►
Description
Briefing of the Buncombe County Board of Commissioners on March 21, 2023. The briefing is a chance for Commissioners to review agenda items before the meeting. No motions will take place during the briefing.
A
I
think
we're
ready
to
get
started
Commissioners.
Are
there
any
questions
about
any
items
on
our
agenda
for
today
or
any
other
items
other
than
those
that
are
listed?
That
Commissioners
would
like
to
discuss
at
the
briefing
meeting.
A
And
the
first
item
is
a
staff
update
on
the
homeless
initiative
advisory
committee.
Matt
cable
is
here
to
help
us
out
with
this
item.
Thanks
Matt.
B
There
we
go.
Thank
you
so
just
as
a
reminder,
and
particularly
for
the
benefit
of
the
public,
who
is
here
and
viewing
I
know
that
there
have
been
a
lot
of
conversations
recently
around
homelessness,
including
the
meeting
that
was
held
in
January,
but
just
to
explain
the
relationship
between
Hayek
and
the
Continuum
of
Care,
as
well
as
to
briefly
explain
what
the
Within
Reach
plan
is,
so
that,
as
we
reference
those
entities
and
that
document
throughout
the
rest
of
the
presentation,
there's
some
context.
B
So
the
Asheville
Buncombe
homelessness
initiative
advisory
committee,
also
known
as
Hayak,
is
a
joint
committee
of
the
Asheville
city
council
and
Buncombe
County
Commission
that
serves
as
the
governance
board
for
the
Asheville
Buncombe
Continuum
of
Care.
So
it
the
Hayak,
is
an
entity
that
serves
as
the
capacity
of
the
actual
Birmingham
Continuum
of
Care
and
a
Continuum
of
Care
is
an
entity
that
guides
local
communities
in
effectively
responding
to
homelessness
as
a
unified
system.
That
entity
creates,
implements
and
evaluates
policies
and
strategies,
as
well
as
steers.
B
Federal
resources
allocated
to
homelessness
to
most
effectively
address
homelessness.
So
again,
the
Hayak
is
an
entity
serving
in
the
capacity
of
the
Continuum
of
Care.
At
the
current
time,
the
Within
Reach
study
or
plan
again,
which
you
received
in
January,
and
a
joint
meeting
between
city
council
and
County
Commission.
This
plan
is
intended
to
identify,
needs
and
develop
recommendations
to
guide
homelessness
work
within
our
community.
It
was
authored
by
the
National
Alliance
to
end
homelessness,
which
is
the
non-profit
organization
committed
to
preventing
and
ending
homelessness.
B
Also
at
the
meeting
in
February,
they
adopted
the
Within
Reach
goals,
so
those
are
specifically
listed
here.
I
will
note
that
the
last
goal
wasn't
specifically
included
with
within
the
within
reach
study,
but
was
added
by
Hayak,
which
is
to
promote
Equity
to
advance
change,
but
the
other
goals
be
bold,
create
accountable
and
transparent
governance
structures,
build
trust
through
Unity
collaboration
and
justice,
focus
on
Housing
Solutions
value.
The
voice
of
people
with
lived
experience,
maintain
Fidelity
to
data
and
evidence.
B
B
So
the
first
of
the
four
work
groups
is
the
governance
work
group
and
their
job
is
to
prepare
a
new
Continuum
of
Care
governing
Charter,
and
this
is
to
transition
from
Hayak
to
an
independent
Continuum
of
Care.
So
the
Within
Reach
plan
provides
a
lot
of
details
about
that
potential
transition.
But
the
focus
of
the
governance
work
group
is
going
to
be
to
look
at
the
the
model
of
a
new
Charter
and
then
how
to
actually
execute
that
activity.
B
It
includes
each
include
a
person
with
lived
experience,
at
least
one
also
representatives
from
the
Homeless
Coalition
County
Representatives,
both
elected
and
staff
representatives
and
then
City
Representatives,
again,
both
elected
and
staffed,
depending
on
which
work
group
in
the
governance
work
group
gen
Teague,
who
serves
as
our
Hayak
member,
is
also
chairing
of
the
governance
work
group,
the
shelter
work
group.
This
group
is
focused
on
leading
efforts
to
plan
for
and
Implement
newly
funded
shelter
bed
capacity
by
30
So.
B
That's
its
targeted
work,
commissioner
Beech
Ferrara
is
serving
on
that
work
group
as
well
as
Rachel
Nygaard,
with
strategic
Partnerships,
so
they're
serving
in
that
capacity.
The
coordinated
entry
work
group
is
working
to
update
and
revise
standards,
policies
and
procedures
for
a
new
coordinated
entry
system.
B
Jonathan
Jones
within
the
Community
Development
Division
has
been
attending
and
participating
in
those
meetings
as
representative
from
the
county
and
then
the
Outreach
and
encampments
work
group,
which
is
leading
efforts
to
create
a
comprehensive
encampment
resolution
policy
and
developing
a
plan
for
collaboration
of
multiple
current
agencies
involved
in
Street
Outreach.
The
current
County
representative
to
that
work
group
and
member
of
Hayek
who
is
attending
is
Claire
Hubbard.
A
B
There
are
a
lot
of
very
specific
details
within
the
within
reach
study.
It's
embedded
in
there
specifically
related
to
development
of
an
encampment
policy,
and
so
encampments
have
have
presented
issues
within
the
community
and
seeking
to
identify
a
way
to
resolve
those
issues
with
encampment
structures.
You
know
individuals
on
property,
that's
owned
by
someone
else,
some
of
the
things
that
that
they're
trying
to
address
it's
really
about
developing
a
policy
at
the
corporate
COC
level.
B
B
B
C
B
B
So
each
work
group
has
been
assigned
a
task
and
so
kind
of
their
first
job
is
to
identify
how
long
they
think
it's
going
to
take
them
to
complete
what
they've
been
asked
to
do
so
different
work
groups
have
been
undertaking
different
activities.
The
governance
structure
has
probably
the
most
established
time
frame.
B
There's
really
a
goal
to
get
a
charter
developed
by
June,
so
they
can
take
some
action
potentially
as
early
as
July,
the
shelter
work
group
has
been
doing
tours
of
shelters
within
the
community
as
kind
of
a
first
step
in
their
process,
so
each
work
group
will
kind
of
identify
they
have
their
their
marching
orders,
their
tasks
that
they
are
to
complete
and
the
chair
will
be
reporting
back
likely.
The
very
next
meaning
kind
of
what
the
time
frame
is
on
their
deliverables
is
my
understanding.
D
Thank
you
so
much
for
all
this
and
I
can
just
share
a
bit
more
context
from
this
working
group,
again:
Rachel
Nygaard
and
myself
from
the
county
mayor
mannheimer
from
the
city
with
Emily
ball
and
then
various
Hayek
and
community
members.
D
We
began
by
basically
reviewing
the
recommendations
that
came
in
the
nieeh
report
and
have,
for
the
last
several
weeks,
been
doing
in-person
tours
of
different
programs
abccm
the
winter
safe
shelter,
the
Jubilee,
shelter,
wnc,
Rescue,
Mission
and
Haywood
street,
so
far
so
more
tours
to
come,
and
that's
really
providing
some
really
important
dialogue
opportunities
with
folks
doing
really
critical,
Frontline
work
and
also
just
helping
us
continue
to
sort
of
really
tease
out
that
there
are
very
strong
program
options
within
Buncombe
County,
for
instance,
folks,
who
are
entering
into
recovery
programs
at
transition
or
and
and
living
at
transition
house
abccm.
D
Our
transition
Village
at
abccm,
for
instance,
but
that
this
Gap
around
High
access
shelter
is
really
where
this
most
pronounced
need
is,
and
so
you
know
the
recommendations
included
fairly
specific
breakdowns
on
the
types
of
beds
that
would
be
created
and
really
delineating
between
shelter
beds
versus
beds.
D
That
offer
that
really
are
part
of
a
program
we
have
as
a
working
timeline
within
that
group
and
talking
about
sort
of
a
three-month
timeline
for
being
able
to
bring
forward
I
think
maybe
some
of
the
first
ideas
around
recommendations
are
such
so
that's
kind
of
what
we've
been
using
within
the
working
group
for
for
a
timeline
conversation.
D
Is
my
understanding
as
a
member
of
the
group,
so
yeah
and
yeah
I
think
we'll
figure
out
sort
of
the
the
more
specific
timeline
for
when
formal
recommendations
will
be
ready
to
come
forward.
But
it's
my
understanding
that
that's
at
least
a
starting
point
in
the
timeline
that
we're
working
around.
B
And
I
will
just
mention
so
each
of
the
work
groups
has
met
at
least
once
not
all
of
them
have
established
their
meeting
schedule
yet,
and
they
are
meeting
in
a
virtual
capacity
outside
of
the
shelter
work
Group,
which
has
been
doing
some
touring
of
of
shelter
and
program
bed
facilities.
So
in
terms
of
having
a
definite
time
frame
for
a
deliverable,
they're
still
establishing
their
meeting
schedules,
but
all
have
met
at
least
one
time
to
begin
to
begin.
Their
work.
A
So
I
it's
obviously
there's
not
a
recommendation
yet
I'm
like
okay,
here's
where
the
additional
shelter
space
will
be
physically
located
and
operated.
So
I
know
this
is
kind
of
an
abstract
question
at
this
point,
but-
and
that
is
a
pretty
big
additional
increase
right,
so
so
wherever
that
ends
up
being
recommended
for
is
it
anticipated
that
whatever
funding
is
needed
for
capital
or
operational
costs?
For
that
30
increase
is
going
to
there'll,
be
a
request
to
the
city
and
the
county?
Are
there
other
resource
options
for
how
to
grow?
A
That
just
again,
I
know
we
don't
have
this
plan
yet,
but
just
thinking
about
something's
going
to
come
forward
right.
What
are
the
different
investment
options
in
terms
of
how
to
bring
one
or
more
facilities
online
to
meet
that
goal?.
D
Again,
I
don't
want
to
head
of
Meyer
anyone
else's
skis
in
this,
but
I
can
share.
The
kind
of
conversation
has
certainly
been
a
joint
funding
model
where
the
city
and
the
county
would
be
at
the
table
and
I
think
we'd
hope
to
approach
philanthropic
Partners
about
their
interest
in
being
at
the
table
as
well,
and
you
know
I
think
at
the
one
of
the
ways
I
have
heard
this
described
in
this
working
group.
D
D
This
need
that
we
have
and
is
not
currently
being
met
for
this
sort
of
24
7
365
days
a
year,
no
matter
who
you
are
or
kind
of
what
shape
you're
in
you
can
show
up
at
and
get
shelter
and
start
that
process
of
accessing
services
and
ideally
accessing
a
path
into
housing
options.
So
that's
kind
of
at
the
conceptual
level
now
the
particulars
of
whether
that's
all
housed
at
one
site,
whether
that's
housed
across
different
sites.
E
D
A
F
Good
afternoon
Commissioners
good
afternoon
so
today
what
you're
going
to
hear
now
is
Tiffany's
going
to
give
you
an
update
on
some
follow-up
responses
to
questions
related
to
the
gel
reduction
part
of
the
resident
well-being
group
and
then
later
there'll
be
a
conversation
around
kind
of
Overdose
deaths
and
opioids.
That
will
speak
to
the
substance
abuse
of
part
of
it,
but
before
Tiffany
could
start
just
want
to
let
you
know
that
kind
of
what's
coming
down
the
pipeline,
so
in
April.
E
Okay,
I
presented
in
Jan
gel
population
reduction,
enhanced
Public
Safety,
and
there
was
a
questing
question
particular
to
the
data
that
was
asked
about
the
failure
to
appear
so
for
people
returning
to
custody
due
to
failure
to
appear
what
types
of
charges
are
involved:
Lee
craden.
What
strategy
Innovation
and
myself
looked
at
the
data
and
the
strategies
that
we're
employing
as
it
relates
to
it.
E
So
over
half
the
people
that
are
returning
to
custody
due
to
only
failure
to
appear
having
a
misdemeanor
as
a
top
charge
and
when
we
broke
that
down
looking
at
the
misdemeanors
and
particularly
one-third
of
those
returning
were
the
lowest
level
misdemeanor.
So
that's
the
class
two
and
class
three
misdemeanors,
and
basically
these
order
of
arrests
originate
out
of
District
Court,
where
many
of
or
most,
if
not
all
the
misdemeanors,
are
heard
in
the
kind
of
lowest
level.
E
Court
appeared
to
be
about
70
percent
coming
into
the
Detention
Facility
for
just
a
failure
to
appear
regardless
of
the
charge.
So
this
would
include
felonies
as
well
considerations
regarding
failure
to
appear
so
in
February
we
looked
at
the
average
daily
population
for
those
in
custody.
Only
for
the
reason
of
an
order
for
arrests
for
not
showing
up
for
court
that
was
about
12.8
percent
of
the
pre-trial
population
and
41
of
those
cus
on
those
in
custody.
E
Out
of
that
20
12
excuse
me,
originated
from
court
dates
or
order
for
arrested
from
2021
or
earlier,
and
these
bonds
are
set
as
order
for
arrests
at
the
discretion
of
the
judicial
official
issuing
the
order
for
arrest.
If
there
is
no
bond
set
or
order
for
arrests,
the
magistrates
are
required
to
double
the
initial
Bond,
and
so
research
does
suggest
that
bail
Amounts
is
not
significantly
associated
with
failure
to
appears
many
reasons
that
people
fail
to
appear
in
research
has
shown
is
related
to
finances.
E
People
cannot
miss
work,
Transportation
barriers,
people
have
stated
Family
and
Child
Care,
no
amount
of
assigned
bail,
will
incentivize
people
out
of
the
barriers
of
transportation
and
work
conflicts,
and
we
have
studied
and
worked
on
this
order
for
a
rest
and
failure
to
appears
to
try
to
increase
court
appearance
and
some
of
the
things
that
we've
done
with
the
funding
of
the
safety
and
Justice
challenge
is
to
work
collectively
to
create
Court
reminder
cards.
We
have
big
signage
in
the
courthouse.
E
We
have
pocket
cards,
so
every
person
has
access
to
a
reminder:
we've
partnered
with
the
ID
Bureau
and
just
the
service
staff
to
enroll
people
that
are
being
released
so
we'll
do
it
for
them
we
get
their
permission
and
we
get
their
phone
numbers
and
we'll
automatically
we'll
enroll
them
manually
into
the
court
reminder
system
through
the
use
of
the
safety
Injustice
challenge
funds.
We
were
able
to
add
one
additional
attorney
to
the
district
attorney's
office
and
the
public
defender's
office.
E
They
meet
weekly
to
look
at
those
in
custody,
with
an
aim
of
either
Expediting
the
release
or
disposing
of
the
case.
We've
been
partnering
with
Episcopal
to
restore
driver's
license,
one
consequence
for
failure
to
appear
or
not
paying.
E
Fines
is
the
revocation
of
a
driver's
license
so
trying
to
reduce
barriers
and
then
really
addressing
and
working
towards
root
causes
understanding
why
people
aren't
showing
up
for
court,
not
only
the
research
that
we
found,
but
also
in
our
community
understanding,
substance
use
and
those
that
are
coming
into
the
court,
charged
with
substance,
use,
related
charges
and
ensuring
that
we
can
get
people
access
to
treatment
in
a
timely
manner,
and
we
also
implemented
most
recently,
a
court
Navigator
we
partnered
with
Goodwill,
and
we
have
a
kiosk
or
a
kind
of
front
desk
person.
E
So
when
people
are
coming
into
the
court
a
room
or
excuse
me,
the
courthouse
they
can
engage
with
somebody
in
friendly
face
to
help
way.
Fine
navigate
help
enroll
them
in
the
court.
A
reminder
text.
If
you
see
the
signage
to
the
right
of
her
or
her
left,
probably
helping
people
enroll
in
the
court
reminder
system
and
she's
also
able
to
connect
them
with
the
programs
and
services
that
we
offer
in
the
courthouse.
G
So
I
I
wasn't
going
to
offer
questions
as
much
as
just
make
sure
I'm
interpreting
what
you're
saying
correctly,
because
a
lot
of
this
is
is
positive
news
just
kind
of
tied
up
in
in
some
stats
here.
That
I
think
would
be
helpful
context.
So
most
of
the
class
two
and
three
charges
in
my
experience
have
been
really
low
level.
Non-Violent
misdemeanors
right
like
these
are
we're
not
talking
the
serious
things.
G
These
are
just
low
level,
largely
driving
charges,
maybe
an
occasional
resist,
but
largely
things
that
would
not
land
you
in
any
significant
period
of
custody
anyway.
So
we're
dealing
with
people
who
are
non-violent
offenders
who
are
missing
Court,
some
of
them
almost
half
of
them
from
charges
that
are
old
charges
2021
two
years
ago
and
that's
about
48
people
am
I
understanding
that
right,
no.
G
E
And
that's
the
it
could
be,
and
this
is
the
complexities
in
the
criminal
justice
system.
There
are
other
charges
out
there
that
they
might
be
showing
up
for
like
in
Superior
Court.
They
might
have
a
felony
case,
but
they
are
being
booked
on
the
order
for
arrest
for
the
top
charges
and
misdemeanor.
G
So
the
spirit
Court's,
making
a
determination
that
they're
not
dangerous
enough
to
Merit
the
custody
for
what
they're
facing
there,
but
they're
ending
up
back
in
court
because
of
a
low
level
could
be
I'm
not
going
to
hold
you
to
that.
But
in
general
that's
that's
the
story
of
some
of
the
people
that
we're
dealing
with
at
this.
E
Point
and
most
people
with
the
serious
charges
show
up
to
court.
They
have
an
attorney,
they
have
the
court
dates
and
what
we
didn't
mention
and
we're
working
on
and
our
district
court
judges
have
been
working
to
do
is
reduce
the
number
of
continuances.
Sometimes
people
are
asked
to
come
to
court
12
times
in
one
year,
and
so
that's
repeat
so
you
may
miss.
You
may
be
present
for
11
those
court
dates
and
then
miss
that
one.
Then
you
are
order
for
arrests,
may
be
issued.
E
C
So,
first
of
all,
I'm
really
excited
that
you're
looking
at
the
root
causes
and
also
the
court
Navigator
seems
like
a
wonderful
addition.
That
would
be
very
helpful
to
people
so
I'm
excited
to
see
how
that
plays
out
and
is
helpful
and
and
actually
my
specific
question
kind
of
is
what
Martin
was
getting
to
I
was
wondering.
Could
you
give
us
examples
of
class
two
and
three
charges
just
so?
We
have
a
better
understanding,
sure.
E
Disorderly
conduct,
possession
of
marijuana
the
one
thing
that
don't
have
a
lot
of
Rigo
room
is
DWIs,
but
they
are
technically
misdemeanor
level
offenses,
but
there's
a
lot
of
statutory
restrictions
to
be
flexible
with
DWIs
and
usually,
if
you
are
your
first
time
offender,
you
would
not
get
an
active
sentence
on
the
charges
if
you
were
convicted.
If
you
were,
let's
say
you
have
repeat:
charges
you
maximum
time
for
a
class.
Three
would
be
about
20
days
with
200
as
a
fine
for
a
class
two.
A
What
was
the
first
item
you
mentioned
on
that
list?
The
class
threes
you
know
before
the
marijuana.
What
was
the
one
before
that.
E
Disorderly
conduct
we
can
give
a
class
list,
I
don't
want
to
Rattle
me
might
be
more
familiar
in
Criminal
Court
than
I
am,
but
usually
those
real
lower
level.
Misdemeanor
larceny
is
a
good
one,
so
someone
shoplifting
and
getting
Maybe
there
was
one
actual
charge
of
like
in
the
grocery
store
or
at
a
shopping,
mall
and
you're.
Picking
up
something
under
a
thousand
dollar
value.
E
Yeah
and
one
thing
we
didn't
mention-
we
have
diversion
programs
for
these
type
of
misdemeanor
level
charges,
so
people
do
enroll
in
the
diversion
program.
They
can't
get
their
case
dismissed
by
the
District
Attorney's
office,
and
that
might
be
just
a
different
population
of
those
who
are
actually
enrolling
in
our
programs
versus
those
who
are
not
enrolling
and
then
also
not
showing
up
for
court,
and
we
can
probably
look
at
that
data
as
a
layover
who's
who
we're
missing
in
our
diversion
programs.
G
D
Thanks
for
this
update,
can
you
can
you
walk
us
through
what
tends
to
happen
once
someone
is
in
custody
because
of
the
failure
to
appear?
How
long
are
they
staying?
D
E
Can
look
at
the
length
of
stays
so
folks
are
expected
to
have
a
first
appearance.
The
next
day,
I
have
seen
just
sitting
in
court
that
population
might
get
missed
because
they're
an
attorney,
so
they
might
not
necessarily
get
a
first
appearance
court
date
because
they've
already
been
advised
by
the
judge.
E
So,
if
we're
not
actively
looking
at
whose
custody
somebody
might
sit
there
longer
than
they
actually
would
need
to
usually
pre-trial,
does
a
good
job
of
coordinating,
and
that's
only
if
they're
assigned
to
pre-trial,
and
so
that's
why
the
jail
review
team
is
like
integral
in
reviewing
cases
that
come
before
them.
E
So
folks,
don't
just
sit
in
custody
off
of
a
failure
to
appear,
because
sometimes
they
might
not
even
know
why
they're
in
custody
or
what
their
bond
is
and
I
think
we
can
give
dates
of
length
of
state
and
try
to
proactively
look
at
mitigating
people
staying
in
custody.
E
It
also
depends
on
the
bond
amount
if
they're
able
to
post
bond
and
if
they've
missed
several
court
dates.
It
might
be
that
the
and
I'm
speculating-
but
these
are
like
common
themes
that
we
see
So
anecdotally
speaking,
they
might
sit
there
until
their
case
is
actually
resolved,
because
it's
the
fear
of,
if
I,
let
them
out
they're
not
going
to
show
back
up
to
this
next
court
date.
H
I
guess
to
piggyback
off
of
that
you
mentioned
length
of
stay,
I
mean
there's
a
there's,
a
range
right,
because
it's
kind
of
almost
random
or
by
chance
or
accident.
Can
you
give
us
kind
of
a
sense
of
what
the
the
range
of
length
of
stay
is
and
it's
something
I'd
love
to
see
more
data
on
I
guess
at
a
later
time,
I.
E
Think
we
can
provide
that
I,
don't
know
if
we
have
it
readily
available
or
if
Lee
has
it
already
pulled,
but
it
can
be
the
next
day
they
get
out
and
it
can
sit
until
their
case
is
resolved,
which
may
take
weeks
to
a
few
months.
G
And
I'll
say
even
even
when
we,
if
we
did
come
back
with
that
data,
some
of
the
story-
that's
not
told
just
from
the
paperwork
itself,
is
what
date
your
court,
your
next
court
date
set
on
by
the
Ada.
So
if
they
pick
the
officer's
date
who
arrested
you,
that
could
be
19
days
out.
That
could
be
later
that
week,
but
that's
not
something
that
the
county
or
anyone
else
on
our
side
would
have
control
over
and
also
to
mention
I
neglected
to
mention
that
one
of
the
more
important
on
second
degree
trespasses.
That's.
E
E
It's
the
same
kind
of
we're
talking
about
like
homelessness
and
who's,
getting
picked
up
and
who's
sitting
in
jail
for
being
homeless
or
trespassing
in
communities
and
I.
Some
people
have
no
court
date
that
are
in
our
jail
that
a
court
date
hasn't
been
assigned
yet
for
and
I
think
Martin
being
Criminal.
Court
could
speak
more
to
it
than
I
can,
but
the
defense
and
the
Ada
maybe
not
being
ready
to
proceed,
so
they
might
sit
in
jail
and
not
have
any
court
date
assigned.
D
Making
this
presentation
and
before
beginning
want
to
just
take
a
moment
to
recognize
that
many
people
in
the
room
who
show
up
every
single
day
and
often
work
through
the
night
I'm
working
on
these
issues
and
across
multiple
departments
within
montgom
County
government
and
the
Sheriff's
Office,
have
stood
up
some
of
the
most
life-saving
impactful
and
innovative
programs
that
that
we
see
in
in
the
state
and
in
some
cases
in
the
country,
and
also
that
many
many
people
in
the
room
have
very
personal
stories
that
bring
them
to
this
as
well
so
before
beginning.
D
Any
conversation
just
always
want
to
take
a
moment
to
recognize
folks
who
are
on
the
front
lines
of
this
work,
with
a
lot
of
gratitude
and
folks,
myself
included,
who
have
lost
people
to
addiction
and
and
Carey.
This
was
part
of
our
stories
so
with
that
I'll,
just
very
briefly
kind
of
tee.
This
up
and
then
turn
things
over
to
Parker
and
then
he
par
he
Martin
and
I
will
sort
of
tag
team
and
then
open
it
up
to
a
discussion.
We
very
much
look
forward
to
it.
D
The
commission
and
staff
level,
just
at
the
impetus
for
this
conversation
today,
is
the
recent
trends
that
we
are
seeing
in
Buncombe,
County
related
to
Rising
overdose
deaths
and
there
those
numbers
having
reached
an
all-time
high
in
our
community
and
feeling
like
it,
was
really
important
for
us
to
have
some
dedicated
very
focused
time
for
discussion
about
how
we
respond
to
that
reality
and
how
we
can
build
on
everything,
we're
learning
about
programming
and
services
that
are
saving
lives
to
reach
more
people,
including
those
at
highest
risk.
D
All
of
this,
of
course,
falls
under
the
very
big
umbrella
of
the
total
portfolio
of
of
work.
That's
happening
through
Buncombe
County
government
through
the
Sheriff's
Office
and
many
many
Community
Partnerships,
responding
to
the
very
acute
need
to
save
lives
and
reduce
overdose
and
overdose
deaths,
and
the
ongoing
work
of
supporting
people
as
they
move
through
the
treatment
and
recovery
process
and
rebuild
their
lives,
so
just
wanted
to
take
a
moment
to
sort
of
situate
today's
conversation
and
and
lift
up
that,
because
the
issues
of
addiction
are
so
multifaceted,
oftentimes
when
it.
D
When
a
presentation
comes
to
us,
we
hear
about
many.
Many
things
at
once,
and
our
hope
today
is
really
to
have
a
laser
focused
conversation
about
one
thing,
which
is
how,
as
a
community,
we
can
first
of
all
name
what's
happening
and
name
it
as
a
crisis
and
then
how
we
can
respond
so
that
we
can
reduce
the
number
of
deaths
happening
as
a
result
of
overdoses,
all
of
which
is
to
say
really
how
we
respond
to
a
crisis
to
save
more
lives.
D
And
today's
conversation,
rather
than
being
another
sort
of
big
picture
briefing,
is
really
a
very
laser,
focused
discussion
about
what's
happening
and
how
we
can
move
forward
as
a
community
and
responding
to
that
and
with
that
I'll
turn
things
over
to
Parker.
D
H
D
A
A
H
Okay,
title
slides:
okay,
moving
to
the
first
slide,
I,
don't
know
where
I'm
pointing
okay,
so
just
get
it
started
off.
I'll
give
you
a
understanding
of
where
we've
been
starting.
With
going
back
to
September
of
last
year,
we
had
a
briefing
on
kind
of
the
first
wave,
we're
talking
it
talking
the
first
wave
of
opioid
settlement
funds,
so
we
got
an
education
on
that.
H
H
H
You
know
if
you're,
if
you're
like
me,
you
don't
look
at
public
health
related
or
drug
use,
related
line
graphs
a
whole
lot,
so
you
needed
a
kind
of
behind
the
scenes.
Education
on
the
scale
of
the
of
the
crisis
and
just
what
what's
what's
occurring
behind
the
scenes
to
to
make
it
this
bad.
H
H
And
so,
throughout
this
discussion
you
know
we're
going
to
talk
about
these
three
topics.
There's
a
uniqueness,
there's
a
lot
of
unique
things
about
this
about
this
moment,
both
both
good
and
very
bad.
You
know
the
overdose
death
rate
is
is
very
high.
It's
it's
it's
above
the
state
average.
H
So
that's
you
know
that's
kind
of
a
scale
to
me
only
reminiscent
of
of
cobit
19..
The
other
thing
unique
about
this
moment
is
is
there's.
There's
funding,
that's
kind
of
coming
to
our
to
our
doorstep,
for
this
very
thing
in
different
ways,
in
a
sustained
way,
which
is
which
is
unique
and
the
other
thing
unique
about
about
us
is
Buncombe.
H
County
has
existing
programs
both
in
the
Sheriff's
Office
and
in
and
in
Brooklyn
County
EMS,
with
fantastic
staff
that
know
what
they're
doing
that
that
know
understand
the
techniques
that
that
work
under
understand
the
treatment
programs
that
can
help
people
and
save
more
lives,
and
that's
that's
the
goal
and
what
we'll
talk
about
at
the
end
of
this
discussion,
which
is
what
tools
we
have
to
implement
to
save
more
lives
and
I?
Will
pass.
D
Looking
at
oops
there,
we
go
give
me
a
second
to
get
my
bearing
with
this.
Where
did
you
click
it
Parker?
Or
did
you
point
it
there?
We
go
okay,
we'll
start
with
just
kind
of
looking
at
this
at
the
area
from
an
aerial
view,
and
just
reviewing
that
we
know
that
overdose
deaths
are
the
leading
cause
of
death
for
people
under
age
50
in
our
country
that
overdose
deaths
are
increasing
and
have
reached
an
all-time
high
in
Buncombe
County
in
recent
years.
D
We
know
that
without
current
local
efforts,
we
would
see
even
more
people
dying
and
yet
what
we
also
know
from
those
with
lived,
immediate
experience
and
those
on
the
front
lines
of
this
issue
is
that
we
have
entered
a
new
phase
of
the
overdose
crisis
and
that
the
demographics
of
those
most
impacted
and
most
at
risk
have
changed,
and
therefore
we
need
to
do
more
to
reach
those
most
at
risk
of
dying
with
our
current
strategies
at
that
county
level.
D
We
also
know
that
eliminating
deaths
as
a
result
of
substance
abuse
is
a
goal
under
resident
well-being
of
our
strategic
plan.
So
this
is
something
we
have
set
goals
and
vision
around
in
our
ongoing
work.
D
On
a
take
a
moment
and
talk
about
the
data
we'll
be
referencing
today,
which
comes
from
two
sources:
state
level
data
is
collected
around
overdose
deaths
and
is
a
very
important
part
of
how
we
understand
what's
happening
at
the
state
level.
Deaths
are
tracked
by
county
or
residents.
D
Additionally,
for
years,
we've
seen
that
the
Buncombe
County
Sheriff's
Office
and
the
Register
of
Deeds
office
have
been
collaborating
to
generate
local
data
through
the
manual
review
of
death
certificates
and
this
data
tracks
the
number
of
deaths
that
have
actually
occurred
in
Buncombe
County,
so
whether
someone
has
an
official
residence
of
Buncombe
County
or
not
if
they
die
in
Buncombe
County.
That
death
shows
up
in
this
local
data.
D
It's
really
important
to
note
that
both
data
sets
are
critically
important
and
we
need
both
to
understand
fully
what's
happening.
The
state
data
is
especially
important
for
comparative
purposes.
The
local
data
is
especially
important
to
understand
what
services
first
of
all
are
being
utilized
and
need
to
be
built
out.
D
D
D
As
we
look
at
this
data
from
2015
to
present,
what
we
see
is
that
we're
experiencing
currently
all-time
highs
of
Overdose
deaths
just
to
explain
this
data
for
a
second.
This
is
locally
generated
data,
so
this
is
people
who
died
within
Buncombe
County,
the
final
Circle
there
is
2022
data.
This
slide
was
based
on
data
that
was
pulled
about
three
weeks
ago
in
the
time
since
then,
there's
been
additional
review
of
2022
data
and
that
number
is
actually
up
to
177
with
more
death
certificates,
yet
to
be
reviewed.
D
D
Let's
dig
a
little
deeper
into
what's
actually
happening,
Within
These
deaths.
D
The
first
thing
that
we're
seeing
is
that
overdose
deaths
related
to
prescription
drugs
have
decreased.
I
want
to
take
a
moment
for
that
to
sink
in
for
many
years.
When
this
issue
would
come
in
front
of
us,
we
knew
that
a
major
driver
on
what
was
leading
to
addiction
and
then
what
was
leading
to
death
was
prescription
drugs,
and
we
have
actually
seen
that
number
decrease
for
a
lot
of
different
reasons,
but
among
them
the
many
strategies
that
have
been
deployed
to
push
to
decrease
that
number.
A
A
So
that's
that's,
obviously
very
encouraging
and
just
any
other
like
to
what
extent
is
it
decreases
it
marginal
or
you
know
quite
significant
I
mean.
D
Quite
significant
yeah
there
are
some
slides
to
this.
We
also
have
many
subject
matter:
experts
in
the
room,
so
I
would
maybe
once
we
open
up
the
discussion.
Folks
can
jump
in
and
correct
anything
that
needs
to
be
corrected
or
amended,
but
I
would
say:
we've
seen
significant
decreases
there.
D
D
An
illustrative
data
point
is
that
in
2015,
33
of
Overdose
deaths
involve
fentanyl
by
2021
74
of
overdoses
did
an
823
increase.
Just
for
a
brief
bit
of
context.
Fentanyl
was
introduced
into
the
local
drug
Supply
around
2015..
It's
a
synthetic
opioid
that
is
being
added
to
Other
Drugs,
including
stimulants
such
as
methamphetamine.
D
This
next
slide,
which
is
a
little
hard
to
see
on
the
screen
but
folks,
can
see
on
the
printed
copy
in
front
of
them
show
shows
you
from
that
2015
to
2021
period,
the
number
of
Overdose
deaths
related
to
fentanyl
related
to
heroin
and
related
to
prescription
drugs,
so
brownie.
This
provides
some
raw
data.
Answering
your
question
about
what
we've
seen
with
prescription
deaths
or.
A
So
the
number
right
okay,
so
the
number
of
the
number
of
fatalities
from
overdoses
related
to
prescription
drugs
has
gone
down,
which
is
positive
and,
and
maybe
you'll
speak
to
this
later.
One
of
the
other
things
I
was
curious
about
in
the
discussion
is,
as
we
started
looking
at
this
giving
more
attention
to
this
several
years
ago
in
the
commission,
one
of
the
other
pieces
of
information
that
we,
you
know
were
impressed
upon
boys.
They
had
a
really
high
percentage
of
people
who
develop
addictions.
A
D
Problems
which
we'll
talk
about
in
just
a
second
and
the
next
slide
addresses
them.
D
One
of
the
big
things
that
has
changed
is
driven
by
the
fact
that
fentanyl
has
now
been
introduced
into
almost
every
drug
that
people
are
using,
and
the
term
for
that
in
this
field
is
called
basically
polysubstance
use.
Polysubstance
refers
to
someone
taking
more
than
one
drug
intentionally
or
accidentally.
D
Fentanyl
is
usually
the
Fatal
additive
to
Other
Drugs
such
as
methamphetamine
that
causes
death.
So,
basically,
if
to
put
it
simply
five
years
ago,
the
story
might
have
been,
someone
has
surgery,
they're,
taking
pain
pills,
they
develop
an
addiction
they
next
go
to
heroin
because
that's
what
they
can
find
and
then
they
get
fentanyl.
The
story
now
might
be.
D
Someone
is
taking
meth
and
it's
laced
with
fentanyl
that
they
did
or
did
not
know
about
and
they're
dying
as
a
result
of
that
so
two
very
different
kind
of
origin
stories
on
how
addiction
or
how
drug
use
is
happening
and
then
how
people
are
actually
ingesting,
something
that
is
killing
them
again.
We
have
a
lot
of
subject
matter
experts
in
the
room
who
can
do
much
deeper
Dives
on
this,
but
but
that's
a
big
piece
of
what's
changed.
D
A
data
point
on
this
is
that
in
2015,
three
percent
of
all
overdose
deaths
were
bypoc
individuals
by
2021.
13
of
all
overdose
deaths
were
by
individuals,
so
that
is
another
new
trend
that
is
showing
up
in
real
time
and
on
the
front
lines
of
these
issues
that
we
need
to
be
aware
of
and
responding
to
some
context
on
this,
which
is
really
important,
is
that
to
date,
a
lot
of
the
opiate
epidemic.
D
Work
has
been
framed
around
opiate
use
disorder
largely
to
the
exclusion
of
those
whose
primary
use
of
stimulants-
and
that
gets
to
your
question
brownie.
A
lot
of
the
strategies
that
have
been
developed
and
are
saving
lives
are
oriented
around
people
whose
addiction
and
drug
use
originates
in
opiates.
D
Now
people,
his
drug
use
and
addiction
is
with
other
substances,
are
also
at
very
high
risk
of
overdose
death
across
health
issues,
and
this
is
something
we've
talked
about
across
many
many
different
issues.
We
know
that
the
bipac
community,
in
Buncombe,
County
and
and
across
the
state
and
Country
experience
historical
and
current
disparities
in
health
outcomes
and
then
access
to
culturally
aligned
and
Equitable
Services
and
on
both
of
these
issues,
polysubstance
use
and
and
disproportionate
impact
among
bipod
communities.
D
Just
in
summary
again,
we
know
that
overdose
deaths
are
the
leading
cause
of
death
for
people
under
age
50
in
our
country,
they're
increasing
and
I've
reached
an
all-time
high
in
Buncombe.
County
deaths
are
increasing
at
alarming
levels.
Among
people
who
are
poly
substance
users
and
among
bypoc
individuals.
D
We
know
that
without
current
local
efforts,
even
more
people
would
be
dying.
However,
we've
entered
a
new
phase
of
the
crisis,
for
the
demographics,
of
those
most
impacted
have
changed
and,
as
a
result,
our
current
strategies
are
not
yet
reaching
those
most
at
imminent
risk
of
dying
and
with
that
I'll
turn
things
over
to
commissioner
more
to
walk
us
through
the
next
section.
G
Some
good
news
in
the
midst
of
a
lot
of
the
shocking
data
that
we've
gotten
thus
far
so
talking
about
our
current
high
impact
efforts
and
I,
will
Echo
Jasmine's,
appreciation
and
and
Parker's
appreciation
for
the
folks
who
are
already
doing
this
work,
many
of
whom
are
sitting
in
the
room
and
addressing
the
Myriad
of
ways
that
we're
approaching
this.
So
just
to
give
a
very
quick
overview
of
where
we're
at
right
now
and
what
we're
doing
to
save
lives.
G
Without
the
folks
who
are
already
in
this
field,
we
would
be
seeing
even
more
deaths,
so
we
have
some
high
impact
strategies,
things
that
are
working.
The
common
theme
that
you're
going
to
hear
today
is
these
things.
Take
time.
Recovery
is
a
process.
It's
something
that's
going
to
take
a
bit
of
time
to
work,
but
what
we
do
have
in
the
works
right
now:
that's
actively
changing
lives,
increased
access
to
medication,
assisted
treatment
Matt
through
the
Buncombe
County
Sheriff's
Office
map
program
Innovative.
G
G
Our
community
Paramedic
program,
our
community
paramedic
map
program,
which
we
got
to
see
firsthand
most
of
us
on
commission
and
really
just
see
how
this
we're
reaching
people
in
our
community
at
different
levels,
wherever
they're
at
we're,
making
those
connections
and
we're
finding
how
we
go
about
serving
folks
bunker,
County
Bridges
to
care
partnership
with
mayhec,
along
with
a
few
other
initiatives
that
that
we
don't
have
as
much
time
to
go
into
today.
But
these
are
some
of
the
big
things
that
are
working
right
now,
long
term
addressing
what
we're.
G
What
we're
dealing
with
here.
Our
community
paramedic
post
overdose,
Response
Team,
our
Port
teams
and
the
port
program
and
mobile
Outreach
teams
and
increase
access
to
what
naloxone
to
reduce
some
overdoses.
So
we
are
making
an
impact.
What
we're
doing
has
been
effective
again.
The
common
theme
being
recovery
takes
time.
G
I,
don't
know
if
this
is.
That
is
still
right.
So
if
someone
correct
me,
if
I'm
wrong
on
this,
but
I
think
we're
one
of
only
maybe
one
percent
of
jails
in
our
country
or
jails
or
prisons
in
our
country
offer
Matt.
So
we're
ahead
of
the
curve.
On
a
lot
of
what
we're
doing
right
now
and
it
is
yielding
positive
impact
for
our
community
but
again
to
address
Jasmine's
point.
G
G
This
really
specific
again,
as
Jasmine
said,
laser
focused
kind
of
approach
on
how
we
stop
deaths.
The
Buncombe
County
Sheriff's,
Sheriff's,
Office
and
The
Innovation
that
they've
been
undertaking
along
with
Community
Medical
providers,
may
have
been
a
really
big
partner,
Community
organizations
and
leaders
throughout
who
are
talking
about
this
and
keeping
it
at
the
front
of
our
our
desks
and
our
radar
to
make
sure
that
people
are
not
being
left
behind.
G
G
And
without
them
we
certainly
would
see
more
overdose
deaths
more
overdosing
in
general,
but
all
of
these
strategies
are
built
to
address
opioid
use
disorder.
So
I
think
the
thinking
here
for
us
is
that
we
need
to
do
something:
that's
specific
and
expanded
to
reach
those
who
are
poly
substance,
users
and
members
of
the
bipod
community.
So
as
we're
working
on
the
The
Five-Year
20-year
plan
here,
what's
going
to
stop
people
from
dying
immediately
and
that's
kind
of
the
impetus
for
where
we're
at
today
so
I
will
hand
that,
back
to
you,
Jasmine.
D
Conversation
about
where
we
can
go
next,
just
to
take
a
moment
for
some
level
setting
part
of
our
hope
in
having
this
conversation
today
is
really
about
kind
of
creating
a
container
for
us
at
commission
level
to
be
focusing
on
this
in
a
sustained
way
and
working
in
partnership
with
staff
with
the
sheriff's
office,
with
Community
Partners
on
how
we
move
forward.
Part
of
that
is
naming
this
as
a
crisis
and
saying
we
need
to
treat
it
like
a
crisis.
D
We
need
to
act
quickly
and
in
a
coordinated
way,
as
we
would
in
any
crisis
where
people
are
dying
at
this
rate.
Thinking
about
how
we
responded
to
a
pandemic,
how
we
respond
to
natural
disasters,
something
that
is
elevated
to
the
level
of
knowing
that
that
folks
are
dying
at
alarming
rates
that
deserve
that
level
of
response.
D
D
Strategies
that
are
proving
to
be
high
impact
need
to
be
expanded
and
made
accessible
to
people
who
are
at
greatest
risk
for
overdose
and
death,
particularly
folks
who
are
poly
substance,
users
and
members
of
the
bipod
community.
This
means
we
know
meeting
people
where
they
are
and
building
trusted
Bridges
to
these
high
impact
strategies.
D
Increasing
access
to
mat
medication,
assisted
treatment,
is
one
of
the
most
impactful
steps
we
can
take
to
reduce
deaths,
and
we
also
know
we
need
new
approaches
to
ensure
that
these
services
are
accessible
to
those
most
at
risk
of
dying
and
just
to
say
it
out
loud
I
think
something
we
all
carry
with
us
in
various
ways,
but
just
knowing
this,
this
work
needs
to
be
informed
by
data
by
equity,
by
the
perspectives
of
those
closest
to
the
problem,
those
most
impacted
and
by
collaboration,
and
this
process
will
need
to
say
Nimble
and
adaptive.
D
D
That
will
address
this,
and
our
responses
to
this
specific
laser
focused
challenge
of
how
we
reduce
overdose
deaths
will
need
to
be
adaptive
and
resourced
in
a
way
that
recognizes
that
those
most
impacted
and
those
on
the
front
lines
of
the
issue
are
going
to
need
to
continually
be
assessing,
what's
working
and
what's
not
and
making
adaptations
to
ensure
that
these
Services,
which
we
know
can
save
lives,
are
actually
accessible
to
the
folks
who
need
them
today
tomorrow
and
the
day
after
that,
in
terms
of
proposed
next
steps.
D
D
First
is
with
a
request
to
County
leadership
and
management
and
to
staff
from
across
departments,
to
come
back
as
quickly
as
possible
to
commission
with
action
items
and
budget
requests
to
expand
high
impact
efforts
to
reduce
overdose
deaths,
specifically
ideas
around
how
ems's,
Community
Paramedic
program
can
expand
and
strengthen
work,
thoughts
and
ideas
from
County
management
about
how
to
best
support
data
sharing
and
coordination
across
departments
and
when
the
sheriff's
office
at
a
timeline
that
works
for
the
Sheriff's
Office
hearing,
ideas
about
how
to
strengthen
and
expand
the
reach
of
the
very
impactful
mat
program.
D
Specifically,
what
we
envision
is
that,
as
these
ideas
are
ready
to
come
forward,
they
will
come
to
us
and
we
will
have
the
opportunity
for
discussion,
but
they
will
also
come
with
requests
for
funding
which
could
be
made
through
budget
amendment.
As
you
all
will
recall,
we
received
the
first
Year's
allocation
from
the
wave
one
opioid
settlement
that
initial
funding
was
front
loaded.
D
We
dispersed
458
thousand
dollars
our
approved
dispersal
of
458
thousand
dollars
a
spring,
there's
an
incredible
Community
steering
committee
that
has
been
doing
a
lot
of
heavy
lifting
and
work
on
thinking
about
broad
strategies
around
that
and,
as
we
think,
about
allocation
I
think
you,
you
know,
we'd
be
looking
at
drawing
from
that.
First
Year's
allocation
from
the
settlement
to
immediately
put
some
resources
behind
strategies
that
could
be
saving
lives.
D
Moving
forward,
what
we
would
propose
and
look
forward
to
hearing
other
people's
feedback
on
is
that
in
our
fiscal
year,
24
budget
discussions
during
budget
workshops
and
other
other
discussion
points.
D
We
are
looking
at
ways
to
ensure
ongoing,
stable
resources
for
overdose
prevention,
overdose,
death
prevention
and
for
the
County's
overall
portfolio
of
work.
Combating
the
opiate
and
addiction
crises,
which
we
recognize
includes
death
prevention
strategies
and
also
includes
how
you
support
people
several
years
into
their
treatment
and
recovery
process.
D
We
would
also
like
to
see
Commissioners
and
staff
work
together
on
a
multi-year
strategy
and
goals
to
reduce
overdose
deaths
that
include
acute
services
like
we've,
been
discussing
continuity
of
care
and
prevention
efforts
getting
to
those
root
causes,
and
that
this
would
include
funding
strategies
deploying
a
combination
of
General
funds,
opiate
settlement
funding
from
wave
one
and
presuming
it
moves
forward,
wave
two
and
then
opportunities
for
grant
funding,
as
well
as
creating
systems
for
regular
updates
to
Commission
on
the
impact
of
these
strategies.
D
What
we're
learning
overdose
data
and
overdose
death
data
so
that,
as
close
to
possible
in
real
time,
we
are
tracking
the
impact
of
what's
of
the
work,
that's
happening
and
understanding
what's
happening
with
this
crisis
we
know,
broadly
from
decades
and
decades
in
our
country
of
of
watching
how
one
crisis
after
another
has
kind
of
crashed
on
the
shores
of
various
communities
around
drugs
and
addiction
that
we
are
often
playing
catch-up
by
the
time,
we're
in
a
position
to
build
Out
programs
and
services,
and
one
thing
I
think
we
hope
to
do
as
much
as
possible
is
collapse
and
and
and
and
Shrink
that
period
between
when
a
new
trend
is
happening
in
people's
lives
on
the
ground
in
Buncombe,
County
and
people
are
living
through
that
and
people
on
the
front
lines
are
seeing
that
and
how
long
it
takes
to
bring
online
a
response
to
it.
D
And
in
saying
all
of
this,
recognizing
that
you
know,
none
of
this
is
easy
work.
It's
not
easy
to
figure
out
how
to
solve
problems
that
don't
have
easy
solutions.
It's
not
easy
to
figure
out
how
to
coordinate
work
across
at
least
five
departments
and
multiple
agencies,
and-
and
it's
not
easy
to
be
in
the
in
the
front
lines
of
this
work
day
in
and
day
out.
D
So
with
all
that
said,
what
we're
excited
to
do
is
is
really
turn
this
to
the
full
commission
for
discussion
and
invite
in
this
questions
and
perspectives
from
staff
and
again
there's
many
folks
in
the
room
working
on
this,
who
might
be
able
to
take
deeper
Dives
on
any
of
the
questions
that
come
up
so
I
think
that
concludes.
C
Let's
start
us
off
and
just
say
thank
you
to
the
three
of
you
for
digging
into
this,
and
especially
for
staff
to
working
with
you
and
and
bringing
this
to
our
attention,
and
with
that,
can
you
you
are
someone
who's
expert
in
this
area,
elaborate
more
on
the
fentanyl
overdose
kind
of
building
awareness
at
the
community
level
with
us
having
this
conversation,
can
you
just
provide
more
awareness
around?
What's
going
on
with
that.
D
If,
if
there
are
staff
who
are
comfortable
addressing
that
I
I
would
love
to
defer
to
folks
who
work
in
this
field,
but
I
can
just
start
by
saying
is
that
you
know
I
think
a
huge
thing
that
people
need
to
be
aware
of
is
that
fentanyl
is
present
in
many
of
the
drugs
that
people
are
purchasing
or
using,
and
that
can
be
stimulants
like
methamphetamine
any
number
of
different
kinds
of
drugs,
and
sometimes
people
are
aware
of
that
and
sometimes
they're
not
when
people
take
fentanyl,
whether
they
meant
to
or
not.
D
If
you
take
it
over
time,
you
can
also
develop
a
dependence,
an
addiction
to
fentanyl,
which
is
an
opiate.
So
even
if
you're,
the
primary
drug
that
you
use
is
methamphetamine,
for
instance,
and
you've
used
it
for
many
years.
If
fentanyl
is
now
in
that
Supply,
you
can
develop
a
secondary
addiction
to
an
opiate
Fentanyl
and
because
we
know
The
lethality
of
Fentanyl,
and
we
know
you
know
that
people
are
at
a
very,
very
high
risk
of
Overdose
and
overdose
death
anytime.
D
They
ingest,
Fentanyl,
I,
think
those
are
some
important
things
for
folks
to
be
aware
of.
For
many
many
years
when
we
talked
about
fentanyl,
we
talked
about
opiates.
We
talked
about
the
overdose
crisis.
It
was
all
oriented
around
this
one.
This
this
one
story
around
opiate
use,
addiction
and
folks,
who
might
have
been
using
other
drugs
or
communities
where
other
drugs
were
more
commonly
used,
might
have
felt
like
that,
had
nothing
to
do
with
their
experience,
and
that
has
all
collapsed
now
into
one
crisis.
It's
still
the
opiate
crisis.
D
J
Commissioner
and
Sloan
and
more
you
did
a
fabulous
job
commanding
that
information.
The
data,
it's
very,
quite
impressive.
Speaking
to
the
fentanyl
specific
question,
when
we
start
when
I
started.
J
Looking
at
the
data
in
2015,
10
of
our
deaths
in
Buncombe,
County
were
stimulant
related,
so
that
would
be
say
a
cocaine
or
Methamphetamine
when
we
get
to
2021
50
of
the
deaths
have
stimulants
in
them
and
that's
because
they
also
have
fentanyl
in
them,
which
is
very
highly
lethal,
as
as
was
mentioned
going
into
the
specifics
of
fentanyl
numbers
and
again
this
is
just
bringing
some
context
with
the
absolute
figures
in
2015
we
had
13
deaths
that
had
fentanyl
in
it
with
the
from
the
medical
examiners
autopsy
report
in
2017.
J
In
two
years
it
jumped
from
13
up
to
102
of
the
deaths
had
fentanyl
in
it.
So
we
had
a
significant
escalation
within
a
two-year
Mark
in
2021
I've
got
120
deaths,
Mark
that
had
fentanyl
in
it.
So
again,
that's
what's
driving
the
deaths
and
right
on
point
with
you
know:
fentanyl
is
an
opioid,
so
the
good
news
is,
it
can
be
reversed
with
Narcan
with
naloxone
right.
We
can
reverse
it.
We
can
also
treat
it,
but
when
we've
got
stimulant
users
that
don't
realize
there's
fentanyl
in
their
drug
Supply,
it's
creating
overdoses,
foreign.
K
Thanks
so
much
it's
amazing
to
hear
like
how
what
a
comprehensive
understanding
you
have
of
these
processes.
Just
even
in
the
past
couple
weeks.
I
can
speak
to
the
other
side
of
it,
which
is
the
operational
and
medical.
So
it
sounds
like
again.
Everybody's
got
a
really
good
understanding
of
why
people
are
dying
across
the
board
from
different
demographics,
but
the
treatment
side
of
it
is
really
difficult
right.
As
you
stated,
we've
had
some
straightforward,
I
say
straightforward,
very
Loosely,
because
no
addiction
is
straightforward,
but
the
pathway
to
opioid
recovery.
K
What
is
and
was
much
more
straightforward,
poly
substance
is
a
much
more
difficult
Beast
to
to
treat
and
to
manage,
and
so
it
requires
a
much
broader
and
greater
bandwidth
of
people
and
providers
and
resources
to
try
to
get
ahead
of
it
and
to
actually
help
people
get
through
treatment.
Since
it's
much
more
difficult
to
keep
them
supported
when
they
also
have
a
methamphetamine
or
polysubstance
addiction.
A
One
other
question:
I
have
about
kind
of
on
the
same
topic
is
and
kind
of
partly
going
back
to
an
earlier
question.
You
know
in
terms
of
the
trends
we
see
in
the
community
over
the
last
six
or
seven
years,
I
mean.
Are
we
seeing
that
there
are
there's
a
higher
percentage
members
of
the
community?
Who
are
you
know
wrestling
with
some
form
of
addiction
like,
let's
just
say
not
including
alcohol,
but,
like
you
know,
in
this
set
of
drugs?
A
A
What
might
have
been
you
know?
A
really
difficult
challenge
for
a
lot
of
people
who
were
struggling
with
addiction
has
become
much
much
more
dangerous
because
of
the
introduction
fentanyl
into
into
the
whole
mix
here.
But
so
those
are
I.
Guess
it's
a
two-part
question,
although
we
sing
overall
levels
of
addiction
rising
or
is
it?
Is
it
really
fairly
similar
to
where
we
were
before,
and
it
is
really
just
at
the
introduction
of
fentanyl
has
made
all
of
this
so
much
more
dangerous
than
what
we
saw
prior
to
that.
K
I
I
certainly
don't
have
data
around
the
first
question.
I
would
say
we
we've
been
seeing
addiction
and
death
via
addiction
for
a
long
time,
I'm
sure,
with
kobit
and
with
I'm
sure
there's
a
million
factors
that
contribute
to
I
would
I
would
guess
an
overall
Horizon
in
substance
use
in
the
past
few
years,
but
even
even
without
that,
we've
seen
a
very
significant
increase
in
deaths
from
fentanyl
in
the
past
three
or
four
years,
just
on
uncomplicated,
straightforward
fentanyl
deaths,
I
think.
K
For
a
long
time
we
tried
to
figure
out
who
was
doing
fentanyl
by
accident
or
who
was
doing
it
on
purpose,
quote
unquote
and
I.
Think
at
this
point,
like
commissioner
vitrar
said
it's
just
the
drug
Supply
is
so
saturated
across
the
boards.
That
I
would
actually
include
people
with
alcohol
use
disorder
in
that
I
would
I
would
include
anybody
who
has
social
determinants
of
Health
who's
in
poverty.
Who's
addicted
to
anything
I
would
include
them
as
in
danger
of
consuming
fentanyl
on
purpose
or
by
accident.
K
L
It's
one
of
the
things
one
of
the
things
Commissioners
I
want
to
point
out
is
Across
the
Nation
we're
seeing
rise
in
toxicity,
and
that's
certainly
true
here
when
you
look
at
the
medical
examiners.
Data
okay,
as
far
as
Fentanyl
is
stronger
okay,
so
it's
binding
stronger
with
his
receptor
sites,
and
so
it's
requiring
higher
doses
of
Narcan.
L
So
when
I
started
my
career
as
a
paramedic,
the
heroin
patient
we're
given
0.4
milligrams
of
Narcan
and
waking
them
up
resuscitating
today
we're
using
four
to
eight
milligrams.
We
hit
at
10
milligrams,
saturation
of
where
Narcan
doesn't
work
is
effective
in
waking
people
up.
This
is
a
toxicity
and
things
like
the
xylazine
and
things
like
that
that
we're
seeing
to
give
you
a
longer
high,
it's
harder
to
wake
those
patients
up
and
resuscitate
541
times.
Last
year
we
give
Narcan,
not
our
community
paramedics,
our
EMS
paramedics
and
the
firefighters
in
the
field.
L
That's
541
lives
saved.
Okay.
If
we
wasn't
doing
this
type
of
response
and
working
together,
you
know,
there's
there's
also
data
where
we
know
the
public
give
a
lot
of
Narcan
prior
to
us
arriving,
but
we
weren't
asking
that
question
until
recently.
So
one
of
the
things
that
we're
going
to
and
we're
going
to
work
very
diligent
on
is
getting
stronger
data
to
answer
these
questions
and
I.
Think
one
of
the
things
that
y'all
asking
for
is
is
we
kind
of
get
more
tighter
in
our
instant
command
system
of
how
to
handle
this
issue?
L
L
These
things
go
together,
okay
and
it's
real
important
that
they
are
elevated
together,
so
that
we
can
keep
saving
lives
because
EMS
is
not
only
getting
taxed
with
increasing
overdoses,
but
we're
seeing
more
Strokes,
more
heart
attacks
we're
seeing
more
chronic
disease
issues
post-covered
world,
and
it's
really
important.
We
drive
down
our
response
times
because
there
may
come
a
day
in
the
near
future.
The
Narcan
Administration
is
not
even
going
to
work.
We're
gonna
have
to
get
there
and
ventilate
and
oxygenate
people
and
be
there
in
that
four
minute
response
time.
L
Are
they
going
to
be
clinically
dead,
and
so,
as
we're
figuring
out
these
strategies,
we
got
to
be
mindful
of
all
the
competing
interest
in
Rising
that
tide
together
in
a
uniform
passion.
It's
better
serve
the
whole
whole
community
and
that's
what
I
really
want
to
talk
about
is
the
whole
Community
response
to
not
only
what
we're
doing
as
a
community
in
the
community
Paramedic
program.
But
all
the
other
agencies
in
the
county
is
working
together
to
facilitate
the
best
outcomes
for
our
patients.
M
M
What
do
we
really
need
to
look
at
in
conjunction
with
that
EMS
study
and
what
we
know
we
need
to
step
up
on
in
terms
of
our
EMS
paramedic
staff,
as
well
as
our
Fleet,
but
what
also
needs
to
go
along
with
that
probably
a
little
separately
as
we
think
about
our
our
opioid
response.
But
then
how
do
we
look
at
that
to
tie
it
all
together,
as
you
just
said,
sort
of
that
interdepartmental
interagency
collaboration
as
well?
M
L
I
think
the
initial
response
to
answering
this
question
is:
we've
got
to
follow
the
device
of
the
study.
You
know,
we've
got
to
add
more
trucks,
we've
got
to
add
more
Community
paramedics
to
meet
this
need.
You
know,
and
we've
got
to
have
a
joint
strategy
on
that.
You
know
right
now
we're
in
supply
chain
shortage.
We
can't
just
call
up
and
order
a
truck
if
I
put
an
order
in
for
an
ambulance
today,
I'm
looking
at
an
over
a
year
on
delivery
date
for
that
ambulance.
L
You
know,
and
it's
things
like
that
to
where
we
need
to
follow
the
recommendations
of
the
EMS
study
as
we
move
forward.
We
need
to
drill
down
on
this
opioid
epidemic
because
it's
going
to
get
worse,
you
know
when
I
look
at
our
responses
and
what
we've
done
you
know
our
numbers
are
high
in
North
Carolina,
but
they'd
be
a
lot
higher
if
they
wasn't
for
those
541
resistations,
you
know
in
the
field,
I
mean
so
this
problem.
L
You
know
when
we
look
at
that
death
data,
we're
looking
at
part
of
it.
It's
also
we've
got
to
look
at
the
resuscitations
and
what
we're
doing
is
working
right
now,
but
we
can't
slide
back
on
that's
what
I'm
saying
so
we
got
to
elevate
this
in
the
unified
effort.
Move
together
with
increased
EMS
Personnel.
Not
and
what's
really
important,
is
just
realize
as
high
as
this
opioid
crisis
is
increasing.
So
is
our
cardiac
emergencies.
So
is
our
traumas.
You
know
the
our
call.
Volume
is
increased
in
the
last
two
years
by
almost
50
percent.
L
You
know
so
when
we
look
at
that.
That's
what
the
strategy
I
want
to
look
at
the
whole
community
and
taking
those
steps
in
the
study
to
move
forward,
but
also
simultaneously
looking
at
these
things,
because
here's
the
thing
more
paramedics
on
the
street
means
quicker
response
types,
whether
they
call
Community
paramedics,
because
in
our
system
they
respond
to
those
high
priority,
calls
and
overdose
cause.
L
You
know
when
I
look
at
overdose
calls
responded
to
and
dealt
with
last
year,
it's
nine
around
983
I
think,
but
when
I
look
at
total
costs,
looking
at
4
000
calls
they're
doing
a
lot
of
Outreach
in
support
of
community.
You
know
in
doing
things
like
just
keeping
people
in
homeless
camps
informed
that
it's
going
to
code
purple
night
and
then
connecting
them
with
a
service.
You
know
when
we
had
the
arctic
front
coming
in
it's
getting
out
and
getting
people
to
connect,
so
it
didn't
freeze
to
death.
L
L
D
So
appreciate
you
saying
that
and
couldn't
agree
more
and
I.
Think
part
of
well
part
of
the
intent
in
today's
conversation
is
making
sure
we
do
that
honestly
that
recommendations
that
just
came
forward
regarding
land
acquisition,
building
of
new
facilities,
expanding
the
fleet
working
conditions
are
so
critical
to
how
we
expand
and
modernize
the
totality
of
EMS
services
and
simultaneous
to
that.
We
have
dedicated
funding
coming
through
one
settlement
and
likely
a
second
that
we
can
deploy
and
we're
need
to
deploy,
as
strategically
as
possible,
to
respond
to
the
opiate
crisis.
D
D
This
laser
focused
conversation
around
how
we
most
effectively
deploy
opiate
settlement
funding
to
prevent
overdose
deaths,
which
is
absolutely
related
to
how
we
expand
the
overall
capacity
of
EMS
to
respond
to
calls,
and
also
a
really
distinct
question
from
a
programmatic
perspective,
from
a
Services
perspective
and
from
a
funding
perspective
in
that
sense
and
making
sure
that
we
also
at
the
commission
level,
are
sort
of
fully
tracking
the
totality
of
work.
D
That's
happening
around
overdose
and
addiction
response
and
and
really
making
sure
we're
having
those
conversations
about
settlement
funding,
grant
funding,
philanthropic,
State
Federal
grant
funding
and
how
that
all
intersects
with
General
funds
allocations
and
how
that
all
intersects
with
our
number
one
budget
priority
this
year
around
Public
Safety,
so
I
see
these
as
conversations
that
absolutely
inform
each
other
that
strengthen
each
other
frankly
and
that
make
sure
that
we
are
putting
particularly
their
settlement
dollars
to
highest
best
use
in
responding
to.
D
You
know
responding
to
what's
what's
happening
in
real
time
in
our
community
right
now,
so
so
appreciate
you
raising
all
of
that
at
once
and
think
it's
Inc,
it's
it.
It's
really
our
incumbent
upon
us
to
make
sure
we're
always
having
that
bigger
picture.
Conversation
and
situating
a
focused
conversation
like
this
in
that,
in
that
broader
context,.
I
D
I
Jasmine
is,
as
we
discuss
this,
you
know.
First
I
want
to
thank
our
staff,
because
if,
if
we
didn't,
if
we
weren't
doing
what
we're
doing,
it
would
be
even
worse
than
what
it
is,
but
as
we
sit
here
and
I
listen,
the
question
I
have
is,
as
we
save
these
lives
as
we
put
the
narcon
out
there
as
we
put
more
trucks
out
there,
but
isn't
that
also
going
to
cause
us?
I
G
G
Their
lives
to
answer
part
of
that
I
I
think
that's
exactly
right.
I
think
that
we've
talked
before
about
the
path
to
recovery
being
a
long
one
for
a
lot
of
these
folks.
Jumping
on
that
means,
following
up
right
once
we
save
these
lives,
which
is
our
first
key
step
right,
it's
kind
of
a
non-starter
if
you
don't
make
it
past
the
save
the
lives
part.
Once
we
get
to
the
point
that
we're
saving
people's
lives
I
do
want
to
praise
our
staff
ranging
from
EMS
and
our
community
paramedics.
You
know
all
of
them,
yeah.
G
We
got
to
get
out
there
and
see
firsthand
that
they
are
continuing
that
work.
That
is
an
ongoing
process
for
them
and
Justice
Services
Department
doing
some
tremendous
follow
up
and
making
sure
that
these
people
are
navigating
their
sobriety,
navigating
the
court
system
putting
themselves
back
in
a
position
where
they
can
Thrive
I,
think
the
missing
piece
or
the
underserved
piece
for
a
long
time
has
been
getting
them
to
a
point
that
we're
even
keeping
these
people
alive.
We
have
a
lot
of
resources.
C
I
have
a
question
just
trying
to
kind
of
figure
this
all
out
so
from
what
I'm
hearing
the
with
some
of
the
overdose,
the
prescription
overdose
related
to
that
you're,
saying
that
we're
seeing
that
Trend
down
and
then
other
overdoses
are
trending
up,
and
so
what
I'm
trying
to
understand
here,
with
with
what
we
have
in
place,
what
we're
currently
doing
so
you're,
seeing
all
that
as
positive
okay,
but
so
are.
Are
you
proposing
that
I'm
trying
to
understand?
C
D
D
What
we're
seeing
is
efforts
to
get
the
vaccination
to
this
population
is
working
but
we're
seeing
lower
numbers
than
we'd
expect
over
here.
So
we
need
to
kind
of
double
down
on
efforts
to
make
sure
that
this
community
has
access
to.
A
D
And
this
I
see
is
sort
of
a
parallel
moment
in
if
in
in
that,
these
strategies
are
working
quite
well
and
have
worked,
among
other
things,
reduce
deaths
from
prescription
drugs.
But
there's
a
whole
new
group
of
people
in
our
community
at
very
high
risk
of
who
are
dying,
not
just
at
risk
of
dying
who
aren't
accessing
these
services.
D
You
change,
yeah
I,
think
I'll
speak
to
that
and
then
maybe
Sarah
does
I
think
a
range
of
things,
one.
The
capacity
of
these
programs
two
they
were
designed
to
respond
to
opiate
use
disorder
not
to
reach
people
with
polysubstance
people
were
poly
substance
users.
D
They
were
and
figuring
out
how
these
Services
can
be
made
accessible
to
people
who
are
polysubstance,
users
can
be
made
accessible
within,
particularly
the
black,
indigenous
and
Latino
communities,
where
we're
seeing
Rising
numbers
of
Overdose
deaths
is
the
work
that
is
in
front
of
us
as
a
community,
and
that
sort
of
the
data
is
very
clearly
pointing
towards.
H
And
Jerry
I
think
just
an
additional
answer
to
that
question
is
that
we
have
this
successful
mat
program
in
the
jail,
but
as
Jasmine's,
alluding
to
there's
other
populations
who
aren't
interacting
with
either
the
jail
or
that
program
within
it,
and
so
you
know
thinking
of
ways
and
leveraging
these
funds
to
implement
strategies
to
engage
with
other
populations.
That's
that's
a
lot
harder
to
do,
but
that's
what
we
need
to
do
to
get
these
numbers
down
as
well.
C
Okay,
thank
you
both
that's!
That's
helping
and-
and
just
so
I
understand
this
to
like,
because
you're
speaking
about
the
the
opioid
funding
and
I
know
last
year,
when
we
went
through
this
process,
it
was
emphasized
multiple
times
that
there
was
this
process
we
were
going
through
and
we
were
following
that,
and
so
I
want
to
understand
better
because
I
think
what
I'm
hearing
is
a
suggestion
to
deviate
from
that
process
or
not
so
I
just
want
to
understand
what.
D
Yeah
no
I
think
that's
a
great
flag.
I,
don't
see
this
as
deviating
from
that
process.
I
see
this
as
recognizing
what's
happening
around
us
and
you
know
an
incredible
steering.
Committee
of
community
members
has
worked
very
diligently
to
develop
recommendations
around
how
some
of
that
settlement
funding
get
used.
I
don't
think
there
was
ever
a
decision
point
that
the
totality
of
that
settlement
funding,
either
in
year,
one
or
any
of
the
16
years
or
in
wave
two
settlement
funding
over
13
years.
D
D
How
do
we
actually
deploy
the
totality
of
these
funds
and
how
do
we
think
about
developing
the
right
systems
so
that
we
can
be
as
adaptive
as
possible
so,
for
instance,
in
our
community
we're
investing
in
incredible
programs
like
the
Start
program,
which
DSS
presented
a
few
weeks
ago?
D
That's
an
amazing
program
or
the
any
number
of
different
programs
and
what
we're
not
investing
or
what
what
we
are
trying
to
elevate
is
a
need
that
is
becoming
increasingly
urgent
to
have
dedicated
strategies
around
overdose
death
prevention,
which
is
about
saving
someone's
life
today
and
increasing
access
to
the
strategies
that
can
actually
save
someone's
life
so
affordable.
D
How
are
access
to
housing
is
critically
important
for
someone
on
their
path
to
recovery,
but
access
to
housing
isn't
going
to
save
someone's
life
today,
and
what
we're
trying
to
do
is
ask
staff
to
come
back
with
the
sort
of
best
ideas
from
across
multiple
departments
and
agencies
on
how
based
on
everything
we
know
right
now
and
the
level
of
Acuity
we're
seeing
around
this.
We
can
make
sure
that
services
that
can
save
someone's
life
tonight
or
tomorrow
can
reach
the
those
people
most
most
at
risk.
D
So
this
is,
you
know
we
never
did
the
sort
of
Deep
dive
work
at
the
commission
level
to
fully
articulate
and
develop
a
multi-year
strategy
on
the
settlement.
What
we
embarked
upon
was
a
plan
for
Year
One
that
would
inform
future
years,
and
what
we're
saying
right
now
is
hey.
We
need
to
stop
for
a
second
and
look
at
what's
happening
in
real
time
and
make
sure
we're
being
fully
responsive
to
that
and
I
will.
D
D
J
As
well
yeah,
if
I
could,
commissioner
Rose
your
question
was
great.
If
I
heard
you
correctly,
it
was
if
what
we're
doing
is
working.
Why
is
it
getting
worse?
Is
that
what
I
heard
you
ask?
It's
a
great
question
in
simple
numbers
in
2015,
64
of
our
deaths
were
just
opioid
involved,
so
opioid
use
disorder
is
effectively
treated
with
medication.
Assisted
treatment,
mat
in
2021,
29
of
our
deaths
were
only
opioid
involved.
So
we've
cut
that
in
half
much
like
we
did
the
prescription
drugs
right,
we've
gone
down.
J
50
in
those
deaths
of
solo
opioid
use
disorder
has
been
reduced
by
50
in
our
overall
death.
So
that's
a
great
example
of
what
we're
doing
is
working
and
on
the
converse.
The
strategies
were
were
utilizing,
broadly,
are
not
impacting
those
who
are
most
now
impacted
the
stimuli
users
and
those
who
are
bypoc
of
the
bipod
Community.
Their
deaths
have
gone
up
considerably
from
13
up
to
50
percent
of
of
that
population
and
I've
got
some
good
news
and
all
of
this,
the
jail
deaths
correlated
jail
deaths
within
a
five-year
span
have
gone
down.
J
22
percent
and
I've
been
able
to
Crunch
the
22
2022
numbers
as
well
and
they're
consistent.
So
for
the
past
three
years,
the
work
that
we're
doing
in
the
jail
is
effective
and,
even
more
surprisingly,
it
was
surprising
to
me
to
see
the
difference
of
the
individuals
who
are
stimulant
users
within
the
jail
population
in
2019.
It
was
at
74,
but
three
years
later,
it's
down.
J
It's
been
reduced,
26
percent,
so
the
strategies
we're
employing
in
the
jail
specific
to
this
problem
of
polysubstance
use
is
effective
and
so
I
think
that's
really
important
to
report
that
there
are
things
that
we
can
do
and
part
of
that
has
been
broadening
the
scope
of
who
we're
serving
right.
If
somebody's
a
stimulant
user,
we're
not
simply
saying
you,
don't
you're
not
eligible
right,
because
we
know
that
fentanyl
has
infiltrated
that
population
when.
J
J
Of
everybody
in
Buncombe
County
reflected
in
these
deaths
over
50
percent
of
those
individuals
had
been
in
detention.
I
think
the
specific
number
was
57
within
a
five-year
period
of
their
death,
so
if
they
died
here
five
years
back
within
that
window,
they'd
been
in
our
building.
So
we
we
keep
moving
that
Governor
forward
to
see
how
effective
our
program
is
and
what
we're
seeing
is
a
22
reduction
of
that
population
deaths.
Since
we
started
our
programming.
F
G
This
is
not
some
abstract
version
of
our
community
that
we're
reaching
out
to
these
are
people
who
we
can
track
back
to
a
specific
point
that
are
likely
to
appear
again
and
we're
intervening
at
a
point
where
we
are
saving
lives,
so
I
I
do
want
to
at
least
thank
you
for
you
and
Claire,
both
for
your
Innovation
and
your
hard
work
and
and
doing
a
lot
of
this.
This
is
really
important
that
you're
saving
lives
through
this
sure.
J
Thank
you
and
the
jail
really
is
a
Crossroads
I,
know,
I,
say
this:
a
lot
and
I
get
harassed
a
little
bit
for
my
data,
but
I
will
say:
percent
of
our
jail
population
in
a
three-month
period
reported
An
Occurrence
of
an
overdose.
Now
this
was
a
non-fatal
overdose
right.
So
this
these
are
the
overdoses
that
Taylor's
teams
are
responding
to
that
our
health
department,
reversal
kits,
are
are
impacting
folks
moving
through
that
are
not
dying,
they're,
also,
a
higher
risk
higher
risk
for
overdosing
again
right.
A
J
J
And
those
are
the
individuals
who
make
it
through
the
medical
intake
points,
so
they're,
not
just
booking
and
releasing
a
large
majority
of
our
population
walk
straight
through
the
building
without
spending
any
extensive
amount
of
time
there.
So
these
are
individuals
who
have
been
there
from
four
hours
to
24
hours,
making
it
through
that
first,
medical
intervention.
E
I
felt
like
equity
in
our
programs
and
I,
can
speak
from
what
I'm,
seeing
in
terms
of
like
justice,
services
and
working
with
Health
and
Human
Service.
We
know
from
years
of
study
that
people,
regardless
of
race,
use
substances
at
the
same
amount
or
same
level,
but
what
we
do
see
is
like
Trends
and
where
substances
coming
from
and
how
they
get
into
communities
covet
is
a
perfect
example
of
what
communities
that
Target
first
and
then
we
saw
the
disparities
coming
into
African-American
communities
a
few
months
out.
E
But
what
we
do
see
and
what
we're
experiencing
is
a
lack
of
diversity
in
our
programming
and
so
in
then
there's
also
a
mistrust
of
systems
and
government
right.
So
how
do
we
encourage
people
to
especially
those
who
have
been
marginalized
or
have
been
over
police
or
have
fear
of
DSs
getting
called
and
all
these
barriers
adequately
one
enroll
in
services
and
want
to
participate
Even
in
our
two
programs
that
are
centered
around
substance
use
the
felony
drug
diversion
program
and
the
treatment
courts.
E
We
see
that
black
people
are
more
likely
to
qualify
or
have
eligible
charges,
but
they're
not
necessarily
enrolling
in
the
program,
and
if
they
are
enrolling
in
the
program,
their
completion
rates
look
a
little
bit
different.
Are
they
completing
and
what
we
found
is
wanting
to
ensure
that
we
have
trust
we
build
in
culturally
competent
material
and
that
we
are
partnering
with
black
LED
organizations
to
help
support
us
in
doing
the
work
and
providing
education
and
awareness.
E
Hhs
is
doing
similar
work
around
going
into
marginalized
communities,
creating
Outreach
partnering
with
the
community
engagement
markets
and
being
intentional
about
how
we
do
our
programming
and
how
we
do
our
efforts
in
outreaching
these
communities.
But
it
is
a
it
is
a
partnership
in
building
Trust.
M
And
looking
at
things
through
a
lens
of
equity
and
I
think
this
is
one
particular
area.
We
have
not
really
laser
focused
and
really
put
our
money
where
our
mouth
is
on
that
and
what
I
hear
you
say,
Echoes.
So
much
of
what
we
hear
when
we
do
talk
about
meeting
the
needs
of
our
racially
diverse
community.
So
thank
you
for
what
you
just
said
and
I
hope
that
we'll
all
commit
to
making
sure
that
we're
looking
at
this
again
through
that
lens
of
racial
Equity
as
we're
addressing
this
particular
issue.
I
L
So
I
just
recently
did
a
presentation
with
the
State
medical
director.
We
presented
numbers,
and
so
this
is
a
snapshot,
but
it's
recent
numbers
that
looks
at
our
mat
program
for
the
year,
which
goes
right
in
line
what
Sarah
just
said,
kind
of
answers.
The
question
that
commissioner
white
signed
and
Mr
Wells
was
saying:
are
these?
L
L
Okay,
but
we
didn't
have
mat,
then
so
what
the
patients
we
were
losing
were
the
patients
we
could
not
connect
with
a
service.
So
let
me
tell
you
where
we're
at
today,
93
percent
of
the
patients
referred
to
mayhec
92
percent
of
those
93,
which
means
we're
only
losing
one
percent
or
connecting
with
that
primary
care
physician
to
do
follow
through
to
stay
on
the
mat.
And
so,
commissioner,
to
your
point
about
rehab
three
to
six
months
later,
67
percent
are
staying
in
the
program
versus
only
63
joining
the
program
before.
L
So.
What
that
shows
me-
and
this
is
just
a
snapshot-
that
what
we're
doing
is
making
a
huge
impact,
because
when
you
look
at
National
Trends
they're,
somewhere
between
the
teens
and
the
and
the
like
low
20s,
for
a
success
rate
where
people
stay
in
in
a
program
for
Rehab,
so
like
what
we're
doing
without
a
doubt,
some
of
the
best
were
in
the
nation
and
in
the
state
I
mean
the
State
medical
director
just
told
us.
L
He
said
I
need
to
see
more
of
your
data
and
that's
one
of
the
things
we
come
back
and
having
this
conversation
about
EOC
and
kind
of
getting
an
ICS
structure.
So
we
can
provide
that
data
more
and
be
more
transparent
with
it,
because
right
now,
I
knew
that,
because
that's
my
ex
data,
that's
not
our
data.
It's
what
we've
been
collaborating
with
them
and
I
know
it's
a
snapshot
because
I
just
did
the
presentation
on
that.
You
know
three
months
from
now.
L
My
gut
feeling
is:
that's
probably
going
to
look
a
lot
better
because
we
were
finding
the
program
and
getting
a
lot
more
deliberate
with
trust
in
the
community.
We
also
got
new
programs
coming
on,
like
the
community
health
care
workers,
that's
going
to
be
in
the
housing
authority
to
help
connect
people
that's
another
way,
we're
building
inequity
and
Trust
in
the
community
through
relationships
and
a
lot
of
this
life-saving.
L
Technology
that
we're
doing
is
not
so
much
technology
is
it's
just
good
old-fashioned
relationships
getting
to
know
people
and
building
trust
with
people
in
our
community.
Paramedics
are
so
passionate.
I
can't
say
enough:
this
ain't
Taylor's
work,
Claire's
work
I
mean
even
though
Claire's
doing
some
Grassroots
stuff,
like
I've
never
seen
before.
This
is
like
their
passion,
they're
out
there,
putting
that
extra
effort
into
it
every
day
and
it's
truly
making
a
difference
and
I
can
show
you
all
that.
D
Just
want
to
express
appreciation
to
staff,
you
joined
that
conversation
and
shared
your
expertise
and
to
Fantastic
questions.
I.
D
Think
just
to
reiterate
again,
if
there
was
a
simple
formula
to
follow,
we'd
be
doing
that,
and
what
we
are
trying
to
do
today
is
bring
this
on
a
platform
where
the
many
programs
and
agencies
and
departments
working
on
this
can
bring
forth
their
best
ideas,
informed
by
Equity,
informed
by
data
about
how
we
respond
to
the
crisis
in
front
of
us
and
how
that
is
situated
within
our
broader
work
and
broader
commitments
around.
D
To
the
opioid
crisis
in
our
community,
so
just
really
appreciate
the
Deep
dive
and
I
think
just
in
terms
of
making
sure
we're
synced
up
on
next
steps.
The
county
manager,
if
it
works
for
you,
would
Parker
Martin
and
anyone
else
who
would
like
to
join.
D
The
conversation
will
stay
connected
with
you
all
about
sort
of
when
different
departments
are
ready
to
come
back
and
sort
of
bring
forth
ideas
and
then
the
best
ways
that
we
can
marry
this
conversation
to
the
to
the
work
we'll
do
in
this
budget
cycle,
but
also
to
have
that
multi-year
to
develop
that
multi-year
strategy
around
how
we
deploy
the
settlement
funding
and
how
we
support
the
totality
of
this
work.
As
we
move
forward.
A
The
last
question
I
want
to
just
ask,
and
if
and
if
there's
someone
here
who
would
like
to
comment
on
it
briefly,
we
do
need
to
adjourn,
and
you
know
it's
been
a
great
conversation.
The
one
of
the
questions
I'm
still
interested
in
learning
more
about
I
mean
the
conversation
today
is,
has
been
very
focused
on.
How
do
we
help
people
avoid
a
lethal
overdose
right?
A
And
so
that's
obviously
super
important
I
would
like
to
get
an
update,
and
maybe
maybe
I'll
just
ask
staff
to
maybe
share
some
information
with
commission,
so
so
not
try
to
insert
right
now,
but
around
the
Dynamics
of
the
question
I
asked
earlier
around
when
we
look
at
all
of
the
folks
in
our
community
who
end
up
experiencing
an
overdose,
maybe
they
get
help
and
it's
not
lethal
or
for
those
who
it
is
lethal.
A
You
know
again,
when
we
kind
of
when
the
commission
started
looking
at
the
opioid
epidemic
five
or
six
years
ago
and
putting
more
attention
on
it.
You
know
that's
really
where
we
look
at
these
data.
You
know
back
in
2015,
2016
things
really
exploded
and
they've
only
gotten
worse,
but
there
was
you
know
there
was
a
gigantic
increase
in
overdoses
and
and
deaths
starting
around
that
time
and
and
again
we
were
hearing
from
as
we
were
sort
of
looking
at
this.
A
Looking
at
this
National
crisis
that
you
know
it
was
such
a
high
percentage
of
people
who
were
were
wrestling
with
addiction
where
it
started
because
they
were
prescribed
medications
by
a
doctor
and
they
developed
an
addiction.
So
they
were,
they
were
injured,
they'd
had
surgery,
but
it
it
didn't
it
didn't.
You
know,
sort
of
went
against
this,
perhaps
common
assumption.
Many
of
us
held
that
at
least
at
that
time.
The
most
common
source
of
the
origin
of
the
addiction
challenge
was
recreational
drug
use.
A
Right
it
was
actually
a
medical
prescription
was
the
origin
of
what
led
to
people
developing
the
addiction.
So
I
would
love
to
hear
some
updates
from
the
folks
who,
who
are
tracking
all
this
around
what
role
that
origin
plays
in
terms
of
medically
prescribed
drugs
that
compared
to
other
other
ways
that
these
stories
start
so
I
think
I
just
like
to
kind
of
kick
put
that
out
there
for
something
that
maybe
could
be
emailed
or
we
can
talk
more
about
it
when
we
have
further
discussions.
So
all
right,
hey
thanks.