Boulder County BOCC, CO Regional Opioid Council, 24 Apr 2023

Previous Meeting Next Meeting

⏯

youtube image

►

From YouTube: Boulder County Regional Opioid Council (April 2023)

Description

Sixth meeting of the Boulder County Regional Opioid Council (BCROC). Recorded April 24, 2023. For more information on Region 6 Opioids Abatement activities, visit: https://boco.org/Region-6-Opioids-Council

A

uh This is the April 24th 2023 meeting of the Boulder County Regional opioid Council and um commissioner Levy had a conflict um which she notified me about, but I didn't um I I got mixed up about it, so she's actually conducting a public meeting about our our program with our arpa staff.

A

um So that's that's conflicting with this meeting and then Boulder City manager, neria will will also not be able to attend today, but I leave I. Believe we've got everyone else.

A

So welcome thanks for your time and I'm, going to pass it over to Kelly for her PowerPoint to get on the screen and then to begin with our agenda.

B

Great thanks, Robin, let's give me two seconds here. This is a little bit of a different format. Can everyone see my slides, yep? Okay, perfect so, um as Robin mentioned, welcome to the April uh meeting of the Boulder County opioid Regional Council, um so as just a quick recap of our agenda today uh and we're going to start with our virtual meeting guidelines. So uh you know first and foremost, uh thank you to any members of the public that are joining us here today.

B

um As this is a pub. This is a public meeting, but not a public hearing, uh so we are not allowing for public comment or interaction in the course of conversation.

B

um We do welcome any comments, concerns sort of questions um to be put into the chat, but with recognition that it will not be formally introduced into the course of the conversation with the council members today, um so for our agenda today, we're going to start with a discussion of current opioid trends that are going on across our region and by Commander Nico goldberger, with Boulder County, Sheriff's Office and the drug task force.

B

We're also going to follow up on some conversation that we started in our March meeting around the possibility to test uh Wastewater in the region for um opioids and what that might tell us what the scope of that might look like. Etc I will be giving an update on our selection process for our request for proposal.

B

We have mentioned this in the last couple of meetings about putting out an RFP For assistance with facilitation and evaluation work, and then we will also be welcoming Jack Patterson and Jamie Feld, with the Colorado opioid abatement council at the Attorney General's office, to talk a little bit about some important updates from the state level, and then we can close out with any other items for the good of the order.

B

So that's that I will pass it off to Nico to get us started. Nico I can just continue to advance these slides for you. If that works.

C

That would be perfect. Thank you very much. We can uh move to the odm app good afternoon. Everyone I wanted to give you a little brief, update and understanding of what OD map does for uh Boulder County as a community itself, with this helping with public health and other treatment and preventative options out there. So OB map was designed by a high intensity, drug trafficking, Association out east. It's a federal entity that law enforcement medical responders as well as emergency departments. Eds can input information, and, let me let me backtrack.

C

I want to talk about the information I'm talking about is information of people who have either passed away or were saved by the use of naloxone or other medical resources. So I want to say we're talking about lives here. So when I say data I do it with all the respect, because people have passed away when we're dealing with this platform, so how this works is when law enforcement. uh At this point law enforcement responds to an incident, they can add data information into OD map.

C

This gives us a live time opportunity to see what is occurring in our County, because all the law enforcement agencies in Boulder County are signed up for this I'd like to say that Boulder County is the only County in all of Colorado, where every law enforcement entity has signed up we're. Also the DA's office coroner's office working on the Mobile County Public Health they're working out some of the minutia on getting that going, so this county is actually up to speed and really doing well on that.

C

So I uh give your attention to the map that you see in front of you on the right side is the legend. The diamonds indicate that somebody has died. The circles indicate that somebody did not die. The different color coding shows that whether naloxone was used. One of the common trading Mark names is Narcan another one out. There is clocksado, but Narcan is a word that you've seen or heard many times so the diamonds do show the deaths and whether Narcan was used not used.

C

How many Administrations the bottom left shows you a few numbers total suspected overdoses. Now these this is not official. It does not come from the coroner's office. This information is showing that when law enforcement responded on the scene, they suspect that probably some type of Overdose, whether it was let's say, fentanyl or another, drug alcohol or anything else if they think it was present currently year to date, that number would be indicating 46 persons.

C

The next uh part you see down, there is fatal right now, year to date, there are 10 suspected fatal overdoses again, not official until the coroner's office give us their information and lastly, at the bottom is the naloxone use. So whether law enforcement responded or somebody a civilian attempted to give Narcan or naloxone to somebody. This would be documented in this, and then we could see how many people were affected again, not official. That goes to the coroner's office for all that.

C

What we'll see, though, is how it is detailed, is we put down an address that address is encrypted. Nobody can see it, but then you'll see all those different addresses. Excuse me, I should say diamonds or circles throughout the county map indicating the jurisdiction. Of course, we've had deaths in every jurisdiction law enforcement, jurisdiction, primarily the larger jurisdiction for a boulder Lafayette Longmont, and a few, the 19th and 20th of this month, Boulder County did have two fatal suspected overdoses, Boulder police police department had nine incidences since the 10th and thank gosh.

C

None of them were fatal, but they were nine incidents. Since the 10th of this year would those six are suspected to be fentanyl to alcohol and one um is an unknown. Excuse me as I. Look at my notes.

C

um That is the general gist. First, on what OD map is and with this live data, Public Health other treatment um and prevention agencies can use that information to find out where there are uh places are occurring, maybe even more so the frequency um and maybe think of ways to tackle this and think ahead for giving uh things such as we've talked about vending machines in different locations.

C

um Items of that sort to help uh give our community members the treatment go ahead on the next one, Kelly.

C

So on this I want to give you a little bit of information on the trends that we've been seeing lately for the past few years, and right now, I'm going to talk about those m30 pills. Those are the ones that are suspected to be containing fentanyl when they have been uh past a few years, we've been seeing a cost on the street uh between five and twenty dollars right uh current cost now is drastically lower.

C

You can easily find these pills um even two dollars or, if you buy in the bulk, unfortunately, you can get it even cheaper. Why it's supply and demand and everything with our um these? uh How should I say these cartels?

C

um These cartels are getting very good at the distribution Network that they have. They are very efficient and with more time as they go, they pick up more drug traffickers and drug dealers to sell their product. Their Wares in any state Colorado, of course, is one of them, a large amount, of course, because the supply and their uh distribution is coming up primarily from Mexico and coming up towards our location.

C

Other competition to keep the uh prices low, of course, is the different drug trafficking organizations around the state, but also there is person-to-person dealing and then, of course, there's the internet, which you've been hearing about uh very frequently that also drives costs down.

C

One of the other drugs that you've probably heard about as well is uh xylazine. um This is getting the West Coast the east coast and it will come to Boulder County. We have not seen xylazine yet in any Coroner's reports, but I can guarantee you. Unfortunately, that is coming. Xylazine is a animal tranquilizer.

C

So what happens? Is they normally mix and when I say they I'm just going to blame this one right now on the cartels, some other people can do it by themselves, but the uh proportion is. The cartels are mixing opioids, primarily fentanyl with xylazine.

C

They give both a very similar effect. But if you give Narcan to somebody who is on the opioid and the xylazine, the opioid excuse me, the Narco naloxone will assist. Hopefully, Reviving The person reference the opioid, but it has no effect at all on the xylazine, because it's a tranquilizer, and that is why it's so imperative that people still get medical treatment, because whether the naloxone wears off or the xylazine is not treated, people can die um if I did not mention it.

C

uh There's been four overdoses in the Denver area that are associated with uh xylazine, none here frequent, uh not in Boulder County frequent names that you have that you'll hear on the street. The primary one is trench and that's because it is a tranquilizer.

C

um Then I want to touch a little bit about um what we're also seeing down here on um cases that Boulder County has had um months ago. We had an active excuse me months ago.

C

Months ago, the drug task force and the DA's office partnered on a criminal investigation against Mr Valdez. We charged him with manslaughter and Fentanyl because of the fentanyl distribution and he was convicted.

C

We currently have active prosecution against multiple different people as well, some of which are for manslaughter partnering with the DA's office and then, lastly, last last month or excuse me last week, you might have heard of the prosecution of a Longmont gentleman last of uh first of tan, tan, first and last of tan tan, he was convicted on multiple charges, drug charges containing or related to Fentanyl and methamphetamine.

C

Why I say this is important, is because the equipment that was successful or helped in the conviction of these people are is the equipment that I've asked for with the opioid litigation fund, the approximate ninety five thousand dollars a year out of each year? It's looking like at 1.7 mil we're doing 95.

C

This is helping the community members around uh Boulder County, giving a successful prosecution. Now I gave you a whole world with this stuff and I passed over some things that you might have questions. So is there any questions that I can answer or any research I can find out and get the answer for you.

A

Doesn't I see your hand thanks.

D

So much for the the information that I wasn't able to see the map very well. I, don't know, I was trying to zoom in on it. Is there a way? um Will you be sending this out? Did it get sent out and I just didn't see it.

B

It hasn't been sent out yet, but I can send them afterwards. Yeah and I know Nico and me you could probably speak more to this. It was um it wasn't populated with any localized data, so it was mostly just yeah, so it was sort of more of a static image to show you what OD map is, but it um I'm not sure it had any actual data on it. No.

C

I I did not I did not have the data on there that there's. uh We cannot give people access or see that it's it's just the the contract we have with odmap um the partnering agencies, law enforcement, coroner's office, DA's, uh Boulder, County, Public Health will be able to see that data. uh When they are all signed up, then they can share that information with the preventative and treatment um facilities. All over right, saying, hey, we've had a high rise of something occurring in this area.

C

Let's come up with a plan to battle that and see what we can do, but yeah you will not see that and I want to focus again is you will not see addresses? You will not you'll see very very general areas where uh an overdose occurred of some sort right. It does not delve down into the minutia of the address of at 1234. Main Street never gets like that, and it's also encrypted. So no one that information never comes out.

D

And this is just a second quick question: it's a little bit naive, probably on my part, but just as far as the Law Enforcement cases I'm, assuming these are all direct distribution cases and that I understand that law enforcement is probably looking for the source. How often are they successful in in finding the source, uh whoever is making the drug and and has a broader distribution of it.

C

And that's a that's! A good and hard question uh time is life and I mean that seriously? um If we can, let's say hypothetically, we can get a phone from a victim or um we're able to arrest the drug dealer and get into his or her phone quickly.

C

We have better chance of of doing that and that's what this equipment does. I can't give you a hard number, but the equipment gives us the chance to do it without this equipment with whether it's a locked phone or it's been turned off, and we again, we can't have access to it.

C

We will never get the information to find out who the other source of Supply is we'll, never get enough information to give enough to the prosecution to charge different criminal charges against these drug traffickers, because that's where most of the information is is hidden is in the phones or I should say: digital platforms, computers or anything else.

D

Thank you very much. You're.

C

A

Nico I know it's it's early in the game and I know you don't have a crystal ball but I wonder if the increase in overdoses is indicating, you know a potential increased threat and will we see more and is that what the law enforcement agencies are worried about and is there? Is there a call to action related to that Beyond? What's already happening.

C

I think we are at our our. We have done so much for the notifications to the public about the drugs in our community.

C

It's almost can't get any clearer than that, except we can keep repeating the same message we keep battling or trying to find out these drug traffickers are when we take one off two, three or a whole group.

C

um There are more back there right, so the law enforcement part of this is we will never stop the drugs from coming in, um prevent to me means stop. We will not prevent, we will lessen the amount of drugs coming into our community, meaning we will lessen the chance that somebody could die or give a better chance at less people will die. If that answered your question, um but it is never ending.

A

Understood. Thank you.

A

Are there any other questions for Nico or um wonder if anyone wants to share their perspective and observation? What's happening locally, that you're seeing um and then the final question Kelly and I had is around? Are these sorts of updates useful and how often should we be bringing them forward? I think the secondary um interest on our part is again just putting real time um names, not people's names, but that these are people's lives.

A

And if you remember our first rock meeting had a person with lived experience, and so we want to periodically check in in that way as well. So welcome any observations or comments about how often we should be reviewing the local scene.

D

I wonder about quarterly I, don't know how often the data changes but I wonder if quarterly might be good.

A

Thanks Susan Lexi, you have your hand up.

E

Yeah um Nico, thank you so much. um This was a really helpful presentation and I think we're already seeing the dividends of investing in the OD map uh collaboration. We've recently had some unfortunate incidents, as you mentioned in our community and um from public Health's perspective.

E

It used to take a really long time, sometimes months, to get the information back, and you know I feel like we're at the beginning of the exploration of what this technology can do, to support us to be much more Nimble and responsive to our community needs and I would just encourage us to to continue to think creatively about how we can use the information um really advancing.

E

um Recognizing that needs may change over time that it's. This is a very Dynamic space um and that new needs are occurring and we may find that new Solutions are needed to as we begin to move into response modes more quickly. But thank you very much for this. It's beginning of what what I hope will be a really useful tool for us.

C

You bet, one thing I did forget is to inform you. We started inputting data into OD map September of last year, so I can't give anyone a real comparison on what it last year was compared to this year. The only thing we could, unfortunately, do is look at the numbers from the coroner's office, but this is the first great year where all the agencies, putting in that information, will help give you guys a road map of where we are live time for the decisions that you make.

B

Thanks Miko were there any other thoughts, observations, questions or comments before we move forward.

A

Sounds like there's consensus about reviewing this data and maybe we'll start with quarterly, and then, if we have you know some explosion or emerging um issues that come up between those borders, we could bring it to the board.

B

Okay, thanks again for joining us Nico, you.

C

Betcha you take care, everybody have a great day, bye.

B

Okay, so next up, uh we did want to review a conversation that we had started in our March Rock meeting around the possibility of doing uh some testing of the County's waste water. To see sorry I keep getting email alerts uh to see if there's any Rising, Trends spikes um prevalence that we can sort of zero in on particular hot spots of opioids that are kind of coming up in the Wastewater, and so just a quick reminder of what this project entails.

B

So the background is really that Wastewater testing has been an ongoing effort, and specifically, during the pandemic, there was an increase in testing Wastewater to identify communicable diseases such as covid um the hot spots, the trends again uh sort of spikes, so that we could figure out. You know, are there areas that we want to Target our resources or have really targeted initiatives, or how do we we evaluate what's going on over time, so that translates forward to today when this technology is really being expanded to test for opioids within Wastewater?

B

And so what that might look like is you know, fentanyl traces coming up to identify uh where you know where these drugs are appearing within our community, and that could point us in the direction of having a more tailored approach uh to sort of tackling that in those specific areas. So, after our March discussion or I should say during our March discussion, really the charge from the council was you know to to go and investigate this a little bit further and see? What are we really talking about in terms of scope?

B

Opportunities, bring back some use cases. So where is this? Actually, this testing being done to identify opioids in Wastewater and what are what are localities doing with this information? So a little bit more of the answer to you know to what end um and then bring back an understanding of Financial and staff capacity that might be required to launch or stand up an initiative like this and then finally, The Rock provided the feedback that they would like this. To also be a conversation that the opioid operations group holds, and we are meeting uh this Thursday.

B

So we can carry forward both the March and today's conversation to that group for subsequent discussion. So really with that charge, we went and investigated with two primary sources, both uh biobot, which is the MIT based organization. That really uh leads and is advancing. The use of this testing technology, as well as our local uh or I, should say our state Partners up at Colorado, Department of Public, Health and environment cdphe, and so uh before.

B

We kind of go into those two um two viewpoints just wanted to have a slight caveat and mention um that this is definitely a conversation with many different uh perspectives and points of view and really just kind of again Echo that we're bringing forward this information from a neutral perspective, so that council members can feel more informed in having a conversation of whether or not. This is a good fit for Boulder County to pursue.

B

So, first up the summary that we got from our partners at cdphe um was that this is, you know, potentially an opportunity, but there's some some serious sort of drawbacks to to be considerate of um for cdphe uh itself. As an agency, there are some funding restrictions, uh so the centers of Disease Control at the federal level, are not allowing cdphe to fund uh any efforts around Wastewater testing for or for opioids.

B

So at this time it doesn't seem like there is any clear path for how to fund or sustain this effort, should cdphe determined to take that on um also some Express concerns around the drawbacks to the testing capabilities, uh so some ethical concerns around whether or not it would stigmatize certain neighborhoods or regions. If we're really drilling down uh to see that you know, opioids are spiking within said region or neighborhood. So a few concerns about what that might do at that ethical level.

B

There's also some concern that this is not really tested proven vetted quite enough in order for it to really be tied to any cohesive, Public Health response, either at the state level or any of the sort of local levels of Public Health Initiative. In response also, some concerns that testing for opioids in Wastewater. It doesn't allow us the ability to distinguish between valid use of opioids that might be showing up in the Wastewater, such as prescriptions versus invalid or illicit use.

B

So again, some concern that we're not really going to be able to get at that question of you know to what end. What is this data really telling us, and what can we? How is it meaningful and uh how can we act on it, uh and there was also some conversation about alternative testing sources, so we do know that state has surveillance data that has been in use by our Public Health Partners.

B

We also know that there are improvements coming to various State data about excuse me, dashboards data dashboards, uh both the cdphe, as well as the Consortium for prescription drug abuse prevention, are building out more of the indicators that are reflected on their data dashboards that speak to use potential, abuse of opioids and sort of different prevalence trends that uh you know this is a source, that's already current and present in in use by our Public Health Partners today.

B

So um just some, some hesitancy there from cdphe and I'll actually just deliver the the feedback from biobot as well, and then we can kind of pause for questions and see once we've taken it as a whole. I think that probably makes the most sense.

B

So the opposing side uh of this conversation, I shouldn't, say opposing but different perspective is biobot. So again, biobot is the testing and research organization housed out of MIT, that's really kind of leading the charge and using this technology to test Wastewater for a number of different uh communicable diseases, as well as fentanyl, traces and other opioids. uh So you know just kind of the brass tax.

B

First and foremost, the cost of this service would be approximately uh 50 000 per year per location, so that location would really be the number of Wastewater facilities that we have in Boulder County. That would include weekly testing of the Wastewater. It would also include program support, so there's a various there's, various uh capacities that they sort of bring in their team to assist in not just delivering the data, but helping us to incorporate it into our activities.

B

Our strategies, how we communicate to our our partners in our community Etc, our app, also biobot sort of sees the uh the stigma lens a little bit differently, so noting that many of their Partners actually choose to do Wastewater testing, because it is anonymous, and it is one of the ways that um we can figure out. What's going on enough at a local level that we can drill down and have targeted interventions.

B

However, at the end of the day, there are enough individuals within a community feeding a particular Wastewater Plant that it's it's essentially Anonymous at that sort of individual level staff capacity. So this was a question that the the council member members brought forward and just said what would it look like to actually participate in this concept?

B

um So primarily the capacity falls on the Wastewater testing staff to pull the actual samples and then mail them into biobot in discussion with their team. They mentioned that you know this is part of the everyday workflow of folks at the Wastewater facilities, already they're they're, drawing these samples on an ongoing basis and sending them into various compliance agencies, and so they have not found this to be of any strain to current wastewater treatment, plant staff uh and then in terms of County staff.

B

So we did ask you know how would this be accompanied or supplemented by you know staff should the county take it on, and they said that their team does typically work with a program manager who sort of leads the effort and pulls all the pieces together, uh as well as an epidemiologist, usually out of the public health department that helps kind of Drive the data into again.

B

That's that um that public health response- or you know, ties it to our initiatives and strategies and also provides a little bit more of the local context to the data.

B

So in terms of use cases, this was another question that we had uh the rock ask about. So biobot is doing Wastewater testing in 400, 400 locations, 250 counties and all 50 states. uh So we did pull forward just a couple of uh use cases so to speak to in Marin County California.

B

They are currently using this testing to identify opioid, spikes and Trends, and they too have sort of pitched their use of this technology as something that is uh reducing stigma and an approach that will actually allow them to drill down, but without actually looking at data that is not anonymized, so in Cary North Carolina. They are looking at this at a neighborhood level and also utilizing the information to have very targeted interventions within those specific neighborhoods.

B

The CDC Centers for Disease Control, National Wastewater surveillance system, as well as U.S HHS, are also using this technology right now to continue the um the monitoring of communicable diseases and spread of those diseases in certain areas.

B

um So I think it was HHS that had set in their press release that, as the clinical data sort of decreases around communicable diseases like covet or monkey pox that there's actually the ability to draw more usable data from these. That would these sources that would allow us to still monitor traces and prevent Resurgence of of those diseases.

B

So now I'm going to pause and see if there's any questions or just kind of open it up to the group to have some conversation around this.

A

Doesn't I see your.

D

Hand up yeah Kelly thanks so much um for digging into the details around this. It's really interesting and um I appreciate the the statement around kind of the stigma, stuff and I think it's something we run into with any geographical mapping that we do is we have to be really careful about how we're messaging things and how we're using the data. That's that feels really important, regardless of what what data we have um I'm interested in you know the Marin County and Cary North, Carolina and kind of their targeted interventions.

D

I think it's you know something we're trying to do across a lot of the work is, is how do we stretch the dollars that we have and and really Target our inventor our investments to try to to get to the people who are in uh in the most need and I see that the same in this area? So it's it's really interesting and I appreciate also the flip side of some of the complications and the expense and- and it's not- it's not perfect, uh either, but really appreciate the details.

B

Yeah and I'd be happy to get more information about um these three use cases and the specific sort of interventions that they put in place around this data. If that would be helpful to kind of flesh out that picture a little bit more.

D

Yeah I mean I, do I appreciate. The other side of this, though, is that there is prescribed opioids that are going to show up as well and there's no way to know the difference, but I you know, is there something about that that can lead to you know, use or abusive of um illegal drugs? You know because they're so addictive and if you know even targeted interventions for those for those people or those neighborhoods could benefit them in the long term. Potentially.

A

E

Thanks yeah Kelly I'm, hoping um you might be able to clarify uh Susan's Point real quick I've heard conflicting reports on whether the technology can distinguish between uh prescription, opioids and.

E

Other illegal use, opioids or kind of street drugs, um I and I- don't know the answer to it, but um some folks that I have had conversation with have said. Actually the technology can, just you know, distinguish between many different types of fentanyl, for instance.

E

um The other question I have is what I'm seeing on your slide is that the use cases include in all 50 states and I'm curious. If you know, is there a group in Colorado, that's been um using Wastewater treatment tracking for opioids.

B

I don't know if there is specifically a group in Colorado I do know that the biobot team mentioned that they were working closely with the coax at the Attorney General's office to see if there were opportunities, so it seemed like there was starting conversation around the potential partnership um to really kind of move into this space.

B

I know that some of the conversations they had mentioned were a little bit more focused on Denver as a region, so probably just trying to to kind of enter the state through the most populated Zone first, but I'd be happy to find out. If there are, you know, some of those are captured um within I would assume if all 50 states are reflected. There's some in Colorado, so I'm happy to figure out some more there. I will say a majority of the county level ones.

B

um When I did look were in the state of California and I I, don't know any. You know any inference of what that means, but I know that they have a strong presence in the state of California.

B

Sorry Robin go.

A

Ahead, um Maria I just put a thing in the chat, um but she also passed along that. Csu has developed um an assay for 22 opioids and Other Drugs, including Fentanyl.

A

um She thought I don't want to speak for her, but what she mentioned was um she. She thought that one sample site for these 22 um would cost a thousand per sample, so that's considerably less expensive than the biobot, so Kelly, maybe that's something that you could follow up on um as well.

B

Yeah for sure, happy too and I should clarify too some of these use cases. You know I I, see it says: 50 states reflected um not all of them. These are use cases around use of this technology for opioid testing. So um you can see like the CDC example. That's what I included that one is really they're still using this uh primarily for identifying the spread of uh or prevalence of communicable diseases and sort of in that consideration. Phase about extending that use outward. So just a point of clarification.

B

E

B

I also realized Lexi, I, didn't answer your first question about uh the prescription: drug prescription, opioids I, don't know the answer to that. One I know when we spoke to them. They really focused on fentanyl as something that they can pull forward and so I think that was um really. uh You know in an implied indication of more of an illicit sort, but I don't know if that's maybe just me trying to make that connection. I am happy to dig into that a little bit further and see what the sort of capability is. There.

A

I think the at this point we're not going to make a decision either to both go forward or not I. Think the the decision I would like to hear from the board is um whether this is worth continuing to use staff time to explore to get the opioid operations groups feedback as well um it.

A

It feels to me and I may be wrong check me on this- that there's still enough curiosity about it um and again, I think I think we're all grappling with you know, who's being impacted and then what's our response, whether it's some sort of you know campaign or um directing resources to a specific neighborhood or recognizing the issues of stigma.

A

So I just wanted to check that with the group and see if there's a thumbs up to move ahead with exploration or if people feel like you have enough information uh to to make a determination given, given that commissioner Levy and Maria are not available today, I I would table a final vote, even if you feel like you're ready to make that decision today.

A

um Susan was your thumbs up to continue exploring yeah yeah. Any other comments.

E

um Just that uh the sense that I got from some of the communications with the state and with our Public Health Partners in other counties, is that this is an ongoing conversation that um I'm not seeing folks jumping into uh super quickly in terms of a decision.

A

Thanks for that,.

A

So Kelly I think to continue to explore and yeah. You know again: I want to support your Your Capacity um in terms of what you might need and to to continue this work, um and um you and I can just keep in touch about that sure.

B

Yeah, no, that's really helpful. I think you know having these really specific questions come forward. Is um it kind of streamlines that, because we're able to kind of be in communication with these teams now and just get right to the Brass tax of what's most interesting uh for council members to hear a little bit more about so it's great.

A

So I would invite any council member if, if after the meeting is over, if a question comes up or if you've heard something from another Community or any colleagues that you want to pass on to Kelly in the meantime, that would be welcome for sure.

B

Any other questions before we move on okay, so another update to a conversation that we started in our March Rock meeting is around our selection process for an agency that might assist us um with some facilitation, Community engagement, strategic planning and evaluation around our opioid abatement strategies, so just wanted to give a snapshot of the process so far. Some of this is a little bit repeat from last time, but some of it is new.

B

Since then we did receive six responses to the request for proposal and we did take a first dab at the initial grading by staff. We took summaries of four of those six remaining that we thought were worth. You know having the operations group weigh a little bit more in on. uh We brought those summaries to the Ops group in March and we had some discussion around. What's the preferred approach of this group, what are some next steps that the group sees as relevant?

B

Would group members like to be involved in those next steps and what are the preferred follow-up questions to have in those subsequent conversations?

B

um Then we had a similar conversation in our last meeting together and just kind of carried forward. Some additional questions that rock members did want to see. These finalists agencies speak to in a little bit more detail.

B

Three of those agencies were moved forward to interviews except around the conversation and questions that came forward from both the Ops group, as well as the The Rock. We also allowed participation from Ops group members or I shouldn't, say a loud welcomed, uh opscript participation in those interviews and provided recordings of the interviews back to the full group afterwards. So if you were able to also weigh in who were not able to attend those interviews but still wanted to to kind of weigh in on the on the agencies,.

B

So these are the three finalist agencies that continued to the interview process and really the conversation that we had in these interview process or excuse me in these interviews- was uh the questions that this group, as well as the Ops group, carried forward about Community presence. What is the opportunity or plan for their staff and their agency to be present in the community?

B

How do they plan to sort of engage community members and have a local context, because if you can recall, many of these agencies were from based out of states, and so we knew that that was something that was really important to hear more about uh evaluate evaluation techniques. So all three of these programs did apply for both the facilitation piece, as well as the evaluation piece of the RFP.

B

So we did want to hear some specific questions around evaluation technique and the approach to measure impact across not just the programs, but also the suite of programs as a whole. We also wanted to hear more from the staff that would be on the project and so welcomed each of these teams to bring any of their staff members. That would be involved in the process forward, so they could speak a little bit more to their sort of touch on the project and their their credentials and experience and similar work.

B

And then we also asked the groups to speak to their own sort of perceived barriers or challenges and how they might plant and mitigate them. In doing this, work in Boulder, County.

B

So our recommendation at this time is to move forward with third Horizon strategies, um so really the uh the strengths that came out for third Horizon um were multiple, the first and foremost they do have a local presence. They have staff that will be leading this project that live in the Denver metropolitan area.

B

um They are well versed and immersed in the um koak and the opioid abatement efforts at the state level with the Attorney General's office, so they were able to reflect a really strong understanding of what's going on both locally and nationally around opioid abatement. We also received some really strong references from the references that they put in their RFP, particularly I wanted to call forward that uh they were one of their references mentioned that there's they.

B

They thought that their biggest strength was in their Community engagement approach and having a really meaningful stakeholder engagement process and really being intentional about how they folded in stakeholder input into any recommendations or products that they created. So we I thought that was pretty important to reflect since it's come up so many times in conversation with the operations group, as well as this Council.

B

In terms of their evaluation methods, they were able to speak to sort of a mixed method approach, which was really great um so, first and foremost knowing and utilizing any of the data sources that are already available within our region, as well as looking into other investigative work projects, groups that are doing similar um sort of Investigations so that they can tie these efforts together again. That collaboration piece is it's something we heard come forward as a a priority or value both from this group and the operations group.

B

um Also they. They were very intentional about being aware of the state's reporting requirements and, what's or at least the timeline for which we'll be hearing a little bit more about the state's reporting requirements and how they plan to sort of roll that into their evaluation technique. They also wanted to base their evaluation on a strong understanding of each intended impact of each in each individual program.

B

So you know they were able to reflect this understanding that each of these programs are going to be held to a different level of outcome process outcomes Etc based on what they're really hoping to achieve. But then also, how are we tying those outcomes and evaluation of those outcomes into a broader picture? And then they also were really. uh You know, conscious of speaking about this from a system level, so you know ways and methods that they would illuminate system gaps.

B

Looking at data gaps that are sort of known and how they use proxy measures or other supportive means to sort of fill those gaps until the full full story of what's going on within our community and then finally, one of their strengths was really the the staff and the credentials and experience on similar bodies of work for those who would be most involved in in leading this project from third Horizon.

B

So I want to pause and see if there's questions any concerns with this recommendation.

A

I just want to remind the group that the board did did say that we would. We supported um staff in the Ops group to make the recommendation, but we're interested in if there's any concerns or other things. That you'd like to note before we proceed with Contracting.

A

See none Kelly I just want to commend you. Oh Lexi, you have your hand up I'm.

E

Sorry, I'm always just a little bit late to the game. um Kelly I'm just wondering if you have any insight um and additional information on the point about their local presence and handle on local context. If you could share that.

B

Yeah, so their lead, investigator, Mindy, I, I, believe it's cloud in or cloudman I apologize for losing sight of the last name. um She lives in Denver, she's, been local to Denver area for a while and has been involved in opioid abatement. Work addiction, work, research around recovery systems across Colorado, so it's I'm happy to get a little bit more information. Those are the things that really stick out for me.

B

um I know that the local presence was something that you know. Both groups really echoed was super important. Mindy was able to speak to how they plan to budget to be in person for specific meetings, specific meetings that they knew would be better to lead in person versus ones that they thought could potentially be facilitated virtually.

B

So it was really clear that there was some forethought into you know how they were going to be as present as possible, both physically and sort of having their finger on the pulse of the local context as much as possible.

E

Thank you and that's a nice alignment because, as I'm looking at the website, I see that she's the managing director specifically for Behavioral Health. So that's a good match.

B

Any other questions about this decision or recommendation before we move forward.

A

Ellie I just wanted to thank you and commend you another staff, as well as the Ops group who participated in this process. That seemed really thorough and thoughtful. um So so thank you for bringing this recommendation forward. Yeah.

B

Absolutely we're excited to get working with them. We know we have. We've got a lot to tackle, so I'm excited all right, so I'm gonna go ahead and move us forward with some updates from the state, um and we do have Jamie Feld and Jack Patterson from the Colorado opioid abatement Council, the Attorney General's office joining us again, I believe they were on our February call, so uh just to kind of cue up some of the updates.

B

um So as a reminder, we do meet with the coax staff, as well as representatives from the other 19 settlement regions on a monthly basis on a learning uh collaborative uh call, and so just wanted. To kind of. uh You know clue in the the group about some of the um updates that have come from the previous meetings as well as what's coming up in May, so in March the collected used that meaning to demo a data dashboard, so the dashboard really kind of covers what each settlement region is doing with their abatement dollars.

B

It gives you an understanding of how much their funding allocation is, where they chose to sort of allocate dollars a costs across the three main category areas, and so it's sort of driving an awareness of.

B

What's going on in other parts of the state uh in April, the group hosted se2, which is the contractor that the state has chosen to launch a Statewide Public awareness campaign, and we had some really good conversation around what we would like to see come from a Statewide campaign and also what we would like to not see, and so um these are the three questions that we had some conversation around.

B

You know: what do you want to see in a campaign what would be a deal breaker in a campaign and Are there specific opportunities in your community where the campaign could have a presence, so good discussion. There I think some of the examples that came out were you know, make sure that you have all of your resources and materials in multiple languages in terms of some of the deal breaker conversations, what stood out for me was any messaging that has stigmatizing or fear-based.

B

Language is just kind of a deal breaker across the board, for you know, representatives from all of the regions, and so it was a really good conversation and then coming up in may. We are going to have a focus on fiscal and expenditure report, which is really exciting because we'll know a little bit more about what our obligations are in terms of what we need to pull from our recipient programs and report back to the state on an ongoing basis.

B

Some other updates, uh so Jamie had mentioned this in our last meeting, but our settlement amount did go up from our recent settlement from CVS and Walgreens right now, our total sits at approximately 30 million still across that 18-year Arc and then a little bit about a Statewide conference that the coax will be hosting every year, the in August they well.

B

This will be the second year, but August 16th through 18th uh will be the dates for that conference this year and there's a link if you want to provide some feedback about what would be most useful for you to hear more about at that event. So that said, I'm going to pass it off to Jamie and Jack to sort of expand or add anything I missed.

F

Ellie I think you got it all, so that was a great update and I'll. Let Jack say if there's anything more, but I just want to reiterate our appreciation for Boulder County staff participating so actively in our regional forums and being um so responsive. um We also appreciate Boulder County staff, assisting with the recent participation forms that we had to gather around the state.

F

All the participation forms were gathered for Boulder County region, including Jamestown, which is notoriously difficult to reach, um so really just a huge kudos to your staff and um to all of Boulder County for the act of collaboration, um and please just let us know if there's anything we can do for technical assistance.

F

We have a great team, I'm Jack Patterson who's here on our teams, very responsive and manages our opioids email, and so, if, if one of us doesn't know the answer, we'll get you to the right folks, I did put the link to our dashboard on in the chat. Once we get, you know more information about um every part, we'll we'll let you know as soon as possible, um particularly around the settlement numbers, the expenditure reporting process, um but we we really are working front line with your Regional primary contacts, which is Kelly Jim adamsberger.

F

um To relay this information to you all so um again, thank you for the work you're doing um we're excited to see the next steps with you hiring this facilitator and then please, let us know you know, as a former Boulder County employee I, just always love hearing about the great work you're doing so we look forward to staying tuned in.

F

Jack is there anything I missed.

G

No I think uh Kelly I think pretty much all of our updates as as I think just a testament to how engaged Boulder has been with the state efforts and I. Just again would shout out both to Kelly, as well as to the to Bob, Halpin and Jim for all these sessions, as well as all the other additional support staff for uh the continued partnership, especially with the opioid salmon forums. So thank you all and please uh do not hesitate to reach out if we can be of any additional assistance.

B

Thanks Jamie thanks Jack sorry I just meant to cue it up and then I just kept talking.

G

um I think actually, the only other things uh to mention are the state will be uh Jamie. If you want to touch on the infrastructure and Innovation part.

F

Yes, so um we will be sending now a notice um through our newsletter about two funding opportunities. One is the infrastructure share and one is the Innovation share.

F

um They have our Colorado opioid abatement Council, which oversees the infrastructure portion um has made a slight Amendment to the policy to recommend not only underserved but also rural communities, for the infrastructure share, and that will be posted early May and go out through our newsletter and then another complimentary funding opportunity is the Innovation Grant, and this is an exciting new funding. Opportunity that comes out of our state share to fund Innovative models to drips the opioid crisis, there's going to be three funding, tiers, small, medium and large and I think you know Boulder.

F

That might be one area you want to think about as Boulder often Pilots Innovative projects to address this, you can include in why it's Innovative, as well as maybe, if you have any anticipated evaluation to show how this could be replicated in the state um that will be also launched in May on our website and through our newsletter. We'll have to be a little bit radio silence once it goes. Live May 1st, but there'll be information from our procurement team.

F

If you have questions and a question and answer period as well as office hours for each of those funding opportunities, so those are all meant to supplement Regional funds.

F

So, in addition, this would be on, in addition to your Regional Council funds, and one thing to note is that part of the application for infrastructure is that it recommends that applicants reach out to the regional opioid abatement councils first to get a letter of support before applying, because we really want to, especially for the infrastructure, ensure that the Regional Council has some awareness of these applications, and the last piece about that is that the infrastructure is available only for the regional councils and governmental entities, whether State, local participation, local governments, counties, The Innovation will be open to those entities as well as non-profits and for-profits, most likely so a little bit broader, again.

F

Yeah more information to come, but particularly for the Innovation Grant I. Think that might be something this group might be interested in.

A

Jamie, what are the due dates for those opportunities we.

F

Once they're launched, the due dates will be specified but I'm, anticipating that our grants coordinator will put the end of June for both of them so launch, probably early May um due date. End of June.

A

Yeah, just it just matters to us for being able to have a discussion about what we might submit um and- and you know figure it out- that timing, yeah.

F

Any thoughts about that we they have not been finalized. Those due dates, um I'd be curious, is two months seem feasible for um from your perspective,.

A

Well, I think that's plenty of time to submit an application, but the issue with us is with monthly meetings yep. We would have to have that discussion prior to a submission. So so that's the timing issue for me. That would that's what happened to us for the last round. Yeah.

F

We have I think the the finalized version will say that erect that the letter support is recommended strongly recommended, but not required understanding that a lot of councils won't be able to meet in that time frame. And then the applicant could put a reason why they didn't, um but that is that is um specified in the current version that it's not required and that they could say. You know, because the committee doesn't have time to meet and approve prior to the submission.

A

Thanks for that,.

D

A

Great I don't want to put you on the spot, but we've got a previous conversation about the Wastewater testing for opioids. If you've been involved in some of those conversations, um Kelly provided a great overview of you, know, sort of the pros and cons, including reaching out to the MIT group as well as cdphe.

A

Some council members had some other some other thoughts. We're going to continue to explore it. But I didn't know if you. If there was anything you cared to mention I'm.

F

Hesitant because I I'm not wearing my Epi, like my background as an epidemiologist I'm, not wearing that hat in this current role, um I think my one thought around it. Having seen the response from cdphe you know is that there are some other surveillance mechanisms that are already in place like the syndromic surveillance that might not be fully used to their existing potential, um and so you know sometimes at least when we were considering whether we would fund it at the state level we thought like.

F

Are we even using our existing surveillance for actionable items like timely syndromic surveillance, which gives you you know, emergency room visits, um and then there are some concerns, I think with Wastewater around it not being able to differentiate between opioids for treatment like Suboxone versus opioids, for you know, misuse or as prescribed and so I think those are some limitations to using it as like an actionable surveillance tool um and I. Think too.

F

The last thing is that there is, you know, Staffing capacity issues with it, um just as with any surveillance system, um but I think it's always interesting to pursue it a little bit further and I know yeah Lexi Nolan and um your commissioner reached out to us um when, when she was a city, the mayor of Lafayette- and we did start some conversations with biobot, so always interested to continue those conversations.

F

And then I think last yeah go ahead. Sorry, Robin, no I, just I was just thanking you, okay, I would say. The last comment is that we have not, at the state like finalized, a really great robust surveillance system, at least from the Attorney General's office, so I do understand kind of the need or the desire from locals to get ahead of it, because at the state we don't have a finalized version available. So I do understand that that interest.

A

Any other questions for Jamie or Jack her comments.

A

B

I think that was actually that was it for us, so we we might have a big gift of time here unless there's other items for the good of the.

F

B

Yeah uh Lexi, it was around 17 million 17 and a half ish million.

A

Any other input or announcements or updates from any of the council members that they'd like to share.

A

I saw a public notice that the city of Boulders council meeting on Thursday is going to have an update on specifically on meth, so that'll be interesting. Lexi are you participating in that.

E

A

Okay, well not seeing any more comments.

A

um Thanks, everybody for your continuing engagement and for the discussion today, um we have one more meeting scheduled so you'll be receiving an email from me trying to schedule the next two months uh for June and July. It's a difficult group to schedule, but I'm always going to try my best to get at least two meetings on the books at a time.

A

um So thanks again and have a good rest of your day and week.

A

E

Thanks everyone.