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Authorize the County Administrator to execute, pending county counsel concurrence, an agreement and any amendments with Health Management Associates on behalf of the California Department of Health Care Services to receive $25,000 under the Expanding Medication Assisted Treatment in County Criminal Justice Settings: A Learning Collaborative Grant for the period August 1, 2018 through March 31, 2019; and Approve an Appropriation Transfer Request to recognize $25,000 in unanticipated grant revenue and related appropriations to participate in learning collaboratives and receive training and guidance (4/5 vote required)
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Published Notice Required? Yes ____ No _X _
Public Hearing Required? Yes ____ No _X _
DEPARTMENTAL RECOMMENDATION:
The Sheriff’s Office recommends that the Board of Supervisors:
1) Authorize the County Administrator to execute, pending county counsel concurrence, an agreement and any amendments with Health Management Associates on behalf of the California Department of Health Care Services to receive $25,000 under the Expanding Medication Assisted Treatment in County Criminal Justice Settings: A Learning Collaborative Grant for the period August 1, 2018 through March 31, 2019; and
2) Approve an Appropriation Transfer Request to recognize $25,000 in unanticipated grant revenue and related appropriations to participate in learning collaboratives and receive training and guidance (4/5 vote required).
SUMMARY:
On July 23, 2018, the Department of Health Care Services (DHCS) awarded the County of Solano Sheriff’s Office a Learning Collaborative grant in the amount of $25,000 to expand Medication Assisted Treatment (MAT). The grant would support a County Team assembled to address challenges and to develop an implementation plan for Board consideration that is based on best practices and that builds on the experience of other California counties. Twenty-three California counties have been awarded this grant.
In Solano County, the profile of the adult jail population shows that 85% of inmates are impacted by substance use. The last decade brought the explosion of methamphetamine use, and while trends indicate that the opioid crisis has not yet hit California as hard as other states, it is on its way. Eventually we may see a much higher number of opiate addicts in Solano and in the jails and this is an opportunity to be proactive. Funding from the MAT grant would educate Solano County on how to effectively treat inmates/clients in order to improve health and wellness and decrease the possibility of overdose and death.
FINANCIAL IMPACT:
Funding under the MAT award is not contingent upon matching funds from the County. The award provides $25,000 for the County Team to attend in-person Learning Collaboratives, participate in monthly coaching calls, webinars, and podcasts, and access resources established specifically for this project including a Resource Library, an Advisory Group, technical assistance, and training to develop and implement data collection.
The Sheriff’s Office requests approval of an ATR for $25,000 for FY2018/19.
The costs associated with preparing the agenda item are nominal and absorbed by the department’s FY2018/19 Adopted Budget.
DISCUSSION:
The United States faces an epidemic of opioid addiction and overdose deaths. Drug overdose is now the leading cause of accidental deaths in America. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 1.8 million people in 2013 had an opioid use disorder related to prescription pain relievers, and about 517,000 had an opioid use disorder related to heroin use. In April 2017, SAMHSA awarded the State Targeted Response to the Opioid Crisis Grant to DHCS. The purpose of the grant is to address the opioid crisis by improving access to treatment, reducing unmet treatment need, and reducing opioid overdose related deaths through the provision of prevention, treatment, and recovery activities for opioid use disorder. California’s sub-grant program is the California MAT Expansion Project.
MAT is the use of FDA-approved prescription medications, usually in combination with counseling and behavioral therapies, to provide a whole-person approach to the treatment of substance use disorders. MAT has been clinically effective to alleviate symptoms of withdrawal, reduce cravings, and block the brain’s ability to experience the opiate’s effect. MAT maintenance has been proven to cut overdose rates in half and decrease rates of HIV and hepatitis C transition. Detoxification (use of medications for 1-3 months), in contrast, increases mortality rates and does not improve long-term outcomes. Research shows that a combination of MAT and behavioral therapies is a successful method to treat substance use disorders. MAT in correctional settings has been proven to lower mortality on release; the Rhode Island Department of Corrections dropped overdose deaths by 61% within a year of implementing their MAT program (which offers all MAT options - buprenorphine/Suboxone, methadone, and naltrexone/Vivitrol) to inmates. In addition, inmates receiving methadone continuation during incarceration are three times less likely to act out than those in forced methadone withdrawal and are also four times more likely to engage in community treatment after release.
Solano County has not considered use of MAT in our jails. Staff would like to be a part of this learning collaborative in order to develop a better understanding of MAT, understand how it has been implemented in other jails and jurisdictions, understand the best practices in criminal justice settings, and have guidance in developing a plan to implement MAT in the jails to present to the Board for consideration at a future date. An understanding of how to develop a continuum of care from jail to the community and vice versa is also a critical component of this process.
The ultimate goal of this grant is to increase the knowledge of the Solano County Collaborative about MAT and evidence-based practices for MAT in criminal justice settings; and developing a plan to provide continuity of MAT between Drug Court and Jail for Board consideration.
ALTERNATIVES:
The Board of Supervisors could choose not to accept the grant; however, this alternative is not recommended as the opioid crisis is not limited to our communities, it impacts inmates in the County’s custodial care and funds are needed to train staff and provide the necessary resources to develop a feasible plan for Board consideration.
OTHER AGENCY INVOLVEMENT:
The County Team includes representatives from the County Administrator’s Office, the Department of Health and Social Services, the Probation Department, the Superior Court of California, County of Solano and the Solano Coalition for Better Health.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION