12/08/2021 Agreement
DATE: April 19, 2022
TO: Cynthia Hall, Assistant County Attorney
County Attorney’s Office
FROM: Liz Yongue, Deputy Clerk
th
SUBJECT: December 8 BOCC Meeting
Attached is an electronic copy of the following, which has been added to the record.
V9 Settlement Agreements in class action opioid litigation, including Florida Opioid
Allocation and Statewide Response Agreement between State of Florida Office of Attorney
General and Monroe County, the Florida Subdivision Participation Form for settlement with
Distributors, and Florida Subdivision Participation Form for settlement with Janssen (Johnson &
Johnson); and also, authorized the Mayor or Mayor Pro Tem to execute any other necessary
documents.
Should you have any questions please feel free to contact me at (305) 292-3550.
cc: Finance
File
fA�RTB`�'
Kevin Madok, CPA
h`o •......•. . Clerk of the Circuit Court& Comptroller—Monroe County, Florida
DATE: December 10, 2021
TO: Cynthia Hall, Assistant County Attorney
County Attorney's Office
FROM: Pamela G.,Hanco . 6.C.
SUBJECT: December 8th BOCC Meeting
Attached is an electronic copy of the following items for your handling:
V9 Settlement Agreements in class action opioid litigation,including Florida Opioid
Allocation and Statewide Response Agreement between State of Florida Office of Attorney
General and Monroe County, the Florida Subdivision Participation Form for settlement with
Distributors, and Florida Subdivision Participation Form for settlement with Janssen (Johnson&
Johnson); and also, authorized the Mayor or Mayor Pro Tem to execute any other necessary
documents.
Should you have any questions please feel free to contact me at (305) 292-3550.
cc: Finance
File
KEY WEST MARATHON PLANTATION KEY PK/ROTH BUILDING
500 Whitehead Street 3117 Overseas Highway 88820 Overseas Highway 50 High Point Road
Key West,Florida 33040 Marathon,Florida 33050 Plantation Key,Florida 33070 Plantation Key,Florida 330
305-294-4641 305-289-6027 305-852-7145 305-852-7145
FLORIDA OPIOID ALLOCATION AND
STATEWIDE RESPONSE
AGREEMENT
BETWEEN
STATE OF FLORIDA DEPARTMENT OF LEGAL AFFAIRS,
OFFICE OF THE ATTORNEY GENERAL
And
CERTAIN LOCAL GOVERNMENTS IN THE STATE OF FLORIDA
This Florida Opioid Allocation and Statewide Response Agreement(the "Agreement") is
entered into between the State of Florida (`State") and certain Local Governments ("Local
Governments" and the State and Local Governments are jointly referred to as the "Parties" or
individually as a"Party"). The Parties agree as follows:
Whereas, the people of the State and its communities have been harmed by misfeasance,
nonfeasance and malfeasance committed by certain entities within the Pharmaceutical Supply
Chain; and
Whereas,the State,through its Attorney General, and certain Local Governments,through
their elected representatives and counsel, are separately engaged in litigation seeking to hold many
of the same Pharmaceutical Supply Chain Participants accountable for the damage caused by their
misfeasance, nonfeasance and malfeasance as the State; and
Whereas, certain of the Parties have separately sued Pharmaceutical Supply Chain
participants for the harm caused to the citizens of both Parties and have collectively negotiated
settlements with several Pharmaceutical Supply Chain Participants; and
Whereas, the Parties share a common desire to abate and alleviate the impacts of that
misfeasance, nonfeasance and malfeasance throughout the State; and
Whereas, it is the intent of the State and its Local Governments to use the proceeds from
any Settlements with Pharmaceutical Supply Chain Participants to increase the amount of funding
presently spent on opioid and substance abuse education, treatment, prevention and other related
programs and services, such as those identified in Exhibits "A" and "B," and to ensure that the
funds are expended in compliance with evolving evidence-based "best practices;" and
Whereas, the State and its Local Governments enter into this Agreement and agree to the
allocation and use of the proceeds of any settlement described herein
Wherefore, the Parties each agree to as follows:
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A. Definitions
As used in this Agreement:
1. "Approved Purpose(s)" shall mean forward-looking strategies, programming and
services used to expand the availability of treatment for individuals impacted by substance use
disorders, to: (a) develop, promote, and provide evidence-based substance use prevention
strategies; (b) provide substance use avoidance and awareness education; (c) decrease the
oversupply of licit and illicit opioids; and(d)support recovery from addiction. Approved Purposes
shall include,but are not limited to,the opioid abatement strategies listed in Exhibits "A" and"B"
which are incorporated herein by reference.
2. "Local Governments" shall mean all counties, cities, towns and villages located
within the geographic boundaries of the State.
3. "Managing Entities" shall mean the corporations selected by and under contract with
the Florida Department of Children and Families or its successor ("DCF") to manage the daily
operational delivery of behavioral health services through a coordinated system of care. The
singular"Managing Entity" shall refer to a singular of the Managing Entities.
4. "County" shall mean a political subdivision of the state established pursuant to s. 1,
Art. VIII of the State Constitution.
5. "Dependent Special District" shall mean a Special District meeting the requirements
of Florida Statutes § 189.012(2).
6. "Municipalities" shall mean cities, towns, or villages located in a County within the
State that either have: (a) a Population greater than 10,000 individuals; or (b) a Population equal
to or less than 10,000 individuals and that has either (i) filed a lawsuit against one or more
Pharmaceutical Supply Chain Participants; or (ii) executes a release in connection with a
settlement with a Pharmaceutical Supply Chain participant. The singular "Municipality" shall
refer to a singular city, town, or village within the definition of Municipalities.
7. "'Negotiating Committee" shall mean a three-member group comprised by
representatives of the following: (1) the State; and (2) two representatives of Local Governments
of which one representative will be from a Municipality and one shall be from a County
(collectively,"Members")within the State. The State shall be represented by the Attorney General
or her designee.
8. "Negotiation Class Metrics" shall mean those county and city settlement allocations
which come from the official website of the Negotiation Class of counties and cities certified on
September 11, 2019 by the U.S. District for the Northern District of Ohio in In re National
Prescription Opiate Litigation, MDL No. 2804 (N.D. Ohio). The website is located at
https:HalIocationmap.iclaimsonline.com.
9. "Opioid Funds" shall mean monetary amounts obtained through a Settlement.
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10. "Opioid Related" shall have the same meaning and breadth as in the agreed Opioid
Abatement Strategies attached hereto as Exhibits "A" or`B."
11. "Parties" shall mean the State and Local Governments that execute this Agreement.
The singular word "Party" shall mean either the State or Local Governments that executed this
Agreement.
12. "PEC" shall mean the Plaintiffs' Executive Committee of the National Prescription
Opiate Multidistrict Litigation pending in the United States District Court for the Northern District
of Ohio.
13. "Pharmaceutical Supply Chain" shall mean the entities, processes, and channels
through which Controlled Substances are manufactured, marketed, promoted, distributed or
dispensed.
14. "Pharmaceutical Supply Chain Participant" shall mean any entity that engages in, or
has engaged in the manufacture, marketing, promotion, distribution or dispensing of an opioid
analgesic.
15. "Population" shall refer to published U.S. Census Bureau population estimates as of
July 1,2019,released March 2020, and shall remain unchanged during the term of this Agreement.
These estimates can currently be found at https:llwww.census.gov. For purposes of Population
under the definition of Qualified County, a County's population shall be the greater of its
population as of the July 1, 2019, estimates or its actual population, according to the official U.S.
Census Bureau count, which was released by the U.S. Census Bureau in August 2021.
16. "Qualified County" shall mean a charter or non-chartered County that has a
Population of at least 300,000 individuals and: (a) has an opioid taskforce or other similar board,
commission, council, or entity (including some existing sub-unit of a County's government
responsible for substance abuse prevention,treatment, and/or recovery) of which it is a member or
it operates in connection with its municipalities or others on a local or regional basis; (b) has an
abatement plan that has been either adopted or is being utilized to respond to the opioid epidemic;
(c) is, as of December 31, 2021, either providing or is contracting with others to provide substance
abuse prevention, recovery, and/or treatment services to its citizens; and (d) has or enters into an
interlocal agreement with a majority of Municipalities (Majority is more than 50% of the
Municipalities' total Population)related to the expenditure of Opioid Funds. The Opioid Funds to
be paid to a Qualified County will only include Opioid Funds for Municipalities whose claims are
released by the Municipality or Opioid Funds for Municipalities whose claims are otherwise
barred. For avoidance of doubt, the word "operate" in connection with opioid task force means to
do at least one of the following activities: (1) gathers data about the nature, extent, and problems
being faced in communities within that County; (2) receives and reports recommendations from
other government and private entities about activities that should be undertaken to abate the opioid
epidemic to a County; and/or(3)makes recommendations to a County and other public and private
leaders about steps, actions, or plans that should be undertaken to abate the opioid epidemic. For
avoidance of doubt, the Population calculation required by subsection (d) does not include
Population in unincorporated areas.
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17. "SAMHSA" shall mean the U.S. Department of Health & Human Services,
Substance Abuse and Mental Health Services Administration.
18. "Settlement"shall mean the negotiated resolution of legal or equitable claims against
a Pharmaceutical Supply Chain Participant when that resolution has been jointly entered into by
the State and Local Governments or a settlement class as described in (13)(1)below.
19. "State" shall mean the State of Florida.
B. Terms
1. Only Abatement- Other than funds used for the Administrative Costs and Expense
Fund as hereinafter described or to pay obligations to the United States arising out of Medicaid or
other federal programs, all Opioid Funds shall be utilized for Approved Purposes. In order to
accomplish this purpose, the State will either: (a) file a new action with Local Governments as
Parties; or(b)add Local Governments to its existing action, sever any settling defendants. In either
type of action,the State will seek entry of a consent judgment, consent order or other order binding
judgment binding both the State and Local Governments to utilize Opioid Funds for Approved
Purposes ("Order") from the Circuit Court of the Sixth Judicial Circuit in and for Pasco County,
West Pasco Division New Port Richey, Florida (the "Court"), except as herein provided. The
Order may be part of a class action settlement or similar device. The Order shall provide for
continuing jurisdiction by the Court to address non-performance by any party under the Order.
2. Avoid Claw Back and Recoupment - Both the State and Local Governments wish
to maximize any Settlement and Opioid Funds. In addition to committing to only using funds for
the Expense Funds,Administrative Costs and Approved Purposes,both Parties will agree to utilize
a percentage of funds for the Core Strategies highlighted in Exhibit A. Exhibit A contains the
programs and strategies prioritized by the U.S. Department of Justice and/or the U.S. Department
of Health & Human Services ("Core Strategies"). The State is trying to obtain the United States'
agreement to limit or reduce the United States' ability to recover or recoup monies from the State
and Local Government in exchange for prioritization of funds to certain projects. If no agreement
is reached with the United States, then there will be no requirement that a percentage be utilized
for Core Strategies.
3. No Benefit Unless Fully Participating - Any Local Government that objects to or
refuses to be included under the Order or refuses or fails to execute any of documents necessary
to effectuate a Settlement shall not receive, directly or indirectly, any Opioid Funds and its portion
of Opioid Funds shall be distributed to, and for the benefit of, the Local Governments. Funds that
were a for a Municipality that does not join a Settlement will be distributed to the County where
that Municipality is located. Funds that were for a County that does not join a Settlement will be
distributed pro rata to Counties that join a Settlement. For avoidance of doubt, if a Local
Government initially refuses to be included in or execute the documents necessary to effectuate a
Settlement and subsequently effectuates such documents necessary to join a Settlement, then that
Local Government will only lose those payments made under a Settlement while that Local
Government was not a part of the Settlement. If a Local Government participates in a Settlement,
that Local Government is thereby releasing the claims of its Dependent Special District claims, if
any.
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4. Distribution Scheme — If a Settlement has a National Settlement Administrator or
similar entity, all Opioids Funds will initially go to the Administrator to be distributed. If a
Settlement does not have a National Settlement Administrator or similar entity, all Opioid Funds
will initially go to the State, and then be distributed by the State as they are received from the
Defendants according to the following distribution scheme. The Opioid Funds will be divided into
three funds after deducting any costs of the Expense Fund detailed below. Funds due the federal
government, if any, pursuant to Section B-2, will be subtracted from only the State and Regional
Funds below:
(a) City/County Fund-The city/county fund will receive 15%of all Opioid Funds
to directly benefit all Counties and Municipalities. The amounts to be distributed to each
County and Municipality shall be determined by the Negotiation Class Metrics or other
metrics agreed upon,in writing,by a County and a Municipality,which are attached to this
Agreement as Exhibit "C." In the event that a Municipality has a Population less than
10,000 people and it does not execute a release or otherwise join a Settlement that
Municipalities share under the Negotiation Class Metrics shall be reallocated to the
County where that Municipality is located.
(b) Regional Fund- The regional fund will be subdivided into two parts.
(i) The State will annually calculate the share of each County within the State
of the regional fund utilizing the sliding scale in paragraph 5 of the Agreement, and
according to the Negotiation Class Metrics.
(ii) For Qualified Counties, the Qualified County's share will be paid to the
Qualified County and expended on Approved Purposes,including the Core Strategies
identified in Exhibit A, if applicable.
(iii) For all other Counties, the State will appropriate the regional share for
each County and pay that share through DCF to the Managing Entities providing
service for that County. The Managing Entities will be required to expend the monies
on Approved Purposes, including the Core Strategies as directed by the Opioid
Abatement Task Force or Council. The Managing Entities shall expend monies from
this Regional Fund on services for the Counties within the State that are non-
Qualified Counties and to ensure that there are services in every County. To the
greatest extent practicable, the Managing Entities shall endeavor to expend monies
in each County or for citizens of a County in the amount of the share that a County
would have received if it were a Qualified County.
(c) State Fund-The remainder of Opioid Funds will be expended by the State
on Approved Purposes, including the provisions related to Core Strategies, if applicable.
(d) To the extent that Opioid Funds are not appropriated and expended in a
year by the State, the State shall identify the investments where settlement funds will be
deposited. Any gains, profits, or interest accrued from the deposit of the Opioid Funds to
the extent that any funds are not appropriated and expended within a calendar year, shall
be the sole property of the Party that was entitled to the initial amount.
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(e) To the extent a County or Municipality wishes to pool, comingle, or
otherwise transfer its share, in whole or part, of Opioid Funds to another County or
Municipality, the comingling Municipalities may do so by written agreement. The
comingling Municipalities shall provide a copy of that agreement to the State and any
settlement administrator to ensure that monies are directed consistent with such
agreement. The County or Municipality receiving any such Opioid Funds shall assume
the responsibility for reporting how such Opioid Funds were utilized under this
Agreement.
5. Regional Fund Sliding Scale- The Regional Fund shall be calculated by utilizing the
following sliding scale of the Opioid Funds available in any year after deduction of Expenses and
any funds due the federal government:
A.Years 1-6: 40%
B. Years 7-9: 35%
C.Years 10-12: 34%
D.Years 13-15: 33%
E. Years 16-18: 30%
6. Opioid Abatement Taskforce or Council- The State will create an Opioid Abatement
Taskforce or Council (sometimes hereinafter "Taskforce" or "Council") to advise the Governor,
the Legislature, DCF, and Local Governments on the priorities that should be addressed by
expenditure of Opioid Funds and to review how monies have been spent and the results that have
been achieved with Opioid Funds.
(a) Size - The Taskforce or Council shall have ten Members equally balanced
between the State and the Local Government representatives.
(b) Appointments Local Governments - Two Municipality representatives will be
appointed by or through Florida League of Cities. Two county representatives, one from a
Qualified County and one from a county within the State that is not a Qualified County,will
be appointed by or through the Florida Association of Counties. The final representative
will alternate every two years between being a county representative (appointed by or
through Florida Association of Counties) or a Municipality representative (appointed by or
through the Florida League of Cities). One Municipality representative must be from a city
of less than 50,000 people. One county representative must be from a county of less than
200,000 people and the other county representative must be from a county whose population
exceeds 200,000 people.
(c) Appointments State -
(i) The Governor shall appoint two Members.
(ii) The Speaker of the House shall appoint one Member.
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(iii) The Senate President shall appoint one Member.
(iv) The Attorney General or her designee shall be a Member.
(d) Chair - The Attorney General or designee shall be the chair of the Taskforce
or Council.
(e) Term - Members will be appointed to serve a four-year term and shall be
staggered to comply with Florida Statutes § 20.052(4)(c).
(f) Support - DCF shall support the Taskforce or Council and the Taskforce or
Council shall be administratively housed in DCF.
(g) Meetings -The Taskforce or Council shall meet quarterly in person or virtually
using communications media technology as defined in section 120.54(5)(b)(2),
Florida Statutes.
(h) Reporting- The Taskforce or Council shall provide and publish a report
annually no later than November 30th or the first business day after November 30th,
if November 30th falls on a weekend or is otherwise not a business day. The report
shall contain information on how monies were spent the previous fiscal year by the
State, each of the Qualified Counties, each of the Managing Entities, and each of the
Local Governments. It shall also contain recommendations to the Governor, the
Legislature, and Local Governments for priorities among the Approved Purposes or
similar such uses for how monies should be spent the coming fiscal year to respond to
the opioid epidemic. Prior to July 1st of each year, the State and each of the Local
Governments shall provide information to DCF about how they intend to expend
Opioid Funds in the upcoming fiscal year.
(i) Accountability - The State and each of the Local Governments shall report its
expenditures to DCF no later than August 31st for the previous fiscal year. The
Taskforce or Council will set other data sets that need to be reported to DCF to
demonstrate the effectiveness of expenditures on Approved Purposes. In setting those
requirements, the Taskforce or Council shall consider the Reporting Templates,
Deliverables,Performance Measures,and other already utilized and existing templates
and forms required by DCF from Managing Entities and suggest that similar
requirements be utilized by all Parties to this Agreement.
0) Conflict of Interest - All Members shall adhere to the rules, regulations and
laws of Florida including,but not limited to, Florida Statute §112.311, concerning the
disclosure of conflicts of interest and recusal from discussions or votes on conflicted
matters.
7. Administrative Costs- The State may take no more than a 5% administrative fee
from the State Fund and any Regional Fund that it administers for counties that are not Qualified
Counties. Each Qualified County may take no more than a 5% administrative fee from its share of
the Regional Funds. Municipalities and Counties may take no more than a 5% administrative fee
from any funds that they receive or control from the City/County Fund.
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8. Negotiation of Non-Multistate Settlements - If the State begins negotiations with a
Pharmaceutical Supply Chain Participant that is separate and apart from a multi-state negotiation,
the State shall include Local Governments that are a part of the Negotiating Committee in such
negotiations. No Settlement shall be recommended or accepted without the affirmative votes of
both the State and Local Government representatives of the Negotiating Committee.
9. Negotiation of Multistate or Local Government Settlements - To the extent
practicable and allowed by other parties to a negotiation, both Parties agree to communicate with
members of the Negotiation Committee regarding the terms of any other Pharmaceutical Supply
Chain Participant Settlement.
10. Program Requirements- DCF and Local Governments desire to make the most
efficient and effective use of the Opioid Funds. DCF and Local Governments will work to achieve
that goal by ensuring the following requirements will be minimally met by any governmental entity
or provider providing services pursuant to a contract or grant of Opioid Funds:
a. In either performing services under this Agreement or contracting with a
provider to provide services with the Opioid Funds under this Agreement, the State and
Local Governments shall be aware of and comply with all State and Federal laws, rules,
Children and Families Operating Procedures (CFOPs), and similar regulations relating
to the substance abuse and treatment services.
b. The State and Local Governments shall have and follow their existing policies
and practices for accounting and auditing, including policies relating to whistleblowers
and avoiding fraud, waste, and abuse. The State and Local Governments shall consider
additional policies and practices recommended by the Opioid Abatement Taskforce or
Council. c.In any award or grant to any provider, State and Local Governments shall
ensure that each provider acknowledges its awareness of its obligations under law and
shall audit, supervise, or review each provider's performance routinely, at least once
every year.
d. In contracting with a provider, the State and Local Governments shall set
performance measures in writing for a provider.
e. The State and Local Governments shall receive and report expenditures, service
utilization data, demographic information, and national outcome measures in a similar
fashion as required by the 42.U.S.C. s. 300x and 42 U.S.C. s. 300x-21.
f. The State and Local Governments, that implement evidenced based practice
models will participate in fidelity monitoring as prescribed and completed by the
originator of the model chosen..
g. The State and Local Governments shall ensure that each year, an evaluation of
the procedures and activities undertaken to comply with the requirements of this
Agreement are completed.
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h. The State and Local Governments shall implement a monitoring process that will
demonstrate oversight and corrective action in the case of non-compliance, for all
providers that receive Opioid Funds. Monitoring shall include:
(i) Oversight of the any contractual or grant requirements;
(ii) Develop and utilize standardized monitoring tools;
(iii) Provide DCF and the Opioid Abatement Taskforce or Council with
access to the monitoring reports; and
(iv) Develop and utilize the monitoring reports to create corrective action
plans for providers, where necessary.
11. Reporting and Records Requirements- The State and Local Governments shall
follow their existing reporting and records retention requirements along with considering any
additional recommendations from the Opioid Abatement Taskforce or Council. Local
Governments shall respond and provide documents to any reasonable requests from the State or
Opioid Abatement Taskforce or Council for data or information about programs receiving Opioid
Funds. The State and Local Governments shall ensure that any provider or sub-recipient of Opioid
Funds at a minimum does the following:
(a) Any provider shall establish and maintain books, records and documents
(including electronic storage media) sufficient to reflect all income and expenditures of
Opioid Funds. Upon demand, at no additional cost to the State or Local Government, any
provider will facilitate the duplication and transfer of any records or documents during the
term that it receives any Opioid Funds and the required retention period for the State or
Local Government. These records shall be made available at all reasonable times for
inspection, review, copying, or audit by Federal, State, or other personnel duly authorized
by the State or Local Government.
(b) Any provider shall retain and maintain all client records, financial records,
supporting documents, statistical records, and any other documents (including electronic
storage media) pertinent to the use of the Opioid Funds during the term of its receipt of
Opioid Funds and retained for a period of six (6) years after its ceases to receives Opioid
Funds or longer when required by law. In the event an audit is required by the State of
Local Governments, records shall be retained for a minimum period of six (6) years after
the audit report is issued or until resolution of any audit findings or litigation based on the
terms of any award or contract.
(c) At all reasonable times for as long as records are maintained, persons duly
authorized by State or Local Government auditors shall be allowed full access to and the
right to examine any of the contracts and related records and documents, regardless of the
form in which kept.
(d) A financial and compliance audit shall be performed annually and provided to
the State.
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(e) All providers shall comply and cooperate immediately with any inspections,
reviews, investigations, or audits deemed necessary by The Office of the Inspector General
(section 20.055, F.S.) or the State.
(f) No record may be withheld nor may any provider attempt to limit the scope of
any of the foregoing inspections, reviews, copying, transfers or audits based on any claim
that any record is exempt from public inspection or is confidential, proprietary or trade
secret in nature; provided, however, that this provision does not limit any exemption to
public inspection or copying to any such record.
12. Expense Fund- The Parties agree that in any negotiation every effort shall be made
to cause Pharmaceutical Supply Chain Participants to pay costs of litigation, including attorneys'
fees, in addition to any agreed to Opioid Funds in the Settlement. To the extent that a fund
sufficient to pay the full contingent fees of Local Governments is not created as part of a Settlement
by a Pharmaceutical Supply Chain Participant, the Parties agree that an additional expense fund
for attorneys who represent Local Governments (herein "Expense Fund") shall be created out of
the City/County fund for the purpose of paying the hard costs of a litigating Local Government
and then paying attorneys' fees.
(a) The Source of Funds for the Expense Fund- Money for the Expense Fund
shall be sourced exclusively from the City/County Fund.
(b) The Amount of the Expense Fund- The State recognizes the value litigating
Local Governments bring to the State in connection with the Settlement because their
participation increases the amount of Incentive Payments due from each Pharmaceutical
Supply Chain Participant. In recognition of that value, the amount of funds that shall be
deposited into the Expense Fund shall be contingent upon on the percentage of litigating
Local Government participation in the Settlement, according to the following table:
Litigating Local Amount that shall be
Government Participation in paid into the Expense Fund
the Settlement(by from (and as a percentage
percentage of the population) o the City/County City/County fund
96 to 100% 10%
91 to 95% 7.5%
86 to 90% 5%
85% 2.5%
Less than 85% 0%
If fewer than 85% percent of the litigating Local Governments (by population) participate,
then the Expense Fund shall not be funded, and this Section of the Agreement shall be null and
void.
(c) The Timing of f Payments into the Expense Fund- Although the amount of
the Expense Fund shall be calculated based on the entirety of payments due to the
City/County fund over a ten-to-eighteen-year period, the Expense Fund shall be funded
entirely from payments made by Pharmaceutical Supply Chain Participants during the first
two payments of the Settlement. Accordingly, to offset the amounts being paid from the
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City/County Fund to the Expense Fund in the first two years, Counties or Municipalities
may borrow from the Regional Fund during the first two years and pay the borrowed
amounts back to the Regional Fund during years three, four, and five.
For the avoidance of doubt, the following provides an illustrative example regarding the
calculation of payments and amounts that may be borrowed under the terms of this MOU,
consistent with the provisions of this Section:
Opioid Funds due to State of Florida and Local Governments (over 10 $1,000
to 18 years):
Litigating Local Government Participation: 100%
City/County Fund (over 10 to 18 years): $150
Expense Fund(paid over 2 years): $15
Amount Paid to Expense Fund in 1 st year: $7.5
Amount Paid to Expense Fund in 2nd year $7.5
Amount that may be borrowed from Regional Fund in 1 st year: $7.5
Amount that may be borrowed from Regional Fund in 2nd year: $7.5
Amount that must be paid back to Regional Fund in 3rd year: $5
Amount that must be paid back to Regional Fund in 4th year: $5
Amount that must be paid back to Regional Fund in 5th year: $5
(d) Creation of and Jurisdiction over the Expense Fund- The Expense Fund
shall be established, consistent with the provisions of this Section of the Agreement, by
order of the Court. The Court shall have jurisdiction over the Expense Fund, including
authority to allocate and disburse amounts from the Expense Fund and to resolve any
disputes concerning the Expense Fund.
(e) Allocation of Payments to Counsel from the Expense Fund- As part of the
order establishing the Expense Fund, counsel for the litigating Local Governments shall
seek to have the Court appoint a third-neutral to serve as a special master for purposes of
allocating the Expense Fund. Within 30 days of entry of the order appointing a special
master for the Expense Fund, any counsel who intend to seek an award from the Expense
Fund shall provide the copies of their contingency fee contracts to the special master. The
special master shall then build a mathematical model, which shall be based on each
litigating Local Government's share under the Negotiation Class Metrics and the rate set
forth in their contingency contracts,to calculate a proposed award for each litigating Local
Government who timely provided a copy of its contingency contract.
13. Dispute resolution- Any one or more of the Local Governments or the State may
object to an allocation or expenditure of Opioid Funds solely on the basis that the allocation or
expenditure at issue (a) is inconsistent with the Approved Purposes; (b) is inconsistent with the
distribution scheme as provided in paragraph„ (c) violates the limitations set forth herein with
respect to administrative costs or the Expense Fund; or(d)to recover amounts advanced from the
Regional Fund for the Expense Fund. There shall be no other basis for bringing an objection to the
approval of an allocation or expenditure of Opioid Funds. In the event that there is a National
Settlement Administrator or similar entity,the Local Governments sole action for non-payment of
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amounts due from the City/County Fund shall be against the particular settling defendant and/or
the National Settlement Administrator or similar entity.
C. Other Terms and Conditions
1. Governing Law and Venue: This Agreement will be governed by the laws of the
State of Florida. Any and all litigation arising under the Agreement, unless otherwise specified in
this Agreement, will be instituted in either: (a) the Court that enters the Order if the matter deals
with a matter covered by the Order and the Court retains jurisdiction; or (b) the appropriate State
court in Leon County, Florida.
2. Agreement Management and Notification: The Parties have identified the
following individuals as Agreement Managers and Administrators:
a. State of Florida Agreement Manager:
Greg Slemp
PL-01, The Capitol, Tallahassee, FL 32399
850-414-3300
Greg.slemp@myfloridalegal.com
b. State of Florida Agreement Administrator
Janna Barineau
PL-01, The Capitol, Tallahassee, FL 32399
850-414-3300
Janna.barineau@myfloridalegal.com
C. Local Governments Agreement Managers and Administrators are listed on
Exhibit C to this Agreement.
Changes to either the Managers or Administrators may be made by notifying the other Party
in writing, without formal amendment to this Agreement.
3. Notices. All notices required under the Agreement will be delivered by certified
mail, return receipt requested, by reputable air courier, or by personal delivery to the designee
identified in paragraphs C.2., above. Either designated recipient may notify the other, in writing,
if someone else is designated to receive notice.
4. Cooperation with Inspector General: Pursuant to section 20.055, Florida Statutes,
the Parties, understand and will comply with their duty to cooperate with the Inspector General in
any investigation, audit, inspection, review, or hearing.
12
5. Public Records: The Parties will keep and maintain public records pursuant to
Chapter 119, Florida Statutes and will comply will all applicable provisions of that Chapter.
6. Modification: This Agreement may only be modified by a written amendment
between the appropriate parties.No promises or agreements made subsequent to the execution of this
Agreement shall be binding unless express,reduced to writing, and signed by the Parties.
7. Execution in Counterparts: This Agreement may be executed in any number of
counterparts, each of which shall be deemed to be an original, but all of which together shall
constitute one and the same instrument.
8. Assignment: The rights granted in this Agreement may not be assigned or
transferred by any party without the prior written approval of the other party. No party shall be
permitted to delegate its responsibilities or obligations under this Agreement without the prior
written approval of the other parties.
9. Additional Documents: The Parties agree to cooperate fully and execute any and
all supplementary documents and to take all additional actions which may be reasonably necessary
or appropriate to give full force and effect to the basic terms and intent of this Agreement.
10. Captions: The captions contained in this Agreement are for convenience only and
shall in no way define, limit, extend or describe the scope of this Agreement or any part of it.
11. Entire Agreement: This Agreement,including any attachments,embodies the entire
agreement of the parties. There are no other provisions, terms, conditions, or obligations. This
Agreement supersedes all previous oral or written communications,representations or agreements
on this subject.
12. Construction: The parties hereto hereby mutually acknowledge and represent that
they have been fully advised by their respective legal counsel of their rights and responsibilities
under this Agreement, that they have read, know, and understand completely the contents hereof,
and that they have voluntarily executed the same. The parties hereto further hereby mutually
acknowledge that they have had input into the drafting of this Agreement and that, accordingly, in
any construction to be made of this Agreement, it shall not be construed for or against any party,
but rather shall be given a fair and reasonable interpretation, based on the plain language of the
Agreement and the expressed intent of the parties.
13. Capacity to Execute Agreement: The parties hereto hereby represent and warrant
that the individuals signing this Agreement on their behalf are duly authorized and fully competent
to do so.
13
EXHIBIT A
Schedule A
Core Strategies
States and Qualifying Block Grantees shall choose from among the abatement strategies listed in
Schedule B. However,priority shall be given to the following core abatement strategies ("Core
Strategies")[, such that a minimum of % of the [aggregate] state-level abatement distributions shall
be spent on [one or more of] them annually].'
A. Naloxone or other FDA-approved drug to reverse opioid overdoses
1. Expand training for first responders, schools, community support groups and families; and
2. Increase distribution to individuals who are uninsured or whose insurance does not cover the needed
service.
B. Medication-Assisted Treatment("MAT")Distribution and other opioid-related treatment
1. Increase distribution of MAT to non-Medicaid eligible or uninsured individuals;
2. Provide education to school-based and youth-focused programs that discourage or prevent misuse;
3. Provide MAT education and awareness training to healthcare providers, EMTs,law enforcement,
and other first responders; and
4. Treatment and Recovery Support Services such as residential and inpatient treatment, intensive
outpatient treatment, outpatient therapy or counseling, and recovery housing that allow or integrate
medication with other support services.
C. Pregnant& Postpartum Women
1. Expand Screening, Brief Intervention, and Referral to Treatment("SBIRT") services to non-
Medicaid eligible or uninsured pregnant women;
2. Expand comprehensive evidence-based treatment and recovery services, including MAT, for women
with co-occurring Opioid Use Disorder("OUD") and other Substance Use Disorder("SUD")/Mental
Health disorders for uninsured individuals for up to 12 months postpartum; and
3. Provide comprehensive wrap-around services to individuals with Opioid Use Disorder(OUD)
including housing,transportation,job placement/training, and childcare.
D. Expanding Treatment for Neonatal Abstinence Syndrome
1. Expand comprehensive evidence-based and recovery support for NAS babies;
2. Expand services for better continuum of care with infant-need dyad; and
3. Expand long-term treatment and services for medical monitoring of NAS babies and their families.
i As used in this Schedule A,words like"expand,""fund,""provide"or the like shall not indicate a preference for new or
existing programs. Priorities will be established through the mechanisms described in the Term Sheet.
1
E. Expansion of Warm Hand-off Programs and Recovery Services
1. Expand services such as navigators and on-call teams to begin MAT in hospital emergency
departments;
2. Expand warm hand-off services to transition to recovery services;
3. Broaden scope of recovery services to include co-occurring SUD or mental health conditions. ;
4. Provide comprehensive wrap-around services to individuals in recovery including housing,
transportation,job placement/training, and childcare; and
5. Hire additional social workers or other behavioral health workers to facilitate expansions above.
F. Treatment for Incarcerated Population
1. Provide evidence-based treatment and recovery support including MAT for persons with OUD and
co-occurring SUD/MH disorders within and transitioning out of the criminal justice system; and
2. Increase funding for j ails to provide treatment to inmates with OUD.
G. Prevention Programs
1. Funding for media campaigns to prevent opioid use (similar to the FDA's "Real Cost" campaign to
prevent youth from misusing tobacco);
2. Funding for evidence-based prevention programs in schools.;
3. Funding for medical provider education and outreach regarding best prescribing practices for opioids
consistent with the 2016 CDC guidelines, including providers at hospitals (academic detailing);
4. Funding for community drug disposal programs; and
5. Funding and training for first responders to participate in pre-arrest diversion programs,post-
overdose response teams, or similar strategies that connect at-risk individuals to behavioral health
services and supports.
H. Expanding Syringe Service Programs
1. Provide comprehensive syringe services programs with more wrap-around services including linkage
to OUD treatment, access to sterile syringes, and linkage to care and treatment of infectious diseases.
L Evidence-based data collection and research analyzing the effectiveness of the abatement strategies
within the State.
2
EXHIBIT B
Schedule B
Approved Uses
PART ONE: TREATMENT
A. TREAT OPIOID USE DISORDER(OUD)
Support treatment of Opioid Use Disorder(OUD) and any co-occurring Substance Use Disorder or
Mental Health(SUD/MH) conditions through evidence-based or evidence-informed 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 support services.
4. Improve oversight of Opioid Treatment Programs (OTPs) to assure evidence-based or evidence-
informed practices such as adequate methadone dosing and low threshold approaches to treatment.
5. Support mobile intervention, treatment, and recovery services, offered by qualified professionals and
service providers, such as peer recovery coaches, for persons with OUD and any co-occurring
SUD/MH conditions and for persons who have experienced an opioid overdose.
6. Treatment of trauma for individuals with OUD (e.g., violence, sexual assault, human trafficking, or
adverse childhood experiences) and family members (e.g., surviving family members after an overdose
or overdose fatality), and training of health care personnel to identify and address such trauma.
7. Support evidence-based withdrawal management services for people with OUD and any co-
occurring mental health conditions.
8. Training on MAT for health care providers, first responders, students, or other supporting
professionals, such as peer recovery coaches or recovery outreach specialists, including telementoring
to assist community-based providers in rural or underserved areas.
9. Support workforce development for addiction professionals who work with persons with OUD and
any co-occurring SUD/MH conditions.
10. Fellowships for addiction medicine specialists for direct patient care, instructors, and clinical
research for treatments.
11. Scholarships and supports for behavioral health practitioners or workers involved in addressing
OUD and any co-occurring SUD or mental health conditions, including but not limited to training,
z As used in this Schedule B,words like"expand,""fund,""provide"or the like shall not indicate a preference for new or
existing programs. Priorities will be established through the mechanisms described in the Term Sheet.
3
scholarships, fellowships, loan repayment programs, or other incentives for providers to work in rural
or underserved areas.
12. [Intentionally Blank—to be cleaned up later for numbering]
13. Provide funding and training for clinicians to obtain a waiver under the federal Drug Addiction
Treatment Act of 2000 (DATA 2000)to prescribe MAT for OUD, and provide technical assistance and
professional support to clinicians who have obtained a DATA 2000 waiver.
14. Dissemination of web-based training curricula, such as the American Academy of Addiction
Psychiatry's Provider Clinical Support Service-Opioids web-based training curriculum and
motivational interviewing.
15. Development and dissemination of new curricula, such as the American Academy of Addiction
Psychiatry's Provider Clinical Support Service for Medication-Assisted Treatment.
B. SUPPORT PEOPLE IN TREATMENT AND RECOVERY
Support people in treatment for or recovery from OUD and any co-occurring SUD/MH conditions
through evidence-based or evidence-informed programs or strategies that may include,but are not
limited to, the following:
1. Provide comprehensive wrap-around services to individuals with OUD and any co-occurring
SUD/MH conditions,including housing, transportation, education,job placement,job training, or
childcare.
2. Provide the full continuum of care of treatment and recovery services for OUD and any co-occurring
SUD/M I conditions, including supportive housing, peer support services and counseling, community
navigators, case management, and connections to community-based services.
3. Provide counseling,peer-support,recovery case management and residential treatment with access to
medications for those who need it to persons with OUD and any co-occurring SUD/MH conditions.
4. Provide access to housing for people with OUD and any co-occurring SUD/MH conditions,
including supportive housing, recovery housing, housing assistance programs, training for housing
providers, or recovery housing programs that allow or integrate FDA-approved medication with other
support services.
5. Provide community support services, including social and legal services, to assist in
deinstitutionalizing persons with OUD and any co-occurring SUD/MH conditions.
6. Support or expand peer-recovery centers, which may include support groups, social events, computer
access, or other services for persons with OUD and any co-occurring SUD/MH conditions.
7. Provide or support transportation to treatment or recovery programs or services for persons with
OUD and any co-occurring SUD/MH conditions.
8. Provide employment training or educational services for persons in treatment for or recovery from
OUD and any co-occurring SUD/MH conditions.
4
9. Identify successful recovery programs such as physician, pilot, and college recovery programs, and
provide support and technical assistance to increase the number and capacity of high-quality programs
to help those in recovery.
10. Engage non-profits, faith-based communities, and community coalitions to support people in
treatment and recovery and to support family members in their efforts to support the person with OUD
in the family.
11. Training and development of procedures for government staff to appropriately interact and provide
social and other services to individuals with or in recovery from OUD, including reducing stigma.
12. Support stigma reduction efforts regarding treatment and support for persons with OUD, including
reducing the stigma on effective treatment.
13. Create or support culturally appropriate services and programs for persons with OUD and any co-
occurring SUD/MH conditions, including new Americans.
14. Create and/or support recovery high schools.
15. Hire or train behavioral health workers to provide or expand any of the services or supports listed
above.
C. CONNECT PEOPLE WHO NEED HELP TO THE HELP THEY NEED (CONNECTIONS
TO CARE)
Provide connections to care for people who have—or at risk of developing— OUD and any co-
occurring SUD/MH conditions through evidence-based or evidence-informed programs or strategies
that may include,but are not limited to, the following:
1. Ensure that health care providers are screening for OUD and other risk factors and know how to
appropriately counsel and treat(or refer if necessary) a patient for OUD treatment.
2. Fund Screening, Brief Intervention and Referral to Treatment(SBIRT)programs to reduce the
transition from use to disorders,including SBIRT services to pregnant women who are uninsured or not
eligible for Medicaid.
3. Provide training and long-term implementation of SBIRT in key systems (health, schools, colleges,
criminal justice, and probation), with a focus on youth and young adults when transition from misuse to
opioid disorder is common.
4. Purchase automated versions of SBIRT and support ongoing costs of the technology.
5. Expand services such as navigators and on-call teams to begin MAT in hospital emergency
departments.
6. Training for emergency room personnel treating opioid overdose patients on post-discharge planning,
including community referrals for MAT, recovery case management or support services.
7. Support hospital programs that transition persons with OUD and any co-occurring SUD/MH
conditions, or persons who have experienced an opioid overdose, into clinically-appropriate follow-up
care through a bridge clinic or similar approach.
5
8. Support crisis stabilization centers that serve as an alternative to hospital emergency departments for
persons with OUD and any co-occurring SUD/MH conditions or persons that have experienced an
opioid overdose.
9. Support the work of Emergency Medical Systems, including peer support specialists, to connect
individuals to treatment or other appropriate services following an opioid overdose or other opioid-
related adverse event.
10. Provide funding for peer support specialists or recovery coaches in emergency departments, detox
facilities, recovery centers, recovery housing, or similar settings; offer services, supports, or
connections to care to persons with OUD and any co-occurring SUD/MH conditions or to persons who
have experienced an opioid overdose.
11. Expand warm hand-off services to transition to recovery services.
12. Create or support school-based contacts that parents can engage with to seek immediate treatment
services for their child; and support prevention, intervention, treatment, and recovery programs focused
on young people.
13. Develop and support best practices on addressing OUD in the workplace.
14. Support assistance programs for health care providers with OUD.
15. Engage non-profits and the faith community as a system to support outreach for treatment.
16. Support centralized call centers that provide information and connections to appropriate services
and supports for persons with OUD and any co-occurring SUD/MH conditions.
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 that may include,but are not limited to,
the following:
1. Support pre-arrest or pre-arraignment diversion and deflection strategies for persons with OUD and
any co-occurring SUD/MH conditions, including established strategies such as:
a. Self-referral strategies such as the Angel Programs or the Police Assisted Addiction Recovery
Initiative (PAARI);
b. Active outreach strategies such as the Drug Abuse Response Team(DART)model;
c. "Naloxone Plus" strategies, which work to ensure that individuals who have received
naloxone to reverse the effects of an overdose are then linked to treatment programs or other
appropriate services;
d. Officer prevention strategies, such as the Law Enforcement Assisted Diversion (LEAD)
model;
e. Officer intervention strategies such as the Leon County, Florida Adult Civil Citation Network
or the Chicago Westside Narcotics Diversion to Treatment Initiative; or
6
f Co-responder and/or alternative responder models to address OUD-related 911 calls with
greater SUD expertise
2. Support pre-trial services that connect individuals with OUD and any co-occurring SUD/MH
conditions to evidence-informed treatment, including MAT, and related services.
3. Support treatment and recovery courts that provide evidence-based options for persons with OUD
and any co-occurring SUD/MH conditions
4. Provide evidence-informed treatment, including MAT,recovery support, harm reduction, or other
appropriate services to individuals with OUD and any co-occurring SUD/MH conditions who are
incarcerated in j ail or prison.
5. Provide evidence-informed treatment, including MAT,recovery support, harm reduction, or other
appropriate services to individuals with OUD and any co-occurring SUD/MH conditions who are
leaving j ail or prison have recently left j ail or prison, are on probation or parole, are under community
corrections supervision, or are in re-entry programs or facilities.
6. Support critical time interventions (CTI), particularly for individuals living with dual-diagnosis
OUD/serious mental illness, and services for individuals who face immediate risks and service needs
and risks upon release from correctional settings.
7. Provide training on best practices for addressing the needs of criminal-justice-involved persons with
OUD and any co-occurring SUD/MH conditions to law enforcement, correctional, or judicial personnel
or to providers of treatment, recovery, harm reduction, case management, or other services offered in
connection with any of the strategies described in this section.
E.ADDRESS THE NEEDS OF PREGNANT OR PARENTING WOMEN AND THEIR
FAMILIES,INCLUDING BABIES WITH NEONATAL ABSTINENCE SYNDROME
Address the needs of pregnant or parenting women with OUD and any co-occurring SUD/MH
conditions, and the needs of their families, including babies with neonatal abstinence syndrome (NAS),
through evidence-based or evidence-informed programs or strategies that may include,but are not
limited to, the following:
1. Support evidence-based or evidence-informed treatment, including MAT, recovery services and
supports, and prevention services for pregnant women—or women who could become pregnant—who
have OUD and any co-occurring SUD/MH conditions, and other measures to educate and provide
support to families affected by Neonatal Abstinence Syndrome.
2. Expand comprehensive evidence-based treatment and recovery services, including MAT, for
uninsured women with OUD and any co-occurring SUD/MH conditions for up to 12 months
postpartum.
3. Training for obstetricians or other healthcare personnel that work with pregnant women and their
families regarding treatment of OUD and any co-occurring SUD/MH conditions.
4. Expand comprehensive evidence-based treatment and recovery support for NAS babies; expand
services for better continuum of care with infant-need dyad; expand long-term treatment and services
for medical monitoring of NAS babies and their families.
7
5. Provide training to health care providers who work with pregnant or parenting women on best
practices for compliance with federal requirements that children born with Neonatal Abstinence
Syndrome get referred to appropriate services and receive a plan of safe care.
6. Child and family supports for parenting women with OUD and any co-occurring SUD/MFI
conditions.
7. Enhanced family supports and child care services for parents with OUD and any co-occurring
SUD/MfI conditions.
8. Provide enhanced support for children and family members suffering trauma as a result of addiction
in the family; and offer trauma-informed behavioral health treatment for adverse childhood events.
9. Offer home-based wrap-around services to persons with OUD and any co-occurring SUD/MFI
conditions, including but not limited to parent skills training.
10. Support for Children's Services—Fund additional positions and services, including supportive
housing and other residential services, relating to children being removed from the home and/or placed
in foster care due to custodial opioid use.
PART TWO: PREVENTION
F. PREVENT OVER-PRESCRIBING AND ENSURE APPROPRIATE PRESCRIBING AND
DISPENSING OF OPIOIDS
Support efforts to prevent over-prescribing and ensure appropriate prescribing and dispensing of
opioids through evidence-based or evidence-informed programs or strategies that may include,but are
not limited to, the following:
1. Fund medical provider education and outreach regarding best prescribing practices for opioids
consistent with Guidelines for Prescribing Opioids for Chronic Pain from the U.S. Centers for Disease
Control and Prevention, including providers at hospitals (academic detailing).
2. Training for health care providers regarding safe and responsible opioid prescribing, dosing, and
tapering patients off opioids.
3. Continuing Medical Education (CME) on appropriate prescribing of opioids.
4. Support for non-opioid pain treatment alternatives, including training providers to offer or refer to
multi-modal, evidence-informed treatment of pain.
5. Support enhancements or improvements to Prescription Drug Monitoring Programs (PDMPs),
including but not limited to improvements that:
a. Increase the number of prescribers using PDMPs;
b. Improve point-of-care decision-making by increasing the quantity, quality, or format of data
available to prescribers using PDMPs,by improving the interface that prescribers use to access
PDMP data, or both; or
8
c. Enable states to use PDMP data in support of surveillance or intervention strategies, including
MAT referrals and follow-up for individuals identified within PDMP data as likely to
experience OUD in a manner that complies with all relevant privacy and security laws and rules.
6. Ensuring PDMPs incorporate available overdo se/naloxone deployment data, including the United
States Department of Transportation's Emergency Medical Technician overdose database in a manner
that complies with all relevant privacy and security laws and rules.
7. Increase electronic prescribing to prevent diversion or forgery.
8. Educate Dispensers on appropriate opioid dispensing.
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:
1. Fund media campaigns to prevent opioid misuse.
2. Corrective advertising or affirmative public education campaigns based on evidence.
3. Public education relating to drug disposal.
4. Drug take-back disposal or destruction programs.
5. Fund community anti-drug coalitions that engage in drug prevention efforts.
6. Support community coalitions in implementing evidence-informed prevention, such as reduced
social access and physical access, stigma reduction—including staffing, educational campaigns, support
for people in treatment or recovery, or training of coalitions in evidence-informed implementation,
including the Strategic Prevention Framework developed by the U.S. Substance Abuse and Mental
Health Services Administration (SAMHSA).
7. Engage non-profits and faith-based communities as systems to support prevention.
8. Fund evidence-based prevention programs in schools or evidence-informed school and community
education programs and campaigns for students, families, school employees, school athletic programs,
parent-teacher and student associations, and others.
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 of support community-based education or intervention services for families, youth, and
adolescents at risk for OUD and any co-occurring SUD/MH conditions.
11. Support evidence-informed programs or curricula to address mental health needs of young people
who may be at risk of misusing opioids or other drugs, including emotional modulation and resilience
skills.
12. Support greater access to mental health services and supports for young people, including services
and supports provided by school nurses, behavioral health workers or other school staff, to address
9
mental health needs in young people that(when not properly addressed)increase the risk of opioid or
other drug misuse.
H. PREVENT OVERDOSE DEATHS AND OTHER HARMS (HARM REDUCTION)
Support efforts to prevent or reduce overdose deaths or other opioid-related harms through evidence-
based or evidence-informed programs or strategies that may include,but are not limited to, the
following:
1. Increase availability and distribution of naloxone and other drugs that treat overdoses for first
responders, overdose patients,individuals with OUD and their friends and family members, individuals
at high risk of overdose, schools, community navigators and outreach workers, persons being released
from jail or prison, or other members of the general public.
2. Public health entities provide free naloxone to anyone in the community
3. Training and education regarding naloxone and other drugs that treat overdoses for first responders,
overdose patients,patients taking opioids, families, schools, community support groups, and other
members of the general public.
4. Enable school nurses and other school staff to respond to opioid overdoses, and provide them with
naloxone,training, and support.
5. Expand, improve, or develop data tracking software and applications for overdoses/naloxone
revivals.
6. Public education relating to emergency responses to overdoses.
7. Public education relating to immunity and Good Samaritan laws.
8. Educate first responders regarding the existence and operation of immunity and Good Samaritan
laws.
9. Syringe service programs and other evidence-informed programs to reduce harms associated with
intravenous drug use, including supplies, staffing, space,peer support services, referrals to treatment,
fentanyl checking, connections to care, and the full range of harm reduction and treatment services
provided by these programs.
10. Expand access to testing and treatment for infectious diseases such as HIV and Hepatitis C resulting
from intravenous opioid use.
11. Support mobile units that offer or provide referrals to harm reduction services, treatment, recovery
supports, health care, or other appropriate services to persons that use opioids or persons with OUD and
any co-occurring SUD/MH conditions.
12. Provide training in harm reduction strategies to health care providers, students, peer recovery
coaches, recovery outreach specialists, or other professionals that provide care to persons who use
opioids or persons with OUD and any co-occurring SUD/MH conditions.
13. Support screening for fentanyl in routine clinical toxicology testing.
10
PART THREE: OTHER STRATEGIES
I. FIRST RESPONDERS
In addition to items in sections C, D, and H relating to first responders, support the following:
1. Educate law enforcement or other first responders regarding appropriate practices and precautions
when dealing with fentanyl or other drugs.
2. Provision of wellness and support services for first responders and others who experience secondary
trauma associated with opioid-related emergency events.
J. LEADERSHIP,PLANNING AND COORDINATION
Support efforts to provide leadership,planning, coordination, facilitation, training and technical
assistance to abate the opioid epidemic through activities, programs, or strategies that may include,but
are not limited to, the following:
1. Statewide, regional, local, or community regional planning to identify root causes of addiction and
overdose, goals for reducing harms related to the opioid epidemic, and areas and populations with the
greatest needs for treatment intervention services; to support training and technical assistance; or to
support other strategies to abate the opioid epidemic described in this opioid abatement strategy list.
2. A dashboard to share reports, recommendations, or plans to spend opioid settlement funds; to show
how opioid settlement funds have been spent; to report program or strategy outcomes; or to track, share,
or visualize key opioid-related or health-related indicators and supports as identified through
collaborative statewide, regional, local, or community processes.
3. Invest in infrastructure or staffing at government or not-for-profit agencies to support collaborative,
cross-system coordination with the purpose of preventing overprescribing, opioid misuse, or opioid
overdoses, treating those with OUD and any co-occurring SUD/MH conditions, supporting them in
treatment or recovery, connecting them to care, or implementing other strategies to abate the opioid
epidemic described in this opioid abatement strategy list.
4. Provide resources to staff government oversight and management of opioid abatement programs.
K. TRAINING
In addition to the training referred to throughout this document, support training to abate the opioid
epidemic through activities,programs, or strategies that may include,but are not limited to, the
following:
1. Provide funding for staff training or networking programs and services to improve the capability of
government, community, and not-for-profit entities to abate the opioid crisis.
2. Support infrastructure and staffing for collaborative cross-system coordination to prevent opioid
misuse,prevent overdoses, and treat those with OUD and any co-occurring SUD/MH conditions, or
implement other strategies to abate the opioid epidemic described in this opioid abatement strategy list
(e.g., health care,primary care,pharmacies, PDMPs, etc.).
L. RESEARCH
11
Support opioid abatement research that may include, but is not limited to,the following:
1. Monitoring, surveillance, data collection, and evaluation of programs and strategies described in this
opioid abatement strategy list.
2. Research non-opioid treatment of chronic pain.
3. Research on improved service delivery for modalities such as SBIRT that demonstrate promising but
mixed results in populations vulnerable to opioid use disorders.
4. Research on novel harm reduction and prevention efforts such as the provision of fentanyl test strips.
5. Research on innovative supply-side enforcement efforts such as improved detection of mail-based
delivery of synthetic opioids.
6. Expanded research on swift/certain/fair models to reduce and deter opioid misuse within criminal
justice populations that build upon promising approaches used to address other substances (e.g. Hawaii
HOPE and Dakota 24/7).
7. Epidemiological surveillance of OUD-related behaviors in critical populations including individuals
entering the criminal justice system, including but not limited to approaches modeled on the Arrestee
Drug Abuse Monitoring (ADAM) system.
8. Qualitative and quantitative research regarding public health risks and harm reduction opportunities
within illicit drug markets, including surveys of market participants who sell or distribute illicit opioids.
9. Geospatial analysis of access barriers to MAT and their association with treatment engagement and
treatment outcomes.
12