Pasco BOCC Workshop, 08.28.2018

[Applause] [Music] [Applause] [Music] I'm estranged so I'd like to call the order the workshop for August 28 2008 seen if we could simply stand for the pledge and indication of pledge amen cleanliness in the flag of the United States of America and to the Republic for which it stands one nation under God please hear thank you thank you we appreciate uh amber Mariano being here and I understand that mr. piller rockets will be here shortly and I appreciate everyone everyone else being here it's the reason we're kind of shuffling around is it's it's important to me that we're all together on this I would love to have us all sitting at this table but it sounds like we can't make it work for today this will not be the last meeting this will be the first of many meetings that we have together as one we've always operated in my opinion at separate silos we wouldn't be here today if we all don't care about our community and others and that's that's what this is about and it's important to me again that we are all together so I apologize we're not all together table today but I can assure you speak up this board we are all together I want to get into us being in last place whatever place we're in but we're not in a good place I'm not okay with the words not okay with it and I know each of you are not okay with it this is the day that we need to work together to make change see what we all do differently what we're doing isn't working and I challenge each of you through today to to look at those things and see together what we can do and that's really what it's about it's great to have I'm just so stay here I believe is any of the aides here like mr. Burgess or senator Simpson do we know Robert but I know the thing they couldn't make it because we kind of gave him a little bit of a not enough notice next time we will well we know that this is a county problem estate problem a federal problem and I hate to say problem let's say opportunity and we are going to be able to see this number increase period has to and it will so I just want to thank everybody for the time again I apologize thank you judge crane and save it in the Monica sorry take your chop here the table but next time if it's pretty much now you will all be at the table because we really are wok so thank you and with that if I could go ahead and pass it over to Kim great thank you first I want to thank you commissioners for having us here today at the table and also to our esteemed colleagues in the field we all work together as commissioner well said it's important for us to have a plan of action and we need to come up with that as we as he said we work in silos silos don't effectively than anything I've been in this field for a while and the difficulty is with opioid addiction it's not something we can get rid of completely because there are people who

need opioids we all know someone who's suffering from cancer or someone who's using these drugs in the effective proper way but we also know someone that's abusing them so to take them off the market completely it's not even an option what we need to do is find a way to prevent the abuse while still serving the public that needs the opioid drugs and that's a difficult thing to do so what we've done together is bringing together the experts in our field locally to speak to the commissioners today and everyone else other dignitaries that are here to go over what they're doing currently and what we can do together as a team in the future so we have today six different speakers they're each going to have about 15 minutes to go over their presentation we're going to go around the table though each come up and speak after they're done they'll go back to that table if they have any if you have any questions for them please feel free to ask keep your questions to a very minimal time frame because of time constraints and then at the end we can kind of bring whoever back to the table if you have questions so the first speaker today is going to be captain Mike Jenkins from the Pasco County Sheriff office he is here to represent the Sheriff's Office programs to address the opioid epidemic and Captain very good well first of all thank you very much for the opportunity you're today I'll be brief with the introduction so that we can jump in I know time is very valuable so I've been asked to talk about two things number one give a snapshot of what's occurring within our County from a law enforcement perspective so we're gonna go through we're gonna look at some data here in just a moment but but before we do that I'd like to talk about the second thing briefly as well just to let you know what to expect second thing we're gonna be talking about is some of the things that the Pasco Sheriff's Office has been involved in order to address this epidemic and so those are gonna be the two areas that they were looking at if you look at your first page one of the data points that I thought would be particularly helpful is to look at our overdose cases for the last particularly starting in January of 2000 here's what's interesting most of us know that through 2006 before as we were setting the rest of the country experience in the opioid epidemic we were not experiencing the same problems in Manatee County we just simply weren't there all of a sudden in 2017 we started to notice it started to creep into our area to the point in 2017 where are our overdose deaths and opioid related deaths reach the same level so if you look at this chart you'll notice in the red right that's up you'll see the blue line that's all of last year you'll notice that there is actually a significant increase in overdoses reported overdoses that the sheriff's office and our EMS have been responding to over the past year and a half and it continues to increase so there's been a rapid rapid increase if you look at the

next page we're all we're looking at all overdoses by outcome so the last slide that we looked at simply talked about overdoses that include overdoses that ended in death and overdoses that did not end in death this page that you're looking at now with the blue line in the red line shows the number of overdoses in blue and the number of overdoses that resulted in death in red now here's one boy's spot that I think we can talk about in the midst of these terrible statistics and that's this although the number of overall overdoses has gone up significantly the number of overdose five ahead of where we were at the same time now again certainly we still have issues we have issues that need to be resolved that's why we're all here together today we'll talk about why I think that may be there although the overdoses have increased significantly why the overdose deaths have not increased in calm you turn to your next page you know we we tried to utilize our resources based upon the data that is available and and what is concerning and I think what really validates an earlier statement which is we weren't experiencing the opioid epidemic here in Pasco County in 2015 and even 2016 it is hard in 2017 we're continuing to get hit hard 2018 statistics here show then 2018 76% I'm sorry 67% of the overdoses are related to heroin or fentanyl and so I'd like to talk to you just a little bit about right so heroin and fentanyl are two of the primary opioids that were experienced with illicit narcotics use in the past fentanyl first came out that was the hidden killer right people were taking fentanyl they were putting it in the air when in order to increase the high people were not accustomed to that they were overdosing somewhere dying breath the addicts out on the street has realized that Becnel actually produces a different kind of high a different kind of high that is stronger to the person who has a strong addiction to heroin we actually have addicts on the street now that are not interested in heroin and so we're starting to see you know an increase in this opioid addiction cycle and it's very very dangerous we've also found one of the difficulties that we have the sheriff's office it's very taxing on the resources so we have individuals who are being arrested they're addicts they go into the jail to begin to experience symptoms obviously of not having access to that drug experience and throughout that process what happens oftentimes we have a medical protocol that will help them get through that process they get clean and they even go back down on the street and a lot of them are shooting up the heroin and fentanyl the exact same level then when they came in that's what's leading to a lot of the overdoses as well because there's a tolerance level that's associated with that next slide we've created a heat map and really this heat map I think is really informative it's not only informative for the Pasco Sheriff's Office but it's informative for all of the individuals here today because it

helps us to really define where are these problems at and one of the things that you will notice immediately is that it is that us 19 corridor really from county line to county line that is where we are experiencing the vast majority of our overdoses and our overdose yes and so I referred to why I think that although the overdoses are increasing significantly the overdose the deaths have not increased in kind I think one of the reasons why that is occurring is because of the deployment of narcan so many of you know that the Pasco Sheriff's Office in March of 2017 our sheriff made a decision that all of our law enforcement personality training and actually receive narcan at the end of August we have 43 to go we're seeing obviously doing it and we're finding the narcan availability to your average citizen is also leading to people who lives or means that we spoke to somebody recently that we arrested [Applause]

Natick sentence he said look don't apply logic to the Attic that you yourself with that being said there's no doubt what's happening is they're gonna take the drug regardless of whether or not in our can available finding it the narcan I don't know that it empowers them per se to get that drug because the attic mine I don't have narcan today but but again certainly it increases he just triggered something when you said the dealer why is that dealer on the street still so I guess that's the question is how many fruits it with that person so we have people that are abusing the drugs and stuff was it you know it's really not I'm saying this guy doesn't need help to sure people they need help right we have this person that's out there all these lives in the day to day basis because of what they're doing to make money I know sometimes they're making it for them have at the same time making money to make money so how many times is this person released how many times is this person gone to court how many times this person had been in jail before they actually set foot in prison so so this person that we've actually arrested as spend a significant amount of time in jail and past isn't addict deals in order to support that and base possible recent charges will be returning back for significant the as far as it's a problem I can tell you that I oversee the Special Investigations Division so while all the Sheriff's Office law enforcement personnel conduct narcotics investigation my hair is responsible for the investigation so what we have done based upon this data we have reprioritized our investigations we are conducting advanced investigations that are targeting sources and supply into the past couple counties a right now it's not prudent for me to talk a whole lot more about that just simply because we don't want to jeopardize the nature those investing well of course how much do they have to hold to be charged with a felony well if they sell any amount any amount of a controlled controlled substance it can be it's a felony it's a second-degree felony and then it goes up from there the trafficking amounts and and if you have an over an ounce of cocaine for instance that's a trafficking amount and and the more you have the higher the punishment and the penalty is the answer the first part of your question if I could what happens is our goal in the treatment court and drug court is we can take that person who's dealing to support their habit as captain Jenkins is referred to and then our job is to get that person out of their habit and therefore we kind of take a dealer off the street we take someone out of custody and then we and remember these people are seen on a regular basis by me drug screen and that sort of thing and if and if appropriate they're put right back over you know in Land O'Lakes if it's appropriate under the circumstances so we try to think a balanced approach to that and and have the opportunity to give someone their

life back that they didn't already have as indicated once again by captain Jenkins point well made didn't wake up and say gee whiz I think I'm gonna really not use today because a narc hands not available or or I think I'm going to get caught or whatever they just you know they're in this vicious cycle and that cycle rules there I could appreciate that I guess but but and if I could it there does certainly come a point in time that these folks need to be held accountable and responsible for what they're doing to our community let's make no mistake about that that's one of these very typical to help allow these people when they have access and these people are the ones that are giving them access yeah we provide that what we have found though is that the problem that we're experienced we don't really view certainly there's a there's a supply issue and that's a concern but but in reality is it's the needed the Attucks that drive it so what we have found is that as we arrest from Olympic drug dealers who have all we don't know ghost ask that boy feels very quickly simply because it is very very profitable one of the things and I know dealers or users yes sir so one of the things that we do and I'm jumping a little bit ahead here but we look for strategic partnerships and so we have Task Force agents on both the DEA and FBI and we are constantly evaluating whether or not is appropriate to take some of these prolific violent drug dealing offenders who are not necessarily users although some potentially can be heroin along with the possession of a gun that's a 15 year been made so we're constantly looking at what is gonna give us the best bang of the buck in order to bring the highest level of accountability to the people who are directly responsible for providing these drugs and quite frankly leaning to the decibel and those folks for the folks that don't come to drug court you don't have good let make sure we're clear on that right and so what I think you're probably fine if we turn to the next page is Captain represented Mariano had a question I was gonna ride along [Music]

[Applause] yeah most so or statute was passed where is no longer prescription is not required any longer to have access so their giveaway programs I know some of the ASAP events there have been no narcan is available that is given for free out to the public people can generally go to any one of Walgreens or CVS and and purchase narcan's availability yes the availability is it's very easy it's very accessible somewhat how it's expensive is it tonight I thought I was going to impress giving giving away even I had seen $75 for two doses is it one is it one one-time use utilize it congressman bill erectus we appreciate you being here monthly and let me just update the board I know captain Jenkins talking about 44 deployments of narcan that he's used last year you know some numbers from our fire team they have ministered 853 last year so think about that let that sink in I mean we're talking about you you all use you know we've got 853 which I thought was interesting where over 50 percent of that is majority 50 or above most of the majorities over 70 yeah which is interesting I would think it would be a younger demographic but that's it's it's significant so one of the reasons why we deployed it ordinarily right that is a life-saving measure you have the different speakers come up today I think that you're probably gonna follow that all of the proposed actions are actions that are currently being taken are gonna probably fall into these four categories right and they're people may have different names for that but prevention and education that that's significant right treatment you have people who are addicts and they need help any trade treatment intervention those are people who obviously are are are addicts and they need something someone somehow to intervene to help get them on the right path and then finally obviously recovery those are people who for addicts they've gone through treatment and now they're at a continuous cover to make sure that they could address back into that problem behavior so at the Pasco Sheriff's Office like many of the other agency here in Pasco path we recognize that the Pasco County Sheriff's Office can I solve this problem we cannot arrest our way out of the opioid epidemic it's just simply not the practical it's not cost-effective and it's just not realistic certainly there is an important law enforcement component we've discussed that already briefly however treatment recovery of the intervention in the education and so one of the things that we've done in the past by Sheriff's Office is we partner with the faith-based community and we have a celebrate recovery program in the jail and that's where individuals get access to faith-based resources to help get them in the right direction provide them with the resources and then of course when they get out the idea is that they continue to partner with those state based organizations to get the support and the encouragement the resources needed in society another

people have access to and yeah okay we've got to make sure that people have access to it and you said that it's available at the sheriff's office for free okay where is it available for free I mean yes so the individual companies will have a process in which people can apply for it for free so if you're indigent you don't have insurance and you make less than a hundred thousand dollars a year a person can fill out a paper form fax it to the manufacturer so and ezio would be one of them and then they are then shipped the the item at no cost the trick is you know not everyone has access to a printer or a fax machine so it is a bit of a lengthy process but a really cool opportunity to partner with those companies to expedite that process the other I just wanted to add something to what you said with regard to the the seniors the high-risk seniors that are taking opioids we passed legislation actually was my legislation to to make sure mandate a lock-in program now we've got to be careful folks because I hear from my constituents on a regular basis I'm sure you do too jack you know an amber where they're not getting their pain medication and that's a big problem too so but this lock-in program will apply to high-risk seniors so they were lock-in a couple pharmacies maybe up north why not north to down here so that we can keep track the pharmacies can keep track you know so we can eliminate some of this pharmacy shopping and and frankly doctor shopping and and that's not going to alleviate the problem completely but I think it will be helpful but we've got it get back to the narcan we've got to make sure I mean you're filling out the application I guess it's similar to the 340b program where if they can't afford to get it they apply for it but I think you know since we've appropriated these funds we've got to make sure people have access to it sorry I did have another way people can get narcan there are a few DCF is contracting with a few nonprofits in the state so I think we we have a few in like Bradenton but they get shipments of narcan that they can give out for free as they so choose so that could be another opportunity to look into partnership because that's very good is that we're trying to come up with solutions here right so we're talking about the seniors that that needs to be part of the conversation in my opinion going back you know whether we involve the Area Agency on Aging because it obviously is an education factor people are mismanaging their medications that's a problem and they need to be included in the toss yeah we're trying to find solutions here today so that has to be I think part of that part of the solution very good to kind of piggyback off that one of the things that we recently implemented were in the process of implementing we developed a partnership with Haida that's high intensity drug trafficking areas that's not Washington DC yes yes they said what they have to

have something what's called OD map and what we what we would like to implement we're gonna need to partner with Fire Rescue to discuss the best way to do this but is implementing overdose data inside of a database real-time so that we can begin to start having real-time data involving over those activities so that's helpful so I've showed you some heat maps that's delayed right that's usually about a month or so behind just because the analysts need to crunch the numbers and develop the maps OD map has an opportunity through through mobile phones members of the sheriff's office and Fire Rescue can actually enter in the overdose data and it can immediately go in and then we can have a snapshot real-time about what kind of overdoses are occurring what drugs are involved and I think that the implementation of that if we can get widespread usage and come up with a great policy between the Sheriff's Office and in Fire Rescue how that's gonna be implemented that's gonna be helpful because we're gonna be able to deploy resources appropriately based upon real-time data and so that's something that we recently signed an agreement we're working through and we're gonna be sitting down with a fire rescue to discuss exactly what that's gonna look like a lot of its in my district it's here that one should be farmed spider Mike should be I'm wondering if as you're mapping I mean are there certain residences that have high incidence of calls to certain residences and how they're off you know and I think of leisure lane trip and you know it's not happening myself so what are we doing to be proactive about places where this is occurring yeah and so we've actually identified residences where there have been upwards of four or five overdoses they've actually occurred so those homes become an investigative difficulty is that when you suppress area like these are Lane will the best people some of them will go to prison and then there are other individuals who will move right and so on you know we were working with the sheriff on a rental registry and I know the sheriff gave us a model ordinance for rental industry and one of the premises in that registry was to hold the landlord accountable for the actions occurring in his shop and our rental registry is a little stalled but I know the sheriff is I do think that when you have someone who's as property that's being used they allowed to continue if they're aware of it obviously we've got our relationship in the drug court or judge crane is gonna talk about that Pascoe ASAP we've got Monica here who's representing again there's already a lot going on so I know that it's tempting for us sometimes to look at this epidemic look at the numbers recognize that it's growing and there's a temptation sometimes to think hey nothing's being done here's what I can tell you there's actually a lot with that being said we need to improve we need to continue to be teachable we need

to explore other opportunities so that we can get better but I can tell you this with that is if we did not have the efforts that we're currently going on Vince finally I'm talking about our strategic partnerships again I mentioned the FBI and the DEA before again we at the Sheriff's Office are constantly looking we want to hold these people the highest level of accountability and there are times we're not taking it to the state system drug offenders we can get minimum mandatories for very dangerous individuals take them out of society a couple of other things that we're doing that's very intentional I referred to this earlier we haven't bath and advanced investigative efforts that are focused on while certainly right the users are an issue focus our efforts particularly from the Special Investigations Division on the dealers and the source of supply that's really good things come back currently we do have in-house tracking I can email every overdose every single overdose the Sheriff's Office response to my area and my chain of command we get an overdose and we begin to about look at raw data but also for investigative opportunities what congressman had mentioned about all of the funds that are available we're pursuing hundreds of thousands of dollars of grants from the federal government in order to support our efforts particularly from a law another thing we've created a VSO addiction guide who are in the jail people go out on the street just introduces them to resources that are available that can assist them with their recovery with their treatment and so on and so forth and then finally one of the things that we've done recently you know we're talking about this workshop and hey let's all get together and let's figure out what the great ideas alright I'll tell you some of the best ideas or stolen ideas those are ideas that we can get from other jurisdictions so we've actually started reaching out to other jurisdictions who have experienced this at higher level and said hey what are you doing how are you doing it what's been successful what's not been successful and that's how we found out about OD map and a variety of other things you know one of the things I learned during a recent conversation is that EMS it sounds like our EMS is already doing it which is wonderful but they have a big red we just say for a lot please take a look at the information enclosed and get help and then they have a series of different things that if we really want to be effective we absolutely have to have a comprehensive multidisciplinary strategic and coordinated response so I would just like to say thank you for the opportunity to come and just give you a basic overview talk about some of the things that the Pasco Sheriff's Office is doing but also these types of conversations help facilitate the breaking down of silos coming together and be more unified in our response as a county in captain Jenkins that's to me that's what it's about to this board

that's what it's about it's not that we we're not doing anything and I don't think anybody's ever said that but but you talked about funding and under the state set aside fifty three million just for example and we need all be together with that if we're gonna apply for something we should be applying together or not you applying and then you know Monica applying and then judge you know we we need to pour stronger together I mean I can relate it to homelessness you know we've all been meeting all the board's met with Florida Homeless Coalition from the state they're coming in meeting with every silo to help us deal with this opportunity and they were able to take Sarasota and get the population population down 50% it's the same thing here and I would love to see something like that happening here and maybe it's us performing a task force as a county to work with other counties that have been successful wherever they're at so we can continue to address this because I again this isn't something we're gonna be sitting down once a year talking about this this summer with its top of mind for all of us we need to continue when you track we need to hold each other accountable so thank you for everything your team's doing but I just know we all can do more and I have I know we will or he wouldn't be here sister customer okay I agree I know where yeah we do have to keep it going mr. really appreciate you being here your insights and Terry angel alleged to hear I mean I think your conversation started this whole meeting to happen so I appreciate your being absolutely yeah I want to touch in congressman bill Iraq I should be there to it what I want to throw this for kind of thought you know care if I can answer right away but I want you to think about this we know how bad these things these open eyes out to be in a decade okay they're they're allowed to be leading when I look at it the danger that I police are first responders will in the minor paramedics well the dangers room with these people on these drugs that aren't unconscious if you're surviving how dangerous is for these people compared to if they were if more people are in medical marijuana and when I look at the percentage of people that are over the age of 50 years old I can't mention these guys going on the street looking for these drugs until they get started on it medically and in commissioner Wells I think you did it almost when you took our own people not to distribute opioids when they're treating this paramedic as well I'd be really looking at the wrong causes and really let's get down to the basics like opioids they're dangerous or addictive they can have their places regulated properly but we've better off looking to make marijuana legal in the sense it at least make it a lot more available medicine for these people to get the treatment so they don't get stuck in this mix we can see thank you I know where this is an important subject I know we're gonna go over on time and I have to be somewhere one but I'm willing to take it as long

as we need to you know but again I know we're going over but this this is important and again this will not be the last meeting I think we try to push it through to plan if you have to step out then you know but hey judge okay the next car we came to everybody know you're safe I'll be okay I'm hoping I'll be able to answer some of your questions as well everybody our today so I really would like that first of all take the opportunity thank you all for inviting me to be involved in this process and inviting them to talk or even quite teens in Pasco County to be involved in this process I also need to thank you all for your help your consideration and your constant support with regard to what we're trying to do in these courts and and chairman I think it's wonderful that we're here talking about these sorts of things this is an important topic and in Pasco County the treatment courts I mean I decided over the drug court at the Veterans Court and the family dependency treatment course so obviously there's a lot of these issues touch on a lot of things that I see on a daily basis yes oh yeah my clicker going here this is a headline that none of us wanted to see none of us felt good about back in 2010 2011 passed north Pinellas County the sixth Judicial Circuit led this state in overdose deaths now I think we put this in perspective action Horseman county and state legislators really kinda set aside and once again okay and I can't stress this enough to thank the state the county the federal government for all the help they've supported in this effort we have some relatively famous people recently who you know opioids and as old is new again you know we heard a lot about and now here they are again related incident or as we can see and this is this is a little bit dated now but we can see that poisoning has outpaced motor vehicle traffic deaths and firearm deaths in our country obviously why we're sitting here today making the mixing drug cartels I've really been helping the fuel the fentanyl move me because fentanyl is a synthetic drug that they can manufacture and they can maintain and control the entire chain of production industry so we can see here that little bit that you see by that any is sufficient to overdose you know danger do as you said first responders that show up and deal with these sorts of things I watched a video of two law enforcement officers who were stealing a bag with evidence in it and you know sometimes when you see a bag a little right your kitty then but I don't think the audience's know I'm sorry you are okay I need to speak up by this one the first time he's ever been accused of not speaking loud enough most of the time they're telling me to tone it down a little bit in court so as we can see I mean we're talking about very very small amounts and very very deadly substances involved here what I'm we have as you can see we talked about fentanyl fentanyl as the big helper just because of the sheer intensity of the drug that we heard earlier about the different type of high gives the fact that these

folks that there are folks out there now that are that are looking for just fentanyl which is you can imagine the tiniest little variation in that amount is is deadly and and I think that that leads to a lot of the situation's we're having and we're hearing about the narcan being administered in that sort of thing very very very strong and they're mixing it a lot what we need to remember as most of these folks and most of the people I see are what are called poly substance abusers meaning they don't abuse just one drug and I'm going to talk about that and a little bit more in just a moment about what we see that's gonna be on the horizon poly substance abusers so very few people use just you know just opiates they use opiates use methamphetamine they use cocaine these marijuana they use they use suboxone they use a lot of different drugs and and I mean it's not on it certainly has happened many times in my court where we drug test somebody and they'll test positive or five six different types of substances on their system at the same time so like I said a lot of it is what you can get your hands on what's cheap what's available what's that sort of thing and I think that's that's important kind of in a totally the number of people that I see that start with opioids that come from being prescribed by doctors actually very low a lot of people just get into it for recreational purposes and they're the people that I see in front of that come before me this is what's happening now what like I said I talked about this poly substance abuse now we're starting to mix heroin and methamphetamine and and I just wanted to include some of these slides to give you all a foreshadowing years ago I was at a national conference the National Association for drug court professionals also known as any DCP and we go to this conference every year and it's where the kind of the nation's experts on this sort of thing gather and it's a great source of information I always learn things when I go there and years ago I was there and they were talking about crack cocaine and this and that and I'm sitting there thinking crack cocaine well we're seeing is opioids you know I'm a Pasco County the pill mills are here and there and no one's really talking about because it hadn't spread really to the rest of the country yet and then they kind of mentioned it a little bit yeah opioids are on the horizon well I'm you know we're knee-deep in it here in Pasco County well now what we're starting to see and I just want to foreshadow a little bit the increase in methamphetamine and I'll show you slide in just a moment that talks about that so now we have people using methamphetamine and because it's so cheap compared to some of the opioids and that sort of thing and that is because once again the Mexican cartels are kind of taking this over and they can manufacture almost pure methamphetamine and it is so cheap and I have a son who's in the FBI who's on the border and the information they get is if you buy a ton of cocaine you're going

to take either one or two tons of methamphetamine what so the cartels and the Mexican cartels are really pushing the methamphetamine hard because there's such a profit margin because they don't have to rely upon the Colombians or anybody else to bring them the cocaine and that sort of thing so that is kind of on the horizon so I think we need to be ready for that the New York Times has written an editorial this year that meth is everywhere The Forgotten killer and I'm just gonna go through this quickly this was from a newspaper article that appeared this year in Pasco County there was 725 methamphetamine or ass 131 heroin and 130 opioid arrests so that gives you a little bit of an idea of where that kind of stands this is just a little bit of information from one of the other New York Times articles that just talks about methamphetamine coming back into our our communities in in Portland Oregon more people died of methamphetamine overdoses than those who died for opioids and I just bring that because there's a little foreshadowing I'm gonna talk about drug courts now for every dollar invested in Nationwide taxpayer saved $3 and 36 cents in avoiding criminal justice costs if we add to that the fact of the other associated cost it can be up to as the taxpayer savings as much as twenty seven dollars for every dollar invested so the money invested in in drug courts and in treatment course I think is money well spent there's a cost savings between three and thirteen thousand dollars per client or per defendant in the program with reduced victimization with reduced recidivism and that sort of thing and they just they just work I mean they they work because and then just give you all the brief model of what we do when someone comes into my court when they're referred to we have worked and partnered with the State Attorney's Office and the public defender's office and the sheriff's office to identify people who would be a good fit for that program early on so we can get them out of the jail they get in front of me they then are seen every two weeks by me at first and they're drug tested every week and they have to go to drug treatment every week they have to go to silver support meetings every week more than one a week so these so we engaged heavily in treatment and encourage that treatment as they do better I get to extend them out every three weeks every four weeks and then we eventually get folks to graduate and if given the opportunity I'd like to although the time frame today I won't do it but show you some of those videos the graduates because it's quite emotional who have returned to our community who are productive members who have jobs whose family whose children are out of the system who are paying taxes who are now contributing in many ways to our community all because of their treatment through our program and it's it's actually really nice to see and it's I've often said as a circuit judge one of the best things I do our adoptions I

love putting families together probably second best thing is watching people graduate from drug court and get their lives and their family they're held accountable make no mistake that's part of what we do without accountability of being held accountable to the court and that's where we differ from some of these drugs treatment programs and and where the sheriff's office shows up and and also the EMS and they give them the opportunity for help many people won't take it well I have that probably unique solution that I can encourage that opportunity where they may not be able to do so you can just walk out of detox you're not walking out of London Lynx jail so and that candidly is a lot you know I've often said in court 99% of the people cannot do it on their own it's our with our health and our kind of cajoling you know people are able to do it and get their lives back and these are good people these are very good people who lost their way and and I know I'm painting with a broad brush but I can tell you if you sat it and watch some of these folks you will see these are very good people who merely lost their way and it's our job as as a community as wanted to improve our community it's our job to give those people a hand up and a leg up and give them the chance to get back to where they were before I'm there regularly drug tested they have to report to court we've talked about that and they were rewarded and also sanctioned for hunt depending upon how they do and once again and I know he sound like a broken record but without your all's help without the buy-ins of mr. McCabe and mr. Dillinger and sheriff NACO and then the the legislators at this table we wouldn't be able to do what we do so I thank you on behalf of the whole drug court and Family Court and family Bennett's treatment court injection port community so I just wanted to thank you also and now any questions some of them have been recreational drug users for decades and that's what's interesting that you know what's interesting you don't think of you know some of the grandfather sitting there and then he comes in and I say well how long you been using and they go I've been using 30 years you know and you just like you know it's just shocking you know it's just it's hard sometimes to get to wrap your head around that and and we have people literally that have used for decades and we finally give them that give them the tools and give them the opportunity and this is hard work remember this is really hard work but that's sort of that's where many of them come from I have very few people and and we've had discussions about this and certainly not to say there aren't there aren't people there but it's certainly not anywhere near the majority or even close to it that say I started because I was prescribed it and now I just kept doing it that's a fairly low percentage of the people I see and I'm just speaking in a totally I'm not speaking anything else I would like to offer the opportunity we

there was some discussion with regard to bringing folks into the school system we have a program that we started many years ago called the drug court Ambassador Program where we were I got tired I was in juvenile court and I got tired of the juvenile saying that's no big deal you know I'm just using it's not that big of a deal well you can we have people who have former addicts and we and you talked about Ryan Leaf and and we spoke about the young man from Gulf I there's a young man in Dade City named DeAndre Reed and some of you may remember D Reed took the Pasco Pasco pirates to the state playoffs a number of years ago and he received the full football scholarship to play at Maryland lost that scholarship because he kept testing positive subsequently I got a fool I'm sorry marijuana for marijuana he his nickname became D weed I mean because he was he said he or D reefer because he was smoking so much marijuana and and he got caught then he got caught again then he got a full scholarship to Bethune Cookman never finished there subsequently gets involved in the trafficking of drugs and first time he's ever arrested he goes to federal prison for seven and a half years and he is one of our speakers and he is dynamic he is amazing he he he along with and there we have folks on there that started out in drug court with me and are now getting their PhDs we have and I've already got their masters we have people we have a young man named Steven sieminski who has over 50 arrests and here in Pasco County and talks about running from the sheriff and and all these sorts of things and now he's gone back to school in college and now he works as a mental health tech at one of our drug rehab programs and he can talk to the young people so those people would love we have drug counselors now in the drug counseling field who were former addicts they come in and speak it's really a great group of people and they are they would be they would love to come into the schools they keep asking me to go in and so I would certainly volunteer those folks cuz I know their heart is in the right place they've done it many times before they know what that what's appropriate to say in schools and what's not and we have people from nope we partner with note which is narcotics overdose prevention and education one of the moms comes in and talks about losing her son going to wake her son up one morning and he was sitting upright in bed with his cell phone on his lap and she shook him and he had passed away in the middle of the night and she comes in and talks about the loss of her son and she talks about Landon and the effect it had upon upon her and her family and and so we have you know I'm willing to bring this presentation anywhere anytime and I know these folks are willing to come as well so that's kind of you know I just want to make sure that's out there and let the school system know we are all ready willing and able all geared up to go we've been doing it for probably five or six years I know I called you kind of last minute but do we have an E the number she gave us a great

Argos to improve every day and we can always do that and I mean that that's just not lip service we literally concentrate on that how do we do better every day and that's okay I'll need to get I need to start pulling those numbers for you and do my best because we are doing and I'd like to in what I may try to do is put together and maybe put it up on our website some more of our graduates because I think if you all had the opportunity to see some of these people with people graduating back because remember to graduate you have to have all your fines cost some financial obligations taken care of you've had it done generally some sort of community service you have to have a job where you actually pay taxes you know a lot of people tell me I'm working under the table I go it's not gonna work you got to pay taxes like the rest of us and so these people are giving back to the community they have jobs they're taking care of their financial obligations and they're and they're meeting all their requirements as far as drug tests absolutely and those are the requirements to drive safe and so it's it's good stuff and I would invite any of you that want to come I appreciate that congressman bill erectus thank you right yeah absolutely I've seen people six-figure incomes six-figure incomes Oh son lose everything lose everything I mean you know it's just amazing people in the healthcare field I mean it's it's some of it's just heartbreaking and then I do family dependency treatment court where not only is that happening but we're now having the shelter their kids and bear that cost our expense and also the trauma upon the children I mean is is tremendous so so you know I have the opportunity to speak and visit with the children and I certainly take advantage of that every chance I get yeah well and that's really or they or they can just rotate to another drug like say or multiple drugs like I said it it is it is not uncommon for people to test positive for more than one substance when they test positive and like sometimes you're like it's easier for us to say what's not in your system isn't what is in your system I mean inside you wonder how some people are upright you know literally I mean you're like you literally have no methamphetamine cocaine ox you know oxys opiates marijuana I mean you got it all you're on board I mean that's fabulous point four fabulous point and I was at the jail recently and talking to folks at the jail thanking them for the hard work they do because as captain Jenkins pointed out many of these people that are arrested go in there and they start detoxing and that is a critical part of the process and but nonetheless they do a lot of hard work and many times they don't get to see the result that I get to see so they see him it's on the front end so I went in and have previously gone and thanked their medical staff for their hard work and let them know that they're making a

difference on the other end and how important that is the folks will pass through County but your point is very well taken wait up you have to come for da I don't know are you with we know we normally don't take if you want to be brief but we don't in order to help - my name is Luke Irish I'm Dunedin resident and I'm with Thermo Fisher Scientific and we do more drug testing in the world and I just wanted to introduce myself to this and I love the forum that you're having then platform because important to me obviously it's my job but more importantly is my community and so I wanted to make myself available as a resource of any of the things that you may or may not need to assist your problem-solving towards behavioral courts and things that any other person makes that thank you all very much thank you I think that's the key is education bringing these people into the classroom to speak to the kids the earlier the better as far as I'm concerned is there any way I mean I like the help you've approached the supervisor all these rivals propriety about that we've actually yeah he's actually been the decap seen have been very impressed by it I've had members of the school board former members of the County Commission comes into the chat program it is powerful and then the thing is when when I do it I'm an old guy going don't yours drugs and they'll go yeah that's no guy going don't use drugs and then when they get up like when the under three gets up and starts talking about it and you know like you know the kids are like oh and he's like what do you tell me about trucks I'd used everyone there is what are you gonna tell me that you know when that what I don't know I and so they are in Steve so Pinsk I mean he's like I got 52 arrests when you're unaccompanied about being arrested using drug some you know the kids are like they can't get around that they can't get around the truth of that then the rawness of that then and it's amazing having you stay after and you have been always there whether it's veterans work with you in your office and see if we can get into the school all right a great segue to our next speaker who is going to be David Lambert he's the chairman of the Pasco County Housing Authority he's going to speak to us about opioid addictive addiction related to mental health and homelessness and as it's a great segue from what we spoken about so far because we all know that once these people become addicted they can become homeless and it does affect their living situation so thank you for joining us today good afternoon commissioners and Congressman bill Arrakis thank you for everything you do I don't know I know everybody in this room knows what the congressman does but the entire federal delegation has been pretty instrumental because they've seen this happen in communities throughout the country with their colleagues so the congressman senator Nelson and senator Rubio have been actively trying to bring

more resources into Florida which has been very good for us now it has hit us on the local level in Pasco County I've grown up here on my entire life we now have big city problems that we didn't have to deal with before and now it's going to take some significant work and continual work we've heard from captain Jenkins we've heard from judge crane who start with the folks from the beginning get them through the courts then it becomes a big issue of what are we going to do with them oftentimes we've seen people with six-figure salaries have nothing they also have a criminal record so they don't have housing and they don't have a support system often most cases their family has just basically left them at the front door and said we're not going to do anything to help which causes a bigger issue where they can relapse back into into using so we have at the housing authority worked on multiple levels we have fourteen hundred and eighty Section eight vouchers and three hundred and Plus homes that we work with to help people the only way that you are not eligible for that through the Department of Housing and Urban Development is if you have been caught manufacturing drugs so we run a pretty broad brace program where we will bring them in intake when they come in the housing authority and when units become available we work specifically with the public defender Bob Dillinger and we work with our fan we've created a family self-sufficiency program where when these folks come in we look we have a case manager who helps them an advocate keeps them out of the system and helps them work to get a home because keeping a home over their head is critical for us it keeps them out of the hospital out of the jails and out of everything that can you know really cause a problem the continuum of care I think you're going to see on the next group I know a lot about the electric business I never really knew anything about the housing business until about eight years ago but also we started seeing throughout the county problems our lineman at WRC would come in and report all along the u.s. 19 corridor I mean just needle after needle when they would go out to restore power to someone's home within an area so much so that we actually started you know open it up for our linemen to be treated for like hepatitis things like that to get the vaccinations usually it used to it wasn't required we don't require it now but we open it you know we let them know the the health department has sent out advisories where we've had outbreaks of hepatitis B and hepatitis A primarily hepatitis B in the West Pasco area where people have been using so a big deal it's a big issue for us so we started wanting to tackle the root cause of the issue so when you all voted on your on the family housing program over here or the Old Boys & Girls Club the Housing Authority put a hundred section 8 vouchers behind that program that's over a million some dollars a year which will rotate to help get these families once they get through the court system and they get into recovery it

helps provide them a home a place for them to go also we have worked to bring Vincent house here to Pasco County we opened in Hernando County about a year and four months ago we're now at sixty some plus members many of those folks that are mentally ill also turn to drugs because they have a mental illness seventy five percent of the people we see that are homeless are mentally ill that's a big issue it's a big number across the country so we have to work to tackle those problems together as a group and we have come up with some creative ways to do that through the Housing Authority the first thing was the homeless navigation Center the next thing we've been working with the pinellas pasco public defender Bob Dillinger to bring Vincent house to Pasco County senator Simpson got us a million dollars in the state budget for that also he came down and toured Venson house down in Pinellas County two weeks ago so we're going to really make an impact there because the goal is to keep those folks once they go through the courts once or if they have a mental illness and they're not in in the court system that we keep them in recovery and keep them out of the court system so that's that's a big issue for us the continuum of care is transparent all the way through so the Sheriff's Department has an issue they arrest them they get them through detox they go through judge cranes court then the next step is getting them a roof over their head because if you send them back out on the street without a roof over their head they're going to be back into the system there's no doubt about that so that's where we come in we try to help with the homeless navigation Center we have provided section 8 voucher for the program we are now bringing and Vincent house at the co-op to help because we build communities you all seen what we have been able to accomplish together when we work together in LA kuchi we're now doing that with mental health it was a big issue that came on the horizon for us about six years ago the Housing Authority now is transitioning hopefully today we will sign a contract by the end of the week to purchase land in the west side of the county to build 60 units of veterans housing a big deal for us we've been working with your group at Community Development to help do that and it will focus on homeless veterans and their families within our County so we ask for your support on that so we we get through this whole continuum of care and it takes everybody every link in this chain and I applaud you all for having this today because I've never seen it before and we have been dealing with it in a local level throughout our entire service territory what happens in 919 in this 19 corridor is not going to stay here it's going to go to Hernando it's going to the east side of the county and if we don't aggressively get out in front of it you're going to see more and more and more of these issues it's just want to proliferate so we have an opportunity here today we don't you know this is this is an opportunity for

us to get better we're at a learning curve here I think the Commission realizes that and and we're going to do our part at the Housing Authority and we're going to do our part to continue to try to help bring in these services and it's all about collaborative partnerships it's all about getting people off the streets keeping them in recovery and in doing what we need to do to really focus on keeping them there no we're just the Housing Authority for people who come in the housing authority the only thing that I can tell you is we're 99 percent occupied we were 73 percent about seven years ago so we are full and people are on a waiting list for housing typically know if there's drug use and the Sheriff's Department comes and we find that there's an issue they are taking taken out of housing and then they typically go back to where Judge to the court system but typically when someone comes out and we don't just take people who have you all folks are eligible for for housing that meet the requirements that are below the poverty level so but we don't typically find that we don't what into housing we don't we can't we don't keep those statistics we don't keep numbers the only thing we do is take referrals when they come through Bay care or someplace like that we don't get involved in anybody's well I'm sure with judge crane and in the Sheriff's Department there is a capacity to do that but we don't there's certain questions that we are allowed to ask and we are not allowed to ask under federal fair housing laws we do a background check to make sure that you were not manufacturing drugs we keep the communities that we have safe and then we take in referrals from folks like Bay care and other places to keep them housed we do not go and track them we do have advocates within the system that help but we don't necessarily per se know what they have it's not we can't ask them any medical questions that's just towed [Music] I think if we hold to that area probably a major piece put some major housing in there because habitat is gonna take them a few years to raise the money to go build it and with your section of housing vouchers as well you can probably double the length of them to try to make this a real big project we will certainly work with and two of our board members of the Housing Authority are on once on the West pesco Habitat for Humanity and the others East basco we have donated significant dollars to both Habitat for Humanity's because you are really one of our only low-income housing providers and our job at the Housing Authority is to get people housed that's our our big deal but with as it specifically pertains to the veterans project okay we are going to use vash which is a federal program so vash has a different set of requirements we are allowed to be a lot more lenient with that so as we move through this process and we purchased the property

that's already developed then we're going to build unit after unit there as we get get the money to do so and then we have applied to the federal government to what they call project base to a specific site those Vash vouchers and it gives us a lot more leeway because some of those folks can have a different set of issues with the court system so that's that's the reason that we're tackling this project first is because there's a lot of viability within the federal level to help veterans so but we will happily both of you want any type of housing community that's one that's what we do thank you okay our next speaker is gonna come to us from Bay care behavioral health this is actually a partner of ours here in the county that when we have someone come through our offices that needs to go somewhere immediately we work very closely with big hair so I'm very happy that they're here at the table today and joy Toscani who is the clinical services manager she's going to speak to us about opioid use disorder and treatment options that they have to pay here thank you okay so um okay would use disorder and treatment options so the disease model so if we look at addiction you know in terms of a disease model it's a chronic brain disease it's progressive not curable meaning people are in recovery and that's a process that happens you know throughout their lives they experience relapses and remissions so we've all heard about relapse it's a part of the process very often for most people a little bit closer sorry and it's treatable you know we all know that it's treatable as well there are many evidence-based modalities many evidence-based practices that we can utilize to treat folks if we can get them in the right place and it may be fatal if left untreated that's always an important thing to remember opioid use disorder and this is the definition I found from Samsa I'm they reduced perception of pain but can also produce drowsiness mental confusion euphoria nausea constipation and depending upon the amount of the drug taking can depress respiration and this is the part of course that makes them so deadly and so fatal the respiration your ability to breathe so that's what's so frightening and people don't realize that they're seeking that euphoria that's the constant thing that they're seeking initially anyway but unfortunately can lead to very frightening consequences so in the u.s. 115 plus people die each day that was I just went to the father conference just a couple of weeks ago for up on drug abuse Association and these are some of the statistics that I walked away with and I was absolutely floored 115 people die a day opiate related death 14 deaths a day in Florida the crisis opioid crisis cost 502 billion to the system when we think about all the different costs legal costs housing dependency loss of work emergency departments all the medical stuff that goes with others it's just astronomical 80% of those addicted to heroin or originally prescribed opiates

so I know those support center for information today and the u.s. is consuming 90% of the world opiates I I was astounded by that so it's definitely our County it's our state but it our country I mean I was I was absolutely floored by that statistic okay so ACM this is I'm sorry I didn't need to get into too much terminology but this is how we determine this is the manual that we use to determine someone's level of care it's the American Society of addiction medicine and this was their definition of addiction it's a primary chronic disease of brain reward motivation memory and related circuitry dysfunction in these circuits leads to characteristic biological psychological social and spiritual manifestation so the person is constantly pathologically pursuing reward and relief so if that makes sense the reward is that euphoric high right and then relief when they don't have that so when you're going through withdrawal initially it's the reward cycle they get caught up in they want to feel that that euphoria eventually it becomes just an wanting to have an escape from being dope sick would be what it's referred to and going through that withdrawal process and you get caught up in this cycle over and over and over again so so the dsm-5 this is our diagnostic criteria that we use to determine if someone has a diagnosis of opiate use disorders so the opiates are taken in larger amounts or for a longer period than intended so they're using way more than they thought they would great deal of time spent in activities to obtain so they're always trying to get it and then recover from it so those two things craving strong desire to use always wanted to use feeling that in their body those cravings can be incredibly intense and incredibly powerful and they can be triggered by anything they can be triggered by a sound a smell something they hear something they see something they feel and I recently heard story about someone coming off the basketball court they've been playing basketball and so they were sweaty and they were getting ready to do something that made them feel anxious they were about to talk to somebody that made them feel anxious it was a combination of being sweaty hot and and anxious and they said anything so someone in recovery they said oh my gosh I mean they've been in recovery for years oh my gosh I feel like I have to go use but that combination so you just it can be multiple things and people don't always know what it is that sends them into those cravings so they've often had unsuccessful its efforts to cut down so they've tried many times to stop using on their own and haven't been able to do that many activities are given up because of use despite negative effects so bad things keep happening and yet they keep using failure to fulfill major role obligations work school taking care of their children those kinds of things paying bills and continued use despite social and interpersonal problems relationship issues recurrent using

hazard situations this could be driving this could be work this could be you while they're taking care of their children this could be many things and continue to use despite having persistent medical issues that are exacerbated tolerance so they have a higher tolerance they need more and more and more of the substance or to mix a substance with other things to experience the same result and withdrawal from opiates so very often again taking opiates just to avoid going into withdrawal state so emotional pain so opiates are actually better in helping people manage emotional pain unfortunately than physical pain so better I use that in quotes what that means is that people are using more because it's masking and minimizing how they feel so it actually leads to increased physical pain because your body stops managing its own pain in a healthy way so people are using over and over again to not deal with the emotional pain so very often at the root of all of this is some type of trauma and if we're not addressing and dealing with this trauma that leads to this addiction then they're gonna just remain in this cycle if they don't have the tools and the skills that they need to manage the trauma that's gonna present itself as soon as someone gets sober and gets into recovery then they're gonna go right back to using so that's why treatment is so important so you look at you'll see there's exaggerated responses he's just the way some people have described their feelings when they were under the influence of substances all my problems disappeared it felt like I was under a warm blanket thought this was how normal people feel I thought that was really powerful you know and just if you're dealing with a lot of trauma throughout your life and some time's very often kind of growing up it's been there forever they don't know what it feels like to feel normal so they're thinking they found it with the substance that just I'm continuing to use so best dream I ever had but I was awake so these feelings are very powerful and very intense so I just saw presenter recently who described heroin use and he said if you think about I think about a fantastic meal you had recently it was like so good you just sat back you know like wow that was fabulous I enjoyed that it's amazing what a great meal so that hits about 500 pleasure domain release is what happens with that heroin is about 500 million so it's dramatic how it impacts someone's body and their you know their pleasure release so it's it's really hard to combat when you're trying to get people to focus on everyday things and they've had that experience it's very hard for them to walk away from them the neurobiology of addiction so it's an activity which initially stimulates the limbic system which results in changes of neurotransmitter levels which are perceived as euphoria so that's that euphoria we're talking about the limbic system is the most primal part of the brain that's responsible for GoGet impulses this is the part of our brain

that's like yeah go get whatever you want do what you want you know don't think about consequences and this is fully developed when we're 21 days old our limbic system is all ready to go at 21 days old its counterpart the frontal cortex is responsible for the impulse control decision-making the stop part of our brain so the limbic is our go part and our frontal cortex is the stop part that's fully developed at 25 years old so you can see we have a big gap there which leads to a lot of problems in terms of our decision-making so the part that gets hijacked in addiction is the limbic system the GoGet system and so we don't get to the part of the stop and think you know the frontal cortex part and doesn't get to get engaged because of the GoGet part of the limbic system okay so so circuitry must be rewired for recovery to occur we have to get people out of that active addiction get them to a place where they're keen get them where they build those skills to manage and deal and cope with that trauma and rewire that circuitry and this can take a long extended period time and that's why recovery you know support is so important because relapse is definitely very often a likely part of that process so so we use screening and assessment tools to identify an appropriate level of care so when someone comes in to us you know very often by the time they get into a treatment environment to have an assessment you know we there's likely a problem they've gotten involved in a system you know typically and that's what brings them to us so we're looking at severity duration frequency of use to determine the appropriate level of care additionally the impact of their use on their daily life and the consequence they experience the higher the severity the higher the appropriate level of care however if someone's not internally motivated doesn't have any motivation it doesn't really matter what level of care we put them in you know they're not likely to be successful so sometimes that motivation has to start externally it might be a court system and we'll take that you know if we start externally sometimes it's dependency it's their child welfare but if we can start there and we can move them towards an internal motivation to change if they can and we do that through a process called motivational interviewing and get them to understand how their lives can be better if they stop but we have to get them to us first and to be able to have those conversations so we use part of our a sign criteria we're looking for to determine this level of care we're looking for acute intoxication obviously they need to go to detox are they having such a problem that they're not medically stable you know so we need to make those kind of determinations biomedical conditions that could complicate their recovery emotional behavioral conditions our readiness to change are they ready to do this you know if we try to put them in residential and they're not ready to change they're probably not going to be successful and they're probably going to

leave so we really need to get them to a place where they're ready we have to look at relapse continued use and continued problem potential and their recovery living environment if they're in an outpatient setting which means that is coming in to us and their recovery living environments they're surrounded by people who are in active use you know they're gonna have significant problems being able to maintain recovery so and the likelihood is very low that they will [Applause] you know let me ask a couple questions I'm again I appreciate your time I want to hear about Pasco County you know what you know mr. angel asked a good question we're you know working with David Lambert when we put folks in housing Baker puts folks in Hollywood what's the follow-through what's the success rate what's the goals what can we do more together I don't see anything in there about Pasco County I just that's really I think again it's not bad information I think it's good information both to bring home and maybe read later but ideally you know we're here and baked here is a great partner we support bake here we couldn't do without you but this is an opportunity for us all to sit down and say okay here's what we're doing here's opportunity so hopefully you have some information on maybe specifically what you all are doing it past the county because again I know I know the things you're doing from when Doug was there and I just you have been good partners but I think we all the public needs to hear more specifically and garen like it had a good question with those folks that have I just don't want to waste time so let's talk about where they stand you know success rates number of people you treat on a yearly basis maybe even a monthly basis and breakdown of that so we have an idea of what's actually going sure not saying this innocent great information and we appreciate information it's an education for some we need to have we need to know what our solutions are gonna be and to do that we're gonna know where we are now right I hear you don't know where we are now we're not gonna have nowhere how to get there right right right absolutely so and I don't I don't have specific numbers for what we're you know how many people were treating I can't speak to that right now and that's certainly something we could have at a later time I would just kind of get bringing some treatment information like how we make treatment decisions and what our options are for treatment so Commission would you pass public funds to Bay care sure yeah absolutely are we kidding are the citizens of Pasco County getting a return on their investment for the dollars that are being used this effort right difference on those dollars will no longer go to those areas we will sway those to somewhere else right you know that's got to be a big part of our conversation going forward absolutely yeah and and big hair you

know obviously does you know get a lot of funding and then we do treat a very large indigent population so a lot of the folks that are coming into our doors kind of we're talking about maybe through the court system through child welfare have no insurance so very often we're treating them you know through those kind of State dollars so they're coming in and often receiving outpatient you know group therapy sometimes going to our residential programs where they can be there for extended period of times they're coming to detox which is our acute you know treatment process they're at the you know three to five days for detox so all of that stuff there are State dollars and funds that support and pay for you know all of those treatment options right residential I believe it's 33 or yes yes so our residential is a Community Recovery Center which is right next to North Bay Hospital so yeah we have you know all of our beds are right there yeah and some of those are state-funded and some of those are you know through insurance as well if you don't mind I'll make there to help with this a little bit they we work and we partner with Bay care in with Veterans Court drug court and family dependency treatment court they are a wonderful partner some of those beds are veterans beds congressman bill Iraq is specifically designated for veterans and we use the community recovery center for the veterans through their that they are regular part of our program they're there for our Staffing's the Baker also has the fit program which helps in dependency court which helps people goes into their houses helps them get to get their children out of the system and bring them back I do family depends to treatment courts I work with the fit program sometimes big here are some veterans dollars that they were able to receive they helped us in Veterans Court aside from even crc so there are so bei care that's kind of where they intersect in Pasco County and they intersect in a very real way we were kind of the rubber meets the road and we're much appreciative for that I know these things again there's some numbers I don't know and I'm not taking away I just say we're here to talk about the great things going on and the way we can all do better in Pasco County than others you know that's kind of where I'm trying to get out you have to have 33 beds ideally how many beds do you need and what can we do together to get there well we would need you know 333 but it's very important how many those people are coming back so our residential program you know if that's the only one in Pasco County how many people can you serve right so obviously there's a much higher need than we have in terms of availability so some people do come back but we have recently changed our residential program to be a longer residential so they're not there as short of a period of time so the longer they're in treatment the better the outcome is going to be so we have I

think it's six to nine months now as opposed to three the cost per patient yeah that I wouldn't know yeah so that so that depends I mean that would be sometimes it's going to be that if they have insurance and that will be paying other times that is state-funded that we do have you know folks who are state-funded who are receiving you know those services worst in the state and now we're in 2018 and we're worst in the state note view it still and if I look at the chart from the sheriff's office we're tracking essentially a hundred percent over two thousand seventeen s numbers but yet our addiction program doesn't track any statistics and so for me I look at this and this is fifteen pages of accountability for I think the more important metric to watch is the accountability for big-hair to the patient's sure okay we're not tracking that how do you know if you're successful other than and I know Baker's of business right so it is taking in money and paying these patients and a lot of times it's it's kind of like the private prison system where look there's a dollar sign on a patient and what do we like that or not that's the fact into it I don't see any any numbers to substantiate success I think we're doing the same thing year over year over year over year and that's where we're just getting worse well absolutely and there's there there are things that need to change and we look at these statistics and it's frightening and I completely agree with you and we do have numbers I don't have them with me today but we absolutely do have numbers I was you know kind of asked to talk about treatment options and and how we get to those conclusions so I do apologize and we can have that another time but I do want to speak to the fact that like I was just recently at that fat a conference and they were talking about people there all over at the state of Florida and we do need to do things differently some of the things that we need to do differently is we need to intervene as early as possible there are pilot programs throughout the state who are in meaning at the emergency room who are meeting the folks who are coming in who have just been you know shot it with a narcan and they're intervening with those folks right then and we currently have a position for a peer specialist that I'm trying to fill and we'll get that person in there who will go so this is a peer this is someone who is also in recovery that's going to go meet with those folks right then right when they're coming in and engage them you know and get them to hopefully commit to coming into a treatment program and to at least give that a try so that those are the those are the pilot programs throughout the state that are happening and the things that would help us as a county really affect change and do things a little bit differently so there are those things that are happening out there and I think it would be really great if Pasco was also doing those things I'm not being critical we're just

again right sure meeting we appreciate everybody and what they do well I'm not I'm not because Bakke here does a great job yeah but again it comes down to again we're not picking on it's not about we're all one we all want the same thing we all want to help our here right absolutely make it that way I know but I think the numbers are important to return on investments important I think absolutely folks the county need to hear the great things that we already have going on Commissioner and then I'll go to a waiting list for residential yeah yeah so there would be there would be folks that would be on the waiting list I don't manage the residential program so I don't have those numbers that my fingertips I do the outpatient side of it well we use them every day so it depends how many people are leaving how many people are leaving successfully leaving yeah it can really fluctuate depending upon the population within for instance CRS a I mean that's a question we deal with every day that is a great question well I'd like to answer that question too but first Commissioner I know this gentleman here Zant's asking a lot of questions on statistics we weren't asked to do that we were asked to come and give you an overview of what we do and that we I think we would have been better prepared had we had been asked to give you statistics we were just asked to give you what you do but to answer that question commissioner yeah and we certainly want to give you everything your yeah certainly want to give you everything that you're asking for for sure because we live in this community and we've got a vested interest we have over a year's waiting list at the housing authority to provide housing some of those wait some of those can be three to four years there is not enough beds available there are not enough houses available especially in Pasco County for affordable housing some of our seniors can be on a waiting list for over three years to have affordable housing some of our veterans that's why we're building a veteran housing complex for those can be on a waiting list for four to five years you know not only does the federal government provide us vouchers but sometimes it's a bouncer is for a landlord tenant so we don't have available affordable housing for that voucher to give those folks a to find a home in Pasco County so it's it's a big issue all the way around the spectrum and those of us who deal with it in that classification every single day we can have people on that list for four to three years in certain instances there's a huge need and not enough supply and there's not a lot of money to be made off of load to no income people in housing accessory dwelling units allowing and then go into a smaller reducing our minimum house and maybe putting multiple minimum houses you know katrina cottages or whatever you want to call them on in certain areas so i think we're going to start looking at creative ways to get more yeah and i think that we have a lot of great opportunities here and it's

it's really inspiring to see you all coming to the table with this yeah well i just want to say that get a paid care does an outstanding job and i know you can back it up with the number the next week sharon has been outstanding i have to leave but i wanted to share some good news this state the federal government has appropriated four billion dollars additional dollars towards substance programs it will be allocated soon and one of the recipients will be premier community health centers in Pasco County mmm-hmm and so they will be performing those services as well now I want to make sure that they have the narcan you know if it's a discounted rate for small amount people have to pay based on their based on their income that's fine too but it's gotta be rated ready to available so let's I just want to say again this is an issue that I truly care about these people at this table are outstanding the reason you are successful and look I know or the statistics and everything but it would be a hell of a lot worse if we didn't have you participants and contributors so I appreciate y'all I'm willing to get involved if you want me at the next meeting if I don't have votes in DC I'd be happy to be here so thanks for doing this we have to deal with we have to deal with the mental health substance sometimes it's together people have issues with abuse but also mental health we have to tackle it so thanks for including me today thank you absolutely absolutely um just one last thing I want to say real quick is about medication assisted treatment I want to make sure that you're familiar with that we have been we started a program it's been almost a year that it's been operational where we're providing vivitrol and and there are other options for medication assisted treatment suboxone and methadone of course has been around for years but those there's a lots of federal funding there's a lots of focus on that right now as a new way to treat this this epidemic and that's kind of one of the things in terms of providing that in the emergency rooms is starting that kind of treatment right from the get-go when people are coming in after being revived from narcan and and starting those kind of programs right away so there's a lot of focus on that statewide as a way to intervene with this epidemic so thank you for everything Baker does because I know thank you so much our next presenter is going to be Monica Russo who is the coordinator for Pasco County Alliance for substance abuse also known as ASAP she's going to be talking to us about tackling the opioid crisis in Pasco County hello hey thank you so much I've been waiting you know a few weeks to wear it because I voted by meal so it's very exciting for her presentation of him I just want to say thank you to our presenters that have come up so far and this is the very first workshop so they weren't a hundred percent sure what was expected of them so when I told asked them to present I

did ask them to give you an overview of what they did I told them the questions that came up we would not know exactly well we will take those questions back and I absolutely all right so yes so tackling the opioid crisis in Pasco County I just have a really brief overview I would be absolutely remiss if I didn't explain a little bit about ASAP to this group so I'm going to do that and I'm going to describe some indicators and influences of the opioid crisis here in Pasco and then just talk about some of the strategies that we're implementing at a community level so to start ASAP is an addiction prevention coalition so just for your reference there is a a coalition like ASAP in every single county within the state of Florida all 67 counties have an addiction prevention coalition and basically what that means is we are a diverse group of stakeholders around the community that come together to create those community action plans to reduce the biggest drug issues in the community so as you can guess opioids is obviously one of them here in Pasco and we also work upstream so from parents to teachers to law enforcement - you know judges you name it we have people who are engaging in our coalition to come up with the best solutions to our problems here and we would do that by mainly working upstream and when I say that I encourage you all to imagine this picture I'm so sorry most of you have heard this already I'll give you a brief brief view or version of this story but basically in this in this picture you know there's this beautiful stream imagine that we're all eating lunch at the bottom of the stream right and we just keep seeing kits floating down this river there's so many kids floating down this river that we have an assembly line pretty much made up we have one person in the water getting the kids out throwing them to the bank one person doing CPR one person calling 9-1-1 one person posting on social media to get everyone down here because there are kids drowned in the river and we need all hands on deck ASAP is running upstream to figure out why those kids are falling in the river so that's what we do as a coalition so we do our best to make sure those kids aren't drowning right so that might be giving them life preservers that might be teaching them how to swim it might be fixing the bridge that they're falling off of and into the water to begin with so those are always going to be our priorities we're looking at the environmental infrastructure and why we might be seeing high risks of certain issues that's the wrong way so this is just some of our community partners this is not a comprehensive list this was about two years ago so obviously we have a lot of community partners that engage in all of these plans including many of you so thank you so I mean as if we need to go over some of the data again you know we know that we have a big issue here in Pasco County basically this just shows you the rank of several counties in Tampa Bay against one another so out of all 67 counties in

the state of Florida Manatee County ranked number one for overdose deaths in 2018 for the 2018 rank the data itself is two years worth just prior to 2018 it is but the majority of them are opioids at this point so as you can see Pasco County is ranked fifth Pinellas is seventh Hillsborough is fifteen so this is just your Tampa Bay area if you look at the 2017 ranks you'll see that Pasco County was ranked fourth and now a ranked fifth so it's a rate per hundred thousand so actually that is a really great segue into my next slide so this is the rate per hundred thousand for both of those years so Pasco County in 20 the 2018 rate was 25 so if we had a hundred thousand people only living in this county twenty-five would have died that would be the the rate again this is data from 2016 and 2017 collated to provide you this rate and then similarly 2017 rate was 22 so what I'd like to not about this is that our numbers are getting worse according according to these metrics but our rate our rank is going down so it makes it look if you're looking at this if you're looking at our rank we're fifth and last year we were fourth it makes it look like we're doing better but other people are just doing a lot worse so that's really disheartening you know it I mean we're so thankful that we're not doing as worse as we could be but I mean it's it's just it's all over Florida it's all over the United States I know you all know that this is just a few other indicators I just want to make sure that everyone doesn't forget how substance abuse addiction is in all of these difference leading causes of death so this is a chart of the ten leading causes of death in Pasco County provided by Florida charts you will not see overdose on here right it's not on there but it is embedded in multiple of these so unintentional injury is the fourth leading cause of death in Pasco County about a third to about a third to almost a fifth are caused by poisonings and depending on the age group it's the number one cause of death is poisonings in unintentional injury similarly you can go down to suicide a lot of those are drug-related and at the very bottom number ten you have chronic liver disease and cirrhosis which are overwhelmingly only caused by untreated hepatitis and alcoholism all right so the scope of the problem obviously we know that there's a high mortality I really want to emphasize that this issue isn't just limited to that this is a lot of people are obviously dying but we have a lot of illness spreading from this as well we're seeing hepatitis B rates increase or seeing hepatitis C or hepatitis C rates are three times the state average our hepatitis B are five so this is largely believed to be from needle sharing we're also have very high rates of neonatal abstinence syndrome and according to the latest data that I have from Healthy Start coalition in Pasco we saw a 200% in increase in babies being born going through withdrawal obviously the stress erupts families and community connectedness and there is a

high emotional and economic cost so I get this question a lot you know how much does the opioid crisis cost you know Florida or what not I can say that's the council of economic that basically the White House came you know they they commissioned a report to see how much it cost the whole country and they came up with the most modest number of being 294 billion so I mean you can divide by 50 states and you can divide by 67 counties and we're still millions and millions of dollars in total costs so about the crisis I really need to emphasize that addiction is an evolving disease of despair we can talk about it as an opioid crisis we are doing ourselves a disservice if we do that throughout the last ten years we continue on then that but for the last many many years we continuously view different addiction issues and we kind of play whack-a-mole right oh it's the it's the crack epidemic oh it's heroin no it's the pill epidemic and we we do our best to solve that one individual problem but addiction evolves it metastasizes it would be like saying to someone who has cancer of mainly of the liver but it's already metastasized that we're only going to focus on treatment of your liver right you have to look at the whole community you have to look at the whole person and a cancer treatment you have to look at the whole community and basically if people are very addicted to one drug and they don't have access to that drug anymore they'll find a way to get another drug that's why we have so many different types of comorbidities in addiction the street price with the drug - so it's kind of like the trend so hopefully always or the now what's the cheapest one on the street so that's why you're seeing it move from heroin to you know pill form oxy or and back and forth whatever's cheapest on the street now yeah I can I definitely see that if a dictionary based on on drug Mexican well and it's that's an excellent question so part of ASAP we have a lot of different task force's and one of the task forces within ASAP is our recovery committee which you've been able to meet at a few of our different meetings and proclamations they tell us a lot of different reasons about why they specifically switch to math so some of them are trying to wean themselves off of opioids themselves alone and he used meth yeah and then you know had a completely different experience and were immediately addicted to meth so there's many different reasons so I wouldn't want to say it's only because of availability or cost but it definitely evolves based on those and then many other reasons as well and then I also want to really emphasize kind of what Joe already mentioned that addiction is strongly influenced by emotional pain so we can talk about physical pain and we really have done that as a nation we've talked about how physical pain and the prescription of opioids is a great precursor to being addicted but it's that emotional pain that we're really not talking about and that is a huge

huge driver it's often very influenced by social determinants of health that risk map that you all saw or that heat map that captain Jenkins showed we've gathered data at zip code levels to be able to see what else is going on in those communities so not only are the communities that have the highest arrests or opioids in the holiday the the west part of the county those zip codes are also having the highest rate of removal of children from their families by DCF we're seeing the lowest socio-economic range in those groups are seeing the worst grudge Weejun rates in those groups this is a it is a multi-faceted issue going on there it's not just arrests it's the death rates are higher everything is higher in those areas and naturally if you are getting removed from your family in you're being displaced and your family keeps relapsing what are your good outcomes going to be for your personal self as a young person and that's often why addiction is cyclical and intergenerational and yes it is caused in part by prescribing practices but something we haven't mentioned yet today is hospital 21 maybe you know representative Mariana we'll go into that a little bit more but we will not be seeing as many doctors prescribing overly prescribing opioids moving for some of these issues he actually screamed at the sheriff's office and said this is your fault and of course we inquire as to what his thought process was that he explained when you guys made it illegal and we begin to monitor the pill mills and who started the PDMP prescription drug monitoring program that did not allow us to have doses that were measurable now my friend who before could the honor his habit in a way that was more healthy for him has to turn to heroin and fentanyl which is not regulated it's causing additional problems so the reason that I bring that up is just simply to say that sometimes we try to solve one problem and then there unattended consequences we can solve one problem and then we can potentially create another problem that's just something to consider as we talk about obviously government government's involvement and legislative certainly I think there's a place for that we just need to be very thoughtful and learn from the failures of the past or the lessons and then last thing I have on here is that it's often a child onset disease so this is just going into solutions what are we doing at a community level I did just want to put this up here this is called the socio-ecological model it's my favorite thing in my field so it just shows you that there are strategies you can deploy at the individual interpersonal organizational community and policy level and at the higher up you go the more impact you'll have basically so what are we doing in Pasco County we're doing a lot of things so again ASAP is all about its partners we are nothing without our partners you saw that list of partners earlier in the presentation so when we talking about

ASAP we're really talking about the combined work of the Sheriff's Office judges teachers everybody all together and this is what we're doing from a primary prevention so from education and prevention perspective we are doing safe medication disposal initiatives we are showing people where they can dispose of their medications we're encouraging them not to keep them in their houses because we have a lot of senior citizens doing that they're terrified to throw their medication away they're terrified to flush it down the toilet so they just keep it in their house which puts them at a very increased risk of people coming in and taking it from them but also younger people dabbling in their drugs as well we helped coordinate education in schools so right now we have 16 different schools that are receiving evidence-based curriculum for drug prevention and overall health and wellness and that is being provided by Bay care behavioral health and youth and family alternatives we do a lot of medication safety trainings we do youthful at campaigns and we do our best to create a culture of health in general and I am happy to answer questions on all of these but I'm gonna go through this in the interest of time from the secondary prevention perspective we work really hard to increase access till not till unlock zone and I did want to mention that Bay care recently received some free narcan kits and I believe and either Tracy or joy can correct me on this that they are giving those to patients families so if there is a patient going in for an opioid issue the family member might want to have that that narcan on them in case their loved one would overdose they have that available for them we work really hard on reducing stigma of this to be honest and I know you guys know that we come up to you for proclamations all the time about decreasing the stigma and that's because it is a huge issue in people wanting and seeking help to begin with and that's not just resonated in national statistics but also in our own local focus groups we try really hard to increase access to care education on what's going on if to our ER doctors so that they can be best prepared increasing knowledge and medication assisted treatment which Joyce presentation is great for that and then the Good Samaritan Law so basically the number one people reason people die from the opioid crisis is often time it's time it's time because we have naloxone we have the ability to revive a person but they don't get it in time and a lot of the time the reason that is is because people are too scared to call 9-1-1 a lot of people who overdose are overdosing with someone we need to increase the call to 9-1-1 we need to increase access to naloxone so one of the things we really try to push is the Good Samaritan Act if you are acting in good faith to save a life you will not be prosecuted for the the charges of having drugs on you that's not always the case if you're trafficking or if

you're selling obviously but for the most part you won't be prosecuted for that tertiary why's we are increasing access to recovery groups we work with youth recovery services and really trying to get those services for young people creating an environment in which people in recovery can thrive and this is really where my you know dissertation research will be focused as I started working on that and the next few months but basically you know we do see relapse rates that are comparable to other diseases you know they can range between 60 and 80 percent just like diabetes heart disease whatnot so what can we do as a community to make that better you know we know that if you have diabetes we can create sidewalks we can you know create do our best to make sure we don't have food deserts we have environmental strategies to make sure you can manage your chronic illness so what do we need to do for addiction and then these are just a few pictures of what's going on so this is one of our naloxone townhall community discussions where we talk about how to call 911 Minister naloxone where to get it how to get it for free these are your seven permanent Dropbox sites here in Pasco County all operated at law enforcement agencies obviously seven is not enough to serve the half-million people here in Pasco County so we have invested in doTERRA bags so this is a really great partnership that we are embarking on with the Department of Health as well where you can go to the little road office and you will get a free doterra disposal bag so making sure that the people who most need to dispose of their medication have access to and we kind of you know know our community really well and the people who are going to the health department are probably the least likely to drive you know far down the county to dispose of their medications at a sheriff's office other people who are targeted for these items are the elderly and people who've previously been arrested we're also investing in medication storage devices so that you can see the last time you opened your medication this helps you not only keep you on track to make sure that you take your medication in time in a timely manner but it helps you know if somebody is going in there and taking your medication when you don't want them to one of this is important for the you know opioid crisis it's also really important because we're seeing the record high levels of kids attempting suicide with medication we say this over and over again if you have a gun at home you lock up your gun if you have medication you have kids in your home you make sure that's monitored and stored and then of course we work and to do our best to reduce stigma so on the right that's a proclamation for national recovery month and on the left these are people in recovery who have one of them has had narcan used on him seven times these are people who have had multiple chances and are finally living successful lives in recovery and wanted to thank AMS for saving their lives this is an upcoming events where

if any of you would like to engage with people in recovery I hope you do if you want to come to this event it is on September 22nd it's at the church Trinity Church of Christ in New Port Richey this is our annual national recovery celebration event a great opportunity to break down the stigma and silos and really show support for people living in recovery and make sure they succeed make sure they have all the things that they need in order to succeed we also have our note candlelight vigil on October 25th this event is much more focused on making sure we properly honor those who have passed away while also linking people to treatment so again another great event last year we had 230 people show up for a vigil I mean that's not the most exciting event in the world you know to come and grieve but our community is so impacted by it that we had 230 people our conference please save the day please don't plan anything for this date I'm all of you all of you okay so it's May 14th 2019 it will be at Saddle Brook again we're very excited we are we have a really great speaker whose name is tragically not in my mind right now but he's a Columbine survivor so he talks about you know his his emotional trauma from Columbine how he became addicted how he overcame addiction and is now working as several he's a member of several boards for addiction treatment and then this is you know pride and joy and I know representative Mariano has had the pleasure to meet some of these students and knows how cool they are but these are some of our amazing students who help dry our efforts so students in recovery themselves or students who have experienced addiction from their families really helping us know what we need to do to make sure to change the culture and make sure that we have a culture of health and this is them being cool they won the youth outstanding award from the West Pasco Chamber of Commerce and then this is them on a podcast so all right so areas of need moving forward our students tell us all the time they need more recovery services we overwhelmingly focus on adults and not kids the general mentality among adults is that when kids are dabbling in drugs that it's a phase it's not always a phase they can the addiction is a child onset disease they need services as well so 12 steps for them etc we need increased access to health care so as a County Commission this is something that we can look into without necessarily needing the state Hillsborough does have their own health insurance plan to help some of the neediest families based on you know their own monetary system but basically if I'm trying to prevent women of childbearing age from having a child's being born with going through withdrawal I need to make sure those women have access to birth control or I need to make sure those women have access to treatment the problem is if they are not already pregnant they don't have Medicaid and if they're

not already pregnant and using they're not a priority population I have no way to unless they they can travel to the Health Department or premier which is far I have no real way to reach those women before they get pregnant and have a child who is struggling with withdrawal I'm happy to go into that in more detail but basically a lot of the evidence-based strategies that we could deploy to link people to care isn't health insurance or health access is actually required to make sure that that happens so again I can go in I can go into further detail on that the next thing concentrated community healing efforts again we know the zip codes where this is hitting the hardest and this is going to take a multi-faceted approach at schools at community centers family level you name it but we know the areas in highest need house it will always be a huge issue we have people in recovery who who would like to have more affordable housing options with other people in recovery and then ASAP fundraising we are entering our last year of federal funds so we are very much interested in making sure to sustain the efforts that were already doing and we are open to suggestions on that intent and then questions there is a need and also when it comes to medication disposal we're talking about different silos and I'm not sure I have to ask Kevin or a fire team but have you talked to them about having names proposed every firehouse actually Commissioner Mariano brought that up last time that we spoke and we've had some discussions about how to do that the issue isn't necessarily creating the disposal site it's the removal process so we just get hung up in that so it's just communicating a little bit more frequently but if I can rope one of you two into it I bet we can expedite that process yeah yeah perfect look at that that's the Sheriff's Office yeah [Applause] so you don't have to you don't have to crush them so basically you can pour 12 ounces of fluid into them or right and yep you just add a little bit of water into it and it's you activate it yep you can throw it away in your trash perfect in Monica I would like to part with one of those bottles that time-sensitive with our homebound seniors again people forget if they took their medication or not and that kind of medication if you double up on it it's not like doubling up on some minor medication that's it can cause an overdose so earlier right so there's a solution right Mauritius I'm so enjoy those people were over 70 years old yeah we can deliver them to their homes when we deliver their meals Thank You Monica all right okay all right last but not least certainly not least we are going to hear from ya Geron angel who is the CEO of magical butter and also dr. Marc Rosenfeld from Ananda scientific they're gonna talk about the serious role of cannabidiol oil or CBD in treating and preventing opioid addiction so thank you Karen for joining us and we have dr.

Rosenfeld on skype can you hear us dr. Rosenthal that's sure cam thank you for joining us I'd rather be where you are than in Utah which is where I'm sitting right here just a few takeaways from this really what I do for a living is strategy I come up with ways to solve problems be it for company or government and we've been very successful we've been very successful through the years doing this and in listening to today's different accounts of the silos if you will there's some things that we see like working upstream for example I had mentioned this to a couple of County Commissioners some good friends of mine were with Cambridge analytic a very famous data scientist firm at this point but one of the things that came out of that they had one program that was philanthropic at Cambridge analytic and it was looking at the data science to see who would be predisposed to addiction based on their social media habits and that's those resources are available to Pasco County they're my friends we can use some of that stuff and be progressive and be really at the head of the pack what I see in in this is we have not had a comprehensive strategy in eight years we've remained at the bottom and that's not acceptable and it's not anyone's individual fault it's a lack of unity or a lack of community whatever we want to call it and when I look this is this is a multi-faceted approach for example we're here because opiates are a big problem well you're 10 times as likely to be arrested in Pasco County with cannabis than you are with opiates you're twice as likely than with meth and you're six times as likely than if you do coke that's a problem all right so I think part of it is you can't arrest your way out of the problem we're arresting our way into a problem by selective enforcement of the wrong narcotics right if you have non if you have something that can't cause an overdose or it's non-lethal why are we wasting resources prosecuting them when we're in last place in a different category so to me that's just it's it's alarming statistics that as a strategist I look at and I say how do we affect change in these areas one of the big problems Mike and I had had dinner last night and we were discussing economic development for Pasco County the problem that's hit the most is 19 it's the only place that has lacked economic development in our County and so simply shifting some focus back towards the redevelopment of the problematic areas it will cause new jobs to come in and as people have jobs like the judge it mentioned earlier he does see people who have $100,000 a year jobs plus who wind up in drug court however for the most part those people who are higher higher earners are functional drug addicts at least they're not weighing on the system as much and the first thing we have to do is get the weight off the system so we can start to create a regenerative culture where we're preventing the problem and when I look at our statistics I know all of us

have said oh you're doing a great job you're doing this and I'm not saying anybody's not doing a good job but our statistics don't indicate that we're moving in the right direction so I as a resident of this county and not happy with any of the programs that we have in place and I think it takes a serious look in the mirror to say are we doing our County justice by these silos and not having a comprehensive strategy so we're here today to talk about solutions I think one of the solutions is to make this meeting frequently you know if this is this big of an epidemic when you look at the numbers we're tracking a hundred percent above 2017 that's alarming guys like this this needs to be realistically almost every county commissioner meeting should should say weigh 20 or 30 minutes for opioid addiction until we get ahead of this and this is like a cancer patient right when somebody has cancer you're not necessarily trying to resolve the cancer you're just trying to press pause you're just trying to buy time and in this situation we need to press pause we need to get people to a point where they're not seeking these drugs you can't arrest your way out of a problem if somebody wants to do drugs they're gonna do and and the only way to do it is to get people to press pause on their desire to do the drugs and that's through good jobs education and community support it's it's the same parameters everywhere today we're very fortunate to have one of the top molecular biologists in the world with us he's one of my colleagues and one of my best friends actually mark Rosenfeld and just a quick intro on mark really fascinating individual what he does in life is he finds the molecule he found the molecules I got panda bears to copulate in captivity the giant panda bear came off the endangered species list in large part due to his discovery he's one of the inventors of the ca-125 cancer screening test that's still in use today he's the us's advisor to the UN on bird flu again he finds molecules and mark and I teamed up with Hebrew University and some amazing scientists and doctors around the world physicians to bring a specific molecule to the marketplace that looks like it has tremendous application across a lot of different disease states and some people right at 80% I saw the statistic here 80% of these opioid patients are opioid addicts are starting with a prescription we didn't discuss anything about a way to educate our physicians on a way to prescribe alternatives and really you have to start at the source and that's one of the sources and also when I look at the statistics here for Pasco and candidly I didn't know a lot of them before here they're broken different age groups and it's not going to be the same methodology that we apply to that 25 year old that we'd apply to the 75 year old so putting together comprehensive programs that are H Pacific income specific and have actual use in utility where we're giving people alternative to opioids is paramount to get ahead of

this one of the molecules that looks to have tremendous utility for the reduction of opioids is cannabidiol and mark why don't you discuss a little bit about cannabidiol and our early successes to date in human case studies okay I just want to actually start by saying the you know McGarrett what Garrett said for a strategy that needs to be taken by Pascoe economy is actually something that's been taken on by the country of Australia and next week I'll be doing a physician a nationwide physician workshop in Sydney Australia literally on what I'm about to talk so this is getting traction around the world I myself as stated is big on public health problems usually on a large scale we can actually go to the second slide the slides are not be projected now there we go go to the second spider yeah the first slide everyone up to see there's no reason the top I'm actually going to be talking about cannabidiol and I want to start by staying very very safe well documented in scientific and medical journals and as a matter of fact the World Health Organization has just published its intent to reschedule cannabidiol as a safe compound the data are summarized here basically that it's non psychoactive and non addicting and otherwise does not seem to have much of any effect to include the fact that it's got no noticeable side effects it's the very unusual homology but I want to go right away on the third slide to POW feeds and to navigate it when you get attachments to the ocean receptor now to tap your biopic deletes the cravings of addictions and meta people it turns out that the cannabidiol also finds to the same acceptor and when it does that it actually produces tends to reduce the cravings for the individuals demand for opioids I also want to mention it was brought up after the tournament emotional dependence and that is the fact that I'm secretly is a very unusual compound because at the same time that activates the opens it also regulates which means it makes the body make the chemical it up regulates serotonin which is what makes you feel it's the reason why you take for example a Knick doctor breath so for emotional dependence it help it go far to help so to summarize without going into more detail key advantages of CBD as a potential treatment that number one it does not make users hot and otherwise there are no prospects of it miss we missed you so what that basically means is that this is a worth trying you know just from this information alone and furthermore for that there is absolutely you know that you know mr. Botha you never say absolutely nervous next slide please okay I listened to your presentation I do want to mention something I've actually participated in similar kinds of presentations in Pennsylvania and so far I actually thought they was was them productive so that's worth but in any case I'm not going to go over Pasco County statistic but here is real date CBD okay what it done is a series of case study trials in which we took stage

for cancer patients and these stage for cancer patients were being prescribed fentanyl for breakthrough cancer pain and when they were colored ministered CB ticket and all he own instruction was for them to take CBD twice a day what happened is there were voluntary decline or elimination of fentanyl this in fact the voluntary decline were greater than fifty percent across and twenty five percent of patients who were receiving CPD actually eliminated fentanyl use and decided to just continue with the CPD I because there were no side effects noticeable and it was controlling pain and it's right so we do had no welcomes we had no side effects in the study and furthermore another notable consequence especially in the younger cancer patients where it's very typically see more of your diction although it was interesting to hear you guys talk about post seventy people taking seven equals an addiction which means I have to put the medical school library rescue people today but in any case what we found is that not only they reduce their their intake fences or Eliminator and take a vent we found no withdrawal symptoms associated with the reduction in these people have been taken for a period of time so the hypothesis now that we're working on is at number one we can reverse the demand for you know the body's demand for fentanyl's to play but administrated CPD and secondly we can actually perhaps who says withdrawal therapy that CBD becomes administered and craving that causes people the recidivism and not an opioid abuse you know will not slow please I want to point out I'm trying to keep this as brief as possible I come with human resources that may be of great help and after these two Pasco County and this is actually just a partial list of the people with whom I work these people have volunteered to be of any assistance that you wish in any case I'll take any questions or otherwise let guarantee go conversation CBD CBD is legal it can be used it's farmed under the farm Act we work closely with Mitch McConnell and Rand Paul and in moving legislation forward to make this federally more acceptable and restore banking to two farmers it's this is one tool right we're here because we don't have a vested interest we're not being paid anything from Pasco County we just want to give resources this is my hometown it's my County and it sucks that we're doing so poorly in opioids and in all drugs for that matter it's not opioids right and I also own a company called magical butter and from that we probably have the largest database of individuals who are using cannabis at home and I can't tell you how many people have went from 20 pills to two now this is an on psychotropic option but cannabis and which let's call this hemp okay which is CBD derived and cannabis which is more THC derived they both have utility in battling this because some people enjoy the psychotropic effect and you're not going to get every addict to buy into the fact that they don't want to walk around high so if you're gonna have an

addict walking around high anyway at least have it be a non-lethal compound and I'm not here to advocate to move THC forward right I'm here to advocate moving CBD forward I know personally I'll put some money up to help I've offered that to the County Commissioners will give products you know and mark them marks a CEO and I'm the strategy officer of a company that has really tremendous CBD that that will be willing to give to the different programs to to implement let's let's really come out this as a community where we're giving people alternative and he realize that we're setting trends if you want to get an addict to stop being an addict first you have to give them hope and if you just put them in the same system that they failed in 10 times they probably lost their hope and realistically I just I hope that this this first workshop like Mike said it's almost monthly at this point until we get ahead of this now when when I do strategy for a company or a country we do a conference call at least once a week and there's an hour-long call and everybody gets there a lot of time to discuss it but that's how you move projects and programs forward and Pasco County needs to move forward on this we we can't stand about last place which is the same plant that you find in the health food stores now morning smoothies that when they have the health food store again we have the scientists here so he can answer it's a little bit different than pulling the oils out concentrating Ron I guess concentrated yeah I'll have more highly concentrated the tree versus somebody goes at the health food store and buys yeah there's a difference between different CBD manufacturers both in the chemistry the efficacy and the bioavailability and CBD for example has a notoriously low bioavailability about five to eight percent will typically get into the bloodstream so it's a very inefficient molecule and it's in its natural state even with some carrier oils like you might get at the health food store to combat this problem we actually reverse engineered this and got drug delivery involved in it and now there's novel chemistry that surrounds the Maalik and it delivers it into the bloodstream at a 15 to 20 axe bioavailability increase which means the patient or the the addict can take much less but have it in their bloodstream longer it's more stable it would be like the one example earlier about fentanyl versus when it was not available and they went to heroin in the streets and they didn't have a measured dosage right when you when you combine nano sciences and with bioactives or with Kent and cannabinoids now you have a more measurable response rate yeah let me interject one thing and that is that from the onset I think that you have a dial from the perspective of two things number one medicinal development molecular biologist the reason I'm sitting in Utah on the forum faculty at the University of Utah school medicine like this had never left up my house and the the the other part is that there really seems to be a public health

compare will just want how to make this a major project what we do with CBD is to make it real medicine and everything that we do to make it real medicine is util uses what are called browser generally recognized as safe molecules so in other words the preparation that we made is highly effective but also it's on top and that's that's a hallmark of we've been able to and with that we brought this to unprecedented levels that's now allowing us to enter into very serious trust need for it a little bit the importance for our doctors to get trained to go through so they know what to prescribe what levels to go through I think it's a very critical thing so let me just kind of a fire a question to joy what did the presentation for Bay Care do you guess you CBD at all and I said we're entering into Sierra's clinical trials but we have done case study actually has fair amount of study work both here in the United States also yeah I had a clarifying question for her Garin so I'm just trying to understand what specifically you're speaking to and you know obviously we have a podiayia gund Marinol that's fda-approved CBD derived you know highly tested and then we have the medical marijuana movement where you know you have to go through the the prescribing doctors and the dispensaries so where does the product that you are discussing in your suggestion fit into these two paradigms so PDL X which is recently approved by the FDA as a CBD medicine the challenge with it is it lacks bioavailability so when you look at the clinical studies without drug delivery CBDs response rate is erratic and when you apply drug delivery becomes a much tighter standard deviation mean what we're talking about here has nothing to do with medical marijuana nothing to do with medical cannabis this is in over-the-counter product that can be purchased and implemented into everybody as a dietary supplement and ultimately what it appears that CBD does is it decreases the body's inflammation so when you have somebody I know that chronic pain was one of the things that was discussed as as an entry point for opiates if we can reduce inflammation the thought pattern is that we can reduce the pain in the individual which reduces their their need or want for opiates let me interject you know so that there's clarity to this there really are three things to consider here number one Garen is spot-on correct and as a matter of fact it was the original reason that I became attracted to cannabic uphill and that is that it is it is perhaps the most effective in seconds like motoring I've ever encountered but number two is that it truly does buying 2 opieop except with that it does provide it seems to provide some aspect of analgesic relief either directly or indirectly and we'll go into details if somebody wants that I can give that so that's number two and then number three relative relevant to this discussion is also at the same time as you're reducing anti-inflammation as we are providing direct analgesic relief through the

opioid receptors they're also creating an environment which more serotonin because so the patient is also that perspective then we could talk about a whole host of other possible interactions that may be beloved but those are probably the rates your studies the best anti-inflammatory you've ever seen oh the incense yeah well there's ibuprofen which actually an ibuprofen to do an effective analgesic not an analgesic and anti-inflammatory you have to take 800 milligrams per day by the way which is for OTC tablets not to just so people know however the level of anti-inflammation that you get is is is minimal relative to what you could experience with cannabidiol cannabidiol as an uncanny ability what it does it's the primary there there is a particular protein that is largely responsible for inflammation now particularly that that particular protein directly impact by the presence of cannabidiol so what happens is it dramatically produces in and actually quite rapid versus ibuprofen all it does is a temporary suppression okay thanks Lana George so you don't cure anti-inflammation or you don't you know remove and the inflammation is a factor in a patient about an actual with ibuprofen it so it's chronic use it's necessary there on the other hand the case of cannabidiol you have prospect of actually eliminating inflammation what about it it's it's pain relief oxycontin it goes you know hydrocodone oxycotin and then we go up to the wonders of fit by the way just want to make a comment because it wasn't made that you had mentioned oxycontin early but most of the illegal oxy contact the whale I said is actually primarily fungible yeah just so just for point of information but in any case oxycontin is you know attaches to the other acceptor provides analgesic relief it's as simple as that does nothing to it has nothing to do with anything else it does not make it makes you feel better for the perspective of pain relief and it does give you some euphoria that's associated with that and that's the attraction to people but on the other hand does not provide know as a serotonin which is natural feel good or natural feel good you know chemical in the body nor does it have anything to do with or [Music] inflammation in FLETC or a second that's a little story about myself I don't say four or five years ago I had a deviated septum that was blocked 99% they think it might have been from birth don't know but my doctor found it so we put me into surgery didn't ask me what I wanted for medicine just prescribed one of the oxy codons I took it for five days as I was sitting down at my mother's chair I would take it every four hours with Tylenol and I have package of crackers that I went through and I didn't move for like five days going through and I did it the day after a Board of County Commissioners meeting when we had uli coming in a little bit after that we had to do a presentation so I missed the morning part of the meeting went to Saddle Brook in the previous day I

probably call my doctor ten times because I was running out of pills got like three pills left I am 40 hours before he's gonna see him again I heard this that gone out of my nose which the most painful thing I've ever felt in my life and I didn't want to go through the same pain taking the splints out they were left behind so I kept pulling him know when I'm running out I don't running out I need to get these pills and it's like three o'clock in the afternoon the last time I took a pill was four in the morning and it's like through the time of him coming over to Saddle Brook so he goes jack I hear you call my office continually all day yesterday what what's going on Isis doc I'm running out of pills you're gonna take the splints off tomorrow my mother's friend told me how painful that was gonna be and go his jacket I only prescribed it for a few days I don't know how you got a week's worth of pills but I want you off those things ice but doc ice is I'm coming to see you tomorrow and I wanted we need to take this out he does check are you any pain right now in the struck bag oh no I'm not in any pain but mentally this thing that gets hooked up in your brain makes you want to take it over and over again and I tell you one way to hurt Ryan Leaf speak he's a number one NFL draft pick went through things between injuries whatever he was on those pills he get hooked on it so bad the stories he would tell which I can't wait to have him come to golf I'm sure he'd like to do to tell the story what he went through I could really directly to what he was saying and how people get hooked on this stuff so to me it's so critical that we actually get this so we helped the doctors not only want to prescribe it but learn how to prescribe that obviously make the supply out there so that we can make these things go out there because now I'm hearing different data but for one of the data I heard if 80% of these people get started by prescriptions that's where the route is we need to change that whole dynamic I agree and I think just to wrap up because I know everybody has time constraints myself included my dad's 70th birthday today so you know we're here as a resource we're not here to antagonize the situation we are here to shine light on things that need lights but ultimately how can we help Pasco County this is my hometown I'm incredibly successful and whatever resources is County needs either professionally or monetarily let's put stuff in order and start to have a good strategy where we reduce our opioid epidemic got a veteran family slash friend that was prescribed 160 pills a month now he was to leave he's got his medical marijuana she needs you should have access to and he doesn't have the issues not addictive don't can't overdose or so many things so so it's as a county I think being innovative we know these things are coming we know they're coming to the

state it's about you know what's with this trial period how soon so we can see it to be available what you're talking about what the doctor is talking about to where we can use it here let's say in Pasco County with medical it can be used in Pasco County starting tomorrow yeah and by the way if you talk to me I prefer mark instead of doctor look again thank you all thank you thank you mark for taking the time and I think we we got a lot of accomplished today I think we can all agree we have a long ways to go but I know we're all committed here I know everyone that there was no back and forth everybody's on maybe not on the same page but at the end of the day everybody cares about our County it's our County and our residents so I don't know that I can lift it once a month but I think we'll send out something to everybody and it's included that we you know maybe we add some folks I know some of that city Anupa Ritchie's like hey what about we're over here - we're on 19 we want to talk about it work together I didn't even think about that that makes sense you know I don't mind the idea of a task force I know Monica you talked about different task force you have maybe that's something we do again I'm on enough task force but and Mead and boards but I don't know that there's any board or task force more important than what we can get done today and tomorrow and moving forward because I can tell you when we sit down a year from now I don't think any of us are gonna be ok to see these same numbers we better not see these thing no worse because I know together we can we can't address this we can fix this period again I'm not taking it where our first responders are handing it out actually don't you do guaran I want to thank you for bringing this idea to kind of push this envelope through our communications without whether everybody to make this happen because I think it is a big step I really like Darrin's idea about having it so it's a report every every let's say meeting to the board but I think we need every inmate once a month right here in new parish where most abuse is done right here but I think a monthly schedule about 15 minutes 20 minutes for me let's talk about what we're doing so we keep it on the pulse and watch it every step of the way and I want to thank you for inviting represented Mariano can Congress fellow action as well because I think we do need the federal and the state people to joined with us all our ideas we've got some folks but I think all these silos together we're gonna be those help from the feds in the state with it whatever fun dues are out there to try to help us yeah absolutely it was good to hear that congressman Gloria smidgen death funding coming out from the feds to help out for me our health care which is great I seem like Mike did you want I am it sorry we come forward real quick Mike Tim I can from the state standpoint DCF I might appear a health officer Pasco County Health Department Florida Department of Health DCF has funding and the state is really

when we talk about state funding has funded it through DCF so DCF should be here as well the hospitals all have a vested interest in this and we're we're on that they're the ones that are taking the hospital patients that are coming so I think having the hospital CEOs come if we're gonna have this as a community effort it's going to take that level of engagement they also have money and are interested in investing in upstream to prevent those those hospital admissions so it cost them a lot of readmissions because they're also charged for readmissions so I think Hospital people could be involved as well and I think the medical community your doctors your doctors have the hospital physician associations get some of them as representatives there because if we're going to talk about writing prescription then they got a police themselves as well as we try to legislate that so just a couple thoughts on it doctor recent Tom Santa would be present to the Board of County Commissioners from before if they have a close yet they're pretty close to close and so that might be an asset that we're going to look at internal don't put people in front of a better facility if they get a little bit of help to go through so maybe don't know your are they looking at a rehab for service yeah well yeah yeah exactly the total rehab side of it exactly okay that's probably okay thank you thank you all again with that weren't returning [Music] you