# Opioid Abatement Commission - February 14, 2025 > Auto-transcribed civic record · Commission · February 14, 2025 - **Permalink**: https://meetings.lexingtonky.news/meeting/6339 - **Source video**: https://lfucg.granicus.com/player/clip/6339?view_id=14&redirect=true - **Date**: 2025-02-14 - **Body**: Commission - **Last revised**: March 27, 2026 - **Length**: 14,014 words > ⚠️ **Auto-generated content.** Audio from the official Granicus video was auto-transcribed by OpenAI Whisper-1, with speaker labels folded in from Granicus closed-captioning. Structured facts were extracted with GPT-4o; the narrative summary was written by Anthropic Claude Sonnet. Speaker labels and verbatim wording may contain errors. See [methodology](https://meetings.lexingtonky.news/about/methodology) or [report a correction](mailto:editor@lexingtonky.news). --- ## Meeting Overview The Opioid Abatement Commission met with Dr. Stephanie Raglan presiding. The meeting included three agenda items: two informational presentations and one action item. Presentations were delivered by Dr. Twin Tran and Alex Elswick, both of which were informational in nature. The Commission also took up Work Group Recommendations, which were approved. Across the meeting, four votes were taken, two presentations were given, and no public comments were heard. ## Attendance The following members were present at the February 14, 2025 Commission meeting: - Dr. Stephanie Raglan - Tara Stanfield - Kimberly Baird - Sierra Bowman - Brandon Helm - John Moses - Connie Neal - Margaret Pesciano - Dale Sanders - Mark Woods - Angela Evans **Absent:** Dr. Matt Webster and Laurie Brock were not in attendance. No members were recorded as late. ## Votes and Decisions The Commission took four votes during the February 14, 2025 meeting, all of which passed by voice vote. - **Adoption of the Meeting Agenda** [timestamp: 0:03:18]: Brandon Helm moved to adopt the agenda, seconded by Sierra Bowman. The motion passed by voice vote. - **Approval of the December 13th Meeting Minutes** [timestamp: 5:26]: Connie Neal moved to approve the minutes from the December 13th meeting, seconded by Mark Woods. The motion passed by voice vote. - **Approval of Recommendations to the Mayor** [timestamp: 1:32:12]: John Moses moved to approve the recommendations to the mayor, seconded by Mark Woods. The motion passed by voice vote. - **Adjournment** [timestamp: 1:35:22]: A motion to adjourn the meeting passed by voice vote. No mover or seconder was recorded for this motion. All four votes were conducted by voice vote; no roll call votes were taken, and no individual vote tallies were recorded. ## Presentation by Dr. Twin Tran [timestamp: 12:03] Dr. Twin Tran delivered a presentation focused on the treatment of addiction, with particular emphasis on opioid use disorder. The presentation addressed the medical dimensions of addiction treatment and highlighted the critical importance of providing medication-assisted treatment (MAT) to individuals who are incarcerated. A central theme of Dr. Tran's presentation was the elevated overdose risk faced by individuals with opioid use disorder, particularly upon release from jail. Dr. Tran underscored that making medication-assisted treatment available within jail settings is a key intervention for reducing this risk, as individuals who are abruptly cut off from treatment during incarceration face significantly heightened danger when they return to the community. The presentation was informational in nature, providing the Commission with a clinical and public health framework for understanding opioid use disorder as a medical condition requiring evidence-based treatment, rather than solely a behavioral or criminal justice issue. No votes or formal actions were taken as a result of the presentation. ## Presentation by Alex Elswick [timestamp: 1:03:50] Alex Elswick presented on behalf of Voices of Hope, describing the organization's work in providing recovery support services and harm reduction to individuals in the community. Elswick emphasized the organization's philosophy of meeting people where they are — an approach centered on engaging individuals at whatever stage of their recovery journey they may be in, rather than requiring them to meet predetermined conditions before receiving support. This framing underscored Voices of Hope's commitment to accessible, non-judgmental services. The presentation was informational in nature, and no votes or formal actions were taken as a result. ## Work Group Recommendations [timestamp: 1:22:34] Dr. Stephanie Raglan presented three recommendations from the work group regarding the use of opioid abatement funds. The three recommendations were: - **Annual Summit:** Establishing a recurring annual summit related to opioid abatement efforts. - **Grant Opportunities:** Creating grant opportunities to direct opioid abatement funds toward relevant programs and initiatives. - **Interest-Bearing Account:** Establishing an interest-bearing account to support the long-term sustainability of opioid abatement funding. The commission discussed these recommendations, with the interest-bearing account proposal noted as a mechanism for ensuring the funds remain viable over time. All three recommendations were approved by the commission. --- ## Decisions - **Motion** — passed (0-0): Adoption of the meeting agenda - **Motion** — passed (0-0): Approval of the December 13th meeting minutes - **Motion** — passed (0-0): Approval of recommendations to the mayor - **Motion** — passed (0-0): Motion to adjourn the meeting --- ## Full transcript ? ? ? ? ? ? ? Good morning, everybody. We want to welcome you to the Opioid Abatement Commission meeting. We're glad that you're all here, and it's real nice and warm in here because it's cold outside. So I want to call this meeting to order, and we ask at this time that the roll would be called. Good morning, everybody. So Chair, Dr. Stephanie Raglan. Present. Vice Chair, Tara Stanfield. Present. Kimberly Baird. Here. Sierra Bowman. Here. Chief Weathers or a designee. Here. Oh, you can actually go over there, yes. And what was your name again, sir? Brandon Helm. Brandon Helm. Okay. So we have Brandon Helm as the designee for Chief Weathers. Mr. John Moses. Here. Ms. Connie Neal. Here. Ms. Margaret Pesciano. Here. Mr. Dale Sanders. Here. Dr. Matt Webster. Dr. Mark Woods. Present. Ms. Laurie Brock. And Ms. Angela Evans. Here. We have a quorum. Thank you. Thank you so much. Before you, you have the agenda, a robust agenda today. It's very busy, so I'd like to take a moment, if we will, and look at the agenda and then I'll receive adoption. Commissioner Evans, would you bring a couple with you, please? Thank you so much. Mr. Helm. I move to accept the agenda. Bowman seconds. All right. It's been moved and seconded. All those in favor? Aye. Anyone opposed? I need more time. Are we good? Motion carried. Thank you so much. Before you are the minutes from the December 13th meeting. If you would take the opportunity now to go over the minutes. Thank you. Okay. I move to accept the meeting minutes from the December 13th meeting. Who is that? Neal. Neal. All right. Is there a second? Mark Woods seconds. All right. Are you ready for the question? All those in favor? Aye. Anyone opposed? Anyone abstain? Motion carried. Thank you so much. The next item on the agenda is the report out from our executive board meeting. And we've been very busy in our executive board meeting getting prepared through discussions with our work groups and the recommendations that will come before us later on in this meeting today. And during that executive board meeting we also had our law department to clarify about the allowable purchases or expenses with the opioid abatement litigation funds. And so that was what we talked about along with the notion that several of us have been given emails from the boards and commissions because our terms are expiring. And so we have an opportunity to reapply for those of us who got the email. We have an opportunity to reapply for assignment to the commission. We have two-year terms and we have four-year terms. And the reasoning for that was so that all of us doesn't come off the commission at the same time. And if I'm carrying this information correctly, the two-year terms, if we get reappointed, if we reapply for those that have the two-year term, that term would be a four-year term with a maximum of serving ten years. And then those that have the four-year terms, when that time comes they will have a maximum serve out if reappointed of eight years. All right? And so for those of us who received it, if you're wanting to reapply, please get those applications in to the mayor's office as soon as possible. Those that received the two-year notices, yes? No, we've received two. You've received two? All right. All right. Any questions on that? All is good? All right. That's good. So we had a lengthy discussion during our executive board just trying to interpret the law on that. And I want to thank Attorney Brittany for jumping on, Brittany Smith for jumping on and helping us clarify what that means for us. All right? And the hope is that those that have the two-year appointments will come back and reapply again and hopefully be approved to come back and serve on this board. All right. The other things that we talked about was we have to reassign the executive board. Those terms are up. And so at this time looking and, as I always say, praying for those individuals that will serve for the executive committee. And so that will be coming up here shortly. And if you have an interest in serving, if you'll reach out to me and let me know, I would be most appreciative. All right? And then the last thing we talked about, along with setting the agenda, was the template and the format in which we are to submit the recommendations to the mayor. And we got all of that lined out. And so I believe that we are good and we are ready to go with that and that was the gist of our executive commission meeting. But I do also want to talk about the dates on the calendars for this coming year, 2025. And the one date that I do want to bring up is that we need to move our June 13th meeting to 1030. So please mark your calendars that the June 13th meeting will be at 1030 instead of 10 o'clock. And I want us at this time to take a look at our calendars to make sure that there are no other dates that we have on the calendar for our regular scheduled meetings that we need to change. All right? Carmen, do we have a list of the dates? Do you have that? I'm looking right now and the only one. I think we're good. We're going to be good. Second Friday, I don't think they fall on any holidays. So we'll have today and then we'll have March the 14th and then we'll have April the 11th, May the 9th, June the 13th, July the 11th, August the 8th, September the 12th, October the 10th, November the 14th, and December the 12th. So it may just be the executive committee meetings that we'll have to readjust because they're the week before. Okay? All right? And then, of course, if we have other issues, we can individually deal with that as they come. All right? And that is all of the report from the executive board meeting. And I've already talked about the commission appointments and so we can move forward now to our presentations. And we do have some folks here that are going to present and we're glad that they're here. And so we want to give them now an opportunity to come and tell us about what they do. And so I want to start and I'm going to tear this name up, Dr. Tran with second chance. How about that? And you'll have to tell me what your first name is. Twin. All right. Thank you so much. If you'll come. Great. Good morning. Good morning. My name is Twin Tran, physician, partner and CEO of Second Chance. We specialize in the treatment of addiction, providing care for mostly opioid, but we do extend that to other addictions, other substances, et cetera. Before I start, I would like to thank you, Dr. Ragland, and all the members of the commission for providing me the opportunity to come and speak to you today. I've been doing this since 2006. I got board certification in 2013 when it became available. And so I am addiction certified. And we've been operating Second Chance since 2012, so a little over 11 plus years. And I think we have probably one of the largest clinics in the area. We probably have over 2,000 encounters a month and probably see over 1,000 patients a month. So we see a fairly large number of patients. We offer fairly comprehensive treatment to include, of course, the medical assessments and the MOUD, the treatment. We provide the counseling, both the individual and the group sessions. And then most importantly, the case management, because I think that we have to start thinking of an individual as a whole person and their socioeconomic needs as well. And, of course, we partner with many of our community partners, Jubilee Jobs, for instance, to help people who have overcome their struggles and want to create a new path towards recovery and be productive members of society. We, of course, rely on Voices of Hope to help us with the peer support, because that plays a very significant role in these folks' recovery and to stay that way. And so I would love to entertain any questions, but if there are none, I can start with my presentation. I'm sorry? Okay. Sit. All right. Some disclosures. Again, I stated earlier I'm the partner founder of Second Chance. I'm also the CEO. And also I would like to disclose that since May of 2024, we have been providing MAT to the incarcerated patients at the Fayette County Detention Center. That was quite a task to get that implemented at the jail. And finally, the contents of this presentation represent only my views, my opinions, and my interpretations of the data. I am not speaking on behalf of any organization. First thing I want to share is the deaths associated with the opioid epidemic. I'm sure you are very familiar with this data, but I would ask that you remember these two statistics for just briefly. Since the opioid epidemic in 1999 until 2022, we had roughly 700,000 deaths related to opioid overdoses, both the prescription and the illicit. In 2024, there's about 90,007 deaths attributed to opioid overdoses nationwide. In Kentucky, 2023, we had about 1980, roughly 2,000 people in Kentucky died. So doing a quick math, that's 100,000, 50 states, that's about 2,000. Considering that the size of Kentucky, what, over 4 million, a little over 4 million? Wow, that's an awful lot of deaths in Kentucky, relatively speaking. Earlier I asked you to remember the 727,000 deaths and the 97,000 deaths. While these are staggering numbers, I would like to put these numbers into another perspective. And I think it would have even more impact. So I went and looked up the deaths, whether it's related to the battle itself or non-battle deaths, illness, et cetera. Of all of the American wars since the Revolutionary War to Desert Storm, and I tallied up all of the deaths. If you look at the total, 1,200,000 deaths, wow. The opioid epidemic isn't too far behind all of these deaths. Again, that helps us put things in perspective. Look at the Vietnam War, 90,000. I just told you we had 97,000 deaths in America last year. Imagine if we said every year we have the equivalent death toll of a Vietnam War, every year. That puts things, I think, in a much better perspective for us to understand that. We have incredibly smart people at the CDC, ASAM, NIH, NIDA. These folks are all working to properly approach and tackle this very complex issue. I just wanted to summarize collectively what the aim is. Number one, we must monitor the trends so that we can understand how to target the responses. We have to advance research so that we can collect the data and analyze it to precisely look at the contributing factors to opioid overdoses. We have to ensure that the data we're collecting is valid data and not garbage in, garbage out. And then finally, if we do these things properly, we can now better identify the targets to promote our prevention and treatment efforts. And then, of course, this is an important one. We must have the collaboration at the federal, state, and more importantly, the local level. And I just told you, Kentucky is heavily afflicted. We are overrepresented in the nation in regards to the opioid epidemic deaths. I know that there's always talk about promoting the advancement of the research, but I'm very glad that we are now starting to focus on improving the opioid prescribing, focusing on the patient safety aspect. We are making the public more aware of these misuse and overdose situations. So I'm very glad that we have a commission like yours to make this happen. I think many of you are very familiar with the CDC graphs of the three waves of the opioid overdose deaths. I want to take an opportunity to highlight some things. If you look at the advent of the opioid deaths with prescription drugs and look to about 2015 or so, I think that was a success. And many of you will probably immediately question and push back, Dr. Tran, I believe the slope of every one of those graphs are positive and increasing. That is true. Mathematically, you are absolutely correct. The slopes are positive, and it is rising. But I challenge you, and I firmly believe that had we not intervened at the federal, state, and local level, these graphs would have been much more horrendous. Now, after 2015 or so, we saw the surge of fentanyl. This is a very complicated topic as to why and what's contributing to the escalation of that graph. Way smarter people than I are tackling this, and so I'm not even going to pretend that I'm smart enough to talk about it. But I am going to talk about a contributing factor to that curve, and it is the incarcerated patient population. I've been working with the incarcerated population for about nine months now, and every one of our new patients' drug screens are positive for fentanyl. That's problematic. Interestingly enough, about 70% of them are also positive for meth. This data is consistent with the literature of 80% meth, which is hitting the Kentucky very, very hard. By the end of the year, we should see much more meth. Not that we want to, but that's what it is. And fentanyl will completely basically wipe out the state, because everyone's going to have it, whether it was intentional or inadvertently, as you know, they sprinkle this stuff on everything. So my focus today is to look at the incarcerated patients, because I think it is also contributing to the spike that we're seeing here with fentanyl. Giving you some background, Mittal et al. in 2020 looked at the relationship between incarcerated patient history and overdoses in North America. Some of the correlations that they noticed, one, incarceration history was a significant risk factor for overdose. Highest risk of death occurred immediately after release. Concomitant mental health increased the risk of overdose. Their conclusion was that the findings were significant enough that they strongly recommend large-scale implementation of evidence-based practices, interventions in correctional settings. We in the community have always known about these correlations, because we see it every day. The part that we did not necessarily identify right away was the highest risk of death occurred immediately after release. Why is that? I think many of you understand, but bear with me. I'd like to go ahead and reinforce it. When I come to jail, I am entered, whether willingly or not, into an abstinence program. And while I'm abstinent, my opioid tolerance drops. When I leave, because I have not received adequate treatment, I have not received my necessary peer support or counseling or other interventions, I relapse. And when I relapse, because my tolerance for opioids is lower, the likelihood of overdose is very significant. I normally take a handful, so I go back and I take a handful. Well, my body can no longer tolerate this handful, because that tolerance is decreased, because of my brief abstinence in the jail. And that's what leads to the death. So we in the community have known about these things, the concomitant mental health, the incarceration. We've known about these things, but it was interesting for them to put it all together. In 2023, Hartung et al., in the Journal of Substance Use, they did a retrospective review looking at all of the fatal and non-fatal opioid overdose following release of prisons. They looked at over 18,000 patients who had been released from the jails from 2014 to 2017. They noticed two-thirds of the people with substance use disorders who needed treatment did not receive treatment. 20% of these individuals had mental health disorders that required treatment, but were not given adequate treatment. Following release, 579 overdosed and 65 fatal deaths occurred. This is about a tenfold increase compared to the general population. And if you are reading the literature, a recent study about two years ago in North Carolina basically found the exact same thing. The population that was released from the North Carolina jail system had a significant increase in deaths upon release. And they said as few as within two weeks. That doesn't give us a lot of time. Moving off topic slightly, the Americans with Disabilities Act stated a person who has legally prescribed medication to treat their substance use disorder and is no longer engaging in illegal use of drugs is a person with a disability and therefore protected by the ADA. Section 504 of the Rehabilitation Act of 1973 protects these people with disabilities to include incarcerated individuals. Jails and prisons must make reasonable attempts to provide prisoners with disabilities equal access to programs, services, and benefits. ASAM, in a public policy statement January 23rd, 2025, also identified incarcerated patients with OUD to be vulnerable individuals at very high risk of overdose during detainment and upon release. Methadone and buprenorphine will reduce this risk by 50%. These are evidence-based. We have done studies looking at this. This is not in question. Their stance is that correctional settings are diverse. We know that. And they face significant barriers to providing MOUD, but we need to look at implementing systemic changes to ensure that our patients at correctional institutions receive the standard of care medicine for opioid use disorder. All right. What are these barriers that they're talking about? Well, the NIH HEAL Initiative in 2019, supported by NIDA, did a survey at probably 100 plus jail systems throughout the United States. And of all of the respondents, 90% of them identified medication costs and the cost of supporting clinical staff and our guards to administer the treatment. 100% of them identified diversion as being problematic and a huge barrier for treatment. My personal experience, in the nine months that I've been at the jail, I want to give a brief shout out to the folks at the Fayette County Detention Center and Yes Care, the medical services associated with them, for their outstanding collaboration with us to successfully implement MOUD at the prison. I think we've made a tremendous impact. My personal observation of barriers, again, are very similar to what I've just stated in the literature, and that is the medication costs. The cost to support clinical staff and guards for passing medications, and then the diversion. Allow me to back up a little bit and talk about the cost to support clinical staff. For many of you who are not really familiar with the outpatient setting, when you go see the doctor and the doctor prescribes you a medication, he or she will give you a prescription. You go to the pharmacy, you fill it, you're done. You take your medicine, you go about your business. In the jail system, it's not quite that simple. These are controlled substances, the buprenorphine, the methadone. So a nurse needs to dispense it, and the nurse has to dispense it at the cell of each of these patients. So you can see it's going to take time to pass the medications to every one of these patients who need this medication. Also think, I've got a nurse wheeling around a cart full of controlled substances. Yeah, we're going to have to have a guard walk around to protect this cart because it's full of controlled substances. Then the part that you would never think about, but certainly the guard needs to examine the oral cavities of all these patients to ensure that there's no diversion. And what I'm going to share next is somewhat crazy and probably very incredible, but it is what it is. Patients who are incarcerated will often cheat their medication. They will often hide their medication, then spit it out secretly to divert the medication. And I know it sounds crazy. Sadly, it's true. I find it absolutely amazing that a tablet that has been in someone's mouth and spat out has a high demand and sale value within the jail system. I'm not here to ridicule anyone, but it does sadden me that what this means is that we have a large number of people incarcerated who still need treatment. Why? We've learned in the community that the majority of patients who divert are diverting to self-medicate. They can't get access to the care, so they are treating themselves. So we know that from the community, and we're seeing the same thing in the incarcerated population. So what is my recommendation? My personal recommendation is to provide the beef and orphan injections. That will lower the costs for the clinical staff, and it will also mitigate the diversion. I think that many of us are intuitively capable of quickly recognizing that if I have to pass out a medication daily, the sublingual version, versus a monthly injection, the cost of human resources, the cost of the nurse, the cost of the guard, clearly it's better to do the injections monthly than the tablets. Hwang et al. did a time study looking at precisely that. It was a study funded by IndieViewer. I wanted to make sure that we're transparent. But what they did was something that we intuitively figured out and deduced, but it was nice to actually have actual data. If you look at the graphs, it compares the staffing hours for methadone. They call it oral beef and orphan, but it's really sublingual, and the extended release of the beef and orphan injection. One of the things I wanted to highlight is that if you look at the dark blue, you can see that the dispensing of the medication and the guard examining to verify that, indeed, the patient has taken his or her medications, that took the bulk of the time. You see that dark blue on the top there? If you want a number, for 100 incarcerated patients per month, it would cost 486 man hours or person hours compared to 52 if you use the extended release. So again, intuitively we suspect that to be true, but now we have a time study to actually demonstrate that. So again, I feel strongly that the extended release is going to help us save some dollars if we're going to treat our incarcerated population. And the extended release delivery mechanism is going to mitigate diversion, which is a major concern for many of our correction institutions. In summary, we have done much to combat the opioid epidemic, but I think there's so much more that we have to do, particularly the recent fentanyl surge. We demonstrate patients with opioid use disorder at a very high risk of overdose, particularly within the two weeks after release, and I think I've demonstrated that data. The use of extended release buprenorphine products may reduce the cost associated with the daily administration, and I think I've shown you the time study, and we intuitively can figure that out. Plus, it's going to mitigate the diversion factor that all the institutions are concerned about. And then finally, I just want to leave you with something that, again, I think we all know, incarcerated patients get released and become a member of our society. So an investment in these individuals is an investment for our members in society as well. So with that, I will open up for questions and answers, and I hope that you see my stance of this is my opportunity to make a dent in that tremendous surge of fentanyl overdose-related deaths, and I think that if we all did our part to combat this, we will win. So thank you very much for your time. I have a question, and that sticker will fall off again, I'll tell you. The stickers are hard to deal with. They fall off quick. Who pays for the medication when people are incarcerated? So the exact finances, I am not 100% sure. My understanding, and again, this is just my understanding, is that the jail currently supports the funding for the cost of the medication. I know about grants at the federal level, and then, of course, we have your commission. But I don't know what the jail's actual funding looks like every year. I'm sure that it's very similar to other organizations, and that is their typical FTE needs, the overhead costs of running the business, of providing housing for the incarcerated patients. But I'm not sure exactly where their funds would come from for the delivery of health care. One would assume it would come out of the medical costs, you know, that they're allocated. But certainly when the funding, the budget was created, I don't think that accounting for the cost of buprenorphine and MAT was put in. And I'm a very strong advocate in that we treat the entire person, not just the disease. I think it's wrong if we choose to only look at the medication treatment and forget about the rest of the individual, because I think that the patient's socioeconomic situation, homelessness, not having transportation, these are all factors that will continue to push them towards relapse. And I think our next speaker will certainly talk about that. We need to talk to the entire individual. We need to look at their personal needs, whatever it is. And more importantly, and this is one of our clinic's motto, and that is, as a clinician, my job is to stabilize, get you on the path to recovery with the counseling and the other psychotherapeutic modalities, and take it one step further with case management, and that is prepare you for post-recovery, bringing you back into society as productive citizens, doing something, whether employment. You know, we want to get you back. We're not stopping with just handing you a medication and good luck and we'll see you. I don't think that works. So I think our clinic's been successful because we do touch on all of these elements. And I hope that you will recognize the importance of taking care of the entire individual and not just the disease itself, because the disease is rampant. It's like diabetes. We've learned, you know, you can't just treat the sugar, right? You've got to take care of the entire person. Is the challenge of moving to the extended release cost more than practical? No. I think that we make these same determinations in the community practice. So if you saw me in my clinic, we would have the same discussions. Do you want to pay for the medication every day or do you want a shot once a month? It comes out to be about the same. I don't know the exact dollars, depending on your insurance and whatnot. 70-plus percent of the patients in my clinic right now are Medicaid. The disease is like schizophrenia. I don't care where you started, you end up at the bottom. Sadly, that's what happens. So many of our patients are Medicaid, and so Medicaid currently pays for all of the medication, whether it's the sublingual or the injection. I believe that with the threat of fentanyl hitting Kentucky, my personal thought is that if I can start promoting more of the injections because the injection will satisfy the plasma levels to protect you, and I don't want to bore you with all of the neurophysiology, but having that buprenorphine sitting on your immune receptor, the opioid receptors, is a protective mechanism. That's how it works. If I go out with buprenorphine over my receptor and take some fentanyl, the fentanyl will have a hard time dissociating my buprenorphine off of my receptor, and therefore, if you will, I'm protected from that accidental overdose. And so I am leaning towards pushing the private patients to the injections as well. But at the end of the day, it is your right to pick and choose what you think, and my job is to give you the information. Your job is to make that decision. I have a question. Yeah, there's probably so many questions. I'm going to defer because I probably have 20 questions, and I'm going to have to distill it down to maybe two or three. I've got two. So is the jail on board for knowing that, like, because I don't know how many patients you all see right now because you're currently at the jail, right? And how many patients do you all see and give the medication to? So to back up, the jail patients, the patients who are incarcerated at the Fayette County, their duration of stay is usually four to six weeks, sometimes even more rapid. And so understand that patients come, they get discharged, and we are ensuring with our case management that they have a follow-up because upon leaving, we don't know sometimes when they leave, but they have a place to go, whether it's to our clinic, a clinic of their choice geographically, but we ensure that they have a follow-up appointment. That's number one. Number two, the jail currently only has sufficient FTEs to accommodate about 100, 120 patients. So we're seeing the maximum 120 patients on any given month. The jail has about 600, give or take, total patients. Based on literature, there's about 20-something, 30% of those patients need treatment. So there's about 300, 250 patients that need treatment. I think at any given point in time, if you walked into the jail, we are touching about one-half to one-third of the total number of patients that require the treatment. Does that help you answer your question? Yes. Thank you. And thank you for coming and presenting a great presentation today. I wanted to ask, and so how does a client get into your program? What's the format? That's my first question. We are certainly on social media platforms. No, I'm talking about in the jail. In the jail. Yes. So there is a process, and this is something that the jail and YesCare have created. I certainly contributed to their process. We screen the patient, they screen the patients, and if the patients have a history of opioid use disorder, we simply ask, do you want to be treated or do you not want to be treated? If you want to be treated, you get put on the list. And we try to get to as many of the people on that list as we can. But given the restraints due to financial burdens, we can only get to about half or a third of them. And as I mentioned earlier about the diversion, the reason why there is such a high demand for this horrible, you know, medication that has been in somebody else's mouth and spat out, and yet they're still willing to take it, just illustrates to me that we have a lot of work that needs to be done. We have a lot of people that still need to get treatment. Because we cannot, we financially don't have the manpower at the jail or the cost, we can't get to these people. I would love to get to all these people. We have the manpower, the supply, if you will. We have multiple physicians who are ready. They've been processed, credentialed for the jail. At a snap, we can get all of these providers into the jail and easily accommodate their 200, 300 patient load, because we're ready to take that on. It's just that the jail doesn't have the manpower to dispense, and that's going to be an issue. When we transfer, when we transition to the injection, the cost of the injection medication would then be a factor. We're going to reduce the cost of labor way down, but we do have the cost of the medication itself. Regardless, I mean, I think the investment has been demonstrated to be well worth it. I believe there was a general surgeon, the Surgeon General a couple of administrations ago said something along the line, for every $10,000 that you invest in MAT treatment, the value or the benefit is something like $100,000 downstream, only because you're mitigating some of the negative effects of diabetes drug use, hep C in particular, and all the other complications associated with addiction. And we have learned from taking care of diabetes, if I can jump in and intervene and mitigate the hyperglycemia and its consequences on the kidneys, the heart, and the brain, I am going to slow down that process so that you don't get a stroke, you don't have a heart attack, your kidneys don't fail. Those things are a huge chronic disease burden to our society's health care. So the trick here is if we can get early and mitigate that, we would actually save. And so if the return on investment is that promising and that good, why are we not jumping on it? It's kind of like if we all could go back in time and look at Amazon stocks when it first came out, wouldn't we throw a bunch of money into it because the investment would be huge, right? Okay. And then I wanted to ask, is there any forms of counseling that goes along with the medication? And then my last question, because I know there's others. Sometimes the clients leave. So if they have been taking medication and they leave without knowing, I'm just wondering about the fallout behind that, especially if they've been taking the medication and then they're gone, what happens? Or if you know that they're leaving, is there a form of following them in the community? Dr. Ragland, that's a very insightful question. Thank you for asking. I'm going to break it up into two sections. The first section is earlier I mentioned our clinic standard protocol. And I don't care where you go, but it should be something along this line. The first thing I do is I stabilize you and get rid of that dope sickness, the withdrawal symptoms. That I can do with the medication. Number two, I need to now introduce you to psychotherapeutic modalities, counseling, one-on-one, group, et cetera. Before I stabilize you, no matter how good you are at counseling, you can't get through to me. I am too focused on my withdrawals and my dope sickness. Nothing's coming through. So we have to stabilize that, and then we provide the psychotherapeutic modalities. And yes, we do stress the importance of the counseling aspect in our treatment. That's what really changes the reinforcement pathways within your brain. You know, the hindbrain, the midbrain, and the prefrontal cortex. These pathways have been reinforced for years because of the addiction. Now we need to rebuild these reinforcement pathways, and that's through counseling, behavioral therapy. Touching on the third principle, and that is earlier I mentioned the importance of treating the entire, the whole person. So we need to go in and say what are socioeconomic predisposing factors that haunt you in particular and make you vulnerable. I don't have housing. I don't have food. I don't have a job. I'm getting beat up by my husband every day. Whatever it is, we bring our case managers to identify these so that we can start focusing on providing resources to help you. And most importantly, because I kept saying it over and over again, people die when they leave the jail systems. What are you doing to mitigate that? That is the number one focus, and the jail has finally understood this. The day after I see them, the first thing we do is throw case management at them with all right, should you get discharged tomorrow? What's your plan? Where are you going? What are you going to do? And the backup is go to Second Chance. If there's no other option for you, Second Chance will open our doors every day, pardon me, Monday through Saturday. We do close on Sundays, but we will open every day, and we will allow the walk-ins. So you can come in immediately on the day of discharge, and we will get you your medication. We will hook you up with the doctor. We will get you into treatment. And should your plans change because, or whatever the reason is, but at least we have an immediate bridge to help them. And if they choose to stay with us, that's fine too. But we have a mechanism to protect it, just like you were describing. Thank you so much. Yes, ma'am. Dr. Tran, thank you so much for coming today. I think what you're doing is incredibly important. So I've got a couple of real quick questions. Is the Fayette County Detention Center currently offering extended use buprenorphine? We currently are, the Fayette County is currently not offering it. The logistics was somewhat problematic, but we have worked through that for probably three or four months now. And I don't know if I can share this quite yet, but I just met with them on Tuesday and they have figured out the funding, some of the funding aspect of this. So we hope to implement the injections soon, but I'm here because I do feel very passionate about the need to take care of these people well. And I hope that you would look and see if you could support the jails, the Fayette County in particular. And my hope is to take these standard models to other jail systems in the state of Kentucky, because I do believe a huge chunk of that spike, at least for Kentucky, comes from our incarcerated patients. It'd be great to give them an injection on the day of discharge, wouldn't it? That would protect them for at least 30 days. Yes, so, and is the, I understand the ADA protects those who are currently not using illicitly and taking MOUD. Are you able in the jail to initiate treatment to someone who is not already on it? This is a question that is very complicated and many people are not able to understand. And I'll reword it in another way. This guy's been abstinent for months and he's doing fine. So why are you initiating treatment on this guy? Well, let me explain. When I am abstinent, whether voluntarily or involuntarily, and I get over that brief period of dope sickness, the craving for the medication, the craving for the drugs will persist until death. If you go back and look at our history, there was a great physician who treated addiction way back in the 70s in the state of Kentucky who talked about this thing called cues and triggers. And years after addiction, the doctor was able to trigger the patient to immediately go into withdrawals, okay? So we know that there's a significant, and it's in the temporal lobes and the hippocampal regions of the brain that brings back these memories. And what happens that these people have a trigger, whether it's watching somebody play around with the needle or whatever it is that triggers them, their brain immediately sends images and flashes of, wow, that was a great thing. And they will actually start precipitating into withdrawals. And because that dope sickness is making them very uncomfortable, guess what they're gonna do if they're not in jail? They go and find their favorite drug. And guess what? Their tolerance level has declined significantly. And when they touch that, they are at very high risk for overdosing and dying on the spot. Hence, even though these people look like they're stable or they're not ill, it is important to protect them. Because once they get out of that involuntary situation of abstinence, the temptation, you know, I come back, I see my old friends, and my old friends are doing what they're not supposed to do, guess what? I'm gonna get sucked into it, and the next thing you know, I'm dead. And so that's why we want to go ahead and capture those people and protect them as well. No, and I understand that, and I totally agree with that. Have you been able to do that? And so you're not only treating people who came in on MOUD, you're also able to reach those that have a history of substance use disorder and or were in active use at the time they were arrested. Yes, it took some convincing of the powers to be. I'm sure it did. Because it was a difficult concept for some to appreciate. But yes, they are willing to allow. Now, you know, if I see the patient and the patient is not a good candidate or doesn't really need, I have turned some people down. Okay. But for the most part, I do take all of this into consideration. And yes, the jail has been very cooperative, very collaborative. That's awesome, thank you. Yeah, congratulations on a wonderful presentation. I think that's obvious by all the questions that we're getting. I think we've been trying to find out exactly what's happening in the jails and at what level and to what degree. And I think this has probably been the most informative of all of our attempts. So thank you for that. I think along Margaret's questioning was one of mine was induction versus maintenance. Are you guys just treating people that come in that's been on it before or is currently on it versus are you taking people that have never been on this and doing induction and starting? It sounds like you guys are starting to flirt with that a little bit, it sounds like. We're doing both. And so the induction process is something that is widely debated. We no longer have one standard induction protocol. We now have micro-inductions, macro-inductions. We have all sorts of things that have been validated through legitimate studies, randomized studies. At the jail, if someone is naive to buprenorphine, which is pretty rare to find because almost all these guys have taken them off the street. But we do run into the naive buprenorphine patients. We do have a process and the protocol that we utilize is consistent with the KBML's recommendation for induction. And it's the standard induction process that we've done. Unlike the private community where I ask the patient to stick around the clinic for three hours to do the induction, in the jail, it just means much more time intensive, something they don't have. They don't have nurse hours, officer hours. So they don't like it when I ask for an induction, but they know how to do it. And the protocol that I've written, we have passed it to the pharmacy folks, the nursing folks, everybody knows it. And I try to keep it standardized so that it mitigates confusion because it can get complicated to go through all of the assessments work. And people can get sick if you don't do it right. And I've also made myself available to their jail doctors should there be any questions, 24 seven. Of course you have. Yeah, I can tell that. And you, let me ask this. You made a comment a little earlier. I'm going to both disagree with you, but I'm also going to support you and agree with you. And you mentioned that the manner or the route in which the patients or the people that are in jail take their medication was a choice. And in nursing school, we learn the five rules of medication, one of them is the right route, the five rights, right? And one of them is the right route. And I would suggest to you simply that this extended release is the right route based on the conditions they're in, the length of time that you have with them, the effectiveness of it. And so that's how I would push back on that, but also simultaneously support your work. The other pieces, I'm going to skip some of those just in the interest of time, but I would like to invite you back actually to learn more. I like your recommendations, RNs, LPNs, licensed staff to be able to assist with this. How many do you have currently, just out of curiosity? What's availability? I believe they currently have three LPNs who are dispensing medications, is that right? I think there's at least two, maybe three this morning. Yeah. I don't know. Yeah, I believe there are three people. Working on three. And if you took those three people and they weren't passing pills anymore, but they were giving shots, what do you feel like the reach would go from current to future? The same three. So if I was going to entertain that question, you're looking there, it's estimated that it would take care of 100 patients using the sublingual 500 hours per month. Yeah. Versus 50. So you can see that's a tenfold. Yeah. And potentially, if I could persuade everyone to get on the injections, I may be able to. I was gonna say, let's use your numbers. You said a half to one third. Dr. Trang, can you speak into the microphone? Pardon me. So you said earlier, you said you're able to connect or reach one half to about one third of the people. So all of them, it sounds like. Yeah. Yes, I believe you're correct. And I only wanted to make sure that we entertain ethical perspectives as well as what is most reasonable. Yes, from a clinical perspective, I think the best thing for you is the injection, but by the same token, I also respect your right as an individual to choose. And as long as it's not a poor choice, I still let you have that choice. My job as a physician is to give you options, good options, but at the end of the day, I still have to respect whatever choice you wish to make. Absolutely. You need me standing right next to you saying to them, though, in an emergency room, if a patient was experiencing anaphylactic shock or anaphylactic reactions, we could give them PO Benadryl, or we could give them a Benadryl IV or shot. We would never say it's your choice to take this pill, because we know that that's not in their best interest. So I'm just saying, I'm pushing harder for you. Sure, no, I welcome that. IV antibiotics versus oral antibiotics. Someone who's got bacterial endocarditis, we're not going to give them PO antibiotics. Sure, and I would firmly love to be able to say, this is the better product. You guys, let's go with PO. We don't have any other options. This is our option. We have extended release. This is what we do at this jail, because we know it's evidence-based, and we know it's going to give us the best outcomes for our money. So that's why I'm pushing. And that would be the ideal situation. I was just giving a notice. I think one of you earlier asked about the financial allocation, and I've just been informed that jail has not received any funding for this program. And I hope that I've done a decent job of presenting the need, the justification. And so I hope that you would find it in your heart to look at funding the jail for this program. And I think together we can make a dent in this fentanyl spike, if you will. Last question, last question. I'm sorry. One thing you have to consider, based on the amount of time that you have with the individual, I think we said maybe they're there four weeks, six weeks, whatever. Do you have any concern about patients that may go and just get one injection, and then you don't see them again? Or what is your plan to keep them sort of connected? Because in theory, we see here too, you're spending a lot of time with patients every day when they're taking the pill. Well, it sounds like I'm arguing the other way again. I'm not. I just, I do worry. Like, okay, so now you're spending less time with the individual. They get a shot. How do you keep that going? Thank you for that question. Again, that's a very insightful question. Our 11 year experience with pretty large numbers of patients is, number one, once the patient comes in and receives treatment, and he or she looks at his or her life, and I'm gonna quote a patient, you have saved my life. I don't know where I would be. And so they usually change their tune from a hostile type of patient or uncooperative patient to a pretty darn good patient, and they continue to come back. One of the things that we have done is in the beginning, when you are unstable, we dedicate much, much more resources. We have the doctors see you weekly. We have the counselors touch you every week. We have somebody do something to you. As you become more stable, we start backing off the visits and give you a little more time so that you go to work. You can't get a job if you keep going to the doctor's office every day, right? So we're trying to balance this. So we do back off. In the jail, when they leave, as I mentioned earlier, our first priority is they must have a place to go on day one, and that is they can walk into our clinic and we will open and welcome them with open arms day one. The only day we're closed is Sunday, but every other day, they're welcome to come in. Once you have them in your hand, you dictate where they're gonna go, and if you're going to be good at taking care of them, they will trust you, and they will follow instructions, and they will stay with you. They will continue to get treatment, et cetera. Will there be some that drop off? In our experience, once they get into a treatment program, the dropout rate is pretty small. In a rough estimate, what's the dropout rate? The dropout rate? Dropout rate from jail to first visit with you guys. Oh, well, in the nine month, we don't have that exact data, but I think I can get it for you. It's pretty darn good. We get them somewhere. Jenna here is somebody who may know right off the top of it, but I would dare say that we get 90 plus 95% of the discharge to a follow-up, because if all fails, go to Second Chance. We will open you. Unlike other clinics, we have the capacity to just everybody just come. Thank you so much for presenting for us today, and I'm sure there may be other questions, but we do have another presentation that we want to get to, so we thank you, Dr. Twin, for coming and sharing, and thank you for the work that you do at Second Chances. Thank you very much for the opportunity. Thank you. All right, Alex Elswick with Voices of Hope. Well, good morning. Good morning. Commission, thank you for the opportunity to share a little bit about Voices, and thank you for the service that you all are doing. I'm sure you don't need me to remind you, but you all possess a tremendous amount of responsibility and a tremendous amount of power in doing the work that you do, so I'm really glad to have the opportunity to address you. I'll try to keep my comments well under 20 minutes here. Let me see if I can go back for a second. So my name's Alex Elswick. I'm an assistant professor at the University of Kentucky and a co-founder of Voices of Hope, and I'm really excited to have the opportunity to share with you a little bit about not just what Voices does, but why it's so significant in the community. I think I know many of you personally, I know many of you all are very well aware of Voices and what we do, so I'll spend a little more time talking about the significance rather than just the services that we provide, but the story of Voices of Hope starts with my own experience, and I also know that some of you have heard this dozens of times, so I will not bore you with this story entirely, but my personal experience, I'm from Lexington, born and raised. I grew up really privileged, and when I was 18 years old, I got addicted to prescription opioids. I had wisdom teeth removed. I got addicted. Addiction took me all the places that people go. I went in and out of jail, and in fact, 15 years ago today, I was sitting in Boyle County Detention Center on drug trafficking charges. I went in and out of treatment, and in and out of treatment, and in and out of treatment the entire time, trying desperately to stop, and unable to stop, and was able to access treatment all throughout that, but I wasn't able to get the things that I needed in terms of recovery support services after treatment. And so when I finally did find a kind of recovery that worked for me, I realized that the experience that I'd had, where I had help with housing, and where I had help with transportation, and where I had help with education, and where I had help with employment, and where I had help with my mental health care, and my physical, it's a long and endless list of resources that I had access to that virtually no one in my community had access to. And so we decided to do a series of things and so we decided that we wanted to create a one-stop shop for recovery, and we learned that there's a model that already exists called a recovery community organization. These are actually some of the real notes that we wrote on kind of our brainstorming session about 12 years ago. And we went to the northeast to a place called CCAR in Connecticut, a place called Anchor in Rhode Island. We visited two recovery community organizations, and it was so much better than visiting one because what we learned is that this model can look very different in different places, and it really adapts to be responsive to the needs of the local community. And so in 2019 we had our grand opening for our Old Vine Street location, and then today we have our other location on Broadway. And I believe, obviously I'm the most biased person in the room to be saying this, but I believe that Voices of Hope fills some of, if not the most critical gaps in the continuum of care for substance use disorder, and I'll speak to that. You all may have seen this before. This is the core cascade of care. What you see represented in those hexagons at the top are kind of what we think of as our traditional buckets in the continuum of care, prevention, treatment. This is where we spend the most of our time, most of our resources, most of our energy. And so often when we focus our time and effort and energy on only prevention and treatment, what we neglect is harm reduction and the building of recovery capital. And part of what is not well represented by this graphic is when you look here, according to this graphic, it would make it seem like the gaps in the continuum of care are very small, are these very little gaps. And the reality is the gaps in this continuum of care are massive gaps. And so rather than just bore you with a bunch of bunch of data, I'm just gonna give you one statistic that I think is the single most important statistic that all of us in this space overlook. And that has to do with the treatment gap. Actually, Dr. Tran referenced this in a number of ways, but year after year after year, the National Survey on Drug Use and Health, which is our large epidemiological survey of drug use, shows a 90% treatment gap. That is 90% of people with substance use disorders who need treatment don't get it. And most often we frame that as a problem of treatment accessibility. And we say, well obviously if all these folks need treatment and they're not getting it, we need to erect more treatment centers and we need more treatment beds because treatment accessibility is the problem. But if you do a deeper dive on those data and you ask in very simple terms, ask the 90% who didn't receive treatment this year, how come you didn't get treatment this year? Is it because you tried to access treatment and you couldn't get it? Well those folks are only represented by the green sliver on this pie chart. The 95% are represented by folks who themselves did not feel they needed treatment and therefore were not treatment seeking. That's an uncomfortable statistic because we don't know what to do with those folks. Heretofore, up until this point, the way that we in this community and really across the United States have addressed those folks is we've said, come back when you're ready to get sober. We say cheeky things like you haven't had enough, you're not sick and tired or being sick and tired and you haven't had enough suffering yet. And we say it to some folks who experience some of the most suffering in our communities, some of the most vulnerable, minoritized identities as if what they need is more suffering. And we don't serve them. So in simple terms, what I'm saying is if all of our money is invested in treatment, then 95% of people with substance use disorders won't be getting service. So that means the most vulnerable people, the people who are most likely to show up at our ER with endocarditis and difficult and expensive to treat conditions aren't getting any help at all. So when we talk about the value of a place like Voices of Hope, it's about providing a really broad, broad pathway of recovery. Sometimes I like to tell people that Voices of Hope is where harm reduction marries recovery. So often people talk about harm reduction like it's the antithesis of recovery and nothing could be further from the truth. So really quickly, let me kind of just share a little bit of our services and then I'll leave you with a story and get out of your hair. Our mission is to promote lifelong recovery from the chronic disease of addiction through recovery support services, advocacy, research and education. I like to tell people that we're really not concerned with abstinence. If someone comes to us and abstinence is their goal, that's fantastic and of course, we're gonna support their goal to be abstinent. Those are the 5% who are frankly the easiest to work with when their goals are aligned with your goals, right? But we like to tell people that we're not about abstinence because abstinence is about what you don't do. What we're about is recovery and recovery is about what you do instead, what you've recovered. So instead of evaluating our programs based on how many people are abstinent or how many people have reduced drug use, we evaluate our programs according to SAMHSA's definition of recovery, which is holistic improvements in health and wellness, improvements in the ability to live an autonomous, self-directed life and to reach your full potential. And we do that through building recovery capital. And if you've ever heard me speak before, I go on and on, ad nauseum, you all probably rolled your eyes, me talking about recovery capital because I believe it's the stuff of recovery. That was my experience and that's the experience of the folks who come to us at Voices of Hope. So we have a brick and mortar center, which before I even talk about any of our interventions, the brick and mortar center is itself an intervention. Because up until this point, 12-step programs, for instance, anonymous programs, had to be in church basements. And part of the reason for that is because substance use was so stigmatized that we couldn't stand up and shout it out loud. Voices of Hope, as a recovery community center, is a place where we stand up and very proudly, out loud say, I'm a person in recovery. We have a sign out front that says Recovery Community Center. Within our brick and mortar center, we offer lots and lots of services, which I'll mention a few of here. But the most important thing that we do is create community for people who use drugs and for people with substance use disorders. And I'm always very careful to use that language together in a very inclusive way because, as I mentioned, the rest of the treatment apparatus is only interested in serving people who are interested in abstinence today. And that's not our shtick. The primary intervention is recovery coaching. All of our staff, about 85 staff, are people in recovery. That's their peers. They're not master's level clinicians. They're not social workers. Their credential is that they have lived experience, that they've been there. And they build recovery capital. They help people with housing and employment and all those things that I had access to that most of our community members don't have easy and readily available access to. Many of our coaches are embedded in partner organizations throughout central Kentucky, in detention centers, in prisons, in health departments, et cetera. One of the things that makes us so different and one of the critical gaps that we fill in the recovery space in Kentucky is by supporting all pathways of recovery. Abstinence is one wonderful, very safe pathway of recovery, but it's a minority pathway of recovery. Most people who recover from substance use disorder will not follow a path of pure abstinence. And so in addition to abstinence-based mutual aid meetings, we also host dozens and dozens of meetings that support other pathways of recovery. So just as one immediate example, people who use medication, many of the medications that Dr. Tran would prescribe, which you've heard are the gold standard for treating their disorder, are stigmatized in abstinence-based communities. So we have meetings that are dedicated spaces for people who are on medication. We do a great deal of community outreach, and one of the ways that we do that is through our mobile unit, which dispatches to, you know, the tagline for harm reduction, figuratively, is to meet people where they're at. And of course, our mobile unit does that, but it also does it literally, by dispatching to where people who use drugs are at and to meet needs. One of my favorite examples of that is the very first day that our mobile unit was on the ground, we set up at the Plasma Donation Center. You all may know that, you know, people use drugs sometimes to sell plasma as a way to make money. And the very first day we set up the mobile unit out in front of the Plasma Donation Center, we reversed an overdose that happened in the parking lot within about 45 minutes of being there. So we're like, all right, this is obviously exactly where we need to be. We also enhance the outcomes of so many of our community partners. And we didn't plan this, I didn't know Dr. Tran was gonna be here today, but we partner with lots of providers of medication for opioid use disorder because we recognize the data, we recognize the efficacy of those medications, we recognize the stigma and the limited accessibility. Dr. Tran could probably tell you better. I think about a third of people who might benefit from those medications actually have access right now. So, and one of the ways that we do that is not just with respect to buprenorphine, but also specifically with respect to methadone, which you all probably know is much more tightly controlled in OTPs. And so we started a transportation program. Our transportation specialists are peers in recovery, and they drive people on a daily basis to their appointments. We recently published a paper, and the title of the paper was To the Moon and Back, because our drivers have driven so many miles they could have literally driven to the moon and back. And we've supported so many people in rural communities. So, so many, so many things that we do. I wanna be so careful with time, so let me just leave you with a four-minute story, and then I'll be done. And I recognize you can't read what's on the screen. This is just a placeholder for me to remember, but this is a note that a participant wrote us that I think for my money is the best exemplar of what Voices of Hope does and how it fills really critical gaps that no one else in our community can fill. Our sign out in front of our center says Recovery Community Center. And as I've told you a little bit today, to many people in our community, the word recovery means abstinence. When they hear recovery, that's all they hear in their head is abstinence. And so there's a woman in our community experiencing homelessness. She's an IV drug user. She's pushing her shopping cart out in front of our center, and every time she passes the sign that says Recovery Community Center, she hears abstinence center, and she goes, nope, that's not for me. She's one of the 90% who stands in that treatment gap who's not interested in pursuing treatment, okay? And so day after day, she walks by the center, and she goes, that's not for me, that's not for me. I'm not interested in abstinence. And then one day, just by word of mouth, she heard that she could get her laundry done at Voices of Hope. We offer a washer and a dryer for free in exchange. All that we ask is that you meet with a recovery coach. You don't have to commit to any kind of behavior change. You don't have to go to treatment. You don't have to, you just make a connection with a coach for five minutes. So she thought, that's pretty low barrier. That's not asking much. So she started coming and doing her laundry at the center, and now she's doing her laundry at a center and spending two hours hanging out at maybe the one place or one of two or three locations in the entire community that is a dedicated space for her to belong, not a place where people are saying, are you ready to get sober yet? Are you ready to get abstinent yet? Are you ready to completely modify your life? It's a place that says you're good right as you are. And on the third week, completely true story, on the third week of doing this, she put her laundry in the washer. She goes out back to the smoking pad to smoke a cigarette, and she turns to our recovery coach, and out of the blue, she said, hey, if I wanted to get into treatment, could you get me into treatment? And recovery coach is like, girl, I'll have you in treatment in an hour. And that's exactly what they did. And today, not only is that individual in recovery, but she's in abstinence-based recovery. And even though that is clearly not the stated goal of harm reduction, that's my favorite story to exemplify why Voices of Hope does what it does. If our preoccupation when she walked through our door had been, are you ready to get abstinent yet? She would have tucked tail and run the other direction. But because we have a different ethos, because we have an approach that starts with connection, and that met her right exactly where she was, she was able to build community, she was able to start to build some recovery capital and some relationships, and through that experience, it motivated her for a kind of recovery that worked for her. So, there's so much more that I would love to share about Voices, we do a lot a lot, but at the risk of it getting all lost in the morass, I would just say, for my money, it's really difficult to explain why this is so critical. The vast, vast majority of the resources are supporting about 10% of people with substance use disorders. And the most vulnerable, 90%, are getting little to none of the resources. So, this is just a plea for us to pay attention to harm reduction and recovery support services. Yeah. I'm happy to answer questions if you have them. Thank you all. I don't so much have a question. Again, Alex, every time I see you, you know that I spend a huge chunk of my life trying to get people to understand what you've just told us today, and to be comfortable with allowing the process to work by being kind to people, and knowing that we can't arrest it away, we can't force it, but if you look them in the eye and are kind to them and provide them something like washing clothes, or sit down and charge your phone, or have a cup of coffee, that you're gonna build those relationships. And so, I commend you all for everything that you're doing there. We are trying to do that same thing at the health department. And it turns out that we get a lot more people into treatment doing it that way, by warming up to it as opposed to trying to force it when they're in active addiction. So thank you all for what you're doing, and all the harm reduction, and just the belief in it, knowing that the process works, and you have to be comfortable with that. A lot of times people are wanting to know about the money, and how many people have done this, and how many people have done that, and it's really not about that. It's just about building relationships so that people feel human. Yes, I appreciate that. And to that end, there was a paper published a couple months ago, and I forget the title, but the basic findings of the paper were that people who use methamphetamine can slowly over time reduce their use into abstinence. And it's a great paper, great methodology and all that, but when I read it, there's a part of me that wants to go like, no kidding, of course. That's how all behavior change happens. You wanna lose weight, you do it incrementally. Why would drug use be the only condition for which people need to completely and immediately turn their lives upside down? Sure, and if you don't even recognize that you need treatment, or that it's available, then you're not even looking for that, so. Right, and also, just to add on, so many of those 90% who are not treatment seeking this year, it was only this year that they're not treatment seeking, so it may very well be the case that they've gone through 16 episodes of inpatient treatment before. It's not that they're not treatment seeking because they don't want help or they don't wanna get better. They've done that, they've been there, done that. They're like, that doesn't work for me, and so that's a pretty reasonable response, I think, for. And we can't expect people to hit rock bottom, as you've said before, and why would we want that? Why would we want to not give support to someone until they are at the very worst that they could possibly be? Right, yeah, thanks. I've been told I can't say anything, so we've been muzzled. We love you guys, and your mother, and the work you guys are doing is tremendous. It's in between the gaps of everything else, and it's just, I can't say enough about you guys, so. Well, I'll let you know I love you. I remember from the very beginning, yes, and what a great testimony, great work that you're doing, and very proud of you, and tell your mom I said hello. I will. And I have no questions, because we already know what Voices of Hope does, and we're very grateful for the work that you're doing in this community. So thank you for coming and presenting with us today. Yeah, and thank you all for the opportunity. Appreciate you all. Thank you. All right. The last item on our agenda is the work group recommendations, and so let me first and foremost say that we're here. We finally got to this point, and I know that everybody has been waiting and wondering when is the board or the commission going to do something, and so let me take this opportunity to say thank you to Carmen and her staff for the work that they've done behind the scenes, and thank you to John Moses and to Sierra Bowman, Sierra Bowman, amen, for chairing our prevention and treatment, and also our housing and support, family support. And so we have three recommendations that you have in your packets, and I'm just gonna give a brief overview of those, because we all know what they are, and after which the hope is to receive a motion to approve to move forward with these recommendations to the mayor. And so again, we have three recommendations for the opioid abatement funds, and the first recommendation before you is the annual opioid abatement summit, and the purpose of the summit is to be able to establish a two-day annual summit here in Lexington, the Fayette County area, to do a number of things, to educate and to support and to connect individuals who are affected by opioid use disorders. And so the summit itself will provide education, provide resource connections, and training to be able to reduce the stigma and strengthen support systems and promote collaboration. That's the purpose of this two-day summit. Some key components of the summit would be, we would have targeted tracks that would include clinicians and families and individuals with lived experiences, students and community stakeholders, and with an opportunity to have some CEUs that may be available for this particular summit. There'll be workshops and networking that will take place that will involve evidence-based treatment, harm reduction, recovery pathways, and then career education. Along with that, we're talking about, you know, we're always talking about building communities, so community collaborations, being able to partner with individuals to ensure affordable and inclusive attendance, and then the main goal, of course, is sustainability, which is funding through the opioid abatement funds, sponsorships, and registration fees. And so that is our first recommendation that we would like to make to the mayor's office, all right? And if you all have questions or want to add to anything that I've said, you can do so at this time. If not, I'm just gonna move forward. All right, our second recommendation is the Fayette County Opioid Abatement Grant Opportunities, and the purpose is to support grassroots initiatives and larger organizations addressing prevention, harm reduction, treatment, and recovery, and to strengthen recovery networks and support families who are affected by addiction. And as it relates to the funding, we talked about many grants up to $50,000 per project with a renewable funding cycle based on impact and sustainability. The larger grant opportunities would be available based on the LFUCG structure and community program needs. The categories for the grants, of course, would be the mini and the grassroots grants, and those would be community-led programs such as peer support groups, emergency financial assistance, transportation support, and childcare services. And then if we looked at the larger grants, what we would find is we would expand treatment facilities, crisis intervention services, workforce development, and second-chance employment programs. And the eligibility for these particular grants would be local nonprofits, coalitions, educational institutions, faith-based organizations, government entities, and individuals with a physical agent. All right? Can I move forward? Okay. All right. Some focus areas as it relates to this particular, the mini grants would be prevention, of course. We're talking about youth programs, education campaigns, and harm reduction strategies. And then we would look at treatment to expand access to services, including mobile and community-based programs. As it relates to recovery support, we're looking at recovery housing, employment training, and family reunification programs. And then lastly, equity, as we address the gaps in the underrepresented and the high need in the communities. And that is the premise for the grant opportunities. And then our third recommendation is to establish an interest-bearing account for long-term sustainability. And the purpose of this initiative or this recommendation would be to establish an account where 10% of annual opioid settlement funds are saved to generate additional revenue for long-term recovery and family support initiatives. And so those are our recommendations. And so I'm going to, well, I'm gonna open up the floor to see if there's anything that we needed to add or we're good with these. If you remember, while we had two work groups, we, you know, I think our initiatives, our recommendations kind of blended. And so we've put these together. They will go individually to the mayor, but in essence, we tied them all together to make three recommendations. All right? Are there any thoughts or comments or anything based on these before I move into the next steps? I've just got one question. So what you have there in front of you, are those the actual recommendations or are we submitting to the mayor more detail about? These are my talking points. Okay, great. I just wanted to make sure that there was more explanation, particularly for the interest. You have the recommendations in your packet. Each work group, you have your list of the recommendations as they are in the template that was developed by Carmen and others. And so this is just a condensed so we wouldn't spend time going through each one of the recommendations. So each work group has their list of the recommendations in your packet and all of that will be presented to the mayor. And everybody was on a work group. Everybody was on a work group. That works out really well, I think. I would like to make one recommendation that we get a group picture on the day that we make the recommendations to the mayor, just as a group, if you all don't mind. All right. Anything? Are you, that would be today if you guys plan on moving forward with these recommendations. Right. Awesome. Would it be today or would it be when you actually, because I think Dr. Raglander, you're gonna talk a little bit about pulling those together, those recommendations to a final proposal to the mayor. Is that what you're talking about? When I talked to the mayor, I actually met with the mayor and she was okay with just having them in this kind of format. When I thought about pulling them all together, it was leaving out wording from each work group. So it was like, it was almost redundant, but at the same time, I think it's important that she sees them individually. Yeah, sure. And then, but you guys can decide, you're the commission. Yeah, I would think that they're ready to go. Okay. Totally fine. I just know that at one point we talked in the committees that we might need to do that, but that's great. And I think too, one of the things Dr. Woods, you might be talking about is we talked about, like at the end of Mr. Moses's work group about some other things that we may want to recommend. So I think that's okay to continue meeting as a work to individual work groups to come up with additional recommendations to give to her. Oh, the work is not, the work is not over. The work has just begun. And so there are some next steps that we're gonna talk about. But before we do that, I would like to, entertain a motion to make these recommendations to the mayor. John Moses. Happy to make the recommendation to the mayor on our information from our work groups and as a whole commission. All right. A second motion. All right, it's been moved and seconded. Are you ready for the question? Yes. All those in favor, vote by the sign of I. I. Anybody oppose? All right. Now this is if I were in church. And who seconded that? Was that Dr. Woods? Dr. Woods seconded the motion. If I was in church, I would say, now let the church say amen. Amen. All right, we're finally there. All right. And so thank you all again for your work. I know it was tedious trying to get everybody's schedules together so that everybody could meet. And, but I'm glad that we have finally made it to this point. And so again, I just want to say thank you. The next steps, of course, as we continue to look for recommendations to send to the mayor and with the hope that we'll get approval of some, if these are approved, we're looking forward to the next step of developing committees, planning committees for the summit, for the grants and for the sustainable efforts. You know, we'll be looking at drafting budgets and securing fellowships, things of that nature for each of the initiatives and to align proposals with the opioid abatement funding guidelines to maximize the impact. Along with that, we'll implement some type of application process and then, you know, monitoring and evaluating the funded programs for effectiveness and for sustainability. And again, we need to, as we come to the close of submitting these recommendations, you know, we have to remember that they mark the beginning of strategic efforts to allocate the opioid litigation funds effectively and also so they would be sustainable over time. All right? And so thank you all for your work again and I'm excited and we don't have to sweat anymore. I think we're on our way to doing some good work, so I appreciate it. It'll be a different sweat, yes. All right, do we have any open comments on our agenda today? If not, we thank you for your attendance and I believe we do know when our next meeting is. It's not on my agenda, but our next meeting is scheduled for the second Friday in March and so until then, stay warm. I'll entertain a motion to close this meeting. So moved. Is there a second? I'll second. It's been moved and seconded. Are you ready for the question? All those in favor? Aye. Motion to adjourn is accepted. ♪♪