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| | 2. | | Roll call.
Minutes note: Present 10 - Murphy, Lappen, Mathy, Hutchinson, Kurter, Libal, Ginlack, Smith, Shogren, Bukiewicz
Excused 1 - Wright
Absent 1 - Rainey | | | |
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| | 3. | | Committee membership introductions.
Minutes note: Member Kurter introduced himself as a board certified addictionologist and psychiatrist, born and was raised in Milwaukee, went to UW-Madison, completed his residency at the Medical College of Wisconsin, worked predominantly with patients suffering from heroin and other addictions, had a clinic on 100th St. and Capitol Dr. with a multi-disciplinary team of therapists and other psychiatrists, seeing a rise in overdose deaths and fentanyl deaths, and wanted to lend to the committee and community at large his expertise and knowledge base. | | | |
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| | 5. | | Review or updates on City-County programs, initiatives, grants, efforts or activities.
Minutes note: a. Milwaukee Overdose Response Initiative (MORI) update
Appearing:
Aziza Carter, Milwaukee Health Department
Captain David Polachowski, Police Department
Ms. Carter gave an update. The MORI grant extension was ending at the end of September. There were enough funds to spend for Milwaukee Fire Department salary and other expenses.
Chair Murphy questioned the metrics on the number of people redirected to treatment under the MORI program.
Captain Polachowski replied that the numbers were decent from August to September and would gather and provide further information.
Chair Murphy requested for a formal report regarding successful diversion and referral to treatment data based on year-to-date. He added that the Common Council, under his request, approved legislation to dedicate settlement monies from big pharma companies to augment the MORI program, Milwaukee Health Dept., or other initiatives addressing opioid overdose and deaths. The City Attorney would reveal when and how much money would be made available.
b. Overdose Public Health and Safety Team (OD-PHAST) update
Appearing:
Constance Kostelac, Medical College of Wisconsin
Sara Schreiber, Milwaukee County Medical Examiner's Office
Amy Parry, Medical College of Wisconsin
Ms. Kostelac, Schreiber, and Parry gave an update.
MCW was awarded a 3-year County-level grant through the Medical Examiner's Office from the Bureau of Justice Assistance for the Comprehensive Opioid, Stimulant, and Substance Abuse Program (COSSAP). The program was focused on preventing overdoses and fatal overdoses, and multi-disciplinary partners were brought together to form OD-PHAST. The team was composed of the Overdose Fatality Review Team (OFR) and Data Strategy Team (DST) with the shared goal to develop and implement recommendations to prevent future overdoses. OD-PHAST's capacity building included expanding the role of the Community Resource Dispatcher to include interviews with next of kin, adding a toxicology staff member (laboratory technician) at the Medical Examiner's Office to increase capacity to deliver timely toxicology findings, and connecting with the Milwaukee Community Justice Council's Executive Team to expand capacity for recommendation implementation.
Drug death data for Milwaukee County through early September show 78% of 2021 confirmed deaths involved fentanyl alone or in combination with other drugs. Total drug deaths, narcotic deaths, fentanyl related deaths, cocaine related deaths, gabapentin/pregabalin deaths, and methamphetamine deaths have risen in recent years. Heroin related deaths have decreased over recent years. There were 375 confirmed fatal overdoses from January to August 2020. For the same time span for 2021, there was a 8% increase with 405 total fatal overdoses (306 confirmed and 99 pending toxicology). Every month for 2021 so far saw an increase of overdoses when compared to the same months for 2020.
From 2016 to 2020 total drug deaths increased by 59%, and drug deaths involving fentanyl increased by 322%. The percentage of deaths involving fentanyl and other specified substances showed a decrease in no other specified substances from 53% in 2016 to 39% in 2020, a decrease for heroin from 36% in 2016 to 20% in 2020, an increase for cocaine from 25% in 2016 to 43% in 2020, and increases for gabapentin and methamphetamine from 0% in 2016 to 10% and 6% respectively for 2020. The percentage of deaths involving fentanyl by age group showed an increase in 2019 and 2020 for 50-54 age group. The percentage of deaths involving fentanyl by sex consistently show males between 70-74% and women for the remainder. The rate per 100,000 of deaths involving fentanyl by select race and Hispanic ethnicity groups showed increases for white, black, and Hispanic from 2016 (12.3%, 8.8%, 8.8%) to 2020 (50.9%, 44.4%, 25.2%) respectively. The percentage of deaths involving fentanyl by age group were highest in the 55-59 (17%), 50-54 (14%), and 45-49 (14%) age groups among black individuals; 35-39 (20%), 30-34 (15%), and 25-29 (15%) age groups among Hispanic individuals; and 30-34 (18%), 25-29 (16%), and 35-39 (15%) age groups among white individuals. In summary of age distribution by race/Hispanic ethnicity among deaths involving fentanyl showed 56% of black individuals were age 45-64 years, 50% of Hispanic individuals were age 25-39 years, and 50% of white individuals were age 25-39 years. Based on deaths involving fentanyl by incident and resident zip codes, 95% of decedents were residents of Milwaukee County. Zip codes 53215 and 53204 have the highest rates. Concentration of overdoses compared to drug treatment counseling by Milwaukee County zip code show that drug treatment counseling is not properly align with the zip codes with the highest concentration.
OD-PHAST's guiding principles included the shared goal (North Star) of reducing overdoses in Milwaukee County, recognizing substance use disorder as a chronic, treatable disease, using multi-sector data responsibly to inform response strategies, and sharing accountability for reducing overdoses. For overdose prevention, SWOT primary themes included funding, data sharing and collaboration, criminal justice, access to treatment and support services, and stigma. There were additional SWOT themes identified regarding strengths, opportunities, weaknesses, and threats. An important strength theme was creating and launching a public facing overdose dashboard in the near future which would make more data available on a regular basis. An important opportunity theme was the need for peer support specialists to engage more people in treatment. Some important weakness themes were to see peer support specialists as experts, be paid a living wage, getting hospital systems to be involved in efforts like OD-PHAST. A threat theme was prioritizing the timely identification of drug trends.
DST priorities of note included building capacity on the DST to share important information across sectors, bringing in additional partners where significant gaps exists, and identifying treatment and recovery resources and gaps in access based on location and insurance coverage.
Some sample recommendations from OD-PHAST included making fentanyl test strips more readily available to ensure individuals are aware of the presence of fentanyl in substances they are considering for use, investigating the co-occurrence of cocaine and fentanyl in overdose incidents in Milwaukee County to tailor prevention and intervention strategies.
There were two local recommendations with recent implementation plans: persons who are incarcerated should be trained in administration of and equipped with naloxone prior to release from incarceration and support efforts to utilize community paramedics to follow-up with individuals who have left treatment prior to agreed upon discharge between patient and provider.
Chair Murphy inquired about recommendations to increase services in the two zip codes seeing the most overdoses.
Member Kurter said that the availability of treatment facilities were in areas surrounding those areas most in need, he hoped that the availability of treatment facilities would increase in those areas most in need of them, there needs to be better warm handoffs between hospitals and clinics concerning patients.
Ms. Kostelac, Schreiber, and Parry replied. An emphasis would be to educate the communities that have resisted treatment facilities of the benefits of having such facilities in their communities. They were working on establishing timelines and accountability and would provide further updates to the task force regarding successes and challenges.
Chair Murphy said that the metrics presented were important in formulating strategies and determining how to address different populations based on ethnicity, age, and sex; there should be the identification of responsible parties, accountability determined, and timelines established relative to recommendations implementation; he would like information on the programs and funding needed to carry out recommendations in order to help fund them with the anticipated big pharma settlement dollars; the Milwaukee Health Department Commissioner be present at future meetings; the City proper has not allocated enough resources to address overdose deaths, which have surpassed deaths from homicides and car accidents combined; and the big pharma settlement dollars would go a long way to rebalance the priority to combat overdose deaths.
c. Support for legalizing fentanyl test strips
Appearing:
Senator Lena Taylor, Wisconsin State Senate, District 4
Supervisor Sylvia Ortiz-Velez, Milwaukee County Board of Supervisors, District 12
Aziza Carter, Milwaukee Health Department
Senator Taylor said that a bipartisan bill to legalize fentanyl test strips would be pushed through the upcoming State Senate and Assembly sessions and support from the task force as well as other entities (such as Milwaukee Fire Department, Milwaukee Police Department, Mayor) was sought.
Sup. Ortiz-Velez said that the test strips would detect fentanyl in substances prior to use; be a crime prevention tool; give people a choice; and assist medical professionals, law enforcement, Department of Corrections, and aftercare.
Members inquired about the State hearing dates on the bill, the test strips not being FDA approved, federal funds to purchase the test strips, and the legality of the test strips.
Sup. Ortiz-Velez replied that the dates were forthcoming, the task force would be informed of those sessions, and that there was ARPA funding available from the President Biden administration.
Senator Taylor replied that there may have been pilot programs, and she would look further into the FDA approval status.
Chair Murphy said that he would put in legislation to support the bill, request the City's Intergovernmental Relations Division to lobby to the State, the City funded the Health Department for harm reduction, and the Health Department was purchasing and distributing test strips.
Ms. Carter said that the Health Department did purchase a large supply of test strips, have distributed between 500-800 strips, was still working on distribution, has met some hesitancy from organizations who were wary of the risk and legality associated with the strips, 6000 test strips were purchased, there was still supply available, clients were made aware of the supply by word of mouth, coordination for distribution would be made on distribution, and an inquiry may have been made to the City Attorney's Office on the legality of the strips.
Senator Taylor added that the hesitancy was due to fear of prosecution for distribution, but there would be no prosecution once the bill was passed.
Chair Murphy said that he would like to follow-up on the legality of the test strips with the City Attorney's Office and further Health Department metrics on the distribution of the test strips.
d. BHD programs.
i. Prevention and treatment services
ii. Oxford House
iii. Near-term opportunities
Vice-chair Lappen gave an update as follows:
BHD has been expanding its awareness campaigns through media events, advertising with billboards and bus shelters, and numerous brochures. A constituent's testimony regarding his daughter's heroin and fentanyl overdose at a recent County Executive budget public listening session a few weeks ago was an example that there had not been enough awareness done. Stigma was an ongoing challenge. BHD has access clinics (East and South) available for walk-ins regarding substance abuse issues. BHD has a provider network with access points (virtual and in-person services) for people to get connected to services at no costs. The County had the Community Access to Recovery Services (CARS), Crisis Intervention Services, and MAT: Behind the Walls programs. There was narcan direct provider list with contact information.
The Oxford House program was expanding. There were 6 houses (2 for females and 4 for males) in the Milwaukee area with a total of 44 beds. Occupancy rate was about 80%. One of the house has been down due to a fire. An Oxford house in Ald. Murphy's district was able to improve relations with the neighborhood and seen as a positive through the house's volunteerism in doing landscaping and cleaning up around the area. Stigma of these homes was an ongoing issue, and finding sites continues to be a challenge. 5 additional homes are anticipated for this year with BHD funding $150,000 for the development and legal teams for the homes.
MAT: Behind the Walls was a successful program in the House of Corrections that assists with vivitrol administration and warm handoffs to treatment support services for incarcerated persons. Further data and outcomes from MAT: Behind the Walls can be obtained in the future.
Other residential substance abuse programs became possible with the Medicaid benefit coverage expansion, which has changed the landscape for the County. Medicaid programs are able to get funding. There should be more active advocacy for the expansion of treatment services like safe and sober housing, outpatient clinics, and other forms of housing services. There were ongoing challenges to site acquisition for these programs unfortunately.
There was the new Hub & Spoke Health Home clinic by Wisconsin Community Services (WCS) on the north, central side of the City. The clinic helped with coming up with recovery plans for people, make connections, and focus on the global health of participants. Perhaps a presentation from WCS could be made at a future meeting.
BHD continued to work with the Milwaukee Health Department Commissioner on collaboration. There was collaboration to submit ARPA requests to advance prevention awareness campaigns. There was an idea to also provide information on substance abuse treatment services and suicide prevention when MHD does its door-to-door campaign for violence prevention or vaccination purposes.
Informing and spreading the word to the community regarding all the many BHD services and programs available was an ongoing need. | | | |
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