CITY-COUNTY HEROIN, OPIOID, AND COCAINE TASK FORCE

200 E. Wells Street City of Milwaukee Milwaukee, Wisconsin 53202 Meeting Minutes CITY-COUNTY HEROIN, OPIOID, AND COCAINE TASK FORCE ALD. MICHAEL MURPHY, CHAIR Michael Lappen, Vice-Chair James Mathy, Ald. Khalif Rainey, Daniel Bukiewicz, Ken Ginlack, Cassandra Libal, Courtney Geiger, Michael Wright, James Hutchinson, and Selahattin Kurter Staff Assistant, Chris Lee, 286-2232, Fax: 286-3456, clee@milwaukee.gov Legislative Liaison, Tea Norfolk, 286-8012 Monday, October 31, 2022 11:00 AM Virtual Meeting This is a virtual meeting. Those wishing to view the proceedings are able to do so via the City Channel - Channel 25 on Spectrum Cable - or on the Internet at http://city.milwaukee.gov/citychannel. Those wishing to speak on a particular item should contact the staff assistant listed above to receive the log-in information. Please make this request no later than 24 hours prior to the start of the meeting. 1. Call to order. The meeting was called to order at 11:04 a.m. 2. Roll call. Present (9) - Murphy, Lappen, Hutchinson, Rainey, Kurter, Wright, Ginlack, Geiger, Bukiewicz Excused (2) - Mathy, Libal Also present: David Polachowski, Milwaukee Fire Dept. Captain Amy Molinski Kari Rummel-Peters Sarah Schreiber, Milwaukee Medical Examiner’s Office Dr. Constance Kostelac, Medical College of Wisconsin Amy Parry, Medical College of Wisconsin Nicole Fumo, Medical College of Wisconsin 3. Committee membership introductions. Member Geiger introduced herself as a new task force designee member and a Public Health Strategist - Substance Misuse and Overdose Prevention from the Milwaukee Health Department. Chair Murphy said that the vacancy left by Ryan Shogren as a law enforcement City of Milwaukee Page 1 CITY-COUNTY HEROIN, OPIOID, AND Meeting Minutes October 31, 2022 COCAINE TASK FORCE professional task force member would be addressed. 4. Review and approval of the previous meeting minutes from June 7, 2022. The meeting minutes from June 7, 2022 were approved without objection. 5. Discussion, review, or update on City-County efforts, programs, initiatives, grants or activities. a. BHS programs Member Lappen gave an update on Behavioral Health Services programs and initiatives. New vending machines were purchased and would supply harm reduction products. BHS would work with community stakeholders further to determine the location and maintenance of the vending machines. BHS was working with DHHS to submit proposals for the County's opioid settlement awards. The proposals would focus on harm reduction and to maintain medication-assistance treatment (MAT) to those incarcerated at the House of Corrections and jails for continued support to them. County tax levy dollars was being used in the interim for the MAT initiative due to the grant having ended. Opioid settlement dollars would help continue and expand MAT treatment, which was limited currently. BHS would also submit a proposal to provide incentives for providers where they can apply for infrastructure grants to help them deliver services to the community, especially to underserved communities. BHS would continue to work with providers to reduce and prevent barriers to services. BHS would be applying for a $4 million TANF grant. BHS would apply on behalf of the County to participate in the NACo Opioid Solutions Leadership Network and to increase understanding of opioid abatement in the region. BHS would work closely with the City to void duplication. Chair Murphy concurred that BHS and Milwaukee Health Department (MHD) were working closely with each other. b. Milwaukee Overdose Response Initiative (MORI) Captain Polachowski, Ms. Molinski, and Ms. Rummel-Peters gave an update presentation relative to MORI year-to-date outcome measures. For 2022 total contacts attempted were 3,262, successful patient contacts were 523, non-patients contacts were 538, patients enrolled into treatment were 54, post-MORI patients with repeat overdose were 65, and patients with two or more completed visits were 38. Narcan Hope Kit distribution thus far totaled 1,410 and included 650 by the field (9-1-1), 112 by field (walk-ups), 648 by MORI/CP, and 950 by 9-1-1 Narcan/Naloxone administered. Three examples of MORI contacts included a 36-year old male currently in treatment after MORI contact and who initially used opiates at 8 years old; a 33-year old male currently in treatment after MORI contact and who struggled with opiates for the last 7 years; and a 40-year old female coming up on 1 year sobriety and who started with pain medication (more than 20 years ago), progressed to using heroin, and having gone through medical issues (such as a coma). Chair Murphy questioned further on tracking for recidivism, a heat map on MORI data, and status of the MORI grant. Captain Polachowski replied that they do follow-up, try to check up on contacts, track those that sign release of information. City of Milwaukee Page 2 CITY-COUNTY HEROIN, OPIOID, AND Meeting Minutes October 31, 2022 COCAINE TASK FORCE Ms. Molinski said that they were not able to do real numbers, would work with and check with their peer partners who directly works with individuals, there were barriers to contact patients long-term, and they would provide a heat map in the future. Member Geiger added that MORI had two grants. One was from NAACHO ($400,000) ending July 2023, and the second from DOJ-COSSAP ($1.2 million) ending September 2024. Chair Murphy said that it was important to hear the stories of MORI contacts to realize the reality of the issue and not to only see statistics. c. Overdose Public Health & Safety Team (OD-PHAST) Dr. Kostelac, Ms. Parry, and Ms. Schrieber gave a presentation. The OD-PHAST project was for 3 years being funded through the Bureau of Justice Assistance at the federal level and part of the Comprehensive Opioid Stimulant and Substance Abuse Program. Funding was coming to the County Medical Examiner's Office. The focus was on preventing overdoses and fatal overdoses in particular. There critically over 540 and 640 fatal overdoses in 2020 and 2021, respectively. OD-PHAST would expand the social worker positions at the ME Office and the role to include interviews with next of kin, add a toxicology staff member at the ME Office to increase capacity to deliver timely toxicology findings, and connect with the Milwaukee Community Justice Council's Executive Team to expand capacity for recommendation implementation. With the expanded services, contact would be attempted with the next of kin for all suspected overdose deaths to offer resources. Next of kin interviews have recently been initiated. OD-PHAST had the guiding principles of North Star to reduce overdoses, recognize substance use as a chronic treatable disease, use multi-sector data responsibly to inform those response strategies, and share accountability across the group. OD-PHAST was comprised of the Overdose Fatality Review Team (OFR) and Data Strategy Team (DST). OFR provided a multi-disciplinary, in-depth review of individuals' fatalities to identify gaps and barriers. DST provided multi-disciplinary analysis of real-time aggregate data to identify trends. There was the shared goal to develop and implement recommendations to prevent future overdoses. 2022 year-to-date (for the last 5 years) 78% of drug deaths involved fentanyl alone or in combination and 56% involved cocaine alone or in combination. Heroin-related drug deaths have trended down while other drug-related deaths have trended up. When comparing 2021 to 2022 (January - September), there was a 11% increase in drug deaths with 515 (401 confirmed and 114 pending toxicology) for 2022 and 462 confirmed for 2021. Chair Murphy questioned what could be communicated from OD-PHAST to the County to improve the County's services, the impact of cocaine on different races/ethnicities, and said that the data from OD-PHAST helps to inform and cater education to different demographics. Dr. Kostelac and Ms. Schreiber replied that there have been improvements, they would come with details on those results and their interviews in the future, improvements were tied to aspects like treatment availability and community opportunities, rates of City of Milwaukee Page 3 CITY-COUNTY HEROIN, OPIOID, AND Meeting Minutes October 31, 2022 COCAINE TASK FORCE drug deaths due to cocaine have increased the most for older African Americans and for younger Whites and Hispanics. Ms. Fumo continued presenting. The Education and Awareness Action Team had hired a consultant team to carry out community listening sessions. The first session occurred at the Black Historical Society where turnout gradually increased over consecutive days. Present at the sessions were peer support, treatment and recovery professionals. Attendees ranged from 14 to 70 years of age. Facilitators of the sessions were those with lived experiences. Primary themes resulting from the sessions were grouped based on what the community knew and what the community needed. Communities knew of the impact, barriers to healing and thriving, fentanyl laced in other substances, and awareness of overdose as a critical issue. Communities needed prevention and education messaging to come from trusted community members (local churches), increase in prevention and treatment resources, and community engagement and listening sessions to continue. Narcan availability and trusted community members were key priorities. Input from community sessions would help to tailor messaging and education. Community sessions would continue to gain further information, provide outreach, and address myths. Recruitment for the community sessions have been through flyers in the communities through posting at local organizations and libraries. Food and gift cards were give as incentives. There was no target list. Two sessions were done at MLK King Jr. Library. No sessions have been done in the south side, but there is the plan to diversify and hold sessions in the south side. Chair Murphy said that the team should work with MHD and MFD to acquire contacts and help recruit or send mailings for the community sessions, that elected officials from their communities (such as member Rainey) should help serve as trusted community members, and community sessions should occur in the south side where drug abuse and misuse were prevalent. Member Geiger and Ms. Fumo said that MCW, MHD, and MFD (MORI) have all been partners and working with one another. Members commented. Members Rainey (as an elected official) and Ginlack (having lived experience and community activism) would be open to being trusted community members or a resource. Barbershops were also places of community trust and should be engaged. Member Kurter asked about xylozine-related drug deaths. Ms. Schreiber said that there were drug related deaths involving xylozine but the number of cases were 50 or less. Ms. Parry continued with the presentation. Suspected nonfatal overdose mapping would be done in Milwaukee County to understand trends from July 2021 to July 2022. Density maps and details on incidents would be examined for the demographic groups (black, Hispanic, white) with the highest counts of overdose events. The Data Strategy Team would discuss how to best use the information to inform prevention. Next steps would include to refine maps to identify areas with the highest concentration of suspected nonfatal overdoses for each demographic group; assess additional demographic trends and circumstances among the incidents in the areas; identify available harm reduction, treatment, and other preventions resources within the areas; and collectively identify gaps in services in these areas. Map findings would be provided. City of Milwaukee Page 4 CITY-COUNTY HEROIN, OPIOID, AND Meeting Minutes October 31, 2022 COCAINE TASK FORCE d. Milwaukee Health Department Member Geiger gave a presentation. MHD harm reduction supplies distribution for the recent quarter (August through October 2022) totaled 727 narcan and 4,100 fentanyl test strips (FTS). MHD received 200 HOPE bags in September and has distributed most of them. A graphic warning and instruction sheet is given out along with FTS. MHD was involved with International Overdose Awareness Day on August 31, 2022 at three different locations with several partners: Samads House, Recovery Centers of America, 4th Dimension, and MCSAP. There was harm reduction distribution and a community memorial tree. MHD has worked on a number of efforts with several partners. Vital Strategies and MHD were working with community agencies in Wisconsin to connect folks with OUD to a paid survey with John's Hopkins with the goals to understand what people need to say alive, connect to services, expand MAT, and more. North Side Collective and MHD were focusing on the north side of Milwaukee to distribute resources. Foundation for Opioid Response Efforts (FORE) and MHD were working with MCW to conduct geospatial analysis on SUD data and resources. DHS and MHD were doing harm reduction distribution (NDP). MHD and BHS were working closely on related projects to have collaborative response to the overdose epidemic including harm reduction vending machines and other related efforts. For the City's opioid litigation funds there were two proposals approved by Chair Murphy and the MHD Commissioner of Health and would need Common Council approval. Both proposals would target underserved zip codes (including 53204, 53205, 53206, 53208, 53215, 53233) with lakc of resources and high health disparities. One proposal would entail a consultant as a strategic partner with MHD, subrecipient to conduct 10 community events, and an annual overdose prevention summit. The second proposal would entail bridge housing grant to expand bed availability in underserved Milwaukee communities. MHD had two relevant grants. The BJA COSSAP 2022 grant entailed a partnership with the ME Office, CDC Foundation, HIDTA, and SSP's; $1.6 million over 36 months, substance analysis in the community, and needed further Common Council approval. The State - DeTerra Bags grant involved various community partners and MHD clinics. Concerning next steps MHD has RFP submission and projects, would form an application review committee, would design and implement an annual Substance Use and Overdose Prevention summit in Milwaukee, would work with the recovery community, and would have targeted neighborhood approach. Ms. Schreiber commented. MCW started a pilot substance analysis project with swabbing fatal overdose scenes and getting results within 24-48 hours from MIST. ME Office was able to increase its capacity and turn around time through the purchase of its own testing instrument and additional personnel. Chair Murphy requested for updated data on the swab substance analysis pilot project. Captain Polachowski added that MFD (MORI) would be at the North Side Collective to distribute harm reduction supplies today and every other Monday to the community. e. Opioid settlement funds City of Milwaukee Page 5 CITY-COUNTY HEROIN, OPIOID, AND Meeting Minutes October 31, 2022 COCAINE TASK FORCE Milwaukee Deputy City Attorney Todd Farris was not present as requested. Chair Murphy commented. The City would receive about $1 million. Allocation of the funds would be determined by the Mayor, Common Council, MHD, and MFD. Grants would be leveraged. There would be collaboration with the County to avoid duplication. Member Geiger added that she would provide further updates, the first dollars would arrive in mid-December, there would be annual review of using the funds, and funds would be available for the next 18 years. f. Other There was no other discussion. 6. Public comments. There were no public comments. Chair Murphy said that Sen. Lena Taylor (not present) had wanted to speak on ZIMHI, which was discussed at the last meeting, and that he would direct her to MHD further. 7. Next steps. a. Set next meeting date and time b. Agenda items for the next meeting To be determined. 8. Adjournment. The meeting adjourned at 12:19 p.m. Chris Lee, Staff Assistant Council Records Section City Clerk's Office This meeting can be viewed in its entirety through the City's Legislative Research Center at http://milwaukee.legistar.com/calendar. City of Milwaukee Page 6