HomeMy WebLinkAbout04/19/2022 06.I. Resolution authorizing the One Washington Memorandum of Understanding among Washington Municipalities 1
s F` ,1„11„4\
4..
.:„Iiki.0;1 ,
'�,�c.I:' :yes
BUSINESS OF THE CITY COUNCIL
YAKIMA, WASHINGTON
AGENDA STATEMENT
Item No. 6.1.
For Meeting of:April 19, 2022
ITEM TITLE: Resolution authorizing the One Washington Memorandum of
Understanding among Washington Municipalities
SUBMITTED BY: Sara Watkins, City Attorney
SUMMARY EXPLANATION:
A number of Washington municipalities are engaged in litigation regarding the overuse and abuse
of opioid due to the sale, manufacture and distribution by certain pharmaceutical companies. To
participate in any distribution of settlement proceeds, the City is required to agree on a form of
allocation and approved uses of the funds. This Memorandum of Understanding outlines the
allocation percentage for the City as well as the approved uses, and provides that the City can be
issued settlement funds as outlined therein, if the case(s) settle.
ITEM BUDGETED: No
STRATEGIC PRIORITY: Public Safety
APPROVED FOR SUBMITTAL BY THE CITY MANAGER
RECOMMENDATION:
Adopt resolution
ATTACHMENTS:
Description Upload Date Type
0 reso 4/13/2022 Corer Memo
❑ MOU-One WA Settlement 4/6/2022 Contract
MOU-One WA Settlement-Ex A-Abatement 4/6/2022 Exhibit
Strategies
MOU-One WA Settlement-Ex B-Intracounty 4/6/2022 Exhibit
Allocation
2
RESOLUTION NO. R-2022-
A RESOLUTION authorizing the One Washington Memorandum of Understanding among
Washington Municipalities.
WHEREAS, the City of Yakima has been, and continues to be affected by the over use
and abuse of opioids; and
WHEREAS, there is ongoing litigation associated with the manufacture and distribution of
opioids in Washington State, wherein there is an opportunity to share in the distribution of
settlement proceeds under the terms and conditions outlined in the memorandum of
understanding, including, but not limited to, the amount of allocation for the City and approved
uses of the funds; and
WHEREAS, the City Council finds that it is in the best interest of the City of Yakima and
its residents to enter into the One Washington Memorandum of Understanding Between
Washington Municipalities and secure a portion of the settlement proceeds to be used in the City
of Yakima for approved uses as outlined in the Memorandum; now, therefore
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF YAKIMA:
The City Council of the City of Yakima hereby approves the One Washington
Memorandum of Understanding Between Washington Municipalities to access and secure a
share, as outlined in Exhibit B attached thereto, of settlement proceeds from opioid litigation
settlements as outlined therein, and authorizes the City Manager to sign the same as well as any
other contracts necessary to obtain the settlement funds outlined in the Memorandum. The
Memorandum is attached hereto and fully incorporated herein.
ADOPTED BY THE CITY COUNCIL this 19'h day of April, 2022.
Janice Deccio, Mayor
ATTEST:
Sonya Clear Tee, City Clerk
3
ONE WASHINGTON MEMORANDUM OF UNDERSTANDING BETWEEN
WASHINGTON MUNICIPALITIES
Whereas, the people of the State of Washington and its communities have been harmed by
entities within the Pharmaceutical Supply Chain who manufacture, distribute, and dispense
prescription opioids;
Whereas, certain Local Governments, through their elected representatives and counsel,
are engaged in litigation seeking to hold these entities within the Pharmaceutical Supply Chain of
prescription opioids accountable for the damage they have caused to the Local Governments;
Whereas, Local Governments and elected officials share a common desire to abate and
alleviate the impacts of harms caused by these entities within the Pharmaceutical Supply Chain
throughout the State of Washington, and strive to ensure that principals of equity and equitable
service delivery are factors considered in the allocation and use of Opioid Funds; and
Whereas, certain Local Governments engaged in litigation and the other cities and counties
in Washington desire to agree on a form of allocation for Opioid Funds they receive from entities
within the Pharmaceutical Supply Chain.
Now therefore, the Local Governments enter into this Memorandum of Understanding
("MOU") relating to the allocation and use of the proceeds of Settlements described.
A. Defmitions
As used in this MOU:
1. "Allocation Regions" are the same geographic areas as the existing
nine (9) Washington State Accountable Community of Health(ACH) Regions
and have the purpose described in Section C below.
2 "Approved Purpose(s)" shall mean the strategies specified and set
forth in the Opioid Abatement Strategies attached as Exhibit A.
3. "Effective Date" shall mean the date on which a court of
competent jurisdiction enters the first Settlement by order or consent decree. The
Parties anticipate that more than one Settlement will be administered according to
the terms of this MOU, but that the first entered Settlement will trigger allocation
of Opioid Funds in accordance with Section B herein, and the formation of the
Opioid Abatement Councils in Section C.
4. "Litigating Local Government(s)" shall mean Local Governments
that filed suit against any Pharmaceutical Supply Chain Participant pertaining to
the Opioid epidemic prior to September 1, 2020.
1
4
5. "Local Government(s)" shall mean all counties, cities, and towns
within the geographic boundaries of the State of Washington.
6. "National Settlement Agreements"means the national opioid
settlement agreements dated July 21, 2021 involving Johnson & Johnson, and
distributors AmerisourceBergen, Cardinal Health and McKesson as well as their
subsidiaries, affiliates, officers, and directors named in the National Settlement
Agreements, including all amendments thereto.
7 "Opioid Funds" shall mean monetary amounts obtained through a
Settlement as defined in this MOU.
8 "Opioid Abatement Council" shall have the meaning described in
Section C below.
9. "Participating Local Government(s)" shall mean all counties,
cities, and towns within the geographic boundaries of the State that have chosen
to sign on to this MOU. The Participating Local Governments may be referred to
separately in this MOU as "Participating Counties" and "Participating Cities and
Towns" (or "Participating Cities or Towns,"as appropriate) or "Parties."
10. "Pharmaceutical Supply Chain" shall mean the process and
channels through which controlled substances are manufactured, marketed,
promoted, distributed, and/or dispensed, including prescription opioids.
11. "Pharmaceutical Supply Chain Participant" shall mean any entity
that engages in or has engaged in the manufacture, marketing, promotion,
distribution, and/or dispensing of a prescription opioid, including any entity that
has assisted in any of the above.
12. "Qualified Settlement Fund Account," or "QSF Account," shall
mean an account set up as a qualified settlement fund, 468b fund, as authorized by
Treasury Regulations 1.468B-1(c) (26 CFR §1.468B-1).
13. "Regional Agreements" shall mean the understanding reached by
the Participating Local Counties and Cities within an Allocation Region
governing the allocation, management, distribution of Opioid Funds within that
Allocation Region.
14. "Settlement" shall mean the future negotiated resolution of legal or
equitable claims against a Pharmaceutical Supply Chain Participant when that
resolution has been jointly entered into by the Participating Local
Governments. "Settlement" expressly does not include a plan of reorganization
confirmed under Title l lof the United States Code, irrespective of the extent to
which Participating Local Governments vote in favor of or otherwise support such
plan of reorganization.
2
5
15. "Trustee" shall mean an independent trustee who shall be
responsible for the ministerial task of releasing Opioid Funds from a QSF account
to Participating Local Governments as authorized herein and accounting for all
payments into or out of the trust.
16. The "Washington State Accountable Communities of Health" or
"ACH" shall mean the nine (9) regions described in Section C below.
B. Allocation of Settlement Proceeds for Approved Purposes
1. All Opioid Funds shall be held in a QSF and distributed by the
Trustee, for the benefit of the Participating Local Governments, only in a manner
consistent with this MOU. Distribution of Opioid Funds will be subject to the
mechanisms for auditing and reporting set forth below to provide public
accountability and transparency.
2. All Opioid Funds, regardless of allocation, shall be utilized
pursuant to Approved Purposes as defined herein and set forth in Exhibit A.
Compliance with this requirement shall be verified through reporting, as set out in
this MOU.
3. The division of Opioid Funds shall first be allocated to
Participating Counties based on the methodology utilized for the Negotiation
Class in In Re:National Prescription Opiate Litigation, United States District
Court for the Northern District of Ohio, Case No. 1:17-md-02804-DAP. The
allocation model uses three equally weighted factors: (1)the amount of opioids
shipped to the county; (2)the number of opioid deaths that occurred in that
county; and (3)the number of people who suffer opioid use disorder in that
county. The allocation percentages that result from application of this
methodology are set forth in the "County Total" line item in Exhibit B. In the
event any county does not participate in this MOU, that county's percentage share
shall be reallocated proportionally amongst the Participating Counties by applying
this same methodology to only the Participating Counties.
4. Allocation and distribution of Opioid Funds within each
Participating County will be based on regional agreements as described in
Section C.
C. Regional Agreements
1. For the purpose of this MOU, the regional structure for decision-
making related to opioid fund allocation will be based upon the nine (9) pre-
defined Washington State Accountable Community of Health Regions (Allocation
Regions). Reference to these pre-defined regions is solely for the purpose of
3
6
drawing geographic boundaries to facilitate regional agreements for use of Opioid
Funds. The Allocation Regions are as follows:
• King County (Single County Region)
• Pierce County (Single County Region)
• Olympic Community of Health Region (Clallam, Jefferson, and Kitsap
Counties)
• Cascade Pacific Action Alliance Region (Cowlitz, Grays Harbor, Lewis,
Mason, Pacific, Thurston, Lewis, and Wahkiakum Counties)
• North Sound Region (Island, San Juan, Skagit, Snohomish, and Whatcom
Counties)
• SouthWest Region (Clark, Klickitat, and Skamania Counties)
• Greater Columbia Region (Asotin, Benton, Columbia, Franklin, Garfield,
Kittitas, Walla Walla, Whitman, and Yakima Counties)
• Spokane Region (Adams, Ferry, Lincoln, Pend Oreille, Spokane, and
Stevens Counties)
• North Central Region(Chelan, Douglas, Grant, and Okanogan Counties)
2. Opioid Funds will be allocated, distributed and managed within
each Allocation Region, as determined by its Regional Agreement as set forth
below. If an Allocation Region does not have a Regional Agreement enumerated
in this MOU, and does not subsequently adopt a Regional Agreement per Section
C.5, the default mechanism for allocation, distribution and management of Opioid
Funds described in Section C.4.a will apply. Each Allocation Region must have
an OAC whose composition and responsibilities shall be defined by Regional
Agreement or as set forth in Section C.4.
3. King County's Regional Agreement is reflected in Exhibit C to this
MOU.
4. All other Allocation Regions that have not specified a Regional
Agreement for allocating, distributing and managing Opioid Funds, will apply
the following default methodology:
a. Opioid Funds shall be allocated within each Allocation Region by
taking the allocation for a Participating County from Exhibit B and
apportioning those funds between that Participating County and its
Participating Cities and Towns. Exhibit B also sets forth the allocation to
the Participating Counties and the Participating Cities or Towns within the
Counties based on a default allocation formula. As set forth above in
Section B.3, to determine the allocation to a county, this formula utilizes:
(1)the amount of opioids shipped to the county; (2)the number of opioid
deaths that occurred in that county; and (3)the number of people who
suffer opioid use disorder in that county. To determine the allocation
within a county, the formula utilizes historical federal data showing how
the specific Counties and the Cities and Towns within the Counties have
4
7
made opioids epidemic-related expenditures in the past. This is the same
methodology used in the National Settlement Agreements for county and
intra-county allocations. A Participating County, and the Cities and Towns
within it may enter into a separate intra-county allocation agreement to
modify how the Opioid Funds are allocated amongst themselves, provided
the modification is in writing and agreed to by all Participating Local
Governments in the County. Such an agreement shall not modify any of
the other terms or requirements of this MOU.
b. 10% of the Opioid Funds received by the Region will be reserved,
on an annual basis, for administrative costs related to the OAC. The OAC
will provide an annual accounting for actual costs and any reserved funds
that exceed actual costs will be reallocated to Participating Local
Governments within the Region.
c. Cities and towns with a population of less than 10,000 shall be
excluded from the allocation, with the exception of cities and towns that
are Litigating Participating Local Governments. The portion of the Opioid
Funds that would have been allocated to a city or town with a population
of less than 10,000 that is not a Litigating Participating Local Government
shall be redistributed to Participating Counties in the manner directed
in C.4.a above.
d. Each Participating County, City, or Town may elect to have its
share re-allocated to the OAC in which it is located. The OAC will then
utilize this share for the benefit of Participating Local Governments within
that Allocation Region, consistent with the Approved Purposes set forth in
Exhibit A. A Participating Local Government's election to forego its
allocation of Opioid Funds shall apply to all future allocations unless the
Participating Local Government notifies its respective OAC otherwise. If a
Participating Local Government elects to forego its allocation of the
Opioid Funds,the Participating Local Government shall be excused from
the reporting requirements set forth in this Agreement.
e. Participating Local Governments that receive a direct
payment maintain full discretion over the use and distribution of their
allocation of Opioid Funds, provided the Opioid Funds are used solely for
Approved Purposes. Reasonable administrative costs for a Participating
Local Government to administer its allocation of Opioid Funds shall not
exceed actual costs or 10% of the Participating Local Government's
allocation of Opioid Funds, whichever is less.
f. A Local Government that chooses not to become a Participating
Local Government will not receive a direct allocation of Opioid Funds.
The portion of the Opioid Funds that would have been allocated to a Local
Government that is not a Participating Local Government shall be
5
8
redistributed to Participating Counties in the manner directed
in C.4.a above.
g. As a condition of receiving a direct payment, each Participating
Local Government that receives a direct payment agrees to undertake the
following actions:
i. Developing a methodology for obtaining proposals for use
of Opioid Funds.
ii. Ensuring there is opportunity for community-based input
on priorities for Opioid Fund programs and services.
iii. Receiving and reviewing proposals for use of Opioid Funds
for Approved Purposes.
iv. Approving or denying proposals for use of Opioid
Funds for Approved Purposes.
v. Receiving funds from the Trustee for approved proposals
and distributing the Opioid Funds to the recipient.
vi. Reporting to the OAC and making publicly available all
decisions on Opioid Fund allocation applications,
distributions and expenditures.
h. Prior to any distribution of Opioid Funds within the Allocation
Region, The Participating Local Governments must establish an Opioid
Abatement Council (OAC)to oversee Opioid Fund allocation,
distribution, expenditures and dispute resolution. The OAC may be a
preexisting regional body or may be a new body created for purposes of
executing the obligations of this MOU.
i. The OAC for each Allocation Region shall be composed of
representation from both Participating Counties and Participating Towns
or Cities within the Region. The method of selecting members, and the
terms for which they will serve will be determined by the Allocation
Region's Participating Local Governments. All persons who serve on the
OAC must have work or educational experience pertaining to one or more
Approved Uses.
j. The Regional OAC will be responsible for the following actions:
i. Overseeing distribution of Opioid Funds from Participating
Local Governments to programs and services within the
Allocation Region for Approved Purposes.
6
9
ii. Annual review of expenditure reports from
Participating Local Jurisdictions within the Allocation
Region for compliance with Approved Purposes and the
terms of this MOU and any Settlement.
iii. In the case where Participating Local Governments chose
to forego their allocation of Opioid Funds:
(i) Approving or denying proposals by Participating Local
Governments or community groups to the OAC for use of
Opioid Funds within the Allocation Region.
(ii) Directing the Trustee to distribute Opioid Funds for use
by Participating Local Governments or community groups
whose proposals are approved by the OAC.
(Hi) Administrating and maintaining records of all OAC
decisions and distributions of Opioid Funds.
iv. Reporting and making publicly available all decisions on
Opioid Fund allocation applications, distributions and
expenditures by the OAC or directly by Participating Local
Governments.
v. Developing and maintaining a centralized public dashboard
or other repository for the publication of expenditure data
from any Participating Local Government that receives
Opioid Funds, and for expenditures by the OAC in that
Allocation Region, which it shall update at least annually.
vi. If necessary, requiring and collecting additional outcome-
related data from Participating Local Governments to
evaluate the use of Opioid Funds, and all Participating
Local Governments shall comply with such requirements.
vii. Hearing complaints by Participating Local Governments
within the Allocation Region regarding alleged failure to
(1) use Opioid Funds for Approved Purposes or (2) comply
with reporting requirements.
5. Participating Local Governments may agree and elect to share,
pool, or collaborate with their respective allocation of Opioid Funds in any
manner they choose by adopting a Regional Agreement, so long as such
sharing, pooling, or collaboration is used for Approved Purposes and
complies with the terms of this MOU and any Settlement.
7
10
6. Nothing in this MOU should alter or change any Participating
Local Government's rights to pursue its own claim. Rather,the intent of
this MOU is to join all parties who wish to be Participating Local
Governments to agree upon an allocation formula for any Opioid Funds
from any future binding Settlement with one or more Pharmaceutical
Supply Chain Participants for all Local Governments in the State of
Washington.
7. If any Participating Local Government disputes the amount it
receives from its allocation of Opioid Funds, the Participating Local
Government shall alert its respective OAC within sixty (60) days of
discovering the information underlying the dispute. Failure to alert its
OAC within this time frame shall not constitute a waiver of the
Participating Local Government's right to seek recoupment of any
deficiency in its allocation of Opioid Funds.
8. If any OAC concludes that a Participating Local Government's
expenditure of its allocation of Opioid Funds did not comply with the
Approved Purposes listed in Exhibit A, or the terms of this MOU, or that
the Participating Local Government otherwise misused its allocation of
Opioid Funds,the OAC may take remedial action against the alleged
offending Participating Local Government. Such remedial action is left to
the discretion of the OAC and may include withholding future Opioid
Funds owed to the offending Participating Local Government or requiring
the offending Participating Local Government to reimburse improperly
expended Opioid Funds back to the OAC to be re-allocated to the
remaining Participating Local Governments within that Region.
9. All Participating Local Governments and OAC shall maintain all
records related to the receipt and expenditure of Opioid Funds for no less
than five (5) years and shall make such records available for review by
any other Participating Local Government or OAC, or the public. Records
requested by the public shall be produced in accordance with
Washington's Public Records Act RCW 42.56.001 et seq. Records
requested by another Participating Local Government or an OAC shall be
produced within twenty-one (21) days of the date the record request was
received. This requirement does not supplant any Participating Local
Government or OAC's obligations under Washington's Public Records
Act RCW 42.56.001 et seq.
D. Payment of Counsel and Litigation Expenses
1. The Litigating Local Governments have incurred attorneys' fees
and litigation expenses relating to their prosecution of claims against the
Pharmaceutical Supply Chain Participants, and this prosecution has inured to the
benefit of all Participating Local Governments. Accordingly, a Washington
8
11
Government Fee Fund ("OFF") shall be established that ensures that all Parties
that receive Opioid Funds contribute to the payment of fees and expenses incurred
to prosecute the claims against the Pharmaceutical Supply Chain Participants,
regardless of whether they are litigating or non-litigating entities.
2. The amount of the GFF shall be based as follows: the funds to be
deposited in the GFF shall be equal to 15% of the total cash value of the Opioid
Funds.
3. The maximum percentage of any contingency fee agreement
permitted for compensation shall be 15% of the portion of the Opioid Funds
allocated to the Litigating Local Government that is a party to the contingency fee
agreement, plus expenses attributable to that Litigating Local Government. Under
no circumstances may counsel collect more for its work on behalf of a Litigating
Local Government than it would under its contingency agreement with that
Litigating Local Government.
4. Payments from the GFF shall be overseen by a committee (the
"Opioid Fee and Expense Committee") consisting of one representative of the
following law firms: (a) Keller Rohrback L.LP.; (b) Hagens Berman Sobol
Shapiro LLP; (c) Goldfarb & Huck Roth Riojas, PLLC; and (d) Napoli Shkolnik
PLLC. The role of the Opioid Fee and Expense Committee shall be limited to
ensuring that the GFF is administered in accordance with this Section.
5. In the event that settling Pharmaceutical Supply Chain Participants
do not pay the fees and expenses of the Participating Local Governments directly
at the time settlement is achieved, payments to counsel for Participating Local
Governments shall be made from the GFF over not more than three years, with
50% paid within 12 months of the date of Settlement and 25%paid in each
subsequent year, or at the time the total Settlement amount is paid to the Trustee
by the Defendants, whichever is sooner.
6. Any funds remaining in the GFF in excess of (i)the amounts
needed to cover Litigating Local Governments' private counsel's representation
agreements, and (ii)the amounts needed to cover the common benefit tax
discussed in Section C.8 below (if not paid directly by the Defendants in
connection with future settlement(s), shall revert to the Participating Local
Governments pro rata according to the percentages set forth in Exhibits B, to be
used for Approved Purposes as set forth herein and in Exhibit A.
7. In the event that funds in the GFF are not sufficient to pay all fees
and expenses owed under this Section, payments to counsel for all Litigating
Local Governments shall be reduced on a pro rata basis. The Litigating Local
Governments will not be responsible for any of these reduced amounts.
9
12
8. The Parties anticipate that any Opioid Funds they receive will be
subject to a common benefit"tax" imposed by the court in In Re: National
Prescription Opiate Litigation, United States District Court for the Northern
District of Ohio, Case No. 1:17-md-02804-DAP ("Common Benefit Tax"). If this
occurs, the Participating Local Governments shall first seek to have the settling
defendants pay the Common Benefit Tax. If the settling defendants do not agree
to pay the Common Benefit Tax,then the Common Benefit Tax shall be paid
from the Opioid Funds and by both litigating and non-litigating Local
Governments. This payment shall occur prior to allocation and distribution of
funds to the Participating Local Governments. In the event that GFF is not fully
exhausted to pay the Litigating Local Governments' private counsel's
representation agreements, excess funds in the GFF shall be applied to pay the
Common Benefit Tax(if any).
E. General Terms
1. If any Participating Local Government believes another
Participating Local Government, not including the Regional Abatement Advisory
Councils, violated the terms of this MOU, the alleging Participating Local
Government may seek to enforce the terms of this MOU in the court in which any
applicable Settlement(s) was entered, provided the alleging Participating Local
Government first provides the alleged offending Participating Local Government
notice of the alleged violation(s) and a reasonable opportunity to cure the alleged
violation(s). In such an enforcement action, any alleging Participating Local
Government or alleged offending Participating Local Government may be
represented by their respective public entity in accordance with Washington law.
2. Nothing in this MOU shall be interpreted to waive the right of any
Participating Local Government to seek judicial relief for conduct occurring
outside the scope of this MOU that violates any Washington law. In such an
action, the alleged offending Participating Local Government, including the
Regional Abatement Advisory Councils, may be represented by their respective
public entities in accordance with Washington law. In the event of a conflict, any
Participating Local Government, including the Regional Abatement Advisory
Councils and its Members, may seek outside representation to defend itself
against such an action.
3. Venue for any legal action related to this MOU shall be in the
court in which the Participating Local Government is located or in accordance
with the court rules on venue in that jurisdiction. This provision is not intended to
expand the court rules on venue.
4. This MOU may be executed in two or more counterparts, each of
which shall be deemed an original, but all of which shall constitute one and the
same instrument. The Participating Local Governments approve the use of
electronic signatures for execution of this MOU. All use of electronic signatures
10
13
shall be governed by the Uniform Electronic Transactions Act, C.R.S. §§ 24-71.3-
101, et seq. The Parties agree not to deny the legal effect or enforceability of the
MOU solely because it is in electronic form or because an electronic record was
used in its formation. The Participating Local Government agree not to object to
the admissibility of the MOU in the form of an electronic record, or a paper copy
of an electronic document, or a paper copy of a document bearing an electronic
signature, on the grounds that it is an electronic record or electronic signature or
that it is not in its original form or is not an original.
5. Each Participating Local Government represents that all
procedures necessary to authorize such Participating Local Government's
execution of this MOU have been performed and that the person signing for such
Party has been authorized to execute the MOU.
[Remainder of Page Intentionally Left Blank— Signature Pages Follow]
11
14
This One Washington Memorandum of Understanding Between Washington
Municipalities is signed this day of , 2022 by:
Name& Title
On behalf of
12
15
EXHIBIT A
16
OPIOID ABATEMENT STRATEGIES
PART ONE: TREATMENT
A. TREAT OPIOID USE DISORDER(OUD)
Support treatment of Opioid Use Disorder (OUD) and any co-occurring Substance Use
Disorder or Mental Health (SUD/MH) conditions, co-usage, and/or co-addiction through
evidence-based, evidence-informed, or promising programs or strategies that may include,
but are not limited to,the following:
1. Expand availability of treatment for OUD and any co-occurring SUD/MH conditions,
co-usage, and/or co-addiction, including all forms of Medication-Assisted Treatment
(MAT) approved by the U.S. Food and Drug Administration.
2. Support and reimburse services that include the full American Society of Addiction
Medicine (ASAM) continuum of care for OUD and any co-occurring SUD/MH
conditions, co-usage, and/or co-addiction, including but not limited to:
a. Medication-Assisted Treatment(MAT);
b. Abstinence-based treatment;
c. Treatment, recovery, or other services provided by states, subdivisions,
community health centers; non-for-profit providers; or for-profit providers;
d. Treatment by providers that focus on OUD treatment as well as treatment by
providers that offer OUD treatment along with treatment for other SUD/MH
conditions, co-usage, and/or co-addiction; or
e. Evidence-informed residential services programs, as noted below.
3. Expand telehealth to increase access to treatment for OUD and any co-occurring
SUD/MH conditions, co-usage, and/or co-addiction, including MAT, as well as
counseling, psychiatric support, and other treatment and recovery support services.
4. Improve oversight of Opioid Treatment Programs (OTPs) to assure evidence-based,
evidence-informed, or promising practices such as adequate methadone dosing.
5. Support mobile intervention, treatment, and recovery services, offered by qualified
professionals and service providers, such as peer recovery coaches, for persons with
OUD and any co-occurring SUD/MH conditions, co-usage, and/or co-addiction and
for persons who have experienced an opioid overdose.
6. Support treatment of mental health trauma resulting from the traumatic experiences of
the opioid user (e.g., violence, sexual assault, human trafficking, or adverse childhood
experiences) and family members (e.g., surviving family members after an overdose
1
17
or overdose fatality), and training of health care personnel to identify and address such
trauma.
7. Support detoxification (detox) and withdrawal management services for persons with
OUD and any co-occurring SUD/MH conditions, co-usage, and/or co-addiction,
including medical detox, referral to treatment, or connections to other services or
supports.
8. Support training on MAT for health care providers, students, or other supporting
professionals, such as peer recovery coaches or recovery outreach specialists,
including telementoring to assist community-based providers in rural or underserved
areas.
9. Support workforce development for addiction professionals who work with persons
with OUD and any co-occurring SUD/MH conditions, co-usage, and/or co-addiction.
10. Provide fellowships for addiction medicine specialists for direct patient care,
instructors, and clinical research for treatments.
11. Provide funding and training for clinicians to obtain a waiver under the federal Drug
Addiction Treatment Act of 2000 (DATA 2000) to prescribe MAT for OUD, and
provide technical assistance and professional support to clinicians who have obtained
a DATA 2000 waiver.
12. Support the dissemination of web-based training curricula, such as the American
Academy of Addiction Psychiatry's Provider Clinical Support Service-Opioids web-
based training curriculum and motivational interviewing.
13. Support the development and dissemination of new curricula, such as the American
Academy of Addiction Psychiatry's Provider Clinical Support Service for
Medication-Assisted Treatment.
B. SUPPORT PEOPLE IN TREATMENT AND RECOVERY
Support people in treatment for and recovery from OUD and any co-occurring SUD/MH
conditions, co-usage, and/or co-addiction through evidence-based, evidence-informed, or
promising programs or strategies that may include, but are not limited to, the following:
1. Provide the full continuum of care of recovery services for OUD and any co-occurring
SUD/MH conditions, co-usage, and/or co-addiction, including supportive housing,
residential treatment, medical detox services, peer support services and counseling,
community navigators, case management, and connections to community-based
services.
2. Provide counseling, peer-support, recovery case management and residential
treatment with access to medications for those who need it to persons with OUD and
any co-occurring SUD/MH conditions, co-usage, and/or co-addiction.
2
18
3. Provide access to housing for people with OUD and any co-occurring SUD/MH
conditions, co-usage, and/or co-addiction, including supportive housing, recovery
housing, housing assistance programs, or training for housing providers.
4. Provide community support services, including social and legal services, to assist in
deinstitutionalizing persons with OUD and any co-occurring SUD/MH conditions, co-
usage, and/or co-addiction.
5. Support or expand peer-recovery centers, which may include support groups, social
events, computer access, or other services for persons with OUD and any co-occurring
SUD/MH conditions, co-usage, and/or co-addiction.
6. Provide employment training or educational services for persons in treatment for or
recovery from OUD and any co-occurring SUD/MH conditions, co-usage, and/or co-
addiction.
7. Identify successful recovery programs such as physician, pilot, and college recovery
programs, and provide support and technical assistance to increase the number and
capacity of high-quality programs to help those in recovery.
8. Engage non-profits, faith-based communities, and community coalitions to support
people in treatment and recovery and to support family members in their efforts to
manage the opioid user in the family.
9. Provide training and development of procedures for government staff to appropriately
interact and provide social and other services to current and recovering opioid users,
including reducing stigma.
10. Support stigma reduction efforts regarding treatment and support for persons with
OUD, including reducing the stigma on effective treatment.
C. CONNECT PEOPLE WHO NEED HELP TO THE HELP THEY NEED
(CONNECTIONS TO CARE)
Provide connections to care for people who have — or are at risk of developing — OUD and
any co-occurring SUD/MH conditions, co-usage, and/or co-addiction through evidence-
based, evidence-informed, or promising programs or strategies that may include, but are not
limited to, the following:
1. Ensure that health care providers are screening for OUD and other risk factors and
know how to appropriately counsel and treat(or refer if necessary) a patient for OUD
treatment.
2. Support Screening, Brief Intervention and Referral to Treatment(SBIRT) programs to
reduce the transition from use to disorders.
3. Provide training and long-term implementation of SBIRT in key systems (health,
schools, colleges, criminal justice, and probation), with a focus on youth and young
adults when transition from misuse to opioid disorder is common.
3
19
4. Purchase automated versions of SBIRT and support ongoing costs of the technology.
5. Support training for emergency room personnel treating opioid overdose patients on
post-discharge planning, including community referrals for MAT, recovery case
management or support services.
6. Support hospital programs that transition persons with OUD and any co-occurring
SUD/MH conditions, co-usage, and/or co-addiction, or persons who have experienced
an opioid overdose, into community treatment or recovery services through a bridge
clinic or similar approach.
7. Support crisis stabilization centers that serve as an alternative to hospital emergency
departments for persons with OUD and any co-occurring SUD/MH conditions, co-
usage, and/or co-addiction or persons that have experienced an opioid overdose.
8. Support the work of Emergency Medical Systems, including peer support specialists,
to connect individuals to treatment or other appropriate services following an opioid
overdose or other opioid-related adverse event.
9. Provide funding for peer support specialists or recovery coaches in emergency
departments, detox facilities, recovery centers, recovery housing, or similar settings;
offer services, supports, or connections to care to persons with OUD and any co-
occurring SUD/MH conditions, co-usage, and/or co-addiction or to persons who have
experienced an opioid overdose.
10. Provide funding for peer navigators, recovery coaches, care coordinators, or care
managers that offer assistance to persons with OUD and any co-occurring SUD/MH
conditions, co-usage, and/or co-addiction or to persons who have experienced on
opioid overdose.
11. Create or support school-based contacts that parents can engage with to seek
immediate treatment services for their child; and support prevention, intervention,
treatment, and recovery programs focused on young people.
12. Develop and support best practices on addressing OUD in the workplace.
13. Support assistance programs for health care providers with OUD.
14. Engage non-profits and the faith community as a system to support outreach for
treatment.
15. Support centralized call centers that provide information and connections to
appropriate services and supports for persons with OUD and any co-occurring
SUD/MH conditions, co-usage, and/or co-addiction.
16. Create or support intake and call centers to facilitate education and access to
treatment, prevention, and recovery services for persons with OUD and any co-
occurring SUD/MH conditions, co-usage, and/or co-addiction.
4
20
17. Develop or support a National Treatment Availability Clearinghouse — a
multistate/nationally accessible database whereby health care providers can list
locations for currently available in-patient and out-patient OUD treatment services
that are accessible on a real-time basis by persons who seek treatment.
D. ADDRESS THE NEEDS OF CRIMINAL-JUSTICE-INVOLVED PERSONS
Address the needs of persons with OUD and any co-occurring SUD/MH conditions, co-
usage, and/or co-addiction who are involved — or are at risk of becoming involved — in the
criminal justice system through evidence-based, evidence-informed, or promising programs
or strategies that may include, but are not limited to, the following:
1. Support pre-arrest or post-arrest diversion and deflection strategies for persons with
OUD and any co-occurring SUD/MH conditions, co-usage, and/or co-addiction,
including established strategies such as:
a. Self-referral strategies such as the Angel Programs or the Police Assisted
Addiction Recovery Initiative (PAARI);
b. Active outreach strategies such as the Drug Abuse Response Team (DART)
model;
c. "Naloxone Plus" strategies, which work to ensure that individuals who have
received naloxone to reverse the effects of an overdose are then linked to
treatment programs or other appropriate services;
d. Officer prevention strategies, such as the Law Enforcement Assisted Diversion
(LEAD) model;
e. Officer intervention strategies such as the Leon County, Florida Adult Civil
Citation Network or the Chicago Westside Narcotics Diversion to Treatment
Initiative;
f. Co-responder and/or alternative responder models to address OUD-related 911
calls with greater SUD expertise and to reduce perceived barriers associated with
law enforcement 911 responses; or
g. County prosecution diversion programs, including diversion officer salary, only
for counties with a population of 50,000 or less. Any diversion services in matters
involving opioids must include drug testing, monitoring, or treatment.
2. Support pre-trial services that connect individuals with OUD and any co-occurring
SUD/MH conditions, co-usage, and/or co-addiction to evidence-informed treatment,
including MAT, and related services.
3. Support treatment and recovery courts for persons with OUD and any co-occurring
SUD/MH conditions, co-usage, and/or co-addiction, but only if these courts provide
referrals to evidence-informed treatment, including MAT.
5
21
4. Provide evidence-informed treatment, including MAT, recovery support, or other
appropriate services to individuals with OUD and any co-occurring SUD/MH
conditions, co-usage, and/or co-addiction who are incarcerated in jail or prison.
5. Provide evidence-informed treatment, including MAT, recovery support, or other
appropriate services to individuals with OUD and any co-occurring SUD/MH
conditions, co-usage, and/or co-addiction who are leaving jail or prison have recently
left jail or prison, are on probation or parole, are under community corrections
supervision, or are in re-entry programs or facilities.
6. Support critical time interventions (CTI), particularly for individuals living with dual-
diagnosis OUD/serious mental illness, and services for individuals who face
immediate risks and service needs and risks upon release from correctional settings.
7. Provide training on best practices for addressing the needs of criminal-justice-
involved persons with OUD and any co-occurring SUD/MH conditions, co-usage,
and/or co-addiction to law enforcement, correctional, or judicial personnel or to
providers of treatment, recovery, case management, or other services offered in
connection with any of the strategies described in this section.
E. ADDRESS THE NEEDS OF PREGNANT OR PARENTING WOMEN AND
THEIR FAMILIES, INCLUDING BABIES WITH NEONATAL ABSTINENCE
SYNDROME
Address the needs of pregnant or parenting women with OUD and any co-occurring
SUD/MH conditions, co-usage, and/or co-addiction, and the needs of their families, including
babies with neonatal abstinence syndrome, through evidence-based, evidence-informed, or
promising programs or strategies that may include, but are not limited to, the following:
1. Support evidence-based, evidence-informed, or promising treatment, including MAT,
recovery services and supports, and prevention services for pregnant women — or
women who could become pregnant—who have OUD and any co-occurring SUD/MH
conditions, co-usage, and/or co-addiction, and other measures to educate and provide
support to families affected by Neonatal Abstinence Syndrome.
2. Provide training for obstetricians or other healthcare personnel that work with
pregnant women and their families regarding treatment of OUD and any co-occurring
SUD/MH conditions, co-usage, and/or co-addiction.
3. Provide training to health care providers who work with pregnant or parenting women
on best practices for compliance with federal requirements that children born with
Neonatal Abstinence Syndrome get referred to appropriate services and receive a plan
of safe care.
4. Provide enhanced support for children and family members suffering trauma as a
result of addiction in the family; and offer trauma-informed behavioral health
treatment for adverse childhood events.
6
22
5. Offer enhanced family supports and home-based wrap-around services to persons with
OUD and any co-occurring SUD/MH conditions, co-usage, and/or co-addiction,
including but not limited to parent skills training.
6. Support for Children's Services — Fund additional positions and services, including
supportive housing and other residential services, relating to children being removed
from the home and/or placed in foster care due to custodial opioid use.
PART TWO: PREVENTION
F. PREVENT OVER-PRESCRIBING AND ENSURE APPROPRIATE
PRESCRIBING AND DISPENSING OF OPIOIDS
Support efforts to prevent over-prescribing and ensure appropriate prescribing and dispensing
of opioids through evidence-based, evidence-informed, or promising programs or strategies
that may include, but are not limited to, the following:
1. Training for health care providers regarding safe and responsible opioid prescribing,
dosing, and tapering patients off opioids.
2. Academic counter-detailing to educate prescribers on appropriate opioid prescribing.
3. Continuing Medical Education (CME) on appropriate prescribing of opioids.
4. Support for non-opioid pain treatment alternatives, including training providers to
offer or refer to multi-modal, evidence-informed treatment of pain.
5. Support enhancements or improvements to Prescription Drug Monitoring Programs
(PDMPs), including but not limited to improvements that:
a. Increase the number of prescribers using PDMPs;
b. Improve point-of-care decision-making by increasing the quantity, quality, or
format of data available to prescribers using PDMPs or by improving the
interface that prescribers use to access PDMP data, or both; or
c. Enable states to use PDMP data in support of surveillance or intervention
strategies, including MAT referrals and follow-up for individuals identified
within PDMP data as likely to experience OUD.
6. Development and implementation of a national PDMP — Fund development of a
multistate/national PDMP that permits information sharing while providing
appropriate safeguards on sharing of private health information, including but not
limited to:
a. Integration of PDMP data with electronic health records, overdose episodes,
and decision support tools for health care providers relating to OUD.
7
23
b. Ensuring PDMPs incorporate available overdose/naloxone deployment data,
including the United States Department of Transportation's Emergency
Medical Technician overdose database.
7. Increase electronic prescribing to prevent diversion or forgery.
8. Educate Dispensers on appropriate opioid dispensing.
G. PREVENT MISUSE OF OPIOIDS
Support efforts to discourage or prevent misuse of opioids through evidence-based, evidence-
informed, or promising programs or strategies that may include, but are not limited to, the
following:
1. Corrective advertising or affirmative public education campaigns based on evidence.
2. Public education relating to drug disposal.
3. Drug take-back disposal or destruction programs.
4. Fund community anti-drug coalitions that engage in drug prevention efforts.
5. Support community coalitions in implementing evidence-informed prevention, such
as reduced social access and physical access, stigma reduction — including staffing,
educational campaigns, support for people in treatment or recovery, or training of
coalitions in evidence-informed implementation, including the Strategic Prevention
Framework developed by the U.S. Substance Abuse and Mental Health Services
Administration (SAMHSA).
6. Engage non-profits and faith-based communities as systems to support prevention.
7. Support evidence-informed school and community education programs and
campaigns for students, families, school employees, school athletic programs, parent-
teacher and student associations, and others.
8. School-based or youth-focused programs or strategies that have demonstrated
effectiveness in preventing drug misuse and seem likely to be effective in preventing
the uptake and use of opioids.
9. Support community-based education or intervention services for families, youth, and
adolescents at risk for OUD and any co-occurring SUD/MH conditions, co-usage,
and/or co-addiction.
10. Support evidence-informed programs or curricula to address mental health needs of
young people who may be at risk of misusing opioids or other drugs, including
emotional modulation and resilience skills.
11. Support greater access to mental health services and supports for young people,
including services and supports provided by school nurses or other school staff, to
8
24
address mental health needs in young people that (when not properly addressed)
increase the risk of opioid or other drug misuse.
H. PREVENT OVERDOSE DEATHS AND OTHER HARMS
Support efforts to prevent or reduce overdose deaths or other opioid-related harms through
evidence-based, evidence-informed, or promising programs or strategies that may include,
but are not limited to,the following:
1. Increase availability and distribution of naloxone and other drugs that treat overdoses
for first responders, overdose patients, opioid users, families and friends of opioid
users, schools, community navigators and outreach workers, drug offenders upon
release from jail/prison, or other members of the general public.
2. Provision by public health entities of free naloxone to anyone in the community,
including but not limited to provision of intra-nasal naloxone in settings where other
options are not available or allowed.
3. Training and education regarding naloxone and other drugs that treat overdoses for
first responders, overdose patients, patients taking opioids, families, schools, and
other members of the general public.
4. Enable school nurses and other school staff to respond to opioid overdoses, and
provide them with naloxone, training, and support.
5. Expand, improve, or develop data tracking software and applications for
overdoses/naloxone revivals.
6. Public education relating to emergency responses to overdoses.
7. Public education relating to immunity and Good Samaritan laws.
8. Educate first responders regarding the existence and operation of immunity and Good
Samaritan laws.
9. Expand access to testing and treatment for infectious diseases such as HIV and
Hepatitis C resulting from intravenous opioid use.
10. Support mobile units that offer or provide referrals to treatment, recovery supports,
health care, or other appropriate services to persons that use opioids or persons with
OUD and any co-occurring SUD/MH conditions, co-usage, and/or co-addiction.
11. Provide training in treatment and recovery strategies to health care providers,
students, peer recovery coaches, recovery outreach specialists, or other professionals
that provide care to persons who use opioids or persons with OUD and any co-
occurring SUD/MH conditions, co-usage, and/or co-addiction.
12. Support screening for fentanyl in routine clinical toxicology testing.
9
25
PART THREE: OTHER STRATEGIES
I. FIRST RESPONDERS
In addition to items C8, D 1 through D7, H 1, H3, and H8, support the following:
1. Current and future law enforcement expenditures relating to the opioid epidemic.
2. Educate law enforcement or other first responders regarding appropriate practices and
precautions when dealing with fentanyl or other drugs.
J. LEADERSHIP, PLANNING AND COORDINATION
Support efforts to provide leadership, planning, and coordination to abate the opioid epidemic
through activities, programs, or strategies that may include, but are not limited to, the
following:
1. Community regional planning to identify goals for reducing harms related to the
opioid epidemic, to identify areas and populations with the greatest needs for
treatment intervention services, or to support other strategies to abate the opioid
epidemic described in this opioid abatement strategy list.
2. A government dashboard to track key opioid-related indicators and supports as
identified through collaborative community processes.
3. Invest in infrastructure or staffing at government or not-for-profit agencies to support
collaborative, cross-system coordination with the purpose of preventing
overprescribing, opioid misuse, or opioid overdoses, treating those with OUD and any
co-occurring SUD/MH conditions, co-usage, and/or co-addiction, supporting them in
treatment or recovery, connecting them to care, or implementing other strategies to
abate the opioid epidemic described in this opioid abatement strategy list.
4. Provide resources to staff government oversight and management of opioid abatement
programs.
K. TRAINING
In addition to the training referred to in various items above, support training to abate the
opioid epidemic through activities, programs, or strategies that may include, but are not
limited to, the following:
1. Provide funding for staff training or networking programs and services to improve the
capability of government, community, and not-for-profit entities to abate the opioid
crisis.
2. Invest in infrastructure and staffing for collaborative cross-system coordination to
prevent opioid misuse, prevent overdoses, and treat those with OUD and any co-
occurring SUD/MH conditions, co-usage, and/or co-addiction, or implement other
10
26
strategies to abate the opioid epidemic described in this opioid abatement strategy list
(e.g., health care, primary care, pharmacies, PDMPs, etc.).
L. RESEARCH
Support opioid abatement research that may include, but is not limited to, the following:
1. Monitoring, surveillance, and evaluation of programs and strategies described in this
opioid abatement strategy list.
2. Research non-opioid treatment of chronic pain.
3. Research on improved service delivery for modalities such as SBIRT that demonstrate
promising but mixed results in populations vulnerable to opioid use disorders.
4. Research on innovative supply-side enforcement efforts such as improved detection of
mail-based delivery of synthetic opioids.
5. Expanded research on swift/certain/fair models to reduce and deter opioid misuse
within criminal justice populations that build upon promising approaches used to
address other substances (e.g. Hawaii HOPE and Dakota 24/7).
6. Research on expanded modalities such as prescription methadone that can expand
access to MAT.
11
EXHIBIT B 27
Local
County Government °
Adams County
Adams County 0.1638732475%
Hatton
Lind
Othello
Ritzville
Washtucna
County Total: 0.1638732475%
Asotin County
Asotin County 0.4694498386%
Asotin
Clarkston
County Total: 0.4694498386%
Benton County
Benton County 1.4848831892%
Benton City
Kennewick 0.5415650564%
Prosser
Richland 0.4756779517%
West Richland 0.0459360490%
County Total: 2.5480622463%
Chelan County
Chelan County 0.7434914485%
Cashmere
Chelan
Entiat
Leavenworth
Wenatchee 0.2968333494%
County Total: 1.0403247979%
Clallam County
Clallam County 1.3076983401%
Forks
Port Angeles 0.4598370527%
Sequim
County Total: 1.7675353928%
*** - Local Government appears in multiple counties B-1
EXHIBIT B 28
Local
County Government °
Clark County
Clark County 4.5149775326%
Battle Ground 0.1384729857%
Camas 0.2691592724%
La Center
Ridgefield
Vancouver 1.7306605325%
Washougal 0.1279328220%
Woodland***
Yacolt
County Total: 6.7812031452%
Columbia County
Columbia County 0.0561699537%
Dayton
Starbuck
County Total: 0.0561699537%
Cowlitz County
Cowlitz County 1.7226945990%
Castle Rock
Ka lama
Kelso 0.1331145270%
Longview 0.6162736905%
Woodland***
County Total: 2.47208 28165%
Douglas County
Douglas County 0.3932175175%
Bridgeport
Coulee Dam***
East Wenatchee 0.0799810865%
Mansfield _
Rock Island
Waterville
County Total: 0.4731986040%
Ferry County
Ferry County 0.1153487994%
Republic
County Total: 0.1153487994%
*** - Local Government appears in multiple counties B-2
EXHIBIT B 29
Local
County Government °
Franklin County
Franklin County 0.3361237144%
Connell
Kahlotus
Mesa
Pasco 0.4278056066%
County Total: 0.7639293210%
Garfield County
Garfield County 0.0321982209%
Pomeroy
County Total: 0.0321982209%
Grant County
Grant County 0.9932572167%
Coulee City
Coulee Dam***
Electric City
Ephrata
George
Grand Coulee
Hartline
Krupp
Mattawa
Moses Lake 0.2078293909%
Quincy
Royal City
Soap Lake
Warden
Wilson Creek
County Total: 1.20108 66076%
*** - Local Government appears in multiple counties B-3
EXHIBIT B 30
Local
County Government °
Grays Harbor County
Grays Harbor County 0.9992429138%
Aberdeen 0.2491525333%
Cosmopolis
Elma
Hoquiam
McCleary
Montesano
Oakville
Ocean Shores
Westport
County Total: 1.2483954471%
Island County
Island County 0.6820422610%
Coupeville
Langley
Oak Harbor 0.2511550431%
County Total: 0.9331973041%
Jefferson County
Jefferson County 0.4417137380%
Port Townsend
County Total: 0.4417137380%
*** - Local Government appears in multiple counties B-4
EXHIBIT B 31
Local
County Government °
King County
King County 13.9743722662%
Algona
Auburn*** 0.2622774917%
Beaux Arts Village
Bellevue 1.1300592573%
Black Diamond
Bothell*** 0.1821602716%
Burien 0.0270962921%
Carnation
Clyde Hill
Covington 0.0118134406%
Des Moines 0.1179764526%
Duvall
Enumclaw*** 0.0537768326%
Federal Way 0.3061452240%
Hunts Point
Issaquah 0.1876240107%
Kenmore 0.0204441024%
Kent 0.5377397676%
Kirkland 0.5453525246%
Lake Forest Park 0.0525439124%
Maple Valley 0.0093761587%
Medina
Mercer Island 0.1751797481%
Milton***
Newcastle 0.0033117880%
Normandy Park
North Bend
Pacific***
Redmond 0.4839486007%
Renton 0.7652626920%
Sammamish 0.0224369090%
SeaTac 0.1481551278%
Seattle 6.6032403816%
Shoreline 0.0435834501%
Skykomish
Snoqualmie 0.0649164481%
Tukwila 0.3032205739%
Woodinville _ 0.0185516364%
Yarrow Point
County Total: 26.0505653608%
*** - Local Government appears in multiple counties B-5
EXHIBIT B 32
Local
County Government °
Kitsap County
Kitsap County 2.6294133668%
Bainbridge Island 0.1364686014%
Bremerton 0.6193374389%
Port Orchard 0.1009497162%
Poulsbo 0.0773748246%
County Total: 3.5635439479%
Kittitas County
Kittitas County 0.3855704683%
Cle Elum
Ellensburg 0.0955824915%
Kittitas
Roslyn
South Cle Elum
County Total: 0.4811529598%
Klickitat County
Klickitat County 0.2211673457%
Bingen
Goldendale
White Salmon
County Total: 0.2211673457%
Lewis County
Lewis County 1.0777377479%
Centralia 0.1909990353%
Chehalis
Morton
Mossyrock
Napavine
Pe Ell
Toledo
Va der
Winlock
County Total: 1.2687367832%
*** - Local Government appears in multiple counties B-6
EXHIBIT B 33
Local
County Government °
Lincoln County
Lincoln County 0.1712669645%
Almira
Creston _
Davenport
Harrington _
Odessa
Rea rda n
Sprague
Wilbur
County Total: 0.1712669645%
Mason County
Mason County 0.8089918012%
Shelton 0.1239179888%
County Total: 0.9329097900%
Okanogan County
Okanogan County 0.6145043345%
Brewster
Conconully
Coulee Dam***
Elmer City
Nespelem
Oka nogan
Oma k
Oroville f
Pateros
Riverside
Tonasket
Twisp
Winthrop
County Total: 0.6145043345%
Pacific County
Pacific County 0.4895416466%
Ilwaco
Long Beach
Raymond
South Bend
County Total: 0.4895416466%
*** - Local Government appears in multiple counties B-7
EXHIBIT B 34
Local
County Government °
Pend Oreille County
Pend Oreille County 0.2566374940%
Cusick
lone
Meta line
Metaline Falls
Newport
County Total: 0.2566374940%
Pierce County
Pierce County 7.2310164020%
Auburn*** 0.0628522112%
Bonney Lake 0.1190773864%
Buckley
Carbonado
DuPont
Eatonville
Edgewood 0.0048016791%
Enumclaw*** 0.0000000000%
Fife 0.1955185481%
Fircrest
Gig Harbor 0.0859963345%
Lakewood 0.5253640894%
Milton***
Orting
Pacific***
Puyallup 0.3845704814%
Roy
Ruston
South Prairie
Steilacoom
Sumner 0.1083157569%
Tacoma 3.2816374617%
University Place 0.0353733363%
Wilkeson
County Total: 12.0345236870%
San Juan County
San Juan County 0.2101495171%
Friday Harbor
County Total: 0.2101495171%
*** - Local Government appears in multiple counties B-8
EXHIBIT B 35
Local
County Government °
Skagit County
Skagit County 1.0526023961%
Anacortes 0.1774962906%
Burlington 0.1146861661%
Concrete
Hamilton
La Conner
Lyman
Mount Vernon 0.2801063665%
Sedro-Woolley 0.0661146351%
County Total: 1.6910058544%
Skamania County
Skamania County 0.1631931925%
North Bonneville_ _
Stevenson
County Total: 0.1631931925%
Snohomish County
Snohomish County 6.9054415622%
Arlington 0.2620524080%
Bothell*** 0.2654558588%
Brier
Da rrington
Edmonds 0.3058936009%
Everett 1.9258363241%
Gold Bar
Granite Falls
Index
Lake Stevens 0.1385202891%
Lynnwood 0.7704629214%
Marysville 0.3945067827%
Mill Creek 0.1227939546%
Monroe 0.1771621898%
Mountlake Terrace 0.2108935805%
Mukilteo 0.2561790702%
Snohomish 0.0861097964%
Stanwood
Sultan
Woodway
County Total: 11.8213083387%
*** - Local Government appears in multiple counties B-9
EXHIBIT B 36
Local
County Government °
Spokane County
Spokane County 5.5623859292%
Airway Heights
Cheney 0.1238454349%
Deer Park
Fairfield
La to h
Liberty Lake 0.0389636519%
Medical Lake
Millwood
Rockford
Spangle
Spokane 3.0872078287%
Spokane Valley 0.0684217500%
Waverly
County Total: 8.8808245947%
Stevens County
Stevens County 0.7479240179%
Chewelah
Colville
Kettle Falls
Marcus
Northport
Springdale
County Total: 0.7479240179%
Thurston County
Thurston County 2.3258492094%
Bucoda
Lacey 0.2348627221%
Olympia 0.6039423385%
Rainier
Tenino
Tumwater 0.2065982350%
Yelm
County Total: 3.3712525050%
Wahkiakum County
Wahkiakum County 0.0596582197%
Cathlamet
County Total: 0.0596582197%
*** - Local Government appears in multiple counties B-10
EXHIBIT B 37
Local
County Government °
Walla Walla County
Walla Walla County 0.5543870294%
College Place
Prescott
Waitsburg
Walla Walla 0.3140768654%
County Total: 0.8684638948%
Whatcom County
Whatcom County 1.3452637306%
Bellingham 0.8978614577%
Blaine
Everson
Ferndale 0.0646101891%
Lynden _ _ 0.0827115612%
Nooksack
Sumas
County Total: 2.3904469386%
Whitman County
Whitman County 0.2626805837%
Albion
Colfax
Colton _
Endicott _
Farmington
Garfield
LaCrosse
Lamont
Malden
Oakesdale
Palouse
Pullman 0.2214837491%
Rosa l is
St. John
Tekoa
Uniontown
County Total: 0.4841643328%
*** - Local Government appears in multiple counties B-11
EXHIBIT B 38
Local
County Government °
Yakima County
Yakima County 1.9388392959%
Grandview 0.0530606109%
Granger
Harrah
Mabton
Moxee
Naches
Selah
Sunnyside 0.1213478384%
Tieton
Toppenish
Union Gap _
Wapato
Yakima _ _ 0.6060410539%
Zillah
County Total: 2.7192887991%
*** - Local Government appears in multiple counties B-12