Item O3 03
BOARD OF COUNTY COMMISSIONERS
COUNTY of MONROE �� i Mayor Holly Merrill Raschein,District 5
The Florida Keys Mayor Pro Tern James K.Scholl,District 3
Craig Cates,District 1
Michelle Lincoln,District 2
' David Rice,District 4
Board of County Commissioners Meeting
September 11, 2024
Agenda Item Number: 03
2023-2961
BULK ITEM: Yes DEPARTMENT: Administration
TIME APPROXIMATE: STAFF CONTACT: Cynthia Hall
N/A
AGENDA ITEM WORDING: Approval of resolution approving FY 2025 plan for utilization of
opioid settlement funds.
ITEM BACKGROUND:
The purpose of this agenda item is to seek approval to a resolution laying out a plan for utilization of
settlement funds from the County as a plaintiff in an opioid class action lawsuit. The resolution covers
state fiscal year 2025.
In 2019, Monroe County filed suit against manufacturers and distributors of opioid products, including
CVS, Walgreen, Walmart, Johnson & Johnson, and others. The suit was absorbed within the
nationwide multi-district litigation. Ultimately, many of the defendants (other than those in bankruptcy)
entered into settlements with states, and ultimately with local governments, including Monroe County.
One of the terms of the settlement agreement that Monroe County entered into as part of the opioid class
action litigation was that each year, the County would submit a plan to Florida Department of Children
& Families stating how the County intends to spent the settlement proceeds. The intent of this
provision is to ensure that the funds are being spent for one of the approved uses, which are listed in
Schedule A and Schedule B to a Memorandum of Understanding that all parties signed as part of the
settlement documents.
Each year, the County will be receiving two sources of funds. Local Funds will be given directly to the
County by the various settling defendants. In addition, Monroe County's Regional Managing Entity
(South Florida Behavioral Health Network d/b/a Thriving Mind)will receive an additional amount,
which they will give directly to Guidance/Care Center for opioid programs. In Fiscal Year 2024
(ending 7/31/2024), the County received $171,051.41 in Local Funds and an additional $807,273.81 in
Regional Funds. As of the end of the fiscal year, Guidance Care Center(GCC) had spend and the RME
had reimbursed a total of$383,476.52 in Regional Funds. The balance ($423,797.29)will be rolled
over and carried forward for FY 2025.
In January 2024, the BOCC approved the plan for FY 2024. Terms of master settlement agreement
require the County to approve a new plan each year. County staff have conferred with Guidance/Care
Center and with Thriving Mind, and have prepared a plan recommending how the County will use the
settlement funds in FY 2025. The FY 2025 plan continues to use the settlement funds to support the
same programs as in FY 2024. In broad terms, approximately 93% of funds will be used for adult
substance abuse programs, through a combination of programs offered to inmates at the Monroe County
Detention Center and also through outpatient services offered by the Guidance/Care Center. An
additional 7%will be used for preventative programs offered to middle school students.
PREVIOUS RELEVANT BOCC ACTION:
1/31/2024: BOCC approved plan for FY 2024
INSURANCE REQUIRED:
No
CONTRACT/AGREEMENT CHANGES:
N/A
STAFF RECOMMENDATION: Approval.
DOCUMENTATION:
Resolution approving plan for utilization of opioid settlement funds FY 2025.pdf
Exhibit A, Opioid Settlement Monroe County Plan 2025.pdf
FINANCIAL IMPACT:
N/A
RESOLUTION NO. -2025
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 2025.
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 2025 (year 3 of settlement payments), Monroe County
expects to receive approximately $4787378.83. Of this, the County expects $92,080.83
to come to Monroe County directly ("Local Funds"). An additional $386,307 ("Regional
Funds") is expected to be 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
WHEREAS, Monroe County has worked with the Guidance/Care Center to formulate a
1
plan for use of the settlement funds in FY 2025; and
WHEREAS, in broad terms, and as set forth in the Plan attached as Exhibit A to this
Resolution, in FY 2025, the County expects to use the funds to continue the programs
set forth 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,
2024 to June 20, 2025 (corresponding to state fiscal year 2025).
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 2025)," 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 11t" of September, 2024.
Mayor Holly Merrill Raschein
Mayor Pro Tern James K. Scholl
Commissioner Craig Cates
Commissioner Michelle Lincoln
Commissioner David Rice
Attest: KEVIN MADOK, CLERK BOARD OF COUNTY
COMMISSIONERS OF MONROE
COUNTY, FLORIDA
By: By:
As Deputy Clerk Mayor Holly Merrill Raschein
Approved as to form and legal sufficiency:
Monroe County Attorney's Office 8-27-2024
2
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PLAN FOR UTILIZATION OF LOCAL AND
REGIONAL OPIOID LITIGATION
SETTLEMENT FUNDS
(Fiscal Year 2025)
EXHIBIT A
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 (Year 2 of settlement fund payments), Monroe County received a total of
$171,051.41 in Local Funds,2 and an additional $807,273.81 in Regional Funds. Of the
Regional Funds, as of the end of the fiscal year, GCC had spent and the RME had
reimbursed a total of$383,476.52, as follows:
01 Assessment $ 10,062.69
02 Case Management $ 21,633.97
11 Intervention-Individual $ 553.83
14-Outpatient-Individual $ 33,184.09
24 Inpatient Detoxification $ 249,035.83
1 This amount is an average over 18 years. The figures vary, by year and by defendant. Therefore,the dollar
amounts for both the Local Funds and Regional Funds will differ each year. Most of the payments are front-end
loaded, i.e., higher in the earlier years.
z In December 2023, Monroe County received seven (7)checks from the following defendants: CVS,Allergan,
Walgreen,Teva,Janssen (Johnson&Johnson),Walmart,and a group of Distributors.
Page 2
08 In-Home&Onsite $ 321.05
35 Outpatient(Group) $ 68,685.06
Total $ 383,476.52
The balance for the fiscal year ($423,797.29) will be rolled over (carried forward) to FY
2025.3
In FY 2025, Monroe County expects to receive $92,080.83 in Local Funds from payments
from Defendants. The County also expects to receive an additional $386,307 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 to support
the programs identified in this Plan.
11e Il.')U11-lJ 0 Of 1"I� 'trJ II[OW 'fllie COU11111, r uIIll Ill 'trJ
;,all and dL)J1111IIll j f M year 20211.'11
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 filed its report
in July 2024.
During FY 2025, Monroe County intends to continue using its Local Funds and Regional
Funds on essentially the same programs as in FY 2024. Monroe County's plan for the
opiate settlement funds during fiscal year 2025 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%) will be used for school-based
preventative efforts.
s The high remaining balance is likely attributable to the fact that statewide,plans were not approved until
January 2024,halfway through the state fiscal year.
Page 13
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:
Adult 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.
(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.
Page 14
• 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 orfor 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
School-Based Prevention Efforts in
Monroe County Middle Schools
In addition, Regional Funds from the Regional Managing Entity will be used to support
the Guidance/Care Center's school-based prevention efforts for OUD in middle schools
in Monroe County.
A c,u))t 1F1iiie
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.
Page 15
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.
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.
Page 16
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Ises uu Sc[iier,/Jh)),II e s A 'i t c, 'tII e VI 0 U J.
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
• (1)- Increase Distribution of MAT to non-Medicaid eligible or uninsured
individuals-,
• (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)
* (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
* (2) Increase funding forjails 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
Page 17
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
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.
Page 18
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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