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Home My WebLink About11/14/2023 05. Opioid Use Disorder Discussion 1 .. ! a, ____,) BUSINESS OF THE CITY COUNCIL YAKIMA, WASHINGTON AGENDA STATEMENT Item No. 5. For Meeting of: November 14, 2023 ITEM TITLE: Opioid Use Disorder Discussion SUBMITTED BY: Sara Watkins, City Attorney SUMMARY EXPLANATION: At a prior City Council Study Session, the City Council requested a presentation from the Yakima Health District on its Harm Reduction Program and other programs regarding opioid use disorders. The Council also requested that City staff coordinate a roundtable discussion regarding the services available in the community regarding opioid use disorder. Erika Ochoa from the Yakima Health District will make a presentation first, after which there will be a roundtable discussion regarding opioid use disorder. The participants in the roundtable will be: Lilian Bravo, Yakima Health District Megan Tweedy, Community Activist Dr. Gillian Zuckerman, Community Health of Central Washington Cassidy Leslie, Triumph Treatment Dr. Jocelyn Pedrosa, Yakima Neighborhood Health Services Alicia Stromme Tobin, SAFE Yakima Cynthia Martinez, City of Yakima Prosecuting Attorney Dr. Frank Garner, Chief Medical Officer, Comprehensive Healthcare ITEM BUDGETED: NA STRATEGIC PRIORITY: Neighborhood and Community Building APPROVED FOR SUBMITTAL BY THE CITY MANAGER RECOMMENDATION: ATTACHMENTS: Description Upload Date Type D Tweedy_Opioid Litigation Funds 2023 10/31/2023 Backup Material a Syringe Services Program presentation updated 11/14/2023 Presentation a Opioid Roundtable presentation 11/9/2023 Presentation 2 Yakima Opioid Settlement Funds Overview I hope the city and county will use a portion of the opioid settlement dollars to enhance the overdose prevention system already in place, the harm- reduction program, through the Yakima Health District. As noted in a state level comparison to other harm reduction/SSP programs, we are not keeping pace with the services other counties, also hard hit by overdose, are providing. We need to increase operating hours to deliver desperately needed medical and social services, as well as harm reduction strategies. As an immediate first step towards low-barrier health engagement hubs, the motor home at S 3rd and E Adams is equipped for expansion of services. The state has allocated funding for two pilot health engagement hubs and Yakima needs to show the infrastructure exists as more funding becomes available. Can we form a regional opioid abatement council? (A local example: Franklin and Benton Counties, the city of Kennewick and more than a dozen other local municipalities combined their opioid settlement funds) https://news.yahoo.com/tri-cities-recovery-center-moves- 194514283.html?guccounter=2 https://kingcounty.gov/en/dept/dph/health-safety/safety-injury- prevention/overdose-prevention-response/opioid-abatement-council Can we use information and evidence-based strategies that already exist? https://www.asam.orq/news/detail/2023/10/05/crucial-chanqes-to- substance-use--co-occurring-disorder-care-standards-published https://opioidprinciples.jhsph.edu/wpcontent/uploads/2022/04/Primer- on-Spending-Funds.pdf https://www.rand.org/health-care/centers/optic/tools/fu nd- allocation.html https://www.naco.org/resources/opioid-solutions/approved-strategies 3 Can we look to the work our state has done in seeking damages from opioid pharmaceuticals and distribution companies? http://www.vitalstrategies.org/wp-content/uploads/Washington-Opioid- Settlement-Fact-Sheet-V2.pdf https://www.opioidsettlementtrackercorn/ https://www.hca.wa.gov/assets/washington-opioid-settlement-funds- frequently-asked.pdf Can we expand local existing services using established guiding principals? https://www.learnabouttreatment.org/for-professionals/clinical- protocols/ https://www.cdc.gov/d rugoverdose/featu red-topics/evidence-based- strategies.html We are much stronger together. Let's make sure these funds save lives. Yakima County Yakima County 1 .9388392959% $8,379,663.44 Grandview 0.0530606109% $229,327.96 Sunnyside 0.1213478384% $524,465.36 Yakima 0.6060410539% $2,619,309.43 Yakima County total 2.7192887991% $11,752,766.19 Megan Tweedy Community Activist, Preventing Death by Fentanyl Overdose tweedymegan@gmail.com NEAITy Syringe Services �P 1911 �•�� Program %t . '° ` c° . 0 ZCF`" 4 WArc, YHD's Harm Reduction Program °N is cox What is Harm Reduction? P y--- I , T A set of practical, public health 1,111 ' a strate ies designed to reduce the 11/7(4110 � g ' negative consequences of drug use „ • or risky activity and promote healthy individual lifestyles and '. ' communities. I �ti14 What are Syringe Services Programs (SSPs)? 1 Sterile injection supplies Referral resource Safe disposal **Aka .4°:3.7) 01'7 •NI Linkage to care Critical services Syringe Service Programs (SSPs) Prevent Disease • 6 °'° • ° SIX MOMENTS OF INFECTIONAI .. PREVENTION IN INJECTION DRUG USE — • • SSPs help prevent: _ °• o HIV infections MOMENT POTENTIAL INTERVENTIONS PATHOGENS ■ 2019: 36,740 • Use new needle for o Hepatitis C Contaminated needle HIV, HCV, HBV, —31° every injection (prior to filling) delta agent • Use one needle for every • Estimated 57,500 person injecting new infections • Vaccination against HBV per year • Use sterile water Candida and o Other infectious Contaminated other fungal , • Use single-use sachet water or acid infections of citric or asorbic diseases acid • Use clean cooker Contaminated HIV.HCV,HBV, • One cooker for each cooker delta agent person injecting • Vaccination against HBV Presence of SSP has Additional Community Benefits SSPs save lives by lowering the likelihood SSPs promote safe syringe disposal. nof overdose death. Users of SSPs are 5 Cities with SSPs have less discarded "'-` times more likely to stop injecting drugs needles compared to cities without SSPs. than those that don't use them. SSPs protect law enforcement and first SSPs are cost effective. SSPs save responders. One in three officers are stuck taxpayers money in prevention rather with a needle during their career. SSPs have than treatment. been shown to reduce these injuries by 66%. WIP '. SSPs reduce crime. When people have .E, SSPs reduce health care costs access to clean syringes, it is less likely `��! A"" ��a°L by preventing infectious disease le H they will steal supplies from medical iu�_ transmission and providing facilities or other people. medical services to clients. History of SSPs in Washington State • Response to HIV epidemic and the impact on people who inject drugs (PWID) • First publicly funded SSP in the US: Tacoma-Pierce County Health Department (1988) T 'N4,4ii. 'Ir.-. '''c'‘ . . 40.H/' 'Illi, . _. 1. /- ...--4,,,- - :, ...,. ,.,k,_ ., ....„.. r ...,„ :,. ,4 *•( - , , . - .:; „,,... , s...4.r. ,i ',:Lii- . .,-.,-. �.y \il J . y , i ._ I i' 1— 1--.:' _ Ok, - _ . ' ' \ , - A 1 . 1 7" ___ ^'i ��4 2 s:.is �, , y i •P, - I SSP Locations in Washington State L' O Whatcom 1 san Juan t. [Narttteast Tri cqunfyJ �• Pend • 17 local health jurisdictions with at least �: ° ; c Skagit t''' Okanogan Orei!!� 20 sites Islar� � { • Ferry Stevens • 8 community-based organizations with clanam a - A �` ��{,I i`� Snohomish at least 15 sites A. • (ctteta 'ovgks) Jefferson 0 00 Chelan Douglas • 1 federally qualified health center Kilsap r� ' SeattleLincoln Spokane •ipa R,King • (FQHC) Harbor Mason ;r ?.. Cr,unty; --,� Grant - — I_ ,i 'r• :tas • • At least 3 tribal SSPs d • i 00 ,Tacoma-Pierce Adams Whitman _ -Thurston 17._ � I • -- - l 'i:Paciticr Lewis — (Benton-Franklin) f` Garfield Yakima Franklin 0 41Hohkiakifm 1 0 0 Columbia Asotin \ Cowlitz i Benton -S Skamanl walla Walla ;'Clark Klickltat - ® DOH Contracted SSP • SSP supported in-kind • Tribal SSP History of YHD ' s SSP • Established in 1993 1 • 3rd SSP in WA State _ ,:N._ • Started with 1 for 1 needle - exchange only � — • No break in service since �-• implementation �� 3Rs • Thursdays 12:30pm - 3:30pm ... . . . .. .......�S. A.li�� Y. South 3rd Street and Adams Street (Motorhome parked along triangle park) Harm Reduction Services • 1:1 needle exchange , ,..„ We count Neediest o Encourages return of used syringes Please have In bundlers of ''1 - �'i.. 10 • Education - _., % w, Siov.Ex 4:�� o Safe disposal 'Lrn" X�Ca`• Mo, - � �YFL69h�y ..Mttl.a.l16R'in1�gTe IY;SIX o Safer injection practices •e o Communicable disease "" " : ' ...,: -IQ..., d •w04 CO" o Safer sex practices • Naloxone/Narcan distribution and training "� o Prevent and reverse overdoses • HCV/HIV/Syphilis screening o Referrals for treatment for positive cases 4 .' I iF ATTENTION: • Vaccine administration � ~' ' '1 L ' \ There has been anlnueaseofoplaldrelated _ overdoses In Yaklma County related to "Percocet 30"or"Blue Percocet 30". o Hep A, Flu, COVID-19 Harm Reduction Services • Basic wound care o Partnership with CHCW residency program 1 dor 411, _ I - o Improves education experience for future r_. r le-17AR 1 � , providers � , ;, o Decreases ER visits and expenses to the local I, 1 t, t,,.. Il4, : . M healthcare system , - - -- - - - National COVID-19 Health Disparities AVAILABLE SERVICES • Patient navigation and case management with Initiative c 6 Case management u What it is ii referrals for: �, Unkage to social d• alit ��;I�,inrn iinili and medical seances o Drug treatment, chronic disease management, WhoIS_ehg,hie� ,- i�i lei iilyl li i ®Testing and treatment <,I,I of Infectious diseases housing, food, mental and behavioral health r �mi c, G vsr :. .Giii soREl9XSibTor NOfiYOtlyd� A Few YHD SSP Successes • 2019 Hepatitis A Outbreak O 33 vaccines administered n* €. 14 • Naloxone OVf Qo �r , 0 2022- 947 O 2023- 1869 • 2020-2023 Clients served O 2020-2023 9,802 clients (3rd quarter 2023) • 2020-2022 Syringes exchanged O 2020-2022 617,129 Syringes Collaboration with Yakama Nation BHS Support from CityOfficialS Crity OF 5- ..I1_ TIR F• * " 1907 ,� *� A- t•gei _ —,, B 4 it .� 4 .i • P 1' 1' t Al, I • if ' jF .=- ' `'a�+ " �r. �hoxe :hr +cat St11LI7ct 1 • Expanding services to Toppenish • Connection to resources • Building trust and consistency Questions Addressing the Opioid Crisis Yakima Neighborhood Health Services Strategies to • Provider Education on • Substance Use Disorder responsible opioid Professional at YNHS Address the prescribing • Increased access to O Crisis • Medication for Opioid naloxone Use Disorder (MOUD) • Code ORANGE Program • Naloxone (Narcan) training Benefits of MAT: Decreased Mortality Death rates: general population (United States Adults without OUD) People with No Treatment Opioid Use 1.1 Disorder Medication Assisted Treatment (OUD) 0 1 2 3 4 5 6 7 Standardized Mortality Ratio Dupouy et al., 2017 Evans et al., 2015 Sordo et al., 2017 PCSS-MAT AAAP Waiver Course Slide PATIENT Care Coordinator Medical Provider Team-Based Substance Use Disorder Professionals Approach Behavioral Health Provider Psychiatric Nurse Practitioner Pharmacist Housing Case Manager Al Medical respite ' pograms • 455 patients seen in 2023 with OUD • 58% between ages 25-44 years old • 58% assigned male at birth • Race: 85.5% White D u r c U J • Ethnicity: 73.6% Non-Hispanic or Latino Population • 41.5% unhoused • Of unhoused, 46.5% are living on the street • 14% are in Permanent Supportive Housing Q32023OUDDx J 0% 27,13% ■Active at Waters Edge 17,8% ■Chronic pain at YNHS ■Active on Methadone ■MOUD at YNHS prior to Q3 12,6% ■OUD Tx Elsewhere 121,56% Methadone physical ■MOUD at YNHS in Q3 31,14% Code ORANGE Response to Naloxone training for staff the Fentanyl Crisis Microdosing in MOUD — Medical Provider Education COMING SOON : YNHS as a distribution site for naloxone Outreach Workers Naloxone Medical Providers Training at YNHS Nurses Medical Assistants 450 400 389 350 300 -�• What's ® 250 S. •' 9 H ape n ed to �••x• p 200 -� Our Chronic 150• Opioid •-�- 111 100 Patients? . 50 0 2017 2019 2023 Distributed at the Meeting 11-14-23 # MAT Saves Money Buprenorphine vs Abstinence only R.E. Clark et al. /_Journal of Substance Abuse Treatment 57(2015) 75-8C vs Methadon e 2000 1800 1simi 600 C 1400 1200 000 1%\ 800 (/) 600 0 400 V 200 0 1 2 3 4 5 6 7 8 9 101112131415161718192021222324252627282930313233343536 Length of treatment episode in months Length of Treatment Medication Assisted Therapy Reduces Relapses Buprenorphine VS R.E. Clark et aL/Journal of Substance Abuse Treatment 57(2015) 75 Abstinence c n I y 50 45 sal vs Methadone in 40 Ma CU 35 i 30 25 111111111111111MININIMINIMI 20 mimisimiwarimmawA„,.15was li 10 5 - 0 1 2 3 4 5 6 7 8 9 101112131415161718192021222324252627282930313233343536 Length of treatment episode in months . --Buprenorphine Length of Treatment 2003-2010 Mass. Medicaid