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032723 Opioid Settlement Funding Application Review March 27, 2023 — Special Meeting – Opioid Settlement Funding Application Review The Randolph County Board of Commissioners met in special session at 6:00 p.m. in the Randolph County Historic Courthouse Meeting Room, 145 Worth Street, Asheboro, NC. Chairman Darrell Frye, Vice-Chairman David Allen, Commissioners Hope Haywood, Kenny Kidd, and Maxton McDowell were present. Also present were County Manager Hal Johnson, Assistant County Manager/Finance Officer Will Massie, Associate County Attorney Aimee Scotton, Clerk to the Board Dana Crisco, and Deputy Clerk to the Board Jenny Parks. The meeting was livestreamed on Facebook and YouTube. Hal Johnson, County Manager, gave an overview and purpose of this special meeting. In 2022, the initial Opioid Settlement Funds obtained from the big three drug distributors were distributed to assist with abatement of opioid use disorders in Randolph County. A Memorandum of Agreement (MOA) was adopted to administer the funds. This MOA specifies the allocation, use, and reporting of funds from the initial settlements. The allocation is $8.8 million to the County over the next 18 years. The State of North Carolina recently negotiated $21 billion in new settlements with CVS, Walgreens, Walmart, Allergan and Teva, “Wave Two Settlements.” North Carolina’s state and local governments could receive more than $600 million from the Wave Two Settlements. Randolph County’s share will be another $7.8 million if the Board wishes to seek these funds. In order for Randolph County to be eligible for the Wave Two Settlements, the Randolph County Board of Commissioners must sign onto each of the five new Wave Two Settlements as well as a supplement to the North Carolina MOA before April 18, 2023. During this meeting tonight, the Board will hear the first Opioid Settlement Funding recommendations and they will vote on the passing of a resolution authorizing the County Manager to sign the five Wave Two Settlements and the Supplemental Agreement for Additional Settlements of Opioid Litigation and approve the associated Budget Amendment to the Grant Project Ordinance. Mr. Johnson shared that former County Commissioner Stan Haywood, who was a pharmacist, recognized the issues that were forthcoming from opioid use. Mr. Johnson stated that all 100 counties in North Carolina are participating in this settlement program. The North Carolina Association of County Commissioners directed one of their employees, Leia Gearhart, to assist Randolph County with this program as Project Coordinator. Ms. Gearhart gave an update on the Randolph County Opioid Settlement Funding. The goals identified were to enhance community efforts to develop and/or expand evidence-based programs and resources to address opioid use disorder, to build capacity and infrastructure to measure the impact of programs and prevent fatal overdoses in Randolph County, and to strengthen community partnerships to improve access to care related to opioid use disorder. These goals will be met by using existing program support, grant writing skills development and management, data collection building processes, technical assistance, Opioid Collaborative participation, and training/workshops for those administering the program. 3/27/23 Ms. Gearhart went over the assessment process of the thirteen applications that were received. She introduced Jennifer Layton, Assistant Public Health Director, who has been the “co-chair” of this process with Ms. Gearhart. Ms. Layton reported that Executive Committee Training was held to explain the criteria for application evaluation. Ms. Layton stated those organizations chosen will have accountability such as pre-contract accountability, financial accountability, and performance accountability. She shared the eight proposals for the six organizations that were recommended for funding. The funding amount for each was $150,000 for FY24-FY26. Below is a table that shows what the Executive Committee is recommending for approval. Technical Assistance Area FY24-FY26 Action Operations, Organization Program Recommended Planning Evaluation Data Gaps, & Funding and Plan Collection Connect to Timeline Care Early JDRC $150,000 X X X intervention Community Naloxone $150,000 X Hope Alliance Distribution Detention RCSO Center MAT $150,000 X X X Program Community SSP $150,000 X X Hope Alliance Naloxone RCSO $150,000 X X X X Distribution Recovery Support Keaton’s Place Services: $150,000 X Connect to Care 3/27/23 Evidence- Chatham based $150,000 X X X Recovery Addiction Treatment Recovery Support DSS Services: $150,000 X X X X Connect to Care Technical Assistance Areas were identified by the Executive Committee to be addressed by the applicant prior to project implementation in July if they are approved. At the end of the first year, the Executive Committee will conduct a performance review for all awarded agencies. The Executive Committee is recommending all of the above-named applications be approved. Mr. Johnson asked what is meant by “evidence-based.” Ms. Layton explained that evidence- based strategies have been studied and found to be effective in addressing an issue. All of the strategies presented have been studied. They are all vital in addressing opioid use disorder. Chairman Frye asked if any of these funds could be used for administrative and personnel costs. Ms. Layton replied that there was not a limit set on personnel cost, but there was a limit set on indirect costs. Vice-Chairman Allen asked how the funding amount of $150,000 was set for each program. Ms. Layton stated that the Committee has been in contact with other counties across the state of North Carolina that have similar funding packages. These counties recommended starting on the low end for managing the program. The Committee also does not want organizations to become reliant on these funds as their sole funding source. Chairman Frye inquired about other funds that could be used for Naloxone. Ms. Layton stated, during Covid, Covid dollars were used for Naloxone because of sharp increases in overdose fatalities. However, as Covid initiatives wind down, so will the funding that has been earmarked for Naloxone. Chairman Frye asked if all of these programs must be voted on as a whole. Ms. Layton stated that was the recommendation from the Executive Committee. The reason for recommending approval of all eight programs is the collaboration that will occur among providers as opposed to them being in competition with each other. Commissioner Kidd questioned why they were not being voted on individually. Chairman Frye stated them being voted on together was the Executive Committee’s recommendation, but the Board could decide on another option if they wish. 3/27/23 Commissioner Haywood said it was obvious that the programs have been carefully selected for funding and the accountability piece is in place. She stated that Randolph County needs these organizations to be successful and with them working together that goal is attainable. Chairman Frye asked how to stop the opioid problem without making it easier for those that have opioid use disorder to continue to function with their addiction. Ms. Layton stated that is a challenge. It takes a lot of interaction for addicted individuals to build trust with the organizations providing services. It also depends on their willingness to admit they have a problem and need help. Cost of treatment can be prohibitive as well. Chairman Frye asked if the Medicaid expansion would cover any of those costs and Ms. Layton stated it was supposed to. Medicaid expansion would open the door for some individuals that may not have had access to these programs before. Chairman Frye reminded the Board that anyone that sits on the board of any of the organizations that are being presented cannot vote on their items. Commissioner Kidd questioned if there was an up-front audit of these organizations. Ms. Layton stated that there will be an audit required after one year from the time the funds will be given. If the organization cannot provide an audit after the first year, it will hinder them receiving the remainder of the funds. Vice-Chairman Allen inquired about the rubric the Executive Committee used for scoring of these applications. Ms. Layton explained they used one from past funding by the Randolph County Finance Office. Thirteen applications were received and only five were not fully compliant with the Memo of Agreement (MOA). The five that did not qualify were removed from the scoring process. Ms. Layton explained each organization and program being recommended as follows:  The Juvenile Day Reporting Center (JDRC) will support their current programming that addresses early intervention for youth under the age of 18 identified as having opioid use disorder. They will use this program to strengthen the families and the youth to increase their success of overcoming opioid use disorder.  Community Hope Alliance is the largest distributor of Naloxone in the community. Had they not had Naloxone on hand when needed, the fatality rate in Randolph County would be much higher.  The Randolph County Sheriff’s Office (RCSO) will use this funding to supplement the Medication Assisted Therapy (MAT) program in the Detention Center.  Community Hope Alliance offers a syringe service program. Those programs can be expensive to operate but do lessen the chances of the spread of Hepatitis and HIV. There has been a reduction in the traffic through the hospital system and increased connection to services from this program.  The Randolph County Sheriff’s Office (RCSO) has opted to distribute Naloxone to individuals being released from the Detention Center. Because if an individual has been in the Detention Center not using drugs, they become extremely sensitive 3/27/23 to whatever kind of drug they use out in the community. The Sheriff’s Office wants to provide this lifesaving resource.  Keaton’s Place provides recovery support services. They connect individuals to inpatient and outpatient treatment by transporting the patient to the services they need.  Chatham Recovery is an opioid treatment service in the community. They are the only ones providing medications and psychotherapy to their clients. They are an evidence-based organization.  The Department of Social Services (DSS) has seen an increase in the need for foster care homes due to child abuse and neglect as it relates to substance abuse in the county. They would like to hire a licensed Clinical Social Worker to provide intensive support to families that are impacted by opioid use disorder. Mr. Johnson asked if the Board has to vote on all of the applications at the same time or could they be voted on individually. Ms. Layton stated the Executive Committee has presented the recommendation for all to be voted together, however it is up to the Board on how to handle this matter at their May meeting. The total amount of Opioid Settlement funding from the initial settlement is a little less than $9 million and the Second Wave is a little over $7.8 million. If the recommended programs are approved, $1.2 million would be used at the end of three years. The total funds in the amount of $17,690,000 are to be used over 18 years. Chairman Frye asked if there were any specific issues that hindered the five programs from not being recommended for funding. Ms. Layton stated they did not align with the requirements of the MOA with the strategies they identified. Chairman Frye stated he was not aware that all of these would be recommended in a block for approval. The Board will need to decide how to handle the recommendation. Chairman Frye shared that homelessness is a growing issue in the County, especially the downtown area. He has people in the community concerned that these funds would enable those that have opioid use disorder. Ms. Layton explained that through their Opioid Collaborative, housing was a hot topic. It is very difficult for an individual who is seeking to sustain recovery over time if they do not have anywhere to live or a safe place to stay. Commissioner Kidd expressed concern that some of these resources could be an open door to a harm reduction program that could get worse. Looking at bigger cities that have some of these programs, it appears they are enabling the problem making the cycle never ending. He stated that he has seen an issue in downtown Asheboro at his place of business. He has walked over needles in his parking lot. The harm reduction debate is a big concern for him as well as the needle exchange programs. Ms. Layton stated that in the Southeast, communities that no longer have harm reduction programs have seen an increase in HIV and Hepatitis among those using needles. The government had to deploy emergency response because it became a community health threat. These programs do reduce the spread of communicable disease, which reduces the burden on the hospital system, 3/27/23 especially for those individuals that may have complex health issues. Independent evaluation of the North Carolina Syringe Service Program has indicated that participants in this program are five times more likely to seek help and receive services. Long standing, trusting relationships are made between the providers and the clients. Commissioner Kidd asked for explanation on the different drugs used in the MAT program. Michelle Hoenig, nurse with the healthcare provider at the Detention Center (Mediko), came forward and explained the drugs used during medical treatment of opioid use disorder. Commissioner Haywood shared she had recently attended a NACo Conference in Colorado where a panel discussion on opioid use disorder was held. A person from North Carolina on this panel brought an employee. This employee spoke about her journey as an opioid abuser and how the MAT program helped her get clean, stay clean, and obtain a job. She currently works with addicts and has helped them turn their lives around. Commissioner Haywood stated that there are people who debate these programs but may not understand them. If it has been shown to be effective and used wisely to help others, it can be impactful in changing the lives of those with opioid use disorder. Commissioner Haywood stated she sat in on a Zoom call with others county officials across North Carolina. It was clear to her that Randolph County is further ahead of most counties on what direction to take with these programs. Ms. Layton stated that the strong foundation Randolph County has and the model Randolph County is building is setting the standard for the State of North Carolina for these programs. This model is not for a county or community that does not have resources in place. There was already a strong collaboration of individuals active and engaged with one another. Several of these programs are looking for opportunities to expand what they are already doing. Commissioner McDowell questioned what the “Technical Assistance Areas” (in the table presented) were and how will the $150,000 per organization be used. Ms. Layton stated there are four critical pieces required for each organization to complete prior to project implementation for the project to be successful. They are as follows:  Action Planning and Timeline is the “roadmap” for each plan with goals and objectives identified.  Evaluation Plan measures the success of the program by surveying participants receiving services. Part of the evaluation that is required by the MOA will be the success stories.  Data Collection tracks the performance measures in the evaluation plan.  Operations, Gaps, and Connect to Care ensure keeping a close relationship with all of those involved in the program. Commissioner Haywood stated that workforce development is something that is being talked about a lot. Many people that have been released by the Sheriff’s Department are participants in the MAT Program. She knows a small business owner who will only employ people that have been in a detention center or prison. He has employees that are on the medication to treat opioid disorder. The business owner said they make excellent employees because they treasure the opportunity to have a second chance. 3/27/23 Ms. Layton shared that one of the strategies their collaborative will implement over the next few years is recovery-friendly workplace policies. It will give clients more hope of turning their lives around by providing them an opportunity to have a job and find a home. Resolution for Receiving Second Wave of Opioid Settlement Funding Will Massie, Assistant County Manager/Finance Officer, shared information regarding Opioid Settlement Funds -Wave Two. In order to participate in the Wave Two Distributions, the Board will need to adopt a resolution to authorize the County Manager to sign onto the five Wave Two Settlements and the Supplemental Agreement for Additional Funds from Additional Settlements of Opioid Litigation. The Board must also approve a Budget Amendment to the Grant Project Ordinance adding $7,865,262. On motion of Haywood, seconded by Allen, the Board voted 5-0 to adopt the Resolution Authorizing the County Manager to sign the five Wave Two Settlements and the Supplemental Agreement for Additional Settlements of Opioid Litigation and to approve the associated Budget Amendment to the Grant Project Ordinance, as follows: RESOLUTION BY THE COUNTY OF RANDOLPH AUTHORIZING EXECUTION OF OPIOID SETTLEMENTS AND APPROVING THE SUPPLEMENTAL AGREEMENT FOR ADDITIONAL FUNDS BETWEEN THE STATE OF NORTH CAROLINA AND LOCAL GOVERNMENTS ON PROCEEDS RELATING TO THE SETTLEMENT OF OPIOID LITIGATION WHEREAS, the opioid overdose epidemic had taken the lives of more than 32,000 North Carolinians (2000-2021); and WHEREAS, the COVID-19 pandemic has compounded the opioid overdose crisis, increasing levels of drug misuse, addiction, and overdose death; and WHEREAS, the Centers for Disease Control and Prevention estimates the total economic burden of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement; and WHEREAS, certain counties and municipalities in North Carolina joined with thousands of local governments across the country to file lawsuits against opioid manufacturers, pharmaceutical distribution companies, and chain drug stores to hold those companies accountable for their misconduct; and WHEREAS, settlements have been reached in litigation against Walmart, Inc., Teva Pharmaceutical Industries Ltd., Allergan Finance, LLC, Allergan Limited, CVS Health Corporation, CVS Pharmacy, Inc., and Walgreen Co., as well as their subsidiaries, affiliates, officers, and directors named in these Settlements; and WHEREAS, representatives of local North Carolina governments, the North Carolina Association of County Commissioners, and the North Carolina Department of Justice have negotiated and prepared a Supplemental Agreement for Additional Funds (SAAF) to provide for the equitable distribution of the proceeds of these settlements; and WHEREAS, by joining the settlements and approving the SAAF, the state and local governments maximize North Carolina’s share of opioid settlement funds to ensure the needed resources reach communities, as quickly, effectively, and directly as possible; and 3/27/23 WHEREAS, it is advantageous to all North Carolinians for local governments, including Randolph County and its residents, to sign onto the settlements and SAAF and demonstrate solidarity in response to the opioid overdose crisis, and to maximize the share of opioid settlement funds received both in the state and Randolph County to help abate the harm; and WHEREAS, the SAAF directs substantial resources over multiple years to local governments on the front lines of the opioid overdose epidemic while ensuring that these resources are used in an effective way to address the crisis. NOW, THEREFORE BE IT RESOLVED, that the Board of Commissioners of Randolph County hereby authorizes the County Manager to execute all documents necessary to enter into opioid settlement agreements with Walmart, Walgreens, CVS, Allergan, and Teva, to execute the SAAF, and to provide such documents to Rubris, the Implementation Administrator. Opioid Settlement Grant Project Ordinance Budget Amendment #1 Revenues Increase Decrease Opioid Settlement Distributions $7,865,262 Appropriations Increase Decrease Contingency $7,865,262 Adjournment At 7:45 p.m., on motion of Allen, seconded by McDowell, the Board voted 5-0 to adjourn. ________________________________ _________________________________ Darrell Frye, Chairman David Allen ________________________________ _________________________________ Kenny Kidd Maxton McDowell ________________________________ ________________________________ Hope Haywood Dana Crisco, Clerk to the Board 3/27/23