I_OpioidSubstance_2023A 06/29/2023 09:08:35 AM Committee Summary

Chair deGruy Kennedy gave an overview of the purview of the committee and agenda of the day.

Vice Chair Priola gave opening remarks.

Rachel Kurtz-Phelan, representing Legislative Council Staff, gave an overview of the charge of the committee. She went over future meeting dates and agendas.

Yelana Love, representing the Office of Legislative Legal Services, went over the bill drafting process.

Chair deGruy Kennedy went over the bill deadlines.

Dr. Robert J. Valuck, executive director for the Prescription Drug Abuse Prevention Center and Jose Esquibel, director of the Colorado Consortium for Prescription Drug Abuse, presented to the committee.

Dr. Valuck spoke on addiction as a disease and the biological response someone goes through with addiction. He spoke on the frequency and cost of addiction as well as the treatment and recovery availability.

Dr Valuck went over the history of opioid deaths in the country and how distribution expanded across the United States. The problem has expanded from prescribed opioid to illegal substances and synthetic drugs.

Dr. Valuck went over the cause of overdose deaths in Colorado. The primary increase in overdose deaths in Colorado over the last few years has come from opioids and the increase in opioid deaths can be attributed to fentanyl. Over the last few years, methamphetamine and cocaine overdose deaths have also increased. Several rural Colorado counties have higher rates of opioid use.

Dr. Valuck went over the history of the Colorado Consortium. It was created in 2013 and was created to facilitate collaboration between different opioid prevention actors across the state. He also went over the different substance use disorder organizations in the state.

The committee asked about the barriers to the treatment level. The panel stated that there are a variety of factors affecting treatment. Demand for treatment is rising but there are still regions of the state where there is no availability.

The committee asked about barriers to collaboration in the state. The panel stated that certain people who should be engaged are currently not part of the stake holding.

The committee asked about the availability and success of telehealth as well as options in the rural regions in the state that may want options outside of telehelath. The panel stated that since the Covid-19 pandemic, telehealth and mobile service efforts have been able to reach more people. There are also several programs in the state to try to give regions options that are beyond telehealth.

The committee asked about collaboration efforts with law enforcement. The panel talked about the success of diversion programs, training for law enforcement, and work groups in the Consortium to work with Law Enforcement.

Director Jose Esquibel went over his background.

Director Esquibel went over the history of opioid legislation and funding that is coming from a variety of sources related to opioid efforts.

Director Esquibel went over the history of the interim committee. 14 bills have come out of the committee and become law with a variety of impacts. A majority of these bills have been based on evidence based approaches.

Director Esquibel went over the evidence based responses. The state has focused more on recovery and treatment efforts and how to best connect people between treatment and recovery. The focus has been on continuity of care and retention for those in recovery.

Director Esquibel went over the medical-assisted treatment expansion program and the success of the program in rural Colorado. The committee asked questions on the absence of the program in certain rural areas. Director Esquibel spoke on current outreach efforts to bridge the gap in those areas.

Director Esquibel went over harm reduction and care treatment options. Harm reduction is a part of the process to better connect people with resources.

Director Esquibel went over the Prescription Drug Monitoring Program and how the consortium is helping providers. The committee asked about benzodiazepines and what they do. Dr. Valuck went over how they are depressants and a large number are currently being provided. He also went over how the combination of them and opioids can be lethal. the committee also went over the common names of benzodiazepines such as Xanax.

Director Esquibel went over the collaboration with criminal justice groups. The Consortium has helped developed training programs and work with groups to build a greater variety of options to deal with opioids.

Director Esquibel went over how the consortium is distributing the majority of the opioid settlement funding into the local level.

The committee asked about a broad overview of opioid funding. The panel stated the variety of federal and state sources that came into Colorado.

Director Esquibel went over surveys the Consortium had conducted related to the bills the legislature passed.

The committee asked the panel about the barriers to workforce. The consortium has a peer recovery group to help coordinate efforts.

The committee asked the panel about alcohol abuse. The panel stated how alcohol is still one of the largest drug used in the state and how a large number of people with alcohol abuse seek treatment.

The committee asked about emerging drugs entering the state. The Consortium is tracking emerging drugs across the country and alerting providers in the region with known symptoms and treatment for emerging drugs. They also spoke on the need to have more test strips for new drugs.

The committee asked the panel about new treatments for methamphetamine. The panel spoke of contingency management treatment options that are available and used across the state.

The committee asked on how to expand screening efforts. The panel stated how they worked with different groups to expand screening efforts.

The committee went on recess.

The committee came back to order.

Marc Condojani, Director of Adult Treatment and Recovery at the Behavioral Health Administration (BHA), gave an overview of the BHA's work including supporting services and treatment, especially in areas not covered by benefits.

Director Condojani went over the three evidence based approached to reduce overdose: education and naloxone distribution, alternatives to opioids for pain management, and medication for opioid use disorder. The BHA has a variety of programs. They buy services for those who are uninsured and underinsured. They also manage a mobile and pop up health units across the state.

The committee asked clarifying questions on the mobile health units. Director Condojani spoke on their reach and how they partner with local communities.

Director Condojani spoke on the spread of treatment programs across the state and the success of increased access. However, there are still gaps from region to region. The BHA is opening new units and working to combat the stigma to bridge those gaps.

The committee asked Director Condojani about youth treatment. Director Condojani stated that the BHA works with providers to give the most appropriate treatment for youth. He also spoke for the need for intervention as a policy solution.

The committee asked questions about the unhoused population treatment efforts. Director Condojani spoke on partnerships to provide earlier treatment and making it so there is limited wait lists to help the population.

Director Condojani spoke on recovery efforts by the BHA. There are different organizations and housing efforts that the BHA supports that focus on opioid and drug recovery.

The committee asked for more clarity on the mobile medication units. Director Condojani spoke on the collaborative approach to build and learn about the units, as well as the process for providers to become more attached to the units. The units also talked with local community leaders to build awareness, relationships, and reduce stigma.

A panel of Cristen Bates, Deputy Medicaid Director, and Jim Leonard, Deputy Director of the Pharmacy Office, representing Health Care Policy & Financing (HCPF) presented to the committee.

The panel spoke on the investments by the state into behavioral health services and how spending has doubled over the last few years, as well as a brief overview of where some of the funding is going.

The panel gave an overview of medicaid process for individuals. The behavioral health element of medicaid is generally in managed care. HCPF delegates to regional entities which help with administrative support.

The committee asked about medicaid reallocation. The panel stated that HCPF will determine who is eligible for medicaid and went over transition options for anyone who will no longer be on medicaid.

The committee asked about the gap of service between different types of behavioral and developmental disabilities. The panel stated HCPF is working to provide guidelines and training to providers and staff on best way to coordinate cooccuring disorders.

The panel went over how prescriptions have been delivered through the state. HCPF does not have access to the Prescription Drug Monitoring program so it won't be able to see overall trends across the state.

The panel spoke on the chronic pain centers which responds to shortage of providers. The centers help to teach and maximize available benefits.

The panel spoke about federal funding to help innovation, in three phases: OpiSafe; Affordability; and Social Determinants of Health.

The panel spoke on the need to expand Medicaid providers. There are now additional provider types to give more flexibility and funding to providers.

The panel spoke on partial hospitalization as an option for hospitalization that still lets individuals sleep in their bed. It is a useful option for people, but currently not covered by medicaid. In addition, currently no youth residential programs accept medicaid which is a gap in the system.

Lenora Joseph, Director of the Office of Civil and Forensic Mental Health, presented to the committee. The office provides inpatient services for patients and providers. The types of patients treated are in the justice system and referred to the services. There is a waitlist for beds for patients who are not deemed competent, which the state pays a fine for. There are mental health transition living homes that the office is working to create more beds in hospitals.

Director Joseph spoke on the challenge of not being able to get a re-evaluation on patients for competency when the reason for the original evaluation may have been a substance use disorder.

Sam Bourdon and Barbara Gabella, representing the Colorado Department of Public Health and Environment (CDPHE) presented as a panel to the committee.

The panel went over CDPHE programs including overdose prevention, syringe access, harm reduction grants, free naloxone distribution, free fentanyl test strip, medication and sharps take-back, workforce initiatives, and toxicology grants.

The panel went over key trends they found. They found that overdose deaths involving fentanyl continue to increase in Colorado. The number of deaths from other opioids continue to be low and stable.

The committee asked the panel about identifying cause of overdose due to certain opioid. The panel stated that the toxicology reports and looking across a variety of programs and partners helps determine impact of certain opioids.

The committee asked about the bed space shortage in hospitals. Director Joseph mentioned how there are staffing shortages that lead to about 100 beds not being available for use.

Summer Gathercole, Deputy Commissioner of Operations for the Behavioral Health Administration, presented to the committee.

Commissioner Gathercole gave an overview of the creation of the BHA. The BHA was made to streamline services in Colorado so that people don't get bounced around across agencies.

Commissioner Gathercole went over the creation of Behavioral Health Administration Service Organizations (BHASO) as an intermediary between all of the programs and the BHA. The BHASOs will help coordinate and provide a consistent response to agencies and the public.

Commissioner Gathercole went over the six pillars of a strong behavioral health system in Colorado: whole person care, access, affordability, workforce and support, accountability, and local and consumer guidance.

The committee asked on how the services of the BHA worked with physical health Commissioner Gathercole went over partnerships and education efforts for providers in the physical health space.

The committee asked how the BHA is using ancillary staff in workforce development. Commissioner Gathercole spoke on how paraprofessionals are a part of the BHA's staffing efforts.

The committee asked about the continuum of care under the BHA. Commissioner Gathercole spoke on how prevention, treatment, and recovery, as well as social stigma factor in the BHA's continuum of care.

The committee asked how the BHA collaborated with criminal justice actors. Commissioner Gathercole stated the BHA's relationship with law enforcement and working groups within the BHA.

Jamie Feld, Deputy Director of Opioid Response at the Attorney General's Office, presented to the committee.

Director Feld gave an overview of how opioid settlement funding will be distributed across the state as well as their governance structure. All funding from the opioid settlement must be used for opioid abatement.

Jefferson County Commissioner Lesley Dahlkemper and Prowers County Commissioner Wendy Buxton-Andrade joined Ms. Feld as a panel to speak on the regional opioid response.

The committee asked the panel how they coordinate with the BHA. The panel stated that collaboration with state organizations is a key part of their operating procedure. The panel also outlined their regional process of working with state organizations.

The committee asked the panel what the legislature could do during session to help remove barriers. The panel talked about how additional rules makes it difficult to get more trainees in rural parts of the state. They also talked about the need for good data and sustainability for a better approach.

The committee asked about the concern of BHASOs overlooking rural regions of the state. The panel stated it is a concern but the goal is to make the BHASOs a light administrative burden. They also spoke of not splitting BHASO regions and their opioid regions so that counties would not have to report to different structures.

Director Cristen Bates, representing HCPF, spoke on finances in the department and different programs the funding is used on.

The committee asked about the safe transport program. Director Bates spoke on how ambulances and certified drivers can pick up individuals in crisis and take them to support services.

The committee asked if the 1115 waiver system is a federal or state program. Director Bates said that it can work as a state program as long as it is in statute.