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A
Wonderful
good
afternoon,
everyone
welcome
to
assembly
committee
on
health
and
human
services.
I
will
begin
the
meeting,
but
madam
secretary,
please
call
the
roll.
C
A
Here,
having
a
quorum,
we
are
ready
to
go.
I
would
note
that
assemblyman,
matthews
and
assemblywoman
thomas
are
absent
excused.
A
A
A
And
if
I
can
remind
our
presenters
to
please
clearly
state
your
name
for
the
record
before
speaking
just
so,
our
committee
secretary
can
make
sure
she
is
capturing
who
says
what,
when.
C
Thank
you,
chairwin
david
orent,
liquor
from
assembly,
district
20
in
las
vegas
and
henderson,
and
I'm
grateful
for
the
opportunity
to
just
present
assembly
bill
345
today.
I
am
joined
by
some
experts,
joanne
chetta
and
alex
crawl.
Who
will
talk
about
the
research
on
these
sites
and
then
also
some
other
people
from
the
community
who
know
a
lot
about
opioid
abuse
and
how
we
can
deal
with
it.
C
So
ab-345
is
designed
to
reduce
harm
and
save
lives
in
nevada,
and
I
we've
I've
had
much
help
and
development
from
joanne
chetta
who
and
megan
kamalasi
here
in
lcb
and
the
seeds
for
this
bill
were
planted
three
years
ago
when,
at
the
at
unlv
our
health
law
program,
we
hosted
a
conference
on
the
opioid
epidemic
in
nevada
in
the
united
states,
and
we
invited
professor
cheddar
to
come
speak
about
the
experience
in
other
countries
with
addressing
similar
problems
and
when
she
talked
about
overdose
prevention
sites.
It
blew
me
away.
C
C
I
also
had
great
help
from
lisa
lee
carla
wagner
liam
moser
robert
harding
experts,
here
in
in
nevada
and
other
members
of
a
working
group
that
we,
when
this
was
bdr,
978
and
also
jason
griffin,
helped
out
on
this.
So
I
want
to
start
this.
Bill
is
designed
to
reduce
harm
from
the
problem
of
opioid.
C
Opioid
use
and
harm
reduction
is
here's
one
definition:
a
set
of
practical
strategies
aimed
at
reducing
negative
consequences
associated
with
drug
use.
We
can
do
harm
reduction
in
other
settings,
it's
not
just
drug
use,
but
that's
a
common
area
where
you
have
a
behavior
that
causes
that
you
can't
control
entirely.
Sometimes
you
don't
want
to
control
it
entirely.
Sometimes
you
do,
but
at
least,
if
it's
going
to
exist,
you
want
to
make
sure
you
minimize
the
harm,
that's
caused.
C
C
So
these
are
all
examples
in
in
the
area
of
drug
use,
but
here's
another
example
in
another
setting
and
that
is
seat
belts
and
airbags
and
motor
vehicles.
We
hope
we
don't
have
automobile
accidents,
but
we
can't
eliminate
them
entirely.
So,
at
least
if
people
are
wearing
seat
belts
and
heavy
air
bags,
we
reduce
the
harm
from
motor
vehicle
accidents,
the
opioid
problem.
This
has
been
a
serious
problem
and
especially
during
the
pandemic,
in
the
united
states
and
and
in
nevada
as
well.
C
So,
for
example,
in
2019,
almost
50
000
people
in
the
united
states
died
from
opioid
involved
overdoses.
This
past
november,
the
national
drug
hotline
placed
nevada
on
a
red
alert
status
because
of
the
increase
of
death
from
overdoses
and
we've
seen
this
problem
be
exacerbated
by
covet.
Here's
a
chart
that
shows
states
from
2019
to
2020
the
increase
in
opioid
problems,
and
you
can
see
nevada
we're
in
dark
red,
which
means
we've
seen
more
than
a
50
percent
increase.
C
So
this
bill,
ab345
has
two
components:
to
save
more
lives.
One
is
to
authorize
overdose
prevention,
site
pilot
and
I'll
talk
more
about
what
that
means
and
two
to
make
sure
that
doctors
are
prescribing
naloxone
prescriptions,
naloxone,
giving
naloxone
prescriptions
to
patients
who
are
at
higher
risk
for
overdose,
and
these
two
together
will
provide
more
harm
reduction
from
opioid
abuse
in
nevada.
C
D
D
G
D
It
okay,
no
no
problem.
I
won't
introduce
myself
again.
D
I
would
just
say
again
in
the
mid
1980s
as
this
drug-related
hiv
problem
exploded
around
the
the
heads
of
people,
the
swiss
decided
in
the
shadow
of
their
own
parliament
in
bern
to
create
a
space
where
people
could
come
and
inject
drugs,
but
with
medical
personnel
around
them,
so
that
if
there
was
so
first
of
all
the
the
to
be
sure
that
people
had
clean
injection
equipment
and
also
if
there
was
overdose
for
there
to
be
medical
people
to
help
reduce
the
harms
of
it.
D
In
canada,
there
was
only
one
supervised
consumption
facility
opened
in
2003
until
2016
when
canada
realized
it
had
the
same
kind
of
overdose,
dramatic
increase
in
overdoses,
as
we
have
experienced
in
the
us,
and
then
those
sites
again
multiplied
across
the
country.
D
Because
of
this
decades
now
of
experience
that
we
have
with
this
service
and
thanks
to
the
enterprising
work
of
a
lot
of
researchers,
I
would
say
especially
those
at
the
university
of
british
columbia
in
vancouver.
We
have
a
robust
body
of
evidence
to
look
at
the
outcomes
associated
with
this
intervention.
D
Obviously,
these
these
services
were
created
to
reduce
overdose
and
most
of
them
boast
many,
many
thousands
of
overdose
episodes
without
a
single
death
or
brain
injury
associated
with
overdose
again,
because
people
have
health
help
right
nearby
needle
sharing
obviously
goes
down.
That
means
hiv
transmission
as
well.
D
The
better
ones
of
these
services
and
I've
visited
many
of
them
around
the
world
have
good
systems
of
referral
to
other
kinds
of
health
and
social
support,
including
in
many
cases
access
to
various
forms
of
treatment
of
drug
dependence.
The
service
in
vancouver,
that's
been
so
well
studied,
actually
has
on
the
premises
a
drug
treatment
facility.
D
Obviously,
a
less
disposal
unsafe
disposal
of
syringes,
most
of
them
most
of
the
these
places,
have
been
able
to
demonstrate
an
in
a
decrease
in
open
drug
scenes
and
public
disorder.
There's
no
evidence
that
I
know
of
in
the
literature
in
peer-reviewed
literature
anyway,
that
there's
been
an
increase
in
crime
in
the
neighborhoods,
where
these
services
exist
and
no
increase
in
initiation
of
drug
use,
which
is
often
a
fear
expressed.
D
People
will
be
taken
to
hospitals
that
all
has
declined
dramatically
in
places
like
vancouver,
where
I
visited
before
the
neighborhood
in
question
before
the
service
opened,
and
it
was
just
constant
back
and
forth
of
ambulances
and
lots
of
people
going
to
hospitals
who
now
don't
need
to.
D
In
spite
of
this
evidence,
when
the
conservative
government
was
elected
in
canada
in
2006,
it
decided
to
close
down
the
facility
in
vancouver
that
was
challenged
by
actually
by
some.
D
On
the
right
there
you
see
the
inside
of
a
of
a
supervised
consumption
bus
and
again,
the
political
viability
of
these
facilities
is
that
they
have
now
a
very
long
history,
thousands
and
thousands
of
overdose
episodes
with
no
deaths
on
their
premises
and
in
germany,
as
as
would
be
the
case
in
the
netherlands
and
a
number
of
other
places
that
we
could
look
at.
These
services
exist
in
in
part
of
a
a
spectrum,
a
range
of
harm
reduction
services.
D
You
see
that
I've
explained
some
of
them
here,
both
fixed
and
mobile
drop
in
centers,
fixed
and
mobile
consumption
spaces
there's
also
first
aid
centers,
where
people
with
soft
tissue
infections
can
get
those
treated
free,
hiv
and
hepatitis
testing
even
a
place
in
that
last
symbol
on
the
list
there,
where
people
can
bring
pets.
Now
these
symbols
are
well
known
in
in
berlin,
people
who
people
know
what
they
mean.
D
And
let
me
just
say
that
it's
obvious
from
the
picture.
That's
shown
here
that
the
european
union
has
never
seen
the
level
of
overdose
mortality
that
we
are
now
suffering
with
in
the
us,
and
I
think
that
that's
for
three
main
three
main
reasons,
maybe
among
others
that
we
could
talk
about
as
well.
D
Secondly,
with
nationalized
or
quasi-nationalized
health
systems,
you
would
not
see
the
same
kind
of
out-of-control,
unscientific,
marketing,
aggressive
and
and
deceptive
marketing
of
opioid
medicines
that
caught
us
up
here,
and
that
was
in
many
ways
an
engine
for
this
dramatic
increase
that
we
see
in
the
graph.
And
thirdly,
and
perhaps
most
importantly,
in
most
of
these
countries,
minor
drug
offenses,
non-violent,
drug
offenses
are
are
decriminalized
or
at
least
depenalized,
which
is
to
say
that
people
don't
go
to
jail
for
them.
D
I
just
wanted
to
give
you
a
few
links
to
some
of
the
sort
of
more
summaries
of
of
the
research
that
we
have,
so
you
can
see
with
the
more
recent
one
by
arm
brecht
and
others
from
icer
you'll
be
able
to
see
some
of
the
more
recent
peer-reviewed
literature,
the
one
the
second
one
here
was
done
for
the
city
of
philadelphia
when
it
first
started,
considering
having
a
supervised
injection
or
overdose
prevention
facility,
and
the
third
one
is
the
evidence
that
actually
went
to
the
canadian
supreme
court
from
the
pilot
years
of
the
insight
facility
in
vancouver.
D
H
C
H
Okay,
great
is
my:
can
you
see
my
screen
as
well?
Is
that
is,
that,
being?
Is
that
working
the
share
screen
broadcast.
G
G
H
Will
do
that?
Yes,
my
name
is
alex
crowl,
I'm
a
distinguished
fellow
at
rti
international
and
we're
I'm
an
epidemiologist.
I've
been
studying
drug
use
here
in
the
united
states
for
since
1993
and
one
of
the
things
just
to
bring
this
to
more
to
the
us
context.
I
you
know
here
in
the
united
states.
A
G
Mr
crow,
we
one
thing
that
you
might
try
is
to
turn
off
your
camera
just
to
lower
the
broadband
that
might
help
us
deal
with
the
issue.
G
It's
still
fairly
quiet.
If
you
could
sit
closer
and
please
remember
to
project
as
best
you
can.
H
We'll
do
that,
okay,
so
in
the
united
states,
you
know
at
this
point:
we
are
having
about
71
000
deaths
in
overdose
per
year,
hiv
we're
seeing
2
400
new
infections
a
year,
hepatitis
c,
38,
000
new
infections,
a
year
infective
or
endocarditis.
A
heart
disease
is
something
that
also
on
the
up
with
20
000
cases
a
couple
of
years
ago,
and
then
soft
tissue
infections
we're
also
about
half
a
million
a
year.
So
the
health
complications
associated
with
injection
drug
use
in
the
united
states
are
is
are
quite
broad.
H
So
what
we've
done
in
the
united
states
is
there?
There
are
no
legally
sanctioned
overdose
prevention
programs
in
the
united
states.
At
this
point,
however,
there
is
one
unsanctioned
site
somewhere
in
the
united
states
that
we've
evaluated
and
that's
been
open
for
six
years
now.
It
essentially
entails
much
like
what
you
saw
in
the
previous
presentation:
two
separate
rooms,
one
for
injection
and
one
for
post
injection.
H
They
have
six
stainless
steel
tables
with
mirrors
and
table
for
assisted
injection
and
there's
a
staff
person
there
in
the
room
at
all
times.
Who
can
help
to
save
somebody
or
counsel
them?
As
need
be,
we
published
a
paper
in
the
new
england
journal
of
medicine
last
july
that
basically
looked
at
all
of
the
overdoses
that
happened
in
that
site,
and
so,
during
the
six
years
it's
in
operation
there
were
over
10
000
injections.
At
this
site
there
were
33
people
who
overdosed
and
none
of
them
died.
H
We
also
did
a
study
looking
at
crime
in
the
neighborhood.
What
these
graphs
are.
I
know
there
are
a
few
dots
going
on
here,
but
essentially
what
you
have
on
the
left
here
is
you
have
10
years
of
data
five
years
before
the
site
opened,
and
then
you
see
the
vertical
line
there,
and
then
you
have
five
years
of
data
after
the
site
open.
The
green
is
the
neighborhood
within
500
meters
of
the
site
and
the
blue,
and
then
also
on
the
right,
the
red.
H
Those
are
sort
of
control
neighborhoods
in
the
same
city
that
are
very
similar
neighborhoods,
but
that
don't
have
a
safe
consumption
site,
and
what
you
see
is
that
crime,
as
for
police
reports,
went
down
after
the
implementation
of
the
site
in
the
500
meters
around
the
site,
but
in
the
in
the
in
the
control
neighborhoods,
both
in
the
blue.
There,
you
see
things
actually
going
pretty
much
stable.
H
They
went
down
similarly
in
one
of
the
other
control
neighborhoods
as
well,
but
certainly
it
shows
that
there's
good
news
in
in
terms
of
crime
around
the
site.
I
also
want
to
add
one
more
thing
is
we
did
a
study
that
we
published
in
the
peer
review
journal
two
years
ago
that
showed
that
if
you
implement
the
same
type
of
site
that
they
have
in
vancouver
in
a
city
in
the
united
states,
it
would
save
the
city
three
and
a
half
million
dollars
a
year.
Basically,
because
you
have
savings
in
overdoses,
you
have
savings.
H
That
ambulance
is
not
coming.
You
have
less
hiv
hepatitis
c
abscesses
those
kinds
of
things
that
I
talked
about
earlier.
H
H
Lastly,
I
just
wanted
to
say
in
the
united
states
this
is
not
the
only
state
bill.
That's
currently
up.
All
you
see
on
the
on
the
left
side,
you
see
there
are
very,
very
similar
bills,
right
now
being
argued
and
being
deliberated
in
arizona
in
in
california
new
mexico.
A
lot
of
the
states
that
are
are
very
similar
around
to
to
nevada
as
well.
H
There
are
also
many
cities
that
have
had
mayors
that
declare
that
they
want
to
implement
these
overdose
prevention
sites
and
some
of
them
on
the
east
coast,
some
of
them
on
the
west
coast
as
well.
So
that's
the
end
of
my
presentation,
specific
to
what's
going
on
around
overdose
prevention
sites
in
the
united
states.
Thank.
H
C
So,
thank
you,
doctors,
chedda
and
paul
for
that
very
helpful
information.
So
now
I'm
going
to
fix
my
presentation
here.
C
Okay,
here
we
go
so
as
we
heard,
the
american
medical
association
has
endorsed
the
concept
of
overdose
prevention
sites.
The
american
public
health
association,
assemblyman.
G
Liquor,
I
absolutely
apologize.
We
are
not
seeing
your
screen
share.
Can
we
please
start
it
over
again.
B
C
C
Okay,
so
these
they
indicate
they've
been
endorsed
by
the
american
medical
association,
the
american
public
health
association.
So
now
I'll
go
through
what
the
bill
does
so
in
an
overview
this
it
has
enabling
language
it
doesn't
would
not
create
an
overdose
prevention
program
by
passage
of
the
bill.
It
would
enable
a
pilot
program
so
washoe
and
clark
county
would
each
have
authority
to
open
a
one
pilot
program
in
each
county
and
if
that
goes
well,
then
other
counties
would
have
the
option
to
so.
C
This
is
an
option
for
counties
nothing's
required,
but
it
allows
them
to
do
it.
It
could
be
done
either
a
brick
or
mortar,
fixed
site
or,
as
we
saw
in
the
berlin
example,
we
could
have
a
mobile
site.
It
would
be
operated
by
health
authority,
an
academic
institution
say
unlv
or
unr
school
of
medicine,
nonprofit
organization
or
a
combination
of
those
any
of
those
three
how
it
would
work.
C
So
as
we
saw,
these
are
controlled
environments
with
you
with
on-site
trained
personnel,
and
then
you
can
connect
the
users
to
provide
education
and
connect
them
with
referrals
for
treatment,
and
there
would
be
oversight
by
state
or
local
health
authority
to
make
sure
that
these
are
carefully
regulated
and
then
in
terms
of
the
specific
provisions.
So
their
number
of
safeguards
for
the
community
before
opening
a
pilot
site,
the
the
authority
or
the
entity
that
would
want
to
do,
it
would
have
to
consult
with
law
enforcement
health
authorities
in
the
public.
C
They
would
have
to
make
sure
that
their
safe
and
proper
disposal
of
used
injection
equipment.
So
we
don't
one
of
the
virtues
we've
seen
instead
of
needles
and
syringes
being
left
out
in
parks
and
sidewalks
and
streets
they're
disposed
of
properly
in
these
facilities,
and
there
would
be
oversight
by
local
health
authorities.
County
commissioners
and
the
state
board
of
health
would
all
have
oversight
authority.
C
Some
of
the
safeguards
for
the
participants
there
would
be.
These
would
be
staffed
by
trained
personnel.
There
would
be
just
distribution
of
sterile
needles
and
syringes,
so
they
aren't
transmitting
communicable
diseases.
They'll
be
monitoring
the
participants,
as
we
saw
the
example
in
the
unsanctioned
site,
where
there's
the
treatment
room
in
the
post-treatment
room
administration
of
onsite.
First
aid,
if
necessary.
C
C
If
preliminary
review
indicates
that
things
are
going
well,
as
we
expect
based
on
the
data
from
other
countries
and
then
and
the
unsanctioned
site
in
the
united
states,
then
if,
after
two
years,
it
would
be
possible
for
the
board
of
health
to
authorize
pilot
programs
in
other
counties,
and
they
would
review
the
number
of
participants
and
what
happened
were
there,
overdoses
and
referrals
and
other
things
to
to
gauge
how
they're
operating
and
then,
finally,
after
four
years
for
any
pilot
site,
there
would
be
a
formal
review
to
decide
whether
it
could
transition
to
a
permanent
site
and
then
also
whether,
if
it
all
went
well
and
washoe
or
clark
after
one
year,
would
that
would
they
now
be
authorized
to
expand
beyond
the
one
site.
C
Okay,
that's
the
first
part
of
the
bill
and
the
main
part
of
the
bill
there's
also
a
second
part
of
the
bill
in
section
12
dealing
another
harm
reduction
policy,
naloxone
co-prescribing.
So
the
idea
here
is
for
people
who
are
being
prescribed
opioids
and
who
are
at
risk
for
overdoses.
C
Provide
a
prescription
for
naloxone
along
with
the
opioid
prescription,
so
the
patient
will
have
on
hand
naloxone
in
case
of
an
overdose,
so
10
states
have
legislation
or
regulations
on
this.
Eight
states
require
that
the
prescription
be
provided.
Two
states
require
that
the
prescription
be
offered
and
what
we
see
in
those
states
it
does
lead
to
increases
in
pharmacy
dispensing
of
naloxone,
but
we
don't
know
yet.
C
We
don't
have
enough
data
yet
to
know
how
this
method
of
expanding
access
to
naloxone
compares
with
programs
like
we
have
in
nevada
for
non-pharmacy
community
distribution
of
naloxone
ab.
The
provisions
we
have
in
ab345
are
modeled
after
rhode,
island
regulations.
They
seem
good
ones
to
to
start
with.
Although
we'll
talk
about
that
some.
So
what
what
we?
What
we
brought
in
from
the
from
the
rhode
island
regulations?
C
And
so
if
a
physician
is
prescribing
for
patients
at
higher
risk
for
opioid
overdose,
then
they
would
provide
a
naloxone
prescription
and
the
categories
of
patients
who
would
be
considered
higher
risk
are,
if
they're,
taking
more
than
50
morphine
milligram
equivalents
per
day
if
they
get
to
that
higher
dose.
If
they're
taking
an
opioid
and
a
benzodiazepine
that
increases
the
risk
or
if
they
have
a
history
of
opioid
overdose
or
opioid,
use,
disorder
and
and
one
thing
important,
we
there's
a
conceptual
in
our
conceptual
amendment.
We
revise.
C
We
took
out
previous
sections
12.3
and
12.4
and
there's
a
new
12.3
to
to
clean
up
some
problems
that
we
had
with
the
original
language.
So
if
you're,
if
you're
looking
at
the
people
who
would
get
this
prescription,
it's
important
to
be
looking
at
the
conceptual
amendment,
that's
posted
on
nellis,
but
we
these
we,
it
seemed
like
rhode.
Island
had
a
good
model,
but
we
this
one
you
know,
is
not
the
data
aren't
as
clear
as
with
the
overdose
prevention
site.
So
we
welcome
suggestions
on
refining
the
criteria.
C
C
So
I
want
to
thank
natalie,
johns
and
narelle
alarcon
from
my
office
for
their
excellent
help
in
preparing
and
if
you
would
like
to
co-sponsor
this
bill,
I
will
be
happy
to
add
you
on
by
an
amendment.
So
thank
you
for
allowing
me
to
present
and
I
look
forward
to
your
questions.
A
Thank
you,
assemblyman
orton
liquor.
I
do
believe
we
have
quite
a
few
questions
as
I
imagine
we
would
having
such
a
big
policy
conversation
about
your
bill.
First
up,
I
have
assembly
woman,
titus.
I
Thank
you,
madam
chair,
and
indeed
thank
you,
assemblyman
orton
liquor
for
bringing
up
this
discussion
and
this
bill.
I
think
it
is
a
good
policy
discussion
to
have
I'm
glad
that
you
mentioned
section
12.
I
That
was
one
of
the
first
things
that
I
was
going
to
especially
section
12
number
three,
where
you
describe
not
being
able
to
prescribe
the
the
narcan
or
reversible
drug
if
or
opiates,
if
you're
given
benzodiazepine
and
I
as
I
know,
you're,
not
a
practitioner
but
as
a
practitioner
I
would
say
it
would
be
very
important
that
the
practitioners
themselves
make
that
decision.
I
So
I'm
anxious
to
see
what
that
looks
like
in
your
amendment-
and
I
haven't
had
a
chance
to
review
that
so
I'll
follow
up
with
any
questions
I
have
with
that.
Once
I
see
that
amendment.
The
next
question
I
have
is
is
is
first
a
statement.
The
cdc
recent
you
know
released
a
a
graph
recently
on
the
overdoses
and
we
know
that
the
opioid
epidemic
came
in
three
ways:
right
then,
in
99,
on
the
prescription,
opioids
and
then
in
2010,
the
heroin
over
overdoses
and
then
that
third
wave
with
the
fentanyl
overdoses.
I
So
we
in
the
state
over
the
last
several
sessions
since
I've
been
in
session.
This
is
my
fourth
one.
We
have
successfully
actually
tried
to
curb
that
and
and
through
that
we
were
an
early
state
to
adopt
the
narcan
prescriptions
and
allow
that
to
be
dispensed
with
the
packaging
family
members.
Those
kind
of
things
we've
really
done
that
we've
held
a
provider
such
as
myself,
who
do
prescribe
these
accountable
for
how
we
do
this,
and
so,
and
we've
also
entertained
needle
exchange
programs
and
all
of
that.
I
So
what
I'm
asking
with
this
particular
bill,
since
I
don't
number
number
one
I
don't
know.
If
any
I
need
to
know.
If
any
other
states
have
this
legislation,
I
heard
a
number
of
states
are
going
to
pass
really
curious
about
the
number
of
states
who
actually
passed
this
legislation.
That
would
be
my
first
question.
H
I
have
to
answer
that
the
this
is
alex
crowl
again
there
there
are.
There
are
no
current
states
that
have
passed
that
that
there's
a
bill,
that's
passed
through
both
health
committees
and
public
safety
committees
in
other
states,
but
this
but
but
there's
none,
that's
passed
so
far.
I
And
so
the
standard
of
cara
know
that
that
the
first
one
started
in
1986
in
switzerland.
So
this
isn't
a
new
idea.
The
first
program
actually
started
in
switzerland,
and
that
was
when,
when
I
was
in
actually
I
graduated
from
medical
school
in
81,
so
we
were
dealing
with
hiv
epidemic,
and
so
we
were
dealing
with
someone's
true
issues
about
needle
sharing.
I
Since
that
time,
however,
we've
progressed
even
and
thinking
about
sharing,
not
you
know
not
being
able
to
share
needles.
So
I'm
curious
about
the
statistics
on
the
actual
drugs
who
who
supplies
the
drugs.
What
drugs
are
they
allowed
to
use?
Do
they
bring
in
their
own
or
or
is
this
a
volunteer
program,
and
so
who
controls
it
does
the
heroin?
Do
they
tell
the
folks
there
that
I'm
gonna,
I'm
gonna,
take
an
ounce
of
this
who
controls
the
actual
process
and
where
do
the
drugs
come
from.
H
Sure
I'm
happy
to
essentially,
yes,
people
have
to
that.
There's
no
drugs
provided
at
the
sites,
and
so
people
have
to
bring
in
their
own
drugs
and
use
their
own
drugs.
And
typically,
what
happens
is
they
will
let
the
attendant
know
what
type
of
drugs
they're
using
and
and
and
that's
essentially
it
they
are,
then
free
to
use
as
much
or
as
little
of
those
drugs
as
as
they
want
to
use.
Obviously,
if
they
use
too
much
and
we're
to
overdose,
then
they're
there
to
help
save
them
at
that
point.
H
But
but
there's
no
drugs
given
out
at
the
site-
and
you
know
basically
pre-obtained
you're,
bringing
them
in
yourself
and.
I
So
is
there
if
I
might
continue
manager?
Sorry,
thank
you
so
before.
Thank
you.
So
when
you
bring
in
your
own
drugs
which
heroin
perhaps-
and
we
know
that
that's
not
that's
still
federally
illegal
and
it's
illegal
in
this
state,
I'm
curious
about
the
federal
government
enrollment
government
enrollment
in
this,
although
conceptually
it's
nice
to
be
in
a
safe
area-
and
I
have
done
my
homework
on
this-
I
do
know
that
there's
no,
you
know
increased
crime
around
there
and
that
you
can
prevent
these
overdose.
I
H
So
so
we
so
that
that
that
indicates
to
us
that
people
aren't
doing
they're,
not
more
risky
in
these
environments
than
they
are
out
in
the
community.
I
And
in
the
in
the
areas
that
you
s
yeah,
you
say
if
I
might
that
they
have
these
locations,
there's
been
a
decrease
in
the
number
of
deaths
because
of
narcans
available.
You
testified
to
that,
but
as
a
narcan
already
available
in
these
states
in
these
areas,
or
unlike
nevada,
where
we
already
have
narcan
available,
is
that
the
unique
situation
there.
H
You
know
the
difference
here
between
this
and
and
other
things.
Mr.
A
H
This
is
alex
crowl,
distinguished
fellow
at
rti,
international,
and
so
the
difference
here
is
that
when
you're
using
drugs,
if
you
are
using
them,
while
you're
alone,
you
could
have
all
the
naloxone
you
want,
but
you
can't
use
it
on
yourself
because
you're
or
you're
overdosed,
and
so
the
point
of
these
sites
is
to
make
sure
that
there's
somebody
there
who
is
a
professional
who
knows
how
to
use
that
and
has
naloxone
or
oxygen
frankly,
they
are
available
for
them.
H
I
And
they-
and
thank
you
for
all
of
that-
I
just
again
with
the
I'm
just
curious
and
bringing
it
all
back
to
the
state
of
nevada,
because
that's
where
we're
looking
at
this
assemblyman
like
or
have
you
done?
I
this
is
the
recent
pandemic,
the
studies
that
we've
seen
and
the
actually
the
decreased
rates
and
we've
actually
had
lower
rates
of
overdose.
I
In
the
these
three
major
things
of
overdose
that
we've
signed,
some
of
them
are
actually
going
down,
except
for
this
pandemic,
which
is
the
outlier,
and
we
are
seeing
overdoses
in
this
last
year
and
increased
five
percent
six
percent,
and
it's
and
it's
a
significant
tragedy.
How
many?
How
do
you
know
how
many
of
those
or
the
state
of
nevada?
Now
I'm
talking
about,
have
been
a
heroin
overdose
or
other
injectable
drug
overdoses?.
C
David
or
at
liquor,
assembly
district
20
for
the
record,
I
don't
have
that
we
do
have
a
couple
other
nevada
experts
who
I
think
are
on
zoom
lisa
lee
and
robert
hardy,
who
may
know,
but
let's
bear
in
mind
that
it's
it's.
What
we
always
know
is
we
get
recurring.
C
This
is
not
an
outlier
that
we
have
wave
after
wave
they're
and
that
they
they
seem
to
be
inevitable,
and
I
think
we,
the
extent
of
data
we
have
is,
is
quite
impressive
and
there's
no
reason
to
think
that
nevada
would
be
any
different
than
what
we've
seen
in
all
these
other
locations
that
have
benefited
tremendously
from
these
sites.
I
And
my
final
question
is:
would
these
be
restricted
to
nevada
residents?
Would
you
have
to
show
an
id
health
insurance
card,
some
sort
of
health
care
information
in
case
there
is
an
overdose
where
you
then
have
to
reverse
them?
They
do
have
to
be
hospitalized
how
much
information
gathering
will
be
mandated
or
required.
C
I
My
current
court,
my
concern,
of
course,
is
you
know
the
overdose.
If
you
need
to
seek
health
care
medical
care,
do
they
have
to
sign
some
sort
of
waiver
at
the
door?
How
do
we
as
health
care
providers,
take
care
of
them
if
this
happens?
Having
worked
thousands
of
hours
in
emergency
room
and
dealt
with
overdoses,
I'm
just
curious
as
how
this
process
will
work
and
how
it
will
affect
those
folks,
given
the
the
care
that
these
these
folks
potentially
may
need.
So
again,
thank
you
for
all
that
string
of
questions.
I
I
have
probably
a
thousand
more,
but
I'm
gonna,
I'm
gonna
stop
there
and
I
can.
I
can
reach
out
to
the
assemblymen
or
link
her
offline
and
thank
you
very
much
for
the
conversation
and
the
questions.
A
Thank
you.
I
see
miss
lisa
lee
on
the
line.
I
don't
know
if
she
has
any
nevada,
specific
data
that
she
wants
to
respond,
but
if
you
do
feel
free
to
unmute
and
remember
to
state
your
name
for
the
record.
J
Thank
you,
madam
chair
lisa,
lee
for
the
record.
You
know
data
is
always
so
so
slow
to
catch
up
to
us.
So
I
think
the
latest
current
available
data
on
the
opioid
dashboard
is
from
2019
data
in
nevada.
Show
you
know
pre-pandemic
about
400
people
have
a
fatal,
opioid
overdose
each
year
and
there's
a
good
share
of
those
overdoses
that
are
due
to
poly
substance
of
use
of
opioids
and
benzodiazepine.
J
So
I
think
that's
important
to
note
with
the
co-prescribing
of
naloxone
in
section
12.
things
are
looking,
I
mean
I.
J
I
asked
the
medical
examiner
here
in
washoe
county
for
the
quarterly
report,
so
I
try
to
stay
on
top
of
that
because
I
work
you
know
doing
our
issue
with
people
who
use
drugs,
and
so
I
want
to
make
sure
that
if
there's
a
bad
batch,
I
can
warn
people,
and
I
now
have
fentanyl
test
strips
that
I'll
be
taking
out
and
doing
some
outreach
there
and
data
collection
up
here
in
the
north.
In
addition,
I
wanted
to
say
that
there
is
data
collection
planned
we're
going
through
the
irb
process
currently
with
dr
wagner.
J
That
will
be
doing
some
studies
collecting
data
with
people
who
use
drugs
to
talk
about
what's
going
on
on
the
ground
as
well
as
acceptability
of
the
ops's
going
forward.
A
And
if
there
is
additional
information,
I
would
encourage
you
to
provide
that
to
assemblyman
or
liquor
and
he
can
get
it
to
committee
staff
to
distribute
it
to
everyone.
We
do
have
quite
a
few
questions,
so
I'm
going
to
go
next
to
assemblyman
hafen.
K
I
thank
you,
madam
chair,
and
thank
you
assembly,
lynn,
hornlicker,
for
the
presentation
today.
I
also
have
a
number
of
questions,
but
I'm
gonna
touch
on
two
sub
two
different
sections
of
the
bill
and
then
maybe
come
back
after
everybody
else
has
had
a
chance.
K
In
section
nine,
it
discusses
the
confidential
nature
of
the
information
that's
being
collected
and
I'm
I
know
you're
the
expert
on
this,
and
so
that's
what
I'm
going
to
ask
is
is:
do
you
think
that
that
language
will
stand
up
to
a
foia
request
and
that
this
information
will
not
be
released
to
individuals
that
do
request
it.
C
A
J
Please
delete
for
the
record.
I
would
actually
like
to
call
on
robert
harding
who's
present
today.
I
believe
robert
can
answer
that
question
more
thoroughly.
G
Hi
committee
and
thank
you
chair-
I
can't
address
that.
I
just
want
to
bring
up
that
this.
The
language
pulled
for
section
9
is
actually
pulled
from
a
previous
legislation
here
in
nevada
that
authorized
the
syringe
access
programs
back
in
2013,
so
we
haven't
had
any
challenges
with
those
those
records
since
then,
so
I
don't
foresee
any
problems
moving
into
the
future.
A
K
One
other
one
other
question,
and
first
of
all
thank
you,
mr
harding,
and
my
my
concern
here
is
that
you
know
this
is
still
the
actions
are
still
considered
criminal,
and
so
I
don't
want
this
information
to
be
released.
So
I
appreciate
the
the
answer
there.
K
The
other
question
that
I
had
was
in
regards
to
section
seven
subsection,
one
references,
but
these
will
be
operated
by
health
authority,
higher
ed
or
non-profit
or
any
combination
there
of
it
didn't
seem
to
be
specific
to
nevada,
higher
ed
or
nevada
health
authorities,
and
so
I
was
part.
One
of
the
question
is:
is
that
limited
to
the
nevada
entry
program,
southern
nevada,
health,
district
or
not?
And
if
so,
have
they
have?
K
C
David,
like
your
assembly,
district
20,
for
the
record,
our
assumption
was
they
would
be.
I
have
had
conversations
with
people
at
unlv,
school
of
medicine
and
the
person
I
spoke
with
said
they
would
be
very
interested
and
participate
participating
in
a
project
like
this
and
lisa
and
robert
may
know
might
be
able
to
speak
to
university
unr,
but
our
intent
was
to
that
this
would
apply
to
nevada
entities
that
would
operate.
J
Lee
for
the
record,
thank
you
for
your
question.
We
did
have
what
we
currently
have
still
a
large
stakeholder
group
that
includes
people
from
the
southern
nevada
health
district,
as
well
as
the
washoe
county
health
district
in
the
washoe
county
manager's
office,
as
well
as
associate
professors
from
the
university
of
nevada
reno.
So
we
are
in
constant
conversations
around
these
issues.
J
L
So
in
this
committee
we
have
talked
quite
a
bit
about
the
stigmas
that
we
hold
as
a
society
around
behavioral
and
mental
health
and
the
impact
that
that
has
on
access
to
treatment
the
type
of
treatment
you
can
receive
in
some
places
and
feeling
like
the
kind
of
the
burden
of
carrying
those
issues
in
your
life.
L
And
I'm
wondering
if
you
would
talk
a
little
bit
about
how
this
plan
works,
to
kind
of
break
down
those
stigmas
and
destigmatize.
The
mental
and
behavioral
health
related
to
addiction
and
other
issues.
A
F
I
probably
I
was
actually
referring
to
the
previous
question,
so
I
thought
it
was
something
peter's,
but
I
just
want
to
say:
clark
county
is
very
eager
to
go
forward
with
this
program.
I've
set
up
both
the
board
of
health
and
the
county
commission,
and
I
have
places
in
my
district
that
we're
ready
to
go
so
it's.
This
is
all
we
need
a
little
help
and-
and
I
even
though
I'm
testifying
in
support
of
the
bill,
I
love
the
bill.
I
would
urge
you.
A
D
Joanne
chad,
at
columbia
university.
I
just
wanted
to
say
that
in
many
of
these
places,
people,
if
you
talk
to
them,
there's
lots
of
qualitative
literature
on
this.
If
you
talk
to
people
who
use
drugs
and
use
these
facilities,
they
often
say
that
it's
the
only
place
where
they've
been
able
to
get
non-judgmental
care
and
for
for
many
of
these
facilities,
it's
als
also
the
only
way
to
sort
of
integrate
them
into
any
other
kind
of
health
or
social
service
system.
D
J
Lisa
lee
for
the
record
really
exciting
question
assemblywoman
peters,
as
a
woman
in
long-term
recovery
from
opioid
use
disorder.
While
I
haven't
had
the
privilege
of
utilizing
one
of
these
overdose
prevention
sites,
I
can.
I
can
safely
say
that
I
probably
wouldn't
have
lived
with
hepatitis
c
for
21
years.
I
can
safely
say
that
many
of
my
friends
would
still
be
alive
at
this
point.
Stigma
is
a
real
thing
that
unfortunately
ends
in
in
people
not
getting
care
that
they
need.
J
I
can
tell
you
that
you
know
I
have
not
gone
to
medical
care
and
lanced
my
own
abs
abscesses,
while
experiencing
homelessness
and
being
an
injection
drug
user
because
of
stigma
and
was
constantly
endangering
my
life,
not
to
mention
the
people
around
us
with
necrotizing,
fasciitis
and
whatnot.
That
is
a
direct
result
of
prohibitive
policies
and
keep
people
who
use
drugs
in
the
shadows
without
care,
and
so
I
think
spaces
like
this
are
deeply
meaningful.
J
You
know,
I
know
the
opioid
crisis
has
really
been
in
the
american
sort
of
mass
purview
for
quite
a
limited
time,
but
I've
been
having
an
opioid
crisis
for
decades,
and
I
think
of
places
like
this,
and
I
just
know
that
a
lot
of
a
lot
of
people
would
still
be
here.
A
lot
of
people
probably
would
not
live
with
stigmatizing
blood-borne
infections.
J
There
would
be
limitations
of
soft
tissue
infections
that
go
untreated
and
end
up
turning
septic
or
into
endocarditis,
and
so
stigma
is
a
real
thing
that
kills
people,
and
I
I'm
glad
you
brought
that
up
and
I'll
stop
talking,
I'm
very
passionate
about
the
stigma
thing.
Thank
you.
A
I
also
see
mr
harding,
if
you
can
go
ahead
and
state
your
name
prior
to
speaking.
G
Thank
you,
robert
harding,
for
the
record
just
to
follow
up
on
that
and
reinforce
that
there
are
two
forms
of
stigma:
there's
external
stigma,
which
is
the
form
of
stigmas
that
are
placed
on
a
person,
there's
also
internal
stigma,
which
is
when
we
take
those
stigmas,
and
we
start
to
feel
them
deeply
within
our
soul
and
think
about
them
as
a
person
and
having
harm
reduction
services
that
support
somebody
and
support
people
who
use
drugs
and
provide
that
space
in
that
environment
really
helps
to
break
down
and
change
that
internal
stigma,
which
can
be
just
as
deadly
as
the
external.
A
Thank
you,
mr
harding.
I
have
a
couple
of
questions
and
if
you
do-
and
if
you
do
have
questions,
please
send
me
a
message,
so
I
can
get
you
in
the
list
next,
because
we
do
need
to
get
to
our
testimony
and
support
opposition
and
neutral
this
bill,
and
we
do
have
one
more
bill.
So
I
have
a
couple
of
questions.
A
I
I
I
am
very
excited
that
you
have
so
much
data
to
be
able
to
analyze.
Unfortunately,
you
know
it
is
outside
of
the
united
states
and
a
lot
of
these
other
countries
that
have
different
health
care
systems
have
different
public
health
care
systems
have
had.
You
know,
prolonged,
like
education
campaigns
to
de-sigma
stigmatize
this
you
know
as
well.
How
do
you
see
being
able
to
take
some
of
that
data?
And
how
do
you
see
it
playing
into
the
success
we
might
have
and
our
like
health
care
model.
D
That's
for
me,
joanne
chad,
at
columbia,
university
yeah,
it's
a
very
good
question
and,
of
course
the
history
is
different.
The
again
the
nationalized
or
quasi-nationalized
health
systems
make
an
enormous
difference.
The
criminal
law
is
different.
I
do
think,
however,
that
the
actual
service,
the
the
actual
interventions
that
go
with
these
services
or
that
could
be
linked
to
to
an
overdose
prevention
site,
are
have
a
certain
universality
that
can
be
that
from
which
we
can
extrapolate
from
the
the
decades
of
experience.
That's
already
out
there,
just
because
overdose
is
is
not
different.
D
From
I
mean
the
overdoses
that
are
suffered
in
in
europe
in
the
end
at
the
moment
of
the
episode
are
not
different
from
the
ones.
Here
I
don't
know.
Maybe
alex
has
another
perspective
on
this,
but
I
think
that
the
the
other
data
that's
very
useful
is
is
the
cost
data
and
there
have
been
some
really
good
costing
studies
and
those,
I
think,
are
you
know
it's
it's
rare
to
get
good
costing
of
any
kind
of
intervention
that
deals
with
marginalized
populations
in
there.
A
A
Possession,
so
how
does
that
work
here
I
mean
this
is
still
a
felony
charge
here
in
the
state
of
nevada.
So
how
does
that
work
within
this
legislation?
Like
you
know,
I
don't
want
a
situation
where
we
have
these
like
facilities
set
up
and
there's
just
police
officers
waiting
outside
to
like
arrest
people
going
in
or
out
of
these
facilities.
D
D
This
the
sites
there
operate
on
an
exception
to
the
controlled
substance
act
that
enables
people
to
not
be
prosecuted
for
the
or
what
goes
on
in
the
facilities
and
it's
a
matter
of
community
liaison
work
to
be
sure
that
the
police
are
not
standing
outside
to
arrest
people
as
soon
as
they
come
out,
but
that's
not
happening
in
most
of
these
places,
as
you
say
where
possession
is
decriminalized,
but
basically
there
has
to
be
an
exception
to
the
so,
whatever
can,
whatever
drug
control
acts,
there
are,
even
in
western
europe,
where
there's
been
a
longer
history
of
decriminalization,
the
drugs
are
still
illegal
in
most
of
these
places,
not
in
portugal
and
not
in
a
few
other
places,
but
but
but
the
the
law
allows
for
an
exception
to
to
the
to
the
drug
control
criminal
framework.
H
If
I
may
ask,
if
I
may
add,
this
is
alex
kell
for
the
record
again
yeah.
The
only
country
out
of
all
these
countries
that
decriminalize
drugs
is
is
portugal.
H
H
You
need
public
safety
and
and
public
health
to
work
hand
in
hand
for
these
programs
to
work.
We've
been
doing
that
successfully
in
many
many
states
in
the
united
states.
You
know
for
for
for
decades
now
around
syringe
access,
and
I
don't
see
a
reason
why
you
couldn't
also
do
that
with
respect
to
this
particular
intervention.
A
Sorry
I
I
just
had
some
concerns.
You
know,
in
addition
to
the
the
question
that
was
kind
of
asked
by
assemblyman
hayson
about.
I
would
hate
to
have
this
as
like
a
an
option,
for
you
know
people
to
go
and
do
foia
requests,
get
the
inks
and
addresses
of
like
people
that
are
in
here
and
use
that
to
further
criminalize.
A
You
know
people
that
are
trying
to
get
help,
so
I
would
love
it
if
you
could
include
that
you
know
I.
I
don't
remember
seeing
that
in
the
language
of
the
bill,
and
maybe
I
just
missed
it,
but
that's
something
that
I
think
should
probably
be
considered
as
well
as
part
of
the
you
know:
legislation
I'm
looking
around
here.
I
don't
see
any
other
questions
that
oh
I
see
it
another
one
from
assemblyman
haven.
Keep
it
quick.
K
And
we'll
keep
this
very
brief.
I
apologize
assemblyman
oren
liquor
in
reviewing
the
documentation
in
the
actual
bill
language.
I
don't
do
not
see
any
age
limitation
on
this
program,
so
it
doesn't
preclude
minors.
The
legislative
digest
implies
that
there
is
an
age
restriction
where
the
person
has
to
be
at
least
18
years
or
older,
and
so
I
just
I
didn't
know
what
your
intent
was,
because
I
was
not
able
to
find
that
in
the
actual
bill
language,
but
it
is
in
the
legislative.
C
Digest
david
licker
assembly
district
20.,
I
that's
something
I
have
to
think
about,
but
I
invite
our
any
of
our
other
presenters
if
they
have
thoughts
about
that,
whether
it
makes
sense
to
draw
age
distinctions
or
not,.
A
I
think
I'm
going
to
go
to
mr
harding.
If
you
go
ahead
and
mute
yourself,
I'm
going
to
try
to
stick
it
to
one
person
to
answer
the
question.
Otherwise
we
probably
won't
we'll
need
to
move
on,
but
go
ahead.
G
Thank
you,
robert
harding,
for
the
record.
I
would
like
to
definitely
address
that
question.
I
would
encourage
the
committee
to
be
cautious
of
requiring
ids
or
documentation,
as
that
is
something
that
someone
living
on
the
streets
and
living
without
shelter
often
end
up
without,
and
this
program
would
be
the
most
beneficial
to
those
individuals,
as
they
don't
have
clean,
sterile
spaces
to
utilize
their
their
supply
of
drugs,
so
requiring
that
we
have
some
sort
of
id
documentation
when
they
come
in
definitely
creates
a
big
barrier
there.
G
I
also
want
to
reinforce
that.
I
again
the
language
that
I
brought
in
in
section
nine
from
the
prior
syringe
services
program,
kind
of
went
into
the
and
addressed
the
the
anonymity
of
the
program,
one
to
protect
the
clients
from
any
kind
of
failure,
requests
and
two
to
keep
that
barrier
low.
A
And
and
miss
lee
did
you
have
a
response
or
an
answer
to
like
the
juvenile
question.
J
Yes,
thank
you
lisa
lee,
for
the
record,
I
believe
when
we
put
together
the
original
draft
language-
and
I
I
was
just
reviewing
the
bill
as
well,
to
see
because
I
do
see
it
in
the
legislative
digest,
but
our
intention
was
18
and
up
in
in
the
language
to
answer
your
question.
Thank
you.
A
Thank
you,
and
I
just
have
one
follow-up.
I
know
I'm
trying
to
move
on,
but
in
some
of
these
other
countries
that
have
like
programs
like
this,
do
they
have
age
limits
or
do
they
target
adults
go.
D
Ahead,
joan
chetta
columbia,
university
and
some
of
them
there
are
the
facility
staff
are
trained
to
refer
people
under
age
18
to
other
kinds
of
services,
but
in
some
of
them
there
is
no
age.
There's
no
proof
of
age
required
and
no
identity
documents
required
that,
for
instance,
in
the
ones
in
denmark
which
are
have
been
widely
visited,
and
where
people
who
use
drugs
were
part
of
the
design
from
the
beginning.
A
Thank
you.
I
appreciate
your
presentation.
I
know
that
we
have
lots
of
questions
and
lots
of
comments
and
like
assemblywoman
titus,
and
I
I
tend
to
agree.
We
could
probably
be
here
all
day
discussing
this,
so
I
would
encourage
everyone
to
reach
out
to
assemblyman
orrin
licker
and
I'm
sure
he
would
be
happy
and
willing
to
provide
some
of
the
contact
information
from
some
of
the
presenters
that
were
here
today
and
with
that
I'm
going
to
start
testimony
in
support
opposition
neutral
of
assembly
bill.
A
A
A
staff
will
be
timing.
Each
member
to
ensure
everyone
is
given
a
fair
opportunity
to
speak,
and
with
that
I
will
begin
testimony
in
support
of
ab345.
I
know
that
we
have
one
person
on
the
zoom
to
testify
in
support
of
that
bill.
So
go
ahead,
mr
secretary,
when
you
are
ready.
F
Thank
you
very
much,
madam
chair
and
members
of
the
community.
I'm
kick
sagar
bloom,
t-I-c-k-s-e-g-e-r-b-l-o-m
county,
commissioner
and
member
of
the
clark
county
board
of
health.
Although
I'm
not
appearing
on
behalf
of
those
institutions,
I
can
say
that
this
bill
is
really
fantastic.
It's
greatly
needed.
As
you
know,
the
war
on
drugs
is
over.
We
basically
lost
oregon,
just
decriminalized
all
drugs,
and
I
think
that's
the
way
the
nation's
headed.
F
So
now
we
have
to
deal
with
it
with
the
issue
of
how
we
deal
with
people
that
actually
use
them,
both
as
far
as
making
sure
that
they
don't
kill
themselves
and
then
how
we
can
provide
services
and
hopefully
they
can
get
off
of
them.
I
have
my
district
includes
the
flamingo
wash,
which
goes
right
next
to
you
and
all
the
huge
numbers
of
drug
addicts,
drug
users
in
that
wash
they
come
out
of
the
wash
into
the
neighborhoods
there's
syringes
everywhere.
F
We've
started
a
program
where
a
syringe
exchange
program,
so
we
started
that,
but
the
next
step
is
going
to
be
this,
where
they
can
actually
come
to
a
secure
facility
and
with
respect
to
the
fact
that
it's
illegal
I'll,
remind
you
that
marijuana
is
a
seed,
is
a
felony
of
the
federal
law
and
yet
I'm
sure,
probably
today
or
over
the
next
couple
weeks,
you're
going
to
be
dealing
with
not
only
marijuana
laws
but
having
places
where
you
can
go
smoke
marijuana.
F
So
if
you
can
do
go
smoke
it
under
your
laws,
I
don't
see
why
you
couldn't
also
go
to
a
place,
bring
your
own
fentanyl,
whoever
you
have
and
and
and
use
that
in
some
kind
of
a
site
it
just
the
time
is
now
the
one
coming
I
have.
I
don't
want
to
be
a
opponent
of
the
bill,
but
I
think
one
side
for
las
vegas
is
really
way
too
small.
I
would
just
say
there
are
have
pilot
programs
that
don't
know
limited
the
number.
A
B
B
G
Hi,
jim
hoffman
h-o-f-f-m-a-n,
representing
nevada
attorneys
for
criminal
justice,
nacj
supports
ab345
and
just
quickly.
I
believe
it
was
chair
wynn,
had
a
question
about
foyer
request
and
criminalization.
G
As
I
read
the
bill
section
10
states
that
a
person
cannot
be
prosecuted,
arrested,
charged
et
cetera
for
involvement
in
this
either
working
at
the
place
or
for
consuming
or
possessing
drugs
in
connection
with
it.
So
there
is
a
basic
level
of
protection
there.
G
The
bill
as
a
whole
studies
have
shown
that
safe
injection
sites
reduce
the
amount
of
outdoor
drug
use,
prevent
overdoses
and
transmission
of
disease
and
provide
wraparound
access
to
addition.
Addiction,
counseling
nevada
has
spent
the
past
40
years,
trying
mass
incarceration
as
a
response
to
drug
use.
G
B
M
Hello,
my
name
is
erica
minneberry,
that's
e-r-I-k-a-m-I-n-a-b-e-r-r-y
and
I
am
privileged
enough
to
have
been
in
recovery
for
the
last
15
years,
but
15
years
ago
I
did
almost
die
from
an
infection
that
was
left
untreated.
I
do
consider
myself
lucky
because
a
lot
of
my
friends
did
not
make
it
to
that
point.
They
were
never
given
the
opportunity
to
recover
and
they
had
very
brilliant
brains.
M
B
N
B-A-R-R-I-N-E-A-U,
I
just
wanted
to
talk
a
little
bit
about
my
past.
At
the
beginning
of
my
drug
use,
I
was
kidnapped
and
sold
for
sex
and
if
that
girl
would
have
known
about
a
place
like
an
overdose
prevention
site,
how
amazing
would
that
have
been?
I
can't
tell
you
how
many
times
I
tried
to
escape
and
my
kidnapper
would
find
me
and
beat
me
and
torture
me.
I
really
didn't
have
a
way
out.
N
I
didn't
know
what
to
do
and
if
there
was
a
place
where
I
could
go
use
safely
and
also
with
all
the
resources
that
are
are
available
for
human
sex
trafficking
victims.
How
soon
could
I
have
been
saved?
How
much
less
trauma
would
I
have
had
to
suffer
if
not
for
a
place?
That
would
have
been
like
that.
B
O
O
My
daughter,
kirsten
yamaoka,
died
from
a
heroin
overdose
here
in
reno
nevada.
She
was
21
and
it
was
her
birthday
personally
and
as
an
advocate,
there
are
several
reasons
I
support
this
bill
with
the
creation
of
programs
for
the
prevention
of
overdoses
and
disease.
Those
with
substance
use
disorder
can
come
to
a
non-biased
place
that
will
prevent
the
admission
to
our
hospitals
for
infection,
overdose
and
other
transmission
of
disease
such
as
hepatitis
c
and
hiv.
O
O
This
seems
elementary,
but
it
is
a
huge
part
of
how
we
can
guide
those
to
treatment
and
give
education
regarding
substance
use
disorder
in
nevada.
We
have
at
least
one
death
from
overdose
every
day.
Let's
create
programs
in
our
community
that
foster
harm
reduction
and
reduce
the
stigma
of
substance.
Use
disorder
create
and
provide
a
safe
place
to
use
substances
with
policies
put
in
place
for
the
safety
of
those
who
have
substance,
use,
disorder
and
staff
of
such
programs.
O
B
O
Assemblyman
orient
liquor
is
joining
the
course
of
lawmakers
who
are
moving
the
state
away
from
the
criminalization
policies
that
destroy
our
communities
and
people's
lives.
Ab345
is
the
right
solution
to
this
crisis
prevention
sites
offer
the
promise
of
reduced
overdose
fatalities,
increase
access
to
health,
increase
access
to
health
services
and
promote
overall
benefit
to
public
safety.
O
A
Thank
you.
Can
we
go
to
callers
in
opposition
to
this
bill.
A
B
P
Good
afternoon,
madam
chair
members
of
the
committee
for
the
record
bradley
mayor
partner
and
our
gentlemen
partners,
testifying
in
neutral
today
on
behalf
of
the
southern
nevada
health
district,
southern
about
health
district,
has
been
at
the
table,
as
this
bill
was
being
crafted
and
really
for
the
purposes
of
providing
some
information
in
context.
P
It
is
important
to
acknowledge
that
there
are
currently
no
sanctioned
overdose
prevention
sites
operating
in
united
states
and
really,
as
it
pertains
to
the
provisions
of
this
bill
that
involve
or
relate
to
the
southern
nevada
health
district.
We
don't
have
any
issues
with
how
this
bill
is
currently
written,
and
we
thank
you
for
your
time.
A
C
Thank
you,
chair
and
thanks
to
all
my
co-presenters
and
participants
in
this.
As
you've
heard
this,
we
have
an
opportunity
to
implement
a
well-tested
well-vetted
intervention
that
will
reduce
a
lot
of
harm.
Save
a
lot
of
lives,
bring
a
lot
of
marginalized
people
into
the
back
to
our
community
to
the
services
they
need.
C
You
know
there
are
a
lot
of
proposed
interventions
that
we
hope
will
work
and
don't
have
much
data,
but
it's
hard
to
imagine
having
more
data
than
we
have
to
support
this.
The
fact
that
the
american
medical
association,
the
american
public
health
association,
all
these
expert
organizations
have
endorsed
this
should
make
us
confident
that
this
is
the
right
thing
to
do.
So.
Thank
you
very
much
for
the
hearing
and
for
the
suggestions.
C
A
Thank
you,
assemblyman
liquor,
and
with
that
I
will
close
the
hearing
on
assembly
bill,
3
45,
and
at
this
time
I
will
open
testimony
and
open
the
bill
hearing
on
assembly
bill
260..
This
bill
provides
for
confidentiality
of
contact,
tracing
assemblyman
levitt.
Thank
you
for
being
patient.
Please
unmute
and
begin
when
you
are
ready.
E
Thank
you
man
of
chair
members
of
the
committee
for
the
record.
I
am
glenn
levitt,
representing
assembly
district
23
within
southern
the
southern
part
of
clark
county,
I'm
here
to
present
assembly
bill
260
for
your
consideration.
E
All
of
you
know.
Since
june
20
of
2020
contact
racing
has
been
an
important
strategy
for
for
slowing
the
spread
of
coven
19.
On
june
1st
2020
governor
syslack
released
the
nevada,
kovid
19
disease
outbreak
management
strategy
in
coordination
with
the
depart
department
of
public
safety,
the
nevada
national
guard
and
the
department
of
health
and
human
services.
E
I
applaud
these
efforts
and
to
maintain
patient
privacy
in
in
a
time
when
the
public
health
is
of
utmost
importance.
However,
we
can
certainly
do
more
to
ensure
that
these
attempts
be
successful,
including
codifying
into
law
specific
provisions
that
protect
patient
privacy
as
it
relates
to
contact
tracing
now
I'll
go
into
sections
of
the
bill.
If
that
pleases.
You,
madam
chair.
E
So
sections
two
through
four
of
the
bill
define
contact,
tracings
and
covet
19.
section.
Five
of
the
of
the
bill
prohibits
a
government
entity,
person,
government
entity
or
persons
from
disclosing
information
obtained
through
contact
tracing.
It
also
prohibits
the
law
enforcement
agency
from
conducting
contract
from
conducting
contact
tracing
and
prohibits
a
court
from
disclosing
information
related
to
contact
tracing
from
a
government
entity
or
person.
E
Section
6
of
the
bill
authorizes
the
government
agents
entities
that
conducts
contact
tracing
may
disclose
the
information.
If
a
person
gives
consent,
information
is
needed
to
conduct
the
contact.
Tracing
information
is
needed
to
save
a
person's
life.
Information
is
needed
to
protect
the
public
health.
The
information
is
needed
for
an
investigation
after
a
person
has
given
consent
or
information
is
highly
material
to
an
investigation.
E
Additionally,
it
allows
for
the
represented
representative
to
to
consent,
on
behalf
of
a
person
for
a
minor
or
a
person
that
lacks
the
capacity
to
provide
informed
consent.
Lastly,
it
requires
a
government
entity
to
keep
a
written
record
of
that
disclosure
section.
Seven
of
the
bill
requires
the
government
agencies
that
may
disclose
information
may
not
include
personal
identifiable
information.
E
Now
that
being
said,
that
was
the
initial
bill.
We've
had
some
some
amendments,
some
friendly
amendments
that
were
conceptually
received
after
talking
to
the
nevada
department
of
health.
E
They
had
inquiried
about
the
30-day
limit
for
keeping
data
and,
and
they
said
that
that
that
they
are
required,
they
they
are
mandated
to
keep
their
data,
for,
I
believe
they
said
a
year
and
so
in
in
in
section
5,
subsection
5,
the
period
of
30
days
will
be
amended
to
a
year
and
in
the
other
friendly
amendment,
they
also
raised
a
concern
that
that,
when
they're
those
who
are
incarcerated,
they
want
to
be
able
to
to
do
a
further
investigation
of
contact
tracing
for
those
who
are
are
are
held
in
jail
or
prison.
E
That's
my
presentation,
sorry.
It
was
so
brief
and
short,
but
that's
all
I
got
and
I'm
happy
to
attempt
to
answer
any
questions
on
this
complicated
issue.
A
Thank
you
for
that
presentation
of
someone.
I
love
it,
I'm
not
really
sure
which
assemblyman
levitt
I'm
talking
to,
because
there's
two
on
my
screen.
A
No,
you
could
leave
it.
I
think
we
need
some
levity
here
on
a
friday.
Do
we
have
any
questions
from
our
members?
I
know
that
there
were
some
later
amendments.
Obviously
you
know
I
appreciate
you
being
able
to
present
this
bill
with
that
short,
like
notice,
but
are
there
any
people
that
have
any
questions
here
on
the
zoom
and
in
the
committee?
L
You
chair
and
and
thank
you
assemblyman
levitt,
for
bringing
this
up
this
bill.
I
still,
I
think,
have
some
confusion
around
how
this
differs
from
what's
already
occurring
for
contract
tracing.
Can
you
can
you
just
talk
a
little
bit
about
the
need
of
the
bill
in
the
long
term
rather
than
having
it
be
like
policy
driven
as
part
of
the
response.
E
Well,
I
don't
it's
hard
to
it's
difficult
to
answer
that
question,
because
everything's
so
unknown
with
covet
19
right.
E
We
I
mean
we
hope
that
everything
will
be
under
control
and
we
won't
have
to
worry
about
it
a
week
from
now
two
weeks
from
now
a
year
from
now
we
hope,
but
we
don't
know-
and
so
I
think
that
that
putting
protections
in
place
now
is
is
a
step
forward
in
what
we're
doing,
even
though
we're
remedying
the
situation
as
it
currently
exists,
the
reason
for
it
is
is
because
contact
tracing
does
not
currently
fall
under
hipaa.
So
that's
that's
the
need
for
this
particular
issue.
L
I
do
I
have
one
other
follow-up
question
and
it
has
to
do
with
the
limitation
of
this
bill,
which
is,
you
know,
relatively
large,
to
just
the
kova
19
situation,
and
would
it
make
sense
to
expand
it
to
other,
like
pandemic
style
scenarios?
In
case
we
have
something
like
a
an
avian
flu
outbreak
or
you
know,
ebola
or
something
like
that.
E
I
in
my
in
my
opinion,
and
I'm
happy
to
to
look
into
that
and
and
and
expand
it
beyond
just
kevin
19.
for
other,
rather
other
diseases
that
are
that
are
not
that.
Don't
fall
currently
fall
into
it
within
hipaa.
I
think
that
you
know
the
main
goal
of
this
bill
is
just
so
we
don't
have.
E
A
Seeing
none
broadcast
services,
do
you
I
and
assemblyman
love
it.
Do
you
have
anyone
on
the
zoom
to
testify
and
support.
A
Seeing
none
on
broadcast
services
again,
I
will
remind
callers,
please
clearly,
state
and
spell
your
name
for
the
record
and
limit
your
testimony
to
two
minutes
to
ensure
that
we're
given
a
fair
and
equal
opportunity
to
receive
testimony
from
both
support,
opposition
and
neutral
broadcast
services.
Is
there
anyone
on
the
line
in
support.
B
P
Good
afternoon,
madam
chair
members
of
the
committee
for
the
record
bradley
mayer
partnered
our
gentleman
partners,
testifying
in
opposition
today
on
behalf
of
southern
nevada,
health
district.
We
I
would
say
that
we
don't
we
we
met
with
assemblyman
levin,
and
we
appreciate
the
intent
of
what
he's
trying
to
bring
forth.
We
actually
talked
with
him
yesterday
and
we
don't.
We
don't
want
to
be
in
a
place
where
we're
opposing
this
bill
and
we
hope
to
work
with
him
to
address
some
of
these
concerns.
P
But,
as
you'll
hear
from
my
colleague
in
washoe
county,
there
are
some
issues
here,
as
it
pertains
to
the
time
limits
for
holding
data
in
this
bill,
beginning
with
section
5
and
subsection
4,
because
it
jeopardizes
current
funding
streams
that
have
specific
requirements.
It
must
be
met
in
regards
to
this
data
and,
of
course,
also
disrupts
kind
of
the
accepted
framework
for
conducting
case
investigations
and
contact
tracing.
As
I
said,
within
levitt
mentioned,
we,
we
also
have
the
issue
of
the
section
5
subsection
2,
asking
that
that
provision
be
deleted.
P
As
currently
law
enforcement
does
contact
tracing
amongst
inmates.
You
know
we
do
agree
on
that.
We
just
think
we
need
to
work
with
someone
levitt
a
little
more
on
the
timelines
that
exist
here
so
something's
workable
for
the
health
districts,
as
it
relates
to
those
issues.
Of
course,
I
just
want
to
reiterate:
we
do
support
the
general
concept
of
what
is
trying
to
be
accomplished
here.
We
just
need
to
do
some
more
work.
B
Q
Hello,
madam
chair
members
of
the
committee,
this
is
chuck
callaway
c-a-l-l-a-w-a-y,
representing
las
vegas
metropolitan
police
department,
generally
we're
in
support
of
the
bill.
We
share
the
same
concern
that
was
just
voiced
by
the
previous
caller
about
section
5-2.
We
believe
that
needs
to
be
clarified.
Our
agency
does
contact
tracing
on
employees
if
we
had
an
officer
that,
for
example,
was
involved
in
training
or
was
in
a
briefing
setting
and
and
had
coveted
19.
Q
We
have
an
obligation
as
an
employer
to
ensure
that
other
workers
were
not
infected,
and
that
involves
our
risk
management
section,
doing
contact
tracing
amongst
our
employees
and,
as
was
stated,
there
could
potentially
be
issues
with
ccdc
and
inmate
population
with
contact
tracing.
So
we
would
just
like
the
opportunity
to
have
that
section
clarified.
Thank
you
very
much.
A
Thank
you
for
your
testimony
and
opposition.
Do
we
have
any
other
callers
and
opposition.
B
B
R
R
However,
we
still
do
have
one
slight
problem
with
section
5
5,
subsection
5,
where
it's
it
limits
the
storage
of
data
for
one
year.
Unfortunately,
I
know
it
sounds
interesting
that
it's
different
from
dhhs,
but
we
have
to
store
data
longer
for
research
and
measurements
that
we
send
to
the
cdc,
among
other
places,
for
funding
mechanisms
and
without
changing
that
time
limitation
we
could
be
subject
to
losing.
R
A
I
think
I
have
one
person
on
the
zoom
and
to
testify
in
neutral,
so
go
ahead.
S
Yes
hi,
my
name
is
lindsay
kinsinger
for
the
record.
I
am
the
manager
of
the
office
of
public
health
investigations
and
epidemiology
for
the
state
of
nevada.
We
are
testifying
in
neutral
with
this
bill.
I
think,
like
some
of
the
counties
expressed,
I
think
we
would
welcome
the
opportunity
to
work
with
the
assembly
member
to
give
it
a
little
more
clarity.
S
Right
now
I
can
say
that
we
do
treat
contact
tracing
and
disease
investigation
data
and
information
for
covid
with
hipaa
protections,
so
I
will
assure
you
that
information
is
not
being
given
out
unless
something
like
a
subpoena
or
law
enforcement,
but
we
are
here
to
work
with
you
guys
and
we
support
the
idea
of
the
bill
and
would
just
look
forward
to
helping
you
maybe
rewrite
a
few
of
the
things,
as
well
as
the
data
policy.
E
Thank
you,
madam
chair.
Well,
it
looks
like
we're
making
good
progress
on
this.
I
apologize
that
I
didn't
get
the
amendments
exactly
right.
I
I
found
out
about
the
hearing
very
very
recently,
so
we're
still
working
on
the
amendments,
and
I
will
get
those
to
the
committee.
E
I
I
don't
think
that
any
of
the
issues
for
bose
don't
seem
too
difficult
to
overcome,
and
and
I'm
I
will
continue
to
work
with-
with
the
southern
nevada,
health,
district,
washoe
health,
district
and
and
and
and
all
those
other
stakeholders
that
that
voiced
their
concerns
and
get
the
get
the
language
right
so
that
we
can.
We
can
move
on
and
and
have
this
go
from
a
great
concept
to
a
great
bill,
and-
and
this
concludes
my
presentation
on
assembly
bill
260.-
I
believe
it's.
E
This
is
an
important
piece
of
legislation
to
keep
individuals
information
private.
I
will
continue
to
work
with
the
stakeholders
to
ensure
we've
come
find
some
common
ground
and,
and
the
working
product
that
we
pass
out
to
the
committee
in
the
future
will
be
will
be
solid.
Thank
you,
madam
chairs,
and
members
of
the
committee.
For
your
time.
Sorry
I
took
so
long.
A
Thank
you
love
it
at
this
time
I
will
close
the
hearing
on
assembly
bill
260..
At
this
time
we
will
move
into
public
comment
as
a
reminder.
If
you're
providing
public
comment,
please
clearly
sell
your
name
for
the
record
and
limit
your
comments.
Two
minutes
broadcast
services.
Do
we
have
anyone
on
the
line
in
public
comment.
B
A
Well,
wonderful
at
this
time,
I
will
take
any
comments
from
members.
Do
we
have
any
comments
before
I
adjourn
today's
meeting?
Seeing
none?
A
I
will
remind
everyone
that
we
probably
have
a
really
jam-packed
next
couple
of
weeks,
as
you
heard,
probably
on
the
floor
today
and
with
some
of
our
committee
introductions,
we
have
quite
a
few
bills
that
have
come
in
in
these
last
couple
of
weeks,
so
plan
on
being
here
on
monday,
wednesday
and
friday,
and
possibly
we
might
have
another
evening
meeting
if
we
need
to
schedule
that
in
order
to
hear
these
bills
as
best,
we
can
before
first
committee
passage.
So
with
that,
I
will
adjourn
until
monday
at
1.
30.