0ity of Sequim ûeT 2s 2019 !-ìe cclilecl ADOPTED CORE VALUES The City's most important role in economic development is to accomplish our mission, which is "We provide quality, cost-effective services, facilities, and infrastructure to build an exceptional community and a great place to live." The following are the core values and guiding principles, adopted by the City Council on October 13,2014, which should be followed and used to help make decisions related to economic development: 1. Maintain strategic, operational, and financial plans to support the anticipated increase in businesses providing employment and residential growth while maintaining Sequim's small town atmosphere. 2. Continue to encourage tourism as an economic driver and promote the City's and the surrounding Sequim-Dungeness Valley's features and assets, including the natural environment, recreational opportunities, agricultural industry/heútage, cultural attractions and culinary experiences._ 3. Maintain, advocate and work in partnership with regional and community alliances that improve the quality of life and economic vitality within the City of Sequim. 4. Provide the development community with a review process that delivers accurate and concise information as it relates to development standards and the costs of development to ensure that Sequim remains an attractive municipality in which to invest capital. 5. Support development and redevelopment within downtown Sequim which will preserve the district's small town charm, support pedestrian-oriented circulation, and retain the downtown core as the culture heart of the Sequim-Dungeness Valley. 6. Encourage the retention of the unique and small businesses that lend character to our City and are an attraction while supporting new development and infill development of regional retail shopping centers, light industrial, and research and development businesses that help create a diverse economy in Sequim. 7. Evaluate the economic development impact on proposed City regulations which will help maintain economic stability and health. 8. Continue to nurture its role as a desirable location for business, family, and retirement populations and to provide encouragement to the industries that support and serve these populations. Washington State Medication Assisted (;iiy riÍ Sequim Treatment - Prescription Drug and Opioid Addiction Project tlT ti ?)i]19 Preliminary Outcomes through Year Two ,. i .':li Elizabeth Speaker, ñ1S .Jim lz1d.vfìelcl o Sawir \ãkup, M5 ¡ Ba¡i¡¡m Felver, MES' MPA i ìn coilèborålion [;th W¿sl-'ìngton Stare s Deprr'tnìerlt o{ Scc'êl ancl He¡hh Set'¡ices Dìvisiotr oi Behar.ioral He¡l¡ñ 3nC Reco,.e¡tt H¡rbory;erv l,ledical Centef ônd ËverglÊen TieåliÌerit 5€tu'ices !-HE MEDICATION ASSISTED TREATMENT * PRESCRIPTION DRUG AND OPIOID ADDICTION (MAT- I pOOnl PROGRAlvl expanded access to buprenorphine for the treatment of opioid use disorder I (OUO¡ in Washington State. The expansion of this treatment option was to address the growing opioìd epidemic. ln 2015,2.5 million Americans had an OUD.1 Further, fatal drug overdoses have been on the rìse due to an increase ìn opioid deaths, and now overdose is the number one cause of accidental death, outpacìng car crashes and gun Tatalkies.2 ln August 2015, Washington State's Department of Social and Health Services (DSHS) received a three-year MAT-PDOA grant from the Substance Abuse and Mental Health Services Administratron (SAMHSA). The Washington Stâte MAT- PDOA project implemented an evidence-based office-based opioid treatment with buprenorphìne (O8OT-B) model in three locatìons. One location is a large. urban hospital-based safety-net primary care cìinic in Seattle. The other two are opioid treatment programs (OTP) in Olympia and Hoquiam that serve predomìnately rurâl populations via telehealth. MAT-PDOA clinics treated 532 patients in t\¡/o years of operation and successfully achieved the lour goals established by the project: ìncrease MAT capacity, enhanCe ¡ntegrated care and retention, reduce substance use, and reduce adverse outcomes of opioid abuse. MAT-PDOA Project Goals ln the Year One report, lve described the progress of MAT-PDOA during the first year of implementation.ì This report describes the continued progress through the second year of the project (ending July 31, ¿O17). Accomplishments through year tv/o are: MAT-PDOA clinic sites enrolled 532 patients in MAT rvith No 1. 49% buprenorphine. 2. Fifty-one percent of enrolled patients rovere retained in treâtment for a Retained year or longer. ¡n treatmênt 3. Alcohol and drug use rates decreased six months after enrollment ìn one year or treatment. longer? 4. Adverse outcomes related to opioid use disorder, such as hospitalization and unemployment. were reduced six months after enrollment in treåtment. àt DqBrtmcrl of Sxi¡l & llr¿lth S{r!i(6 DSHS Rese¡rcir dnC Dè:a rn¡i] sis Divrs ot Cìympra, Washingloo ' RDå REPORI 4 i02 çÐ^U,S .2 )r-\ I [vr s{s lп,*^ Wrl', tt S+*d GOAL 1 City of Sec¡uinr Increase MAT capacity and number of patients served objectives were estâblished for FIGURE 1, Four specific 2û19 Goal 1: MAT-PDOA Grant Site Locations 0cî 2S 1. lncrease the number of service providers Ëvergreen Treatment sewices, Grays Harbor Clinic iil'ii:,,'¡ii offering MAT. Hoquiam. Grays Hâtb-r Coun¡j il sites use 2. Train staff at designated to I '!. practices implement MAT , evidence-based to 'Ì' 'r with buprenorphine. r:- + ìl 3. lncrease the number of patients receiving MAT for opioid use disorder {OUD). 4. Develop b¡lliñg protocols for MAT. 'l lncrease the number of MAT providers. ln year one. three clinic sites were selected in Gr¿nt lite -Harborview Med¡cal Cenler counties with a high need for OUD treatment Locàtions seatle K¡ng County services based on local opioid treatment Catch,¡enr Aæa i lor Evergreen r Evergreen Treatment serv¡ces, South admissions, OUD related deaths and crime lab Treatment Sound cl¡nìc cases related to opioids. Seruice¡ clinics ì ol)mPia. Thurston county The selected sites were the Harborvierv Medical €enter's Adult Medicine €linic (HMC) (an urban, hospital-based, safety net primary care clinic in Seattle) and two Êvergreen lreatment Services (ETS) opioid treatment progrâms (OTP) (South Sound Clinic (SSC) in Olympìa and Grays Harbor Clinic (GHC) in Hoquiamd) (Figure 1). No addit¡onal clinics were added in year tvvo. Training Staff in Evidence-Based MAT. Project sites hired and trained staff using grant funds in year one. All hired staff were trained on the evidence-based MAT models selected in year one.5 Nurse care managers (NCM) and progrâm managers were hired to assist healthcare providers wiih MAT service delivery. All but one project staff were retained through year two. One NCM at the GHC site resigned and was temporarily replaced by existing clinic staff due to difficulties recruiting qualified staff ¡n that rural community. During year two, all clinics hired one to two medical assistants to assist with MAT service delivery and increase patient capacity. The HMC Adult Medicine Clinic had seven waivered6 physicians who could prescribe buprenorphine in year one. During year two, HMC facilitated two Drug Addiction Treatment Act (DATA) 2000 trainings which were mandated for all medical residents. ln total, the HMC system has 38 rvaivered physicians and trained 18 residents lvho can obtâ¡n the waiver upon medical licensure. ln year one, ETS recruited one addiction psychiatr;st and one pa¡t-time physician-both with waivers- to serve pat¡ents ât both EfS sltes via telehealth. During year two. ÊTS recruited three additional waivered medical providers, including a medical doctor, an advanced registered nurse Practitloner, and a physician ass¡stant. rTo learn more ebout the clini.al site5 sel€cìed. see Speaket E. et ô1. (see page I faotnote 3). 5 ¡bic, É To prerribe or dispense buprenorphine e liceosed physician must apply for a Drug Add¡ctian ¡reatment Å.t 2000 s"iver $ith the Drug Enforcemerìt AgencJ'¿nd complete eight hour: c{ training speciffc to dìspensing conîrolled substa¡cer. See https,/r*".nv.deadirersion.usdoj.gov,/pubs/docs/dvip-buprenorphine.htm. c\¡ ì.4¡êshingron Assi5ted Ìreatment Fre:.ription Drug and Cpioid Add¡ct¡on Prcjecti '1 State Medication - Prelìminðry OL¡lcomes thrcu3h Yeðr TNo lncrease the Number of Patients receiving MAT. The goal for MAT-PDOA is to provide OBOT to 776 patients-over the three-year project. ln year one, 21 1 unique patients began treatment in MAT- Ci!r'nl Seouim PDOA. By thè close of year two, the project had enrolled 532 unìque patients: 198 at HMC, 169 at SSC, and 165 at GHC. Patients enrolled in the program were predominately white, non-Hispanic (76 percent), more likely to be male (54 percent) and aged 26 to 35 {41 Percent) (Figure 2). Of the enrolled patients, 83 percent were receiving publicly funded healthcare (Medicaid). t: :: :::! FIGURE 2. WA MAT-PDOA Demographics of Enrolled Patient Total Participants = 532 GENÞER, AGE DISTRIBUTION RACE,/ETHNICITY M¡NORITY DETAIL Fem¿le Male 767o White, Hìspanic/Lalirro 4696 41o/o Non-Hispani< Bl¡cVAfrìca¡ Ame¡ican Àme¡ican ln.lian/ 20o/o M;nority Alaska Narive 14o/o 24o/o Asian/Pt Õther' 7Vo 6Yo 5o/o 4yo 5Vo 18-25 26-35 36-45 46-55 56+ ' lß¡¡C6 mubÈ ræ4 CdegqÈs æ rpt mrtÉlt trlurÀe NOTE: Ge¡der is unrepoded fo. one Palient. The majorìty (70 percent) of patients enrolled in the MAT-PDoA project were beginning a new MAT ep¡sode. Other patients transferred into the progrâm either from ânother MAT provider (18 percent) or after being released from a detoxification program (12 Percent) (Figure 3). FIGURE 3- Treatment Engagement Prior to MAT-PDOA Screening Total Part¡cipants 532 Receiving Methadone = n=2<11" Not ¡n Treâlment 7O0'6 . ztz " a=64 Billing Protocols for MAT.