Next up, we're going to talk about some data to help inform your thinking and your decisions in the second half of the day. But before we dig in, I want to touch on something. I got a question in the hallway, and I think it's a really important thing to put on the table. So somebody asked, why are you talking about cost benefits when we're dealing with people's lives? And first of all, it hurts me to hear, because it's such a good point. At the end of the day, we only have so much money to spend. And whatever you spend that money on, you want to make the biggest impact you possibly can to save as many lives as possible. And so I just really wanted to hammer it home that cost benefit does take that into account. And we are here for the people, not the dollars, but we have to figure out how to spend the dollars. And when y'all are in your small groups figuring out what spending strategies you would like to prioritize, the slides that we put together on the evidence-based examples, those are in practice things that are saving lives. Those are where you can go to really see what is working in keeping the most folks alive. So if we didn't make that clear when we started that, those slides are going to be, if that's what's really calling to you and how you want to kind of go about this work, look at those evidence-based strategy slides, because those are the things that are keeping people alive. No, that's true. Okay, data, let's go. Oh, team, this is going to be a bummer because of how small everything is. So we'll do our best to articulate this for you all. Yeah, I mean, the takeaway for this graph is pretty clear. This is looking at annual overdose deaths for any opioid. And as you can see, from 2020-10 to about 2019, this was relatively flat. And from 2019 to about 2022, we saw super scary, very stark increases in fatal opioid-related overdose deaths, predominantly driven by fentanyl. Now we are seeing a lot of fentanyl analogs and kind of one-offs of what fentanyl looks like. One point JK made earlier was that the drugs have less fentanyl in them. We're seeing other versions of fentanyl that they call analogs also. I think the only other thing I would want to point to for this particular slide, in the far right corner, you see that little lonely dot next to finalized? That is showing like they haven't officially analyzed all of the data for that year yet, but it's looking promising. It's looking like we're starting to get a little bit of a decrease in fatal opioid-related overdoses. I think there was a point I wanted to make. That is due to probably a wide range of things, which is maybe a JK soapbox. Would you like to share? I mean, no one has come out and said, we know why overdoses are decreasing. The major difference over such a short period of time is less potent substances. There's also some theories that literally people who have overdosed did overdose, and so there's less of a pool of people using substances to overdose, which is a morbid way of looking at it, but probably contributing to it. Also, there are people who think medication-based and overdose prevention efforts are also working. It's a combination. It's a complex system. It is a combination of those. I tend to think that the short-term change was less potent fentanyl, less people overdosing. We've got quite a few data slides, so I'm going to keep it rocking here. Oh boy. This is looking at fatal overdose by county. We wanted to give you all some comparison counties, not just Yamhill or McMinnville specific. Just like a very stark over-summary of these counties, Lynn is slightly smaller and with a slightly lower annual income per household. Deschutes is slightly larger with a higher gross annual income per household than Yamhill. We have the spectrum, but we chose Lynn and Deschutes because we were told that they were good comparator counties, so thank you for that. This graph is looking at fatal overdoses by county for all overdose. The last one that we looked at was opioid-specific. This includes all substances. The other things in Oregon and, honestly, nationally that we're seeing fatal overdoses around are particularly methamphetamine use. So in, hmm, what do we want to say? You can see increases here starting in about 2019 that match the graph that we looked at before, and Deschutes is the lowest in terms of fatal overdoses, Lynn the highest, Yamhill sits somewhere in the middle. And this is a rate. So this is about 26 people per 100,000 people are fatally overdosing on a substance each year. I think maybe the last point that I'll say here is that this goes through 2023. The last graph stopped a little bit before 2022. This does show trends continuing to increase this way when you're looking at all overdoses. And I believe when you look at this exact chart based on opiates specifically, it looks very similar. So a little bit of a plateau decrease and then starting to increase around 2019 and continuing upwards from 2023 and on. Yeah, there were a lot of other graphs and we didn't include all of them because the trends were pretty similar. Lynn was generally higher, Yamhill was in the middle, and Deschutes was a little bit lower. So ED visits for substance use, all of them look pretty similar. And generally those trended upward until about 2023 at least. Here we've got some different graphs and these are Oregon-wide, right? Not just county, I believe. But they really hold across most states and counties and really the whole country. So the rates are generally a lot higher for males. Males comprise about 70% of fatal overdoses in virtually every state. And here you see that's a little over double, between double and triple the female rate. But one thing I would call your attention to is not that, oh, males overdose a lot more, it's that everybody overdoses a lot more, both females and males, and in fact increases have been significant for both categories, for both genders. And these are, to look at numbers, before year 2000, my guess is these were in the five per 100,000 range. Overdose was relatively rare. And so overdoses have increased for all age groups, all ethnicities, all races, and all genders over the last 20 years. Blanket statement, but very true. Top right you see age group, and so children on the left and over 65 on the right. As with, again, every state, every county, the most common age group is the 25 to 65 range, and really, 25 to 44 is usually a bit higher than 45 to 64, so a little bit out of the ordinary there, but people generally overdose in midlife broadly, from early adulthood to midlife, nothing surprising there. And then down on the bottom is something that people might not be aware of, but this was largely labeled 10 years ago as a white suburban to rural crisis, and that's really changed over the last few years. The face of the overdoses specifically has changed, and as you see here, American Indian, Alaska Natives, and black individuals are much more likely to overdose than white individuals. One difference we see here in Oregon is that Hispanic individuals are actually at quite a bit higher risk than other states, and that's evidently not the case here in Oregon. So a little bit different, but the idea remains the same, that overdoses have generally befallen over the last five to 10 years more racial and ethnic minorities. This is the ED visit data. As I said before, Lynn's a little bit higher, but Yemo's not too far behind in 2023, and you can see here on the bottom right, a lot of people go to the ED for overdose, so it's pretty common, over 100 per 100,000, so about one-tenth of 1% of ED visits are for overdose. Which doesn't sound like a lot, but there's a lot of different reasons people go to the ED, and it's not just overdose in the substance use-related realm. So people go to the ED for skin infections, overdose, withdrawal, and those actually comprise a pretty significant number of ED visits. In Colorado, we did a big data summary, and about 3% to 4% of ED visits are for some form of substance, so that's a lot. And from working in an ED, a lot of these folks take more time because there are a lot of social problems, and so having them leave in a healthy way to a place that's good for them is really, really difficult. So helping to keep people out of the ED, withdrawal, overdose, is really, really important. It's also very morale-sapping to see people come back over and over. Substances involved in overdose has changed a lot, and you've probably heard the narrative that stimulants are a higher part of overdose, and there are more stimulant-involved overdoses, but if you look at this graph, actually, opioids are in the kind of teal and purple, or sorry, teal and orange, and so if you look at that, it's actually gone up. So opioids are the primary overwhelming cause of fatal overdose in the country, with or without stimulants, and so there are more stimulant-related deaths than there were before, but as a proportion, there's actually less. So even though you hear more about stimulants and stimulants, opioids still cause the vast majority of overdoses, and my guess is actually that some of these are just drug-testing errors and that opioids probably account for virtually all overdoses, and we've seen this in Colorado, that if they say that they overdose without an opioid on board, it's really dubious. So fentanyl has been the cause of this, where fentanyl, I think, is on board in 80-plus percent overdoses in most states. Youth data, I found this really interesting because there is county data, and if you look at the top, there is some statewide data on various behaviors by youth, but if you look down at the bottom, starting on the left, you've got organ rates on the left and then Yamhill County next to it. In 2015, 8th graders and 11th graders were less likely to use substances in Yamhill County than the state at large, and something happened between then and 2020 where youngsters in the county were actually more likely to use substances. So big, big change, and these are large numbers. They survey hundreds or even thousands of people, so I wouldn't just chalk it up to the survey's wrong. Seems like there was a pretty big change between 2015 and 2020 as far as substance use goes in the county and statewide, too. Any comments on that? Has that been people's experience, that more youth involved in substance use than there were before? Yeah. Oh yeah, that was a comment and commenter confirmed that during COVID there was less ability to do testing, various forms of treatment, so there are more kids showing up with recent use or with use disorders. And that commenter said that there was more normalization of particularly alcohol use. And to confirm, this is alcohol use specifically. Generally across the country, less youth are using what are called dangerous drugs, stimulants, opioids. And that's not necessarily part of the narrative because more people are overdosing because they're more deadly, but use substance use is actually near, and when I say substances, drug use, is actually near a low since the 80s, yes. I believe she asked if these numbers account for vaping. I believe there's a tobacco products in the top one on the right for the statewide graph, but on the bottom, it's just alcohol. So percent of youth that report drinking at least one alcoholic drink in the past 30 days in Yamaho County and large. Right, more youth data from Oregon and nationally generally shows that more youth use substances in Oregon nationally, which you probably know. And on the top, it's documented substance use disorder. So 5% of Oregon youth had a documented substance use disorder nationally. That's surprisingly high. And then at the bottom, a little bit older crowd, so this is 18 to 25, more young adults than high school and junior high age kids, documented substance use disorder. About three percentage points higher than the national average, which again, over a lot of people, it adds up and it's significantly higher. And that stayed pretty consistent from 2016 to 2019 as far as the disparity between Oregon and the nation as far as young people with substance use disorders. Thank you. Okay, that was a quick run through data. A couple of takeaway points. Youth use is pretty high here. So focusing on youth treatment recovery prevention could not only get a good return on our investment, but start to chip away at the problem. Opioids continue to be the primary substance. Something worth noting here is that opioid settlement dollars must be focused primarily on treating opioid use disorder, but you can use it to treat opioid use disorder and other substances as long as opiates are involved. It's uncommon that someone is a poly or single substance user and the settlement does recognize that. However, opiates continue to be the primary substance overdosed. Okay, now we've talked at you long enough. We're gonna give you the chance to do a little group work together. I think we're gonna have to be a little adaptable in our approach to this, just based on the room and the tech setup. So before I give you the directions, let me point you to a couple of resources. And we can actually send these slides out to you all. I don't know how many folks brought a computer if you want a device to look at. We can email you the slides and then when you're working in your groups, you can access them. So come up here, give me your email address and I'll email them to you in that way. All of these things in blue are hyperlinks. So you can actually just click on it directly from the slide deck and be able to access all of these resources. This is way too much information for you all in order to make decisions. You're never gonna be able to get in your small group and read through Yamhill County's community health assessment and have some brilliant light bulb moment that tells you how to spend your settlement dollars. That is not why these are here. They are, however, really useful tools when trying to figure out where to start, when trying to get your group brainstorming what we want to prioritize, where should we go, what population might we focus on. And these are resources that can be used over time. So a community health assessment and a community health improvement plan are iterative and your public health department will continue to update them. Is it five-year cycles here? Every five years. So remember, this is an 18-year game. This is a marathon, not a sprint. These are tools, some of them, that you can continue to go back to and reference as they're updated so that you can keep making informed decisions on how to spend your dollars. I don't know what that is. Someone clicking on it, maybe. But I think that's all I want to say about this. The bullets under each thing kind of identify what you might find in that report should you want to dig in a little bit deeper. One thing we found is people want more information, more information, more information. And sometimes, frankly, I find that to be sidestepping. You don't save lives without spending money. And you've got a lot of work that's gone into figuring out what to do. And taking the next step is daring, but spending money is the next step. We've honestly never worked in a county this size that had an overdose preventive strategic plan, had overdose fatality review team recommendations. So there's a lot of work that's gone into this and figuring out where those recommendations align with things that are currently unfunded or that are funded and need expansion is really the next step. So we have a lot of people who are like, we should commission a needs assessment. You've got it. It's done. And so I don't want to forestall that happening again because things move quickly in behavioral health, but also, it's time. I think we have one more resource. Lindsey, do you want to come up here or sit where you are and talk a little bit about this? You could probably do it better justice than me. Feel free to come up. Yeah, thank you. So I put this together actually for a community event that happened I think at the end of last summer, but updated it for today. And you can see there's actually without having any knowledge of how they were going to be presenting their information today, had categorized it very similarly. We've got prevention treatment, both outpatient and inpatient, meaning like in a hospital setting versus not, harm reduction and outreach, recovery, and then because I'm a public health nerd, some may say we have a whole category of data collection and response. Again, this was looking at sort of mapping out where we have resource as we were trying to figure out some additional opioid settlement funding coming to us specific to prevention and how we wanted to use those funds. And so our team put this together to really look at where do we have things happening in these different categories to better understand where we have gaps so that we could take those prevention dollars in that case and plug those into areas where we didn't feel like we had enough resource going. And so you can see a couple of things are highlighted there. There are things that are largely missing in our community, things that I hear often from community members, from community partners that we need. And then I added a couple of things down below of just things that are happening or sort of on the horizon that there's active efforts going towards that we don't necessarily need resource for right now. We're well on our way, we've got what we need, and we're going to get those put away. So I'm happy to send this out too in just a PDF so people can look at it and see all the small print too. Thank you so much. Let me give you the mic. We want to make sure people can hear all the things. Yeah, I'm just curious. We've gone through all these different slides and all these different things we could do to address the drug addiction problems in our community. Nothing in this discussion, as far as I can tell, is really dealing with mental health. And so is there a reason for that, that that's out of this? I'm not saying that it's bad, good, and different, but is there a reason that's not part of this dialogue? I love that you brought that up. So a couple of things to say about that. First, it's an opioid settlement, and so you have to focus the dollars on opiate-related issues. Substances can be secondary to that, and so can, I'm sorry, different substances can be secondary to that, and so can co-occurring mental health issues, as long as it is wrapped up with opiate-related issues as well. And so many, if not most, of the things that we talked about across prevention, treatment, recovery, harm reduction, criminal justice, are also getting at people's mental health issues. You heard a couple folks talking about co-occurring issues and the reason why therapy alongside MOUD, Medication for Opioid Use Disorder, is so productive is because the therapy is starting to chip away at those mental health issues. So it's looped in, but we have to be a little bit strategic in how we articulate that in order to make sure you're spending money according to Exhibit E and the allowable uses. Does that make sense? Yeah, I just said there's a lot of things that co-occur. You know, we could put money into housing, but the focus at least nominally has to be on opioids. Like we've had proposals that were great for suicide prevention, for mental health. Frankly, they have to be at least savvy enough to say opioid use in their proposals to get it considered because otherwise it could fall afoul of that Exhibit E. So a lot of co-occurring disorder treatment, co-occurring disorder treatment, not mental health specific treatment, absent opioids or substance use. So yes, absolutely part of it, but not solo. And I think that's the art of this is that there's so many things that go into opioid substance use, but also the settlement was intended for opioid use and we wanna make sure that what happened with the tobacco settlement doesn't befall this, that people start to lose focus and spend tobacco money on things that are very far from tobacco here, being opioid use. I used to think of sobering centers and detox as the same thing, but I know that they're not. And I just wanna make sure that I have the differences straight in my mind. Yeah. Well, detox, I was going to say, what are the yellow ones? Is it medically managed, residential, and then sober? Okay, it's really tiny, I couldn't read it. Well, detox is typically when people think of that, well, there's different levels between like, 3.7 is normally what people think of. So that's the medically managed withdrawal management where you go in and a doctor helps you get off medications or whatever you're doing. So that's 3.7 ACM level. And then a sobering center is where you just kind of go in off the street and they, it is not to, yeah, so it's not a hospital setting. There's a lot different rules if you're a 3.7 versus that's more lower level. So if you have life-threatening symptoms, so when you're screening someone for detox, you have to do some screening. And whenever I was looking at trying to help people to get into different levels, I'm like, well, first of all, what's the substance? How much, how often are you using? What's going on? And if you're at high risk, like if you have complicated medical things, that would not be an appropriate setting because you need more medical assistance, which is the 3.7, which is more of the hospital setting. Whereas the sober living is more just on the street someplace, I guess per se to kind of go in and sleep it off. Especially with like some of the less common things that need that level, like meth is one example. Normally you don't need a lot of a 3.7 detox for meth. You feel crappy, but you're not usually gonna die from a meth overdose. Although I did see there are some, you can sleep that off. So that's normally where you go and you kind of sleep it off instead of an emergency room. Oh, sure. I've heard from more than one law enforcement officer that they wish they had a place to take folks who are obviously under the influence. And I think that the terminology I've heard is detox, but I'm wondering if a sobering center might be more in line with that kind of facility. I don't know, Chief Wood, do you want to weigh in on that? I mean, I think that's a really good question. I think that's a really good question. That kind of facility. I think either option is potentially beneficial, but even if it's the lower-level option so that there is some thing, some resource for my staff to use when they have contact with those folks who are needed, some kind of service that obviously that's not something that law enforcement is there to provide, but we're the 24-7, 365 problem-solving service that people reach out to. So I think either is a viable option, but it sounds like the sobering center is the lower barrier to get somebody into. So I would, I guess either is beneficial to us. Thank you. Okay. I think I'm going to leave time for one more question, comment. The other distinction is medically managed is an insurance paid-for service. It's a medical intervention. You have to be, have a health risk for withdrawing without medical intervention. The sobering centers are not a medical benefit. Insurance, Medicaid dollars can't pay for those kinds of things. So those are the kinds of things we talk about having grant funds or things that have to cover because it's not paid for by insurance. Excellent point. Thank you for that. And I think there's a third thing to add. Yeah, there used to be a different level. They're called social detoxes. That's going away as a level of care. And so the sobering center, in fact, what you're saying is like one of the most popular things we've seen around the country, cops want to drop someone off somewhere that's not jail, that's not needy, where they're going to be safe. And that doesn't exist in most places. As you said, medical withdrawal management has a higher barrier for entry. It is also making, for some of those people that need that, it's billable, it's making good use funds, but it also excludes a lot of people who don't need that medical level of care. And so we're actually procuring that in two different counties in Colorado, and it's really difficult because a lot of people who run those levels of care are more profit-oriented and they want people who are, they want to be in recovery and maybe they're commercially insured. They don't want folks who just are being dropped off. But also we hear over and over from law enforcement that this is what they need. So very common to hear this everywhere and will require a pretty unique solution. Okay, so we've talked about what everything is. We've talked about return on investments, evidence-based strategies. We've reviewed data with you all. We've talked a little bit about what the existing resources and started to think about what the gaps are. Now you all get to finish this activity. I think with the amount of folks in the room, let's do four groups. So I'll help you count off here in just a second. Once you get in your small groups, make sure you know who everyone is and identify someone to write this down. I do have a virtual sheet, but I think with the tech in here, we're going to use these big flip charts instead. So we'll write it down on paper and you are tasked with identifying the most important or useful resources that already exist. No more than 10. This does not have to be exhaustive. And what your group decides are the most important gaps that you should consider filling with settlement funds. I think we probably have about 20 minutes and then we'll come back and do a really quick group debrief where we kind of share what we found out and then we will break for lunch. Any questions before I help you all count off? Yes, sir. Just want to make sure that we're saying this is specific to McMinnville as a city alone. Do you want me to do my best at answering that? Yes. Do you want me to give an assumption or do you all want to speak on behalf of your, you want me to go for it? Okay. So at the end of the day, yes, we're here to figure out how to spend McMinnville's dollars. As I talked about in the context slides earlier, you can pool city and county money and make a bigger impact. And you all know that nobody is seeking services or overdosing in McMinnville city alone. Folks are traveling around. So at the end of the day, we'll talk a little bit about what potential collaboration could look like. But today we're talking about McMinnville's dollars, we're thinking about the money that McMinnville has. So you don't want to spend too, don't dream too big. Think about McMinnville's available dollars. They do y'all justice. Anything you want to add? Reminder that McMinnville is not a service provider. So it all kind of lands on the county. And while you have lots of different things, you could devote the money to ultimately the buck stops with the treatment that is provided by the county. So I don't know, that's just a little biased editorial comment. Thank you, Commissioner. Okay, let's count off. Are you all participating? No. Okay, let's do four groups then maybe instead of five. Does that sound good for you? Okay, we're just going to do one. You don't want to participate? OK. So you're a three? Excellent. Let's put ones over here, twos kind of in the back, threes right here, fours over there in the back. I will bring you all some flip chart paper while you are getting comfy. And we can.

opioid crisis

settlement funds

fentanyl overdoses

demographic differences

prevention strategies

evidence-based treatments

community collaboration