►
Description
Briefing of the Buncombe County Board of Commissioners on October 4, 2022. The briefing is a chance for Commissioners to review agenda items before the meeting. No motions will take place during the briefing.
B
All
right,
thank
you
all
I'm
excited
to
be
here
today
and
more
excited
to
hear
from
those
that
will
be
speaking
after
me,
but
I'm,
hoping
to
just
kind
of
give
you
all
a
brief
introduction
about
the
opioid
settlement
planning
and
how
it
all
fits
right.
Why
are
we
looking
at
these
different
services
and
so
I'll
be
just
sharing
a
brief
update
and
then
we'll
be
hearing
from
our
partners
about
the
impact
of
medications
for
opioid
use
disorder.
B
As
we
continue
to
look
at
Future
funding,
we
want
to
be
sure
you
all
are
aware
of
our
current
resources,
the
impact
they
are
making
and
how
they
all
work
together.
Today,
we
will
be
hearing
from
some
of
our
County
programs
and
partners
that
are
providing
access
to
medications
for
opioid
use
disorder.
B
Everyone's
journey
to
recovery
is
different
and
so
having
a
variety
of
entry
points
and
supports
that
an
individual
receives
increases
the
likelihood
that
they
will
find
the
right
path
for
themselves,
and
so
one
of
our
touch
points
is
our
community
re-entry
team
in
Justice
Services
with
RHA
Behavioral
Health.
This
team
will
meet
with
individuals
while
they
are
incarcerated
to
discuss
their
goals
after
release
and
the
steps
they
need
and
want
to
take
to
reach
their
goals.
B
Assistance
is
provided
in
making
appropriate
referrals
and
sharing
of
resources,
as
well
as
ongoing,
support
after
release
to
problem
solve
and
shift
goals
and
or
steps
based
on
what
they
are
experiencing
at
the
moment.
Right
A
lot
of
times
you
get
out
and
you're
like
not
exactly
what
I
thought
it
was,
and
so
it's
important
that
this
support
is
available
to
help
give
hope
when
there
isn't
hope
to
help,
give
Clarity
and
focus
when
things
seem
too
overwhelming
to
tackle.
B
As
you
can
see
over
the
last
six
months,
almost
90
percent
of
participants
have
not
been
rearrested,
and
this
percentage
is
about
approximately
the
same
for
African,
Americans
and
caucasians.
B
Additionally,
we
have
another
touch
point
which
is
our
linkages
to
care
reentry
program.
This
provides
the
same
type
of
support
for
those
released
from
jail
or
prison
in
the
last
90
days
and
up
to
a
year,
Post
Release
through
a
harm
rediction
lens.
So
perhaps
they
weren't
referred
while
they
were
incarcerated,
maybe
afterwards,
they're
realizing
I
might
need
some
more
support.
B
B
Afterwards,
we
will
then
be
hearing
by
from
Dr
shuk
and
Shukla,
with
mayheck
Claire
Hubbard,
with
community
paramedicine
and
Sarah
Gayton,
our
community
integration
and
math
Services
director
and
the
sheriff's
attention
division.
Please
welcome
Courtney
Lytle
our
Sunrise
operations
director,
who
was
the
first
linkage
to
care
peer
support.
C
Good
afternoon
Commissioners,
my
name
is
Courtney
Lytle
and
I
appreciate
your
time
this
afternoon
and
willingness
to
let
me
share
today.
I
have
a
peer
support
specialist
and
a
recovery
coach
for
Sunrise
Community
for
Recovery
recovery
and
wellness.
I
would
like
to
begin
by
providing
a
brief
overview
of
the
community
linkages
to
CARE
program,
and
the
importance
of
the
program
in
our
community
linkage
to
care
is
housed
in
health
and
human
services
and
staffed
by
peer
support,
Specialists
with
Sunrise
Community
for
recovery
and
Wellness
over
the
last
two
and
a
half
years.
C
This
program
has
had
a
major
impact
on
our
community,
specifically
those
re-entering
from
jails
and
prisons.
Linkage
to
care
peers
are
able
to
provide
immediate
wrap-around
services
for
participants
prior
to
and
after
discharge
from
jail
in
prison
to
assist
in
leveling
barriers
that
exist
for
under
served
and
marginalized
populations.
Linkage
to
care
receives
referrals
from
state
prisons,
treatment,
centers,
Outreach
efforts,
halfway,
houses,
day,
centers,
the
port
team
and
many
other
community-based
organizations
in
our
community.
C
Lincolnshire
care
has
really
become
the
catch-all
for
participants
that
do
not
qualify
for
other
programs.
There
is
no
doubt
that
this
program
has
contributed
to
reducing
recidivism
rates.
Reducing
overdose
deaths
of
those
returning
from
incarceration
and
individuals
being
connected
to
life-changing
resources
then
enable
them
to
live
productive
lives.
Our
community
has
so
many
wonderful
programs,
and
not
one
of
them
is
able
to
do
this
work
alone.
It
takes
all
of
us
working
together.
C
The
current
outcomes
reflect
that
the
evidence-based
practice
of
harm
of
a
harm
reduction
framework
within
this
programming
has
fostered
strong,
positive
engagement
from
participants.
Since
the
start
of
this
program,
we
have
received
478
referrals,
completed
285
intakes
124
people
have
been
connected
to
mat.
119
people
have
been
connected
to
transportation
services.
C
Then
they
connected
with
linkage
to
care
after
release
encountered
port
at
some
point
in
their
Journey
accessed
our
syringe
service
program
at
the
health
department
and
continued
to
reach
out
for
support
from
one
of
our
peers
during
all
of
these
stages,
through
shared
understanding,
respect
and
mutual
empowerment.
Even
if
they
slip
up,
they
are
able
to
reach
back
out
with
no
judgment.
People
are
not
looking
for
more
mandated
Services.
They
are
looking
for
programs
that
provide
support
and
accept
people
exactly
where
they
are
at
today.
C
I
have
the
privilege
and
honor
of
introducing
two
incredible
humans
who
will
share
a
little
bit
about
themselves
and
how
this
program
has
changed
their
life.
Cat
Sullivan
is
the
current
linkage
to
care
re-entry
coordinator
and
toddler.
Grooms
is
the
linkage
to
care
peer,
Navigator
and
hearing
their
stories.
I
hope
you
will
give
serious
consideration
to
continue
supporting
this
amazing
work.
That's
happening
in
our
community.
Thank
you.
D
I
finally
ended
up
in
prison
when
I
was
48
years
old,
when
I
landed
in
prison.
I
wanted
to
do
something
different
with
my
life.
I
just
didn't
know
how
to
do
it,
or
even
if
I
could
do
it.
I
chose
to
move
to
Asheville
to
start
a
new
life
and
I
figured
well.
If
this
didn't
work,
I
can
always
go
back
to
what
I
knew
the
life
of
drugs,
and
it
wasn't
going
to
be
good
a
week
before
being
released
from
prison.
I
was
connected
with
a
program
that
program
is
linked
to
care.
D
This
program
saved
my
life
I
was
connected
to
the
peer
support.
Courtney
Lytle
was
my
peer
support
at
the
time
she
picked
me
up
from
prison.
She
gave
me
a
hug
and
she
she
showed
me
some
compassion
when
I
was
first
picked
up.
I
had
no
belongings,
I
literally
had
the
items
on
my
back,
but
the
clothes
that
I
was
released
in.
D
We
were
able
to
connect.
During
that
first
meeting
she
was
able
to
get
me
some
a
few
outfits
glasses
reading
glasses
that
were
so
I
needed
desperately
during
that
first
meeting
she
shared
part
of
her
story
with
me
and
I.
Remember
thinking,
wow
you've
been
through
a
lot
of
the
same
things
I've
been
through
and
look
at
you
now
I
told
her
I
want
to
do
what
you,
what
you're
doing
using
your
past,
to
help
other
people
and
her
response
to
me
was,
and
you
can,
that
really
stuck
with
me.
D
So
some
of
the
things
that
I
requested
or
that
I
wanted
is
I
wanted
to
be
able
to
live
with
my
son.
He
was
15
at
the
time
and
I
had
no
housing
for
him
to
come
to.
So
it
was
a
linkage
to
CARE
program
that
connected
me
with
the
steadfast
house.
Within
three
days,
I
was
living
with
my
son
in
a
safe
environment
that
was
inviting,
and
it
was
positive,
I
needed
to
see
a
doctor
and
a
psychiatrist
linkage
to
care
connected
me
to
those
I
wanted
to
take
classes
to
become
a
peer
support.
D
D
D
I
passed
on
what
was
given
to
me
by
my
peer
support
and
that's
hope,
somebody
believed
in
me.
Somebody
gave
me
some
resources
helped
me
financially.
They
helped
connect
me
with
the
recovery
meetings
and
they
gave
me
a
sense
of
community
which
I
had
never
had
before
today.
I
can
probably
say
that
I'm,
a
North
Carolina
peer
support,
specialist
I'm,
a
community
health
worker
I'm,
a
full-time
student
carrying
a
4.0
grade
point
average
at
a
B
Tech
I.
Have
my
son:
I,
have
a
home
I?
Have
a
car
I?
D
D
E
So
growing
up,
my
family
was
wealthy
in
love,
and
that
was
about
it.
Throughout
my
life,
I
was
determined
to
to
change
the
cycle.
E
E
I
convinced
my
mother
to
go
to
pain
management
and
I
began.
Selling
opiates
on
campus
I
did
that
for
some
time,
I
ended
up
getting
in
trouble
for
doing
so,
going
to
jail
when
I
got
out
of
there.
I
I
was
no
longer
enrolled
in
college.
E
My
mother
and
I
began
become
addicted
to
the
to
the
pain
pills
that
I
was
I.
Was
selling
I
continue
to
do
that
over
that
period
of
time
after
I
was
out
of
college
I
have
overdosed
over
100
times
as
far
as
I
know,
I've
overdosed,
more
than
anyone
in
Western,
North,
Carolina,
SSP
and
Port
are
major
influences
on
my
journey.
Ssp
Lifesaver,
everyone
in
my
family
carried
Narcan,
which
that's
one
of
the
reasons
I'm
still
here
today.
E
Poor
team
got
to
know
me
real
well,
because
sometimes
I
was
overdosing
twice
a
day.
They
were
there
for
continuous
to
encourage
me
to
try
to
show
me
different
pathways
and
at
the
time
I
just
wasn't
ready
when
I
got
locked
up
for
a
more
serious
charge.
I
was
in
Buncombe
County
for
about
nine
months.
E
That's
where
linkage
to
care
became
such
a
such
an
impact
in
my
life
and
that's
why
I
believe
in
it
so
strongly
today,
linkage
to
care
this.
This
is
where
we're
such
a
valuable
entity
in
the
community,
because
when
people
get
locked
up,
coincidentally,
they
get
sober,
you
know
they
get
some
of
their
emotions
back.
They
get
to
regain
some
some
feelings
and
they
get
to.
You
know
think
about
life
further
than
tomorrow,
so
that's
where
we
get
to
put
a
plan
in
place
and
that's
what
was
done
for
me.
E
Linkage
to
care
I
got
hooked
up
with
an
Oxford
House
when
I
went
to
that
Oxford
House
I
stayed
there
for
almost
a
year.
In
that
time,
I
was
able
to
regain
my
license.
I
went
to
peer
University
I
became
a
peer
support.
Specialist
I
got
hired
by
sunrise
now
I'm
now,
I'm
part
of
the
full
circle
that
helped
me.
E
I've
got
friends
and
family
who
are
locked
up
in
the
justice
system,
who
have
been
an
active
addiction
for
10
plus
years
and
don't
know
the
first
thing
about
sobriety.
What
that
looks
like
and
how
to
get
there
I
mean
and
that's
that's
the
role
we
play
We
introduce
options
to
people
before
they
come
back
to
what
they
know,
which
is
often
a
very
poisonous
situation.
You
go
back
home.
You
get
back
into
the
same
Cycles.
E
You
were
in
once
before
we
get
to
give
them
opportunities
to
go
to
Oxford
houses
or
sober
living
and
give
them
that
choice.
E
Today,
I'm
18
months,
sober
I'm,
super
blessed.
I
have
a
caseload
of
over
35
participants
that
I
connect
with
daily
and
I
get
to
share
you
know.
What's
so
beautiful
is
I,
don't
just
give
advice
or
I,
don't
tell
them
what
to
do.
I
tell
them
my
journey
and
what
works
for
me
and
I
get
to
go,
encourage
people
that
are
in
the
same
position.
I
was
in
I,
reached
out
to
a
few
participants
yesterday,
just
to
give
you
a
voice
from
from
the
people.
This
is.
E
E
My
second
one
is
I
am
seven
months.
Clean
linkage
to
care
has
went
above
and
beyond
to
help
me
be
successful.
I'm
enrolled
in
peer
University,
so
one
day
I
can
return
the
favor
that
someone
else
gave
to
me
and
my
last
one
I
kept
this
one.
Organic
with
the
language
linkage
to
care
is
amazing,
toddler
and
cat
rock
stars
at
what
they
do.
Thanks
for
the
insight
and
guidance
I'm
now
three
months
clean
and
then
still
at
Oxford,
so
linkage
to
care
is
an
essential
piece
of
the
puzzle.
E
Like
was
said,
all
pathways
are
different,
but
we
come
in
at
a
vital
point
in
people's
lives
where
they
are
able
to
comprehend
and
understand
and
think
about
their
next
step.
Thank
you.
B
F
I,
don't
know
you
can
like
step
back
and
forth.
It's
all
good
hello
commissioners,
I'm
going
to
be
walking
back
and
forth,
because
I
want
to
make
sure
I'm
on
the
right
side,
but
my
name
is
suchin
Shukla
I'm,
a
family
doc
in
mayhec
and
I
specialize
in
addiction,
medicine.
F
So
my
goal
and
the
next
set
of
slides,
is
to
make
sure
we're
on
the
same
page
about
what
the
science
consensus
is
around
addiction
and
what
works
and
what
doesn't
so
I'm
going
to
share
some
data,
painting
the
picture
of
the
national
problem
and
the
local
problem.
And
then
what
has
been
proven
to
work-
and
this
is
in
line
with
American
Society
of
addiction,
medicine
and
the
substance,
abuse
mental
health
service,
Administration
and
National
organizations
like
that
foreign.
F
F
And
you
can
see
on
the
bottom,
the
great
increases
over
the
past
couple
years.
Some
of
this
increase
absolutely
appreciated
the
pandemic,
but
the
pandemic
was
not
helpful
in
that
way,
and
you
can
see
I
this
that
there's
about
a
25
increase
nationally
over
a
one
year
period.
I,
don't
know
if
the
dates
line
up
because
I
can't
see,
but
in
that
same
period
North
Carolina
went
up.
F
40
percent-
and
you
know
long
story
short
Western,
North
Carolina
is
doing
worse
than
the
rest
of
state
and
Buncombe
County
is
doing
worse
than
the
rest
of
West
North
Carolina.
So
it's
not
been
a
great
several
years
of
doing
this
work,
seeing
it
firsthand,
despite
the
amazing
resources
we've
developed
in
this
County.
F
This
gives
you
a
snapshot.
I
think
of
opioid
overdose
deaths
and
stimulant
overdose
deaths
over
the
past.
I
think
it's
about
20
years
and
you
can
see
both
of
these
have
coincided
as
a
great
increase
in
the
same
past
five
years.
Oh,
that
makes
my
life
so
much
better.
Thank
you.
F
Okay,
click
this
and
this
gotcha,
so
that's
not
to
say
methamphetamine,
which
is
a
stimulant
Azure
for
Western
North
Carolina
is
causing
overdose.
It's
that
this
is
a
complex
problem
and
and
on
the
stimulant
side,
as
I
said
in
rural
counties
of
this
country,
including
West,
North
Carolina,
driven
by
methamphetamine
and
in
terms
of
opioids.
F
So,
just
as
again
a
reminder,
you
can
see
how
different
counties
fare
in
this
overdose
situation,
and
so
this
is
a
12-month
period,
ER
visits
which
is
easier
to
collect
than
actual
overdose
deaths.
So
you
can
see
a
lot
of
rural
counties
on
state
borders
and
in
this,
and
this
map
of
Buncombe
doesn't
come
up
at
the
top.
F
The
other
thing
to
point
out
here,
besides
the
fact
that
the
folks
who
do
visit
the
ER
in
overdose
situations
tend
to
be
people
in
their
20s
and
30s,
but
the
last
the
bottom
right
graph
really
shows
the
light.
Green
is
the
percent
of
the
population
per
insurance
status.
Self
pay
uninsured,
is
the
first
one
Medicare
Medicaid
and
then
private
insurance
on
the
bottom
and
the
dark
green
is.
F
What
percent
of
that
population
is
represented
from
overdose
rates
in
ERS,
and
you
can
see
the
disproportionate
effect
of
not
having
insurance
and,
as
we
know,
having
Medicaid
in
North
Carolina
by
definition,
usually
means
you
have
a
disability
or
or
are
Indigent
or
both,
and
you
can
see
that
does
not
account
for
overdose.
It's
the
access
to
health,
insurance
or
Medicaid.
That
really
is
the
difference
between
life
and
death.
F
So
this
is
from
a
publication
from
the
CDC
from
2018
and
just
gives
an
overview
of
what
they
termed
endorse
strategies
for
overdose
reduction
and
they
it's
a
great
document.
I
pulled
a
lot
of
resources
and
references
for
this
presentation,
but
it
summarizes
what
are
the
most
evidence-based
strategies.
F
These
are
the
things
that,
if
I
were
a
taxpayer
and
I
am
a
taxpayer
I
would
want
my
my
elected
leaders
to
invest
in,
and
so
you
can
see
I'll
leave
it
up
for
a
second,
because
I
don't
want
to
read
the
slide,
but
you
can
see.
These
are
a
number
of
things
that
my
friends
from
sunrise
and
and
Victoria
mentioned
that
Buncombe
County
has
awesomely
invested
in
over
the
years,
and
the
state
has
also
invested
in
over
the
years.
But
I
really
want
to
point
out
the
naloxone
distribution,
particularly
for
high
risk
individuals.
F
Those
are
folks
leaving
jails
and
prisons
as
well
as
folks
who
have
experienced
overdose
non-fatal
overdose.
Those
two
groups
are
often
considered
the
highest
risk
for
overdose
death,
having
survived
either
a
non-pail
overdose
or
being
released
from
jail
or
prison.
Mat
which
we
now
like
to
call
medication
for
opioid
use
disorder
is
very
effective,
which
I'm
pretty
sure
I've
slides
to
talk
about
that
and
I
would
also
highlight
yeah,
buprenorphine
and
emergency
department
settings.
F
F
So
the
number
one
reimbursed
modality
in
America
is
detox
plus
abstinence.
Their
number
one
utilized
in
America's
detox,
plus
abstinence
that
doesn't
matter
if
that
detox
plus
abstinence
has
a
whole
lot
of
Behavioral,
Health
and
you're.
You
know
riding
horses
in
these.
You
know
really
nice
celebrity
rehab
facilities
in
West,
North,
Carolina
or
if
you're
going
to
jail
or
prison,
the
outcomes
are
pretty
much
the
same.
One
out
of
ten
people
are
doing
good
after
six
to
12
months.
F
I,
don't
want
to
diminish
the
experience
of
that
one
person
because
they're
doing
something
really
important,
but
the
other
nine
people
are
not
doing
well.
If
you
look
at
buprenorphine
and
methadone
5
out
of
10
people
are
doing
well
and
then
Vivitrol,
one
out
of
three
people
are
doing
well,
so
as
a
society,
if
I
again
were
a
taxpayer
and
I
am
I
would
want
to
invest
in
the
thing
that
works
best.
F
Besides
keeping
people
in
care
and
and
not
using
opioids,
these
medications
are
life-saving,
and
some
studies
show
that
the
receipt
of
these
medications,
particularly
the
buprenorphine
and
methadone,
which
have
much
more
evidence
behind
them,
are
associated
with
the
75
decrease
in
mortality
rates.
And
so
you
can
see
that
little
graph
down
on
the
bottom
shows
that
it's
also
associated
with
decreased
risk
of
HIV
and
hepatitis
C
transmission,
which
can
be
a
cost
to
society
and
cost
of
taxpayers
and
insurance
companies
for
sometimes
a
lifetime.
In
the
case
of
HIV.
F
When
we
think
of
folks
involved
in
the
criminal
justice
system,
there's
a
lot
of
overlap
with
substance
use,
depending
on
the
study
50
to
66
percent
of
individuals
in
jails,
prisons
of
state
and
federal,
have
criteria
for
substance
use
disorder
and
North
Carolina's.
Specific
data
from
colleagues
at
UNC
have
shown
that
the
overdose
rate
death
rate
for
folks
leaving
jails
and
prisons
is
40
times
higher
than
the
general
North
Carolina
population,
and
yet
we
do
not
provide
these
services
in
most
jails
and
prisons,
but
not
in
Buncombe
County,
where
we
do
provide
those
Services.
F
So
there's
various
reasons
why
this
is
not
offered
you
know.
Jail
is
a
complex
environment
with
a
lot
of
things
going
on,
as
surrogating
can
maybe
attest
to
in
a
minute
here,
but
the
truth
is
not
providing
these
Services
is
a
real
cost
to
taxpayers
and
to
families
and
communities,
and
life
and
stricter
drug
laws
have
been
proven
in
research
to
not
improve
drug
use
rates.
Overdose
rates
recidivism,
but
they
do
increase
costs.
F
On
the
other
hand,
let's
see
if
I
have
it
here,
I
do
get
to
it.
Okay,
so
when
looking
at
the
science
of
medication
for
opioid
use
disorder
in
Correctional
settings,
we
have
a
few
great
examples
within
the
country.
So
Rhode
Island
is
a
one
County
State
really
small
place
to
do
experiments.
I
guess
you
could
say
so
they
did
a
Statewide,
which
is
a
county-wide
program
to
provide
all
three
FDA
approved
medications,
because
some
people
do
well
on
one,
not
the
other.
F
Because
it's
like
one
facility
there
61
reduction
in
post
over
a
post-correctional
overdose
rates
that
was
within
one
year
of
implementing
this
program,
other
European
countries,
where
they've
been
doing
this
for
longer
in
England,
they
showed,
as
you
can
see,
great
reductions
in
overdose
death
rates
at
all
cause
mortality
and
then
there's
even
science,
showing
that
this
reduces
violence
and
suicide
within
jails
and
prisons,
because
a
lot
of
that
is
driven
by
the
complexity
of
mental
health
conditions
when
you're
in
withdrawal
from
drugs.
F
In
terms
of
cost,
this
all
saves
us
all
money,
because
jails
and
oh
my
tea,
fell
off
imprisonment,
but
jails
and
prisons
are
expensive.
Besides
the
fact
that
it
increases
risks
for
that
individual
and
the
next
Generations
to
come,
whereas
buprenorphine
and
methadone
are
very
inexpensive
medications,
both
generic
there
are
costs
associated
with
the
provision
of
those
meds,
but
definitely
less
costly
than
incarceration,
and
even
Vivitrol,
which
is
a
newer
medication
and
so
still
on
drug
patent
is
still
cheaper
than
the
alternative
and
so
from
the
National
Institutes
of
drug
addiction.
F
Drug
abuse
they've
stated
that
for
every
dollar
we
spend
on
addiction
treatment,
and
that
includes
things
like
certain
services
and
harm
reduction
services
in
naloxone
distribution
for
every
dollar.
We
spend
we
say
four
to
seven
in
non-health
care
costs,
that's
jails,
prisons,
lawyers,
judges,
probation,
all
those
things
when
you
add
in
the
health
care
costs,
it's
eight
to
ten
dollars.
F
Now
those
dollars
are
added
up
in
different
ledgers,
but
in
terms
of
the
overall
cost
of
society.
Additionally,
recent
evidence.
You
know
this
is
sort
of
newer
in
America,
but
recent
evidence
does
show
that
providing
this
medication
in
jails
and
prisons
reduces
recidivism,
rearrest,
reincarceration,
parole,
violations,
criminal
activity,
violence
and
suicide
within
those
facilities,
though,
that
has
not
been
proven
with
the
Vivitrol.
It
is
in
your
medication
without
those
proven
benefits.
F
Just
a
few
other
things
to
highlight,
besides
medication
for
opioid
use
disorder,
which
I
clearly
am
passionate
about,
naloxone
distribution
is
not
only
good
for
saving
lives,
it
also
reduces
substance,
use,
reduces
ER
visits
and
thus
that
adds
up
to
reducing
cost
of
care
and
and
other
harms
related
substance
use
like
HIV
and
FC
transmission
and-
and
there
are-
and
there
are
ways
of
doing
this-
that
are
more
effective
than
others
and
I've
seen
the
correct
way
embraced
by
our
Sheriff's
Department,
which
I'm
really
proud
to
see,
and
so
for
this
post
release
population.
F
It's
particularly
effective
at
reducing
the
risk
of
death
and
harm
and
sort
of
the
same
story
with
syringe
exchange
programs
reduces
overdose
but
also
reduces
substance
use.
This
is
you
know,
in
line
with
what
my
colleagues
just
talked
about,
of
having
linkage
to
care
a
lot
of
people's
linkage
to
care
comes
through
these
syringe
exchange
and
naloxone
distribution
programs.
So
it
actually
ends
up
increasing
participation
in
substance
use
and
mental
health
treatment,
especially
for
folks
who
are
at
a
lower
access
to
care
level,
maybe
lower
trust
in
the
system.
F
So
as
this
one
study
showed
vast,
majority
of
these
participants
are
getting
no
care
from
any
other
segment
of
our
resources
in
in
our
communities
and,
lastly,
a
shout
out
to
peer
support
can't
do
without
y'all
I'll
just
skip
to
the
bottom
there.
This
is
not
just
about
having
a
front
line
on
boots
on
the
ground
service.
This
is
about
literally
reducing
risk
of
Overdose
and
engagement
in
treatment.
F
G
Dr
sugar,
yes
right,
I,
want
to
ask
a
few
questions.
If
that's
okay
leave
slide
number
five
that
had
all
the
various
squares
of
policy
positions
that
you
would
hope.
Governments
would
take
yeah
keep
going
backwards.
F
G
I
want
to
ask
you
what
academic
detailing
is.
I
also
want
to
ask
I'm
getting
my
chemical
names
mixed
up,
but
I
also
want
to
ask
what
an
example
is
of
a
place
where
we
are
not
where
we
could,
in
theory,
do
targeted
naloxone
distribution,
but
are
not
currently
doing
that
today,
yeah.
F
Great
questions,
so
academic
detailing
is,
if
you
all
remember
like
the
old
school
of
drug
detailers,
that
would
go
to
a
doctor
and
give
them
a
pen
or
a
trip
to
Bermuda
and
then
they'd
be
like.
Oh,
that's
not
going
to
influence
me,
but
research
shows
it
does
influence
them.
So
academic
detailing
is
using
that
that
trick
for
the
power
of
good
and
so
I,
you
know,
may
heck's
involved
in
some
Grand
funded
projects
around
this.
F
The
opiate
settlement
funds
can
be
spent
on
this,
but
it's
basically
sort
of
a
peer-to-peer
like
often
a
doctor
or
pharmacist
engaging
one-on-one
with
a
prescriber,
or
you
know
some
other
Healthcare
professional
to
encourage
them
to
do
evidence-based
strategies
of
care.
So
a
good
example
of
this
is
like
the
pivot.
The
Healthcare
Community
has
had
to
add
around
prescribing
opioids
right.
F
We
were
pretty
liberal
with
prescribing
that
over
the
past
whatever
decades
and
now
we're
pivoting
and
I
would
say
that
pivot
has
come
with
cost,
because
suddenly
stopping
someone's
chronic
opioid
therapy
can
put
them
at
risk
for
overdose,
because
then
they
might
use
illicit
substances
so
with
academic
detailing
I
can
both
engage
that
provider
on
how
to
do
this
better,
as
well
as
kind
of
motivate
them
to
do
different
things
like
hey.
Instead
of
dismissing
someone
from
your
practice,
why
don't
you
try
to
take
care
of
their
substance?
G
F
No
I
mean
I'm
I
feel
like
I'm,
pretty
familiar
with
the
resources
Community,
but
I
don't
want
to
I,
don't
know
at
all,
but
I
think
we're
doing
really
great
in
the
jails
and
the
Justice
Services
we're
doing
pretty
good
through
syringe
exchange
programs
like
with
steady
and
wincap
we're
doing
pretty
good
through
the
post
over
this
response
teams.
F
They
they
hand
out
a
lot
of
naloxone
I,
think
you
know,
I
I
think
I'm
I
have
a
like
I'm
credentialed
for
permission,
but
I
haven't
been
working
in
the
hospital,
but
I
don't
think
they
give
a
lot
through
the
ER
that'd
be
a
great
place
for
people
to
have
more
services
and
including
naloxone.
F
You
know
as
a
prescriber
I
can
prescribe
it.
Medicaid
pays
for
with
you
know
the
typical
three
dollar
copay.
So
that's
not
an
issue
so
coverage
for
the
uninsured.
You
know
if
I
see
a
patient
in
you
know
in
South,
Asheville
at
mayak
and
I
say:
hey
go
to
the
health
department.
Some
people
can
manage
that
some
people
can't
so
having
the
port
team
members
to
distribute.
That
has
been
really
a
game
changer,
as
well
as
peer
support.
F
They've
been
really
awesome
to
distribute
that,
but
I
think
any
place
that
you
can
think
of
where
these
folks
engage
in
the
system,
whether
the
criminal
justice
system,
Emergency,
Services
clinics,
churches
I
mean
anything
that
should
be
a
place
where
naloxone
is
available.
F
So
I
think
you
know
naloxone
if,
if
a
little
kid
gets
into
it,
it's
like
safer
than
water.
It's
it's
a
very,
very
safe
medication,
so
it
should
be
available
everywhere
and
essentially
in
North
Carolina.
Because
of
the
standing
order.
You
don't
need
a
prescription.
So
it's
Wednesday
it's
over
the
counter,
but
it
pretty
much
is
you
can
go
to
any
pharmacy
and
pick
it
up
and
they
you
don't
need
a
prescription.
G
I
guess
to
pull
on
that
at
least
Hospital
ER
threat.
A
little
more
I
would
again
not
an
expert,
but
would
gather
that
folks
in
these
types
of
circumstances
would
find
themselves
in
the
largest
ER
in
Western
North
Carolina,
often
or
at
least
you
know,
occasionally
throughout
their
their
addiction.
Experience.
You're
saying
that
that
agency
does
not
do
this
at
all.
F
I,
don't
I,
don't
think
they
have
a
overall
policy.
My
EMS
colleague
may
be
able
to
answer
more,
but
I,
okay,
I,
don't
think
it's
I,
think
people
overdose
and
go
to
the
ER
and
do
not
get
a
naloxone
prescription
when
they
leave.
Okay,
like
that,
is
not
a
rare
thing.
That's
a
common
thing.
F
H
Good
evening,
commissioners,
thank
you
for
having
us
I'll,
go
to
what
I
had
to
say
in
a
moment,
but
I
just
wanted
to
help.
We
were
just
mentioning
that
sometimes
there's
not
funding
for
Narcan
naloxone.
Last
year
we
gave
out
I
believe
5600
two
milligram
dosages
through
via
Health.
It
was
a
donation
from
via
and
we
got
rid
of
those
before
the
year
was
over.
So
we
often
we
have
a
high
demand
for
it.
H
We
just
have
to
seek
funding
for
it
sometimes,
and
that
can
be
complicated
and
have
red
tape,
but
we
are
working
to
try
to
get
it
into
more
spaces.
Schools
take
the
prevention
Avenue
as
well
with
it.
So
there's
an
increasing
demand
for
us
to
have
it
kind
of
readily
available,
but
I
can
let
other
folks
speak
more
to
that.
H
As
many
of
you
guys
know,
we
began
as
a
community
paramedicine
pilot,
which
was
a
post
overdose
response
team
in
November
of
2020,
as
a
port
team,
we're
still
co-responding
in
real
time
through
the
911
dispatch
Center
to
overdoses,
to
anything
that
could
be
a
potential
illicit
substance
situation.
We
have
responded
to
collectively.
At
this
point,
over
six
thousand
calls
mind
you
that's
not
entirely
overdoses
and
we
can
reference
that
in
a
few
slides,
but
we've
stayed
pretty
busy
as
of
March.
This
year
we
did
start
giving
Suboxone
in
the
field
or
buprenorphine.
H
Those
are
interchangeable
and
I'm.
Sorry,
oh
thank
you.
Those
are
interchangeable
and
we
do
give
that
for
up
to
five
days
in
the
field
we
meet
people
where
they're
at
quite
literally,
if
it's
at
a
McDonald's
or
if
they're,
not
comfortable
with
a
family
member,
knowing
that
they're
seeking
help
out
in
a
street
corner
or
just
wherever
people
can
on
a
break
from
work,
we
try
to
meet
people
where
they
are
physically
and
emotionally,
and
that
has
looked
like
a
lot
of
different
things
for
us.
H
I
want
to
also
make
note
that
our
program
is
made
possible
in
part
by
mayhec.
We
partnered
with
them
to
have
wraparound
resources
for
the
patient.
So
once
we
induce
them
with
suboxone
in
the
field
again
through
either
our
911
system
or
the
telephone
that
we
carry
24
7
we're
able
to
give
them
that
medicine
for
up
to
five
days
and
then
we
hand
them
off
through
a
peer
support
person
to
mayhex
side
of
the
program
where
they
can
get
free
services
for
up
to
12
months
again.
H
A
lot
of
that
is
free
medication
and
access
to
care
through
Transportation
emotional
support
stuff
that
our
peers
can
provide
once
our
Medics
have
given
them
medication.
We
have
a
lot
of
data
and
narratives
I'll.
Leave
that
I
wanted
to
call
up
our
peer
support,
lead
to
give
you
some
stories,
but
I
just
wanted
to
go
over.
H
Some
of
the
information
that
we
have
I
did
want
to
note
that
we
also
did
receive
funding
for
our
an
Outreach
team
that
we
hope
to
stand
up
very
soon
here,
sometime
in
November,
and
this
team
came
about.
The
request
for
this
was
because
we
had
so
many
our
poor
nmat
paramedics
were
able
to
identify
so
many
gaps
in
care
that
weren't
strictly
opioid
related,
but
were
rather
poly
substance
or
had
to
do
with
social
determinants
of
health,
and
we
needed
a
lot
of
additional
support
to
get
people.
H
Medical
needs
and
mental
health
needs
and
stuff
like
that,
and
so
I
can
answer
any
questions
about
that.
More
specifically,
but
I
did
want
to
mention
that
part.
I
H
Yeah,
thank
you.
So,
like
I
said,
we
were
able
to
identify
through
the
port
and
mat
teams,
that
there
were
a
lot
of
people
falling
through
the
cracks
medically
that
maybe
they
did
have
substance
use
issues,
but
even
if
we
were
able
to
get
them
on
Suboxone
or
get
them
Narcan
regularly
or
or
meet
them
before
an
overdose
or
after
one,
we
weren't
able
to
get
them
basic,
Medical,
Care.
Otherwise,
because
we
just
didn't
have
the
bandwidth.
H
H
So
this
way
the
paramedics
can
stay
on
9-1-1
calls
and
things
that
require
High,
Acuity
and
the
EMTs
might
be
able
to
make
you
know,
rounds
at
homeless,
shelters
or
downtown
or
the
parks
or
just
try
to
mitigate
some
of
those
911
calls
before
they
happen
when
someone's
really
just
needing
some
wound
care
or
someone
to
talk
to
for
several
hours
at
a
time
which
we
all
know.
Not.
Many
people
have
the
bandwidth
to
do
currently
through
all
of
the
programs
that
we
have.
We
have
very
little
resource
for
that.
H
So
we'll
also
have
some
community
health
workers
embedded
in
the
in
the
community
out
in
different
community
centers.
Sorry
I
just
said
Community
many
times,
but
they
are
they're
out
and
they're
mobile
and
they're
sort
of
acting
as
Liaisons
to
frankly,
First
Response,
because
that's
a
system
of
trust
that
needs
to
be
rebuilt,
so
we're
trying
to
get
community
actively
engaged
so
that
when
we
say
how
can
we
get,
you
know
naloxone
into
areas
that
people
need
it.
H
We
can
get
feedback
and
also
it
gives
them
a
Lifeline
to
contact
our
team
and
require
medical
support
in
areas
where
historically,
it's
felt
complicated
or
unsafe.
We
also
have
a
nurse
liaison
and
a
wound
care
nurse,
and
these
positions
were
created
because
of
the
high
demand
that
we
had
from
our
substance.
H
H
H
So
I
wanted
to
share
our
most
recent
narrative
where
a
person
who
left
the
hospital
overdosed
went
to
the
hospital
we
were
unable
to
meet
them
at
the
hospital
due
to
the
fact
that
they
left
before
we
could
arrive,
and
we
didn't
need
to
find
them
because
they
called
our
phone
because
a
friend
had
given
them
our
phone
number,
so
nothing
against
the
hospital,
but
it
isn't
an
ideal
place
to
to
go
through
detox
or
to
get
wraparound
care
in
the
emergency
department.
H
So
the
short
person
is,
she
called
our
phone
after
hours
around
10
o'clock
at
night,
after
getting
out
of
the
hospital,
we
were
able
to
go
and
induce
her
on
Suboxone
and
have
dosed
her
for
five
days
at
this
point,
and
that's
not
one
of
the
more
emotional
stories,
but
it
is
a
very
logistically
relevant
one.
Just
just
that's
not
a
gap,
that's
easy
to
qualify.
H
So
if
you
have
any
questions
about
this
page,
please
feel
free
and
I'm
going
to
get
Justin
Hall
up
here
for
these
next
two
slides,
because
I
do
think
just.
H
Go
ahead
and
again
I'll,
just
let
him
tell
you
a
little
bit
of
the
short
version
of
his
story
and
how
he
came
to
our
program
and
then
also
just
some
more
of
the
narrative
component
of
our
program.
J
Thank
you
Claire,
and
thank
you
for
Commissioners
for
giving
us
a
chance
to
kind
of
stand
in
front
of
you
today
and
talk
a
little
bit
about
the
remarkable
work
that
we
have
been
doing
for
the
last
couple
of
years.
J
So
I
guess
I'll
start
by
saying:
I
am
a
person
in
long-term,
sustained
recovery
and
that
kind
of
started.
My
journey
I
worked
in
the
mental
health
substance
use
field
for
a
number
of
years
in
various
roles,
and
then
once
I
saw
the
opportunity
and
all
the
wonderful
things
that
the
harm
reduction
approach
here
in
Buncombe
County
was
doing
that
also
included
the
post
overdose
response
team
I
wanted
to
get
connected
with
that.
J
When
I
first
started
with
the
role,
my
main
focus
was
to
figure
out
where
the
gaps
are
understanding
kind
of
the
system.
They
are
sometimes
broken.
How
can
our
team
plug
into
those
gaps
to
really
help
fill?
You
know
the
pieces
and
just
keep
people
finding
hope
and,
and
hopefully,
if
nothing
else,
Staying
Alive
long
enough
to
want
to
find
recovery,
and
so
that's
kind
of
what
a
lot
of
the
conversations
we've
had
today
is
about.
Is
finding
out
where
those
gaps
are
and
how
can
we
solve?
J
Those
part
of
our
mat
program
that
we
started
in
March
was
a
massive
piece
to
that,
because
what
we
learned
was
a
lot
of
the
people
we
connected
with.
We
had
great
interactions,
they
were
ready
and
hopeful
and
motivated
and
then
a
few
hours
later,
the
withdrawal
symptoms
hit,
and
then
we
lost
them
to
either
an
overdose
that
they
had
again
and
died,
or
they
just
disappeared
because
they
just
you
know,
tried
to
go,
find
a
way
to
make
themselves
feel
better.
J
You
hear
poor,
think
Community
paramedic,
because
they
are
interchangeable
and
our
community
paramedics
have
done
a
remarkable
job
being
able
to
find
people
meet
them
wherever
they
are
literally
in
the
community,
under
bridges
down
railroad
tracks
behind
you
know,
Walmart
wherever
to
get
them
their
medication,
because
of
that
we've
been
able
to
successfully
connect
quite
a
few
people
to
mayhec
I
think
our
paramedics
had
dosed
76
people
and
of
those
76.
Thank
you,
60
had
been
able
to
successfully
make
their
first
mayhec
appointment
and
I.
J
You
know,
and
it's
not
just
the
medication,
although
it's
a
big
stabilizer,
it's
the
wraparound
support
a
couple
of
stories
to
share
just
to
kind
of
give
you
a
snapshot
of
some
of
the
situations
we
work
with.
Two
in
particular
come
to
mind.
One
is
an
individual
that
was
homeless
was
actually
in
the
hospital
we
were
able
to
connect
with
him
in
the
hospital.
J
We
did
try
to
partner
with
the
hospital
to
allow
us
to
begin
his
medication
there,
while
he
was
waiting,
because
he
was
literally
just
laying
in
a
bed
kind
of
suffering
until
the
hospital
figured
out
what
they
were
going
to
do.
Unfortunately,
we're
not
able
to
get
the
hospital
staff
to
let
us
dose
him
inside
the
hospital.
So
we
stayed
in
communication
with
him
and
as
soon
as
he
was
discharged,
we
were
waiting
outside
the
emergency
room
door
to
give
him
medication.
J
We
gave
him
medication,
we
gave
him
medication,
we
got
him
connected
to
Costello
house,
which
is
a
sober
living
place
here.
He
is
still
housed
there.
He
is
doing
incredible
and
now
is
working
again
and
I
get
messages
from
him
all
the
time.
Just
thanking
us
for
our
support
and-
and
you
know
just
again
showing
him
that
life
is
worth
living.
You
know
somebody
just
showing
up
to
care
and
plug
him
into
resources,
the
other
one
that
definitely
had
the
opportunity
to
go
a
worse
way.
J
We
had
another
individual
that
we
connected
with
that
was
homeless,
living
in
a
tent
on
the
outskirts
of
Candler,
so
no
access
to
really
bus
routes
or
any
sort
of
resources
out
there.
Not
only
that,
but
she
was
pregnant.
We
met
with
her.
There
are
projects
out
there
for
the
and
pregnancy
population,
struggling
with
substance
use.
Mayhex,
Dr,
shukla's
mayhec
agency
has
a
great
project.
Cara
team
there
again
coming
back
to
filling
gaps.
What
we're
able
to
do
is
go
to
the
community
and
meet
her
where
project
Cara
staff
could
not
do
that.
J
They
could
only
provide
the
outpatient
service.
So
not
only
have
we
been
able
to
bridge
her
to
mayhec
provider
care,
but
we
have
a
peer
support.
That's
stayed
by
her
side
through
the
whole
process
kept
her
fighting
through
urges.
She
was
admitted
to
the
hospital
last
week
with
some
complications
when
she
was
scared
to
death,
she
was
going
to
lose
the
baby.
Our
peer
was
able
to
go
with
her
to
the
hospital,
be
there
with
her
through
that
process
she
gave
birth
yesterday,
our
peer
has
been
through
that
process
from
step
one.
J
Is
there
anything
I
need
to
cover
on
this
slide,
okay,
cool
questions
or
anything.
For
me,.
H
Thank
you,
I
guess
I'd
just
like
to
end
in
saying
that,
obviously
we're
all
on
the
ground
and
the
field
together,
we're,
like
a
constellation
of
you,
know
we're
a
big
team.
It's
just.
These
are
all
just
moving
pieces
in
the
consolation
of
getting
people
care
wherever
they're
at,
but
it's
provided
amazing
work
for
us,
as
well
as
people
in
recovery
and
as
peers
and
as
EMTs.
This
is
not
work
that
we
traditionally
have
access
to
doing
and
so
being
able
to
sort
of
collectively
heal
from
the
trauma
of
the
opioid
crisis.
H
Together.
It
goes
both
ways,
so
thanks
very
much
and
I
think
surrogating
is
up
next.
G
K
K
B
H
Port
is
five:
people
mat
is
four
people,
Outreach
is
eight
people,
so
that
brings
our
staff
in
total,
including
Justin
and
I.
To
well.
I
should
have
put
my
money
where
my
mouth
was
before.
I
could
add
like
that.
But
yes.
I
H
So
we've
got
what
that
equals
is
two
with
the
Outreach
team
included
two
EMTs
on
shift
per
day
working
12
hour
shifts,
and
then
it
equals
two
paramedics
working
at
on
shift
per
day
working
a
24-hour
shift.
So
you've
got
four
EMS
Personnel
on
for
half
the
day
and
then
two
on
24
7..
Does
that
make
sense.
L
Highly
utilized
in
a
24
7
low
barrier,
shelter
setting
as
our
community
kind
of
continues
to
ask
questions
about
whether
that's
a
direction
we're
going
in.
But
we
certainly
know
the
need
for
those
Services
exist
and.
L
His
priorities
are
very
clear,
so
the
fact
that
their
services
will
be
available
will,
on
a
human
level,
be
getting
those
services
to
folks,
but
I
think
will
also
help
us
as
a
community
learn
a
lot
about
what
happens
when
those
services
are
introduced
and
and
and
and
better
inform
the
conversations
we'll
be
having
at
the
community
level
around
the
Liberia
shelter
conversation
and
the
recommendations
that
we're
going
to
be
getting
from
this
consultant.
L
That
was
retained
by
the
city
county
in
Dogwood,
around
homelessness
issues
generally
so
just
kind
of
wanted
to
take
a
moment
to
tee
that
up,
because
we've
had
so
many
conversations
in
this
on
these
Topics
in
the
last
couple
years
and
and
and
I
know,
there's
a
significant
investment
to
support
this
pilot
project.
L
L
The
date
was
moved
up
a
bit,
but
this
outreach
program
will
help
to
think
facility
quality
folks
getting
to
those
purple
sites
getting
to
the
appropriate
or
the
best
fit
called
Purple
site
for
them
and
again
really
represents
sort
of
a
county,
bringing
more
capacity
and
coordination
into
supporting
code,
purple
Services,
which
which
will
be
underway
this
winter.
So
thanks
for
that
and
just
wanted
to
kind
of
add
a
bit
more
context
before
we
move
on
to
the
next
part
of
this
conversation.
H
K
Well,
I'm
Sarah
gate
and
I'm
with
the
Sheriff's
Office
and
I
could
just
maybe.
F
K
Will
do
it?
Oh
I,
do
it?
Oh
all
right
here
we
go
so
quick
overview.
You
all
have
gotten
a
lot
of
information
and
feels
like
two
and
a
half
years
since
I've
stood
before
you
initially
and
we
started
projecting
out
what
was
going
to
happen
and
and
hearing
all
of
these
individuals
present
has
been
pretty
emotional.
K
For
me,
I
have
to
admit,
because
this
is
the
culmination
of
all
the
work
that
you
all
have
committed
to
and
supported
and
backed,
and
so
it's
as
we
jump
into
this
last
segment,
I
really
wanted
to
say.
Thank
you.
These
folks
sitting
in
here
have
lost
countless
people
through
these
past
years,
their
friends,
their
family
members,
and
it's
such
a
beautiful
thing
to
see
the
fruition
of
the
work
actually
working
and
you've
heard
a
lot
of
that
fruit
and
we're
going
to
hear
a
little
bit
more.
So
just
in
brief.
K
We
had
no
data
when
we
started
out
and
we
were
able
to
to
identify
that
over
half
of
everyone
that
was
dying
in
Buncombe
County
in
fact
was
passing
through
the
Detention
Facility
and
of
that
half
50
of
those
folks
were
leaving
within
24
hours,
so
that
informed
that
we
had
a
very
short
timeline
to
reach
the
most
amount
of
people
we
built
up
programming
from
that
point
and
even
before
Community
paramedicine
was
off
the
ground
in
the
early
planning
stages.
K
We
talked
about
how
we
could
co-labor
and
have
some
warm
handoffs
with
that
team,
and
it's
really
exciting
that
Claire's
team
is
we're
getting
to
that
point
where
we're
actually
getting
ready
to
pull
the
trigger
on
that
and
start
moving
forward
with
having
tighter
connections
with
releases
from
jail
and
safety
net
programming,
linking
it
into
linkage
to
care.
That
was
the
same
thing
that
they
were
co-built
and
the
folks
who
were
not
in
jail.
K
Long
enough
to
be
able
to
access
the
map
program
in
our
facility
were
able
to
get
direct
referrals
over
to
linkage
to
care
and
everybody
walking
out
of
jail
if
they
report
opioid
use
they're.
Given
a
resource
sheet
and
an
overdose
kit,
that,
in
fact,
has
the
linkage
to
Care
Resources
listed
on
it.
So
there's
a
lot
of
safety
net
programming
and
overlap
that
we
are
able
to
work
into
the
programming
on
the
right
hand,
side
it's
it's
a
matte,
program-centric
visual.
K
It
just
shows
who
all
of
our
partners
are
our
peers
work
with
to
get
the
folks
that
they're
working
with
directly
connected
into
the
community?
It's
a
lot
of
Partners.
It's
a
lot
of
logistics
and
I'm,
just
going
to
ask
Maya
to
come
up
and
share
a
little
bit
about
what
that
work
looks
like
for
her
in
the
jail
and
the
meaning
of
having
it
in
that
environment.
M
Good
evening
Commissioners,
my
name
is
Maya
Hughes
I'm,
a
person
in
long-term
recovery.
I
am
the
peer
support
specialist
in
the
Buncombe
County
Detention
Facility
I
have
like
just
a
couple
key
things:
I'm
going
to
hit
on
it
to
be
respectful
of
time.
There
are
tons
of
programs
successes
throughout
the
jail.
M
The
fact
that
they're
already
reaching
out
that
they're
asking
for
help
that
they're
saying
I
can't
do
this
by
myself
is
already
a
success
in
itself
to
me.
So
by
the
time
I
go
in
meet
with
them
for
pre-hmps
we
sit
down
the
medical
stuff,
I'm,
not
really
part
of
that
so
I'm,
just
the
part
where
I
go
down
and
I'm
like
hey
I'm
in
long-term
recovery,
let's
try
to
come
up
with
some
kind
of
a
re-entry,
planner
safety
net,
the
doctor
and
the
jail
kind
of
explains
the
mat.
M
If
they
have
any
questions
about
that,
even
people
who
have
been
on
it
previously
still
aren't
sometimes
as
educated,
and
you
know
what
they've
been
taking
so
that
one-on-one
connection
all
the
time.
I
had
a
in
pre-h
P,
four
of
them
this
morning
and
one
of
the
girls
just
bursted
into
tears,
because
she
saw
that
I
have
a
car
in
my
son
back
full
time
and
I
bought
a
home,
and
you
know
I
actually
hold
myself
up
high
now
and
the
same
thing.
M
That
was
what
was
previously
said,
which
is
like
you
can
do
this
too,
so
being
able
to
have
that
connection
in
the
jail
is
so
important
having
them
be
able
to
start
dosing
before
they
are
released.
M
If
we
can
is
is
a
huge
thing
they
can
get
in
their
system
when
they
get
out,
they
can
reach
out
to
myself
and
then
the
community
peer
who's
in
the
community
full
time
we
will
link
them
up
to
an
met
provider,
they're
released
with
five
days
of
medication,
so
that
gives
us
a
second
to
be
able
to
make
sure
that
you
know
we
get
them
where
they
need
to
go.
So
we
can
help
with
halfway
houses.
Phones,
peer
support,
rides
to
court
medical
appointments.
M
All
of
that
stuff
I
did
want
to
touch
on
something
that
I've
come
across
multiple
times,
which
is
really
it
or
Works
me.
Whenever
I
am
going
over,
the
pre-hmps
I
have
to
ask
participants
how
many
times
have
you
been
to
jail
like
a
rough
estimate?
How
many
times
have
you
been
been
to
prison
a
lot
of
them?
It's
10
20
times
in
jail,
five
plus
in
prison,
and
then
a
question
after
that
is
how
many
times
have
you
been
to
treatment
and
a
tremendous
amount
have
never
known
nothing.
They
don't
know
anything.
M
M
I
did
want
to
another
co-worker
of
mine
who
I
was
actually
incarcerated
with
back
in
2015.
We
are
both
fully
employed
for
Sunrise.
Now
we
have
walked
this
entire
journey
together.
Her
face
every
time
I'm
walking
down
to
the
women's
dorm,
is
on
the
big
faces
of
Hope
poster.
So
it
always
gives
me
a
smile
I'm
having
a
bad
day,
knowing
that
we're
where
we
were
from
you
know,
people
ask
about
the
significance
of
mat.
It
is
a
part
of
my
story.
M
I'm
in
long-term
recovery,
I
am
abstinent
from
everything,
but
it
literally
saved
my
life
for
I
was
often
on
it.
For
about
10
years,
when
I
went
through
drug
treatment
Court,
it
was
not.
You
couldn't
do
anything
at
that
time.
Now
you
can,
which
is
great,
so
I
remained
abstinent,
but
I
mean
I.
Don't
too
many
people
are
dying,
it's
just
it's
all
the
time
and
it's
neighbors
and
Sons,
and
you
know
now
I
meet
with
some
people
that
didn't
even
start
using
anything
until
they
were.
M
You
know
in
their
late
30s,
and
it
was
in
a
pill
somehow,
where
you
know
it's
just
it's
yeah
so
I
mean
I
put
that
in
capital.
Letters
is
like
one
of
my
notes.
Just
how
important
getting
people
connected
with
met
is
before
they're
released
if
possible,
and
then
just
that
one-on-one
peer
support,
so
I'm
trying
to
think
yeah
I've
watched,
Piers
get
their
kids
back.
I've
watched
appear.
M
Have
a
baby
she
that
one
is
actually
that
was
last
year:
she's
still
in
long-term
recovery,
get
cars,
some
fall
back
off
and
that's
okay,
but
they
are
comfortable
enough
with
everybody
in
this
room
to
be
able
to
call
and
say,
hey,
I
screwed
up
I
need
some
help.
M
They
know
that
there's
no
judgment
there,
so
yeah
I
think
mat.
There's
just
I.
Everybody
should
have
the
opportunity
if
they
so
wish.
So
I
don't
know.
If
there's
anything
else,
you
wanted
me
to
touch
on,
but
yeah.
It's
wonderful.
So
thank
you.
M
K
You
all
have
heard
a
lot
about
peers.
They,
they
are
the
the
magic
that
makes
this
work
possible
and
makes
it
it's
Salient.
K
K
We
have
seen
a
22
percent
decrease
in
in
jail,
Associated
deaths,
post-release
for
individuals
who
are
Justice
involved
and
registered
deaths
within
our
County
in
these
past
two
years,
and
that's
really
really
significant,
because
the
national,
the
state
and
the
county
averages
and
numbers
all
went
up,
but
what
we
were
seeing
from
folks
who
had
been
passed
through
the
jail
in
the
two
years
of
20
and
21.
Those
numbers
actually
went
down.
K
We
saw
22
percent
correlated
reduction
in
programming,
and
so
that
was
a
breathtaking
moment
right
when
things
are
really
bad
and
things
were
getting
worse.
These
interventions
that
were
doing
these
safety
net
programs
that
we've
developed
and
built
the
strategies
that
have
been
really
specific
and
targeted
are
being
effective.
K
The
naloxone
to
release
linking
folks
to
care
having
the
wraparound
services
and
then
prior
to
launching
we
were
able
to
do
a
study
that
identified
that
people
who
were
just
on
M18
when
they
were
arrested
had
a
18,
lower
recidivism
rate
than
individuals
who
were
an
untreated
addiction.
Our
data
hasn't
gotten
correlated
at
this
point
to
see
what
our
post
programming
numbers
are:
we're
building
up
that
data
set,
but
but
recidivism
is
impacted
by
being
on
treatment
alone
without
any
services.
On
top
of
that,
so
that's
another
motivation.
K
K
On
the
right
hand,
side
this!
This
is
probably
one
of
my
favorite
pictures
to
date.
All
these
are
our
peers
and
our
and
these
three
different
programs
that
you've
heard
of
today
I
call
them
a
trifecta
service
mix,
because
it's
the
mat
in
jail,
the
post,
overdose
response
team
and
then
the
linkage
to
care
programs
creates
this
wonderful,
Community
safety
net.
You
all
can
read
through
this
later.
It's
just
a
distribution
of
who's.
K
Doing
what
again,
we've
got
three
full-time
staff
that
are
operating
under
this
Grant
and
we're
seeing
troves
and
troves
of
people.
Maya
has
got
a
caseload
of
anywhere
from
100
to
200
people
on
the
mat
caseload
and
that's
impossible
to
serve
that
many
people
with
that
few
humans,
and
so
what
that
forces
them
to
do
is
respond
to
the
folks
who
were
presenting
who
are
motivated,
who
are
reaching
out,
but
it's
not
necessarily
providing
assertive
Outreach
to
those
who
would
really
benefit
it
as
well
benefit
from
it.
K
I
did
want
to
point
out
just
briefly,
because
I
know
data
gets
thrown
around
a
lot.
The
North
Carolina
Health
and
Human
Services
has
provided
opioid
dashboard.
That's
got
a
lot
of
data
specific
to
counties
State.
It's
got
a
number
of
different
interventions
from
Child
Welfare
to
Justice
involved
overdose
deaths
Etc.
K
That
information
is
not
as
accurate
on
specifically
with
the
deaths
as
a
partnership
with
our
Register
of
Deeds
that
we're
able
to
connect
with
him
on,
and
so,
if
you
hear
discrepancies
in
the
data,
the
numbers
that
I'm
getting
are
directly
coming
from
the
partnership
with
the
register
of
deeds
and
then
from
there
we're
able
to
bring
it
through
the
Justice
systems
and
set
us
out
some
really
specific
data
that
helps
inform
which,
what
we're
doing
and
how
we're
going
about
doing
it.
K
And
then,
in
the
process
of
that
it
enables
some
interesting
analysis
as
well.
Some
really
powerful
analysis.
We
saw
30
percent
increase
this
year
of
stimulant
use,
stimulant
overdoses
stimulant
with
opioids,
so
the
number
I
don't
want
to
get
it
all
confusing.
But
basically,
individuals
who
are
primarily
using
stimulants
are
increasing
in
their
overdose
rates
by
30
percent
this
year
right,
so
the
population
that
we
were
really
focused
on
opioid
use
disorder,
individuals.
K
Now
this
target
population
has
expanded
and
that
really
should
inform
how
we're
going
about
business,
because
the
the
way
the
drugs
interact
with
the
system
is
different
right
and
so
the
medications
are
different.
Mat
isn't
isn't
effective
for
stimulants,
so
data
is
really
really
powerful,
and
that
requires
a
lot
of
bandwidth
as
well
to
be
able
to
process
that
and
I
believe
that
is
the
end
of
the
show.
On
our
end,
any
any
questions
about
Matt
in
jail.
L
And
if
I
could
just
chime
in
again
here
with
a
tremendous
thank
you
to
Victoria
and
other
staff
working
on
this
and
to
everyone
who
participated
in
this,
this
was
a
just
such
an
incredible
opportunity
to
do
a
deep
dive
on
these
issues.
At
a
time
where
we
are
you
know
facing
such
urgent
Community
needs
based
on
you
know
the
the
most
recent
data,
and
so
many
of
the
stories
we've
heard
and
also
where
we
begin
this.
L
You
know
15-17
year
journey
of
receiving
settlement
funding,
which
can
be
used
as
one
piece
of
a
much
larger
set
of
strategies
on
how
we're
responding
to
the
opioid
crisis.
So
just
really
want
to
thank
figs
for
all
the
time
and
effort
that
went
into
preparing
today's
presentation
and
the
work
you're
doing
on
the
front
lines
every
day,
and
then
just
thank
fellow
Commissioners
for
always
being
so
engaged
on.
L
This
set
of
issues
from
learning
and
update
perspective,
but
also
policy
making
perspective
and
prioritizing
this
within
our
budgetary
decisions
and
I
really
hope
as
we
move
forward
in
it
and
concretely
as
we
start
to
preview
and
look
ahead
to
next
year's
budget
cycle,
that
we
can
really
set
think
think
in
a
big
picture.
Ways
about
how
we
want
to
set
some
2022
and
forward-facing
strategies
in
response
to
the
opioid
crisis.
L
That
certainly
is
inclusive
of
the
work
we'll
do
through
the
settlement
allocation
or
settlement
funding
allocation,
but
also
includes
how
we're
thinking
about
continued
support
and
opportunities
to
continue
expanding
the
community
Paramedic
program
and
ways.
We
can
be
working
with
Community
Partners
on
integrating
these
Services
into
even
more
care
environments
in
places
where
people
might
be
willing
to
take
that
first
step
towards
treatment.
L
So
just
want
to
really
from
the
bottom
of
my
heart,
Express
that
that
thanks
and
also
just
preview,
some
of
the
places
I
think
this
conversation
will
take
us
in
the
months
ahead.
A
Thank
you
so
much,
commissioner
Beach
Ferrara.
We
appreciate
those
comments
and
thank
you
again
to
all
of
our
presenters.
The
timing,
as
she
said,
could
not
have
come
at
a
better
time
for
us,
particularly
before
we
wrap
up,
want
to
thank
Justin,
Maya,
Tyler
and
Kat
for
so
courageously
sharing
your
stories
with
us
today
and
helping
us
understand
where
you've
been
and
how
you
are
able
to
take
what
you've
experienced
and
help
others
in
our
community.
Thank
you
so
much
for
the
work
that
you
do
to
help
others.
We
really
appreciate
you
all.