Thurston County Opioid Response Task Force July 06, 2020 from 3:00pm-5:00pm Thurston County Public Health & Social Services Department Zoom Meeting – Virtual Only AGENDA Description Action Steps/Items Welcome / Schelli Slaughter welcomed everyone to the meeting and noted that introductions would be done during the roundtable, due to being Review Minutes / hosted virtually. The March minutes and the May agenda were approved without updates. Review Agenda Meth & Polysubstance Dr. Caleb Banta-Green, Principal Research Scientist at University of Washington’s Alcohol & Drug Abuse Institute (UW ADAI), presented Use information methamphetamine and polysubstance use (see slides for more information). Dr. Banta-Green explained that a survey is conducted at syringe service programs in Washington every two years, with the intention of gathering data around substance use and related behaviors. Data collected during this survey includes substance(s) used in the prior 3 months, method of consumption (smoking, intravenous, snorting etc.), level of interest in stopping or reduction use, etc. Dr. Banta- Green shared 2019 Thurston County survey data on the number of individuals who reported being somewhat or very interested in wanting to stop or reduce their use – about half of individuals who use stimulants and three-quarters of individuals who use opioids. He expanded on this information, sharing data on the types of help which individuals reported they would be interested in – with the primary response being Medication for Opioid Use Disorder (MOUD). It was explained that many individuals continue to use opioids to avoid feeling bad or experience withdrawal, whereas individuals who use stimulants report a functional benefits as the reason for their use, including: energy to not be victimized at night while sleeping outside, depression relief, energy to work, preventing opioid withdrawal symptoms, etc. The impacts of other substance use on MOUD for opioid use were explored, specifically relating to initial access to treatment and continuation once treatment is initiated. Dr. Banta-Green discussed the barrier of MOUD programs prohibiting polysubstance use or continued use, specifically when a majority of individuals report using multiple substances. He emphasized that many more individuals could access Medication Assisted Treatment if people could start/stay on MOUD while using other substances. This is attributed due individuals lessening opportunities for meth use and allowing time to work on issues during meth use after their opioid use is managed. Dr. Banta-Green shared data relating the positive impact which this can have on treatment engagement from the evaluation of the Bupe Pathways, a low-barrier buprenorphine (MOUD) program in Seattle. Dr. Banta-Green shared that there is not currently an approved medication for the treatment of stimulant use like there is for opioid use (Suboxone/buprenorphine, Methadone, Vivitrol/naltrexone). Initial research on medication-based treatment for stimulant use have explored a range of pharmaceutical intervention possibilities, which are: promising practices, have mixed results, or have modest yet significant impacts. Data from such studies was shared, including the use of methylphenidate (Ritalin) and dextroamphetamine (Adderall). He also noted that long-term engagement in treatment is helpful when exploring potential treatment and supportive services for stimulant use, as cognitive deficits are long-lasting for methamphetamine (6-18 months). The engagement can be encouraged through motivational interviewing and acknowledging the positive benefits which the person experiences from their use. Discussion – Race, Mary Ann O’Garro shared the importance of the intersection between race equity and the Thurston County Response Plan. Goal 5 of Equity, and Goal 5 of the the Response Plan focuses on strategies to address stigma and the risk of overdose specifically in diverse communities and in Response Plan populations which are disproportionately affected by the opioid epidemic. Mary Ann requested that the Task Force brainstorm what could be done relating to race equity and addressing the topic within the Task Force, such as specific trainings or presentations from subject matter experts. Jon Tunheim suggested the need to expand the scope of the strategies within the Task Force to include all substances, rather than focusing exclusively on opioid use – especially after the presentation from Dr. Caleb Banta-Green. He included that this would mirror the direction the State is headed, as the Washington State Opioid Response Plan broadens to become the State Opioid and Overdose Response Plan. Katie Strozyk suggested the Task Force look at Thurston County data to see if there have been disparities in overdoses, both fatal and non-fatal. She included the need to explore interventions which would prevent future disparities from arising, as well as address any historic disparities from worsening. Keylee Marineau emphasized the need to center voices of black and brown individuals, both who work in systems and who access these systems. She included that these race equity conversations cannot be siloed into topic specific vacuums, as this fails to address the larger issue of racism. In avoiding siloed responses, she urged that work should be connective to current efforts in the community and other response plans (Thurston County Homeless Crisis Response Plan, etc.) and conducted in a manner which is transformative in creating meaningful long-term change. Larry Jefferson suggested the book Beyond Inclusion, Beyond Empowerment by Leticia Nieto, as it dives. He suggested having her as a presenter at a future Task Force meeting, sharing glowing remarks from attending a training she hosted previously. He spoke to the need to acknowledge how coercive the legal system currently is and look towards diversifying responses outside of the legal system and other traditional methods - specifically the need to focus on restorative justice across all areas and decrease the reliance on court- based responses. Mary Ann shared that Thurston County Public Health is currently working with other local health jurisdictions and the Washington State Department of Health to advocate for modifications to the Behavioral Risk Factor Surveillance System (BRFSS) survey to include questions which would measure the impact which race and discrimination have on access to care and health outcomes. Meta Hogan commented that the growing up and living in a racist culture is a stressor for everyone and that addressing how these stressors impact disordered substance use would have a positive impact for a wide variety of people in the community. Marianne Clear shared that the current Addressing Pre-Trial Policy & Research (APPR) 5-year technical assistance project that is underway in Thurston County is looking at data points and exploring the pre-trial system through a racial lens while looking at systemic changes and impact. Schelli Slaughter shared that the Thurston County Board of County Commissioners (BOCC) and Board of Health (BOH) discussed how other jurisdictions have declared racism as a public health crisis and are interested in engaging in further conversations around Thurston County data. Commissioner Tye Menser shared that the BOCC/BOH looked at the Pierce County and King County, which both focus on evaluating current policies, and discussed whether a declaration is the appropriate vehicle in moving this work forward – while acknowledging that work will move forward regardless of whether a declaration is made. SMART Objective Update Katie Strozyk provided an update on the adjustments which work groups have submitted regarding their previously set SMART objectives. These revisions to the SMART objectives are being made due to the variety of changes and barriers which have arisen due to COVID-19 response. Katie shared information regarding the following adjustments: • Total SMART objectives = 33 • Objectives complete (as of June 30, 2020) = 8 • Objectives stayed the same = 8 • Objectives revised = 10 • Objectives in review/need more information = 5 • Objectives dropped = 2 Katie Strozyk reported that the Naloxone work group adjusted their goals due to limitations on the ability to hold overdose response trainings and still being unsure as to what form Overdose Awareness Day will operate in with restrictions on social gatherings changing on a continual basis. The main adjustment was to the number of trainings which will be held, due to an inability to offer trainings for multiple months as well as shifting from an in-person training model to a virtual platform. Jon Tunheim shared that the Criminal Justice work group decreased their metrics but kept their overall objectives the same. This decrease accommodates for the Innovative Justice group being unable to convene temporarily earlier in 2020. Jason Bean-Mortinson reported that Treatment work group has tentatively decided to keep their objectives the same. They plan on moving any in-person gatherings within their objectives to a virtual platform. Mary Ann O’Garro shared that the Prevention work group is primarily revising metrics and timelines on their SMART objectives. These revisions allow for objectives which had an in-person element to be moved to a virtual format, as well as adjusting community messaging methods to consider current stressors and information overload due related COVID-19. For the Data work group, timelines are being revised on current objectives. One objective was dropped