All right, good morning everyone. Let's call to order the Health Committee for the Board of Supervisors for Monday, April 14th. Clark, please take the role. Supervisor Tam, President, Supervisor Miley. Present, all right. So our first action is an action item. Review of revenue sources for the housing plan. Good morning, supervisors. Thank you so much for taking the time. I'm Michelle Starrick with the Community Development Agency's Housing and Community Development Department. Your board heard from us on the potential housing plan in January at a work session and you asked for a more in-depth presentation on possible funding sources. And so I'd like to point your attention to the staff report very quickly. There is a cover memo from our office that really gets into the three possible funding sources that are most relevant. Next is the staff report from CSG advisors. There are municipal finance authority authority and they've been in business for over 40 years. We've worked with them several times, but their staff report has several attachments. So I just wanted to point out. This document is actually very difficult to read in the printed format. So I will try and print it out in a much larger format, but these are all of the different funding sources that we examined. And then next comes a list of possible city jurisdictions in the county that have impact fees. And then finally we took a look at all of the various laws and regulations that impact public finance in California. So I just wanted to give you that structure of the staff report because it does seem very, there just seems to be a lot there, but in actuality it's mostly just exhibits. Next slide please. So to analyze these different revenue options, we looked at working with CSG advisors. They have been a partner to us several times over the last 15 years and they've done a really deep dive for us on the different municipal financing sources that would be available for housing and they've come up with a recommendation of three to four different possibilities, including one that's targeted just to the unincorporated county. One of the things that they say is that one of the best things to consider is having a blended financing option, meeting having a dedicated stream that comes in regularly for a long time as well as bond financing and other things that could come in and really kick start different programs. Next slide. The first recommended funding option is a countywide general obligation bond. You'll remember that measure a one is a countywide general obligation bond. This possibility is very similar to what we did with measure A1. It will require a two-thirds majority for passage and the eligible uses are really that it's restricted to capital. So this source can't be used for things like tenant protections, for emergency rental assistance, for some of the other things that your board has really asked for and wanted to have as available for our low income population. But it does help us with building. Next slide. Yeah. And also with the general obligation bond, only a government can put that on the ballot, right? Only the Board of Supervisors can place that on the ballot or a city council for a bill. The bill is not a bill. The bill is not a bill. The bill is not a bill. The bill is not a bill. The bill is not a bill. The bill is not a bill. The bill is not a bill. The bill is not a bill. The bill is not a bill. The bill is not a bill. The bill is not a bill. it's placed by a citizen's initiative, it only needs a simple majority It's basically a fixed levied amount on a property tax so unlike a parse unlike a general obligation bond Which sets its amount based on the value of the property? This is a flat rate across all properties, the exact same amount. So for instance, $150 parcel tax for every property could raise about $70 million annually and we could then bond against that to come up with a very large amount. It's not restricted to capital expenses, which means that these funds could fund things like emergency rental assistance or homeless prevention or operating costs in a building. But yeah, so that is a really flexible source of funding unlike the capital under of the general obligation bond. It will have to go to the voters and the next possible option would be in 2026 or 2028, either June or December. I also wanted to say that, unlike a general obligation bond, a parcel tax, I believe that you can build in waivers for senior citizens or for people who are on fixed incomes, those who are disabled, those whose income is unable to meet the needs. Next slide. The last option was the countywide sales tax. Again, 2 thirds majority needed if placed on the ballot by the Board of Supervisors or a simple majority of its citizens initiative. And again, the timeline is the same. It's 2026 or 2028. The eligible uses for a county wide sales tax are also very flexible. You can spend it on capital, but you can also spend it on operations, on emergency rental assistance, on homeless prevention, things like flexible funds that would allow a household to catch up on their rent, the kinds of things that we see are the reasons why people are becoming homeless. A half-cent sales tax could generate up to $150 million annually. However, you will note that we are actually at our cap in Alameda County and many of the jurisdictions. The very last attachment here is a summary that gives you all of the different city sales tax amounts so that you can see where we're at. We're not all at the same amount, but you can see that we're very close to the top. Next slide. The final possibility is really something that could be done only in the unincorporated county. And this would be an inclusionary housing ordinance or an impact fee ordinance. This is not something that's subject to the voters. It's something that the Board of Supervisors can adopt and in point of fact it is actually on the work plan for the planning department to do an inclusionary housing ordinance as part of the housing element implementation program. But the revenue that could be coming in for the unincorporated county would be about three to $3 to $7 million annually depending. These fees are very flexible also, and the fees can be spent on many different types of things. From capital improvements all the way down to services. There's no timeline, no voter approval required, and so this could actually be done based on whatever public process was decided to go through. I do want to note that there has been a lawsuit against a county that had an impact fee up in I believe it's Plaster County and we'll have to see how that goes through the process of whether or not inclusionary housing or impact fees remain a viable option. right now in Alameda County, every city in the county except for the unincorporated area has either an impact fee, an inclusionary housing ordinance or both, and the unincorporated county is the only one in the county that doesn't have this kind of an option. We have impact fees. No. We don't have housing impact fees now. I will ask in case I'm wrong, but I'm not under the impression that we have housing. We just refunded. Over in the process of those are park fees park fees that's a park dedication that I thought does that is a game from development it does come from development it is specifically for parks one of the things that you know we often fund the parks out of our C. W. G. program and we have been pushing on hard to ask for the impact fees before they ask for CDBG but often they didn't ask so. So those are impact fees for parks. You're talking about now an impact fee for housing. Yeah okay. Or an inclusionary housing ordinance those are two different things but similar. And I'm happy to answer any questions. As I said, it's a long staff report, but most of it is exhibits or appendices. And there are many charts with a lot of different information in there that you can reference back to, including links to the various laws and legal framework for California's fundraising from municipal organizations. Sorry, yes. So in May, we're gonna be bringing the programs that any new funding source would be able to fund. And so we'll be talking about the highest needs and the programs that are responsive to those needs. And then what we're asking is approval to move ahead with hiring a polling firm to gauge community support probably in the fall. It will be coming out of next year's budget allocation. So we would probably be spending boomerang funds, countywide boomerang funds on this. All right. Thank you for the presentation. Let me turn to my colleague first and then I've got some questions as well. Supervisor Tam. Thank you, Chair Miley. Thank you for that presentation. And also the cover memo with the context and the background from both CDA and the consultant. I just have a few clarifying questions just for background. So when there was consideration for the Bafa Bond last year, what was the polling like for just the Alameda County in reaching that two thirds threshold? I don't actually have the polling broken out for just Alameda County. I can ask for that and get back to you. I know that they did look at it regionally, and I know that we had some of the highest besides San Francisco, we had some of the highest support for the Bofibond and Alameda County. Okay, I appreciate that. So in the memo, there was a description of the success of measure A1, We were able to get 42 almost 200 units of that. What was the proportion in the unincorporated area? We have two new construction projects in the unincorporated county. One is 80 units and the other 75 units and the other one is 60 units and that one is in partnership with Hard. And then we also had an acquisition rehab project in the Antincorporated County so that was an old apartment complex that went through a refinancing and rehabilitation. So a little over 200 units, 250 units total. So if we were focusing on the unincorporated in this go-around, how much do you think we would need? Money-wise? Yeah. I'd like to I mean what I think would would make sense, let me back up and say before 2012, there was the redevelopment housing money. And that was a consistent source of funding that local government could use every single year towards new construction of affordable housing and acquisition and rehabilitation, first time home buyer program,, single family rehab for people who are on fixed incomes and own their own homes. There was a lot of standard programs that everybody supported, including our unincorporated county and our redevelopment agency working with our department did the same. When we lost redevelopment, that was a huge impact, countywide, because suddenly there's no dead- the department did the same. When we lost redevelopment, that was a huge impact, countywide, because suddenly there was no dedicated source of funds. And now everyone's uncertain when the next resource is coming and so whether or not they can continue the program or not was up in the air every year. So the reason why a dedicated source, either for the unincorporated County or County why, it is so important, is that development takes time and if you can't consistently count on that source being there, you're not going to plan for it. What we would need, I'd like to see 10 to $12 million a year in the Unincorporated County for 20 years. That would allow the Antiquorporated County to build not just new housing, but to rehabilitate its incredibly old and aging housing stock. We have quite a few apartment complexes built in the 1950s and 60s, all of which are deteriorating. And those are the kinds of things that would be needed. Now, is the source there? I don't know that there's a source there right this minute. So we would probably limp along with whatever we had. What we had under redevelopment was close to about $7 million a year. OK. $6.5 million a year. But even if we put either a go-bond or a parcel tax that requires a county wide vote, even if it's just for the unincorporated area. Correct. So proportionately if you're looking at 200 some odd units out of 4200 units, you can't just confine the votes to the unincorporated area. Yeah. Any vote in the unincorporated county goes county wide. I'm not sure I understand the background of why that is, Barbara and Santa and Santa Barbara and Santa and Santa Barbara and Santa and Santa Barbara and Santa and Santa Barbara and Santa and Santa Barbara and Santa and Santa Barbara and Santa and Santa Barbara and Santa and Santa Barbara and Santa and Santa Barbara and Santa and Santa Barbara and Santa and Santa Barbara and Santa and Santa Barbara and Santa and Santa Barbara and Santa and Santa Barbara and Santa and Santa Barbara and Santa and Santa Barbara and Santa So we don't have one just for the unaccompanied a lot of the other cities have them. We do have school impact fees and as supervisor, an early part impact fee there isn't a housing one. Yeah. Why is that? I think the planning department, it's on their list of things to do from the last housing elements cycle and they just, you know, were overworked and didn't get to it. What would it look like in the unincorporated? What would the ordinance look like? What would the amount that would look like for the impact fee? I don't actually know that off the top of my head. I'd have to do a little bit of examination of this chart to kind of figure it out unless, yeah. We'd have to look it, but it would probably be a range. And through a public process, it would probably come out the other end, something different than what we proposed. Okay. But so the three to $7 million that's in your presentation, that's just were. That's just the unincorporated. Yeah, and it's based on some, the staff report from CSG does a little bit of analysis and the chart, which I'm sorry, I can't read. It's printed too small, provides the framework and the dollar amount is probably in there, but I can't read that. I need to print it on 18 by. Yeah, I need glasses to read that too. So in terms of meeting potentially the needs that the unincorporated may not get to the 10 to 12 for 20 years, but we could get pretty close just for the unincorporated. And this is something solely within the Board of Supervisors authority and purview. It is. Okay. The sales tax, I mean 10.75 is the highest, right? I believe it is. In our county and several cities have that. I should measure A in the city of Oakland past. Well, that get to the 10.75. I believe it does, yeah. So I think that, know what the sales tax data really shows us is that there really actually isn't a lot of room. You know you could do something in the unincorporated county but you know half-cent sales tax there would get you to the top but most of the other jurisdictions Berkeley's at 10.25, Dublin is at 10.25. So some of them have a little bit of room, but I believe most of us are at the top. Okay. And it would require state legislation and a lot of other loopholes to jump through to make new sales tax revenue work. I know. And I mean, I'm obviously conflicted, but supportive of what Oakland needs in terms of its revenue, but trying to put another sales tax on top of a sales tax that could potentially just pass tomorrow, it's going to be very difficult. In terms of looking at the voter initiative, I know that some of the constituents have talked to some of the board members about putting a citizen initiative for the parcel tax, right? Not, it can't be for the GeoBond. What would they need from the border supervisors for that effort? They would need a program, which is why we're coming back. It's not the only reason, but we're coming back to the board with a more detailed list of the types of programs that we think are the highest priority. And they would really need to see the board support for that kind of a program, as well as support for the parcel tax generally. But I don't believe they would need the board to endorse it. I don't know if the board can legally endorse it. No, I don't think the board can actually endorse it. So it really comes down to making sure it's clear what you would support if new money came in, meaning a program. So we will be back in May with a much more detailed programmatic layout of the different options to spend money on. But today you're taking public comment and you're asking the committee basically to move forward on engaging the consulting firm and to evaluate some of these options and hopefully get a lot more information for us to kind of gauge which direction to go on. Correct, okay, thank you. So thanks for those questions. Let's see. First of all, I don't, do you, is your department have the capacity at this point in time to go to the max and get a sense of support for inclusionary housing ordinance or impact fee ordinance. I believe that is we did get an award in conjunction with the Planning Department to move certain things forward and inclusionary housing is one of them. So I believe that yes, the planning department will be working on a road show as we like to call it of all the different Macs for inclusionary housing. Okay, because I think we should definitely be inquiring about that. And I know you pointed out one under tenant consequence. If we do that is, the cost might be passed on to tenants, but we could control that through rent stabilization, good, and we could. Okay. But another and another under tenant consequence, and I need to understand in better, is those jurisdictions that have inclusionary zoning and have impact fees, has there been any negative chilling impact on development? So I need to know that. Yeah, I believe actually there is a study about that and I didn't reference it in my report, but I could go and look and come back to you with a memo that outlines that the Turner Center looked at it as well as I think Eboho took a look at it. Okay. So I will get back to you. Okay. And you know, we can come back. Yeah. At any point. Well, I can also. but is a question. Yeah. Yeah. In this, I definitely support a motion going forward for a poll. I think we'll find out when the saying how things work out in Oakland, because I think that's kind of an indication of voter sentiment because voters in Oakland unfortunately tend to support every tax measure. I live in Oakland and I voted for this increase only because I think it's needed, but I do think Oakland's got a structural problem. There needs to be fixed, and this isn't going to fix it. But the point is, if the voters reject that, I think that's an indication of where people are. We do know from other polls that have been done with the Bay Area Housing Finance Authority, which I said on that voter taste for more taxes has definitely diminished. It is definitely diminished in this county throughout the Bay Area. So trying to get two thirds on anything is going to be a real challenging lift. So, we might either be limited to a direction of a general tax, if it's a parcel or sales tax, depending on how the polling comes back, because that only needs a majority or a citizen initiative. I just don't think two thirds is going to fly. Now, had we had a crystal ball, Michelle, and we looked at that crystal ball and seen most ahead of us, we should have gone for an extension of measure A1 when we had the opportunity to do that. But we didn't have a crystal ball, because I think we could have gotten it back, you know, three, four years ago. Yeah. Yeah. Measurer A1 is not going to expire until 2034, or 2036. And so, had a connolly indicated that we could go in 2032 or 2034. Yeah, but we don't have any more money to do anything. That's what I would have liked to have done. Yeah. To replenish the supply of funding for affordable housing. So it is what it is. The difficulty to is going to be, if we come in June of 2026 or November of 2026, and it's a board initiative, we have to get it on the ballot. In March, Board Assumin Concision for June or August for November. If it's a citizens initiative, I think they might be under the same constraints potentially. But I do think in May, having a framework of a program is gonna be important because regardless of what we do or if it's a citizens initiative, having that framework of a program, what would be the components? And even we don't go forward, hopefully a citizen's initiative would adopt that framework. So that's may will be that more detailed presentation. Yeah, now the other thing is with the fiscal cliff that transit is facing, that ballot measure probably happened next year and I think that'll be potentially a sales tax or it could be a Blended one but the point is we'll see how all that plays out because I think with the poll That we do we need to kind of get a sense. If there is a county-wide or a Bay Area-wide transit tax, what would that do to impact our ability to pass a local measure as well? And then the housing bond, Roboffa, you know, we're not looking to do a housing bond. It's just to kind of have to yell on to, to provide you to him. We're not looking to do a housing bond, it's just to kind of have to go on to supervise your tab. We're not looking to do a regional housing bond. The earliest would be 2028. The earliest would be 2028. But I do hope in our program in out of New County, we consider one of the components of finding resources for a financing entity through Bafa as was envisioned so that that piece can be funded by, if we're successful, some of our local funding. So just to be clear, what you're talking about is taking some of the sales tax revenue that we generate here in Alameda County and passing it on to Bafa to support their agencies. Yeah, well to support financing for photo housing, the caveat would be it would have to come back in Alameda County, so return to source, so anything we raise that we put into this financing, I asked to come back. They'd have to leverage that and bring it back for housing development in our county. I hope that we would also tie it to other counties doing the same. Okay. Let me see what else do I have here. Yeah, it's not a pretty picture. It's just not a pretty picture. What? If we're not successful with the housing bond, that's why I think we need to explore or not even a bond, sales tax, parcel tax, whatever, pursuing what we can do then in corporate area will be important. But I think we need to also look at trying to figure out what other options do we have that can help us incentivize more affordable housing. If none of this happens, you know, that's kind of thinking out of the box. We're going to be coming to your board and to your committee in the end of this month with a report out on some of the innovation items that we've been working on. One of which is to allow us to create a set of plans that can be used for SB 9 projects where you can subdivide the parcel into four. So similar to how the accessory dwelling units have a website and we're getting all of those plans pre-approved of planning departments. We're hoping to do the same for the process of subdivision and we'll be coming to you as an informational item at the end of April. But that's one of the things that, you know, we think that there's a lot of room to build additional units on some of these single family lots and we think that there's a lot of emerging developers who want to be able to do a small scale project. We wouldn't necessarily have the financing to do it, but we could help with pre-approved plans that are shelf ready and that planning departments have already approved. That's the kind of stuff that we think is laying the groundwork when there's no money. Yeah, because hopefully we could get something passed, but let's suppose we can't. Hopefully, a citizen's initiative would pass. That doesn't pass. We've, I just think we can't be sitting back, you know, having a wish and a prayer that either of those happen. I think we need to be looking, what else can we do to support the development of affordable housing, you know, thinking out of the box and bringing that type of ingenuity to the board so we can kind of contemplate that because otherwise it's just going to be the status quo and we can't, you know, status quo is just not acceptable and we can't depend on the federal government. I think what you were pointing out, and you've said it before, a lot of our housing problem. Well, first of all, we got rid of redevelopment. Thanks to Jerry Brown. I think that's one of his big failures as governor. And I like Jerry, but that was sort of a big failure. Getting rid of redevelopment should have been more of a scapul as opposed to just throwing out redevelopment totally, but also the feds. I mean, the feds have just not supported affordable housing for 20, 30 years, and it doesn't depend if it's been a democratic or Republican administration. And we definitely can't just contemplate anything coming from this administration. So the feds aren't. The states out there don't pass any bond measures, any tax measures. We just have to set it. Of course, so is there any, anything else that we can dream up that might help us with affordable housing? We'll do a deeper dive on that. So I think you understand what I'm saying. Okay. Yeah. All right. Anything else before we call speakers? I just want to offer one comment. It's important to have a very healthy bond rating like the counties, Chipotle, because even when Oakland passed measure you the bond funds, they couldn't issue bonds because their credit rating was compromised because of their budget. So when we looked at potentially even with the parcel tax, we mentioned that we could bond against it. Would it basically if you were able to generate $70 million, would you try to float the same amount in bonds? Well, I think what we would probably do is we would look at programming the dollars and figuring out how much would be set aside for a capital program and how much would be for services. As you know, the only way to house are extremely low income population and keep them from becoming homeless is ongoing operating subsidy and rental assistance to help them stay housed. Because most likely where they are right now is cheaper than any new place that they would go to. So understanding and sort of programming out whatever that amount is and then figuring out how much money is left, bonding against it is one possibility. But along with innovation, we had a really great meeting with the San Francisco Accelerator Fund. And they indicated a great interest in acting as a bank for that amount. And if we gave them a steady stream of income, they could advance cash to us. So there are a lot of opportunities out there. I told them, thank you very much. That's a great idea. Let's talk about that once we know whether or not we're going to move forward with anything. And let's see if something passes. I appreciate that. I just noticed that you have obviously a lot more flexibility with things other than a Geo-Bahn. Yeah. OK. It's great. It's great. It's important for the housing world. Thank you. OK, let's have the speakers. Lisa. Marcie Johnson. Thank you and good morning, Honorable Board of Supervisor Miley and Tam. I'm here to speak on behalf of Measure W of Funds. I am asking for the preservation of those funds, specifically for services to the homeless, as an Alameda County Health Care for the Homeless Commissioner, a consumer and community advisory board member for ACHCH, and as a former city of Alameda employee I just wanted to emphasize the importance of preserving this funding that's desperately needed to solve complex problems for those who are homeless or are immediately unhoused. Thank you for your time. Jen Oakley? I'm Jen Oakley. I was formally on house on the streets of Oakland for 10 years. I used all the services I heard Michelle talking about all the way from the bottom to the top. I'm now about to be a homeowner through the first home buyers program. I am on the continuum of care at Regents and Coronation Committee. I'm a member of the cab with a home healthcare for the homeless and I'm on the task force for the home together 2030 planned and homelessness. The main problem I see is the lack of resources. There were 12,000 people homeless they counted at the point in time counting in Alameda County last year. Of those 12,000 there were only 650 affordable housing units and permanent supportive housing units available for those all those people. We already have a solution. We measure W. Measure W is a lot of money that's been collected by voters over the well everybody over the years over 390 million that's supposed to go it was voted to go towards homeless services and now the Board of Supervisors is kind of thinking they don't know what they if they want to spend it all on homelessness I'm advocating for the Board of Supervisors to designate that money to go towards support for homeless services, unchildrened homelessness, and interim and permanent housing. Thank you. I just want to congratulate you for your journey and becoming a first time home buyer. That's really fantastic. The only thing I want to just correct you on is measure W with a general tax. And as a general tax, it needed a majority of the electorate to pass. It wasn't a special tax designated for housing because if it had been a special tax it would have been two thirds and you're definitely right. It all would have to go to affordable housing but it was a general tax and we were sued on that. We won the lawsuit only because it was a general tax and not a special tax for housing. Okay. Okay. So I just want to just slightly correct you on that because we were sued. Well, I'm still advocating for relevant street for affordable housing. Thank you. Serena Clayton. Good morning. My name is Serena Clayton. I am a member of the board of the Alameda Health System Homeless Health Center, but I'm actually commenting here today in my capacity as an individual who has lived in Alameda County for 27 years. I want to really appreciate the conversation just had about revenue measures for housing. I appreciate the fact that you're attending and obviously really concerned about this critical issue. I live off the Piedmont Avenue and every day I walk past a sea of people going to buy $7, $10 lattes and boba drinks, walking past people who don't even have a roof over their head. So it is clearly an issue that is important to all of us. We did pass a measure as everyone has discussed measure W. And while I understand that technically it is a general, whatever the words are used, the language we voted on as voters said to provide essential county services, including housing and services for people experiencing homelessness, men of health job training, social safety net, and then the five words and other general fund services, which I'm sure many of us, when we voted, did not pay close attention or voted for all of the good measures that we thought would come out of us. So I also want to ask you all who obviously care about the issue of housing, to advocate to your fellow supervisors that this money be used for the purpose that was intended by the voters, which I think was to remedy the situation that we live with every day of this immoral unjust situation of walking past people who do not have a roof over their heads every day and and just accepting that as the norm in this county. Appreciate your support. John Genosco. Good morning. Good morning. My name is John Genosco. So it's two of you up there. So I just wanted to, I'm here in support of Measure W and using using that money to help with the homeless services that are available now and creating new homeless services. And also there are new solutions out there that need to be funded to get people off the streets and into a humane living situation until so called affordable housing is created for them. And it shouldn't be called affordable housing. It should just be called housing for everyone because we know, truthfully, in Oakland is really not affordable housing unless you make $120,000 a year. We want to make sure that that funding goes to and that people with lived experience must be directly involved in planning operations and governance. Also, the Alameda County used Measure W strategy to transform how the county and cities address homelessness. Meaning there are new solutions out there. There are tons of vacant lots, vacant buildings that could be renovated. Lots could be opened up for people to self-govern with the communities moving together, which we've learned that there's better statistics of survival. And I also was homeless on a withsuit for 10 years with my friend over here. And now I am housed and I am continually advocating for the unhoused people of 5,500 in Oakland making sure that money goes directly to support them. There's no reason why it should go anywhere else. If we take money funding away from supporting the unhoused out there, they won't have a chance to be in the position that we're in right now speaking to you guys. So I just want to say thank you and please utilize that money towards how those solutions. Freeway? Hello. I'm here today to speak in favor or in support of Measure W as an officer of the Oakland Homeless Union as well as a person with lived experience of being unhoused for the past eight years, a core leader with which to be commons and a harm reductionist. My concern first and foremost is the humane and effective responses to homelessness. Measure W was passed with the understanding that these funds would be used towards homeless services. As we speak today, the City of Oakland's idea of homeless services are costly and effective sweeps. $20,000 a day per sweep and nothing real lasting solution is coming from this. We still see our friends dying in mass numbers that are unacceptable. There's still only one shelter bed for every three unhoused people in Oakland that is unacceptable. These funds would be much better used towards redirecting homeless services towards boots on the ground, frontline workers, people that see and communicate with and have relationships with the unhoused. Just like John said, myself, I am recently housed in a low income unit which presents a whole other set of problems. But the people that I break thread with every day are still on the streets. I still have to hear every other day about somebody that I was friends with, somebody that I broke thread with, somebody that I possibly lived with at one point in time, dying. This is not acceptable. This is inhumane. This is a humanitarian crisis and it's time for the county to do what the city won't do. Thank you. I have no additional speakers for this item. Right. I want to thank the speakers and definitely those of you who have experienced homelessness, they're now housed. That's some additional comments, but I'll see if surprise to him wants to see anything that I'll comment further. You have anything to say? I appreciate everyone coming and speaking about Measure W, we are going through a process right now, waiting for the litigation to be finalized before we start forming up various allocations. But a good portion of it is expected to go to homelessness. But as Supervisor Miley mentioned, this is a very unique opportunity that allows the county to use funds for services, homeless services, whereas normally, as you heard from the earlier presentation, other bond measures, other funding measures don't allow that even though they require two thirds vote. But having said that a lot of the programs and you'll hear later this morning from our behavioral health will be needed for some of the prevention services that are going to be cut either by the federal government or because of state law on their prop one. And so we need to also be cognizant of trying to make sure that there are services. The county is helping Oakland. We in in survivor and mild east district purchased two hotels, the comfort in and the days in to provide permanent supportive housing for the city of Oakland because it's in the city of Oakland but it's, it doesn't come with ongoing funding for services. We may have purchased it through home key funding but we need to also be cognizant of making sure that those Shelters are sustainable over time so that everyone can have access to it Yeah, not I would just Tag on to this and we definitely appreciate your advocacy I Think the board will support a significant chunk of measure W going for homeless services. I can't say what the amount will be but I'm confident it's going to be a significant amount but if we put it all in the homelessness it would just nullify the legal action or or that we anticipating we're going to win because it would just show that it was a ruse, that it was all about homelessness and not about general services that the county needs to provide. But I do anticipate the significant portion will go to homelessness. I also anticipate that some of that money will go towards mental health because what's happened is proposition one passed and it took money from mental health prevention and put it into housing which is important but it took money from mental health prevention so I know a number of us on the board are really, really committed to wanting to fund mental health prevention, because if we aren't finding things that have been successful, we take money that's gone from mental health prevention and put it into housing, which is needed. Now it's not doing prevention, it's just going to, you know, we're just're just kinda whack them whole or we're just plugging one hole to open up another one. So we need to do that. So I'm no, I'm gonna be pushing that some of that money be used for mental health and there's a nexus between mental health and homeless is obviously. So that, and I know I've asked the agency director who's sitting right there to ponder all that with her staff and the other directors in housing and behavioral health. We failure, we failure pain and we understand this needs to happen. I'm a taxpayer in Oakland. I've lived in Oakland for more than 45 years. We pay a lot of taxes in Oakland. I'm not necessarily happy with how Oakland has utilized its resources over time. It's a structural deficit that the city has faced. Hopefully new administrations will begin to correct that structural deficit. It'll take a while to do that The county can't bail Oakland out there 14 cities in Alameda County I will do it the best we can to help Oakland and we already put in hundreds and hundreds and hundreds of million $1.00 into services into Oakland because that's where a lot of the vulnerable population and marginalized population in needy population are resigned and we'll continue to do that and we'll continue to have measure W money going that direction as well. But at the moment, I'm confident that all of measure W money, I'm very, very confident without even the board discussing this. That 100% of it will not be going just to homeless operations, but a significant portion will. And the key is operations because this money can be used for operations in that capital. That's over struggling with, to come up with money to build more housing so that people so we can stop the spicket of people becoming homeless, turn that off so people can stay housed. And that's why I was asking Director of our Housing Community Development Department to come up with others thinking out of the box because if none of these ballot measures pass, we're going to be in the same situation. No affordable housing. In that just, it doesn't, I mean that doctor says it's not as far as I'm concerned. So we've got to figure this out. Hopefully we'll get money raised for affordable housing down the road. But that's even down the road. But if we aren't successful, then we need to figure out how we can get more affordable housing without additional resources. And the other thing to keep in mind, I'm not passing the buck, but as I pointed in my conversation with the housing director, the state and the feds. I mean, we're not in a vacuum. A lot of what's happened is because the cost of living in the Bay Area and in California is so high, and then the federal government hasn't provided the level of support it has needed to do over the last 30 or 40 years, quite frankly. And that's also exacerbated the situation we find ourselves in. So we are struggling to try to do what we can to address this need and we feel your pain and trust me. No one should be unhoused. We haven't always had a house in crisis. It's come about over the last 10 years or so but we're struggling to try to figure out how we can you know reduce it and correct it and turn things around. So I just want you to be confident of that. So thank you for your attentiveness this morning and continue to show up because we will be taking them measure W more directly and it is connected to our efforts around affordable housing. Okay. All right. So let's supervise your time. Do you want to move this item? Make a motion. I'll be happy to move the staff recommendation to secure the consultant to evaluate the options to provide revenue sources for housing. and I'll second it and we'll support this by consensus. The motion passes. Okay. All right. Thank you. All right. And I think the staff will be coming back in May. I think May is in May 12th. Yeah, May 12th. Come back on May 12th because the staff will be coming back on May 12th talking about the housing plan. We might even be talking about Measure W and also some other approaches to addressing the housing crisis. I like, you know, like you were pointing out, how can we use, you know, tax-defaulted properties? How can we use vacant properties? How can we use properties that churches have that are in excess? That might want to use the portal. So they'll be coming back on May 12th with more conversation around all of these approaches because I've asked my staff, Erin Armstrong, who deals with housing to talk to the staff. They'll get all of this on May 12th. And potentially we might have a longer health committee meeting on May 12th as opposed to two hours, three hours. So we can get into all of this that day. Right? It's just, it'll probably be a joint meeting too. Right? Yeah, a joint meeting of the health committee and social services committee. She's on both committees, social services and health. Okay, so thank you. All right, so let's go to item two information line Good morning supervisor Miley good morning supervisor Tam. I am Dr. Karen Trouble, the Behavior Health Director of Alameda County. And today we hope to provide you, it's actually contextually similar to the conversation that you just made. Efforts are for planning and then implementation on some critical opportunities for the county in terms of the opioid settlement plan. And so hopefully today what we'd like to provide to you is grounding context again in terms of what the federal, the state and the local efforts were to focus on per the guidelines as well as an implementation update. We also want to be very transparent in terms of where the money has gone, what it has paid for, and very proudly lifting up through our colleague from the county both Deputy director James Wagner as well as Dr. Kelly Bauer, so he was here from three valleys to speak to again some of the programmatic updates that have happened as a result of the opioid settlement. So with that, I will begin. So again to ground your board, this opioid settlement was at a federal level and this occurred in 2021, 2022, when there was a settlement that was reached given the tremendous number of people who lost their lives due to opioid and the crisis. So very similar to some of the tobacco settlements, the federal government recognized the causal or at least implicated relationships between pharmacies and other distributors of opioids. So for this in terms of what the federal level said, the funds would be paid over time. So six to 18 years. And at this point, we're operating from an 18-year distribution, which will be spoken to as we go on. And on please, we do have our budget director, Julie Hussas in the audience, if you're interested in seeing how and what landscape that we're going through now, both federal and state, God bless you, impacts the distribution of funds. So at the end of the day, the federal government did say 80% of the funds must be used for opioid abatement. Next slide, please. The state then weighed in to the counties in giving us authority. And again, it came to county behavior house across the state to what it needed to prioritize so what they Advised us that it did need to expand the substance use treatment infrastructure that counties did need to use also matching and existing funds To leverages must as possible given that these are not a permanent funding sources and they had to address communities of color and vulnerable population particularly those those are impacted by unsheltered or being unhoused. They were also really critical in emphasizing that individuals really should be focused on having the opportunity for diversion from SUD into the Justice Treatment Center. And again, this occurred several years ago, similar to around the pandemic. And we see that although this landscape has changed, those priorities are really still applicable even today. And at the end of the day, they also wanted us include drug prevention programs who wantable youth. Next slide. Local planning in terms of then what it looked like here, and this is extrapolating from what the federal and state framework was to how it looked here. As you can see funds were distributed and we've provided a breakdown in terms of where the monies go at the top. Pull it again 85% for the opioid remediation strategies. 15% needed to pay for any past related attorney fees or opioid litigation expenses that do come through and are passed. And at the end of the day, the state's funds will be reverted if not expended. Again, that's a similar framework that you all have heard about in terms of images say, beach ship, other capital SP82 is just historic. state will say, if you don't use it, theoretically it could be lost. And so that's something we're committed to not happening given the need here. Initially we believe we would have 46 million and then that estimate rose about 50 million, 70 million and now we're approximately 80 million. And so that's new settlements that come through based on the federal litigation so that is an opportunity and it's a responsibility here for the county to make the best use of those funds. The payment terms each individual settlement that the counties have reached can come again anyway from two to 18 years and that depends on the organization and at the end of the day the entirety of the settlement. These funds are strictly audited and so every single dollar that is spent has to correspond with the activities that has to be required in terms of the regulatory output, what it does, what it pay for, what the expenses are, even the deposits have to be tracked. So we get our finance and our operational teams have to work together to make sure that is accurately accounting for every single dollar. There are written reports that annually have to also be provided to the Selma administrator and the state of California to make sure that the county is being held accountable for any county that opted in. Your board has had an update. We first came to the health committee in May of 2023 to provide a framework. We're very pleased we stayed on track. We use the feedback and incorporated the feedback that we received from the health committee at that time and we're very consistent with our efforts. And so the part that you will hear next is what that looked like. How we approached it, what support we got, and what direction we got as far and as well as the community input because we did a lot of outreach to the community. So based on the county need based on what locally we're happening, the requirements at the federal and state level, as well as county and community residents. And at the end of the day, we did get some direction in terms of also increasing participation with your board offices. So we're very pleased that each of the board across the districts have been participated. And again, my colleague, Deputy Director, James Wagner will speak a little bit more to that. And then the final most recent update, obviously, is for today. Next slide. And with that, I'll hand it over to Deputy Director James Wagner. Morning. So this slide basically represents some of the steps we've been taking to engage stakeholders. Since September of 2023, we've been having public listening sessions that ACBH facilitates. We've had over 300 participants each September. We will do this through the life of receiving the funds. In September 2023, we did four listening sessions and last September, we did three. We also have done outreach and engagement to our mental health board, which your board knows is required through the welfare and institution codes. Some of the feedback that we have heard from the listening sessions and the mental health board is to increase medication assisted treatment. that has happened within the jail. I want to thank Dr. Chapman in his office and Dr. Klanon. They've been instrumental to make sure that's happened in Sanerita jail. Dr. Chapman will talk about that further when he comes up and presents. But we now are able to afford long acting injectables in the jail for Matt. We have not been able to afford that prior to the opioid settlement. They are very expensive drugs to give and as we know, the most vulnerable population to overdosing are those being released from jail. So this is very significant for our county. There was also feedback to add detox beds. So detox beds are hospital-based detoxification beds for people who are in severe withdrawal from substance use. What currently happens in our county is that people go to the emergency department and they're often withdrawn in the emergency department and then they are just released back into the community. We have a beach hip grant and I know your board knows what beach hip is. It is the capital funding to build more behavioral health infrastructure in our county. There's a current beach up grant that we have in to in partnership with the Alameda Health System to have detoxification beds in the Alameda Health System hospitals. This will be significant if it gets funded for our department because we know at any given time, 25 to 50 people could be in use of hospital-based treatment because they are so inhibited. The number might actually be higher. That's just me taking my best guess. A public information campaign for the opioid settlement that's been completed. We the ACBH put out in RFP. We have awarded it to a consultant who's going to do a five-year campaign on the opioid settlement, how to receive services in our county, for both substance use and mental health because we know these two conditions go hand in hand. And they're in the process right now of gathering stakeholder information and they believe that they'll start the public information campaign this summer, late this summer. Seeking input from individuals with lived experience, that is ongoing. We do that all the time, but we're specifically trying to get that feedback at our September meetings where we do the stakeholder engagement around the opioid cell. time but we're specifically trying to get that feedback at our September meetings where we do the stakeholder engagement around the opioid settlement. In those meetings we go through both the crisis, opioid crisis in our county, Dr. Klanin leads that conversation and then we go through the opioid settlement itself. What is it? What are we getting? What can we do? And then we seek direct feedback from the participants to tell us what they would like to receive, how they'd like us to spend this money. We have a slide coming up, cross walking, some of those things that we have already done. We've gotten feedback to support a living voyage for people with lived experience and education programs for people who use substances and then to collaborate and place services and shelters, substance use, treatment clinics and other public places. Next slide please. In addition, we have set up an opioid settlement advisory council. This is an internal council made up of leaders from public health, all five board of supervisor staff members, ACBH leadership and leadership from HCSA. We've met four times, three times in 2024 and we recently had our first meeting in 2025. The advisory council was formed and is comprised of those leaders who hold specialized knowledge of substance use and or county processes and or fiscal expertise and or deep understanding of the opioid crisis as a public health emergency. The department presents what we've done to date to the council, gathers feedback, takes that feedback in and then acts on what we feel like we can. Next slide. So again, these are some of the things that we have spent the opioid settlement on. Dr. Chapman will talk more about the MAT expansion and San Arida Jail, but that has happened. We've added 11 recovery residence beds, funded through the opioid settlement and 85 substance use treatment beds. So the difference between those two things, recovery residents are what used to be known as halfway houses. And it's where someone who's a little deeper in their recovery live in an environment with other people who are recovering. And we've been able to add 11 more of those beds through our contract providers. And then we added 85 residential treatment beds. That's for people who are an active substance use and you need to go to a course of treatment up to 30 days, it can go longer than 30 days if they need that. As you know, we've also had what we call in the department, the mini grants through three Valley Foundation. Those were recently awarded. I'm happy to say we're working with a general service administration to see if we can do another round of awards for the proposals that got submitted. That's looking promising, but it's a little too soon to say for sure, but there may be a board letter coming to your board to approve to award additional funds to more many grant participants. We've awarded more dollars with the opioid settlement to the bridge clinic. And as you know, the bridge clinic is a nationally known clinic, dealing with the opioid crisis that sits in Alameda Health System. We're in the process of putting out through a competitive RFP, what we're calling our substance use outreach teams or IHOT teams. As your board knows, we've had mental health IHOT teams for 10 years, and they do outreach and engagement to those who need services but aren't currently engaged. We've done that on the mental health side, very successful teams, very successful teams for 10 years and we're adding this on the substance use side. We have the public media campaign that it's completed. We are in the process of doubling the budget of options recovery services in Santa Rita, jail to provide substance use counseling. As we know, that's substance use in the jail is a major issue. And this contract, we will double it and we're only able to double it because of the opioid funds. Capital projects, law familiar, they bought a building that they had been running services out of and Adam's point for many decades. They were able to purchase the building. It was sorely in need of capital improvement. They're in the process of doing that now. We awarded them half a million dollars. They have some other dollars that they're matching it with that they raised. It's gonna really turn it into a beautiful facility and they'll have an open house when they're complete with that. As you guys also know, you board the board knows the St. Regis project in Hayward, which was a beach hip and a CCE funded program. We're setting aside some dollars in case we need more money there, opioid dollars. We currently have a BCHIP proposal into the state that we're waiting to hear from, whether it'll fund more money into St. Regis that's turning out to be an expensive project, no surprise, will either offset it with an additional beachhip award or we'll use the opioid funds as a backup. And then I'm very proud that in September of last year, one of the things we surprisingly got a lot of feedback on is our providers not being able to afford the Naloxone stance. Those are the stands where you can get free Naloxone while you walk by them. Maybe you've seen them in some of the county buildings or in the H.S. facilities. We have done that. We have up to 45 stands that we will distribute to ACBH providers. We will do this every fiscal year through the life of the grant. Their, the state gives away free Naloxone to put into the stands and Naloxone is helps prevent overdose when someone's an overdose withdrawal. Next slide. So this is a crosswalk. and the crosswalk is on the left side where it says stakeholder feedback. This is feedback we've gotten through our public sessions or listening sessions in September and then things that we've already implemented. Some of this is repeating, I've already addressed it, but we've got feedback to increase math availability. We've done that in the jail. Expand in a hamps the Substance Use System a care recovery residents and Substance Use Residential Treatment beds. We've done that. Fund more community-based organizations. We've done that through the minigrant process. Increased detox beds. We are waiting to hear if we will get a beachhip award through Alameda Health System. And then the opioid funds will fund the ongoing operation of those beds. Expand and enhance the substance use system. Again, we have an RFP that is about to go out for substance use outreach treatment teams. campaign campaign done, expand and enhance the substance use system to make a doubling the size of options recovery services and standard read a jail. Again, expanding a hand substance use to capital projects, one in LeB familiar, one in St. Regis, and then in the Luxon stands that I just covered. So I think the next slide is... Is Dr. Dan Bauer's? Or is it me? Thank you, James. And I do want to underscore, as he already mentioned, the relationship we have with Alameda Health System, as we mentioned we mentioned the detox facility as well as the bridge clinic as James mentioned it's nationally renowned It actually again was featured in the New York Times and I say that not for being proud But it was recognized as a federal Example metal at a very niche and wide level of what could be done locally. So I think Alameda County should be very proud of that and proud of the partnership that we've achieved through the bridge clinic and some of this work. So I just wanted to highlight that for you. So the next slides are in relation to the dollars. Again, we wanted to give a transparent overview. As I've mentioned, the total settlement funds that Allen and the county is looking for is approximately $80 million. To date, we've received about 23.3 million. And in the proceeding slides, I'll show there is a difference in the way that the monies come in based on the type of pharmaceutical company that really requires our financing leadership and our budget leaders to attend to every single detail. But as you can see of that 23.3 million, 17.8 was around the local allocations in terms of abatement, again to end the settlement, the opioid issue. We also reallocated city's budget. We have a budget for the city's budget. We have a budget for the city's budget. We have a budget for the city's budget. We have a budget for the city's budget. We have a budget for the city's their on their behalf. And again the legal fees are represented by 4.4 million of the 23.3 million. So what we have spent to date after the update we provided to you is approximately $10 million and again the future expenditures really relate to how the money is received and how projects are approved as well as Deputy Director mentioned. If we are approved at those state grant levels, then we can offset and provide the allocations in terms of what it relates to as terms of our planning. Next slide. This slide shows again our projections based on where we have come to date. This is just a replicate of the activities you saw and that Deputy Director spoke about in terms of those activities you see what we spent in fiscal year 23, 24, as well as four, five, and six. And these are anticipated. We will clearly have to adjust them based on when and how the additional funding comes through. That way it gives us more opportunity to do more work. The innovative grants to community organizations, I want to highlight that because again, Dr. Bowers will speak specifically about what that looked like in the grants and the awardees and how that's impacting across Alameda County proper. If you go to the next slide, this gives a little context to why some of those numbers it doesn't add up to 80 million. As you can see, for example, in this chart, it's color coded. On the right you see, it includes Tava, Allergen, Walgreens, CBS, Janssen, all of the distributors that are named in the settlement. If you look at the chart, it shows when they have opted to pay their portion of this settlement. And so as you see in fiscal year 25, for example, Walmart opted to pay a significant portion of theirs. So they spread it out in that particular year. So that is why the budgeting and fiscal management is critically important because we have to determine how and when the funds come in and then program it so that we can sustain it for the life of the grant. This is our anticipated how the payments will go through. So as you can see by the time we get to fiscal year 39, there is less than $2 million to be allocated so that, again, that prudent spending for us and planning based on what the projects look like and then potentially how other entities can leverage and then how can they be sustained. The mini grants again that will be spoken to briefly to briefly, will give an example of why we did that. We wanted to get the community's feedback in terms of the best opportunities that could potentially be evaluated, their performance, their outcomes, and then the departments, and the community can make decisions on how we can best support them if it's truly doing great, impactful work forward. So at this time I want to defer to Dr. Kelly Bowers. Good morning, supervisor Miley and supervisor Tam. It's my pleasure to be here today to follow the lead. It's very fitting that I'm following Dr. Tribble and James because from the very beginning of this project that three valleys has taken on, we have followed their lead and stayed aligned and they are visionary and they are leading the way not only for our county in this area, but for many counties because many other counties are watching to see what Alameda County is doing because they are being very innovative and creative and very responsive to the community. So a community foundation, we exist to accrue and procure local resources for local needs and this is a prime example of that. So I'm just going to share a little bit. What we've been doing was listening as you heard heard the listening sessions, but three valleys needed to listen as well, learning. We not only wanted to learn about the crisis and the reality of it, but also what the community wanted, what the community was looking for, and what nonprofits and community-based organizations were already doing, and their ideas for doing things differently, and more uniquely. And then leading, the county's been leading, and we joining in that and then launching, we were able to launch the mini grants in October and within RFP and then the funds have already begun to be deployed. So part of the learning was that we created using the county's considerable data and statistics and studying of the opioid crisis. created an infographic that is available and it really has helped us tell the story behind every data point is a person, a human and their circle that have suffered and this infographic is available for you but it's also available for others. There'll be a formal PR campaign but we wanted to have this so that people understood the seriousness. So we were fortunate to be selected. We competed to become the physical agent to administer the opioid settlement, innovative mini-grants, and we appreciate your confidence and trust in us. And as I said, we have launched and money is being deployed, which is the intent. So next slide, please. There are, I probably could have 40 slides on this, but I think Dr. Trouble would not prefer that, but she has heard it before, but we did try to pick the most assailant points to share. So the application was developed with an RFP. It was available to community-based organizations. We encouraged collaboration because we know that things can't happen in silos that are going to be sustainable. And so there was actually priority consideration and incentivization for collaboration with additional funds being available for multiple agencies if they were working together. And we also went back to the California's high impact abatement activity priority areas. So they've been pre-identified and we did in the process ask our applicants to speak to one or more of those areas and they all did. And then of course the innovative part, we can't keep doing the same thing and expect different results. And so we really encourage people to, as Supervisor Marley said, thank you out of the box. What did they always wanted to do? What could they do that was based on tried and true practices, but maybe delivered in a different or unique way? And then the priority had to be on the vulnerable populations that are disproportionately affected. And there was priority for that. And they didn't have to be based in Alameda County, they could, but they did have to benefit and serve Alameda County. But it turns out all the applicants that were funded actually are based here as well, which is really nice. Next slide, please. So the innovative, I still have to get over this. They're called mini grants, because in the big scheme of the 80 million that's coming in, they seem mini, but I will tell you to nonprofits and to these community organizations, these are major grants. They're very fortunate that they have this investment coming in to help them achieve their mission, particularly at a time when their federal funding is in jeopardy for a variety of reasons. And so this has really been something that they've been appreciative of. So how were they selected and judged evaluated? They were judged by being creative and innovative, the collaboration I mentioned. And if there was a window of time, it needed to be something that we could achieve progress, not solve all the world's problems, but there needed to be some milestones in progress that could be measured in the next one to two years, ideally 12 to 14 months. And then we looked for ideas and approaches to be sustainable beyond this as well as impact. We need to see that the funds are making a difference in the lives of someone. And for some of the grants, it's a smaller group, but it's really intense. And for some, it's a large group. So we did not determine how many people they needed to impact, but they needed to have that to be measured. The priority populations we talked about unsheltered recently or currently incarcerated vulnerable youth. These are the populations that we were really looking for people of color that are disproportionately affected. Confidence inspiring leadership. Some of them are newer organizations, so they didn't have to have a huge track record, but many did, but we did need to feel the evaluation needed to prove they needed to see their backgrounds and their bios, and then of course reflective representation, and that's the lived experience that needed to be represented either in their plans or in their actual agency of carrying things out. And so the awards were between 50,000 to 250, and again that was many, but we did have some that received up to 300,000 because they are partnering. Next slide please. So this is the big overview. We received, we did extensive outreach through every way's imaginal. We are nested in TriValley, but we focused on the entire Alameda County. So we were very fortunate to receive 41 applications and all of them were eligible. We didn't have to discard any. And then 12 of them were funded. We easily, we all wanted, probably to fund more. There were so many deserving ones, but there was actually even with 2.7 million a limit. So we received 10 million in requests. So that's a nice chunk that went out. But as was mentioned earlier, there is more need. And the grants range from 62,300. Next slide, please. So kind of just a little overall snapshot, a little bit of a landscape of what went out. These are, so we tried to kind of track it to see which projects were funded and which areas were hit the hardest. And what we did find is that all of your districts were touched and five of the projects were county wide, but some are actually have a little more focus and probably rightly so because some of the areas where our supervisors work and represent actually have a disproportionate effect from the opioid crisis, but I will tell you it's everywhere. So these are the populations, these are some of the projects, and you'll notice they don't all add up to 12, and that's because some have multiple areas. And the next slide, please. And these are the grand recipients. We're so proud of them. There's the amounts they're receiving. All of the funds for the first half of their funding have been deployed except for one who is waiting on an approval from their board, their council. And so that'll be coming out shortly. But the work has already begun as of April 1st. In fact, I had a good fortune with other colleagues to go see punks with lunch in West Oakland and volunteer and help Because what we do now is our work is not over. It was to get the funds out But now it's to monitor to support to provide technical assistance to build a cohort of people who are not working in silos on the same They might be working in a different way, but they're working on the same challenging issue And so we'll be taking them under our wing as go along. And we know that the county is watching and supporting every step of the way. And so I did have to give a shout out to your alma mater County behavioral health department, Dr. Trigger, her team, Dr. Chapman, Dr. Klanin, Dr. Kaman, Dr. Ayala, I mean, every single person. And of course, James and Anusa and Enika have been just always responsive. We can't do the work that we're supposed to do with integrity and with transparency if they don't support it and they have. So thank you for that. And I believe that's all I have. I always have more, but that it. I'm not sure if you can see it. I'm not sure if you can see it. I'm not sure if you can see it. I'm not sure if you can see it. I'm not sure if you can see it. I'm not sure if you can see it. I'm not sure if you can see it. I'm not sure if you can see it. I'm not sure if you can see it. community, the stakeholder feedback, the guidance from the opioid advisory council to which again, your staff sits and participates. And we're looking for future opportunities and for additional CBO grants, including the expansion of the mini-grant opportunity. We're really relying heavily on the data that was gleaned from the process, and three valleys has really shown the capacity to help us. So we hope actually to additionally provide additional funds for some of those 41 applicants. Our goal again is to continue to align with the board's priorities, the county mission and vision. And I say that to say we acknowledge and I think there's been some commentary that things are changing at the federal level. And that's all I'll say on that. So we are, namely able should we to pivot as we continue to plan. What is really important to emphasize is Dr. Bauer's mentions is progett program metrics and evaluation. So all of the mini grants, as well as the work that is funded outside and beyond to what you'll hear for them. For example, from Dr. Chapman, we're relative to MAT. We are monitoring how they do what the impact is and whether they're achieving the results that we've desired. And at the end of the day, the most complex, obviously as I mentioned, is the ongoing fiscal oversight given that we will have to track and report and be transparent and also do budget forecasting. I think that's the most creative that causes us to do a little bit of contortions as things change at the federal level, but nevertheless we're committed. Next slide. So with that, thank you for this opportunity and open to if you have any suggestions or direction. Thank you so much for that presentation and your Alamedt County Health and behavioral health, your department definitely rocks and shines as we have heard. The community impact report, this is a very good report, very clear in terms of the recipients and in innovation. But as you know, when we offer these grant programs, there's, you had 41 applications, you were able to fund 12. So I'm just hoping that at some point, we recognize that at least as a CBL that you can't always depend on these funds year after year. And so I think we were trying to also be fair in terms of providing funding for those that probably didn't get it in the first round because they're all obviously very capable and eligible. So how do we communicate that to the grantees? Yes, I'll speak globally, but Dr. Bowers, if you feel comfortable, you can. The framework that we wanted to use again is certainly that it is a one-time opportunity that will evaluate. And so that's been socialized consistently, so I'll defer to Dr. Bowers. Yes, so that is part of the reason why we actually built in as part of the application sustainability plan. Some have matching funds, some once they show concept and return on investment, have other opportunities that will come their way. But a lot of it's about, we noticed in the grants that some of it was about training and investing in their current staff so that they can carry out things forward or some one-time expenses like a mobile van so that doesn't have to be purchased every time. And so they were very, all of the applicants attuned to that. And yet at the same time, if there are more funds, then it would be nice to reinvest as well. Okay. I appreciate that. So, and you talked about the challenges of having the, you know, suddenly we're looking at 80 million instead of 70 or 50 or less, and budgeting for that and forecasting that is going to require. Obviously some creativity to the point where in 2039, you're looking at what, $2 million. So are you timing, because you can't really seem to anticipate from year to year what your maximum be or what your minimum be? Are you looking at a $2 million minimum? Because you can't take $80 million and average it over 18 years. No, you cannot. And that's a wonderful segue segue. So if Jill would come up, that actually is informing our strategy. So for example, as I highlighted before you saw Walgreens that provided a Walmars, excuse me, provided a significant investment in the beginning. We intentionally leveraged the highest cost, higher dollar ones up front when we had the funds. Knowing that, for example, Walmart had elected not to spread its allocations throughout the years. It is incredibly complicated, so I will defer to the expert to talk through. Yeah. The complication comes because each settlement has its own terms about when it will get paid and what will influence incentives or whatever not. And so we're working closely with county council Rayleigh Young on our projections. So when Dr. Trouble showed the slide with the funding by ear, you saw for a current year, there's a lot of money that came in and we do, we're able to project that. There will be changes. So that's just what we want to keep sharing with people that yes this is what we're expecting but reasonably there will be changes to that and we are trying to keep that updated so that we know how much funding is available for our programs by year. One of the challenges will be we only have five years from the date received to expend. So to level that out is not real possible we're going to do our best. That's true. Thank you for that explanation. Clearly I'm sure if you earmark funding for a project you're going to make exactly sustain my item for that project so that you don't run out of funds. Exactly. And in some of our calculations, we've looked at some projects required pre-planning implementation so they could be ready. And we've also looked at how we leverage, as Deputy Director James mentioned, we increased a current contractor. So that contract is already part of our system. So some of the increases that we would have already had to do are captured within the current contract. So that actually is the consistent dance. The good thing, if there is a good thing, regardless of what happens at the federal level because this is a legal settlement, we don't, well, I shouldn't say with any degree of certainty, we expect that because it has already gone through the litigation process that we can continue to plan in this way. But yes, it looks like for us, for the next, until fiscal year 33, we can expect at least four million or approximately. So that means those upfront costs will have to level set at some point. Okay. In your slide presentation, you had reallocated from cities like Alameda, Albany, Hayward, Livermore, New York, Piedmont, and Pleasanton, and the city of Oakland has their own settlement funds. And we've talked or hinted at potentially, at least, Surveyser Miley has, potentially providing more support for Oakland on their macro program. Because it's not exactly a program that sends people out that's an alternative to law enforcement if they're having a mental health care or an opioid crisis. Is there any potential to use Oakland's settlement and some of ours to kind of turn that into a more robust program beyond just outreach. Great question. I'll speak to the programmatic logistics and then I'll defer to Jill around Oakland's allocation or how that may remain I intersect with us. Technically, any jurisdiction in our case, Elimite County can program those funds in the way that you described. I think what we will be looking for is IE, MACRO doesn't only target individuals who have opioid needs. So we would- Orbitity sometimes. Correct. So in that case, either way, technically, you would look at not only the comorbidity, we would look at the number of resonance that served there, actually have a true and verifiable diagnosis in that way. Because so it wouldn't be in a direct apple for an apple. But technically, it would be possible. Our charge will be to look at not only Oakland, as well as Dr. Bowers mentioned, we're seeing need happening all over the county. So, as you saw, City of Oakland is taking their full settlement every time, each time there's a lot of things that we can do, we can do that. And so, as you saw, City of Oakland is taking their full settlement every time, each time there's a lot of things that we can do, we can do that every time there's a lot of things that we can do So as you saw, City of Oakland is taking their full settlement every time. There's a payment, each settlement. Cities are asked, do you want to take it or let it go to your county? Oakland continues to take their full settlement. We could theoretically add some of our funding to fund that program. But as Dr. Trouble said, we'd have to know if it's fully opioid remediation because that's really strict and then our leaders would have to make a decision. Do we want to prioritize that over our other projects because they are doing a outstanding job of getting this funding expended so that we don't risk any reversion? What is Oakland using the funds for? That I'm not aware of, actually. I don't know that there is a direct intersection with us on what they use it, but they have consistently opted in. What's their full share? I will have to go look that up. I don't know. Okay. Appreciate that. The last question I had is a little bit complicated because I mean, Sheriff Sanchez has approached my office about some of the issues that she faces in terms of, she calls it a revolving door at John George. So I had suggested to her that perhaps she could look at some of the buildings at St. Rose Hospital because she's some of the people that she escorts to St. to John George may have comorbidity issues. And she, but she needs a lot of facility that's under law enforcement's authority. And she was that first thinking about the Glenn Dyer jailed the third floor. But that's pretty far away from treatment. Is there any opportunity because of what you described as happening in the jails of providing some of the beach of funding to help with that potential effort? I will, there are multiple question points that I'll respond to in terms of the recycling or cycling back of individuals going to and for some of the analysis that we've looked at, the complexity is that once an individual no longer meets legal criteria to be held beyond the first 72 hours, John George is not able to hold them any longer. And so what it looks at here is those individuals, again, which is one of the reasons that contributed to our long acting injectables at discharge. What usually happens is the individual does well because they are given medications. John George has the capacity to do it. The jail does not. It's not that kind of situation. However, we are stepping in to provide injectable medications to individuals, even when they think they would prefer not to have it, so that we can try to diminish people going there. On a broader sense, I believe it was in 2018, the Santa Clara County jail used to have, and I only give this as context, within it a treatment that did exactly what it was a locked treatment facility. Believe it or not, Alameda County individuals who were in Santa Rita would go there and for a longer term would stay. So it wasn't an acute setting, it was actually a treatment unit and they were treated there. And that did well for a lot of reasons risk and other liability issues precluded all the counties, not just Alameda County from using their jail. So I say that to say, it would be a huge benefit if there was some kind of facility that provided longer term care beyond the acute 72 hours. That would be great. Could be chip supported. The technical answer is yes. The complexity is that with the state, we're chasing a Changing number dollar in terms of what will be available for B chip and what won't be so we have submitted our Applications if the state pivots and if stars in line and all agreed it would be to our benefit We tend to technically to it could apply what it looks like if I'm reading the T. Lease is that that we're not looking for a pull-out of multiple millions and billions of dollars coming out again from the state. They've kind of forecast that the well may be drying up a bit, but that is a technical possible project if all the wheels aligned. And the only other piece that I'll add is, in our case, to the degree to which IE St. Rose is a non-county owned facility will likely help us to make sure we meet the deadlines. For example, that's why in Beechip, we partnered with community-based and other CBOs because they could nimbley quickly build, construct and do some things more quicker than a county entity. So St. Rose is not, it is pseudo, it is element of health system. So technically again, we wouldn't be up against those barriers. But all of that precludes us unless the state says we have another round for which you can submit. Understood. Thank you. You're welcome. Thanks for the presentation. Some questions. And this is going to be all over the place. So, do you have a sense of the services that are being provided to the unhoused? How many have been reached? And do you go into the encampments? Do you mean on be on the settlement just in global? No, with the settlement. With the settlement. So I don't have an immediate account for how many have been reached in terms of the housing needs quite yet. We could gather that information. I could certainly speak to what we've seen globally in terms of behavioral department But for the settlement not quite yet and do in the outreach Because I heard the outreach was spoken of but do people go into the encampments? Yes, so outreach teams do visit and camp make pretty regularly if they need to Okay. And then with the grant 3 million with your projections going out to fiscal year 39 27 20 this clear Let's see, the grants are like one year to 18 months. So why aren't you contemplating another series of grants like in 27, 28 or? You read our minds. 29. We are. Okay. We are. But it's not here. No, it is not. But newsflash. Yes, we absolutely are. You helped us to articulate that is our plan. So I think the first step we're we're looking for with Dr. Bowers group first is to look at those that have already been submitted. Then we know we have 41 that meet criteria, we have 41 that have been vented so we can look there. Now when the distribution actually comes in because all of what you see on slide 11 is a projection, we'll have a better sense of whether we can reopen it in general. It depends on who you talk to or are brilliant fiscal conservative minds tell us to hold. Dr. Treville, wait, don't get to excited. But we're also planning for if we can, once we've looked at the additional 41 applicants that we're not funded, once then we look at whether we can, our intention is to do just that if we are able to. Then with the 41 received 12 approved. So the, what's it, 29, 28, 29? I don't know if you can answer the question, or if Kelly needs to come and answer it. So were those other 29? Those are the 29. If you had the funding, could you have given more money? Or is it just that those are the 29 didn't meet the selection criteria totally and thoroughly? So are the 41 they all met the minimum criteria? There were probably three or four that were not quite fully baked enough that they would want to go back to the drawing board and get some more around it. But I would say there are at least 35 that were fabulous. And I don't get to choose thank goodness because it's too hard hard but as we facilitate the process there were definitely high points in all of them. But there are maybe maybe five to seven that would have just been immediately funded. Okay, sure. And I think one, if I may, if you look at fiscal year 24, we had to make sure we had the cash in hand in order to initiate the GSA. So we may not have received all the cash available to do what you just said. But if we had had it, we would have absolutely been able to expand the amount we used. Okay. Because that's what I was curious about. So additional grants. Came in. That's right. We'll get awarded. Yes, right. We have the money. That's correct. So, do you anticipate having more money to provide more grants in the road? We are, we think. Supposed of three million. Yes, we think we, we certainly can spend more than the three. Now that we have more cash in hand, even after the RFP is to procure the supportive tri-value. So yes, we know that we'll be able to release more. The amount will determine in terms of what we look at when it's coming and when actually the check. to procure the supportive tri-value. So yes, we know that we'll be able to release more. The amount will determine in terms of what we look at when it's coming in, when actually the check is received so that we could do that. But yes. OK. So I'm helping you out, Kelly. And can I just, can I just interject for one thing? To your prior question, four of the projects that were funded with the minigrants are involved with the unhoused. So just so you know. Yeah, I saw that. Thank you. So Kelly, I'm not done with you. Because yeah, I saw that when I was looking at this one slide, it said, for instance, I'm adding up the projects in the different supervizorial districts. 10, 20, 30, 41, 41, 49 projects, but the number of projects that are outlined in the district are more than the number of projects that you have listed. Is it because some projects are duplicated or something? It's because some of them cross all districts and some of them are partnering. There's one that's an Oakland project that's called the town and they're partnering with TriValley, so it actually crosses over because it's a use-based project. And so because we encourage collaboration, many of them are collaborating and expanding. OK, so a project, when it's on this superfazorial map, a project could be from one entity, but in different, so different districts. Yes. OK, so how come there's so few that deal with the unhoused for projects? Do you know? I don't probably just again, actually four is a fairly good number. And some of the projects, those are where their sole focus are the unhoused. So West Oakland punks with lunch is solely with them. with them, but some of the projects, those are where their sole focus are the end house. So West Oakland punks with lunch is solely with them. But some of the others, if you were actually recently incarcerated, obviously their justice involved, some of them are also in that category. But when I did this categorization, I went to their primary focus. But there is some intersectionality. Yeah, because the reason I'm focusing on this, because we know there's a strong nexus between being unhoused and substance abuse, mental health, suffering. Because you really can't get stabilized being unhoused. And so, I was just trying to look at this a little bit more surgically. And of the 12 projects that were funded, I'm familiar with most of them, but are they primarily had courted in Oakland? I think some are looking at it in Oakland. They're not primarily there, but there are probably more that are crossing into Oakland than others, but some, so the city of Fremont Human Services, that's solely focused on Fremont. And Fremont also has their own city money, so they're doing the sustainability piece there. But definitely tribe, west Oakland, punks with lunch, use uprising, black girls, mental health collective. A lot of them are based in Oakland, or at least touching Oakland. Yeah, Pat, CalPap. I mean, I think they're roots. I think they're all in a quarter of Oakland, I think. But the services are going beyond just Oakland. In many instances, yes. Okay. That's part of the sustainability and the innovation, because they want to partner. And I think you answered the question, but I just want to zero in on this. The county has a result space accountability. So what you talked about in one of your slides was a feasibility plan, to sustain the ability beyond the grant and demonstrated impact. So you're going to receive all of that in the county. We'll get that information so we can determine the effectiveness or lack thereof. We provide even before even before the grants went out, we provide a monthly update. And then we'll be doing informal as well as very formal check ins and grant reporting and budget reporting with our grantees. And we do that intentionally along the way to be a support so that we don't wait to find out if there's a challenge, if something shifts or changes. I see. We can be there can be, their success is our success, which is accounting. Right, exactly. Yes. Yeah, okay, great. And let me see, there's anything. If I just wanna say your presentation, the event, because Dr. Rivell and I were there was really fantastic. I thought the state of attorney, state attorney I think. I was a US attorney. I mean his speech was extremely well. I kind of wish he hadn't run out of time because it was really well. In Dr. Dr. Riffle and I, we were sitting next to one another. The whole thing about Fennel was like, it was like just mind blowing. And we were basically saying, I mean, it might go back to what Nancy Reagan was advocating, you know, just say no. Because with Fentonol, it's like, I just couldn't believe, I knew stuff about Fentonol, but that presentation was like, I was just shocked. I agree. It was really eye opening for many, many people. And he is available. He does that for a bono. He goes out to give the message mostly to parents and youth. But thank you. And thank you for being part of the presentation. Both at UN Dr. Trigal. Yeah. Yeah. Did you have anything you would like to say about that? Because the opioid, the phenolzono opioid, right? What is it? It is a man-made development, yes, in that way. It's related. I think what really stuck out to me, echo everything you said, is on a human level, I literally reached out and called one of my college age children to remind them to be very careful. But what really stood out is when you talk about drug testing and when you look at potential using other drugs that it is not foolproof, the tiniest amount of fentanyl can be in relief to death. And that's why we're really very hopeful to as Dr. Chapman will talk about, the opioid distribution, the Narcan. But it was remarkable when you think of just how significant and just how powerful it is as compared to other drugs. All right, I think those answers all of my questions at the moment. So thank you for the presentation. Thank you. Let's see if there are any speakers. I have no speakers on item two. No speakers? No speakers. This was an informational report. Even though you went longer than anticipated, I didn't want to cut you off. This was very useful information. it's very useful information. So thank you. Yeah, thanks a lot. So we're going to go to our next informational item. And if for some reason we can't get everything today, we'll carry it over. So let's go to item three. Good morning, Supervisor Miley, Supervisor Tam. Thank you very much for the invitation and the opportunity. This presentation is really just going to be, it's an extension of what Dr. Trouble and Mr. Wagner were speaking about in Dr. Bowers with a specific focus on where medication assisted treatment is going to fit in with our use of these opioid settlement dollars. So we're going to talk about particularly what we're doing with this new influx of money, but also a little bit about where our department has been in terms of addressing the opioid epidemic and the use of medication assisted treatment really, you know, for the past number of years. If we can go on to the next slide, please. What is medication assisted treatment? I just wanted to start there. It is the use of medications to facilitate the recovery of individuals with substance use disorders. And when I say facilitate recovery, no one thinks that, you know, you're gonna find a pill, one particular medication that is going to address all of the biological, psychological, social, spiritual issues, the confluence of factors that come together for individuals with opioid use disorders or substance use disorders, but medication can help to facilitate that recovery process. For individuals who are experiencing or in the throes of withdrawal or experiencing constant cravings, those can be barriers for those individuals to engage in successful substance use treatment and the variety of the programs that we have throughout the county. MAT, medication assisted treatment, reducing those cravings, reducing the symptoms of withdrawal can in fact help individuals to engage in other aspects of substance use disorder-related care. Just some facts that we know about MAT and partially why it's so important in our community, particularly if we're talking about opioid use disorders, we see lower mortality rates, saves lives, lower rates of HIV and hepatitis C transmission in the community, decreased rates of opioid-related relapse for people who are receiving MAT versus people who are engaged in other forms of treatment that don't include medications, and an overall improvement in care. And just to expand on that a little bit more, I think some things that are important to us, and in this county, we see rates of reincarceration, or incarceration amongst individuals who are receiving MAT. Increased rates of employment and improved social relationships as well. I'm gonna get on my soapbox here for a moment. You know, I say, MAT, it's a medical treatment for a medical illness. And if we believe as we do that substance use disorders, opioid use disorders are in fact medical conditions. This isn't an offering. This is, this is an option of medical treatment for these conditions. And it restores and saves lives. So, the opportunity to use opioid settlement dollars to expand our use of MAT in the county is welcome. Next slide, please. There are different medications that are used and some of of them are probably familiar, as MAT, medication assisted treatment for substance use conditions. Today we have MAT available for people who are familiar for nicotine use disorders. We have patches, we have gums. We also have MAT available for alcohol use disorders, and we specifically today are going to focus on the MAT programs and the MAT agents that we use for opioid use disorders. They have different mechanism of action. Methadone is an opioid replacement. It is in fact also an opioid. And let me step back a moment. Fentanyl, if we're talking about opioid use disorders, fentanyl is an opiate, heroin is an opiate. There are a variety of medically prescribed opiate. So if we're talking about oxycontin, that's an opiate. If we're talking about Norco or hydrocodone, that's an opiate. So those are the agents that are out there that people are using that when we talk about opioid use disorders where our focus is. So methadone and buprenorphine are opioid replacement therapies. Buprenorphine is also a partial opioid blocker. And I'll explain why that's important in a few slides. Thealoxone or Narcan is a completely different agent. It's a opioid blocking agent. And we don't use this so much as part of medication assisted treatment, treatment, but we use it. We want to have that out in the community because it reverses opioid overdoses. And in reversing an opioid overdose, it can save a life. And again, we've made great efforts in our department, particularly with opioid settlement dollars to expand access to Narcan in our communities. Where were we in the past? Well, we were pretty much limited to the use of methadone. And we did, you know, we have decades of support in the behavioral health department in supporting a network of narcotic treatment programs, predominantly methadone treatment programs throughout Alameda County. And those persists, that's an important part of our treatment network. Then Bupe Renorphine came along, but there were a lot of federal restrictions around the use of it. For a physician, it was one of the few medications that I just couldn't pull out my prescription pad and prescribed. I needed to get specialized training to be able to use buprenorphine. I needed to get a special DEA waiver to be able to prescribe buprenorphine. And at least in the early days, I was limited in terms of the number of patients to whom I could prescribe. And you can imagine this created bottle deck of buprescribers, limited access, and it was certainly our uninsured populations and our Medi-Cal recipients that were going to be most impacted by those limitations. Next slide, please. This slide should look familiar. I think Mr. Wagner put this slide up. It is a complete list of various different programs under the opioid settlement. Today, I'm going to specifically focus on the highlighted medication-assisted treatment expansion at the Santa Rita jail, the bridge clinic with Alameda Health System, and free distribution of Naloxone stand boxes and Naloxone in our community. Next slide, please. Again, you know, history, where were we before this? We have been for decades supporting a network of narcotic treatment programs throughout the county, Bart, Bart, lifelong, Lifeline, West Oakland Health Center, makeup part of that network, for, I'd say, past 10 years plus, my office in the behavioral health department has been leveraging. We are a credited continuing medical education provider. And we have been leveraging that accreditation to provide training in the use of buprenorphine throughout the community, not just amongst our behavioral health providers, but providers and FQHCs to providers that were part of the Alameda Health System and across the network of care. Very early on, pre-pandemic, along with Alameda County Sheriff's Office and Well Path, we were part of an early learning collaborative with the Department of Public Health to explore how we could expand and bring MAT services to Santa Rita Jail. And then we have again for the past 10 years plus provided expert psychiatric and addiction medicine consultation to our network of substance use disorder providers. These are predominantly non medical agencies. They don't tend to have medical staff. They're providing more of a social model of substance use disorder care. And we have found that by bringing psychiatric expertise and addiction medicine, expertise to those clinics, they're more likely to recognize people who need medical care or who may benefit from medication assisted treatment. Next slide, please. to expand on medication assisted treatment. Next slide please. To expand on medication assisted treatment implementation at Santa Rita Jail, just something for everyone's awareness, Santa Rita Jail was actually one of the only jails on the state of California that was licensed to provide methodo within that jail. Problem was its use in the facility was limited. We were pretty much limiting it, or the network, the system was limiting it for the treatment of methadone detox. So people who came in with acute withdrawal symptoms, how could we temporarily use methadone to taper them off the opioids that they were using on the street and they were used in pregnancy. Buprenorphine, which is kind of the newest one that people are using the most, was really relatively unavailable or used in very limited amounts in the jail. And the focus at that moment was how do we treat acute medical needs, that acute withdrawal, but it really wasn't to focus on engagement. How can we bring people into substance use disorder care? We don't like to see our clients end up at Santa Rita Jail, but I think we do have to recognize when someone who is using opioids in the community is in Santa Rita jail, there is an opportunity in that moment to engage people into care. And we shouldn't lose sight of that. And I think we are using settlement dollars and expansion of MAT to not only just focus on acute medical needs, but to focus on, you know, individuals, you know, how can we engage this person in medication assisted treatment that might follow them upon release from the jail? So the opioid settlement funds have facilitated an expansion of MAT availability and an expansion on a significant increase in the overall number of patients receiving MAT at Santa Rita jail. I asked my colleague Dr. Charles Rainer who kind of oversees our pharmacy budget to give me some numbers and we you know over 200 doses of buprenorphine as release medications were prescribed in February. I think this was the latest data that he had for me. We also are using, and I'm gonna talk about it on the next slide, but long-acting injectable forms of buprenorphine that have some advantages. They're a little pricey, but in February 46 individuals received in the jail long-acting injections of buprenorphine or medication-assisted treatment. Next slide, please. So as I mentioned, this expansion has included what I'll call state-of-the-art agents, and these are long-acting injectable forms of MAT. These can last up to 30 days in terms of preventing cravings, in terms of preventing withdrawal symptoms, and these may be appropriate for for a wider range of San Areida jail patients. And then, remember I mentioned that what is? terms of preventing withdrawal symptoms. And these may be appropriate for a wider range of sanerida jail patients. And then, remember I mentioned at one of the earlier slides that buprenorphine, it's an opioid replacement that has some blocking action. So imagine if we can give people when they are in the jail, a long-acting injectable treatment that will follow them, because it's in their body, upon release. Again, limiting cravings, reducing withdrawal symptoms, and there's some evidence that it can actually, because of that partial blocking action, that if someone does go into the community and use fentanyl or use other opiates, that it can reduce the risk that they will actually experience a fatal overdose. And as Mr. Wagner mentioned, the reentry population is recognized nationwide as the population at highest risk for death related to opioid-related overdoses. People are in jail, they lose track of what their dose should be, they are released into the community, there's some degree of excitement upon leaving jail, and that's the highest risk population. So this is an opportunity to provide some protection, not just while the individuals in the jail, but upon release from their incarceration as well. And then of course, we're discharging, for people who are not receiving injections, but who are receiving other therapies, we are discharging people with a supply of their medication-assisted treatment to help bridge them from treatment in the jail to wherever they're going to go for treatment in the community. And our care coordination has improved dramatically. And that is with this expansion of a contract with options recovery, as well as partnerships with Alameda Health System in the bridge clinic. Next slide, please. So talking about the bridge clinic, let's move on to that. This is a strong partnership between our behavioral health department and Alameda Health Services. An opioid settlement funds are being used to expand addiction medicine and medication assisted treatment availability across the community. The bridge clinic offers full spectrum addiction medicine care. This is currently taking place at Highland Hospital. There are discussions about expanding that beyond just the Highland Hospital campus and their experts. They have been recognized nationally for their low barrier access to medication assisted treatment for opioid using patients. Patients can walk in and receive MAT treatment the same day. Patients can phone in. They have a strong telemedicine component because really the goal of the bridge clinic at our work with the bridge clinic is how do we reduce barriers to accessing medication assisted treatment. We have strong linkage right now between Centauri to jail and the bridge clinic. So while people are discharged from the jail, released from the jail, with medications at hand, we wanna make sure that they have a place to go, that they know where to go, to continue their medication assisted treatment upon release. And in most instances right now, we're working with the bridge clinic. And when someone engages with the bridge clinic, the original model was one of, hey, this is where we're gonna initiate MAT, and then we're gonna refer them to other community providers. And I think what we've learned over time is that there are a number of individuals who are served best by continuing to receive their care at the bridge clinic. Next, please. This is it. This is our Narcana distribution box. This is what they look like. As Mr. Wagner mentioned, we have 45 of them being distributed throughout the county and amongst various different behavioral health contracted programs and some of our own programs. Again, the idea is the more Narcana that is out there in the community, the more Narcana that is out there in the hands of people who use opiates or who perhaps are loved ones of people who are using opiates, the more overdoses and overdose-related deaths we can prevent. Generally, people don't administer their own Narcan. Generally, people don't know when they're experiencing a life-threatening overdose. But if you have Narcan in communities, particularly in communities of people who are using the likelihood increases that if someone is experiencing an overdose that someone will have Narcan to be able to deploy and use it. There is training, and I'm proud to say that, it's our department and my office that is offering training throughout the county in terms of how to deploy Narcan, how to identify when it's needed, and when you have it in your hands, what do you need to do with it to reverse an overdose episode? So we are using these funds to expand these public access in Narcan or Naloxone vending machines and with the result of we're increasing Naloxone availability in the community at Nost. Next place. So this is just a little bit of a review of where we are today versus where we have been. We're now due to some federal changes and these were good things. Any prescriber can prescribe puberty and those barriers that they had originally about number of patients, you know, those are pretty much gone away. And now in Alameda County, using opioid settlement dollars and in partnership with programs, individuals in this county have access to the full range of MAT medications for the treatment of opioid use disorders. We have expanded access to Naloxone or Narcan to reverse overdoses and save lives. We have a very robust MAT program that is expanding for opioid use disorders amongst individuals who find themselves at Santa Rita jail. And I also wanted to mention he be here today if he wasn't celebrating Passover, but Dr. Joshua Keman is an addiction psychiatrist who we have brought in as our medical director in the substance use disorder continuum of care, and he is providing consultation to me. He's providing consultation to our staff at the jail, and he is integrated with the bridge clinic in terms of really helping us to expand our medical focus on the treatment of individuals with SUD. Next. That's what I had to share. Thank you. So, by the time you have questions, comments, I just have two quick questions and thank you for that presentation. You said that it's very costly to have the long acting injectables. What's the order of magnitude and is expected to go down and as things like methadone gone down? And the challenge is that there are two long acting and injectable forms of buprenorphine. One is I'm sublicate and the other one is brixatti. They are both only brand name drugs. So there's no generic equivalent. And we know that when a drug is only available in a brand name form, they're costly. So these are hundreds of dollars per injection. I could text my colleague of the pharmacy department and get an exact number. These are not inexpensive medications. We are fortunate, at least particularly in the jail, to have access to the opioid settlement dollars to help us to fund our use of these medications, you know, with some extra paperwork are available through Medi-Cal as well. Okay. But only when some when an individual's in the community. The Narcan dispensers, I know that when Santa Clara County was discussing this, one of my colleagues, Surveys or Aolie was saying he would like to see them like in libraries and as successful are they at encampments. So can you give me a sense of the 45 dispensaries, how many are where they're located and how we make sure people know they're there and they have the appropriate training. It's a great question and I'll share that we are one of several efforts throughout the county to expand availability to Narcan and even in the setting up of Narcan bending machines. The 45 of our boxes have been targeted toward our county run behavioral health programs as well as county contracted behavioral health programs. So they're gonna be set up throughout the county at our programs, but we are not, HEPAC is another, they're one of the recipients of opioid settlement dollars, but they're running a separate program, also putting Narcan distribution sites throughout the county. I'll tell you again, I'll get on my self-box. You know, I have a vision, and we've started to do this at our behavioral health sites, but everywhere, I would love to see everywhere in Alameda County, where there is a defibrillator and a AED. Next to that AED, there should be a couple of boxes of Narcan, because I'd ask in this room, let's say someone in this room experienced an opioid-related emergency. Who here knows where the Narcan is? Wouldn't it be great if we always knew where the Narcan was? So we've started within our programs, and again, my work with our pharmacy team to have Narcan right there next to the AEDs. And so if everyone knew next to an AED, there's an available, an availability of Narcan. I think that would serve us well. One of the reasons I asked what Oakland was doing with their settlement dollars is I was hoping that they would also be part of helping to make some of the bending machines or dispensers available throughout the community. Do you know if that's the case? The other contractors that are... No, the city of Oakland's use of their open selling. Actually, I don't know that. I'll look to... Supervisor Feigner. Mr. Wagner, do we know if cities who are receiving their own settlement dollars are using those dollars for opioid ending machines. We do not. Thank you. I think supervisor in the next presentation we have which is part of our OP3 grants which does some of the broader county wide work with cities and with other partners. We might have some more information there, but we'll follow up with you specifically on Oakland. Thank you. Thank you. Thank you. So, supervisor Tam, can I ask one of the questions I had? So the 45, and you said, HEPAC, is it one of the 45? No. They, there is a, there are multiple efforts throughout the county to have our current distribution sites spread out throughout the county. We have taken our focus in our department to make sure that they're available at our treatment programs and our contracted programs. But we know that we're not the only one. Not that., is not one of your programs? They have contracts with the county. Historically, they have, not been a contractor for the behavioral health department. They have been a contractor with Alameda County County. Interesting, okay. Let me thank you. And then your vision, what is restricting us from achieving your vision of Narcan having Narcan where we have to serve the regulators? I think this probably very little. When I'm working with my team, what I see as the biggest challenge is not the placement of Narcan next to the defibrillators. It's the monitoring of that that they're constantly being replaced and so that you have a system that if someone uses the Narcan that's next to a defibrillator, how does that get replaced? And that's not impossible, a little more challenging. Okay, because I'd like to see your vision achieved. Thank you. I don't think there's any. And if the issue is replacement and stuff, I'd like to see you guys work on that. And hopefully when you come back with an update, you will have more good news for us in reference to that. And then, is it possible, I know you're just doing the opioid settlement dollars, but can we get at some point an indication of where an arcane is available throughout the county? I would think that it should be, we could certainly map where we have placed it, but what I sense you're asking is not just what is the behavioral health doing, but where is an Arcane available? I think that that's something, at least, at least if you're asking about county funded efforts, that should be done. Okay, it'd be nice to know, okay. I think you can come back as part of another update. Let's see here. Oh, the bridge, yeah, I wasn't familiar with what the bridge clinic was. So, how do people know about the bridge clinic? How do people know about the bridge clinic? Yeah. We're making our efforts to get word out there every day. Many providers, or I would say most providers who are funded through the county know about the bridge clinic. And there are efforts within communities to provide education and knowledge as well. So people, for example, at the jail individuals who are incarcerated, who are started on MAT while they're at the jail, they are clearly given information about, this is where you can walk in, this is where you can call in. If, you know, to continue the therapy that we started in the jail, upon release when you're in the community. Is there a need for more than one bridge clinic what's that is there need for more than one bridge clinic is it's at the Wilchan Highland campus but do we need one in other parts of the county or is it this sufficient oh yes of course and that is actually conversation within a just the bridge clinic actually started out of the emergency department at Highland Hospital. It's expanded beyond that. But we are having conversations certainly within the AHS system if there are other AHS hospitals that where we would see traffic, where having a bridge equivalent would be helpful. Okay. And Dr. Chapman at the moment, do we know how many people are receiving MAT? Across the county? Yeah. That would be a real challenge, really challenging number to to calculate. You know, because there's so many different systems that are providing it and not just public systems but private systems as well. So to get that information from Kaiser to get that information from S Sutter and just private practitioners in the community, be a challenge. Okay. And then I know you mentioned the drugs are expensive. Do you have, can you kind of give us a sense of the cost of MAT as a whole of the drugs and themselves. I'm sorry, what? Either the cost as a whole or the drugs themselves. I do have an idea for the drugs themselves. Again, the two that stand out as most expensive, well actually I'll say they're a three that stand out as most expensive. And those are the two injectable medications that we use for opioid use disorders. The good news is, it's a 30-day injection. It's no need to take a pill every day. That provides some ongoing protection. The third is Vivitrol. That is predominantly used for alcohol use disorders. But that's also another one that unfortunately, it's brand name only. And it's in the vicinity of high hundreds to perhaps $1,000 per injection. Oh, wow. I'd say wow, too. And if I come home and to add it, we averaged it out. I think when we came back to you a few years ago, it was approximately $5000 individual inmates based on all of the injections that they were supported. 5,000 per individually-ammade? We're costed to makeations, the cost of the administration and such. It looked like we were $5,000. We include the medications and the provider that was the case during it. But the drug itself is 1,000, but 4,000 of it is administering it? I will make sure that we get that you know get those specific dollar amounts to this committee. Yeah because I don't want to I'm talking a little off the top of my head and from memory and these dollar amounts change all the time. Yeah. It's being paid for out of the opioid settlement. So I don't think we're objecting to the cost out of transparency, just like to know. I think another thing to keep in mind is that depending on how long an individual may be at Santa Rita jail for one individual and if we're looking at the cost they may be receiving multiple injections if they're there for more than a month. Okay, all right, let's see if there's any questions on this item. Speakers. Freeway. pretty way. I'd just like to start by saying I know exactly where the Narcan is because it's around my neck. I'm speaking today not only as a harm reductionist and someone who who provides advocacy and supplies to the on-house community, but also as somebody who has been personally affected by this epidemic in multiple ways. I just want to say that first of all, if it were not for sublicate, I wouldn't be standing here right now today. The amount of improvement that I have seen since taking this medication is unmeasurable. I will say that I fully support the fact that the jail system is using sublicate as supposed to other forms of buprenorphine as of red-red-red-red-red-red-red-red-red-red-red- the sublingual strips and that causes a number of problems that don't go into because I'm limited on time. I would also like to say that I really appreciate the fact that the jail's offering this system now. Two years ago, I lost my brother to an opioid death. He was coming out of jail, his tolerance had gone down and he had any no overdose. And I never got to good bye to him. So this has become my life's work is advocating for people who are incarcerated and who need those services. I just wanted to say I really appreciate the presentation and yeah, thank you. I have no more speakers for this item. Yes? I have to be excused. I have a 1230. Okay. So, the other two items are information items. Can we carry those over to our next meeting? We could, if you prefer that. One of them is related to another opioid overdose Prevention program and then one is a med project update So the item four Item four is related to opiates and item five is meds project. Okay, so I Think we can take up With just one committee member, so we let's take a five minute recess and then we'll take up item four. So five minute recess. Recording stopped. Thank you. Thank you. Thank you. We'll take up item four. So five minute recess. Thank you. Recording stopped. you you you you you you you you you you you you the Okay, so we're back and we're going to take it's an information item having one committee member. So item four overdose and poignant prevention program update. informationally and I think we're okay. If it's an information item having one committee member. So item four, overdose and poignant prevention program update. Goodness. I'm going to make this thing work. All right. Supervisor Miley, great to be here. Oh, lean in. Oh, quite the opposite. Already felt like I was being too loud. You know, wonderful questions during the last session. And so I may even come back and address some of them in this one. It was wonderful hearing from our behavioral health colleagues because when we look at the overdose prevention landscape in our county, there's an ecosystem of overdose prevention. We got a good view into what's happening in the behavioral health ecosystem, in the behavioral health system of care. And there's a lot of efforts that are happening outside of or connected to the behavioral health system of care that we get to discuss a little bit today. Could we move to the next one, please? Thank you so much. I'm going to go through a little bit of data for some context. I'm going to talk briefly about both MAT and public access in the lock zone as well as some novel harm reduction programs including drug checking and then some of the funding regional in collaboration and challenges. And you know, this is data that many of you have seen before. It's probably not your first time seeing overdose data. But this is the context of which we exist in this, in our county, which is one we we can see our national trends. With that top line, these are overdose rates. The national trends for overdose deaths are going up. They are rapidly increasing. We can see our state, the line, the blue line, which is our state mortality rate, which is going up. And we've been fortunate in Alameda County to actually have a relatively low mortality rate for overdose deaths. It is lower than the state average and far lower than the national average. Now this data cut ends in 2021, in 22 and 23, state and federal increases flatline and they are stable and our county rates continue to go up in 22 and 23 but are still below the state average. Next slide please. This is specific to our county. Now we can look at all drug deaths at the top line and drug deaths or overdose deaths that also include opioids as the bottom line. And you know the story here is one this is the number of deaths per year this is through 2023 and it also tells the story of that this is a public health crisis that is increasing year over year. Good. Next slide. And I think it's also important to put these in the context of a map to looking at where our neighbors live that are dying from drug deaths and overdose deaths. And we see an overlap between drug mortality, overdose mortality and other health disparities. When we look at national health disparity data, like healthy places index, CDC numbers, when we look at HIV rates, chronic disease, even COVID-19 deaths. We see some of the same disparities in our county and the same regions when we look at the 880 corridor, West Oakland, East Oakland down through Hayward, South Hayward, as being the area codes, the zip, most impacted by overdose deaths. And we can just see more of the demographic trends when it comes to overdose mortality. We see the same chart of the rates increasing year over year. And we can see that this is a, this overdose mortality, overdose deaths don't affect all people equally. We have nearly three times, 300 percent, the increased rate of death among our black and African-American neighbors. Then we do among both white and Hispanic or Latino neighbors. Our white and Latino rates are nearly the same. And we can see by gender, there is a three times increase of overdose of death or mortality among men versus among men. But we don't see is a large disparity across age groups. There is lower mortality among 15 to 24 year olds and above people over 65. But when you look at all of the ages between 24 and 65, we have nearly the same rates of mortality. So it's a disease that affects people of all ages, nearly equally, predominantly affects men, and predominantly affects our black African-American neighbors as well. Next slide. It also overwhelmingly impacts our homeless neighbors. Homeless deaths represent 36% of all homeless of all overdose deaths. So that's over one third of all overdose deaths are among people who are experiencing homelessness. That's 2023 data. It has become the most common cause of death among people experiencing homelessness. And that as this year it has overtaken acute and chronic illness or acute and chronic disease, which includes things like being hit by a car, dying of heart disease, diabetes, other forms of chronic disease, which previously accounted for maybe 40% of deaths among people experiencing homelessness. So not only does it account for 36% of all overdose deaths being among people experiencing a homelessness, but people who are homeless, 42% of them have died of overdose in the last year. And we can see even among the trends of the types of drug poisoning or the types of drug overdoses, we can see that there are changes in drug consumption over time. So when we look at 2018 or 2019, this is the chart on the lower left-hand side, it'll we see that there's roughly the same amount of stimulant-caused mortality. So exclusively stimulant-ca caused mortality. So that's usually methamphetamine between 2018 and 2023. And even of opioids alone has not changed dramatically between 2019 and 2023. However, the gray part of this bar graph, which is a mix of substances or polydrug overdose, has increased dramatically between 2018 and 2023 and accounts for the overwhelming majority of all overdose deaths is a mix of usually stimulants and opioids. And what we've learned, we will cover this in a later slide, is that that is more of a reflection of drug consumption behavior, rather than adulterance in the drug supply. your board through some of the work with Previous Supervisor Keith Carson has paid for our funded drug checking program and some of the early data that we have seen from the drug checking program of checking the drug supply in our county is showing that there is less drug contamination. But we are still seeing the cause of death remaining a mix of opioids and stimulants. We can move to the next slide. And so part of why we're here and talking about this now is the context that, you know, we have a broad healthcare agency and there is an interagency response to the overdose crisis. We heard with a lot of important detail from our behavioral health system and they play large and important role when it comes to substance use treatment. But we also have our healthcare for the homeless teams, the program that I sit in under the medical director, Dr. Kathleen inlanon. We have our EMS system that are involved in field-based overdose reversals with Narcan, with Naloxone leave behind, with field-based bup starts where they're providing buprenorphine in the field, post-overdose, wall being transported or before being transported to a hospital. We have the work that our colleague and the environmental health will talk about regarding prescription drug take back and syringe drop off. We have all of the work at the more public health department in terms of the HIV and HFC programs and some of the data and epidemiology that lives within the public health department. And of course, Santa Rita Jail and the Sheriff's Office plays an important role of providing MAT and health care, field-based Noloxone administration through law enforcement and some of the work that we've been engaging with them in terms of linking people to care and to treatment post-release. Because as we've heard from behavioral health, they have made tremendous strides in improving the medications that are available to people in San Areida, and there still needs to be work to improve people being linked to ongoing care and access to medication after they've been released. And that comes to part of the work of this particular program. This is the overdose and poisoning prevention program, OP3. This is, it's in the office of the agency director with Dr. Kathleen Klanin. And we have four main goals and objectives. It is to improve internal coordination and alignment as we saw from our previous slide. There are many overdose prevention activities happening across our healthcare agency. We want to improve data sharing and integration across all of these programs. We are all collecting data and trying to evaluate our programs independently and we would like to improve the way that we share that data and collaborate. And then we have two specific things that you've also heard from behavioral health because we share some of these goals and that is increasing public access and the lock zone. So the distribution and tracking of access in the lock zone and expanding low barrier access to medications for addiction treatment for MAT. I'll just say in relationship to this too, our friend from Environmental Health, but will be speaking around some of the efforts that they lead with safe medication disposal. You know, a lot of this happens through the meds coalition, and it's sort of an important legacy of the work that the meds coalition has done, led by, of course, your office supervisor, Miley, to reduce injuries and deaths among Alameda County residents, especially due to unused pharmaceuticals and to needles. And so some of the work that we see in this overdose prevention through our program and through our collaboration and some of the interagency work is a result of some of the earlier work that has happened through the meds coalition as well. You know, the purpose of sharing this slide is to share on one hand where some of the funding comes from. We have a mix of federal funding, state funding, and local funding. So we have CDC funding, federal funding. We have our Prop 47, some realignment funding. And then of course we have some measure A funding as well. But this is also just to share about some of our actual prevention activities that are being funded. And so that includes what we mentioned before the health is drastically expanding medications available for inmates and patients in Santa Rita. And we're trying to improve the linkage to treatment for people being released from Santa Rita. So that means working with HEPAC. We've contracted with them. We have a full-time case manager and well-path the health care provider within Santa Rita is providing their phone number as an additional resource to link people to care and services. We're trying to provide additional transportation resources and to follow up with people post-release. There's challenges with this and we can get into that more, but it's a big effort. We're trying to place staff that work alongside well-path within in San Areida to help improve some of those linkages to care because some of the exists. We're trying to place staff that work alongside well-path within Santa Rita to help improve some of those linkages to care because some of the existing resources of relying on well-path to take on this work outside of the normal duties is difficult. Beyond the substance use navigator, we're trying to hire within Santa Rita. We're also trying to improve substance use navigation with other community organizations across the county that mostly serve people who use drugs. So we have worked not just with Santa Rita jail but also with Cherry Hill. We're working with roots, community health, and we're also working with Sutter with both their altibates and their summit campus. And the reason why we're working with Sutter is because when we look at regional data of MAT prescribing, we actually see low rates of prescribing coming from the Sutter system, and they're also one of the highest ambulance transfer, or sorry I should say, one of the highest EMS recipient hospitals. So they receive some of the most overdose transfer patients to Sutter, to Summit and to Ultubates. But they're among the lowest in terms of prescribing for medications to treat addiction. And so we've been in a process of working with Sutter and trying to provide additional resources that includes staff such as substance use navigation to help improve their treatment in the emergency department or the prescription of medications for addiction treatment within the emergency department. Two other pieces are just around harm reduction expansion and we'll talk about that in subsequent slides and expanding some of our internal coordination. So that is included in the med school edition. There's an internal planning groups and we're also looking to expand. I think we've heard even in our presentations today, there is a need to better understand how different cities are planning to use their opioid settlement funds and that has implications with how we as county, health agencies and departments are going to be deploying our resources as well as ongoing coordination with organizations like the community organizations receiving opioid innovation grants, make sure that we're still coordinating and aligning all of our different overdose prevention activities across the county. Next slide. We've addressed some of the low reducing barriers to MAT and that is focused on, at least in our program, that is focused on hiring staff to do patient facing, street-based navigation, substance use navigation to resources, those harm reduction resources, those are drug treatment resources. And these are the partners that we have, they're that we're currently working with, Santa Rita Jail, Sutter, Cherry Hill, and Roots. A big piece of that is Cherry Hill because of the incredibly impactful work that has happened with the behavioral health department in terms of increasing medications. We are looking to continue people's treatment or work with behavioral health and well-path in terms of continuing people's treatment outside of jail. We reference pharmacy barriers and I think that's also connected to Santa Rita as Dr. Chapman and others have explained. We have some novel medications that are being used in the jail, Bruxatti and sublicate long acting injectable MAT. They have very little availability or a difficult availability outside of the jail, so out in the wild. And so it is a barrier that we are seeking to address now, trying to improve the ability and the low barrier access to someone continuing to be able to get in a long-acting injectable form of MAT after they've been released from Santa Rita. I'll just say this one of the piece which is that, you know, providing substance use and navigation, frontline health workers who are working with people who are experiencing homelessness or in drug treatment or in active addiction is very difficult. And we have a part of our program that provides peer-to-peer support and counseling for substance use navigators to improve retention and quality of care. Just a few things about the public access and the lock zone with this has been covered in our earlier presentations. You really appreciate being able to partner closely with behavioral health on expanding Up public access in the lock zone. What we've been trying to do is standardize the process so we don't have you know OAD process access and the public access and the public access and the public access and the public access and the public access and the public access and the public access and the public access and the public access and the public access and the public access and the public access and the public access and the public access and the public access and And so this is a part of making that possible. I just wanna also recognize that this is built on the successes of some of our other colleagues, Healthcare for the Homeless, had a pilot with East Bay Community Foundation in terms of placing the lock zone in some of their residences. And we have learned from their pilot as well in how we have designed and are working with other programs for this public access and locks on. The other part is just around mapping. Can we go to the next slide and then maybe come back? You know, this is data driven. We are looking at not only health disparity data, but we are looking to map over like a overdose heat map of both ambulance transfers for our ambulance calls for overdose and for overdose mortality and then look at the types of the organizations that are requesting Naloxone kiosks and then then mapping them accordingly. There's an interagency panel, reviewing all requests, and we are in the process of making this map public. So there is a new overdose website that has been worked on with the Cape, the evaluation unit within public health. And that buyers has been leading the program and it will have a version of this map that will have all of the locations of public access and lock zone mapped and available. You can type in your address and find the one that is closest to you. We go back and then we'll go up to you. And the last part that I'll say is that there's a lot of important regional collaboration that's been happening. We've been working with some of our neighboring counties, including Santa Clara and Contracosta County. We have been working with all five Bay Area counties that BART travels through because we've been working with BART on a pilot for going to start the parking lot. We're going to start the parking lot. We're going to start the parking lot. We're going to start the parking lot. We're going to start the parking lot. We're going to start the parking hum reduction, harm reduction tends to include things like expanding access to naloxone. Naloxone is at the end stage of providing a harm reduction resource because the harm that you're trying to reduce is death. It is an overdose reversal medication. And so in other forms of harm reduction that we are pursuing, there's both safe and clean use supplies, testing for SDD and STI's programs that the HEPC and HIV programs within public health have been funding and the novel harm reduction program that has been sort of a legacy of supervisor Keith Carson funded through HEPAC, which is drug checking and it's based on the thesis that people can make better health decisions, including about their drug use when they have more information. And this is a program that provides both street and laboratory testing of drug contents. And we can see we can provide additional reports on this, but you know, you can see based on testing results, which types of drugs and which specific drugs have different levels of adulterance. So are they the what the drug is sold as? Are they mixed with other drugs? Is the primary product not detected at all or is a different drug detected entirely. We're processing about 50, or I should say we have contracted with for this program, is processing about 50 samples per month at three different sites. I should say a total of three different sites and 50 different samples per month. There's also a regional coordination effort. HEPPEC is one contracted partner that we're work with. This is through the East Bay drug checking collaborative. There's other organizations that are part of that like West Oakland Punks with lunch and you know not only myself but our colleagues There's no longer here, David Motorsbach, has been leading some of the regional coordination around the use of drug checking as a harm reduction tool. We can go to the next slide. There are plenty of challenges that we could talk about. I think the biggest one for us is, you know, this is a complex problem with many complex large health bureaucracies, whether that's hospital systems, our county health agencies, criminal justice system and ongoing coordination and integration of our efforts is difficult and requires a lot of attention and time. That tends to be focused around improving care at Santa Rita Jail and one of the larger overarching challenges that we're anticipating is just the changes to the federal funding landscape. We have received a majority of our funding through the CDC and ongoing federal funding is uncertain. And I thank you for the presentation. Thank you. Do we have any speakers on this? Deza.. I have no speakers on item four. No speakers. So I found this presentation to be very interesting and informative. So and I really, really appreciate OP three. So you know, looking at it comprehensively and pulling it together. Hopefully some hopefully, some of the questions asked the doctor Chapman, I'll get the answers here. Yeah. So, when is this going to come back? With those answers? We'll circle back with the team and get you a comprehensive. Yeah, this is good stuff. The truck testing, fentanyl, came up the most. And so what noticed that, it did a spike in deaths and in the homeless encampments, maybe as a result of the pandemic. I mean, we saw with the increase in homelessness, that's right. And pandemic, that's when we started seeing that line going up. So clearly there's a nexus there as well. And you pointed it out, most of the folks who are dying a good percentage are homeless. That's correct. Yeah. And then a lot of them are, it's more significant in pronounced significant in pronounced, among African Americans as well. That's right. Yeah. So that heat map, I can't wait to see that heat map too. So I mean, there's a lot here that I mean, I'm just, I'm just excited about it. There's a lot of really good work happening across the agency on this. And so we're happy to bring that back. And we can also send a written update. Yeah, this is great. Because that's why I was thinking, you've heard from a paper health, but I know public health, have PAC, then environmental health, then EMS, I mean, the hospital, I mean, yeah. And then Narcan, is it easy to administer? Extremely easy to administer. Yeah. All right. All right. I'll say there's, man, where do you even start? There's multiple pieces. We'll do Narcan, and then we'll step back to some of the other ones, which is Narcan's easy to administer. On each of the stands that provide public access in the lock zone, there's an instruction, like a visual instruction to provide. There's also a QR code that provides like a one minute video for training and a longer video. If you want more in depth information, we also work with an organization called the National NCA PDA National Coalition against prescription drug abuse, April, or Varyral. Who you know. And we work with her to provide community trainings every month, every other week, and that's something that HealthCare for the homeless had been doing for two and a half years before we started working with April to continue that. When it comes to, you know, yes, this question before, like, how much MAT is being prescribed, you know, where do we see that? Again, I don't have all of the numbers, but there's two domains that are really interesting that we look at. One of those is MAT prescribing in the jail, in Santa Rita, jail. On a monthly basis, we can see, there's 13, 14, maybe 1500 new people being admitted to the jail each month. And the jail screens, every new person that's admitted for substance use disorder. There's a full medical screening and about half of all new people admitted are screened positively for substance use disorder. And of those about half are receiving treatment. And so there's actually pretty good uptake of MAT in Santa Rita. And that is being amplified by and supported by the work from the B. Brawals department in terms of providing improved medications available for patients. I think that provides additional incentive and onus on our health system to be able to provide for those patients post-release. I think that's why I pay additional attention to the second set of data, which is hospital prescribing data, and looking at how much is being prescribed by different hospitals within the hospital systems. We're looking mostly at alming health system and CETR right now, but we've looked at all the different hospitals that we have access to, and looking to see where know, great disparities in terms of the number of patients that they see, but lower prescribing rates and how we can work with them, whether that's around education, training, stigma, or other reasons why prescribing is low, help us understand. And then, Satter Sutter, you mentioned in the presentation, summit in alto baits, but isn't Eden a Sutter hospital too? Yes, but they receive fewer EMS ambulance transfers compared to Sutter in alto baits, so it just hasn't been as much of a focus. Okay. And then with the opioid and fentanyl, I mean, yeah, it's gonna be interesting. A lot of it is the homeless and then folks are incarcerated, but the concern too is among some young people or somebody who just happens to experiment with drugs and then gets a fentanyl and then how that's going to impact them. So I think the North can, having that as broadly available as possible, college campuses and other places, it's important too. So that's right. Yeah. Well this is good stuff. I can't wait for this to come back so we can see an update on this. Yeah. OK. See how it's progressing? Definitely want to monitor this. Yeah. Thank you. Thank you very much. All right. So I know TSA's got another committee in 20 minutes. So we're going to try to take up this other item, even if we just introduce it. And if we have to, you know, cover it in more detail later on, we will. But let's have our next House of Drugs and Sharp Disposable Program update. We'll bring you back so I can ask some more questions. My name is Mbawakana MBA, like the MBA degree. A registered environmental health specialist at Environmental Health Department, and also the last zone for the Safe Household Trucks and Shaps Disposal Program. I know my time on this presentation is limited, and our day is fast spent. But before I get started, I want to applaud and appreciate the providers of Miley and the Board of Supervisors in general for their trailblazing effort in conceptualizing the expansion of our collective responsibility in protecting the environment we live in. I didn't know much about this program until about August last year when my former colleague lived and I was asked to be the last one for this program. I found time to research a bit about this exciting responsibility and I'm amazed by the ingenuity of the idea to mitigate the bad impacts of calories, disposal, of unwanted household meds and shops in our environment and use the Vaisomali, you led the church as I heard, and this is the first time that I'm meeting you. Our county is the first in the nation to mandate pharmaceutical companies to take up the responsibility of moving unwanted meds and and shops. It is an awesome responsibility, Alameda County did to get this started. Mets enable us to live longer, healthier and more productive lives. The public, especially children and the elderly, add more risk of poisoning due to a careless disposal of prescription in my prescription, and also illegal resell. So what we have over there, I had wanted to set this stage to refresh our minds so that we can appreciate more. What we are seeking to accomplish, thanks to the audience and thanks to the supervisor Miley. The self-drug and shops disposal program was but it was method was given by the audience. It's actually audiences. They say, met audience and a Shaps audience. But I might be saying just audience today. It was passed in July 2012 to promote Safe Drug Disposal, reduce illegal resell, and protect groundwater, and drink and water. Producers of drugs that are sold are distributed in Alameda County are required to participate in a plan for the safe collection and disposal of their drugs from the residents, when those drugs are no longer needed or wanted. Producers are required to pay all costs without a specific point of selfie to consumers or a point of collection fee. A drug producer is not prohibited from recouping their costs through the price of their medications. If they like they can add some money. We don't care about it. Or we want to see it's the mixture that I wanted, meds, and removed and disposed of properly. So the ordinance mandated products to wash it plants that will be approved by the environmental health deficient next likely. What we seek to accomplish in our other sites, we review and approve stewardship plans. We also review quarterly and annual reports. They have to let us know what they are doing so that we can be sure they're making progress. We receive and conduct complaint investigations or getting CUSC drop off sites. Occasionally, we investigate and address complaints of unsafely managed CUSCs. For instance, pharmacy staff may be too in non-deted in their work, that they don't keep an eye on the CUSk. And residents can just put their mates and chefs on top of the cask and expose them for a peer-free and falling into wrong hands. We also lay us with other agencies and coalitions with vested interest in protecting the environment from unwanted drugs and chefs, like my friend Joel. We provide overall guidance on the implementation of the Alameda County Safe Drugs and Shaps Disposal Audiences and Environmental Health Regulation. Next slide, please. The stewardship plans that we currently have, we have two. We have the MED project LLC and we have in more.. MED project was approved to collect and dispose of MEDs in 2015. And three years later, we approved to collect and dispose of one dead shafts. Enemah is the other one that is the moment approved to collect and dispose only MEDs, only medicines. I have to, that at the start of the program in 2015, another stewardship organization was approved. That plan was called exalacies, that we approved to collect and dispose of the only one covered drug called cometric. So the company that manufactured cometric stopped selling that in Alameda County and the plan was not renewed. Next slide please. These are the different collection methods utilized by the organizations that are four of them. We have a drop of casks at the moment. We have 105 in between in more and made. We have Mailback Services. These are sites that stack up Mailback envelopes where you just go collect an envelope with an a-reorder instruction on the envelope. So that one is run by INMAR. We have Mailback Services via MATE project. It runs a wonderful cost-interprev providing information on collection services available to residents. And finally we have the tech back events. This one is a major event that in my participate in actively in different events in collaboration with HOSO, HOSO, HOSO, HOSO, HOSO waste in various parts of the county and also with Washington Hospital in three months during the end day. Next slide, please. Okay, this is the meat and butter of my presentation. What is this by weight collected and disposed? Last year in 2024, from the most recent report that I received from last year, meds unwanted meds were 82,650 pounds Shaps were 77,699 pounds All times since the beginning since inception 2015 We've collected and disposed of over 430,000 pounds and Shaps has been been over 267,000 pounds. If you sit back and think about it, these are prescription and non-prescription drugs that would have ended up in our land fields, and ultimately leech into the underground waters us or end up in the wrong hand, or get resolved for illegal reuse. Next slide, please. I look for the future. We are continuing to outreach the potential new CISC drop off sites. Whenever we get information about a potential CISC site, we get the stewardship be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be allowed to be and healthcare providers. Stewardship organizations report that they are outtreating eligible pharmacies, hospitals, and clinics with on-site pharmacies. Community outreach are the reports that they engage in, include TV streaming audio and online videos, digital display ads, signages, brochures, social media platforms, and email blasts. Most recent biannual survey results that they sent to us as demanded by the audience should considerable uptake and level of awareness among the public and health care providers. Next slide, please. Resources. These are places where you can go and get more information that is available. Information that you will get includes binoculars to the stewardship plans that we approve. The annual reports that they sent to us and contact email addresses for drugs and And I have the information for the two approved plans that we use. These websites have information on what to do with your use drugs and provides collection information according to your zip code. Next please. Here is a pictorial example of a cask. Next one please. These are user instructions we see on the cask. They'll guide you on how to open the drawer, place medication, close the drawer, and what's acceptable and what is not acceptable. Next, man. That's additional information you you see on the drop off cask. Next one, please. As information regarding the mailbox services of the pre-addressed envelopes and the order process. Thanks. Thank you. Thank you for the presentation. Let me see if there's any public speakers on this item. I have no speakers for item five. Okay, so I appreciate the presentation this afternoon. I have some questions and comments, but I'm going to hold those and bring this back when we have more time. Because I think it's a decent need to clerk another meeting at 1.30 and she didn't have much time. So but thank you. It will circle back on this. Thank you for the presentation. So let's see. Do we have any speakers on non-agentized items today? I have no speakers for public comment. Okay. All right. So we'll. So it's not agenda items today. I have no speakers for public comment. OK. All right. So we'll we'll adjourn the meeting for today. Thank you all.