MINUTES HEALTH & HUMAN SERVICES BOARD MEETING ROOM #1, OUTAGAMIE COUNTY ADMINISTRATION BUILDING TUESDAY, DECEMBER 13, 2016

MEMBERS PRESENT: Patrick Meyer, Vice-Chairperson; Dan Gabrielson, Secretary; *Justin Krueger; Richard Gosse; Jerry Iverson; Christine Lamers; Keith Suprise; and Cathy Thompson

MEMBERS EXCUSED: Barney Lemanski, Chairperson; and Veronica Flower

OTHERS PRESENT: Rosemary Davis, Director; John Rathman, Deputy Director; *Morgan Hinkley, Brewster Village Administrator; *Megan Vandehey, Brewster Village Student Intern; *Brad Dunlap, Department of Criminal Investigations, Narcotics Bureau; *Chris Wardlow, Substance Abuse Prevention Specialist; Mary Dorn, Public Health Officer/Manager; *Brian Bezier, Clinical Director/Manager of MH/AODA; and Linda Rasmussen, Management Assistant

*Attended a portion of the meeting.

Patrick Meyer called the meeting to order at 4:45 p.m.

APPROVAL OF MINUTES: MOTION – Keith Suprise moved approval of the November 8, 2016 minutes. Seconded by Dan Gabrielson. (7 ayes, 0 nays, 1 abstention) Motion carried.

PUBLIC COMMENT ON AGENDA ITEMS: None

BREWSTER VILLAGE UPDATE AND TABLE OF ORGANIZATION CHANGE: Morgan Hinkley indicated that Brewster Village currently has 2 Administrative Secretaries sharing one full-time position, each working every other week. They are both retiring, which provided an opportunity to evaluate the structure of the position. Various back-up options were looked at, since the two functioned as each other’s back-ups. Additional staff were trained in various duties and discussion was held whether the position could be part time; however, in reviewing a time study and evaluating all of the tasks and how much time is spent on each of those, it was determined that there is a need for the position to be filled in a full-time capacity. The question of whether the position should remain a job share was also discussed. In reviewing this structure, it was discovered that every Monday that each employee worked, they spent a significant amount of their day catching up on the week that they were not there. Other departments within Brewster Village as well as the county were contacted, especially the Human Resource Department. As identified in the Job Description, this position includes many personnel-related functions (background checks, phone screens, drafting of employment offer letters, disciplinary actions, etc.), and it was determined that these responsibilities are best suited to remain as a Brewster Village function.

When taking all of these considerations into account, it was determined that one person in this position, with multiple back-ups, would be most suitable. In doing so, there will actually be a cost savings of approximately $13,000, partly because both individuals that were in the position are in

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the middle to top of the wage scale, and this would also allow budgeting for benefits for one person rather than two.

MOTION – Jerry Iverson moved approval to delete 2 part-time Administrative Secretary positions and add 1 full-time Administrative Coordinator position at Brewster Village. Seconded by Keith Suprise. (8 ayes, 0 nays) Motion carried.

DRAFT RESOLUTION NO.: HS.7—2016-17 – APPROVE VARIOUS BUDGET TRANSFERS IN THE 2016 BREWSTER VILLAGE BUDGET: Members received in their packets a draft resolution to approve various Brewster Village budgetary transfers, as detailed by Morgan Hinkley, Brewster Village Administrator, at the November 8, 2016 Health and Human Services Board meeting.

MOTION: Keith Suprise moved approval of Draft Resolution No.: HS.7—2016-17, to authorize and approve various budget transfers in the 2016 Brewster Village budget. Seconded by Dan Gabrielson. (8 ayes; 0 nays) Motion carried.

UPDATE ON HEROIN AND METH EPIDEMIC: Special Agent in Charge, Brad Dunlap, Project Director of the Lake Winnebago Area MEG Unit, provided members with a presentation regarding the Heroin and Meth epidemic.

The Lake Winnebago Area MEG (Metropolitan Enforcement Group) Unit provides services to Outagamie, Winnebago, Fond du Lac and Calumet counties. The agencies that contribute personnel for the MEG unit include the Winnebago County Sheriff’s Department, Outagamie County Sheriff’s Department, Division of Criminal Investigation, Fond du Lac County Sheriff’s Department, Calumet County Sheriff’s Department, Kaukauna Police Department, City of Appleton Police Department, Lake Winnebago Area Drug Unit, Oshkosh Police Department, Menasha Police Department, Fond du Lac Police Department, Neenah Police Department, Grand Chute Police Department, Town of Menasha Police Department, North Fond du Lac Police Department, and the New London Police Department. The Grand Chute Police Department, North Fond du Lac Police Department and New London Police Department have part time officers in the unit; all others have full time representatives in the unit. The MEG Unit is currently at full staff. Fox Valley Metro Police Department does not have representation in the unit at this time. The unit makes between 450 and 600 arrests per year, about 80-85% of which are felony drug arrests. If it were possible to make heroin go away, the people who are addicted to the substance would find some other opiate drug – probably a prescription drug – to fill that void.

Papaver Somniferum (also known as the Opium Poppy) is a species of plant from which raw Opium is derived. This is the only subspecies of the poppy plant that produces sufficient quantities of raw Opium. Opium can be synthesized into Morphine and then synthesized into Heroin. There are many varieties of the poppy plant, and it is very difficult to tell them apart, but most are not Opium producing.

There are three geopolitical regions where Opium comes from:  Southeast Asia – The Golden Triangle (Laos, Thailand, and Burma)  The Golden Crescent (Afghanistan and Pakistan)  South America (Peru, Columbia, and Mexico)

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Opium is imported into the United States fairly regularly, but it is not considered a “cash drug” such as Heroin or Cocaine, which is sold for profit. Opium is generally imported for medicinal purposes (mostly relegated to the Hmong population).

Heroin is a semi-synthetic. Morphine is produced from Opium, and Heroin is produced from Morphine. In the case of Opium, this is all done in one of the three above-mentioned regions; we do not have Heroin labs in Wisconsin.

Opium has been used for medicinal purposes by many cultures. In the 1970’s, most Heroin was coming from Southeast Asia and was at very low purity (5% or lower). In the 1990’s, most Heroin was coming from Southwest Asia and was at a very high purity (80%). The higher the purity, the more dangerous a drug is with a higher potential for overdose. Higher purity levels allow individuals to snort Heroin versus injecting it to get the same “high” feeling.

In the 1990’s, the narcotic drug of choice was OxyContin, because it was very pure, was easy to obtain, and did almost exactly the same thing that Heroin does. In April of 2010, the producers of OxyContin released a reformulated OxyContin, decreasing the purity to 20% or less.

The Columbians knew that the Cocaine market was saturated in the United States but felt they had not yet tapped the potential of Opiates. They made a conscious decision to ramp down the production of Cocaine and began producing huge quantities of Heroin; therefore, Crack addicts switched to Heroin because it was much more readily available.

Unlike Cocaine and historical Marijuana distribution, Heroin trade is relegated to much smaller quantities that are getting smuggled across the border. From a packaging perspective, approximately three out of four seizures on the street are packaged in “bins” or “bindles”, usually in foil with a very unique fold so they can use the foil as their cooker. The other one out of four are packaged in “gem packs”. A tenth of a gram is the average dose that is sold on the street. Unlike powdered Cocaine where a tenth of a gram is typically the quantity used at one time, the quantity of Heroin used at one time depends on the user’s physical tolerance to Heroin and the purity of the Heroin. A tenth of a gram of Heroin typically costs $40 on the street.

Black Tar Heroin is a product of Mexico, which has not been seen much recently. One of the attractions is that it can be smoked or injected and is a little cheaper and a little less pure.

Heroin is one of the few drugs that both dealers and users may mix with other drugs that contain Diphenhydramine Hydrochloride, such as Dormin or Benadryl. Heroin irritates nerve endings in the skin. Diphenhydramine Hydrochloride is an antihistamine and is mixed with Heroin to combat this side effect. Some individuals mix Black Tar Heroin with Tylenol PM to create what is known as “Cheese”. This helps break-up the Black Tar Heroin so it is more easily dissolved.

Heroin is a Central Nervous System depressant which slows breathing and heart rate. When Heroin is first taken (in the first 3 minutes) a user gets a “rush” or “high” and a very intense feeling of wellbeing. Once the initial “rush” or “high” wears off, users become sleepy or lethargic and begin to slur their words and may even become comatose if they’ve overdosed. If they are functional, they may be seen scratching their skin and staring off into space, and their reactions are slow. Pupil dilation is very slow and typically below 2.9 mm in size (known as pinpoint pupils) if someone is using a narcotic. To avoid noticeable needle (or “track”) marks, some users will use injection sites such as between the toes, the genitalia area, the scalp, or under the tongue.

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Heroin is actually a Morphine high. When someone takes Morphine, their blood-brain barrier is very good at filtering out most of the Morphine. Typically, only about 3% of the Morphine is actually getting into the brain. It gives takers the physical pain relief, but it does not affect the brain. Heroin actually delivers 97% of the Morphine into the brain. This metabolizes very quickly (in less than 3 minutes) in the body into six mono-acetyl-Morphine (6 MAM). 6 MAM metabolizes into Morphine within four to six hours. There is nothing other than Heroin in the human body that will metabolize into 6 MAM. If a pathologist can detect that 6 MAM is in a person’s tissue sample within four to six hours from their death, they have identified that the person overdosed on Heroin.

Several years ago, an individual from Iron Mountain, Michigan was arrested just 3 miles away from the Michigan border. He was getting a supply of Heroin from Chicago to sell in Michigan. The Heroin seized from him was packaged in two zip lock bags; one marked “sell” and one marked “do”. Both packages contained almost equal amounts. When someone gets involved with Heroin, they either turn into dealers themselves or they start committing crimes to support their habit.

Approximately 60% of the dealers currently in Outagamie County are addicts themselves and are “making the run” to Milwaukee. The other 40% are “for profit” only and are often not from the area. In talking about who we as a society are “out to get”, it is not necessarily the 60% who are addicts themselves ... We need to try to help them and take care of the problem that way.

Paraphernalia kits can be obtained through the Needle Exchange Program in Appleton. The three main paraphernalia include:

1. Needles (rigs) 2. Tin Cups or Spoons (cookers) 3. Tourniquets

Heroin is a physically addictive drug, and those addicted to Heroin get to the point of needing to take Heroin to not get sick. They are unable to get the “high” that they once experienced when taking Heroin. This is a cycle that is hard to break. If they cannot get their Heroin, they will often use other types of narcotics to get them by such as Methadone, Morphine, Vicodin or Percocet, to avoid going into withdrawal.

Fentanyl is a transdermal patch that has been around forever and is an extremely effective pain killer, usually used for palliative, end-of-life care, severe pain, trouble swallowing, etc. Carfentanil and Acetyl Fentanyl are being imported from China and being mixed with Heroin, which can be instantly lethal. From a law enforcement or first responder perspective, this is a very dangerous mixture because if a single grain of this gets airborne and is inhaled or gets on the skin, they can overdose and die.

Narcan (Naloxone) is a narcotic (but not a controlled substance) that can be obtained through the Needle Exchange Program at no charge (through a grant). Narcan counters the effects of Heroin and is easy to administer. A non-breather who still has a pulse can be administered Narcan. Once the heart stops, Narcan is no longer effective. A major problem with mixing the Fentanyl with the Heroin is that it is so potent, they will run out of doses of Narcan. With Heroin alone, 1-3 doses of Narcan will probably save a person, but when mixed with Fentanyl, that may not be enough.

Heroin is one of the most addicting and most difficult drugs to get off of. It may take individuals several attempts to fully recover and actually become Heroin-free; statistically, there is a 0% chance

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of success the first time. The withdrawal process takes about three days; this will depend on how long the person has been using, the severity of the addiction, and other physical factors.

Heroin addicts will often designate a person to stay sober so if someone overdoses on Heroin, that designated person can administer Narcan. When a dose of Narcan is used, individuals often wake up in a very argumentative, angry, and combative state because they are actually starting to go through drug withdrawals. They do not typically realize they just overdosed on Heroin.

Methadone is used for the treatment of addiction. While on Methadone, one is unable to experience a “high” as it keeps the Opiate from getting into the bloodstream. When the psychological part takes over and one wants to “get high”, they may stop taking Methadone and start use Heroin again. The latest and greatest hope for treatment of addiction is Vivitrol, which is a long-term Opiate blocker. Even if a person gets past the physical withdrawal, the craving is burned or wired into the brain and the drug becomes a “need”, like food or water. Treatment is an attempt to strengthen and re-route brain circuits to better cope with the craving.

Meth (Methamphetamine) is still an issue and a problem. Law enforcement authorities are seeing a boom in a small-scale meth manufacturing done in soda bottles, using the “One-Pot” synthesis method. This method has made meth easier and faster to make but aso has a significantly increased danger of explosions, burns, and toxic exposures. The ingredients include lithium strips (from batteries), cold medicine (such as Sudafed), ammonium nitrate (from cold packs), and camping- stove fuel. Although meth is highly addictive, it is usually not lethal. Crank Meth is very versatile due to the fact that it can be smoked, snorted, injected, or ingested; Ice can only be smoked. Packaging is very similar to Heroin. Meth is approximately $150 per gram, approximately $100 per half-gram (they are called shards). Meth has a “high” from 8 to 24 hours, and 50% is removed from the body within 12 hours.

From a social perspective, Heroin is by far the biggest dilemma being faced in Outagamie County at this point in time.

A “fifth vital” has been mandated in the medical community over the past approximately 10 years, and staff are now required to ask patients how they would rank their pain level, in order to hopefully identify drug-seeking individuals.

Brad Dunlap gave Board members his contact information, and members thanked him for presenting tonight.

UPDATE ON AFFORDABLE CARE ACT: Jerry Iverson stated that Outagamie County is doing as much as they can to get people enrolled in the Affordable Care Act. Even though there is talk that there will not be an Affordable Care Act, it appears that to undo the coverage will take three years. He feels that although there is a lot of misinformation and miscommunication going on, it is important that everyone who knows people who are uninsured be encouraging them to sign up. Fewer and fewer employers are offering health insurance. We can debate the issues of why it is so expensive for people who are buying it through The Marketplace; however, there are a lot of things that caused its demise. There will be a meeting at the Appleton Library tomorrow which is sponsored by the Citizen’s Action Group of Wisconsin, to talk about how important it is for people to enroll. There has been discussion in the past about the fact that mental health is not excluded in the Affordable Care Act, and if that reimbursement goes away, the county taxpayer will pay for those costs. It is also a significant advantage for people to get preventative care rather than emergency

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care. Individuals can sign up either this month or next month, but after that, there has to be a qualifying event to sign up.

The next meeting was scheduled for Tuesday, December 27, 2016, at 4:45 p.m. Due to the holidays, this meeting will be cancelled. The next meeting will be held on Tuesday, January 10, 2017, at 4:45 p.m.

MOTION – Dick Gosse moved to adjourn. Seconded by Chris Lamers. (7 ayes, 0 nays) Motion carried.

The meeting adjourned at 6:05 p.m.

Respectfully submitted,

Linda Rasmussen

Linda Rasmussen Management Assistant

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