I_OpioidSubstance_2023A 08/07/2023 09:05:49 AM Committee Summary

Keith Weis, Executive Director of the Rocky Mountain High Intensity Drug Trafficking Area (HIDTA), presented to the committee. He spoke on the efforts of HIDTA to get illicit drugs off of the streets and investigate criminal groups. The highest threat that has increased the most over the last few years was fentanyl. Overdose deaths, however, seem to have leveled off since 2022. The seizure rate of many illicit drugs have fallen as compared to the last few years, but seizure rates of fentanyl have increased over the last few years. HIDTA also has an ODMAP program that tracks overdose data.

The committee asked where the fentanyl is coming from and how the state is combatting entry. Director Weiss stated that much of the fentanyl is coming from foreign countries and is being transported through souther states into Colorado through transnational criminal organizations. There is also a coordination in law enforcement across all levels to combat the drugs entry.

The committee asked about the percentage of overdoses that are incidental with fentanyl. Director Weiss stated that the data is not clear on how much fentanyl is incidental, but that there is incidental fentanyl. He additionally stated that a lot of fentanyl use is purposeful.

The committee asked about the drop off of certain illicit drug supplies. Director Weiss stated that purity levels of drugs are at an all time high and that drugs are still at a high level, even if they may be falling.

A panel of Jamie FitzSimons, Summit County Sheriff, and Tyler Brown, Arapahoe County Sheriff, presented to the committee. They spoke on the success of the Medically Assisted Treatment (MAT) program in reducing recidivism rates for users. While the program is successful, it is harder to staff these facilities in smaller, rural counties. Being able to reintroduce patients into the community is also an important part of the program. The stigma of MAT programs was an important barrier to overcome. The program did have tangible improvements in inmates with decreased overdoses and violence.

The committee asked about diversion methods in arrests. The panel stated that diversionary tactics are successful.

The committee asked about the continuity of care for reintroduction in to society and any relationships with sober living or other facilities. The panel stated that having a staff members specifically to help individuals with reintroduction was key to successful efforts. The panel also stated that they work with facilities and community based resources.

A panel of Danielle Culp, Interim Director of Criminal Justice Services in the Behavioral Health Administration, and Cristen Bates, Deputy Medicaid Director in the Department of Health Care Policy & Financing, spoke on financing efforts for those incarcerated. The panel went over Jail Based Behavioral Health Services (JBBS) and assist in funding substance use disorder services, mental health services, pre-sentencing coordination services, and medication assisted treatment. The majority of the state uses JBBS programs.

The committee asked about receiving data early for a report. The panel stated they would try to see what they could share.

The committee asked about the goal of reducing recidivism and how to measure that. The panel stated that their primary focus is based on the health benefits.

The committee asked about diversion programs. The panel went over the success of diversion programs and what parts of the programs would be covered.

The committee asked about ARPA funding use. The panel said the funding was through technical assistance in the jails.

The committee asked about the effect of the federal waiver for medicaid in jails. The panel explained how there would be a goal of having equitable statewide access ot the medicaid funding.

The committee asked about care inside of jail facilities. The panel stated that the health information exchange established medical consistency in treatment.

The committee asked about inpatient care for recently incarcerated individuals. The panel went over the changes to the standards for inpatient care, and how providers are recognizing involuntary abstinence for support.

A panel of Taylor Pendergrass, Director of Advocacy of the American Civil Liberties Union of Colorado, Dr. Vincent Atchity, president and CEO of Mental Health Colorado, and Dr. Katherine LeMasters, epidemiologist and assistant professor at CU Anschutz, presented to the committee on alternatives to incarceration. The panel went over the cost and statistics of incarceration in Colorado.

The committee asked about incarceration on rural communities and the panel stated that rural communities can have longer incarceration sentences.

The panel continued to speak on incarceration rates. Alternatives to incarceration include accessible community based treatment, harm reduction, and meeting basic needs. These alternatives can be achieved through systems such as competency support in the courts and short term supportive housing. Policies need to make easier to get into treatment in the least restrictive setting going forward.

The committee asked about incarceration for drug dealers. The panel stated that the majority of drug dealers are small time dealers who are replaceable and that large wholesale dealers are not incarcerated at the same rate.

A panel of Breeah Kinsella, Executive Director of the Colorado Providers Association, Michael Crews, Policy Director of the Colorado Association of Local Public Health Officials, Jason Vahling, Director of Public Health and Environment at the City and County of Broomfield, and Meaghan Hillman, Director of the Prowers County and Kiowa County Public Health and Environment presented to the committee.

The panel spoke on prevention specialists. Specialists are meant to increase overall health of a community and should not be tied to funding for specific drugs or issues.

The committee asked about stigma with elected officials. The panel stated that dialogue with the community to open the mind of individuals is the best way to combat stigma.

The committee asked if funding is the largest barrier. The panel stated that the flexibility of funding and funding being prescriptive is a large challenge as well.

The committee asked about the success of current programs. The panel stated that celebrating success are key to making sure to acknowledge the efforts in the state. Colorado has significantly improved its outcomes over the last decade for opioid use.

The panel spoke on the success of 5280 High School's peer support and recovery model.

The panel went over how a substance use disorder forms with children, as well as prevention needs to address risks and protective factors. Screening, brief intervention, and referral to treatment (SBIRT) is a model to make sure that prevention in youth can work.

Members of the panel spoke about the importance of intervention and prevention. They spoke about adolescent substance use and the most common exposure. Members of the panel answered questions from members of the committee.

Ilias Stritikus, Students Against Overdose, spoke about naloxone training and distribution being allowed in schools. Shelby DeWolfe, Steamboat Springs School District, spoke about the importance of harm reduction in schools. The panel answered questions from members of the committee.

Lisa Raville, Harm Reduction Center, spoke about the importance of harm reduction. She went over legislation passed recently related to harm reduction and gave statistics on overdoses in the state. She discussed different harm reduction programs and gave statistics on the Harm Reduction Center's work. A handout was distributed to the committee (Attachment A).

Maggie Seldeen, High Rockies Harm Reduction, spoke about the harm prevention work her organization does. Matt Pagnotti, Vivent Health, spoke about the connection between harm reduction services and HIV prevention. Members of the panel answered questions from the committee about overdose prevention centers.

Members of the panel continued to answer questions from members of the committee regarding harm reduction.

Discussion continued between the panel and members of the committee.

District Attorney Brian Mason, Adams and Broomfield County, gave his perspective on overdose prevention centers and other harm reduction methods. Greg Sadar, Commerce City Police Department, spoke about his concerns with safe injection sites. Tyler Brown, Arapahoe County Sheriff, spoke about overdose prevention centers and the importance on treatment. Members of the panel answered questions from the committee.

Discussion continued between members of the committee and members of the panel.

Daniel Blaney-Koen, American Medical Association, spoke about the model used for overdose prevention centers in Rhode Island. Dr. Keith Humphreys, Stanford University, gave an overview of the advantages of overdose prevention centers. The panel answered questions from members of the committee.

The discussion continued between the panel and committee.

Dr. Stephanie Stewart, representing Colorado Society of Addiction Medicine, testified. A handout was distributed (Attachment B). Mr. Duke Rumely, representing Sober AF Entertainment, testified. Mrs. Kristabell Stansbury, representing themself, testified. Brian Erickson, representing themself, testified. Members of the panel answered questions from the committee.

Mrs. Stacey Briggs, representing themself, testified.