Resolution 048-2024 RESOLUTION NO. 048 -2024
A RESOLUTION OF THE BOARD OF COUNTY APPROVING
THE PLAN FOR UTILIZATION OF LOCAL AND REGIONAL
FUNDS FROM SETTLEMENT OF OPIOID LITIGATION,
DURING STATE FISCAL YEAR 2024.
WHEREAS, on April 3, 2019, Monroe County filed suit in federal court against
eight (8) manufacturers of opiates and eight (8) distributors of opiates, for various
claims for relief including nuisance, negligence, fraud, and violation of the federal
Racketeer Influence and Corrupt Organizations Act; and
WHEREAS, Monroe County's lawsuit was later moved and made part of Multi
District Litigaiton, consolidating the County's claim as a "litigating entity" with
claims from other states and local governments, including the State of Florida;
and
WHEREAS, after several years of litigation and negotiations, the states and local
governments entered into settlements with multiple defendants, including
manufacturers Johnson & Johnson, Teva, Allergan, CVS, Walgreen, and
Walmart; and
WHEREAS, in order to ensure that the settlement proceeds were spent on
preventative programs for opioid use, the State of Florida and all Florida
local governments entered into a Memorandum of Understanding ("MOU"),
laying out the approved uses for settlement proceeds and other terms and
conditions for the use of the settlement proceeds; and
WHEREAS, on September 15, 2021, the Board of County Commissioners approved
Monroe County Resolution No. 285-2021, authorizing the County to join with the State
of Florida and other local governments as a participant in the MOU; and
WHEREAS, in fiscal year 2024, Monroe County has received or expects to receive a
total of$978,325.41. Of this, $171,051.41 came to Monroe County directly ("Local
Funds"). An additional $807,274 ("Regional Funds") is being paid to the South Florida
Behavioral Health Network, Inc. d/b/a Thriving Mind (a "Regional Managing Entity"),
and will be paid in turn to Guidance/Care Center for the exclusive use in Monroe
County; and
WHEREAS, paragraph (13)(5)(i) of the MOU requires the County to submit information
to the Florida Department of Children and Families (DCF) each year, to identify how it
plans expend the Local and Regional Funds will be spent. All expenditures must be for
approved uses as set forth in Schedules A and B to the MOU; and
1
WHEREAS, Monroe County has worked with the Guidance/Care Center to formulate a
plan for use of the settlement funds in FY 2024; and
WHEREAS, in broad terms, and as set forth in the Plan attached as Exhibit A to this
Resolution, in FY 2024, approximately 93% of the settlement funds will be used for
adult substance abuse programs, through a combination of services offered to inmates
at the Monroe County Detention Center and services offered through outpatient
substance abuse programs at the Guidance/Care Center. An additional 7% will be
used for preventative programs for middle school students; and
WHEREAS, the intent of this Resolution is to obtain approval to the plan for
expenditure of Local Funds and Regional Funds in Monroe County during the
time period July 1, 2023 to June 30, 2024 (corresponding to state fiscal year
2024).
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF MONROE COUNTY, THAT:
1. The Board of County Commissioners approves the plan for expenditure of Local
Funds and Regional Funds as set forth in the "Plan for Utilization of Local and
Regional Opioid Litigation Settlement Funds (Fiscal Year 2024)," attached hereto
as Exhibit A.
PASSED AND ADOPTED by the Board of County Commissioners of Monroe
County, Florida, at a regular meeting held on the 31st of January, 2024.
Mayor Holly Merrill Raschein Yes
Mayor Pro Tem James K. Scholl Yes a, '
Commissioner Craig Cates Yes -ri Fri
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Commissioner Michelle Lincoln Yes
A Commissioner David Rice Abstained ,�
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By: By:
As Deputy Clerk Mayor Holly Merrill Raschein
Approved as to form and legal sufficiency.
Monroe County Attorney's Office 1-29-2024
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EXHIBIT A
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MON ROE COUNTY
PLAN FOR UTILIZATION OF LOCAL AND
REGIONAL OPIOID LITIGATION
SETTLEMENT FUNDS
(Fiscal Year 2024)
Page 1
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On April 3, 2019, Monroe County filed suit in federal court against eight (8) opioid
manufacturers and eight (8) opioid distributors, with a total of thirteen (13) claims for relief
(primarily Racketeer Influenced and Corrupt Organizations Act ("RICO"), the Florida
Deceptive and Unfair Trade Practices Act (FDUTPA), nuisance, negligence, and fraud).
The suit was later moved and made part of Multi District Litigaiton, consolidating the
County's claims with those from other states (including the State of Florida) and many
local governments.
After several years of litigation and negotiations, attorneys representing the various states
and local governments entered into a proposed settlement with various defendants,
starting with manufacturer Johnson & Johnson and three distributors. The State of
Florida, on behalf of governments in Florida, negotiated a settlement agreement to cover
the State and local governments. On September 15, 2021, the Board of County
Commissioners approved Resolution No. 285-2021, authorizing the County to join with
the State of Florida and other local governments as a participant in a Florida
Memorandum of Understanding ("MOU"), laying out the formula for distribution of
settlement funds from the settling defendants. Schedule A and Schedule B to the MOU
also laid out acceptable purposes for which the settlement funds could be used.
Pursuant to that MOU, Monroe County is expected to receive allocations each year over
18 years.' Of total funds, Monroe County will receive approximately $80,000 per year
directly ("Local Funds"). An additional amount will come to Monroe County through a
"Regional Fund," through a Regional Managing Entity. For Monroe County, the Regional
Managing Entity ("RME") is the South Florida Behavioral Health Network, inc. d/b/a
Thriving Mind, based in Miami. Monroe County is the only entity in this Regional Fund.
Therefore, all of the regional funds will come to Monroe County from Thriving Mind.
In FY 2024, Monroe County has received or expects to receive a total of$885,375.08. Of
this, $78,101.08 came in Local Funds from payments from Defendants.2 The County
expects to receive an additional $807,274 in Regional Funds. The Regional Funds will
be paid by the Regional Managing Entity directly to Guidance/Care Center through the
RME's contract with Guidance/Care Center.
1 This amount is an average over 18 years. The figures vary, by year and by defendant. Most of the payments are
front-end loaded, i.e., higher in the earlier years.
z In March 2023, Monroe County five(5)checks totaling$78,101.08,from Defendants Teva,Allergan,Janssen,
CVS,Walgreens,and the Distributors. Monroe County has not yet received its payment from Walmart. Any
additional settlement funds received during FY 2024 will be spent consistent with this Plan.
Page 1 2
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One of the requirements of the MOU is that prior to July 1 of each year, the State and
each local government must report to Florida Department of Children and Families (DCF)
how they intend to spend their funds for the upcoming year. Also, prior to August 31 of
the following year, the State and each local government must report to DCF how they
have expended their funds during the previous fiscal year.
Monroe County's plan for the opiate settlement funds during fiscal year 2024 is to utilize
approximately ninety-three percent (93%) of the Local Funds and Regional Funds for
three Adult Substance Use Treatment programs, specifically:
- Jail In-House (JIP) intensive treatment program,
- Medication Assisted Treatment (MAT) and
- Outpatient Substance Use Treatment Programs provided by the Guidance/Care
Center, Inc.
In addition, approximately seven percent (7%) (approximately $15,000) will be used for
school-based preventative efforts.
Uninsured and underinsured persons will receive the services through the
Guidance/Care Center. Treatment is provided regardless of ability to pay for services
with use of this funding.
More details about the programs to be offered are as follows:
IAdult Substance Abuse Programs
• The Jail In- House Program (JIP) provides an intensive treatment model for 6-12
months to male and female inmates in the Monroe County Detention Center.
Treatment services include (1) biopsychosocial assessment, (2) individual therapy,
(3) group therapy and (4) case management. Case management ensures the basic
needs the client must address prior to release (e.g., housing, employment, MAT
medication management) are met and necessary linkages made prior to release.
This reduces the stress of re-entry into the community and provides the clients the
ability to focus on the recovery needs post release. Daily services are provided using
five evidence-based treatment practices.
(1) Substance Abuse and Criminal Conduct- Strategies for Self-Change — a
Cognitive Behavioral Therapy based curriculum. Throughout the treatment
episode participants use a client workbook that belongs to them.
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(2) Moral Reconation Therapy, a systematic treatment strategy that seeks to
decrease recidivism among criminal offenders by increasing moral
reasoning.
(3) Seeking Safety — a trauma-informed, trauma specific, and gender-
responsive treatment model that integrates treatment of PTSD and
subclinical trauma into treatment of substance use disorders. Seeking
Safety offers 25 treatment topics. Four combination topics are Introduction
to Treatment/Case Management, Safety, The Life Choices Game
(Review), and Termination. These relational models support the
development of healthy relationships with self, significant others, and the
community at large to reduce the risk of relapse and recidivism.
(4) The Living in Balance treatment model is a wrap-around approach to
improving life function in the context of recovery. This model incorporates
Motivational Interviewing to facilitate movement through the stages of
change and helps participants develop real life tools to cope with relapse
triggers.
(5) Anger Management is a cognitive behavioral therapy (CBT) based
Substance Abuse and Mental Health Services Administration (SAMHSA)
12 session treatment model.
• Medication Assisted Treatment will be expanded to be provided in the Monroe
County Detention center which includes Sublocade and Vivitrol for those screened
as appropriate for continuation or induction. Inmates will be offered substance
abuse treatment either through the JIP program for those with a six month or longer
sentence or for relapse prevention through outpatient at discharge. In addition, all
individuals with an opioid use disorder and receiving substance abuse services at
the jail are given a free Narcan kit at discharge.
• Outpatient Substance Use Treatment Services that will be funded persons with
Opioid Use Disorder ("OUD") and co-occurring Substance Use Disorder
("SUD")/Mental Health ("MH") disorders through the Guidance/Care Center include
the following components:
• Detoxification & Outpatient Detoxification
• Assessment
• Case Management
• Medication Assisted Treatment
• Relapse Prevention Groups
• Other Evidence Based Treatment Groups like Seeking Safety
• Individual Therapy
• Adult Substance Abuse Intervention
• Outreach
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School-Based Prevention Efforts in
Monroe County Middle Schools
In addition, Regional Funds from the Regional Managing Entity (approximately $15,000)
will be used to support the Guidance/Care Center's school-based prevention efforts for
OUD in middle schools in Monroe County.
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The Guidance/Care Center provides the following program and services:
Detox: A 24/7 medical detox using medical and clinical protocols to assist
consumers with withdrawal from the physiological and psychological effects of
substance use. Includes emergency screening, evaluation, short term
stabilization and treatment in a secure environment.
Diversion: Connects inmates' substance treatment so that they can avoid
repeat incarceration at the Monroe County Detention Center.
Intervention: Focus on reducing risk factors associated with the progression
of substance and mental health problems. Includes assessment, support
services, counseling, and referral.
Jail In-House Program (JIP): Intensive drug and alcohol treatment program
located in the Monroe County Detention Center
Other Side of the Fence (ORF): Outpatient substance abuse/co-occurring
treatment and wrap around support services for adult males who are involved in
criminal justice system in Key West.
Opioid Overdose Prevention: Free Narcan (naloxone) kits available at front
desk for any Monroe County resident.
Outpatient: Therapeutic and support services designed to improve functioning or
prevent deterioration of mental health or substance abuse disorders. Services
include individual and group services.
Outreach: Education of the public regarding substance abuse/mental health,
education with high risk groups, and screening, referral and linkage to needed
services.
Prevention: Information dissemination, education, community awareness and
other strategies to preclude, forestall, or impede the development of substance
use problems.
Page 15
REACH MAT: (Recovery and Extended Addiction Community Services for
Healing) Substance Use treatment services in conjunction with Medication
Assisted Treatment (MAT) and naloxone distribution for those with opioid
addiction. Medications provided include: Suboxone, Vivitrol, Subutex, Sublocade.
Guidance/Care Center contracts with the Regional Managing Entity to provide these
mental health and substance abuse treatment programs in Monroe County.
Guidance/Care Center also contracts with Monroe County for numerous purposes,
including to provide residential substance abuse treatment services to local offenders;
to serve as the community transportation coordinator; to provide Baker Act
transportation services; to run Jail In-House Program for incarcerated individuals; to
provide substance abuse mental health services; and to provide services for
disadvantaged, mentally ill individuals living at an assisted living facility, the Heron
House.
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100% of the funds will be used to achieve the following core strategies and approved
uses shown in Schedule A and Schedule B to the MOU.
Schedule A (Core Strategies):
- Item B, Medication-Assisted Treatment ("MAT") Distribution and other opioid-
related treatment
o (1): Increase Distribution of MAT to non-Medicaid eligible or uninsured
individuals;
o (4): Treatment and Recovery Support Services such as residential and
inpatient treatment, intensive outpatient treatment, outpatient therapy or
counsel, and recovering housing that allow or integrate medication with
other support services
- Item F (Treatment for Incarcerated Population)
o (1) Provide evidence-based treatment and recovery support including MAT
for persons with Opioid Use Disorder ("OUD") and co-occurring Substance
Use Disorder ("SUD")/Mental Health ("MH") disorders within and
transitioning out of the criminal justice system; and
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o (2) Increase funding for jails to provide treatment to inmates with OUD.
- Item G. (Prevention Programs)
o (2) Funding for school-based prevention programs
Schedule B (Approved Uses):
Part One: Treatment
- Item A (Treat Opioid Use Disorder (OUD)). Support treatment of Opioid Use
Disorder (OUD) and any co-occurring Substance Abuse Disorder or Mental Health
(SUD/MH) conditions through evidence-based or evidence information programs
or strategies that may include, but are not limited to, the following-
1. Expand availability of treatment for OUD and any co-occurring
SUD/MH conditions, including all forms of Medication-Assisted
Treatment (MAT) approved by the U.S. Food and Drug
Administration.
2. Support and reimburse evidence-based services that adhere to the
American Society of Addiction Medicine (ASAM) continuum of care
for OUD and any co-occurring SUD-MH conditions
3. Expand telehealth to increase access to treatment for OUD and any
co-occurring SUD/MH conditions, including MAT, as well as
counseling, psychiatric support, and other treatment and recovery
supports.
- Item D (Address the Needs of Criminal-Justice Involved Persons). Address the
needs of persons with OUD and any co-occurring SUD/MH conditions who are
involved in, are at risk of becoming involved in, or are transitioning out of the
criminal justice system through evidence-based or evidence-informed programs or
strategies . . .
4. Provide evidence-informed treatment, including MAT, recovery
support, harm reduction, or other appropriate services to individuals
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with OU and any co-occurring SUD/MH conditions who are
incarcerated in jail or prison.
5. Provide evidence-informed treatment, including MAT, recovery
support, harm reduction, or other appropriate services to individuals
with OU and any co-occurring SUD/MH conditions who are leaving
jail or prison have recently left jail or prison, are on probation or
parole, are under community corrections supervision, or are in re-
entry programs or facilities.
Item G (Prevent Misuse of Opioids). Support efforts to discourage or prevent
misuse of opioids through evidence-based or evidence-informed programs or
strategies that may include, but are not limited to, the following:
9. School-based or youth-focused programs or strategies that have
demonstrated effectiveness in preventing drug misuse and seem
likely to be effective in preventing the uptake and use of opioids.
10. Create or support community-based education or intervention
services for families, youth, and adolescents at risk for OUD and any
co-occurring SUD/MH conditions.
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