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HomeMy WebLinkAbout09 ADOPT RESO 21-108 TO JOIN NATIONAL OPIOID SETTLEMENT DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 • Agenda Item 9 AGENDA REPORT Reviewed: ��� City Manager Finance Director N/A MEETING DATE: DECEMBER 21 , 2021 TO: HONORABLE MAYOR AND MEMBERS OF CITY COUNCIL FROM: MATTHEW S. WEST, CITY MANAGER SUBJECT: ADOPT RESOLUTION NO. 21-108 TO JOIN NATIONAL OPIOID SETTLEMENT AGREEMENT SUMMARY: Consider whether to participate in the national settlement regarding opioids. RECOMMENDATION: Staff recommends that the City Council: 1. Adopt Resolution No. 21-108 approving participation in the national opioid settlement and, 2. Authorize the City Manager to take all necessary and reasonable actions to effectuate the City's participation, including executing all necessary agreements and documents subject to the review and approval of the City Attorney. FISCAL IMPACT: Preliminary estimates indicate that the City could receive $920,000 over an 18-year period for opioid abatement activities, though the disbursement schedule is not yet available. City staff time will be required to fulfill the City's annual reporting obligations to demonstrate the proper use of the funds for approved opioid abatement activities, but the extent of these reporting obligations is not expected to be unduly burdensome. BACKGROUND: After years of negotiations, two proposed nationwide settlement agreements were reached in July 2021 that would resolve the opioid litigation brought by states and local political subdivisions against the three largest pharmaceutical distributors and one manufacturer. The settlement agreements will require these combined defendants to pay up to a total of $26 billion over 18 years to participating states and subdivisions to remediate and abate the impacts of the opioid crisis. The City of Tustin will receive an allocation of the settlement funds only if it "opts-in" to participate in the settlement no later than January 2, 2022. DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 Resolution to Join National Opioid Settlement December 21, 2021 The settlement agreements resolve the litigation brought by the states and local political subdivisions against the distributors McKesson, Cardinal Health and Amerisource Bergen ("Distributors"), and the manufacturer Janssen Pharmaceuticals, Inc. and its parent company Johnson & Johnson ("J&J"). The proposed settlements require the Distributors to pay up to $21 billion over 18 years and J&J up to $5 billion over 9 years, for a total of $26 billion. Of this amount, approximately $22.7 billion is earmarked for use by participating states and subdivisions. California's Attorney General estimates that about $2.2 billion dollars will be distributed to California. In addition to the monetary payments, the agreements also require the Distributors and J&J to implement changes to methods of opioid marketing, sale and distribution practices and further require the Distributors to implement additional safeguards to prevent diversion of prescription opioids. This reform package includes the creation of a clearinghouse through which the Distributors will be required to account not only for their own shipments, but also the shipments of the other distributors, and to detect, stop, and report suspicious opioids orders. In addition, J&J (which ceased marketing opioids in 2015 and ceased selling opioids in 2020) will not market or sell any opioid products in the next ten years and has agreed to cease lobbying efforts concerned with prescription opioids for ten years. J&J also has agreed to make the clinical trial data for its discontinued opioids available for medical research. DISCUSSION Initial allocation of the $26 billion to participating states is based on a methodology determined among the state Attorneys General which looks at population and the severity of harm caused by the opioid epidemic in each participating state. According to this allocation formula, California stands to receive approximately 10% of the settlement proceeds, of which (i) approximately 15% of the proceeds will go to the litigating cities and counties for litigation expenses; (ii) approximately 15% of the proceeds will go to the state; and (iii) approximately 70% will be distributed to counties and cities with a population over 10,000 for opioid abatement, provided that the counties and cities opt-in to the settlement. The funds will be paid over an 18-year period. The funds are expected to be released into trust accounts for disbursements beginning or about July 2022. If the City does not affirmatively opt in to become a "Participating Subdivision", then the local allocation for the City would be paid to the County of Orange instead. DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 Resolution to Join National Opioid Settlement December 21, 2021 Funds from the settlement will be available for a range of approved abatement uses designed to: (1) address the misuse and abuse of opioid products, (2) treat or mitigate opioid use or related disorders, or (3) mitigate other alleged effects of, including on those injured as a result of, the opioid epidemic. The list of pre-approved uses includes a range of education, intervention, treatment, and recovery services. A copy of the list of allowed "opioid remediation uses" is attached for additional information. Educational uses could include, but would not be limited to, educating students about the dangers of opioids, and training police officers in the handling of fentanyl or other opioids. By opting into the program, the City will have annual reporting obligations on the use of the funds. Before the funds are released, the settlement agreements are subject to certain milestones, which, if not met, could allow the settling defendants to void the agreements. The principal milestone is that a "critical mass" of both state and local governments "opt in" and, thereby, participate in the settlement. The extent of this participation will determine whether the settlement agreements take effect. If the agreements do not take effect then the agreements would not protect the settling defendants from the litigation but the funds also would not be distributed to the City or other settling entities. Local jurisdictions "opt in" by executing a Participation Agreement. The deadline for Tustin and other jurisdictions to "opt in" is January 2, 2022. The California Attorney General provides more information and copies of the agreements at the following website: https://oag.ca.gov/opioids. A copy of the AG's FAA's is attached for additional information. ATTACHMENTS: 1. Resolution 21-108 Approving Participation in the National Opioid Settlement Agreement and Authorizing the City Manager to Execute All Related Documents 2. List of Opioid Remediation Uses 3. California Attorney General's Frequently Asked Questions re Nations Opioids Settlements DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 RESOLUTION NO. 21-108 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TUSTIN, CALIFORNIA, APPROVING PARTICIPATION IN THE NATIONAL OPIOID SETTLEMENT AGREEMENT AND AUTHORIZING THE CITY MANAGER TO EXECUTE ALL RELATED DOCUMENTS. WHEREAS, a settlement has been reached in multi-district litigation in Ohio brought by states and cities against the three largest opioid distributors—McKesson, Cardinal Health and Amerisource Bergen — and the opioid manufacturer Janssen Pharmaceuticals, Inc. (a subsidiary of Johnson & Johnson); and WHEREAS, the proposed settlement (Settlement) consists of an agreement with the opioid distributors and an agreement with Janssen; and WHEREAS, under the terms of the Settlement $21 billion will be paid by the opioid distributors over an 18-year period and Janssen will pay $5 billion over a 7-year period to states, cities, and counties; and WHEREAS, under the terms of Settlement, California is scheduled to receive approximately $2.2 billion, some of which will be distributed to cities and counties; and WHEREAS, although the City is not a litigating entity involved in this litigation, as a City with at least 10,000 residents, it may opt-in and receive the benefits of the Settlement in exchange for releasing its claims against the opioid distributors and Janssen; and WHEREAS, the more cities with populations greater than 10,000 in population, such as the City, which opt-in to the agreement will enable their respective counties and states to receive more funds under the incentive structure of the Settlement; and WHEREAS, opting-in to the settlement will enable to the City receive funds from the Settlement, which can be used to treat opioid use disorder and for other specified purposes related to opioid abatement costs, as defined; and WHEREAS, the City wishes to agree to the material terms of the proposed Settlement in order to receive monetary payments over an 18-year period to fund opioid abatement costs; and WHEREAS, jurisdictions must opt-in to the Settlement before January 2, 2022. NOW, THEREFORE, THE CITY COUNCIL OF THE CITY OF TUSTIN HEREBY RESOLVES AND ORDERS AS FOLLOWS: SECTION 1. Participation in the National Opioid Settlement. The City Council hereby approves and elects to "opt in" to the settlement agreements reached with distributors DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 McKesson, Cardinal Health, and Amerisource Bergen and with manufacturer Janssen Pharmaceuticals, Inc., a subsidiary of Johnson & Johnson, relating to the National Multi- District Opioid Litigation, as a full participant. SECTION 2. City Manager Appointment. The City Manager is hereby appointed as the City's Authorized Representative and authorizes the City Manager to take all necessary and reasonable actions to effectuate the City's participation in the settlement and sign all necessary agreements and documents, each following review and approval of the City Attorney. PASSED, APPROVED AND ADOPTED this 21St day of December, 2021. AUSTIN LUMBARD, Mayor ATTEST: ERICA N. YASUDA, City Clerk DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 STATE OF CALIFORNIA ) COUNTY OF ORANGE ) SS CITY OF TUSTIN ) I, Erica N. Yasuda, City Clerk and ex-officio Clerk of the City Council of the City of Tustin, California, do hereby certify that the whole number of the members of the City Council is five; that the above and foregoing Resolution No. 21-108 was duly and regularly passed and adopted at a regular meeting of the City Council held on the 21St day of December, 2021 by the following vote: COUNCILPERSONS AYES: COUNCILPERSONS NOES: COUNCILPERSONS ABSTAINED: COUNCILPERSONS ABSENT: ERICA N. YASUDA, City Clerk DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 DISTRIBUTORS' 10.22.21 EXHIBIT UPDATES EXHIBIT E List of Opioid Remediation Uses Schedule A Core Strategies States and Qualifying Block Grantees shall choose from among the abatement strategies listed in Schedule B. However,priority shall be given to the following core abatement strategies ("Core Strategies").14 A. NALOXONE OR OTHER FDA-APPROVED DRUG TO REVERSE OPIOID OVERDOSES 1. Expand training for first responders, schools, community support groups and families; and 2. Increase distribution to individuals who are uninsured or whose insurance does not cover the needed service. B. MEDICATION-ASSISTED TREATMENT ("MAT") DISTRIBUTION AND OTHER OPIOID-RELATED TREATMENT I. Increase distribution of MAT to individuals who are uninsured or whose insurance does not cover the needed service; 2. Provide education to school-based and youth-focused programs that discourage or prevent misuse; 3. Provide MAT education and awareness training to healthcare providers, EMTs, law enforcement, and other first responders; and 4. Provide treatment and recovery support services such as residential and inpatient treatment, intensive outpatient treatment, outpatient therapy or counseling, and recovery housing that allow or integrate medication and with other support services. 14 As used in this Schedule A,words like"expand,""fund,""provide"or the like shall not indicate a preference for new or existing programs. E-1 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 DISTRIBUTORS' 10.22.21 EXHIBIT UPDATES C. PREGNANT & POSTPARTUM WOMEN I. Expand Screening, Brief Intervention, and Referral to Treatment("SBIRT') services to non-Medicaid eligible or uninsured pregnant women; 2. Expand comprehensive evidence-based treatment and recovery services, including MAT, for women with co- occurring Opioid Use Disorder("OUD") and other Substance Use Disorder("SUD")/Mental Health disorders for uninsured individuals for up to 12 months postpartum; and 3. Provide comprehensive wrap-around services to individuals with OUD, including housing, transportation,job placement/training, and childcare. D. EXPANDING TREATMENT FOR NEONATAL ABSTINENCE SYNDROME ("NAS") I. Expand comprehensive evidence-based and recovery support for NAS babies; 2. Expand services for better continuum of care with infant- need dyad; and 3. Expand long-term treatment and services for medical monitoring of NAS babies and their families. E. EXPANSION OF WARM HAND-OFF PROGRAMS AND RECOVERY SERVICES I. Expand services such as navigators and on-call teams to begin MAT in hospital emergency departments; 2. Expand warm hand-off services to transition to recovery services; 3. Broaden scope of recovery services to include co-occurring SUD or mental health conditions; 4. Provide comprehensive wrap-around services to individuals in recovery, including housing, transportation,job placement/training, and childcare; and 5. Hire additional social workers or other behavioral health workers to facilitate expansions above. E-2 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 DISTRIBUTORS' 10.22.21 EXHIBIT UPDATES F. TREATMENT FOR INCARCERATED POPULATION 1. Provide evidence-based treatment and recovery support, including MAT for persons with OUD and co-occurring SUD/MH disorders within and transitioning out of the criminal justice system; and 2. Increase funding for jails to provide treatment to inmates with OUD. G. PREVENTION PROGRAMS I. Funding for media campaigns to prevent opioid use (similar to the FDA's "Real Cost"campaign to prevent youth from misusing tobacco); 2. Funding for evidence-based prevention programs in schools; 3. Funding for medical provider education and outreach regarding best prescribing practices for opioids consistent with the 2016 CDC guidelines, including providers at hospitals (academic detailing); 4. Funding for community drug disposal programs; and 5. Funding and training for first responders to participate in pre-arrest diversion programs,post-overdose response teams, or similar strategies that connect at-risk individuals to behavioral health services and supports. H. EXPANDING SYRINGE SERVICE PROGRAMS 1. Provide comprehensive syringe services programs with more wrap-around services, including linkage to OUD treatment, access to sterile syringes and linkage to care and treatment of infectious diseases. I. EVIDENCE-BASED DATA COLLECTION AND RESEARCH ANALYZING THE EFFECTIVENESS OF THE ABATEMENT STRATEGIES WITHIN THE STATE E-3 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 DISTRIBUTORS' 10.22.21 EXHIBIT UPDATES Schedule B Approved Uses Support treatment of Opioid Use Disorder (OUD) and any co-occurring Substance Use Disorder or Mental Health (SUD/MH) conditions through evidence-based or evidence-informed programs or strategies that may include, but are not limited to, the following: PART ONE: TREATMENT A. TREAT OPIOID USE DISORDER(OUD) Support treatment of Opioid Use Disorder ("OUD") and any co-occurring Substance Use Disorder or Mental Health ("SUD/MH") conditions through evidence-based or evidence- informed programs or strategies that may include,but are not limited to, those that:` 1. Expand availability of treatment for OUD and any co-occurring SUD/MH conditions, including all forms of Medication-Assisted Treatment("MAT') approved by the U.S. Food and Drug Administration. 2. Support and reimburse evidence-based services that adhere to the American Society of Addiction Medicine ("ASAM') continuum of care for OUD and any co- occurring SUD/MH conditions. 3. Expand telehealth to increase access to treatment for OUD and any co-occurring SUD/MH conditions, including MAT, as well as counseling,psychiatric support, and other treatment and recovery support services. 4. Improve oversight of Opioid Treatment Programs ("OTPs")to assure evidence- based or evidence-informed practices such as adequate methadone dosing and low threshold approaches to treatment. 5. Support mobile intervention, treatment, and recovery services, offered by qualified professionals and service providers, such as peer recovery coaches, for persons with OUD and any co-occurring SUD/MH conditions and for persons who have experienced an opioid overdose. 6. Provide treatment of trauma for individuals with OUD (e.g.,violence, sexual assault, human trafficking, or adverse childhood experiences) and family members (e.g., surviving family members after an overdose or overdose fatality), and training of health care personnel to identify and address such trauma. 7. Support evidence-based withdrawal management services for people with OUD and any co-occurring mental health conditions. 15 As used in this Schedule B,words like"expand,""fund,""provide"or the like shall not indicate a preference for new or existing programs. E-4 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 DISTRIBUTORS' 10.22.21 EXHIBIT UPDATES 8. Provide training on MAT for health care providers, first responders, students, or other supporting professionals, such as peer recovery coaches or recovery outreach specialists, including telementoring to assist community-based providers in rural or underserved areas. 9. Support workforce development for addiction professionals who work with persons with OUD and any co-occurring SUD/MH conditions. 10. Offer fellowships for addiction medicine specialists for direct patient care, instructors, and clinical research for treatments. 11. Offer scholarships and supports for behavioral health practitioners or workers involved in addressing OUD and any co-occurring SUD/MH or mental health conditions, including, but not limited to, training, scholarships, fellowships, loan repayment programs, or other incentives for providers to work in rural or underserved areas. 12. Provide funding and training for clinicians to obtain a waiver under the federal Drug Addiction Treatment Act of 2000 ("DATA 2000")to prescribe MAT for OUD, and provide technical assistance and professional support to clinicians who have obtained a DATA 2000 waiver. 13. Disseminate of web-based training curricula, such as the American Academy of Addiction Psychiatry's Provider Clinical Support Service—Opioids web-based training curriculum and motivational interviewing. 14. Develop and disseminate new curricula, such as the American Academy of Addiction Psychiatry's Provider Clinical Support Service for Medication— Assisted Treatment. B. SUPPORT PEOPLE IN TREATMENT AND RECOVERY Support people in recovery from OUD and any co-occurring SUD/MH conditions through evidence-based or evidence-informed programs or strategies that may include, but are not limited to, the programs or strategies that: I. Provide comprehensive wrap-around services to individuals with OUD and any co-occurring SUD/MH conditions, including housing,transportation, education, job placement,job training, or childcare. 2. Provide the full continuum of care of treatment and recovery services for OUD and any co-occurring SUD/MH conditions, including supportive housing, peer support services and counseling, community navigators, case management, and connections to community-based services. 3. Provide counseling,peer-support, recovery case management and residential treatment with access to medications for those who need it to persons with OUD and any co-occurring SUD/MH conditions. E-5 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 DISTRIBUTORS' 10.22.21 EXHIBIT UPDATES 4. Provide access to housing for people with OUD and any co-occurring SUD/MH conditions, including supportive housing,recovery housing, housing assistance programs, training for housing providers, or recovery housing programs that allow or integrate FDA-approved mediation with other support services. 5. Provide community support services, including social and legal services,to assist in deinstitutionalizing persons with OUD and any co-occurring SUD/MH conditions. 6. Support or expand peer-recovery centers, which may include support groups, social events, computer access, or other services for persons with OUD and any co-occurring SUD/MH conditions. 7. Provide or support transportation to treatment or recovery programs or services for persons with OUD and any co-occurring SUD/MH conditions. 8. Provide employment training or educational services for persons in treatment for or recovery from OUD and any co-occurring SUD/MH conditions. 9. Identify successful recovery programs such as physician,pilot, and college recovery programs, and provide support and technical assistance to increase the number and capacity of high-quality programs to help those in recovery. 10. Engage non-profits, faith-based communities, and community coalitions to support people in treatment and recovery and to support family members in their efforts to support the person with OUD in the family. 11. Provide training and development of procedures for government staff to appropriately interact and provide social and other services to individuals with or in recovery from OUD, including reducing stigma. 12. Support stigma reduction efforts regarding treatment and support for persons with OUD, including reducing the stigma on effective treatment. 13. Create or support culturally appropriate services and programs for persons with OUD and any co-occurring SUD/MH conditions, including new Americans. 14. Create and/or support recovery high schools. 15. Hire or train behavioral health workers to provide or expand any of the services or supports listed above. C. CONNECT PEOPLE WHO NEED HELP TO THE HELP THEY NEED (CONNECTIONS TO CARE) Provide connections to care for people who have—or are at risk of developing—OUD and any co-occurring SUD/MH conditions through evidence-based or evidence-informed programs or strategies that may include,but are not limited to, those that: E-6 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 DISTRIBUTORS' 10.22.21 EXHIBIT UPDATES 1. Ensure that health care providers are screening for OUD and other risk factors and know how to appropriately counsel and treat(or refer if necessary) a patient for OUD treatment. 2. Fund SBIRT programs to reduce the transition from use to disorders, including SBIRT services to pregnant women who are uninsured or not eligible for Medicaid. 3. Provide training and long-term implementation of SBIRT in key systems (health, schools, colleges, criminal justice, and probation), with a focus on youth and young adults when transition from misuse to opioid disorder is common. 4. Purchase automated versions of SBIRT and support ongoing costs of the technology. 5. Expand services such as navigators and on-call teams to begin MAT in hospital emergency departments. 6. Provide training for emergency room personnel treating opioid overdose patients on post-discharge planning, including community referrals for MAT,recovery case management or support services. 7. Support hospital programs that transition persons with OUD and any co-occurring SUD/MH conditions, or persons who have experienced an opioid overdose, into clinically appropriate follow-up care through a bridge clinic or similar approach. 8. Support crisis stabilization centers that serve as an alternative to hospital emergency departments for persons with OUD and any co-occurring SUD/MH conditions or persons that have experienced an opioid overdose. 9. Support the work of Emergency Medical Systems, including peer support specialists,to connect individuals to treatment or other appropriate services following an opioid overdose or other opioid-related adverse event. 10. Provide funding for peer support specialists or recovery coaches in emergency departments, detox facilities,recovery centers,recovery housing, or similar settings; offer services, supports, or connections to care to persons with OUD and any co-occurring SUD/MH conditions or to persons who have experienced an opioid overdose. 11. Expand warm hand-off services to transition to recovery services. 12. Create or support school-based contacts that parents can engage with to seek immediate treatment services for their child; and support prevention, intervention, treatment, and recovery programs focused on young people. 13. Develop and support best practices on addressing OUD in the workplace. E-7 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 DISTRIBUTORS' 10.22.21 EXHIBIT UPDATES 14. Support assistance programs for health care providers with OUD. 15. Engage non-profits and the faith community as a system to support outreach for treatment. 16. Support centralized call centers that provide information and connections to appropriate services and supports for persons with OUD and any co-occurring SUD/MH conditions. D. ADDRESS THE NEEDS OF CRIMINAL JUSTICE-INVOLVED PERSONS Address the needs of persons with OUD and any co-occurring SUD/MH conditions who are involved in, are at risk of becoming involved in, or are transitioning out of the criminal justice system through evidence-based or evidence-informed programs or strategies that may include, but are not limited to, those that: 1. Support pre-arrest or pre-arraignment diversion and deflection strategies for persons with OUD and any co-occurring SUD/MH conditions, including established strategies such as: I. Self-referral strategies such as the Angel Programs or the Police Assisted Addiction Recovery Initiative ("PAARI"); 2. Active outreach strategies such as the Drug Abuse Response Team ("DART')model; 3. "Naloxone Plus" strategies, which work to ensure that individuals who have received naloxone to reverse the effects of an overdose are then linked to treatment programs or other appropriate services; 4. Officer prevention strategies, such as the Law Enforcement Assisted Diversion ("LEAD")model; 5. Officer intervention strategies such as the Leon County, Florida Adult Civil Citation Network or the Chicago Westside Narcotics Diversion to Treatment Initiative; or 6. Co-responder and/or alternative responder models to address OUD-related 911 calls with greater SUD expertise. 2. Support pre-trial services that connect individuals with OUD and any co- occurring SUD/MH conditions to evidence-informed treatment, including MAT, and related services. 3. Support treatment and recovery courts that provide evidence-based options for persons with OUD and any co-occurring SUD/MH conditions. E-8 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 DISTRIBUTORS' 10.22.21 EXHIBIT UPDATES 4. Provide evidence-informed treatment, including MAT,recovery support, harm reduction, or other appropriate services to individuals with OUD and any co- occurring SUD/MH conditions who are incarcerated in jail or prison. 5. Provide evidence-informed treatment, including MAT,recovery support, harm reduction, or other appropriate services to individuals with OUD and any co- occurring SUD/MH conditions who are leaving jail or prison or have recently left jail or prison, are on probation or parole, are under community corrections supervision, or are in re-entry programs or facilities. 6. Support critical time interventions ("CTP'),particularly for individuals living with dual-diagnosis OUD/serious mental illness, and services for individuals who face immediate risks and service needs and risks upon release from correctional settings. 7. Provide training on best practices for addressing the needs of criminal justice- involved persons with OUD and any co-occurring SUD/MH conditions to law enforcement, correctional, or judicial personnel or to providers of treatment, recovery, harm reduction, case management, or other services offered in connection with any of the strategies described in this section. E. ADDRESS THE NEEDS OF PREGNANT OR PARENTING WOMEN AND THEIR FANHLIES,INCLUDING BABIES WITH NEONATAL ABSTINENCE SYNDROME Address the needs of pregnant or parenting women with OUD and any co-occurring SUD/MH conditions, and the needs of their families, including babies with neonatal abstinence syndrome ("NAS"), through evidence-based or evidence-informed programs or strategies that may include,but are not limited to, those that: 1. Support evidence-based or evidence-informed treatment, including MAT, recovery services and supports, and prevention services for pregnant women—or women who could become pregnant—who have OUD and any co-occurring SUD/MH conditions, and other measures to educate and provide support to families affected by Neonatal Abstinence Syndrome. 2. Expand comprehensive evidence-based treatment and recovery services, including MAT, for uninsured women with OUD and any co-occurring SUD/MH conditions for up to 12 months postpartum. 3. Provide training for obstetricians or other healthcare personnel who work with pregnant women and their families regarding treatment of OUD and any co- occurring SUD/MH conditions. 4. Expand comprehensive evidence-based treatment and recovery support for NAS babies; expand services for better continuum of care with infant-need dyad; and expand long-term treatment and services for medical monitoring of NAS babies and their families. E-9 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 DISTRIBUTORS' 10.22.21 EXHIBIT UPDATES 5. Provide training to health care providers who work with pregnant or parenting women on best practices for compliance with federal requirements that children born with NAS get referred to appropriate services and receive a plan of safe care. 6. Provide child and family supports for parenting women with OUD and any co- occurring SUD/MH conditions. 7. Provide enhanced family support and child care services for parents with OUD and any co-occurring SUD/MH conditions. 8. Provide enhanced support for children and family members suffering trauma as a result of addiction in the family; and offer trauma-informed behavioral health treatment for adverse childhood events. 9. Offer home-based wrap-around services to persons with OUD and any co- occurring SUD/MH conditions, including,but not limited to,parent skills training. 10. Provide support for Children's Services—Fund additional positions and services, including supportive housing and other residential services,relating to children being removed from the home and/or placed in foster care due to custodial opioid use. PART TWO: PREVENTION F. PREVENT OVER-PRESCRIBING AND ENSURE APPROPRIATE PRESCRIBING AND DISPENSING OF OPIOIDS Support efforts to prevent over-prescribing and ensure appropriate prescribing and dispensing of opioids through evidence-based or evidence-informed programs or strategies that may include,but are not limited to, the following: 1. Funding medical provider education and outreach regarding best prescribing practices for opioids consistent with the Guidelines for Prescribing Opioids for Chronic Pain from the U.S. Centers for Disease Control and Prevention, including providers at hospitals (academic detailing). 2. Training for health care providers regarding safe and responsible opioid prescribing, dosing, and tapering patients off opioids. 3. Continuing Medical Education (CME) on appropriate prescribing of opioids. 4. Providing Support for non-opioid pain treatment alternatives, including training providers to offer or refer to multi-modal, evidence-informed treatment of pain. 5. Supporting enhancements or improvements to Prescription Drug Monitoring Programs ("PDMPs"), including,but not limited to, improvements that: E-10 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 DISTRIBUTORS' 10.22.21 EXHIBIT UPDATES I. Increase the number of prescribers using PDMPs; 2. Improve point-of-care decision-making by increasing the quantity, quality, or format of data available to prescribers using PDMPs, by improving the interface that prescribers use to access PDMP data, or both; or 3. Enable states to use PDMP data in support of surveillance or intervention strategies, including MAT referrals and follow-up for individuals identified within PDMP data as likely to experience OUD in a manner that complies with all relevant privacy and security laws and rules. 6. Ensuring PDMPs incorporate available overdose/naloxone deployment data, including the United States Department of Transportation's Emergency Medical Technician overdose database in a manner that complies with all relevant privacy and security laws and rules. 7. Increasing electronic prescribing to prevent diversion or forgery. 8. Educating dispensers on appropriate opioid dispensing. G. PREVENT MISUSE OF OPIOIDS Support efforts to discourage or prevent misuse of opioids through evidence-based or evidence-informed programs or strategies that may include,but are not limited to, the following: 1. Funding media campaigns to prevent opioid misuse. 2. Corrective advertising or affirmative public education campaigns based on evidence. 3. Public education relating to drug disposal. 4. Drug take-back disposal or destruction programs. 5. Funding community anti-drug coalitions that engage in drug prevention efforts. 6. Supporting community coalitions in implementing evidence-informed prevention, such as reduced social access and physical access, stigma reduction—including staffing, educational campaigns, support for people in treatment or recovery, or training of coalitions in evidence-informed implementation, including the Strategic Prevention Framework developed by the U.S. Substance Abuse and Mental Health Services Administration ("SAMHSA"). 7. Engaging non-profits and faith-based communities as systems to support prevention. E-11 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 DISTRIBUTORS' 10.22.21 EXHIBIT UPDATES 8. Funding evidence-based prevention programs in schools or evidence-informed school and community education programs and campaigns for students, families, school employees, school athletic programs, parent-teacher and student associations, and others. 9. School-based or youth-focused programs or strategies that have demonstrated effectiveness in preventing drug misuse and seem likely to be effective in preventing the uptake and use of opioids. 10. Create or support community-based education or intervention services for families, youth, and adolescents at risk for OUD and any co-occurring SUD/MH conditions. 11. Support evidence-informed programs or curricula to address mental health needs of young people who may be at risk of misusing opioids or other drugs, including emotional modulation and resilience skills. 12. Support greater access to mental health services and supports for young people, including services and supports provided by school nurses,behavioral health workers or other school staff, to address mental health needs in young people that (when not properly addressed) increase the risk of opioid or another drug misuse. H. PREVENT OVERDOSE DEATHS AND OTHER HARMS (HARM REDUCTION) Support efforts to prevent or reduce overdose deaths or other opioid-related harms through evidence-based or evidence-informed programs or strategies that may include, but are not limited to, the following: 1. Increased availability and distribution of naloxone and other drugs that treat overdoses for first responders, overdose patients, individuals with OUD and their friends and family members, schools, community navigators and outreach workers, persons being released from jail or prison, or other members of the general public. 2. Public health entities providing free naloxone to anyone in the community. 3. Training and education regarding naloxone and other drugs that treat overdoses for first responders, overdose patients, patients taking opioids, families, schools, community support groups, and other members of the general public. 4. Enabling school nurses and other school staff to respond to opioid overdoses, and provide them with naloxone,training, and support. 5. Expanding, improving, or developing data tracking software and applications for overdoses/naloxone revivals. 6. Public education relating to emergency responses to overdoses. E-12 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 DISTRIBUTORS' 10.22.21 EXHIBIT UPDATES 7. Public education relating to immunity and Good Samaritan laws. 8. Educating first responders regarding the existence and operation of immunity and Good Samaritan laws. 9. Syringe service programs and other evidence-informed programs to reduce harms associated with intravenous drug use, including supplies, staffing, space,peer support services,referrals to treatment, fentanyl checking, connections to care, and the full range of harm reduction and treatment services provided by these programs. 10. Expanding access to testing and treatment for infectious diseases such as HIV and Hepatitis C resulting from intravenous opioid use. 11. Supporting mobile units that offer or provide referrals to harm reduction services, treatment,recovery supports,health care, or other appropriate services to persons that use opioids or persons with OUD and any co-occurring SUD/MH conditions. 12. Providing training in harm reduction strategies to health care providers, students, peer recovery coaches, recovery outreach specialists, or other professionals that provide care to persons who use opioids or persons with OUD and any co- occurring SUD/MH conditions. 13. Supporting screening for fentanyl in routine clinical toxicology testing. PART THREE: OTHER STRATEGIES I. FIRST RESPONDERS In addition to items in section C, D and H relating to first responders, support the following: 1. Education of law enforcement or other first responders regarding appropriate practices and precautions when dealing with fentanyl or other drugs. 2. Provision of wellness and support services for first responders and others who experience secondary trauma associated with opioid-related emergency events. J. LEADERSHIP,PLANNING AND COORDINATION Support efforts to provide leadership, planning, coordination, facilitations, training and technical assistance to abate the opioid epidemic through activities,programs, or strategies that may include,but are not limited to, the following: I. Statewide,regional, local or community regional planning to identify root causes of addiction and overdose, goals for reducing harms related to the opioid epidemic, and areas and populations with the greatest needs for treatment E-13 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 DISTRIBUTORS' 10.22.21 EXHIBIT UPDATES intervention services, and to support training and technical assistance and other strategies to abate the opioid epidemic described in this opioid abatement strategy list. 2. A dashboard to (a) share reports,recommendations, or plans to spend opioid settlement funds; (b)to show how opioid settlement funds have been spent; (c)to report program or strategy outcomes; or(d)to track, share or visualize key opioid- or health-related indicators and supports as identified through collaborative statewide,regional, local or community processes. 3. Invest in infrastructure or staffing at government or not-for-profit agencies to support collaborative, cross-system coordination with the purpose of preventing overprescribing, opioid misuse, or opioid overdoses,treating those with OUD and any co-occurring SUD/MH conditions, supporting them in treatment or recovery, connecting them to care, or implementing other strategies to abate the opioid epidemic described in this opioid abatement strategy list. 4. Provide resources to staff government oversight and management of opioid abatement programs. K. TRAINING In addition to the training referred to throughout this document, support training to abate the opioid epidemic through activities,programs, or strategies that may include, but are not limited to, those that: I. Provide funding for staff training or networking programs and services to improve the capability of government, community, and not-for-profit entities to abate the opioid crisis. 2. Support infrastructure and staffing for collaborative cross-system coordination to prevent opioid misuse,prevent overdoses, and treat those with OUD and any co- occurring SUD/MH conditions, or implement other strategies to abate the opioid epidemic described in this opioid abatement strategy list(e.g.,health care, primary care,pharmacies, PDMPs, etc.). L. RESEARCH Support opioid abatement research that may include, but is not limited to, the following: 1. Monitoring, surveillance, data collection and evaluation of programs and strategies described in this opioid abatement strategy list. 2. Research non-opioid treatment of chronic pain. 3. Research on improved service delivery for modalities such as SBIRT that demonstrate promising but mixed results in populations vulnerable to opioid use disorders. E-14 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 DISTRIBUTORS' 10.22.21 EXHIBIT UPDATES 4. Research on novel harm reduction and prevention efforts such as the provision of fentanyl test strips. 5. Research on innovative supply-side enforcement efforts such as improved detection of mail-based delivery of synthetic opioids. 6. Expanded research on swift/certain/fair models to reduce and deter opioid misuse within criminal justice populations that build upon promising approaches used to address other substances (e.g., Hawaii HOPE and Dakota 24/7). 7. Epidemiological surveillance of OUD-related behaviors in critical populations, including individuals entering the criminal justice system, including, but not limited to approaches modeled on the Arrestee Drug Abuse Monitoring ("ADAM') system. 8. Qualitative and quantitative research regarding public health risks and harm reduction opportunities within illicit drug markets, including surveys of market participants who sell or distribute illicit opioids. 9. Geospatial analysis of access barriers to MAT and their association with treatment engagement and treatment outcomes. E-15 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 -ate of California-Department of Justice-Office of the Attorney General State of California Department of Justice 1 f V Qo v ou O SNE ATTORNEyCF 0 �Fy ROB BONTA � J G 9 A[torn e General 90EP41iTME� Search Translate Website Traducir Sitio Web Frequently Asked Questions Home / NATIONAL OPIOIDS SETTLEMENTS - INFORMATION FOR CALIFORNIA CITIES AND COUNTIES / Frequently Asked Questions Eligible cities and counties should have recently received a letter via US Mail about two national opioid settlements (the Settlements). This page provides answers to frequently asked questions regarding the Settlements and the proposed California State-Subdivision Agreements. The deadline to join these two Settlements isianuary 2, 2022. FAQs ,( Frequ .nt.[y.Ask.ed.Qu.est.ion.$)I about the National Settlements - Information for California Cities and Counties 1 . We received a letter in the mail about two opioid Settlements. Is it real? 2. How can my city or county join the Settlements? 3. Is there a deadline forjoining the Settlements? 4. Has the State joined the Settlements? 5. Does my city or county need to join both Settlements? https://oag.ca.gov/opioids/fags 1/8 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 -ate of California-Department of Justice-Office of the Attorney General 6. Are all California cities and counties eligible to receive funds from the Settlements? 7. If my city or county joins, how much will it receive? 8. How were the above percentages set? 9. If my city or county joins, will it receive direct payment? 10. If my city does not elect direct payment, is it still obligated to report on the use of those funds? 11 . If my city or county does notjoin, what happens to my allocated share? 12. If my city or county receives direct payments from the Settlements, is it required to spend the monies for particular uses? 13. What about attorney's fees for cities and counties? 14. Why are the California State-Subdivision Agreements "proposed"? 15. Where can I get more information about the Settlements? 1 . We received a letter in the mail about two opioid Settlements. Is it real? o The letter you received relates to two proposed Settlements resolving claims against the nation's 3 largest opioid Distributors (Am erisourceBergen, Cardinal Health, and McKesson) and manufacturer Janssen Pharmaceuticals and its parent company Johnson &Johnson (together,J&J) for their roles in the opioid epidemic. The letters were mailed in September 2021 . California and its cities and counties stand to receive up to $2.2 billion for substance use prevention, harm reduction, treatment, and recovery. Payments would be made over the next 18 years, starting in Spring 2022. The more cities and counties thatjoin, the more the Distributors and J&J will pay California and our participating cities and counties. https://oag.ca.gov/opioids/fags 2/8 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 -ate of California-Department of Justice-Office of the Attorney General 2. How can my city or county join the Settlements? o Cities and counties must first register with the notice administrator at https://settlement-registration.web.app/. You must have your city or county's unique 6-digit alphanumeric registration code, which was included in the letter. If you do not have your unique registration code, please email us at OpioidSettlement-LocalGovernment@doj.ca.gov. Cities may also contact the League of California Cities and counties may contact the California State Association of Counties (CSAC) to obtain registration codes. Registering with the notice administrator does not obligate you to join the Settlements. Registering will help ensure your city or county receives the forms that it will need to join the Settlements. Once your city or county has registered, you will receive participation forms and other information from the notice administrator. If your city or county decides tojoin the Settlements, it may submit the participation forms electronically via DocuSign, once the DocuSign system is operational. Your city or county may also elect to sign paper copies. By agreeing to participate in the Settlements, your city or county is also agreeing to the Proposed California State-Subdivision Agreement for the Settlement(s) your city or county joins. The Proposed California State- Subdivision Agreements provide the framework for how funds from the Settlements may be distributed, allocated, and spent in California. Participation in both Settlements will require four signatures total: 1 . signature agreeing to participate in the Distributors Settlement; 2. signature agreeing to the Proposed California State-Subdivision Agreement - Distributor Settlement; https://oag.ca.gov/opioids/fags 3/8 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 -ate of California-Department of Justice-Office of the Attorney General 3. signature agreeing to participate in the Janssen Settlement; and 4. signature agreeing to the Proposed California State-Subdivision Agreement -Janssen Settlement. 3. Is there a deadline for joining the Settlements? o Yes. Cities and counties that wish to become initially participating subdivisions must sign and submit the participation forms and Proposed California State-Subdivision Agreements byJanuary 2, 2022. Cities and counties that anticipate joining but will not be able to submit the required forms byJanuary 2, 2022, should notify the AG's office by sending an email to OpioidSettlement-LocalGovernment@doj.ca.gov as soon as possible. 4. Hasthe Statejoined the Settlements? o Yes. California Attorney General Rob Bonta, together with the majority of state Attorneys General across the country, signed on to the Settlements in August 2021 . Those AGs and lawyers representing thousands of cities and counties in the national opioid litigation strongly encourage signing-on to the Settlements. Cities and counties that join will help bring more money to California, which will help communities and families with resources for substance use prevention, harm reduction, treatment, and recovery. 5. Does my city or county need to join both Settlements? o No. A city or county may choose tojoin one or both of the Settlements. As noted above, the more cities and counties thatjoin, the more the settling defendants will pay California and our participating cities and counties under the Settlements. https://oag.ca.gov/opioids/fags 4/8 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 -ate of California-Department of Justice-Office of the Attorney General 6. Area I I California cities and counties eligible to receive funds from the Sett Iem ents? o Cities and counties with a population greater than 10,000, based on the U.S. Census Bureau's population estimates for July 1 , 2019 (released May 2020), are eligible to receive funds. Certain litigating cities and counties with a population less than 10,000 are also eligible to receive funds. 7. If my city or countyjoins, how much will it receive? o California expects to receive up to 9.92% of the national settlement funds. The amount California ultimately receives will depend on how many states and eligible cities and countiesjoin the Settlements. The amounts that California may receive will be divided into three funds: 1 ) State fund 15%; 2) CA Subdivision Fund 15%; and 3) CA Abatement Accounts Fund 70%. Subdivisions thatjoin can expect to receive their abatement percentage share of the CA Abatement Accounts Fund as provided in Appendix 1 to the Proposed California State-Subdivision Agreement. California may receive up to $1 .8 billion from the Distributors Settlement and $423 million from the Janssen Settlement. The Distributors will make their payments over the course of 18 years, while Janssen will make payments over the course of 9 years. 8. How were the above percentages set? o The allocation model in Appendix 1 that sets forth the distribution of funds is based on nationally available federal data on opioid use disorder, overdose deaths, and opioid shipments into California, and was developed by lawyers and experts in the national opioid litigation. 9. If my city or countyjoins, will it receive direct payment? https://oag.ca.gov/opioids/fags 5/8 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 -ate of California-Department of Justice-Office of the Attorney General o If a cityjoins, and it is located in a county that decidesto participate in the Settlement, your allocated amount will be paid to the county unless you choose direct payment. You may find your city's abatement percentage in Appendix 1 to the Proposed California State-Subdivision Agreements. You may decide to opt in or out of direct payment at any time, and may also choose to receive only a portion of your share directly. Instructions for how to elect direct payment will be provided at a later date. If a county joins, it will receive direct payment if itjoins the Settlements, unless it chooses to direct funds to another eligible city or county. 10. If my city does not elect direct payment, is it still obligated to report on the use of those funds? o Section 5 of the Proposed California State-Subdivision Agreements lays out certain annual reporting requirements for cities and counties that receive direct payment of funds. There are additional reporting requirements under the Distributors andjanssen Settlement Agreements. If your city or county chooses not to receive direct payment of funds under the Settlements, it will not be subject to those reporting requirements. 11 . If my city or county does not join, what happens to my allocated share? o If a city or county does not join, its share of the CA Abatement Accounts Fund will go to the State. However, since the settlement amount California may receive is dependent upon participation by cities and counties, the total amount that California receives may be reduced. 12. If my city or county receives direct payments from the Settlements, is it required to spend the monies for particular uses? https://oag.ca.gov/opioids/fags 6/8 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 -ate of California-Department of Justice-Office of the Attorney General o Yes. The Settlements require funds to be used primarily for opioid abatement. Please see Section 4.B.ii of the Proposed California State- Subdivision Agreements, Section V of and Exhibit E to the Distributors Settlement Agreement, and Section VI of and Exhibit E to the Janssen Settlement Agreement for specific limitations on the use of Settlement funds. 13. What about attorney's feesfor cities and counties? o The Settlements establish a $1 .6 billion Attorney Fee Fund and $200 million Cost Fund for attorneys representing cities and counties that join the Settlements. The Settlements require outside attorneys who recover from those funds to waive enforcement of their contingency fee entitlements as to all of their clients and notify their clients accordingly. Subdivisions may also enter into back-stop agreements to pay their contingency-fee attorneys from any monies they receive from the CA Subdivision Fund, as provided in Section 5 of the Proposed California State-Subdivision Agreements and Exhibit R, Section 1 (R) of the Distributor andjanssen Settlement Agreements. 14. Why are the California State-Subdivision Agreements "proposed"? 0 Cities and counties will accept the Proposed California State-Subdivision Agreements through the sign-on process. Exhibit 0 to the Distributors and Janssen Settlement Agreements lay out certain requirements that must be met before state-subdivision agreements may be approved. Once those thresholds are met, the California State-Subdivision Agreements will become final. 15. Where can I get more information about the Settlements? https://oag.ca.gov/opioids/fags 7/8 DocuSign Envelope ID: B962D7F6-4468-4F9C-A8F6-FAE66D426929 -ate of California-Department of Justice-Office of the Attorney General 0 Cities and counties that retained attorneys to file opioid litigation should consult their attorneys. Cities and counties may also contact the Attorney General's opioids team via email at OpioidSettlement-LocalGovernment@doj.ca.gov. Additional settlement-related information is available at https://nationalopioidsettlement.com/. Check back for updates to this FAQ. Disclai m er: To the extent any of the answers in this FAQ are inconsistent with the Distributors Agreement,Janssen Agreement, California State-Subdivision Agreement - Distributors, or California State-Subdivision Agreement -Janssen, those agreements will govern over any inconsistent responses in this FAQ. 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