►
From YouTube: June 21, 2023 Public Health & Safety Committee
Description
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A
A
B
A
Let
the
record
reflect
that
we
do
have
a
quorum
with
that.
The
agenda
for
today's
meeting
is
before
us.
There
are
seven
items
on
today's
consent
agenda
item.
One
is
authorized
in
the
police
department
to
enter
into
an
ongoing
Mutual
Aid
contract
with
the
FBI
Bloomington
Police
Department
bomb
squad,
Crow
Wing
County,
Sheriff's,
Department,
Regional
bomb
squad
and
St
Paul
police
department
bomb
squad
for
assistance
in
an
emergency
item.
Two
is
accepting
a
grant
from
the
Minnesota
Division
of
Homeland
Security
to
enhance
Emergency
Management
capabilities
item.
A
Three
is
authorizing
the
extension
of
the
grant
agreement
with
the
Minnesota
Division
of
Homeland
Security
for
six
months
to
allow
the
completion
of
a
multi-year
training
plan
for
Public
Works
water
treatment.
Item
four
is
authorizing
the
submittal
of
a
Grant
application
to
the
Department
of
energy
for
the
Energy,
Efficiency
and
conservation
block
grant
program.
A
Item
five
is
accepting
a
grant
from
the
Environmental
Protection
Agency
for
enhanced
air
monitoring
in
communities.
Item
six
is
accepting
a
grant
from
the
Minnesota
Department
of
Health
to
provide
culturally
specific
family
home
visiting
services.
Item
seven
is
authorizing
a
payment
of
sponsorship
for
City
presence
and
Outreach
at
community
events
for
Juneteenth
and
Somali
week
celebrations.
Are
there
any
discussions
on
this
on
these
items?
Councilmember
wansley.
A
D
Two
yes
awesome.
Thank
you,
Kate
I'm,
just
wanting
to
make
sure
that
the
grant
funding
that's
listed
in
item
two.
That's
only
going
going
towards
Emergency
Management
exercises
for
our
water
treatments.
Just
so
leave
that.
E
Thank
you,
council,
member
Vita
and
council
member
wansley
for
the
question.
The
overall
Grant
supports
primarily
the
Emergency
Management
Department,
but
they're.
The
extension
is
so
that
we
can
complete
the
project
related
to
the
water
treatment,
multi-year
training
and
exercise
program.
Gotcha.
D
Okay,
straightforward
question
on
one:
thank
you
so
much
Kate,
the
first
one
and
I
can
follow
up
with
someone
from
Public
Health,
but
just
wanted
to
make
sure
that
the
bomb
threat
will
only
be
activated
for
the
emergencies
listed
in
the
RCA,
not
for
other
types
of
emergency
situations.
So
just
wanted
to
make
sure
I
could
get
that
clarified.
A
From
absolutely
we'll
make
sure
that
staff
reaches
out
I,
don't
see
Robin
McPherson
here
who's
answered
those
questions
in
agenda
settings
so
we'll
make
sure
she
connects.
Thank
you
councilmember
wansley.
Thank
you.
Is
there?
Oh
council
member
palmisano.
F
Thank
you,
chair
Vita
and
Mr
nugo
I'm
curious.
How
do
we
choose
where
we
seek
NCR
Presence
at
community
events,
and
what
do
we
anticipate
getting
out
of
our
presence
at
them?.
G
Sure
sure
so
this
is
actually
work.
That's
on
behalf
of
the
city,
recognizing
that
the
entire
calendar
year
has
a
whole
host
of
community
events.
Ncr
staff
selects
a
few,
a
handful
that
knows
that
are
culturally
relevant
or
from
that
are
impacting
underrepresented
communities
and
on
particular
neighborhoods
as
well.
So
the
food
that
we
do
select
don't
represent
the
entire
body
of
work
that
other
City
departments
do
in
terms
of
being
present
for
outreach
or
Community
engagement
program.
F
That,
generally
speaking,
we
are
helping
out
and
facilitating
education
for
things
like
animal
control
and
3-1-1
and
Drug
services.
So
your
NCR
is
kind
of
the
bridge.
We're
not
there
at
a
table
about
NCR
nope,
it's
actually
helping
residents
in
our
communities
to
connect
with
different
city
services
or
things
they
might
need.
G
Councilmember
palmisano,
that's
correct.
We
work
to
kind
of
facilitate
a
space,
a
city
presence
recognizing
that
for
some
events
there
are
City
departments
that
are
already
there
as
well,
but
they're
kind
of
scattered
across
the
event
or
particular
area,
so
we're
just
trying
to
consolidate
them
under
a
city,
tent
or
city
presence.
F
It
just
it
struck
me
as
strange
Madam
chair
that
we
pay
the
park
board
as
a
sponsor
and
because
we
have
different
relationships
like
that
and
we're
very
familiar
with
kaju
we're
a
funding
partner
of
kajug
in
many
different
ways.
So
thank
you.
Thank
you
for
revealing
up
yourself
for
the
question.
No
problem.
Thank.
A
You
is
there
well
I.
Just
want
to
note
that
council
member
Ellison
has
joined
us
welcome.
Is
there
any
further
discussion
seeing
none
I
will
move
for
approval
of
the
consent
agenda,
all
those
in
favor,
please
say:
aye
aye
opposed,
nay
that
carries
and
the
consent
agenda
is
approved.
The
next
item
is
continuing
the
presentation
from
the
previous
public
health
and
safety
meeting
on
the
response
to
the
opioid
epidemic
here
to
kick
off
the
presentation
as
Deputy
Commissioner,
Heidi
Richie,
welcome
and
thank
you
for
joining
us
again.
Thank.
H
You
councilmember
Vita
members
of
the
committee
and
thanks
for
having
me
and
the
rest
of
the
opioid
Response
Team,
along
with
Dr
D,
who
you
became
familiar
with
at
our
last
presentation.
Thank
you
for
allowing
us
to
come
back
and
finish
and
then
provide
opportunity
to
answer
any
of
your
questions.
H
I'll
just
start
off
by
a
little
bit
of
a
review.
We
won't
go
through
the
slides
that
I've
already
covered,
but
I
will
review
some
of
them.
First
I
want
to
just
ground
Us
in
what
this
legislative
directive
says.
It's
directing
the
health
department
to
explore
Pathways
for
supporting
and
medication,
assisted
therapy
facility
and
report
back
with
options
and
recommendations
to
the
public
health
and
safety
committee.
H
I
also
just
want
to
restate
our
statement
of
a
problem
because
I
think
it
just
underscores
and
also
grounds
Us
in
in
what
we're
actually
trying
to
solve
for
here
the
rate
of
I'll
go
there.
The
rate
of
fatal
opioid
overdoses
had
has
increased
by
a
hundred
thirty
percent
in
Minneapolis
between
seven
2017
and
2021.
H
H
You
can
see
this
is
Illustrated
in
graph
form
on
this
next
page
I'm
going
to
go
ahead
and
skip
over
the
definitions.
If
you'd
like
to
review
those
they're
part
of
the
presentation,
so
at
any
time
you
can
review
those
definitions
that
I
read
out
at
the
last
presentation:
I'm
also
going
to
skip
over
the
legal
landscape.
I
think
we
are
aware
and
City
attorney
Bert
Osborne
helped
us
understand
that
right
now,
on
the
federal
level,
this
is
prohibited,
but
there
are
some
movements
at
the
state
level
that
we
are
monitoring.
H
Okay,
I'm
gonna
turn
it
over
now
to
Dr
D,
to
finish
the
bulk
of
his
presentation.
As
a
reminder,
Dr
Desiree
nataba
is
an
academic
Emergency
Physician,
with
over
20
years
of
experience,
working
in
large
Urban
teaching
hospitals
and
responding
to
several
Public
Health
emergencies,
he's
currently
completing
a
bush
fellowship
with
a
focus
on
improving
outcomes
and
reducing
local
disparities
in
opioid
use
disorder,
and
he
comes
to
us
with
a
masters
of
Public
Health
at
from
Harvard
and
from
Oregon
Health
and
Science
University
a
doctor
of
medicine,
so
welcome
Dr
D.
Thank
you.
Welcome.
A
I
Thank
you
chair
for
inviting
me
back
members
again,
it's
really
an
honor
to
participate
in
this
process.
I
always
like
to
start
these
conversations
with
the
framing
of
the
biological
basis
of
disease
and
I.
Just
noticed
that
the
last
slide
we
left
off
on
is
also
a
brain
slide.
So
maybe
we
can
forward
to
I
think
it's
slide.
16.
I
From
the
patient
perspective,
it's
helpful
for
me
to
understand
this
biological
basis.
Understanding
this
is
a
medical
disease
with
changes
in
brain
chemistry,
changes
in
brain
anatomy
at
the
molecular
level.
I
think
that
understanding
also
applies
to
some
of
the
root
or
some
of
the
that
root
cause
also
applies
to
some
of
the
downstream
consequences
that
we
see
in
terms
of
behaviors
and
perhaps
in
terms
of
effects
on
communities
and
and
Society.
I
More
broadly
so
just
to
review
normal
brains
have
expected
levels
of
hormones
like
endorphin
and
then
and
dopamine
those
levels
change
with
exposure
to
these
potent
opioids
fentanyl
more
so
than
others
that
we've
seen
previously
heroin
prescription
narcotics
aren't
nearly
as
potent
as
fentanyl,
so
the
effects
of
the
change
the
highs
are
higher.
The
lows
are
lower
that
withdrawal
syndrome
is
more
pronounced.
A
I
The
patient's
aversion
to
that
withdrawal
syndrome
is
also
more
significant,
the
so
the
benefits
of
starting
treatment
in
patients
like
these
starting
the
medications
that
we
talked
about
I'll,
be
focusing
on
buprenorphine
here,
sometimes
I
might
use
a
brand
name
Suboxone,
but
that's
I
don't
have
any
conflicts
of
interest
financially
with
a
company,
it's
just
a
more
commonly
used
term.
So
if
I
use
buprenorphine
and
Suboxone,
those
will
be
interchangeable.
Referring
to
medication
for
addiction,
treatment
or
mat
I've
gone
ahead
and
highlighted
some
of
the
references
to
treatment
and
medication.
I
So
when
you
see
yellow
highlights
that's
an
indication
of
reference
to
this
medication,
when
we
talk
about
the
benefits
of
starting
patients
on
opioids
I
believe
we
talked
a
little
bit
about
the
reduction
in
overdose,
and
we
see
that
across
the
board.
Other
benefits
of
treatment
include
related
harms,
Beyond
overdose.
We
see
decreases
in
infectious
disease,
hepatitis
HIV,
we
receive
reductions
in
violent
crime
and
we
see
improved
treatment
outcomes
overall,
improved
health
and
well-being
next
slide
thanks.
I
I
This
slide
shows
two
examples
of
on
the
top
country
level
interventions
promoting
or
incentivizing
use
of
medication.
The
bottom
half
of
the
slide
looks
at
Baltimore,
so
just
a
little
bit
of
background
in
the
early
90s
France
had
a
bad
heroin
overdose
epidemic.
The
rates
were
increasing
in
terms
of
deaths
and
all
related
harms
year
after
year,
and
then
sometime
in
the
mid
90s
95
96.
I
They
introduced
buprenorphine
this
medication
to
the
formulary,
unlike
the
U.S,
they
didn't
have
any
restrictions
on
who
could
prescribe
this
as
long
as
you
were
a
credential
doctor,
they
didn't
have
any
limitations
on
who
could
access
it.
It
was
incentivized
and
decreased
barriers,
and
just
as
a
result
of
that
intervention,
they
were
able
to
reduce
the
rate
of
Overdose
deaths
by
80
percent
within
just
four
years.
As
far
as
I'm
aware,
that's
the
most
successful
example
of
a
policy
intervention
to
the
opioid
epidemic,
so
just
to
walk
through
this
graph.
I
Here,
the
red
lines
are
heroin.
Overdose
deaths
France
in
the
90s
was
around
325
per
year.
That's
roughly
in
the
ballpark
of
what
we're
seeing
in
Hennepin
County.
In
Minneapolis
the
green
dotted
lines
are
a
number
of
patients
started
on
buprenorphine
and
you
can
see
what
we
call
a
direct
correlation
or
a
mirror.
Image
of
increasing
numbers
of
patients
started
on
medication
and
decreasing
overdose
deaths
in
red
they
landed
on.
You
know
the
far
right
of
the
screen.
85
000
patients
start
on
buprenorphine.
I
They
were
at
a
much
higher
rate,
with
incentives
in
the
lack
of
barriers
and
Regulatory
burden
and
I.
Think
that
helps
explain
why
they
were
able
to
have
an
inflection
not
only
flatten
their
curve
of
increasing
deaths
but
invert
it
towards
80
reduction
so
quickly
in
Baltimore.
In
the
early
2000s,
they
had
a
similar
incentivization
working
in
collaboration
with
Johns
Hopkins,
so
they
had
great
public
health
support
world-class
academic
support.
I
Another
way
of
looking
at
this
in
terms
of
benefits
of
medication,
this
graph
was
conducted
in
our
data
compiled
from
the
state
of
California
over
a
five-year
period,
and
it
basically
reflects
the
survivability
of
opioid
use
disorder
with
or
without
medications
and
the
way
they
frame
this
data,
the
top
gray
bar,
is
the
what
we
call
the
standardized
rate
of
death
in
the
general
population
in
California
standardized
to
one
in
this
instance
for
comparison
purposes,
the
middle
blue
line
is
the
ex
The
observed
rate
of
death
for
patients
with
opioid
use
disorder,
but
without
medications
like
buprenorphine,
and
you
can
see,
there's
a
six-fold
increase
in
the
risk
of
death
or
The
observed
rate
of
death
in
that
subgroup
of
the
California
population
compared
to
everyone
else,
and
then
the
pink
line
on
the
bottom
are
a
subgroup
of
that
oud
population
who
has
started
on
medication,
and
you
can
see
the
that
improves
the
survivability
of
this
group
by
at
close
to
70
80
percent.
I
All
attributable
to
this
medication
nicely
another
way
of
looking
at
this,
because
I
think
it's
so
important,
Oregon
or
Portland
Oregon
had
an
analysis
done
in
2018.
I
believe
where
they
looked
at
a
Medicaid
population
in
a
tri-metro
area
around
Portland
Oregon,
and
they
looked
at
the
rate
of
utilization
or
the
rate
of
needing
to
go
into
the
ER
or
be
hospitalized
in
the
ICU
or
the
general
Flores,
and
then
they
compared
what's
that
utilization
of
the
health
services
for
oud
patients
who
are
either
on
treatment
or
not
on
treatment.
I
So
on
the
far
left
you
can
see
patients
who
are
not
on
treatment
have
the
highest
level
of
utilization.
There's
a
pattern
scene
across
the
country.
But
in
this
analysis
this
is
Oregon.
So
the
upper
kind
of
salmon
color
is
er
visits.
The
lower
Red
Bar
is
hospital.
Stays
that's
on
the
very
left
highest
bar
on
the
very
right
of
the
graph
represents
patients
who
are
started
and
maintained
on
mat
for
six
months
or
more,
and
you
can
see
a
profound
decrease
in
the
rate
of
hospital
and
er
utilization
based
on
patients
being
on
medication.
I
The
other
thing
about
this
graph
is
I,
think
we
can
extrapolate
Beyond
needing
to
go
to
the
ER
or
be
hospitalized
if
these
patients
are
filling
prescriptions
rather
than
trying
to
finance
a
daily
fix
with
illicit
youth,
I
think
we
can
project
decrease
in
utilization
in
other
sectors
as
well,
and
this
analysis
also
done
in
Oregon
same
population
same
time
frame
in
2018..
I
They
saw
drastic
reductions
in
the
number
of
er
visits,
five
thousand
fewer-
and
this
is
just
to
give
you
a
baseline
or
a
denominator,
we're
talking
about
about
900
individuals
in
the
Portland
area,
who
were
identified
as
high
utilizers
in
different
systems,
so
of
those
just
placing
those
900
on
medication,
plus
Supportive,
Services
thousand
fewer
ER
visits,
400
fewer
jail
bookings
and
Better
Health,
better
utilization,
better
outcomes
for
psychiatric
stays.
A
lot
of
these
dual
diagnosis,
mental
health
and
substance
use
and
over
200
fewer
populations
or
200
fewer
hospitalizations.
I
Those
numbers
on
the
far
left
of
the
graph,
the
buprenorphine
group
you
can
see
the
lowest
Blue
Bar
are
patients
maintained,
who
are
taking
their
medication
every
day
and
the
green
barn
next
to
it.
On
the
far
left
are
patients
who
were
started
on
medication,
but
then
relapsed
return
to
use
for
any
number
of
reasons.
Their
rate
of
Overdose
was
lower
than
the
bar
on
the
far
right
which
our
patients,
who
had
never
started
on
treatment
in
the
first
place,
so
there's
a
residual,
durable
protection.
There's
medication
Beyond
when
they're
actively
using
it
foreign.
I
This
graph
represents
a
number
needed
to
treat
which
is
again
a
bit
technical,
but
we
use
it
in
the
clinical
setting
this
metric.
A
measure
of
how
effective
medication
is
so
never
needed
to
treat
is
Loosely
defined
as
how
many
patients
need
to
be
given
a
medication
in
order
to
avoid
a
bad
outcome.
Sometimes
that
outcome
is
death.
Sometimes
that
outcome
is
disability,
but
you
can
see
that
for
buprenorphine.
I
The
very
bottom
number,
the
very
very
bottom
list,
a
row
rather
for
every
two
patients
started
on
a
high
dose
of
buprenorphine
or
every
other
patient
started
at
that
dose
is
maintained
in
treatment
six
months
and
Beyond
to
compare
that
number
needed
to
treat
to
say
true
layers
for
cardiac
arrest.
That
number
is
about
1
and
2.5
aspirin
for
a
massive
heart
attack.
That
number
is
1
in
40.,
so
this
is.
This.
Medication
is
one
of
the
most
effective
interventions
that
we
have
in
the
medical
setting
foreign.
I
Slide,
but
this
helps
clinicians
understand
in
the
setting
of
near
Universal
fentanyl
synthetic
fentanyl
on
the
streets.
Nowadays,
our
practice
is
changing
in
the
process
of
changing
now
to
adjust
for
these
more
drastic
effects
of
the
brain
and
the
symptoms
that
patients
have
so
looking
at
that
diagram
on
the
right.
The
if
the
blue
squares
are
the
opioid
receptors
in
the
brain.
I
This
is
where
our
endorphins
interact,
or
you
know,
natural
hormones
interact,
but
also
these
opioids
synthetic
opioids
also
interact
the
blue
squares
of
The
receptors,
the
red
circles
or
the
fentanyl
molecules
and
the
green
circles
are
the
buprenorphine
molecules
just
again
to
think
about
effects
on
the
brain.
Let's
say:
if
we're
opioid
naive,
never
seen
this
synthetic
artificial
drug,
then
we
might
have,
let's
say
100
opioid
receptors,
just
for
a
basis
of
comparison.
I
I
The
the
benefit
of
a
medication
like
buprenorphine,
is
it
stabilizes
those
receptors,
and
it
prevents
the
withdrawal
syndrome
that
all
these
patients
are
trying
to
escape
on
a
daily
basis,
I
mean
one
to
two
weeks
into
someone's
habit
and
addiction.
It
becomes
a
matter
of
not
trying
to
get
high
they're
just
trying
to
feel
barely
normal.
I
That
increases
from
pills
to
smoking,
to
try
and
get
a
more
of
an
effect
to
injection,
to
try
and
get
more
of
an
effect
to
looking
for
some
of
these
augmented
combined
drugs
like
xylazine
and
what's
called
tranq
dope
and
we're
starting
to
We
believe
we're
starting
to
see
Minneapolis,
it's
a
much
bigger
problem
on
the
East
Coast,
but
we're
anticipating
seeing
more
of
this
problem
locally.
I
I
You
know
later
in
the
night
you
need
to
the
patient
needs
to
be
in
at
least
a
moderate
amount
of
withdrawal
or
severe
withdrawal
before
they're
ready
to
start
the
medication
if
they
are
an
only
mild
withdrawal
or
if
they're,
you
know
if
they
maybe
took
the
fentanyl
a
couple
hours
ago,
and
they
haven't
shown
signs
of
that
withdrawal
syndrome.
Yet
then
there's
a
risk
that
that
patient
might
feel
a
lot
worse
through
it's
explainable
through
the
pharmacology.
I
But
if
someone
is
taken
from,
you
know
a
relatively
saturated
state,
with
a
fentanyl
to
dropped
very
quickly
to
a
rather
normal
state
of
stabilization,
that's
perceived
as
what
we
call
precipitative
withdrawal,
and
that
is
a
huge
barrier
for
patients
because
they
want
to
avoid
or
they
need
some
assurances
that
they're
not
going
to
be
dropped
into
this,
what
maybe
side
effect
or
complication
of
the
medication
if
it's
delivered
either
too
early
or
at
too
low
in
dose.
I
So
that's
a
lot
of
technical
language,
but
this
is
a
I
would
say
a
universal
barrier.
Many
patients,
if
not
all
patients,
then
I
talked
about
starting
this
medication.
Their
number
one
concern
is
avoiding
this
precipitate
withdrawal
and
that's
also
true
for
docs
and
prescribers,
because
they
don't
want
to
necessarily
see
their
patient
get
worse
either
so
there's
a
barrier.
If
there's
hesitation
on
the
patient's
side,
there's
going
to
be
a
lot
of
hesitation
on
the
provider
side
as
well
as
we
evolve
our
practice.
I
G
I
The
you
know,
broadly
speaking,
medication
first
is
so
intuitive.
If
we
think
about
say
a
diabetic
who
comes
into
the
hospital,
they
have
high
blood
sugar,
they
might
have
a
diabetic
coma.
These
patients
all
get
medications.
They
need
right
then,
and
there,
and
then,
if
it's
like,
say
a
new
diagnosis,
then
they
might
be
offered
education
or
referral
to
follow-up
clinics.
How
to
manage
their
new
diagnosis.
I
Seizure
disorder
same
thing,
another
brain
disease.
We
give
the
medication
right
away,
we
don't
let
people
you
know
seize
on
the
streets
or
in
the
waiting
room.
Unfortunately,
there
are
quite
a
number
of
reasons.
Opiate
use
disorder
is
probably
one
of
the
few
examples
I
can
think
of
where
that's
inverted
and
the
medication
is
offered
for
most
patients
after
many
days,
sometimes
a
week
or
more,
and
that's
because
just
the
way
our
system
has
evolved,
patients
need
to
you
know,
fill
out
paperwork
if
they're
uninsured,
they
need
to
go
through
a
lengthy
assessment
process.
I
Intake
to
you
know,
decide
what
level
of
care
they
need
and
what
type
of
medications
they
would
benefit
from.
They
need
to
find
the
availability
in
terms
of
appointments
in
the
clinic
or
beds
available
in
the
treatment
center
if
they
show
up
on
a
Friday
and
the
prescriber.
Isn't
there,
you
know
until
Monday,
that's
not
a
couple
of
days,
but
these
are
the
types
of
barriers
that
are
just
prohibitive
for
someone
who's
dealing
with
intense
withdrawal
syndrome.
I
That's
really
a
matter
of
hours,
if
not
day,
a
couple
of
days
before
that
becomes
overwhelming
and,
however
motivated
or
supportive,
they
are,
if
their
brain
chemistry
is
not
stabilized.
It's
highly
unlikely
that
patient's
going
to
be
able
to
follow
up
with
a
plan
if
that's
delayed
by
days
or
even
weeks,
the.
So
that's
a
long
preface
to
this
medication
first
model,
which
is
first
established
in
Missouri
in
2019,
to
give
you
an
idea
how
recent
some
of
these
evolving
practices
are,
but
in
Missouri
they
were
able
to
show
that
same
day.
I
Rapid
access
to
medication,
like
you
would
you
know
a
diabetic,
would
get
that
same
day.
Rapid
access,
if
you
offer
that
to
patients
with
opioid
use
disorder
than
their
outcomes,
improve
I
think
same-day
rapid
access
they're
more
than
two
times
as
likely
to
be
maintained
in
long-term
recovery,
even
six
months
or
more.
So
the
timing
of
that
stabilization
has
bearing
on
how
well
they
do
they
turn
the
corner
or
not.
I
The
this
is
now
recognized
as
a
best
practice
FDA
samsa,
which
is
kind
of
like
the
the
CDC
for
mental
health
and
addiction.
In
terms
of
federal
level,
you
know,
guidance
and
and
policy
recommenders.
They
all
recommend
this.
They
just
put
on
a
policy
guidance
letter
a
couple
months
ago,
re-emphasizing
the
importance
of
this
and
that
policy
guidance
is
highlighted
in
the
reference
below.
I
This
is
a
portable
treatment
philosophy,
so
this
can
be
done
in
ERS
and
hospitals.
This
could
be
done
in
community
settings
offering
that
medication
if
people
are
comfortable
giving
it
knowing
you
know
the
the
timing
and
the
dosing
there's
no
reason
this
can't
be
done
at
home
or
in
a
drop-in
clinic,
but
those
Logistics
are
a
lot
more
complicated
than
what
I
just
laid
out.
I
The
one
helpful
example
that
we've
been
paying
close
attention
to
is
this
California
Bridge
model
Statewide
in
California
they've,
been
able
to
incorporate
that
medication,
first
philosophy
in
ERS
and
hospitals,
just
because
we
see
such
a
large
volume
of
folks
cycling
in
and
out,
probably
more
so
than
any
other
place
in
the
whole
system,
they're
able
to
incorporate
that
medication
first
and
then
supplement
it
with
a
psychosocial
support
with
what
they
call
a
substance,
use
Navigator,
that's
someone
who
can
provide
what
we
call
accompaniment
at
the
bedside.
I
While
folks
are
struggling
with
these
horrible
withdrawal
syndromes
and
then
they
can
also
provide
some
basic
care
coordination.
Once
a
patient
gets
the
medication
and
gets
that
brain
stabilization,
they
then
need
to
be
referred.
They
then
need
to
find
that
second
step
in
their
Journey
towards
treatment,
stabilization,
long-term
recovery
and
having
that
all
as
a
package
when
the
patient,
you
know,
needs
it
most
and
they're,
ready
and
they're
willing
is
very
successful
and
we've
been
able
to
benefit
from
some
of
the
data.
I
They've
just
recently
released
again
in
the
last
couple
of
months
the,
but
it
turns
out,
if
you
do,
that.
Not
only
the
patients
do
better,
but
the
hospitals
have
better
outcomes
as
well,
because
you
have
decreased
return
visits
and
the
patients
get
better
treatment
outcomes.
So
it's
it's
really
a
win-win.
In
that
sense,.
I
These
next
couple
of
slides
report,
some
of
the
show
some
of
the
data
reported
from
that
California
model
and
I'll
just
draw
attention
to
the
last
number.
The
return
on
investment
hospitals
see
that
when
this
model
is
implemented,
there's
a
17
on
average,
seven
more
than
17
000
in
savings.
This
is
things
like
unreimbursed
care
or
crowding
Hospital
type
of
metrics
that
level
of
savings
for
an
investment
of
just
less
than
350
dollars,
which
pays
for
an
average
of
nine
hours
of
Engagement
for
these
patients.
I
So
the
model
in
California
started
I
think
three.
Four
years
ago
it
was
incentivized
with
maybe
40
million
dollars,
Statewide
big
state.
They
were.
They
had
a
goal
to
have
this
model
available
in
all
other
hospitals
across
the
state.
They
started
with
eight
hospitals
and
they're,
now
close
to
300
hospitals
on
just
four
star
years,
so
they're
well
on
track
to
meet
that
goal
even
beat
it
largely
driven
by
some
of
these
outcomes,
for
you
know
better
outcomes
for
patients,
value
and
return
on
investment.
I
So
it
shows
the
you
know.
All
of
this
essentially
I
think
contributable
most
contributable
to
that
medication.
Access
to
engagement
with
that
medication
and
then
support
with
a
psychosocial
case
management.
I
These
are
the
types
of
solutions
and
examples
of
best
practices
that
we've
been
taking
a
close
look
at
for
close
to
a
year
and
a
half
now
foreign
outcomes
with
follow-ups-
and
this
is
all
substance
use
disorders.
So
this
would
include
things
like
methamphetamines
or
cocaine,
which
act
differently
on
the
brain
still
heavily.
I
Related
to
the
dopamine
levels,
but
different
opioids,
a
different
receptor,
it's
not
an
opioid,
so
the
medication
that
we
have
for
opioid
use
disorder
doesn't
work
for
some
of
these
other
substance
use
disorders,
but
even
looking
at
that
broader
population,
the
folks
struggling
with
addiction
having
the
medication
where
appropriate
and
that
navigator
that
psychosocial
support
that
case
management
showed
improvements
of
you
know.
50
percent
engage
in
treatment
with
that
Navigator
two
to
three
times
more
likely
to
be
in
treatment
because
of
the
Navigator.
I
I
Locally.
We've
started
to
adapt
and
formed
by
the
Missouri
model,
the
Oregon
Data
and
the
California
successes.
We've
started
to
adapt
for
local
implementation,
these
best
practices
and
kind
of
really
trying
to
accelerate
our
evolving
practice
of
medication.
A
lot
of
Provider
education,
a
lot
of
Community
Education
in
terms
of
raising
awareness,
not
only
of
the
risks
of
fentanyl.
You
know
one
kill
one
pill
can
kill
nowadays,
A
lot
of
people,
don't
necessarily
have
that
level
of
awareness
of
the
increased
risks
and
that's
at
the
University
of
Minnesota
Medical
Center.
I
Another
very
important
aspect
of
really
treatment
throughout
you
know
not
only
the
induction
that
medication,
but
the
stabilization
period
and
long-term
recovery
periods.
This
trauma-informed
approach
has
been
understood
to
be
critically
important
and
this
policy
guidance
from
2017
speaks
to
that
and
I
would
say
after
2020,
with
pandemics
and
uprisings,
and
all
this
Collective,
traumatic
stress,
I,
think
it's
even
more
important
today
than
it
was
back.
Then
the
and
I
think
that
also
helps
explain
some
of
the
disparities
that
we're
seeing
locally
here
in
Minneapolis.
I
This
slide
looks
at
not
the
absolute
rates
in
in
population,
but
it
looks
at
the
differences
between
subgroups
by
geographic
area,
so
the
overall
average
according
to
CDC
data
with
across
the
country,
there
are
disparities
between
subgroups.
That's
a
known
challenge.
That's
seen
in
a
lot
of
different
diseases.
I
Covid
was
particularly
raised
a
lot
of
visibility,
around
differences
in
in
outcomes.
If
you
look
at
Minnesota
and
opioid
use
disorder,
for
example,
Native
Americans
tend
to
one
compared
to
the
white
population.
I
When
I
first
started
looking
at
this
data
a
couple
years
ago,
it
was
seven
to
one
in
Minnesota
I
thought
that
was
eye-popping
and
then
2021.
That
goes
up
to
ten
to
one.
But
if
you
look
at
the
Minneapolis
data,
the
highest
contribution
to
the
Minnesota
state
level
disparities,
these
are
the
differences
and
the
differences
among
subgroups
is
coming
from
Minneapolis
and
it's
coming
from.
If
I
I
had
to
guess,
you
know,
coming
from
our
largest
concentration
in
in
South
Minneapolis,
the
30
to
1
disparity,
comparison
and
difference.
I
This
is
the
worst
in
the
country.
This
is
the
highest
difference
in
differences
that
I've
ever
seen
so
I
think
it's
important
to
understand
that
context.
I
think,
there's
a
lot
of
contributions
to
that.
I
can't
speak
for
the
community.
Obviously,
but
I
hear
people
talk
about
things
like
generational
trauma,
things
like
poverty,
discrimination,
things
like
trust
things
like
bias,
layered
on
top
of
stigma,
I
think
these
are
all
contributions
and
I
wonder
how
much
are
South
Minneapolis
experience
in
the
last
few
years
is
also
helping
contribute
to
this
I.
I
The
so
trauma
means
different
things
for
different
folks,
the
for
some
folks.
I
This
physical
trauma
broken
bones,
and
you
know
car
accidents
gunshots,
but
in
this
context
we're
talking
about
traumatic
stress
and
how
it
affects
mental
health
and
addiction
so
samsa
again
the
kind
of
gold
standard
in
terms
of
definitions
here
they
Define
individual
trauma
as
resulting
from
an
event
or
a
series
of
events
or
a
set
of
circumstances
that
is
experienced
by
an
individual
or
perhaps
a
community
as
physically
or
emotionally
harmful
or
life-threatening,
and
that
has
lasting
adverse
effects
on
the
individual's
functioning
mental,
physical,
social,
emotional,
spiritual
well-being,
I.
I
Think
something
like
PTSD
in
our
combat
veterans
is
something
that's
been
understood
for
the
longest
period
of
time
we've
seen
mental
health
and
addiction
in
that
population.
It's
been
well
studied
more
recently
in
the
90s
people
started,
looking
at
adverse
talented
events
and
the
long-term
Health
impacts
that
can
have
more
recently.
We
are
looking
at
chronic
exposures
in
adulthood,
and
this
is
where
I
think
you
know
the
the
poverty
and
discrimination
come
into
play.
I
This
is
where
I
think
we
all
have
a
better
understanding
of
collective
traumatic
stress
now
with
the
pandemic.
The,
but
the
importance
here
is
that
that
has
a
direct
bearing
on
mental
health
and
addiction.
Behavioral
Health
in
this
slide
is
a
bit
of
an
outdated
term.
When
we're
talking
about
people's
levels
of
depression,
anxiety,
people's
dependence
on
substances
can
become
more
pronounced
or
people
are
more
at
risk.
For
that
I
mean
if
we
remember
the
effects
on
the
brain.
You
know
this
is
initially
those
pills
provide
instant
relief.
I
I
can
understand
why
someone
would
be
prone
to
reach
for
that,
the
they
can
be
single
or
multiple
exposures.
Something
like
you
know,
a
devastating
hurricane
can
be
traumatic,
stress
and
I've
talked
about
some
of
the
other
examples.
I
Re-Traumatization
is
also
known
to
this
is
something
that's
cumulative
and
you
know
the
more
exposures,
the
more
often
someone's
re-traumatized,
if
you
think,
of
a
combat
vet
hearing
like
a
car
exhaust
backfiring
or
something
like
that,
each
time
there's
a
reach
re-traumatizing
exposure.
This
effect
gets
more
pronounced.
The
extent
to
which
you
know
that's
affecting
our
communities
and
our
health
outcomes.
I
I
think
is
a
broader
discussion,
but
something
important
to
keep
in
mind
that
certainly
beyond
the
scope
of
my
my
expertise,
the
there's
a
a
number
of
thought
leaders
in
the
field
of
trauma
studies,
Dr,
Sandra
Bloom-
is
one
she's
based
out
of
Philadelphia.
She
came
up
with
this
framework
of
a
public
health
approach
to
trauma-informed
care.
I
The
you
know,
as
a
hospital
if
we
want
to
be
trauma
informed,
it's
not
like
everybody
needs
to
have
a
very
comprehensive
definition,
but
we
would
want
someone
like
say
our
registration
clerk
to
understand
that
you
know
people
who've
had
traumatic
experiences
may
be
at
higher
risk
for
for
the
health
outcomes
trauma,
responsive
care
can
be
thought
of
as
more
like
secondary
prevention
and
hear
populations
with
exposure
to
trauma
being
at
risk
for
additional
problems,
especially
if
you
talk
start
talking
about
Cycles
or
recognization
and
and
whatnot,
and
there
are
policies
and
and
guidelines
that
can
be
incorporated
that
can
be
developed
as
this
is
better
understood
and
then
there's
trauma
specific
treatment,
which
really
depends
on
the
type
of
traumatic
exposure
that
someone
has
the.
I
If
you
think,
of
the
effects
in
the
brain
of
trauma.
This
is
a
really
unpleasant,
perhaps
life-threatening
experience
that
people,
don't
necessarily
they
kind
of
go
into
fight
or
flight
mode,
and
they
don't
necessarily
think
through
in
a
mental
or
in
a
the
mental
model,
is
more
primal
and.
I
You
know
kind
of
more
complex,
rational
thought
and
I
say
that,
because
people
who
experts
who
talk
about
trauma
talk
about
it,
these
are,
if
we're,
if
we're
not.
If
we
don't
have
a
good
mental
model
on
this,
then
it's
just
kind
of
fragments
of
experience
in
the
brain
and
if
we
don't
put
a
finger
on
it,
understanding
what's
causing
this
distress,
this
chronic
depression
and
anxiety,
then
there's
this
analogy
out
there.
That's
like
a
splinter
in
the
psyche.
I
If
that
can
be
identified
and
labeled
with
you
know
words
attached
to
it,
then
we
can
move
people
away
from
a
a
more
visceral
fight
or
flight
survival
mode
type
of
response
to
you
know
having
more
of
a
conversation
about
you
know,
what's
driving
that,
and
and
how
can
we
help
people
with
this?
So
these
are
Frameworks
that
are
still
evolving
there's.
You
know
different
opinions,
there's
a
lot
especially
more
recently,
a
lot
of
different
explanations
and
meanings
for
that.
I
But
I
think
it
has
an
important
role
to
play,
especially
with
this
Public
Health
crisis.
C
And
get
your
Vitara
thank
you
for
starting
the
presentation
with
just
grounding
Us
in
the
legislative
directive
and
I
just
wanted
to
share
additional
context
around
that.
C
We
wanted
to
be
very
explicit
about
medication,
assisted
therapy,
but
one
of
the
things
that
were
implicit
in
it
was
an
exploration
around
safe
use
sites,
and
you
know
the
legal
landscape
is
evolving,
but
right
now
there
is
a
degree
of
clarity,
but
one
thing
that
I'm
trying
to
connect
is
the
it's
really
helpful
to
get
this
the
ground
ourselves
in
the
science
and
the
biology
of
it
and
then
I'm,
just
reflecting
on
the
time
that
I've
spent
at
like
the
encampments
in
my
ward
and
just
the
the
reality
on
the
ground
of
what
this
disease
looks
like
and
I'm.
C
Trying
to
imagine
that
point
of
intervention
when
so
it's
like
it's
pretty
clear
to
me
that
you
pronounce
morphine
is
a
very
effective
medication.
What's
not
clear
to
me
is
how
do
we
get
crossed
that
threshold
into
somebody
choosing
that
path?
In
my
mind,
the
a
safe
injection
site
is
a
more
controlled
setting
to
be
able
to
nudge
people
towards
that
path.
C
In
the
absence
of
that
type
of
strategy,
and
with
this
new
knowledge
around
the
importance
of
the
stage
of
withdrawal
that
somebody
needs
to
be
in
to
start
that,
how
are
we
imagining
this
intervention
happening
on
the
ground
in
the
real
world?.
H
H
One
thing
that
we
are
working
on
is
providing
opportunities
to
address
that
Gap
in
continuity
of
care,
so
when
you're
leaving
the
the
Ed
or
when
you
are
ready
to
be
medically
inducted
into
medication,
assisted
treatment,
oftentimes
there's
a
gap
where
you're
recovering
from
that
withdrawal-
and
you
can't
really
be
you
know
in
a
place
where
there's
not
access
to
a
provider
that
can
help
with
adjustments
to
your
medications
or
whatever
other
services.
You
might
need
to
deal
with
that
withdrawal.
H
One
thing
that
we
are
working
on
is
a
partnership
for
a
facility
that
would
provide
a
minimal
amount
of
overnight
stays.
We
need
to
start
small,
obviously,
because
we
have
to
figure
out
how
to
Target
our
resources
and,
and
so
we're
kind
of
trying
things
out,
and
so
it
would
provide
a
space
for
folks
who
are
coming
out
of
the
Ed
they've
been
medically
inducted
into
treatment,
but
they
really
are
housing
unstable,
and
so
we
want
to
make
sure
that
they
have
a
place,
at
least
for
a
few
days
where
they
can.
H
You
know
have
some
respite
from
the
stressors
of
you
know
every
day,
where
they're
out
trying
to
figure
out
where
they're
going
to
sleep
or
where
they're
going
to
get
going
to
get
their
next
meal
and
add
that
in
to
just
the
medical
piece
of
it,
where
they're
being
supervised
and
watched
so
I
mean
withdrawal
can
be
very
dangerous,
and
so
we
want
to
make
sure
that
whatever
we're
doing
to
get
people
off
of
these
substances
isn't
contributing
to
other
negative
outcomes
medically.
H
So
that's
one
one
way:
we're
also
looking
at
other
treatment
centers
that
want
to
provide
this
type
of
service.
We
have
had
some
instances
where
we've
had
to
look
a
little
bit
closer
at
our
zoning
and
land
use
code,
and
so
we've
worked
with
cped
on
trying
to
figure
out
how
how
that
enters
into
the
picture.
There's
lots
of
considerations
around
where
these
spaces
will
be
and
in
what
neighborhoods,
and
you
know
whether
or
not
we
want
to
concentrate
them
in
certain
neighborhoods.
That's
always
something
where
it's
like
you
know.
H
H
So
I
wanted
to
continue
just
to
wrap
up,
really
quick
if,
if
I
may-
and
this
kind
of
goes
to
some
of
your
questions,
some
of
our
key
points
for
our
future
work
is
incentivizing.
This
medication
assisted
treatment,
expansion,
which
is
what
I
was
just
talking
about,
is
being
able
to
have
some
of
these
creative
Partnerships
with
with
some
of
the
communities
that
we
see
are
disproportionately
impacted.
H
Like
Red
Lake
we've
been
partnering
to
try
and
get
a
facility
up
and
running,
which
I
hope
we're
near
to
do,
and
also
just
like
leveraging
some
of
our
funding.
So
we
need
to
put
some
of
the
resources
that
we
have
into
these
facilities
so
leveraging
our
settlement.
H
There
was
fifty
thousand
dollars
one
time
for
coordinator
of
that,
those
task
force
and
the
subgroups
that
went
into
that
in
2020.
There
was
a
hundred
and
five
thousand
dollar
ongoing
funding
and
that
went
to
hire
our
opioid
response
coordinator
and
then
three
hundred
thousand
dollars
one
time
which
at
that
time
went
to
our
litter,
our
syringe
litter
cleanup.
We
didn't
have
any
mechanism
for
cleaning
up
syringes
or
addressing
that.
So
that's
where
we
started
our
our
efforts
around
that
and
then
in
2021.
H
H
So
that
came
back
to
us
and
we
used
it
for
Narcan
at
that
time
we
had
a
real
need
for
that
and
we
still
do,
but
we
were
able
to
use
that
fifty
thousand
dollars
for
that
and
then
in
2022
we
had
a
hundred
thousand
dollars
ongoing
funding
for
a
community
Hub
which
which
is
kind
of
what
we're
using
for
the
the
facility
that
we're
working
with
red
Lake
on
and
then
also
we've
got
a
team
of
three
and
part
of
that.
H
Funding
also
goes
to
supplement
those
those
staff
salaries
because
they're,
mostly
Grant
funded
other
than
that
hundred
and
five
thousand
dollars
that
we
got
a
few
years
ago.
So
our
total
general
fund
investment
is
currently
205
000,
which
supplements
salaries
paid
by
Grant
funds.
The
Red
Lake
partnership,
for
example,
like
a
public
health
nurse
at
the
the
facility
that
we're
looking
at
and
then,
of
course,
we
have
the
the
settlement.
H
Funding,
which
is
very
it's
I,
would
say
it's
very
prescriptive,
but
it's
also
pretty
flexible
as
long
as
we're
making
sure
that
the
funding
is
going
toward
Mitigation
Of
opioids
The
sticking
point
with
that.
Is
it
doesn't?
It
pays
for
only
10
percent
in
this
Administration
and
so
any
type
any
time
we're
increasing
the
number
of
programming
and
initiatives.
We
need
staff
to
be
able
to
run
those
programs.
We
cannot
use
settlement
money
for
that
beyond
the
10.
H
So
Council
was
gracious
to
grant
us
150
000
of
the
settlement
funding
to
be
able
to
hire
a
public
health
specialist
for
specifically
the
settlement,
money
and
implementation
of
this
programming
and
and
the
10
is
kind
of
a
moving
Target
just
because
we
continue
to
get
the
funding
on
a
rolling
basis,
so
it's
a
10
to
18
year
payout
and
so
the
10
is
cumulative.
H
So
again
we
don't
know
exactly
how
much
that's
going
to
be,
but
we
we
have
an
estimate,
so
we
know
kind
of
where
our
lower
our
lower
Gap
is
or
lower
lower.
Our
minimum
amount
of
the
10
would
be
so
I
wanted
to
just
kind
of
help.
Folks
understand
where
we
are
in
terms
of
investment-
and
you
know,
obviously,
even
with
you
know
the
millions
of
dollars
that
we're
getting
from
the
settlement
fund.
H
The
need
really
does
outpace
the
resources
that
we
have
and
then
the
second
thing
prioritization
and
development
and
implementation
of
trauma-informed
approaches
to
care
in
treatment
and
long-term
recovery.
I
won't
go
into
this
a
lot
because
Dr
D
really
did
a
good
job
in
describing
why
a
trauma-informed
approach
is,
is
so
imperative
in
this
work
and
then
emphasis
on
community
co-design.
He
didn't
talk
a
lot
about
this,
but
you
know
effective
and
Equitable.
H
Co-Design
is
not
a
tool,
but
it's
a
way
of
collaborating
directly
with
the
communities
that
are
being
affected
Often
disproportionately
by
by
these
issues,
and
so,
instead
of
outlining
prescriptive
steps,
we
want
Community
to
co-design
with
the
intention
of
unleashing
that
untapped
creativity
and
capacity
within
the
community
members
that
are
navigating
you
know
whether
or
not
they
choose
to
this
complex
issue
on
their
own
and
so
I
wanted
to
just
talk
a
little
bit
about
what
those
considerations
were
for
future
work
and
then
I.
H
Next
steps
really
are
just
continuing
to
develop
that
long-term
strategy
around
the
opioid
settlement,
funding
leveraging
all
of
the
sources
because
we'll
get
the
direct
allocation.
The
state
also
gets
an
allocation
which
will
then
some
of
that
money
will
be
opened
up
to
other
cities
to
apply
for
Haddam
county
is
the
same.
They
get
a
direct
allocation,
I
believe
it's
around
40
million
dollars
and
we're
getting
around
tennis
again.
It
keeps
moving,
and
so
just
leveraging
that
and
those
Partnerships
to
make
sure
that
the
region
is
able
to
maximize
the
resources.
H
One
of
the
things
that
we've
talked
about
with
Dr
D
is
the
way
that
the
settlement
is
set
up,
really
is
not
it.
It
leaves
it
up
to
the
cities
to
Target
our
resources
again,
the
need
outpaces,
the
resources
that
we
have,
and
so
what
we
need
to
do
is
make
sure
we're
targeting
the
groups
and
communities
that
are
most
disproportionately
impacted
and
the
the
settlement
doesn't
do
that
they
it's
based
on
population
and
census
numbers
not
where
the
hot
spots
and
where
the
most
need
is.
H
C
You
another
question:
I
had
was
related
to
part
of
the
discussion
from
two
weeks
ago,
where
we
talked
about
the
impact
of
naloxone
It
kind
of
putting
you
into
an
instant
and
almost
aggressive
withdrawal
and
I'm
wondering,
with
this
kind
of
new
information
around
the
sensitivities
around
buprenorphine
treatment.
H
H
One
thing:
I
think
that
he'll
talk
about
is
trying
to
initiate
that
that
medical
induction
through
the
paramedics,
when
they're
on
site
at
an
OD
right
now,
it's
basically
done
in
the
emergency
department
or
with
your
provider,
but
looking
at
Creative
Solutions
to
that
is
exactly
what
Dr,
D
and
other
folks
are
doing
so
I'll
just
invite
him
up
to
maybe
say
a
couple
more
things
on
that.
I
Chair
remember,
thank
you
for
the
question.
Yes,
we
are
like
I
say
it's
an
evolving
practice.
The
we
are
doing
this
more
often
in
the
emergency
rooms.
I've
done
myself
several
times.
The
paramedics
are
starting
to
carry
this
in
the
ambulances,
so
that
can
be
offered
on
the
scene.
The
it's
really
the
best
time
to
start
somebody
on
buprenorphine,
because
you
don't
have
to
worry
about.
You
know
how
mild
or
moderate
or
severe
your
symptoms.
I
We
know
they're
in
severe
withdrawal,
and
we
know
they'll
feel
better
within
30
minutes,
feel
better
and
then
probably
normal
again
within
a
couple
of
hours.
That's
a
very
compelling
case
for
this
opportunity.
I
There's
complications
because
you
know
not
everyone
who's
resuscitated.
They
might
have
something
else
going
on.
They
might
have
some
xylazine
on
board
or
some
other
what
we
call
respiratory
depressants
and,
in
that
case
we're
just
not
certain.
The
data
support
a
high
dose
of
buprenorphine
one
of
the
great
things
about
that
medication
is
there's
a
sealing
effect
where
the
effect
of
what
are
the
problems
with
fentanyl
is
people
stop
breathing
one
of
the
side
effects
in
that
precedes?
Death
buprenorphine
is
unique
in
that
it'll
only
it
doesn't
have
that
side
effect
to
dangerous
levels.
I
So
I
can
be
very
confident
giving
someone
high
high
doses
of
this
medication
and
not
have
to
worry
about
that
side
effect,
but
if
they
have
alcohol
on
board
or
they
have
Xanax
on
board
or
they
have
something
else
that
might
also
suppress
them.
I
don't
have
any
I
have
a
lot
less
confidence
that
there's
no
risks
to
this
medication.
So
there
are
in
some
cases
it's
a
perfect
opportunity
if
the
patient
is.
They
also
need
to
agree
to
this
right
and
that
can
be.
I
You
know
a
couple
of
seconds
of
advice,
and
you
know
this
will
help
you
or
there
might
be
a
couple
hours
before
someone
is
ready.
So,
yes,
that
is
happening
more
and
more,
but
part
of
the
challenge
is
figuring
out.
Okay,
who
do
we
avoid
Methadone,
for
example,
because
of
the
way
the
pharmacology
of
that
drug
works?
That's
an
exclusive
using
criteria
for
this
type
of
intervention,
so
there's
details
that
are
being
worked
out,
but
we're
getting
better
at
this
and
I
think
moving
forward
is
going
to
be
a
key
intervention
and.
C
Then
that
raised
my
last
question,
which
is
barriers
to
prescribing
this
and
I,
was
curious,
specifically
as
as
it
compares
to
methadone
and
like
I,
don't
know
the
difference
between
the
two
I
just
kind
of
have
this
loose
understanding
that
you're,
basically
replacing
one
opioid
for
another
one,
that's
less
dangerous!
Is
that
the
same
kind
of
biology
here
with.
I
The
I
would
say
chair
I,
remember,
thank
you,
I
would
say
I,
think
of
it
more
as
hormone
replacement.
B
G
I
If
we
talk
about
diabetic,
who
has
a
pancreas,
that's
not
making
insulin,
we
give
them
the
hormone
that
they
need
to
stabilize
and
lead
a
normal
life
in
opioid
use
disorder.
These
are
patients
because
of
those
changes
in
brain
chemistry,
they're,
not
they're,
no
longer
producing
dopamine
and
endorphin
that
we
depend
on
we,
we
can't
live
without
it.
I
The
so
I
I
see
buprenorphine
and
Methadone,
for
that
matter
is
really
more
hormone
replacement
in
terms
of
stabilizing
the
effect
other
important
differences
Methadone,
for
example,
you
need
to
be
it's
still
highly
regulated,
so
patients
need
to
show
up
on
a
daily
basis,
an
important
difference
with
buprenorphine
is
we
can
now
prescribe.
You
know
like
a
two-week
Supply
a
month
supply,
so
we
avoid
that,
because
it's
considered
a
safer
drug
I
think
we
have
agreement
on
that.
I
You're,
not
you're,
not
at
risk
of
overdosing
on
the
buprenorphine,
whereas
someone
because
methadone
doesn't
have
that
ceiling
effect.
I
talked
about.
There
is
a
risk
of
overdosing
on
methadone.
So
that's
part
of
the
difference,
a
very
important
difference
in
the
regulatory
burden
that
was
lifted
on
buprenorphine.
That
regulation
was
lifted
on
buprenorphine.
Just
a
few
months
ago,
January.
I
So
we
now
have
a
much
broader
pool
of
doctors
who
are
able
to
prescribe
this.
The
challenge
there
is,
with
you
know,
fentanyl
changing
the
chemistry
and
the
dosing.
It's
a
different
disease
now
than
it
was
five
years
ago
10
years
ago.
I
So
those
are
the
types
of
challenges.
Those
are
solvable
problems,
but
that's
why
not
everyone's
writing
for
this
prescription
at
every
opportunity.
J
Thank
you,
madam
chair
Dr,
D
thanks
for
coming
back
here
you
are
a
rock
star,
so
thank
you
for
your
advice.
This
will
be
so
helpful
as
we
move
forward
and
I
just
want
to
say
it
a
different
way
than
councilman
Payne
did.
It
seems
like
we
have
to
have
this
intervention,
whether
it's
voluntary
or
mandatory,
and
then
have
Navigators
helping
keep
that
person
going
so
again.
Your
thoughts
on
the
two,
the
voluntary
versus
the
mandatory
intervention.
I
Chairman,
thank
you
for
the
question.
The
you
know
my
opinion,
my
practice.
It's
it's
essential
that
this
is
voluntary
and
the
reason
is
if
it
became
mandatory.
If
there's
a
risk
of
mandatory
induction
one,
you
know
there
are
one
percent
of
the
time
there
is
this
bad
outcome
of
precipitated
withdrawal
that
can
be
managed.
We
know
we
know
how
to
do
that
with
increasing
confidence,
but
it's
not
a
harmless
intervention.
Sometimes
we
may
add
immediate
harm
that
can
be.
You
know.
I
We
have
medications
and
a
game
plan
to
deal
with
that,
but
I
think
more
importantly,
if
people
avoid
coming
to
the
ER
or
avoid
calling
the
paramedics,
because
they
might
be
subject
to
something
mandatory,
then
we
that's
an
additional
barrier
to
treatment
as
compared
to
say,
if
we're
doing
community-wide
education,
which
we
are
now
and
enlisting
the
help
of
trusted
groups
and
leadership
in
the
community,
we
can
increase
demand
or
increase
interest
in
this
medication
at
the
same
time
that
we're
also
better
preparing
ourselves
as
a
health
system
to
deliver
it.
I
You
know
that
rapid
access
to
medication-
yeah-
that's
my
that's
my
thought
on
that.
Thank.
J
D
Thank
you,
chair,
Vita.
First.
Thank
you
so
much
for
this
fantastic
presentation.
I
want
to
acknowledge
that
it
was
very
thoroughly
done
and
really
helps
us
as
policy
makers
kind
of
Orient
better
to
this
topic.
So
we
can
make
informed
decisions,
and
you
also
very
much
clearly
presented
around
a
problem
that
we
do
have
the
ability
to
solve
and
have
a
variety
of
tools
to
get
at
the
root
causes
of.
D
Why
folks
gravitate
to
some
of
the
substances
that
you
you
highlight
in
this
presentation,
but
I
just
had
a
couple
questions
in
regards
to
the
state
funding
that's
coming
through
I
know,
it
seems
like
there
are
some
restrictions
with
the
opioid
settlement
funds,
but
are
we
anticipating
you
know
applying
for
some
of
the
state
grants
that
is
going
to
be
rolled
out
in
the
coming
weeks,
based
off
of
some
of
the
work
that
our
state
lawmakers
did
around?
H
Chair
Vita,
council
member
wansley
members
of
the
committee,
thank
you
for
the
question.
I
anticipate
that
we're
going
to
apply
for
any
money
that
we're
eligible
for
again
I'll.
Just
reiterate
the
demand
outpaces
the
need,
outpaces,
the
resources
that
we
have.
H
You
know
in
fact,
I
think
it's
later
on
tomorrow
afternoon,
we've
got
a
local
public
health
group
that
gets
together
to
talk
about
what
each
local
public
health
unit
is
doing
with
their
settlement.
Money
Hennepin
County
also
convenes
a
group
of
the
Cities
within
the
county
to
talk
about
what
they're
doing
and
then
ways
that
we
can
partner
and
also
just
ways
that
we
can
leverage
that
funding
I'm,
not
exactly
sure
what
the
state
or
what
the
county
plan
to
do.
H
They
could
very
well
come
out
and
say
we're
going
to
provide
this
funding
to
every
city
except
Minneapolis.
Just
given
the
fact
that
we've
got
a
larger
chunk
of
money,
hopefully
they
don't
do
that
knock
on
wood,
but
you
know
that's
that's,
certainly
a
possibility,
but
but
again
back
to
the
you
know
initial
answer
of
the
question.
We
are
going
to
seek
any
funding
that
we
are
eligible
for.
D
And
follow-up
question:
it's
really
good
to
see
our
health
department
lead
on
this,
especially
with
the
emphasis
of
utilizing
a
public
health
approach
in
this
work,
I'm
interested
to
know
as
you're
working
out
this
comprehensive.
You
know
opioid
response
plan.
H
Yes,
chair
Vita
council
member
wansley
members
of
the
committee
yeah.
Actually,
we've
been
working
with
a
number
of
different
departments
pretty
much
since
we
knew
what
our
you
know
when
we
could
expect
the
settlement
payments
and
how
much
we
took
an
inventory
of
all
of
the
existing
direct
and
not
an
indirect
costs
around
opioids
from
all
the
different
departments.
Every
department,
for
the
most
part,
was
very
cooperative
and
and
helped
us
put
that
together.
H
So
you
know,
we've
got
a
finance
working
group,
we've
got
an
engagement
working
group
and
we
have
a
programming
working
group
and
each
of
those
have
multiple
people
from
various
departments
from
the
office
of
community
safety.
So
we've
got
MVP,
we
have
or
sorry
we've
got
the
department
of
neighborhood
safety,
we've
got,
MPD,
we've
got
fire
and
then
we've
got
cped.
We
have
a
finance,
we
have.
H
Ncr
is
a
big
part
not
just
for
for
what
they
might
spend
or
use
in
and
of
themselves,
but
also
their
ability
to
help
us
reach.
The
folks
out
in
community
they've
got
a
wealth
of
resources
of
Staff
capacity
and
resources
within
NCR
to
help
us
with
this
work
and
I'm,
trying
to
think
if
I'm
missing
any
any
other
department,
race,
Equity,
inclusion
and
belonging
has
been
a
part
of
it.
H
I
don't
know
if
I'm
missing
any,
but
yes
to
the
answer.
Your
question
we
have
been
working
with
them.
Awesome.
D
H
H
That
was
an
estimate
at
the
time
as
to
how
much
we
thought
we
might
get,
and
we
we
have
a
little
bit
more
than
that
right
now
we
had
some
accelerated
payments
come
in
and
so
we're
trying
to
make
sure
that
we
can
bring
you
all
a
set
of
recommendations
on
strategies
that
are
acceptable
uses
of
the
funds,
and
we
want
to
do
that
sort
of
in
as
little
times
coming
back
in
front
of
you
as
possible.
H
So
we
want
to
have
more
of
a
comprehensive
package,
but
there
will
be
some
one-off
items
we'll
have
to
come
forward
because
we
can
do
some
things
faster
than
others,
and
so
I
would
anticipate
that
before
the
end
of
the
year
before
the
budget,
there
might
be
a
couple
things
that
come
before
you,
but
really
I
think
the
bulk
of
it
is
going
to
be
wrapped
up
in
this
budget
process.
D
Okay,
I
just
want
to
recap
that,
in
terms
of
I
I
know,
typically,
we've
been
doing
some
of
the
one-off
things,
for
instance,
even
with
OCS
and
I.
Think
a
concern
has
consistently
been
of
what
is
the
comprehensive
kind
of
plan?
That's
guiding
the
the
work,
so
we
can
see
how
you
know:
we're
threading,
the
needle
throughout
all
of
these
initiatives
and
working
towards
kind
of
a
common
goal.
D
So
I
think
it
was
more
so
that,
like
I
I
understand
through
the
budget
process,
we'll
have
some
of
the
individual
strategies
that
might
need
to
be
approved
and
definitely
within
the
container
restrictions
of
funding,
but
that
overall
lit
list
of
strategies.
It
would
be
good
for
this
committee
to
get
a
sense
of
what
those
are.
So
as
those
individual
items
are
coming
to
us,
then
we
can
say:
oh
it's
part
of
this
or
part
of
X
strategy.
So
that's
what
I
was
really
indicating
of
that
comprehensive
package
of
the
individual
strategies.
D
In
terms
of
when
we
can
anticipate
seeing
something
like
that,
that
seems
kind
of
separate
from
budget
conversations
that
or
budget
release
in
August.
H
Terravita,
council,
member
wansley
and
members
of
the
committee
I
think
in
terms
of
the
budget
process.
H
What
what
we
think
will
happen
is
we'll
be
talking
about
some
of
the
strategies
that
that
we've
taken
guidance
from
the
mayor's
office,
for
example,
in
the
2020
324
budget,
the
645
was
specifically
allocated
towards
evidence-based
treatment
as
a
strategy,
and
so
I
think
we'll
we'll
see
those
types
of
things
come
forward,
so
evidence-based
treatment
as
a
strategy-
and
you
know
maybe
even
more
specific
capital
for
treatment
centers
that
type
of
thing,
but
but
we'll
get
you
you
know
when
we
come
through,
rather
than
having
like
a
specific.
H
We
want
a
treatment
center
right
here.
You
know
that's
developed
by
this
person
and
run
by
this
person.
It
will
be
more
of
that
high
level
bucket.
This
is
the
strategy
that
we
plan
to
employ
and
then,
when
we
get
down
into
the
nitty-gritty,
you
know
you'll
be
approving
contracts,
you'll
be
approving
rfps,
and
things
like
that
for
when
we
do
start
to
need
to
get
that
money
out
into
community
and
of
course,
this
funding,
even
though
we
come
to
the
council
to
in
order
to
draw
down
on
the
settlement
funds.
H
D
And
just
a
point
of
clarification
to
I
mentioned
earlier,
some
of
the
state
funds
which
I
know
when
you're
applying
for
those
state
grants.
They
do
want
you
to
present
a
comprehensive
plan.
So
it
seems
like
again
there's
a
bucket
of
work.
D
That's
going
to
be
structured
around
the
opioid
settlements
because
again
some
of
those
restrictive
Dynamics
and
it
seems
like
existing
Clauses,
as
you
mentioned,
from
budget
discussions
prior
to
right
now,
but
in
terms
of
the
state
funding
that
is
going
to
be
addressing
over
the
overdose
overdose,
preventions
they're
going
to
want
to
see
a
plan
around
that
work
too.
So
that's
why
I'm
mentioning
of
like
it
would
be
good
to
have
that
comprehensive
package
of,
what's
already
in
the
works
and
how
we're
going
to
make
ourselves
competitive
for
some
of
those
grants.
D
That's
about
to
come
down
the
pike
that
are,
you
know,
Statewide
lawmakers
advocated
very
diligently
for
so
I
think
it's
that
piece
where
I'm
still
not
sensing
like
a
collective
plan
or
Collective
vision
of
this
work
versus
you
know,
items
happening
in
isolation
of
one
another
and
I
think
that
is
the
ask
in
front
of
our
Public
Health
Department
of
what
does
it
look
like
to
have
even
at
that
high
level.
All
of
this
centralized
in
one
place
so
we're
not
just
approving
individual
items
and
being
like
wait.
D
What
is
this
connected
to
so
just
want
to
provide
that
point
of
clarification,
too,
of
like
I,
get
the
opioid
settlements,
but
we
have
the
state
funding
too.
That's
going
to
be
helping
shake
some
of
the
work
that
was
presented
in
this
presentation
and
wanted
to
figure
out
how
we're
setting
ourselves
up
to
be
successful
competitors
for
those
grants
when
they
start
being
enacted-
and
it
seems
like
that-
might
not
be
clearly
identified
right
now
and
I
hope
it
will
be
soon
in
terms
of
the
doctor.
D
I
did
have
a
follow-up
question
for
you
in
terms
of
some
of
the
demographic
data
points
I
wanted
to
know
in
terms
of
demographic
breakdowns
for
age
groups.
I
know
you
did
a
really
good.
You
know
breakdown
around
racial
dynamics
of
of
some
of
our
disorder
or
folks.
Who,
typically,
are
you
know
dying
from
overdoses
and
things
of
that
nature?
D
But
one
thing
that
I
hear
repeatedly
is
a
lot
of
our
younger
folks
are
increasingly
dealing
with
substance,
substance,
use
disorders
too,
and
getting
the
sense
of
if
there's
any
data
analysis
around
that
demographics
too,
to
kind
of
back
out
or
again
around
a
comprehensive
approach.
Do
we
need
to
be
looking
at
youth
focus
initiatives
around
some
of
the
interventions
that
we're
going
to
be
leveraging
as
a
city.
H
Chair
Vita
and
council
member
wandsley
members
of
the
committee
I'll
have
Dr
D
come
up
in
just
a
second
to
answer
that
question.
What
I
will
say
is
you
know?
Youth
is
definitely
something
that
we're
looking
at
and
I
totally
lost
the
question:
can
you
restate
the.
D
Question
for
for
youth,
the
youth
breakdown
or
the
fact
or
the
same.
H
Okay,
what
we
do
know
and
I
don't
think
we
have
a
graph
I
just
looked
at
it
was
that
24
to
34
is
the
highest
incident
of
opioid
overdose,
and
so
yes,
that's
definitely
an
area
that
we
are
targeting
and
working
with
Metro
youth
diversion
as
one
of
our
partners
also
generation
hope
as
one
of
our
partners,
so
really
making
sure
that
we
are
targeting
the
youth
as
well
as
the
native
and
East
African
Community,
and
then
the
unsheltered
population.
H
I
Chair,
remember:
Wesley,
I,
I
completely
agree
that
focus
on
the
youth
is
incredibly
important,
especially
when
it
comes
to
prevention,
education,
how
we
talk
about
risk
communication
and
health
promotion.
The
unique
aspect
about
the
Adolescent
brain
is:
if
someone
sees
someone
uses
opioids
I,
think
before
the
age
of
25
and
we're
seeing
a
lot
of
15
year
olds,
we're
seeing
a
lot
of
high
school
students
experimenting
and.
I
Pill
and
then
they're
hooked
that
early
age
of
exposure
increases
your
lifetime
risk
two-fold
compared
to
someone
who
maybe
saw
their
first
opioid
pill
at
the
age
of
30,
say
so
I
think
all
the
more
importance
on
prevention,
education
in
the
youth
I,
would
also
add
the
the
treatment
considerations
are
slightly
different,
but
I
think
maybe
that's
a
little
more
technical,
then
certainly
I,
understand
and
if
I'd
also
comment
on
a
competitiveness
of
Minneapolis
for
a
state
level
of
funding,
I
think
that's
hugely
important
and
if
I
can
speak
as
a
constituent
in
South
Minneapolis
with
the
highest
burden
of
disease
in
the
country.
I
Really,
if
you're
looking
at
those
differences,
the
Gap
that's
like
Chasm,
it's
not
our
expected
Gap
and
differences
amongst
groups.
If
the
state
level
of
funding
is
being
allocated
according
to
population
numbers
across
the
state,
then
that
might
actually
have
the
effect
of
amplifying
these
disparities.
I
I
think
a
better
approach
would
be
focusing
funding.
That's
meant
to
remedy
harm
on
the
areas
with
the
highest
burden
of
disease.
D
Thank
you
for
offering
that
I
hope,
that's
something
that
our
Deputy
is
also
taking
into
account,
and
hopefully
you
know
comprising
a
a
more
comprehensive
strategy
or
sets
of
strategies
that
this
body
can
look
at.
That
is
both
targeted,
but
also
looking
at.
Where
are
we
already
seeing
the
demographic
burden
happening
based
off
of
what
you
just
presented
today?
D
So
thank
you
for
highlighting
that
piece
of
what
can
set
us
up
for
being
successful
again
for
these
grants
at
the
state
level
and
then
also
last
question
on
that
piece
around
the
Navigator
program
at
the
University
of
Minnesota,
the
medical
center
King
user.
How
long
has
that
been
active
for
and
if
there
has
been
any
Data
Tracking
around
that
too?
Or
is
it
kind
of
early.
H
Chair
Vita
council
member
wansley
members
of
the
committee
going
just
back
really
quick
to
the
question
Suzanne
just
texted
me.
Let
me
know
that
we
are.
We've
got
some
state
grants
that
we've
got
started
working
on
for
focus
on
our
youth,
and
so
when
we
come
back
and
do
a
more
comprehensive
presentation
of
our
opioid
work,
which
we
should
have
more
details
around
a
comprehensive
plan
for
the
opioid
strategy,
we
will
also
have
an
update
on
that
work
as
well.
So
obviously
there's
ongoing
work.
H
Besides
what
we're
doing
with
the
opioid
settlement,
we
want
to
wrap
that
all
in
to
one
larger
strategy.
Even
when
we
come
forward
with
you
know
one-offs.
All
of
that
will
be
wrapped
in
the
comprehensive
strategy.
We
just
know
that
the
need
is
real,
urgent
right
now,
so
we
want
to
move
as
quickly
as
we
possibly
can
and.
H
Proposal,
chair
Vita,
council
member
one's
Lea
members
of
the
committee.
We
would
definitely
need
to
work
with
the
chair
on
timing,
just
because
you
know
we
don't
want
to
be
in
a
situation
like
we
were
maybe
last
last
time
we
were
here
where
we
are.
You
know
we're
not
able
to
finish
whatever
we're
doing
so.
H
We
want
to
make
sure
that
the
agenda
has
the
enough
time
to
devote
to
it
so
we'll
work
with
the
chair
on
when
the
best
time
to
come
forward
with
that
is,
and
it
might,
it
might
come
forward
really
with
the
budget
process
as
well.
So
we
just
don't
know
quite
yet
because
we're
not
that
deep
into
the
budget
process
with
the
mayor's
office.
Yet.
D
Awesome
Again
seeing
comprehensive
strategy
that
seems
kind
of
somewhat
interrelated,
somewhat
separate
with
the
budget
process,
but
I
think
the
most
important
thing
this
is
listed
as
a
Next
Step
just
want
to
get
a
sense
of
a
realistic
timeline
of
when
this
body
can
see
something,
and
it
seems
like
that-
still
kind
of
fluid
right
now
from
the
responses
you've
given.
But
if
there
is
in
terms
of
the
University
program,
is
there
any
information
on
that
piece?.
I
A
chair
member,
thank
you
so
answer
that
question
is
I
would
say
we
were
in
early
prototyping
phase.
We
have
launched
the
Navigator
program
just
from
the
last
couple
of
months.
Prior
to
that,
we
were
doing
a
lot
of
Provider
education
around
these
new
prescribing
practices
again
that
DEA
regulation
just
lifted
in
January
of
this
year,
and
we
took
advantage
of
that
opportunity
right
away
to
provide
this
kind
of
continuing
medical
education
on
this
topic.
I
The
fifth,
the
hospital
is
part
of
a
broader
system,
that's
also
very
interested
in
expanding.
You
know
looking
at
some
of
the
same
data
we
talked
about,
so
it
makes
sense
in
in
a
number
of
ways
that
can
be
incentivized
to
speed
that
up.
You
know
for
expansion,
Beyond
to
other
hospitals
in
the
in
the
metro
area,
we're
in
some
discussions
around
that
yeah.
No.
D
I
was
just
super
excited
to
see
this,
because
University
of
Minnesota
is
also
in
my
ward
so
anyway
to
amplify.
You
know
the
fact
that
they
are
using
this
navigating
or
Navigator
model
that
you
talked
about
in
your
presentation.
The
ways
in
which
we've
seen
reduction
in
all
of
these
type
of
high-risk
factors,
as
a
result
of
that
I,
was
just
really
excited.
To
see
that
you
know
the
University
of
Minnesota
was
taking
the
initiative
and
launching
one
of
those
you
know
pieces
to
really
be
responsive
to
this
epidemic.
D
A
A
I
know
that
a
lot
the
issues
that
we
talk
about
daily
on
this
council
with
housing
and
jobs,
and
so
many
other
things
come
with
treatment
like
a
long-term
treatment
for
some
folks
short
term,
so
I'm
happy
to
see
that
that's
a
part
of
the
plan
and
I'm
hoping
that
that's
going
to
be
a
part
of
the
plan
for
us
here
at
the
city
on
how
we
use
our
funding.
We
have
a
wonderful
facility
and
council
member
Ellison's
Ward
that
I've
been
working
with
Turning
Point
has
culturally
specific
treatment
for
African,
Americans
and
I.
A
Think
they
do
a
great
job
they're
right
in
the
neighborhood
people,
trust
them
so
I
would
love
to
connect
you
with
them.
I
think
they
have
Navigators
there
already,
and
we
just
don't
call
them
Navigators
right,
like
they
have
people
that
are
doing
the
work
that
you
described
in.
You
know
how
the
connection
of
services
are
there,
so
my
office
is
going
to
send
you
an
email
and
connect
you
with
some
folks
over
at
turning
point.
If
that's
okay
with
you
Cherry.
A
Thank
you
so
much
and
thank
you
again,
deputy
chief
Richard
for
bringing
this
forward.
We
will
coordinate
for
the
additional
information
on
the
committee
schedule.
Thank
you.
Thank
you
all
and
seeing
no
further
discussions
I
will
direct
the
clerk
to
receive
and
file
this
presentation.
This
report
and
see
no
further
business
before
us.
I
will
declare
this
meeting
adjourned.