoaicostofadditiona| bed slots. There will always bealack ofbeds unless subsidization isavailable. Onthe continent, many counties have developed public programs since the for -profit treatment sector serves only the small slice of independently, financially capable persons. Hawaii Island has several high -end, exclusive and expensive programs, aimed at persons from the continent and with the means to enroll. Residential beds are otherwise inshort supply, with waiting times from 2weeks tomonths, Finding locations for both residential and "cletox" beds is also a challenge, Detoxification/Medically Assisted Withdrawal This does not currently exist onHawaii Island. Persons needing this level ofcare are referred to Oahu. Few ever get there, secondary to insurance, transportation, waiting lists and other delays. Hospitals no longer do medically managed withdrawal. Many patients cannot begin the road to recovery until they are safely "cletoxed" and stabilized. "Social cletox" is needed for persons not requiring a higher level of detoxification. There is no social detox on the Island Recovery Housing Not just "housing", but safe and supportive drug free housing for persons seeking SUD recovery, Clean and sober housing, extended safe -living options after short residential treatment, detox,etc Recovery Housing supports persons who may also be in an outpatient treatment program, or attending acommunity "mutual help" group, such asachurch, AAorNA. Medication, There are three FDA approved, effective medications for OpiuidUse Disorder, yet they are not easily available for those who could benefit from them. Methadone, an old medication, requires daily visits to a federally regulated clinic in Hilo, interfering with the work and other activities of a person in recovery. injectable naltrexone (Vivatrol) requires that a person with opioid use disorder be completely (unless you are hospitalized or incarcerated), Buprenorphine is a safe and effective FDA approved medication that relieves all withdrawal and craving. It can be prescribed by any medical provider who has a standard controlled substance certificate (MDs, DOs, APRNs, Physician Assistants). Unfortunately, very few providers actually prescribe this medication topatients with 0UD. |tisthought that the stigma and ignorance which chronically has surrounded substance use disorders in the main deterrent to prescribing, An additional problem with clinic and private practitioner based treatment of opiold use disorder is the lack mfanadequate inventory afbuprenorphineinHawaii Island pharmacies. This further dissuades practitioners from treating patients and increases the stigma surrounding this disease. Obiective !, Recruit and train existing healthcare Arovderstoaddress substance use disorder with their Workforce development onHawaii Island bnearly non-existent.Non-profit SLID programs are rarely able to recruit locally the level ofexpertise necessarytostaff programs. Pay isnot competitive even when there is a good candidate, and these candidates go elsewhere. The several high scales, private Rx centers (largely catering to people from the continent) make the problem worse by attracting local program staff. There is also a state bureaucracy that makes certification at most levels very difficult, i,e, training for Peer Support Specialists isonly offered onOahu. |tiswell documented that Peer Support Specialists help bring persons into treatment and recovery; they are needed onHawaii Island. Increase telehealthcapacity toreach rural areas. Provide technology for low-income families. OnHawaii Island, transportation bmbarrier to services. Persons without private transportation (cars)are unable to access services which are located far from their residence, especially ifthey need tnattend treatment several days aweek — which istypical. Telehea|thmodels currently inplace for general medical services can be one model for bringing telehealth for SUD into wider availability. {lb/ectkveL4:Invest in a wide range of services to meet people where they are at in terms of readiness to quit. This could include'damp, housingand harm reduction that can still engage folks in care before they are totally sober. Priority 4: Recovery Support. Goal: Ensure people in recovery have the coping skills to deal with daily stressors, craving, Note, Transportation to and from treatment |samajor barrier for many persons seeking recovery. Obiectjve 2:Develop and disseminate educational materials hoeducate the public on how toreceive recovery supports on -island and via the internet. Note: Have material onthe weboite. Objective 3: Support the efforts afnon-profit � � r and/or grass -roots recovery groups and "sober support programs" who are seeking funding tohelp sustain operations. Note: Consider branding funding (combinedand/or apply for grants together, O6iectke 4:Support community and peer intervention models (i.e,peer specialists' programs) that encourage survivors and/or parents of survivors to seek support through shared experiences and planned annual activities (ie.,sign+waoing). Note. Create asupport groups for women, families, adolescents, survivors cf trauma (ves[and consider a men and women "retreat" (i.e., AHA Kane; AHA Wahine). Ob4e1tive 5: Develop a range of re-entry and support programs for justice system involved persons. Especially needed are "Women Supporting Women" reentry programs. Priority 5: Harm Reduction. options for accessing substance use disorder treatment and other health care I a .•F RTPM R_ 'IT Training/Distribution and Fentanyl Test Strips Distribution. Note. Sample actions steps include: Work with data/group to learn which populations are at highest risk. Get data from ER/First Responders to see where the hotspots are (HFD/HPD). Questions like, is it nightclubs, bars, places where people use drugs. Obiective 2: Educate legislators on making Narcan available in County and State facilities. Note. Sample actions steps include meeting with legislators as a group on a regular basis. Explain they can create a mandate for putting in certain places. Incorporate unions as an advocate. Objective 3: Education legislators on making Fentanyl Test Strips legal and available. Note. Keep the momentum going in the Legislature. Continue working with Senator San Buenaventura, and work with all types of legislators. Go to media. Understanding that it (FTS) doesn't promote drug use. Should be part of first aid or AED kits. Obiective 4: Post -overdose outreach teams to engage people who have survived a non -fatal OD and link them to care. Obiective 5: Engaging with the criminal justice system to develop drug assessment protocols for diversion and/or community re-entry. Note. Diversion programs should identify addiction in justice involved individuals pre -charge and upon re-entry in the community. The goal is to avoid charges, connect person to resources, and go into this Diversion Program instead. Utilize drug court. Work closely with agencies like "Going Home Hawaii". M Priority 6: Data Analysis, Evaluation, and Communication. Improving Data Collection, Analysis, and Communication Dissemination. Goal: Collaborate with Treatment Providers, County, and State partners toenhance the ability tuidentify 0)00 inreal time key data points such asoverdose deaths, DATA —° «NOWteDGE high utilizers ofemergency room services due to overdose, administration ofNarcanand lives saved and where, calls made tothe poison center due tu opioid poisoning and being able tacommunicate these findings back tothe public. |t|simperative that this date be available in real time, and that interpretation of data is done with caution and expert input. Obiecdve 1LTrack opioid-rebtodfatal overdoses, Obiective 2: Track non -fatal opioidoverdoses. Obiectke 3:Track high utilizers mfemergency room services due tnoverdose. Objective 4:Track mpmid-rebte6calls nothe Hawaii Poison Hotline. Obiecbve 5: Track EMS/Police patients treated with Naroan. Ob"ective 6:Provide evaluation summaries to the Task Force on a quarterly and/or annual basis, Obiechve 7:Communicate task force activities and accomplishments inamedium (H|RTwobsite Facebook, Instagram, newsletter, emails, etc.) that is relative, easily accessible, and user-friendly. 12 • Big Island Substance Abuse Council (BISAC) • Boys and Girls Club of Hawaii • Bridge House Hawaii • CDC Foundation • Community First Hawaii • County of Hawaii Departments of Fire /Emergency Medical Services Hawaii Police Mayor's Office Prosecuting Attorney • Family Support Hawaii • Going Home Hawaii • Hawaii Island Recovery • Hawaii Department of Health Adult Mental Health Division • Hawaii Public Health Institute • Hawaii Community College • Hawaii Health & Harm Reduction Center • Hawaii Island Community Health Center • Hawaii Island Family Medicine Residency • Hawaii Rise Foundation • Healthy Mothers and Babies Coalition of Hawaii • Hawaii State Rural Health Association • High Intensity Drug Trafficking Area (HIDTA) • Hilo Medical Center • Hope Services • Kipuka 0 Ke Ola Native Health Center • Kona Community Hospital • Ku Aloha Ola Mau • Kumukahi Health and Wellness • Lokahi Treatment Centers • Men of Pa*a • Neighborhood Place of Kona • New Ohana Club of Kona • Pu'a Foundation 13 State of Hawaii- Departments Education Governors' Office, Office of Wellness and Resilience Human Services -Adult Protective and Child Welfare Services • UCERA, Hawaii Keiki Healthy and Ready to Learn * United Stated Drug Enforcement Administration ® University of Hawaii- Hilo • Vibrant Hawaii ® Waimea Community Association M, 1. 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