ASSEMBLY BUDGET TO OF SUB ONE ON
HEALTH AND HUMAN SERVICES
TODAY'S HEARING COVER SUBSTANCE
ABUSE AND ADDICTION PROGRAMS AND
ISSUES.
JUST TO BE CLEAR WE ADJOURN THE
JOINT INFORMATIONAL HEARING ON
HEALTH CARE WORKFORCE AND THIS
IS NOW OUR REGULAR SUB ONE
HEARING.
IF THE FIRST PANEL WOULD PLEASE
COME TO THE TABLE WE WILL BEGIN
.
AND IF WE COULD HAVE THE
TESTIMONY IN THE ORDER IN WHICH
IT IS LISTED.
DR KAREN SMITH.
AARON KLEIN MONICA MORALIS TERRY
SUIT KANALI.
ILEANA RAMOS AND SONYA AT TECH.
WELL ISN'T THIS WONDERFUL A
PANEL OF ALL WOMEN I LOVE IT.
PUBLIC HEALTH TAKEN CARE THE
PUBLIC THERE WE GO [inaudible]
BUT CAL.
I'M TODAY I'M GOING TO TALK
BRIEFLY ABOUT THE PUBLIC HEALTH
ROLE IN SUBSTANCE USE AND THEN
I'M GOING TO TRANSITION TO TALK
A LITTLE BIT ABOUT THE OPIATE
OVERDOSE.
RESPONSE PROVIDE YOU A LITTLE
BIT OF AN OVERVIEW BEFORE WE
MOVE ON TO THE OTHER MEMBERS OF
THE OF THE PANEL HERE.
SO THERE ARE SEVERAL PROGRAMS
WITHIN THE DEPARTMENT WHICH I'M
TOUCH ON OR HAVE AS ONE OF THEIR
FOCI -- PREVENTION OF SUBSTANCE
INTO SUBSTANCE USE AND ADDICTION
AND THESE INCLUDE OPIOIDS
TOBACCO CANNABIS AND PROBLEM
GAMBLING.
THESE PROGRAMS HAVE IN COMMON
THAT THEY WORK ON RISK FACTORS
THAT OFTEN LOSE LEAD TO
SUBSTANCE USE AND ADDICTION
THINGS LIKE -- HAVING
EXPERIENCED TRAUMA SOCIO
ECONOMIC TO DISADVANTAGE.
CITY DURING CHILDHOOD AND AND
COMMUNITY ADVERSITY.
THE COMMON APPROACH THAT WE HAVE
IS TO CONDUCT SURVEILLANCE TO
CONVENE PARTNERS TO REMOTE
LOCALLY ADAPTED INTERVENTIONS
AND THEN TO CARRY OUT PUBLIC
EDUCATION.
WE CONDUCT REGULAR ONGOING
SURVEILLANCE ON THE BURDEN AND
HEALTH IMPACTS OF PROBLEM
GAMBLING OPIATE ADDICTION AND
TOBACCO ADDICTION WE ALSO HAVE
SOME PRIOR YEAR DATA AVAILABLE
ON ON ALCOHOL USE AND OTHER
DRUGS -- BAR FOCUS TODAY THOSE
GOING TO BE ON OPIATES.
WHAT THE CALIFORNIA OPIOID
SURVEILLANCE DASHBOARD -- HAS A
A WEALTH OF INFORMATION DOWN TO
THE COMMUNITY LEVEL ABOUT OPIATE
CURRENT OPIATE USE AND TRENDS
OVER TIME.
I MEAN IT JUST SOME OF THE DATA
POINTS THAT I WAS ASKED.
TO CONVEY TO YOU -- FOUR
THOUSAND EIGHT HUNDRED SIXTY
EIGHT CALIFORNIANS DIED OF DRUG
OVERDOSES IN 201-720-00100
NINETY SIX OF WHICH WERE OPIATES --
SPOKE IT IS VERY CLEARLY A
DOMINANT -- DRUG OF ABUSE.
SIMILARLY THERE WERE FORTY SIX
THOUSAND NINETY EMERGENCY
DEPARTMENT VISITS -- HAVING TO
DO WITH US SUBSTANCE USE OF
THOSE EIGHT THOUSAND THREE
HUNDRED SEVENTY SIX WERE DUE TO
APPEAR TO DO ALSO HAVE SOME
ADDITIONAL DATA IN YOUR PACKET --
THAT SHOWS YOU SOME FOR EXAMPLE
THE EMERGENCY DEPARTMENT VISITS
WHICH ARE OVERWHELMINGLY RELATED
TO ALCOHOL AS OPPOSED TO OTHER
SUBSTANCES.
AND THEN THERE WERE THREE
THOUSAND TWO HUNDRED SIXTY FOUR
OPIOID ASSOCIATED HOSPITAL
ADMISSIONS AS WELL.
I'M SINCE TWENTY FOURTEEN
HOWEVER THE GOOD NEWS WE'VE SEEN
DECREASES IN THE NUMBER OF
PRESCRIPTIONS DISPENSED THE
NUMBER OF PRESCRIPTION RELATED
OF YOUR OPIATE OVERDOSE DEATHS.
INCREASING PRESCRIBERS
UTILIZATION OF THE CONTROLLED
SUBSTANCE UTILIZATION AND
EVALUATION SYSTEM THAT
CALIFORNIA'S PRESCRIPTION DRUG
MONITORING PROGRAM.
ALSO KNOWN AS CURES WE'VE ALSO
SEEN SIGNIFICANT INCREASES IN
ACCESS AND USE OF MEDICALLY
ASSISTED THERAPY -- INCLUDING
BUPRENORPHINE.
AND RECENTLY THOUGH WE'VE SEEN
MAJOR INCREASES IN.
OPIOID RELATED OVERDOSES
SPECIFICALLY FROM THE SYNTHETIC
OPIOIDS TO HAIR AND HEROIN -
WHICH HAVE INCREASED TAX PRETTY
SUBSTANTIALLY HERRON OVERDOSES
OF INCREASED ABOUT 24%.
IN THE PAST YEAR AND OVER THE
LAST COUPLE OF YEARS BUT NO LESS
INCREASED ABOUT FOUR HUNDRED AND
50% THIS MIRRORS WHAT'S
HAPPENING IN OTHER PARTS OF THE
COUNTRY ALTHOUGH OUR RATES OF
INCREASE ARE LOWER THAN THEY ARE
IN OTHER PLACE OF OF THE OTHER
PARTS OF THE COUNTRY.
SO WE'VE HAD A PROBLEM WITH
ADDICTION ACTUAL WITH OPIOID
ADDICTION ACROSS THE UNITED
STATES SENDING CALIFORNIA WELL
BEFORE IT BECAME REALLY APPARENT
TO EVERYONE AROUND.
TWENTY FOURTEEN AND WE STE BUT
WE HAVE HAD SOME SIGNIFICANT --
SUCCESSES AND THAT'S ONE OF THE
THINGS I WANT -- TO TO HIGHLIGHT
FOR YOU PARTICULARLY B. AS THE
SUCCESSES LARGELY HAVE COME
ABOUT AS THE WORK OF THE STATE
WIDE OPIATES SAFETY WORKING
GROUPWHICH INCLUDES MANY STATE
AGENCIES BUT NOW FOR THE LAST
COUPLE OF YEARS ALSO.
PARTNERS AT THE LOCAL LEVEL THE
NONPROFIT SECTOR IT SUTTER TRUE
CROSS SECTOR INTERVENTION.
THE NUMBER OF PRESCRIPTIONS FOR
OPIATES WRITTEN IS DECREASED 16%
THE NUMBER PRESCRIPTION RELATED
OPIATE OVERDOSE DEATHS IS SET
DECREASED BY 17%.
WE SIGNIFICANTLY ENHANCE OUR
SURVEILLANCE FOR OPIOID RELATED
OUTCOMES PROVIDING MORE TIMELY
AND BETTER INTEGRATED DATA.
THE DASHBOARD WITH WHICH YOU'RE
PROBABLY FAMILIAR FROM WHICH
THESE DATA COM IT'S ACTUALLY
BEEN ADOPTED -- AFTER WE
DEVELOPED IT BY SEVEN AND I
THINK IT'S UP TO TEN STATES NOW
BECAUSE IT'S A A GOOD MODEL FOR
THEM TO USE.
WE'VE HAD HIGHLY SUCCESSFUL
ACADEMIC DETAILING PROGRAM WITH
PROVIDERS WHO HAVE HIGH
PRESCRIBING RATES WHICH HAS BEEN
DOCUMENTED TO IMPROVE
PRESCRIBING SAFETY.
AND THAT HAS BEEN A PARTNERSHIP
BETWEEN CD PH UCSF AND OUR LOCAL
COALITIONS WHICH WE FIND.
WE'VE ALSO SEEN AN INCREASE IN
THE NUMBER OF PHYSICIANS WHO ARE
REPORTING IN ACCORDANCE WITH THE
LAW TO THE PRESCRIPTION DRUG
MONITORING PROGRAM.
WE AND SO CITY PAGE NDH CS HAVE
ALSO PROVIDED FUNDING TO THE
DEPARTMENT OF JUSTICE TO HELP
INCREASE THE USER USABILITY OF
THE SYSTEM AS WELL AS INCREASING
ITS CAPABILITIES.
I'M TO THE POINT WHERE THEY ARE
ON THE BRINK OF BEING ABLE TO
ACTUALLY.
EXCHANGE DATA WITH ELECTRONIC
HEALTH RECORDS WHICH IS THE
IDEAL SINCE THAT TAKES THE
POSITION OUT OF THE NEED TO
REPORT.
SAM INCREASED WE'VE INCREASED
ACCESS TO MEDICALLY ASSISTED
THERAPY LARGELY THROUGH WORKING
WITH HEALTH PLANS AND HAVING
THEM CHANGE THEIR POLICY. TO
ALLOW EASE OF USE AND ALSO AGAIN
ONCE AGAIN OUR LOCAL COALITIONS
ONE OF THEIR MAJOR PUSHES HAS
BEEN TO WORK DIRECTLY WITH THE
HEALTH PLANS AND WITH THE
PROVIDERS TO ENCOURAGE THEM AND
TO MAKE IT EASIER FOR THEM TO
BECOME.
PROVIDERS SOME OF MEDICALLY
ASSISTED THERAPY WE ALSO
INCREASED ACCESS TO LAW NALOXONE
THROUGH THE STATE WIDE STANDING
ORDER AND DEVELOPED A NOT LOCKS
AND DISTRIBUTION SYSTEM WHICH
WE'VE SUBSEQUENTLY TRANSITION TO
DEPARTMENT OF HEALTH CARE
SERVICES BECAUSE THEY HAVE
SUBSTANTIALLY MORE MONEY THAN WE
DO.
I'M YOU'LL HEAR A LITTLE BIT
MORE ABOUT THE KNOX AND
DISTRIBUTION -- PROGRAM IN JUST
A BET.
WE HAVE DISTRIBUTED OVER SEVENTY
THREE THOUSAND SENTINEL TEST
STRIPS THROUGH OUR SYRINGE
EXCHANGE PROGRAMS ARE STERN
SERVICE PROGRAMS.
THESE ARE USED BY DRUG USERS TO
TRY TO PROTECT THEMSELVES FROM
INADVERTENTLY -- INJECTING OF
REDUCED LEVELS OF A SYNTHETIC
OPIOIDS WE'VE ALSO PROVIDED
FUNDING TRAINING AND TECHNICAL
SUPPORT TO LOCAL PARTNERS
INCLUDING THOSE WHO WORK WITH
LOCAL TRIBAL COMMUNITIES.
AND PUBLIC EDUCATION CAMPAIGNS
AND TOOL KITS THAT SPECIFICALLY
ADDRESS STIGMA IN THE LOCAL
COMMUNITIES.
BECAUSE OF OUR COLLECTIVE WORK
WE BELIEVE WITH WE BELIEVE THAT
WE DO TAKE SOME CREDIT NOT CITY
PH ALONE BUT THIS LARGE.
IN A MULTI SECTOR WORKING GROUP
IN KEEPING A CALIFORNIA'S OPIOID
USE AND OVERDOSE RATES TO SOME
OF THE LOWEST IN THE COUNTRY.
HOWEVER THE SHIFT TO HEROIN AND
IN PARTICULAR TO VENT SENTINEL
AND OTHER.
A SYNTHETIC.
OPIOIDS ACTUALLY REQUIRES VERY
DIFFERENT KINDS OF INTERVENTIONS
WE'VE BEEN VERY SUCCESSFUL ON
THE PRESCRIPTION DRUGS WE NOW
HAVE TO LOOK MORE TO OUR LAW
ENFORCEMENT PARTNERS AS WELL TO
HELP US.
CONTROL ACCESS TO THE THE
ILLICIT DRUGS WHICH COMING
THROUGH VERY DIFFERENT MEANS
WILL CONTINUE TO PUSH ON
MEDICALLY INCREASING EXPANSION
OF MEDICALLY ASSISTED THERAPY
AND DEPARTMENT HEALTH CARE
SERVICES IS THE KEY PLAYER IN
THAT.
ALONG WITH THE CALIFORNIA
DEPARTMENT OF CORRECTIONS WHICH
IS ALSO EXPANDING MEDICALLY
ASSISTED THERAPY WHICH WILL BE
INCREDIBLY IMPORTANT.
I DO WANT TO TOUCH ON THE
FUNDING THAT THE DEPARTMENT HAS
RECEIVED -- FOR OPIOIDS WITH THE
EXCEPTION OF THE ONE TIME THREE
MILLION DOLLAR STATE GENERAL
FUND FOR THE NALOXONE
DISTRIBUTION ALL OF OUR FUNDING
HAS COME FROM.
OPIATE FEDERAL GRANTS -- WE'VE
RECEIVED THREE CD IS GRANTS FROM
THE CENTERS FOR DISEASE CONTROL
AND PREVENTION WHICH SUPPORTED
OUR VARIOUS ACTIVITIES -- IN
TWENTY FIFTEEN WE RECEIVED AN
INITIAL GRANT FROM CDC FOR THREE
POINT SEVEN MILLION WHICH WAS
THEN SUPPLEMENTED TO A ONE POINT
ONE MILLION ADDITIONAL MONEY TO
ENHANCE SURVEILLANCE.
AND THEN LAST YEAR WE RECEIVED A
ONE TIME OPIOID FUNDING OF THREE
POINT SIX MILLION DOLLARS I
SHOULD NOTE THAT ALL OF THE
SPENDING ENDS IN AUGUST OF
TWENTY NINETEEN WE ARE IN THE
MIDST OF OF CREATING OUR
APPLICATION FOR THE NEXT
COMPETITIVE GRANT FROM THE
CENTERS. FOR DISEASE CONTROL
HOWEVER THAT GRANT COLLAPSED
THOSE FIRST TWO GRANTS INTO ONE
AND HAS SUBSTANTIALLY DECREASE
THE AMOUNT OF FUNDING THAT WILL
BE AVAILABLE FOR CALIFORNIA.
SO WE'RE NOT AND WE DON'T KNOW
YET WHETHER THERE WILL BE --
CRISIS OPIATE FUNDING WHICH WAS
THAT THIRD PART OF MANY.
WHETHER THERE WILL BE ANY
FURTHER THAT THAT'S ACTUALLY
BEEN ONE OF OUR LARGEST
CHALLENGES HAS BEEN THE LIMITED
AND FLUCTUATING NATURE OF THE
FUNDING THAT'S COMING FROM THE
FEDERAL GOVERNMENT. TO SUSTAIN
SURVEILLANCE AND THE LOCAL CO OP
EIGHT COALITIONS IN THE OTHER
WORK THAT WE'VE BEEN ENGAGED IN.
I'M JUST IT BRIEFLY TOUCH FOR A
MOMENT ON BECAUSE THAT WE'VE
BEEN ASKED ABOUT THIS IN THE
PAST POLICY SURVEILLANCE IN
EDUCATION THREE REALLY IMPORTANT --
INTERVENTIONS.
IN ADDITION TO THE NINE BASIC
STRATEGIES THAT THE STATE WIDE
SAFETY WORKING GROUP HAS BEEN
PURSUING WE DID DEVELOP A POLICY
FRAMEWORK THAT COMPREHENSIVELY
ADDRESSES THE OPIOID EPIDEMIC
STATEWIDE.
THE GOAL OF THIS POLICY
FRAMEWORK IS TO ESTABLISH A
BROAD SHARON SHARED AGENDA THAT
THE WORK WE'RE PARTNERS CAN
PURSUE THROUGH THEIR OWN
ORGANIZATIONAL PROCESS SEES.
AND AS WELL AS TO ENHANCE THE
WORK FOR THE TASK FORCES IN THE
WORKING GROUP.
IN SURVEILLANCE IN ADDITION TO
THE DASHBOARD WITH WHICH I'M
SURE YOU'RE ALREADY FAMILIAR
WE'VE BEGUN PILOTING INTER
OPERABILITY AN INTEGRATION OF
DATA SYSTEMS WITH ADDITIONAL
DATA SOURCES IN PARTICULAR WE'RE
WORKING CLOSELY WITH THE EN
MASSE IN ORDER TO INCORPORATE.
EMERGENCY MEDICAL SERVICES BOTH
LOCAL AND THE STATEWIDE
EMERGENCY MEDICAL SERVICES DATA
INTO OUR DASHBOARD.
AND THEN WE'RE ALSO WORKING WITH
CORONERS AND MEDICAL EXAMINERS
TO GATHER SOME AND SOME HIGHER
LEVEL MORE DETAILED INFORMATION
ABOUT OPIOID OVERDOSES WHICH WE
REALLY DO NEED TO BETTER
IDENTIFY RISK FACTORS AND WHAT
ARE THE POPULATIONS THAT ARE AT
GREATEST RISK OF OVERDOSES AND
IN PARTICULAR OVERDOSE DEATHS.
AND THEN FINALLY WE'RE PILOTING
WITH SEVERAL COUNTIES -- A
SYSTEM TO ACTUALLY ALLOW US TO
GET REAL TIME FEEDS FROM
EMERGENCY DEPARTMENTS -- AROUND
OPIATE NON FATAL OPIOID
OVERDOSES AS WELL.
SO ALL OF THAT IS ON GOING
WITHOUT.
THE SURVEILLANCE MONEY THAT WE
RECEIVED.
AS FAR AS EDUCATION WE'VE HAD
SOME MODEST.
EDUCATIONAL INFORMATION
CAMPAIGNS THAT HAVE BEEN FOCUSED
ON RURAL COMMUNITIES AND SPECIAL
POPULATIONS WE WERE WORKING TO
INCREASE AWARENESS OF AND
RESOURCES TO ADDRESS OPIOID USE.
AND TO REDUCE STIGMA
PARTICULARLY WE FEEL THAT THE
REDUCING STIGMA IS THE OTHER
HALF OF INCREASING ACCESS TO ME
T. BECAUSE IN MANY COMMUNITIES
PARTICULARLY TRIBAL COMMUNITIES
AND SOME OF OUR MORE RURAL
COMMUNITIES.
THERE'S STILL A REAL RELUCTANCE
TO ACCESS CARE AND SO WE'RE
WORKING VERY CAREFULLY WITH
COMMUNITIES TO PROVIDE THEM WITH
INFORMATION THAT THEY CAN ADOPT
TO THEIR SPECIFIC ENVIRONMENT
AND USE.
I WE BELIEVE THAT THESE
CAMPAIGNS WILL IN FACT REINFORCE
AND STRENGTHEN OUR ONGOING
COMMUNICATIONS AND THE EFFORTS
OF OUR LOCAL COALITIONS WHICH
HAVE BEEN VERY SUCCESSFUL.
SO THAT'S THOSE ARE MY OVERVIEW
OF THE OPIOID -- ISSUE AND WE
CAN MOVE ON TO THE NO LUCK SO
DISTRIBUTIONS THAT WHAT WAS
SECOND I'M SORRY HAVE SLIGHTLY
DIFFERENT AGENDA LIST -- MARIN A
SECOND SO WHAT WILL SHE
TRANSITION TO CANNABIS
REGULATION THAT.
SHE WANTED TO TALK ABOUT THE
REGULATIONS BEFORE THE LAST
ACCOUNT OF THIS CAMPAIGN WE'RE
TRY WITH WE WERE IT WE HAVE A
SLIGHTLY DIFFERENT AGENDA SO
WE'LL GO WELL IT EVER.
NUMBER ONE IS PUBLIC HEALTH
STRATEGIES ADDRESSING SUBSTANCE
ABUSE AND ADDICTION OKAY.
SO WHAT WE'LL DO THEN IS WILL
SHIFTER ON THE SUB CABINET I'M
SORRY MISTER RAMOS DID YOU HAVE
A QUESTION.
PLACE ON THAT SPECIFIC.
LAST QUESTION HOURS OR QUESTIONS.
WHAT WHAT DO WE WAIT UNTIL ALL
THE PANELISTS HAVE PRESENTED TO
WOULD THAT BE OKAY MYSTERONS?
WELL I WHAT WE COULD DO IS
FINISH THE OPIOID PIECES.
WITH THAT WORK FOR YOU.
MADAM CHAIR.
AND THEN DO THE CANNABIS PIECES.
AND WE ALSO SOMEBODY ELSE IS
GOING TO BE SPEAKING ON OPEN A
LOCK SO DISTRIBUTION.
WE WERE ASKED TO SPEAK TO OKAY
BUT VERY.
VERY HIGH I'M SORRY MR ALMOST.
THIS NUMBER RIGHT AND YES BUT ON
THE WHOLE.
LET'S FINISH THEN WILL
PRESENTATION ON OPIOIDS -- YES
MA'AM.
AND THEN MISTER RAMOS -- UNLESS
THERE'S A SPECIFIC QUESTION
YOU'D LIKE TO ASK OTHERWISE IF
WE CAN WAIT [inaudible]
AND THAT CATEGORY WE ARE VERY
GOOD THANK YOU JUST AS A
REMINDER SENATE BILL EIGHT
THIRTY THREE ESTABLISHMENT A NEW
NALOXONE GRANT PROGRAM WITHIN
THE CALIFORNIA DEPARTMENT OF
PUBLIC HEALTH.
OF WITH THE GOAL OF REDUCING THE
NUMBER OF FATAL OVERDOSES IN
CALIFORNIA FROM WHAT THE DRUG
USE BY INCREASING ACCESS TO
NALOXONE.
AS A RESULT WE GOT A TOTAL OF
THREE MILLION DOLLARS OF GENERAL
FUND.
ON A ONE TIME BASIS TO SUPPORT
THE PROGRAM THROUGH JUNE
THIRTIETH.
TWO THOUSAND NINETEEN CITY PH
OFFERED IN NOT COMPUTER GRANT OF
NALOXONE PRODUCTS TO LOCAL
HEALTH DEPARTMENTS TO KICK OFF
THE NEW LOCKS AND DISTRIBUTION
PROJECT.
AS A RESULT WE HAD SIXTY LOCAL
HEALTH DEPARTMENTS RECEIVE SIXTY
NINE THOUSAND EIGHT HUNDRED AND
THIRTY DOSES OF NOR CANNELLA A
NASAL SPRAY WHAT THE TOTAL COST
OF TWO POINT SIX MILLION DOLLARS.
WE WORKED WITH AGAIN SIXTY LOCAL
HEALTH DEPARTMENTS WITH GLENN
COUNTY NOT PARTICIPATING HOWEVER
WE DID HAVE -- A STRATEGY IN
PLACE WHERE WE PARTNER WITH YOU
COUNTY THE NEIGHBORING COUNTY
WHO SHOULD WE SHARE THE SAME OUR
POPULATION TO ADDRESS -- OF THE
CLEAN COUNTY POPULATION.
AS PART OF THAT EFFORT WE DO
ANTICIPATE TO RECEIVE A FINAL
REPORT BY APRIL FIRST.
TWENTY NINETEEN AS TO THE
DEPARTMENT THE CITY KIDS
DEPARTMENT AND THEN THE
DEPARTMENT OR RIDE A
COMPREHENSIVE -- FINAL REPORTS
TO THE LEGISLATORS BY A JUNE
TWENTY NINETEEN AT THAT POINT
YOU'LL HEAR A LITTLE BIT MORE
ABOUT THE ENTITIES THAT RECEIVE
THE NALOXONE INDIVIDUALS THAT
pALSO RECEIVING THE NEW LOCKS ON
AND HOPEFULLY THEY'LL PROVIDE A
LITTLE MORE INFORMATION TO ABOUT
THE STRATEGIES THAT THEY'RE
USING AT THE LOCAL LEVEL -- ON
THIS ISSUE SO THAT'S A BRIEF
REPORT FOR YOU.
THAT COMPLETES OUR COMMENTS ON
OPIATES.
THANK YOU MISTER RAMOS.
THANK YOU MADAM CHAIR AND
SPECIFICALLY ON THE OF YOUR TEAM
YOU MENTION.
HAVING SOME OF THE LOWEST SOME
AREAS AND THE RATES OF OPIOID
ADDICTION AND THOSE TYPES OF
THINGS OVERDOSES WITH THE
NATIONAL AVERAGE FOR A WIDE
STATEWIDE.
BUT YET THE NATIVE AMERICAN
POPULATION CONTINUES TO OUTPACE
THOSE AND YOU MENTIONED THAT YOU
HAVE BEEN WORKING WITH A PILOT
PROGRAM WITH SOME TROUBLE
COMMUNITIES CAN YOU ELABORATE A
LITTLE BIT MORE ON THAT YEAH.
AND SEEING THAT IT SO HI HOW ARE
WE IS THERE IS THERE IS --
HANDER AND SOME AREAS THAT WE
MAYBE WE SHOULD KNOW ABOUT TO
TRY TO BRING THAT 17% DOWN. TO
MAYBE.
ALMOST EQUAL TO THE DIFFERENT
COURTS AND AND AND CALIFORNIA
YES YOU'RE RIGHT TO THE NATIVE
AMERICAN POPULATION.
HAS WITH THE HIGHEST DISPARITY
IN IN RATES AND YES WHILE OUR
OVERALL STATEWIDE RATES ARE THAT
WE DO HAVE AREAS THAT IT ALSO
GEOGRAPHIC AREAS WITH VERY HIGH
RATES WHICH WE ARE TARGETING.
THE CHALLENGE WORKING WITH THE
TRIBES AND WE ARE WORKING WE'RE
WORKING WITH -- SEVERAL THREE
COUNTIES THAT ARE WORKING WITH
THEIR TRIBES.
WE BECAUSE THEY ARE SOVEREIGN
NATIONS IT'S A IT'S A
PARTNERSHIP THAT WE ENGAGE IN
AND THAT PARTNERSHIP HAS
TRADITIONALLY BEEN WITH THE
LOCAL HEALTH JURISDICTION.
SO IT'S KIND OF A TRIPARTITE WE
PROVIDE SUPPORT TO THE LOCAL
HEALTH JURISDICTION LOCAL HEALTH
JURISDICTION AND THE TRIBE
THEMSELVES ACTUALLY THEN CREATE
THE WORK PLAN.
AND SO THIS LAST.
THIS LAST YEAR WAS THE FIRST
TIME WE HAD ANY FUNDING
DEDICATED SPECIFICALLY TO TRIBAL
ENTITIES.
YES IF WE ARE SUCCESSFUL IN
GETTING THIS NEXT OPIOID --
GRANT THAT IS WILL ALSO HAVE
SPECIFIC FUNDING DEDICATED TO
THE TRIBAL ENTITIES I THINK THE
BIGGEST BARRIER THAT WE'VE SEEN
IS NOT ALL TRIBES -- HAVE
TREMENDOUS.
TRUST IN THE LOCAL GOVERNMENTS
AND THEY ALSO -- I THINK LACK
INFRASTRUCTURE AND SO IT'S
REALLY -- A SERIES OF
CONVERSATIONS ABOUT HOW WE CAN
BEST HELP THEM BUILD THE
INFRASTRUCTURE THAT THEY NEED TO
THEN COME BACK THE ISSUE WITHIN
THEIR OWN TRIBAL POPULATION.
AND NOT SOMETHING THAT WERE
PILOTING WITH WITH -- TO WOLLEMI
COUNTY AND I'M FORGETTING THE
I'M SO I APOLOGIZE I DON'T
REMEMBER THE OTHER COUNTY THAT
WERE WORKING OUT WHERE THEY
REALLY DO HAVE VERY ROBUST
RELATIONSHIPS WE'RE LOOKING
SPECIFICALLY OUT WHAT THINGS ARE
WORKING. TO GOT THE GREATEST
AMOUNT OF RESOURCES TO THE
TRIBES AND WHETHER SOMETIMES
WHAT THE TRIBES WANT OUR IS
MONEY SOMETIMES WHAT THEY WANT
ACTUALLY OR OTHER KINDS OF
RESOURCES.
AND IT'S VERY TRIBE SPECIFIC AND
SO IT'S A IT'S A LEARNING
PROCESS FOR US -- BUT WE THINK
WE'RE BEGINNING TO GAIN SOME
GROUND.
SO -- WE ALSO I SHOULD SAY THAT
THERE IS A MEMBER OF THE BOROUGH
THAT CALIFORNIA RURAL -- INDIAN
RURAL HEALTH BOARD IS ON THIS
THE STATE WIDE WORKING GROUP AND
HAS BEEN A VERY ACTIVE MEMBER OF
THAT GROUP AS WELL.
GOOD AND IT'S THAT PROGRAM I
THINK.
SOME OF THOSE THE INTEREST IN
THOSE AN UNDERSTANDING THAT
PROGRAM WILL START.
TO BREAK DOWN SOME OF THOSE ON
THAT TRUST FACTOR THAT'S THERE.
BUT IF IF UP A NATIVE AMERICAN
IS LOOKING FOR SERVICES -- THEY
STILL COULD ACTUALLY.
ENGAGING THE SERVICES FROM THE
COUNTY AND STATE RESOURCES
CAPSULE SO THAT'S NOT IT.
A HINDRANCE FOR THEM BUT THE
INFORMATION GETTING IN FRONT OF
THEM WHEN THEY'RE DEALING WITH
THIS IS.
PART OF THE CHALLENGE I GUESS IN
ALL THE DIFFERENT PROGRAMS AT
THAT.
THEY GO THROUGH THE STATE OR AT
THE COUNTY LEVEL YEAH AND
HONESTLY AND AVAILABILITY OF
TREATMENT ALONE ISN'T ENOUGH WE
ALSO NEED TO PROVIDE SUPPORTS IN
THE COMMUNITY WITH THAT MAKE IT
OKAY FOR PEOPLE TO COME OUT IN
SEEK TREATMENT AND TO ACTUALLY
SUPPORT THEM IN CONTINUING AND
STAYING.
IN TREATMENT SO THAT SOME OF THE
WORK THAT NGUYEN TRIBAL
COMMUNITIES CAN BE VERY
DIFFERENT.
EVEN THE NEARBY NEIGHBORS IN IN
THE COUNTY SINCE WITHOUT SOME OF
THE THE CROSS CULTURAL WORK
THAT'S ALSO GOING ON THANK YOU
FOR THAT NUMBER.
THROUGH THE CHAIR BY COULD HAVE
A FOLLOW UP MEETING TO TALK A
LITTLE BIT MORE SPECIFIC ON THAT
I SPECIFIC ISSUE AND HOW WE
MIGHT BE ABLE TO LEND SOME
SUPPORT TO TRY -- TO LOOK AT
THAT ISSUE A LITTLE BIT MORE
WE'D BE HAPPY TO DO THAT.
THANK YOU MISTER RAMOS I WILL
TELL YOU THAT THAT WAS THE ONE
STATISTIC THAT SURPRISED ME THE
MOST.
I WAS SHOCKED MOST TO SEE THAT
THE RATE.
OF THERE WAS A HIGHER RATE -- BY
ETHNICITY FOR OUR AMERICAN
INDIAN AND ALASKA NATIVE I WAS
VERY SURPRISED TO SEE THAT
STATISTIC THANK YOU FOR ASKING
THOSE QUESTIONS.
MR FRAZIER THANK YOU MANAGER SO
WHEN YOU TALK ABOUT THE THE OUR
REACH TO THE TO THE NATIVE
AMERICAN.
TRIBES OF CALIFORNIA TRIBES HOW
MANY.
TRIBES HAVE YOU CONTACTED OF THE
HUNDRED AND TWENTY REGISTERED
TRIBES IN CALIFORNIA SO WE DON'T
DIRECTLY CONTACT THE TRIBES THE
TRIBES HAVE RELATIONSHIPS WITH
THEIR LOCAL HEALTH DEPARTMENTS
THAT WERE.
AND M. TO THE PROMISES THEY
DON'T.
SOME DO AND SOME DON'T THAT'S
TRUE -- ONE OF THE THINGS THAT
WE WANT TO DO -- WORKING WITH
OUR REPRESENTATIVE ON THE STATE
WIDE WORKING GROUP IS TO FIGURE
OUT WHERE ARE THE TRIBES WHERE
THE STATE HAVING A DIRECT
RELATIONSHIP MAKES MORE SENSE
THAN THE WE DON'T WANT TO GET IN
THE WAY OF RELATIONSHIPS THAT
EXIST WE WANT.
TO HELP SUPPORT THOSE WHERE
THERE AREN'T ALREADY
RELATIONSHIP SPECIFICALLY ON
THIS ISSUE I THINK WITH THEIR
SOME ROOM FOR US TO BEGIN TO
HAVE THOSE CONVERSATIONS.
I THINK THAT'S WERE WE WERE BOTH
MEMBERS OF THE THE NATIVE
AMERICAN CAUCUS SO ONE OF THE
THINGS WE'RE TALKING ABOUT IS
THE LEVEL OF TRUST.
EXACTLY AND I WOULD SAY THAT ONE
OF THE THE OUTRAGE HAS TO BE --
ON A SCALE OF OF REALLY.
YOU KNOW PROPORTIONS.
YEAH BECAUSE AGAIN THEY'RE GONNA
REBUFF YOUR REBUFF YOU UNTIL.
YOU WHAT THEY UNDERSTAND THAT
YOUR INTENTIONS ARE REAL AND
THEN YOU'RE LOOKING FOR OUTCOMES --
BECAUSE OF THE THE THE THE WAY
THEY'VE BEEN TREATED UP TO YOU
KNOW UNDERSTAND IN THE NEAR
FUTURE FALTER SO WE WOULD
WELCOME ANY ADVICE AND
RECOMMENDATIONS THAT YOU COULD
WE'D BE DELIGHTED TO WORK WITH
YOU ON THIS.
BECAUSE I THINK THE NUMBERS ARE
ACTUALLY LARGER YOU JUST OF
IRAQI AT ALL SURPRISED YOUR
TRACKING.
THE TRACTABLE YES EXACTLY THAT'S
EXACTLY RIGHT AND THEY COME FROM
OUR HEALTH CARE SYSTEM WHICH IS
NOT NECESSARILY GOING TO SEE
EVERYONE AS WELL.
I THINK LOOKING AT ALMOST SOME
OF THESE AREAS AS FAR AS HOW YOU
BEEN ABLE TO BRING SOME OF THE
STATISTICAL IN THE IN THE RATIOS
DOWN.
IS THE SAME APPROACH --
CERTAINLY THERE'S PEOPLE OUT
THERE AND AND I KNOW -- TRAVEL
LEADERS THAT ARE LOOKING FOR FOR
ANSWERS AND AND RESOURCES THAT
ARE GETTING IN FRONT OF THEM.
AND THERE'S BEEN THIS VERY OF
THE THE THE STATE DEALS WITH THE
STATE FEDERAL INDIAN
RESERVATIONS DEAL WITH FEDERAL
IN YOUR RESERVATIONS BUT YET.
YOU'RE IN THE STATE OF
CALIFORNIA AND THERE'S RESOURCES
THAT ARE THERE FOR PEOPLE ARE
GOING THROUGH THIS THIS NEED --
AND CERTAINLY -- THE SELECT
COMMITTEE ON AN AMERICAN AFFAIRS
WHICH WE CHAIR AND
ASSEMBLYMEMBER FRAZIER IS ON
WE'RE GONNA BE LOOKING AT THESE
ISSUES AS FAR AS HOW DO WE BRING
THESE THESE.
THESE PERCENTAGES DOWN RIGHT IN
EVEN TO JUST BE.
EVEN THE HIGHEST ONE THAT'S HERE
AT AT EIGHT POINT SOME PERCENT
WOULD BE A DRASTIC CHANGE.
IN THE NATIVE AMERICAN COMMUNITY.
AND SO LOOKING FORWARD TO
DISCUSSING THAT AND SEE IF
THERE'S ANY WAY THAT WE CAN
ACTUALLY ADD.
OUR VOICE TO MAKE SURE THAT THE
RESOURCES ARE GETTING A FROM THE
PEOPLE THAT NEED THOSE RESOURCES
AT THE TIME IN THEIR LIFE THAT
THEY NEED TO SEE.
SOMETHING -- THAT WOULD
DRASTICALLY CHANGE OUR LIVES WE
WOULD APPRECIATE THAT THANK YOU.
THANK YOU BOTH FOR THE COMMENTS.
ALL RIGHT SO WHAT'S THE NEXT
TOPIC WE'RE GOING TO DISCUSS.
LET'S TO CANNABIS NEXT LEVEL
CANNABIS MAX AND I'LL TELL AND
THEN WE'LL DO PROBLEM GAMBLING
THEY'RE KIND OF CANNABIS AND
OPIATES ARE SORT OF AT LEAST
SLIGHTLY RELATED -- SO I AM
GOING TO TALK SPECIFICALLY ABOUT
THE LESS LET'S TALK CANNABIS
CAMPAIGN THAT WE DID AND THEN --
MARIN IS GOING TO TALK ABOUT OUR
WORK AS A REGULATOR OF CANNABIS
MANUFACTURERS THEN I WOULD ASK
IF I MAY THAT WOULD BE SUS SYNC
TO WITH OUR COMMENTS -- TO ALLOW
FOR TIME FOR PUBLIC COMMENT.
I DON'T WANT PEOPLE TO LEAVE US.
I WANT TO HEAR THE PUBLIC
COMMENT.
OUR ACT SO I'LL CUT TO THE CHASE
ROBIN DR SMITH.
POSITION -- SIXTY FOUR DEDICATED
FIVE MILLION DOLLARS TO THE
DEPARTMENT OF HEALTH CARE
SERVICES FOR A PUBLIC EDUCATION
CAMPAIGN THAT WAS IT COVERED
SOME VERY EXPLICIT -- THINGS
THAT HAD TO BE DONE WE ENTERED
INTO IT IN ANY A INTEGRITY
AGREEMENT WITH THE OUR INTERESTS
ARE INTER AGENCY AGREEMENT WITH
THE WITH THE DEPARTMENT -- FOR
FOUR MILLION DOLLARS OF THAT
MONEY WE CREATED THE LET'S
HEALTH LET'S TALK CANNABIS
CAMPAIGN WHICH PROVIDED
CALIFORNIANS WITH SCIENCE BASED
INFORMATION ON THE PROVISIONS OF
THE ACT ITSELF.
THE SCIENTIFIC BASIS FOR
RESTRICTING ACCESS TO CANNABIS
AND PEOPLE TO PEOPLE TWENTY ONE
YEARS AN OLD OF YOUNGER.
AND POTENTIAL HARMS OF USING
CANNABIS WHILE PREGNANT OR
BREAST FEEDING AS WELL AS
DESCRIBING THE PENALTIES
PROVIDED. FOR PROVIDING ACCESS
TO YOUTH UNDER TWENTY ONE THOSE
WERE THE PRESCRIPTIVE.
THINGS WE DID THIS WE LOOKED AT
FIVE SPECIFIC POPULATIONS ADULTS
IN THE GENERAL POPULATION
SPECIFIC SPECIAL MESSAGING FOR
PREGNANT BREAST FEEDING WOMEN.
MESSAGING FOR YOUTH MESSAGING
FOR PARENTS AND MENTORS AND THEN
WE DID A SPECIAL -- OUT REACH TO
PHYSICIANS PARTICULARLY AROUND
THE IMPORTANCE OF BREAST FEEDING
AND PREGNANT WOMEN NOT USING
CANNABIS WE USE SCIENCE AND
EXTENSIVE FORMATIVE RESEARCH TO
CREATE THE THE V. CAMPAIGN WHICH
CONSISTED OF A WEBSITE WHICH WE
CONTINUE TO ADD RESOURCES.
TO AS WELL AS PUBLIC SERVICE
ANNOUNCEMENTS AND A DIGITAL TOOL
KIT WHICH WE DISTRIBUTED TO OUR
PARTNERS AS WELL SO THAT THEY
COULD ADAPT THAT FOR THEIR OWN --
OF FACILITIES AND THEIR
COMMUNITIES AND WE THAT WE
BELIEVE THE CAMPAIGN'S BEEN
EXTREMELY SUCCESSFUL WE'VE HAD
OVER FIFTY MILLION IMPRESSIONS
AND GARNERED OVER TWENTY FOUR
MILLION VIDEO COMPLETIONS HOUSE
OF YOUTUBE.
VIDEOS FOUR HUNDRED AND THIRTY
SPOT TO BROADCAST ON WHEN IT IS
YOUR OWN IN SACRAMENTO
BAKERSFIELD FRESNO AND SAN DIEGO --
WE HAVE HAD -- ALMOST THREE
HUNDRED THOUSAND VIEWS ARE
VISITS -- ISN'T AND BETWEEN
SEPTEMBER TWENTY SEVENTEEN TO
DECEMBER TWENTY EIGHTEEN TO THE
WEB LOAD IN OVER THIRTEEN
THOUSAND DOWNLOADS OF MATERIAL
AND MANY TWENTY TWO LOCAL HEALTH
JURISDICTIONS AND MANY OTHER
ASSOCIATIONS HAVE USED THE
DIGITAL TOOL KIT. TO CREATE
OUTREACH MATERIALS THAT ARE
CONSISTENT WITH THE MESSAGING IN
THE CAMPAIGN.
THAT FUNDING IS NOW HAS BEEN IT
FULLY EXPENDED AND THERE'S NO
FURTHER FUNDING FOR OTHER
OUTREACH AND EDUCATION ON
CANNABIS.
SO I THINK WHAT WE'LL DO THEN IS
TRANSITION TO OUR REGULATORY
ROLE WITH RESPECT TO CANNABIS
AND OKAY.
GOOD AFTERNOON MY NAME IS MARIN
KLEIN I'M THE ASSISTANT DEPUTY
DIRECTOR FOR THE CENTER FOR
ENVIRONMENTAL HEALTH.
AND CANNABIS PROGRAM IS ONE OF
THE REGULATORY PROGRAMS THAT WE
HAVE IN THE CENTER.
SO AS DR SMITH MENTION ALSO
DEPARTMENT OF WOULD REALLY HAVE
TO DISTINCT ROLES IN CANNABIS --
WHAT I'M GOING TO PROVIDE IS A
QUICK OVERVIEW ON OUR OVERALL?
A REGULATOR LICENSE SEEN.
OUR CANNABIS MANUFACTURERS.
SO THE PART OF PUBLIC HEALTH IS
ONE OF THE THREE LICENSING
DEPARTMENT THAT IS AUTHORIZED TO
OVERSEE COMMERCIAL CANNABIS
ACTIVITY.
THE OTHER TWO ARE TO DEPARTMENT
OF FOOD AND AGRICULTURE AND THEY
LICENSE THE COUNT OF US
CULTIVATORS.
THE BUREAU OF CANNABIS CONTROL
LICENSES -- DISTRIBUTORS TESTING
LABORATORIES RETAILERS AND MICRO
BUSINESSES.
AND THEN THE DEPARTMENT OF
PUBLIC HEALTH IS RESPONSIBLE FOR
LICENSING AND REGULATING.
CANNABIS MANUFACTURERS AND FOR
STEP MACHINE STANDARDS FOR
PACKAGING AND LABELING OF
CANNABIS AND CANNABIS PRODUCTS.
SO OUR GOAL IS TO PROTECT PUBLIC
HEALTH AND SAFETY
BY INSURING COMMERCIAL CANNABIS
MANUFACTURERS OPERATE A SAFE AND
SANITARY WORK ENVIRONMENT.
FOLLOW GOOD MANUFACTURING
PRACTICES AND PRODUCE PRODUCTS
THAT ARE FREE OF CONTAMINANTS.
MEAT PRODUCT GUIDELINES AND ARE
PROPERLY PACKAGE AND LABEL TO
INFORM THE CONSUMER.
SO BACK IN DECEMBER OF TWENTY
SEVENTEEN ALL -- THREE
REGULATING LICENSING DEPARTMENTS
ADOPTED EMERGENCY REGULATIONS TO
LICENSE CANNABIS BUSINESSES.
AFTER COMPLETING THE RULEMAKING
PROCESS DURING TWENTY EIGHTEEN
THE PERMANENT REGULATIONS FOR
CANNABIS BECAME EFFECTIVE ON
JANUARY SIXTEENTH.
TWENTY NINETEEN IN AN EFFORT TO
ASSIST THE INDUSTRY AND CLARIFY
REGULATION REQUIREMENTS.
ASSISTANCE IS AVAILABLE TO HELP
ACCOUNT OF THIS BUSINESS AS A
CHIEF COMPLIANCE.
WE HAVE EXTENSIVE RESOURCES ON
OUR WEBSITE.
AND THIS INCLUDES PRODUCTS SUCH
AS PACKAGING AND LABELING FAQS.
PACKAGING REQUIREMENTS LIST.
LABELING CHECKLIST FOR CANNABIS
THE FLOWER AND ALSO CANNABIS
PRODUCTS.
TECHNICAL ASSISTANCE IS ALSO A
PRIORITY FOR US AND WE CONTINUE
TO DEVELOP GUIDANCE DOCUMENTS TO
ASSIST THE APPLICANTS AND THE
NEW REGULATORY REQUIREMENTS.
AS WE CONTINUE TO DEVELOP NEW
DOCUMENTS WE WILL CONTINUE TO
POST US ON OUR WEBSITE.
ON THE THREE LICENSE IN
DEPARTMENTS STARTED ISSUING
TEMPORARY LICENSES IN JANUARY OF
TWENTY EIGHTEEN OUR CURRENT
ACTIVE NUMBER OF TEMPORARY
LICENSES. FOR CANNABIS
MANUFACTURERS ONLY IS ONE
THOUSAND ONE HUNDRED AND THIRTY
EIGHT IN ORDER TO PREVENT TO
GAPS IN LICENSURE WE ARE
PROVIDING TECHNICAL ASSISTANCE
TO CANNABIS MANUFACTURERS.
SO WE CAN TRANSITION THEIR
TEMPORARY LICENSE EITHER INTO AN
ANNUAL LICENSE OR A PROVISIONAL
LICENSE.
WE HAVE AGAIN DEVELOPED
RESOURCES MATERIALS FOR THE
INDUSTRY THAT ARE LOCATED ON OUR
WEBSITE.
AND THESE RESOURCES ARE LIKE
APPLICATION GUIDELINES AND
APPLICATION CHECKLIST.
WE WE ALSO HAVE CENTER
NOTIFICATIONS TO ALL OF THE
TEMPORARY LICENSE HOLDERS.
REMINDING THEM OF THEIR OF TO
SUBMIT AN APPLICATION FOR
LICENSURE FOR ANNUAL LICENSURE.
AND WE ARE FOLLOWING THAT UP
WITH PHONE CALLS. TO DATE WE
HAVE ISSUED SIXTY ONE ANNUAL
LICENSES WE ALSO HAVE ISSUED SIX
PROVISIONAL LICENSE SAYS.
WE HAVE THIRTY EIGHT
APPLICATIONS THAT ARE APPROVED
FOR LICENSURE AND WE ARE JUST
PENDING PAYMENT -- AND I HAVE TO
SAY THAT THESE NUMBERS CHANGE
FOR US DALY BECAUSE WERE
CONSTANTLY PROCESSING.
RECEIVING YOUR APPLICATIONS US
APPROVING YOUR CATIONS AND SO
ISSUE IN YOUR LICENSE US -- THE
CANNABIS MANUFACTURING WE HAVE
US DEPARTMENT WE HAVE FIVE
DIFFERENT TYPES OF LICENSES AND
THAT'S THE PENDING ON THE TYPE
OF MANUFACTURING THAT THE
BUSINESS THAT -- SAID THEM I'LL
I WON'T GO INTO ALL THE
SPECIFICS OF THE LICENSES BUT I
DO WANT TO MENTION ONE SPECIFIC
LICENSE TYPE WHICH SKULL TYPE S..
THIS IS FOR A SMALL
MANUFACTURERS THAT ARE UTILIZING
WHAT'S CALLED A SHARE
MANUFACTURING FACILITY.
THIS WILL ALLOW BUSINESSES TO
SHARE SPACE AND THE SAME
FACILITY.
THUS REDUCING BARRIERS TO ENTRY
INTO THE LEGAL MARKET.
SO JUST TO CONCLUDE WE ARE
WORKING WITH AN INDUSTRY THAT
HAS NOT BEEN REGULATED BEFORE.
OUR CURRENT STRATEGY IS TO BRING
THE INDUSTRY AND TO THE
REGULATED MARKET AND INTO
COMPLIANCE THROUGH EDUCATION AND
OUTREACH.
AND I'M HAPPY TO ANSWER ANY
QUESTIONS THAT YOU MAY HAVE
[inaudible]
THANK YOU.
ALL RIGHT ONE QUESTION YES
RESTAURANTS ON THE LICENSES ARE
BEING APPROVED ARE THEY FROM THE
THE LOCAL JURISDICTIONS ALSO OR
IS THAT SEPARATE FROM THE
LICENSE ARE BEING APPROVED.
AT THE STATE LEVEL.
SO FOR US TO BE ABLE TO ISSUE A
LICENSE AT THE STATE LEVEL WE
FIRST HAVE TO ENSURE THAT THEY
ARE IN COMPLIANCE WITH THE LOCAL
ORDINANCE LOOKS BORN.
YES SO WE WE HAVE A WE DO
CONTINUOUS CA ACCORDING NATION
AND COMMUNICATION WITH THE
LOCALS.
AND THE BEST METHOD THAT WE HAVE
FOUND IS WHEN WE HAVE A LIST OF
APPLICANTS FROM A STORE TO
LOCALITY WE SENT A LIST TO THE
LOCAL JURISDICTION.
AND THEN THEY WILL GIVE US A
RESPONSE BACK APPROVING THE ONES
THAT ARE IN COMPLIANCE WITH THE
LOCAL ORDINANCES.
SOMEOF THEM ARE STILL GOING
THROUGH THEIR C. U. P. PROCESS --
OTHERS ARE APPROVED -- FOR FOR
AN ANNUAL UP LOCATION SO WE CAN
GO EITHER WAY DAHLE DEPENDS ON
WHAT THE LOCALS TELL US.
SO THEY GO THROUGH A LOCAL
PROCESS BUT THE ACTUAL --
AWARDING OF A LICENSES DONE HERE
AT THE STATE LEVEL YEAH -- NOT
ON THE LOCALS ARE ALSO ISSUING
THEIR OWN ONLINE OKAY SO THERE
COULD BE A HIGHER.
AMOUNT OF LICENSES OUT THERE
BASED ON THE LOCAL AND THE STATE
RIGHT OKAY THANK YOU.
THANK YOU MISTER RAMOS AND THANK
YOU.
ALL RIGHT THEN THE NEXT THE LAST --
TYPE OF ADDICTION THAT THAT WE
DEAL WITH IS OUR PROBLEM
GAMBLING PROGRAM WHICH TERRY
CIVIL ADDRESS VERY GOOD.
GOOD AFTERNOON THEY HAD AN
ADDICTION PROBLEM GAMBLING SO
I'M TERRY SILICON VALLEY DAHLMAN
THE ASSISTANT DEPUTY DIRECTOR.
AND FOR THE CENTER FOR HEALTHY
COMMUNITIES AND I ALSO OVERSEE
THE OFFICE OF PROBLEM GAMBLING
WE'RE CONTINUING TO MEET OUR
MANDATE BY ADMINISTERING BOTH
PER.
M. PROBLEM GAMBLING PREVENTION
AND TREATMENT PROGRAMS WE HAVE
SIX FULL TIME EMPLOYEES
THROUGHOUT THE ENTIRE STATE OF
CALIFORNIA HERE IN SACRAMENTO TO
SERVE THE WHOLE STATE OF
CALIFORNIA.
OUR BUDGET COMES SOLELY FROM THE
INDUSTRY WE HAVE NO GENERAL FUND
SO WE HAVE ABOUT EIGHT POINT TWO
MILLION FROM INDIAN GAMING.
HUNDRED AND FORTY THOUSAND FROM
THE LOTTERY AND A HUNDRED AND
FIFTY THOUSAND FROM THE
CALIFORNIA CARD ROOMS.
OUR PREVENTION PROGRAM OUR
PRIMARY PREVENTION PROGRAM
STARTS WITH OUR TOLL FREE HELP
LINE YOU MAY HAVE NOTICED AROUND
TOWN ITS PROBLEM GAMBLING
AWARENESS MONTH THE ONE EIGHT
HUNDRED GAMBLER.
PHONE NUMBER WE HAVE SERVICES IN
LANGUAGE AND ENGLISH SPANISH
CANTONESE AND MANDARIN WE
TRANSLATE TWO HUNDRED OTHER
LANGUAGES FOR FOLKS THAT CALL
TAXED OR CHAT INTO THE HELP LINE.
IN TWENTY SEVEN EIGHTEEN WE S.
SERVED ABOUT TWENTY SIX THOUSAND
COLORS.
OF THOSE JUST OVER THREE
THOUSAND ACTUALLY HAD AN INTAKE
FOR PROBLEM GAMBLING SERVICES
AND FOUR HUNDRED AND TWENTY FIVE
ADDITIONAL CAME FROM MARK TEXT
AND CHAT SERVICES.
WE HAVE A TRAINING AND EDUCATION
PROGRAM THROUGHOUT THE STATE
WHERE WE TRAIN ON THE SIGNS AND
SYMPTOMS OF PROBLEM GAMBLING
BEHAVIOR WE TRAIN NONPROFIT
ORGANIZATIONS HEALTH
PROFESSIONALS EDUCATORS.
LAW ENFORCEMENT AND GAMBLING
INDUSTRY PERCENT NOW.
WE HAVE A YOUTH PREVENTION
PROGRAM CALLED BETTING ON OUR
FUTURE AND LAST YEAR A HUNDRED
AND EIGHTY EIGHT YOUTH FROM
TWENTY TO TWENTY EIGHT DIFFERENT
SITES THROUGHOUT CALIFORNIA.
HELP DESK IN CREATING
ANNOUNCEMENTS POSTERS PUBLIC
SERVICE ANNOUNCEMENTS IN THEIR
OWN COMMUNITIES FOR PROBLEM
GAMBLING AWARENESS.
OUR OUTREACH AND PUBLIC
AWARENESS CAMPAIGN AND TALKS
ABOUT IT AG GAMBLERS TARGETS BY
AGE ETHNICITY AND PROXIMITY TO A
GAMBLING VENUE.
WE HAVE RADIO A CABLE TELEVISION
AND DIGITAL SOCIAL MEDIA AS AN
IN TWENTY SEVEN AND TWENTY
SEVENTEEN EIGHTEEN WE PRODUCED
ABOUT THREE HUNDRED AND NINETY
MILLION IMPRESSIONS THROUGHOUT
THE STATE OF CALIFORNIA.
WE CONDUCT RESEARCH ON ALL OF
OUR PROGRAMS TO ENSURE THE
EFFICACY.
OUR TREATMENT PROGRAM THE
CALIFORNIA GAMBLING EDUCATION
AND TREATMENT SERVICES PROGRAM
OR CAL GETS IS THE LARGEST MOST
COMPREHENSIVE PROBLEM GAMBLING
TREATMENT PROGRAM IN THE UNITED
STATES.
WE HAVE TODAY SERVED OVER
FOURTEEN THOUSAND FIVE HUNDRED
CLIENTS AND CAL GUESTS.
AND LAST YEAR ALONE WE SERVED AT
JUST OVER TWELVE HUNDRED
GAMBLERS AND ABOUT FOUR HUNDRED
FAMILY MEMBERS ARE WE CALL THEM
AFFECTED INDIVIDUALS.
WE HAVE TREATED AT WE HAVE
TRAINED MORE THAN SEVEN HUNDRED
LICENSED THERAPISTS IN THE STATE
OF CALIFORNIA I'M PROBLEM
GAMBLING.
AND ON HOW TO TREAT PROBLEM
GAMBLING BEHAVIOR.
AND THEN OUR TREATMENT RANGES
FROM AB PROBLEM GAMBLING
TELEPHONE ADVENTURE TELEPHONE
INTERVENTIONS WHERE YOU CAN CALL
ON THE PHONE AND GET COUNSELING
WHEN OUR ACCOUNTS IN SESSION SO
IF YOU'RE DISABLED YOU CAN'T GET
TO A AN OUT PATIENT PROVIDER YOU
CAN CALL ON THE PHONE AND HAVE
THE SAME.
LICENSE PROVIDER HELPING YOU ON
THE PHONE WE HAVE AN OUTPATIENT
PROVIDERS.
OF OUR OUTPATIENT PROVIDERS
CONDUCT INDIVIDUAL AND GROUP
SESSIONS THEY SPEAK OVER THIRTY
ONE DIFFERENT LANGUAGES.
OUR INTENSIVE OUTPATIENT
PROGRAMS ARE HOUSED IN BOTH LOS
ANGELES AND SAN DIEGO PERSON
GOES FOR THREE HOURS A DAY AFTER
THREE TIMES A WEEK TO GET NINE
HOURS OF PROBLEM GAMBLING
THERAPY A WEEK.
AND OUR RESIDENTIAL TREATMENT
FACILITIES ARE HOUSED IN BOTH
SAN FRANCISCO AND LA. TWO
DIFFERENT TYPES OF AND
RESIDENTIAL TREATMENT PROGRAMS
SAME AS DRUG AND ALCOHOL REHAB
BUT FOR GAMBLING.
AND WE HAVE AND LASTLY OUR
CLINICAL AND EVASIONS PROGRAM
WHICH HELPS AS CREATE AND
SCIENCE BASED EVIDENCE BASED.
TOOLS FOR OUR PROVIDERS TO USE
THROUGHOUT THE STATE OF
CALIFORNIA.
RIGHT NOW WE HAVE MORE THAN TWO
HUNDRED AND FIFTY ACTIVE
PROVIDERS WHO ARE WORKING FOR US
IN THE STATE OF CALIFORNIA.
PROVIDING TREATMENT SERVICES FOR
CAL GETS.
THAT'S IT TRIED TO GO QUICK
HOPEFULLY NOT YOU DO THIS NO NO.
I THANK YOU FOR THAT -- DO DO WE
HAVE ANY TESTIMONY FROM ILEANA
RAMOS FOR WE ACTUALLY I I
MISSPOKE WE ACTUALLY.
I CAN'T BELIEVE I ABOUT THIS BUT
WE ALSO DO TOBACCO ADDICTION.
SO WE'VE GOT JUST A FEW COMMENTS
ABOUT THE TOBACCO CALLER ID
PROGRAM AS WELL LET'S HEAR ABOUT
THE BALCONIES SO -- MISSION OF
THE CALIFORNIA CONTROL PROGRAM
IS REALLY AROUND FOR AREAS
LOOKING AT A CELEBRITY DECLINES
IN TOBACCO RELATED DISPARITIES
ALSO SECONDHAND SMOKE AND THEN
MINIMIZING THE IMPACT OF THE
CIGARETTES AMONG YOUTH AND YOUNG
PEOPLE -- WE DO THIS THROUGH OF
FOUR KEY STRATEGIES ONE IS
WORKING WITH THE LOCAL HEALTH
DEPARTMENTS THEY REALLY PROVIDE
THE CRITICAL INFRASTRUCTURE AT
THE LOCAL LEVEL AND THEY WORK ON
THREE DIFFERENT AREAS.
OF MULTI UNIT HOUSING FROM
UNWANTED SECONDHAND EXPOSURES --
TO FROM TOBACCO THEY ALSO WORK
ON PREVENTING YOU FROM ACCESSING
OF FLAVORED TOBACCO INCLUDING
THE CIGARETTES VAPING DEVICE AND
SO FORTH -- AND FINALLY THEY
WORK ON ELIMINATING DISPARITIES --
THE WE'LL TALK A LITTLE BIT MORE
ABOUT THE SECOND INITIATIVE
WHICH IS.
IN TWENTY SEVENTEEN ARTIFACT
MANTRA PROGRAM.
DEVELOP INITIATIVES REDUCE
TOBACCO RELATED DISPARITIES
PUTTING IN PLACE ABOUT SIXTY
FIVE MILLION DOLLARS IN GRANTS
TO SUPPORT EIGHT GROUPS AFRICAN
AMERICANS AMERICAN INDIAN ASIAN
PACIFIC ISLANDER LATINOS LEGEND
GIVE AYE SYCOPHANTS GENDER.
ALSO LOOKING AT RURAL LOW INCOME
AND BEHAVIOR HEALTH.
THEY DO THIS BY A WARNING
STATEWIDE QUARANTINE CENTERS OF
REGIONAL PROJECTS TAKING PLACE
FOR GETTING THESE POPULATIONS.
IN ADDITION WORKING WITH TRIBAL
GOVERNMENTS AMERICAN INDIAN NON
GOVERNMENTAL ORGANIZATIONS.
REALLY WORKING ON OUR REGION
ENGAGEMENT OF LOW INCOME GROUPS
AND COMMUNITIES OF COLOR.
AND FINALLY THE THIRD STRATEGY
REALLY IS ON OUR MEDIA WE ARE
KNOWN NATIONALLY FOR SOME OF THE
GREAT EDUCATION AND MARKETING
THAT WE DO IN TOBACCO.
CURRENTLY WE'RE FOCUSED SEEN --
WE WE ACTUALLY DO THIS YOU THE
TRANSLATE SEVEN DIFFERENT
LANGUAGES OF FROM SPANISH
ENGLISH AND SO FORTH -- THROUGH
TV PRINT ADS RADIO SOCIAL MEDIA
WERE WORKING RIGHT NOW ON THREE
SPECIFIC FOR OF FOCUS AREAS ON
OUR MEDIA WHICH INCLUDES.
TALKING ABOUT OF THE CIGARETTES
THE FLAVORING HOW IT ACTUALLY
CREATES ADDICTION AMONG OUR OUR
YOUNG FOLKS.
ALSO WE'RE LOOKING AT SOCIAL
SMOKING REALLY LOOKING AT
TARGETING YOUNGER ADULTS AND
TRYING TO REALLY EDUCATE THEM ON
THE EFFECTS OF SOCIAL SMOKING.
AND FINALLY SECONDHAND SMOKE
WHICH CONTINUES TO REALLY AFFECT
COMMUNITIES SPECIALLY FOLKS IN
APARTMENT COMPLEXES AND SO FORTH.
SO WITH THAT I WILL CONCLUDE YOU
CAN SEE IF THERE'S ANY QUESTIONS
[inaudible]
THANK YOU.
YES MISTER FRAZIER THANK YOU
MADAM CHAIR.
IS THERE ANY EFFORTS ON THE
SMOKELESS TOBACCO IS.
IN IN -- THE USER IS IN RURAL
AREAS A SEEMS HE PREVALENTLY
ADOPTED YOU KNOW THE CHEWING
TOBACCOS.
AND I HAVEN'T HEARD ANYTHING
ABOUT THAT EFFORT OF GOING
FORWARD.
YEAH IT'S DEFINITELY ONE OF THE
STRATEGIES I CAN GET YOU MORE
INFORMATION ON THAT ONE OF THE
EIGHT POPULATIONS THAT I QUICKLY
RAN THROUGH IS RURAL COMMUNITIES
AND WORKING WITH THEM.
AND TRY TO EDUCATE THEM BUT I
CAN I'LL BE HAPPY TO SEND YOU
MORE INFORMATION SPECIFICALLY TO
THAT.
I APPRECIATE THAT BECAUSE IT
SEEMS LIKE IN THE RURAL
COMMUNITIES IS MORE.
MORE PREVALENT AS THE GET OUT OF
THE NATURE OF THEIR INCLINED TO
START.
DIPPING OR OR CHEWING TOBACCO
AND AND I ONLY KNEW THAT BECAUSE
I GREW UP IN A RULER HIT AND I
DID.
AND IT TOOK ME A LONG TIME TO
QUIT ONCE I STARTED SO IF WE CAN
GET SOME EDUCATION GOING FOR IN
THE END THE YOUNGER'S.
YOUNGER POPULATIONS IN THE RURAL
AREAS I THINK THAT WOULD BE THE
MOST EFFECTIVE.
WHICH I HAD IT.
THANK YOU MISTER FRAZIER.
AND ALONG THE SAME LINES WERE
TALKING ABOUT ARE YOU -- THE
QUESTION IS WHAT ARE WE DOING
EXPLICITLY TO ADDRESS THE
INCREASE OF YOUTH USING E.
CIGARETTES AND I KNOW YOU
DRESSED ABOUT.
OF MEDIA -- SOCIAL MEDIA BUT
WHAT ARE WE DOING SPECIFICALLY
IN THAT REGARD SO THERE'S A
COUPLE OF EFFORTS -- TO ONE OF
THEM IS WORKING WITH THEIR LOCAL
HEALTH DEPARTMENTS IN PART OF
THEIR SCOPES OF WORK THEY HAVE A
SPECIFIC OUTCOME RELATED TO USE
ANY CIGARETTES.
THERE'S STILL A LOT OF MYTHS OUT
THERE ARE ON E. CIGARETTES THAT
OUR LOCAL HEALTH DEPARTMENTS
WITH THE DEPARTMENT OF EDUCATION
AND WITH OTHER COMMUNITY BASED
ORGANIZATIONS ARE WORKING TO
EDUCATE.
YOUNG PEOPLE ON THE IMPACT OF
THE CIGARETTES.
IN ADDITION ONE OF THE MEDIA AB
PIECES THAT WERE WORKING ON
WHICH HOPEFULLY YOU'LL START
SEEING SOME OF THESE ADS THEY'RE
ACTUALLY QUITE REMARKABLE
IMPACTFUL ON IT'S NOT JUST VAPE
BEING RIGHT THERE THERE'S MORE
TO VAPING THERE'S NICOTINE IT'S
STILL AFFECTS.
THE DEVELOPING A YOUNG PEOPLE
AND SO WE'RE HOPING THAT THROUGH
THOSE COUPLE STRATEGIES FOR WE
CAN START EDUCATING FOLKS ON THE
THE IMPACT OF A NICOTINE IN THE
CIGARETTES AND SMOKE AND THEY'VE
BEEN AND SO FORTH AND I THINK
THERE'S SEVERAL THINGS WE DID A
GREAT DEAL OF FORMATIVE.
RESEARCH WITH PARENTS AROUND --
YOU CIGARETTES AND MORE FRANKLY
STUNNED AT HOW LITTLE
UNDERSTANDING THEY ACTUALLY HAD
OF WHAT.
WHAT WAS IN THE CIGARETTES THAT
NICOTINE WAS ADDICTING AND ALSO
TO THE THE HOW EASY IT IS FOR
THEIR KIDS TO HAVE THESE DEVICES
AND NOT BE SEEN?
THE OTHER THING THAT -- WE DO
BESIDES WORKING AT THE LOCAL
LEVEL WITH AND HAVING THESE HUGE
STATEWIDE CAMPAIGNS AS WE WORK A
LOT ON COMPILING.
BOTH LOCAL ORDINANCES AND ALSO
STATEWIDE POLICIES THAT HAVE
BEEN EFFECTIVE IN DECREASING --
OF CIGARETTE USE AND AND SIT
THERE ARE FOR EXAMPLE -- WERE
MORE MONITORING THE EFFICACY OF
THE BANNING OF FLAVORED
CIGARETTES WE KNOW THAT
FLAVORING BOTH IN PARTICULARLY
IN E. CIGARETTES BUT ALSO
FLAVORED TOBACCO IS A WAY TO
BRING PEOPLE INTO BECOMING
ADDICTED AND SO.
WE DO A FAIR AMOUNT OF
MONITORING OF POLICIES THAT ARE
IN PLACE TO SEE WHAT'S WORKING
WHAT ISN'T WORKING IN THE MAKE
THAT INFORMATION AVAILABLE TO
POLICY MAKERS [inaudible]
VERY GOOD.
IT IS IS THERE ANYTHING NOW VERY
GOOD I'M NOT VERY GOOD BUT VERY.
WHAT ONE LAST AREA IS AT THE TOP
OF PAGE?
FOR ON OVERDOSE DEATHS IN
CALIFORNIA IN TWO THOUSAND
THIRTEEN ALCOHOL FOUR THOUSAND
FIVE HUNDRED AND FIFTY FOUR I
KNOW THE NUMBERS ARE. EIGHT AND
THE NEXT.
LOWEST IS OPIOIDS AT FOURTEEN
HUNDRED EXACTLY IF WE LOOK AT
PAGE.
SIX NONFATAL EMERGENCY ROOM OR
MEMBERS MERGED INTO DEPARTMENT
VISITS FOR ALCOHOL.
AND OTHER DRUG DIAGNOSIS ALCOHOL
ONLY THREE HUNDRED AND TEN POINT --
FIVE AND YET OTHER IT MAKES
DRUGS.
FORTY THREE THEN I'D LIKE FOR
YOU TO LOOK AT PAGE.
TEN ALCOHOL ABUSE PREVENTION AND
CONTROL.
AS SHOWN THE DATABASE OF
COMPARED TO OTHER TYPES OF DRUGS
EXCEPT TOBACCO.
ALCOHOL IS THE LEADING CAUSE OF
MORBIDITY MORTALITY AND
EMERGENCY ROOM VISITS.
THE FOLLOWING ARE THE STATE'S
PUBLIC HEALTH INVESTMENTS AND
EFFORTS AND ALCOHOL ABUSE
PREVENTION YOU'LL SEE THERE'S A
BIG BLANK.
THAT'S SOMETHING THAT --
HOPEFULLY I RECOGNIZE IT'S ALL
ABOUT A QUESTION OF MONEY -- AND
HOW MUCH IS BUDGETED BUT WHEN WE
SEE THAT THE NUMBERS ARE SO HIGH.
AND YET IT ISN'T PART OF OUR
INVESTMENT.
I JUST.
WANT US.
TO I SHARE YOUR CONCERNS.
WHEN WE FIRST BEGAN TALKING
ABOUT OPIOIDS IKE AND PEOPLE
WERE USING ALL SORTS OF?
ALARMIST LANGUAGE IT'S KILLING
MORE PEOPLE THAT AND I KEPT
SAYING.
ALCOHOL.
WE'RE STILL WE HAVE AN ENORMOUS
PROBLEM WITH ALCOHOL IN OUR
SOCIETY AND WE CHOOSE NOT TO PAY
MUCH ATTENTION TO IT.
IF THE RESOURCES WERE MADE
AVAILABLE.
SHOULD STAY INVEST SHOULD THE
STATE INVEST IN ALCOHOL ABUSE
PREVENTION.
I AM BY NO MEANS AN EXPERT IN
THAT AREA I WOULD -- SUGGEST
THAT YOU ALL YOU ALSO ASK THAT
QUESTION TWO OF OUR COLLEAGUES
AND PART OF HEALTH CARE SERVICES
WHERE THE SUBSTANCE USE
DISORDERS PROGRAMME SLY ONE
THING I COULD SAY IS I THINK
THAT MANY OF THE STRATEGIES THAT
WE USE.
FOR TOBACCO AS WELL AS PROBLEM
GAMBLING EDUCATION OUT REACH
WORKING IN LOCAL COMMUNITIES --
I KNOW THEY'RE YOU KNOW THERE
ARE THERE ARE ACTUALLY QUITE A
FEW YOUTH PREVENTION PROGRAMS
AND THAT IS SOMETHING THAT DH CS
CAN SPEAKTO THEIR FUNDED
THROUGH THE THROUGH SAM SO THE
FEDERAL AGENCY.
THEY WORK -- THERE JUST ISN'T
MUCH OF THE ART ORANGE OUR
INVOLVEMENT IN ALCOHOL HAS BEEN
EXCLUSIVELY A SURVEILLANCE
GATHERING DATA ON HOSPITAL -- IN
PARTICULAR -- EMERGENCY
DEPARTMENT VISITS -- AND SO THE
SURVEILLANCE IS PRETTY MUCH THE
ONLY WORK THAT WE DO ON ALCOHOL.
IN OUR DEPARTMENT [inaudible]
HER GET.
QUESTIONS COMMENTS VERY GOOD.
ALL RIGHT THANK YOU VERY MUCH --
I'M SORRY PUBLIC COMMENT.
THE MOST IMPORTANT PART OF THIS
[inaudible]
PUBLIC COMMENT.
SEEING AND HEARING NONE.
YOU ARE ALL EXCUSE THANK YOU.
ALL RIGHT WE'D LIKE TO CALL UP.
THE NEXT PANEL ISSUE NUMBER TWO
SUBSTANCE USE DISORDER SERVICES.
AND AGAIN I WOULD ELSE THAT WE
TESTIFIED IN THE ORDER LISTED --
JENNIFER CAN'T.
BRENDA GRAY LISH.
DR ALICE CLEGHORN.
I NAM CON.
CHRIS COOK AND RYAN MELENDEZ.
SO GOOD AFTERNOON I IMAGINE FOR
CAN'T DIRECTOR FOR THE
DEPARTMENT OF HEALTH CARE
SERVICES -- SO I'M JUST REALLY
QUICKLY TO GO OVER AND AND TOUCH
ON SOME OF THE KEY -- POINTS IN
THE AGENDA SO WITHIN THE
DEPARTMENT OF HEALTH CARE
SERVICES WE OPERATE BOTH ON
MEDICAID AND NON MEDICAID
RELATED SERVICES AS IT PERTAINS
TO SUBSTANCE USE DISORDER.
SO OBVIOUSLY THE LARGEST PROGRAM
THAT WE HAVE IN THE DEPARTMENT
IS THE MEDICAL PROGRAM WE HAVE
TWO DISTINCT DELIVERY SYSTEMS
THAT WE OPERATE AS A PERTAINS TO
SUBSTANCE USE DISORDER WE HAVE --
COUNTIES THAT PROVIDE WHAT ARE
KNOWN AS THE STATE PLAN SERVICES
THERE'S FIVE STE -- NOTED
SERVICES IN THE AGENDA AND THEN --
BACK IN TWENTY FIFTEEN WE
NEGOTIATED -- SECTION ELEVEN
FIFTEEN WAIVER AMENDMENT THAT --
IMPLEMENTS -- THE DRUG MEDI CAL
ORGANIZED DELIVERY SYSTEM WAIVER
WE HAVE WE HAVE APPROXIMATELY
TWENTY FIVE COUNTIES THAT HAVE
OPTED INTO THIS WAIVER AND AS
THE AGENDA LAYS OUT IT REALLY
FOR THE FIRST TIME IN THE
COUNTRY -- WE WERE THE FIRST IN
THE NATION TO CREATE SUCH A
DELIVERY SYSTEM.
IT IS THE FULL SPECTRUM OF
SERVICES FOR INDIVIDUALS AND
MEDICAID -- STARTING AT THE
HIGHEST LEVEL OF THE QT FROM A
VOLUNTARY -- INPATIENT DETOX
DOWN TO RESIDENTIAL TREATMENT
DOWN TO OUTPATIENT -- TREATMENT
WITH MEDICATION ASSISTED
TREATMENT AND OTHER TYPES OF
SUPPORT OF SERVICES INCLUDING
BECAUSE CONSULTATIONS IN CASE
MANAGEMENT -- WE HAVE TESTIFIED
NOT ONLY BEFORE -- THE ASSEMBLY
BUT THE SENATE IN RECENT --
WEEKS AROUND THIS PARTICULAR
WAIVER PROGRAM AN INITIATIVE
WE'RE VERY PROUD OF THE WORK
THAT THE COUNTIES HAVE DONE --
THEY HAVE BEEN SIGNIFICANT --
PARTNERS AND STEPPING UP TO BOTH
CREATE THE SYSTEM IN THE
INFRASTRUCTURE BUT ALSO -- TO
DELIVER ON A LOT OF THE
COMPLIANCE ISSUES BECAUSE THEY
ARE ESSENTIALLY BEING TREATED AS
MANAGED CARE PLANS FOR PURPOSES
OF THIS WAIVER AMENDMENT.
SO -- BY THE TIME WE ARE DONE
WITH THIS INITIATIVE WHAT WE
HOPE TO HAVE AS UP TO FORTY
COUNTIES -- IN THOUGH
VOLUNTARILY OPTING INTO THE
WAIVER WHICH WOULD COVER
APPROXIMATELY 96297% OF THE
STATE'S ENTIRE POPULATION --
THERE WAS A HEARING A COUPLE OF
WEEKS AGO IN WHICH BOTH LOS
ANGELES AND RIVERSIDE COUNTY --
TESTIFIED TO THEIR
IMPLEMENTATION BOTH
OPPORTUNITIES AND CHALLENGES --
RIVERSIDE WAS ONE OF THE FIRST
COUNTIES TO IMPLEMENT THE WAIVER
AND PRIOR TO THE WAIVER OR THE
MONTH BEFORE THEIR CALLS INTO
THEIR COUNTY FOR TREATMENT WAS
AROUND THREE HUNDRED INDIVIDUALS.
THE MONTH THAT THE LATE THE
WAIVER WENT LIVE THEY WENT UP
OVER THREE TO FOUR THOUSAND
CALLS AND HAS STAYED CONSISTENT
AND SO WHAT WE ARE.
BOTH -- PROUD OF BUT ALSO
RECOGNIZING IS THAT THERE'S AN
ENORMOUS NEED FOR SERVICES --
FOR INDIVIDUALS AND SO THE
COUNTIES HAVE REALLY -- HAVE
REALLY BEEN GOOD PARTNERS IN
IMPLEMENTING THIS WAIVER AND
OBVIOUSLY IT WILL BE SOMETHING
THAT WE HAVE CONVERSATIONS WITH
THE FEDERAL GOVERNMENT ABOUT
WHEN OUR WAIVER EXPIRES AND
TWENTY TWENTY ON THE NON
MEDICAID.
WAIVER SIDE -- WE HAVE ALSO BEEN
THE RECIPIENT OF SIGNIFICANT
AMOUNTS OF FEDERAL FUNDS -- AS
IT PERTAINS TO THE OPIOID --
EPIDEMIC SO WE HAVE
APPROXIMATELY TWO HUNDRED AND
THIRTY MILLION DOLLARS SPANNING
OVER TO FEDERAL GRANTS -- THOSE
GRANTS OVERLAP WITH EACH OTHER
IN TERMS OF THE YEARS IN WHICH
THE MONEY IS AVAILABLE.
AND AS A DIRECTOR SMITH HAS
TESTIFIED IN AS WE'RE HAPPY TO
TALK ABOUT A LITTLE BIT MORE IN
DETAIL.
WE HAVE USED THOSE FEDERAL
GRANTS TO NOT ONLY -- DIRECT
SPECIFICALLY TOWARDS OPIOID
RELATED ACTIVITIES BUT ALSO
TOWARDS BUILDING THE
INFRASTRUCTURE THAT WE BELIEVE
IS NECESSARY.
IN THE LOCAL -- AREAS AROUND --
BETTER AWARENESS REDUCTION OF
STIGMA -- INCREASING -- PROVIDER
CAPACITY -- IN SOME CASES --
HELPING IN PRIMARY CARE
PROVIDERS BECOME FAMILIAR WITH
AND WILLING TO TREAT SUBSTANCE
USE DISORDERS RECOGNIZING THAT
WE CANNOT BUILD -- AN ENTIRE
WORK FORCE -- AROUND ADDICTION
SPECIALTY AND OBVIOUSLY I WAS
WATCHING YOUR WORK FORCE
DISCUSSION EARLIER -- WE REALLY
HAVE TO HAVE PRIMARY CARE
PROVIDERS AND OTHER TYPES OF
PROVIDERS BE COMFORTABLE WORKING
WITH PATIENTS -- IN THEIR
PRACTICES AND SO THE FEDERAL
MONEY THAT WE RECEIVE FROM THE
OPIOID GRANTS -- HAS BEEN USED --
FOR TRIBAL -- IN A T. SO AGAIN
TO YOUR ACKNOWLEDGEMENT OF THE
REAL DISPARITY AN OPIOID
OVERDOSE AND DEATH RATES IN THE
TRIBAL POPULATION WE HAVE SPENT
A LOT OF TIME WORKING WITH --
TRIBAL IN A T. PROJECTS --
TRIBAL -- IF AB OPIOID
COALITIONS SPECIFICALLY AIMED AT
THAT WE'VE DONE A LOT OF
NALOXONE DISTRIBUTION SO THIS IS
IN OUR CANS OF THE INHALED
VERSION OF THE OPIOID REVERSAL.
DRUG WE'VE -- BEEN USING THAT IN
OF PUBLIC SAFETY JAIL SAID
DEAN'S LIBRARIES COMMUNITY BASED
ORGANIZATIONS COLLEGES -- THEY
SIMPLY -- EMAIL INTO OUR PORTAL
REQUESTING CAN AND IT'S
DISTRIBUTED OUT TO THEM -- SO WE
HAVE BEEN VERY PROUD ABOUT THE
WORK THERE AND BELIEVE THAT THAT
IS A SIGNIFICANT ONGOING WORK.
AND THEN LASTLY A SIGNIFICANT
CHUNK OF THE FUNDS IN THE IN THE
OPIOID GRANT HAS BEEN AROUND HUB
AND SPOKE.
SO THIS GETS TO THE WORKING WITH
AN ESTABLISHED NARCOTIC
TREATMENT PROVIDER OF A
SPECIALTY CENTER IF YOU WILL FOR
ADDICTION TREATMENT.
AND THEY SERVE AS THE HUB AND
THEN WE'RE WORKING WITH THEM TO
IDENTIFY A SPOKE OUT IN THE
COMMUNITY SO THOSE ARE CLINICS
AS A PRIMARY CARE PROVIDERS.
AND IT'S WORKING WITH THEM TO
GET THEM BOTH FAMILIAR WITH THE
PROCESS FAMILIAR WITH THE
PRESCRIBING AND IF A PATIENT IS
AYE REQUIRING A LITTLE BIT MORE
OF AN EXPERTISE THEY CAN REFER
TO THAT HUB.
AND THEN BE REFERRED BACK ONCE
THEY'VE BEEN STABILIZED SO A LOT
OF REALLY -- EXCITING WORK IN
OUR DEPARTMENT THAT WE'RE VERY
PROUD OF CERTAINLY ACKNOWLEDGE
THAT WE ARE COMMITTED TO
CONTINUING TO OBVIOUSLY IMPROVE
AND BUILD ON THE SYSTEM AND THEN.
AGAIN TO ECHO -- DIRECTOR
SMITH'S COMMENTS -- WELL OPIATES
ARE CERTAINLY THE DRUG AS PRESS
ATTENTION AND OVERALL ATTENTION
THESE DAYS ALCOHOL BY AND FAR
CONTINUES TO BE THE MOST ABUSE
SUBSTANCE IN OUR POPULATION --
IT DOESN'T EXTREME AMOUNT OF
HARM AND SO WE WERE WERE ALSO
MINDFUL OF THE FACT THAT ALL OF
THE INFRASTRUCTURE THAT WE'RE
BUILDING AS AROUND.
ALL SUBSTANCES AND NOT JUST
OPIOID SO -- WITH THAT HAPPY TO
ANSWER QUESTIONS WHEN THE PANEL
CONCLUDES [inaudible]
THANK YOU.
BRENDA GRAY LICIOUS NOT HERE --
DR DALLAS CLEGHORN.
HELLO I'M DR ALICE CLICK CORN TO
AND I'M THE DIRECTOR OF
BEHAVIORAL WELLNESS IN SANTA
BARBARA COUNTY.
IT'S BEEN MY PRIVILEGE TO SERVE
OVER TWENTY FIVE YEARS AS A
COUNTY EMPLOYEE BUT IF SERVE TWO
VERY DIFFERENT COUNTIES FOR THE
FIRST NINETEEN AND A HALF YEARS.
I WAS IN SAN FRANCISCO THE CITY
AND COUNTY OF SAN FRANCISCO WERE
OVERSAW -- THE ALCOHOL AND DRUG
TREATMENT PROGRAMS THERE AS WELL
AS BEING DEPUTY DIRECTOR OF
BEHAVIORAL HEALTH.
SO I HAVE TWO VERY.
CONTRAST IN EXPERIENCES WITH THE
ALCOHOL AND DRUG TREATMENT
SYSTEMS.
SAN FRANCISCO IS WELL KNOWN AS A
COUNTY THAT INVESTS IN SOCIAL
PROGRAMS AND IN NINETEEN NINETY
SEVEN THEY ALLOCATED ADDITIONAL
FUNDS TO PROVIDE SUBSTANCE ABUSE.
TREATMENT ON DEMAND IN SAN
FRANCISCO WHICH ULTIMATELY
RESULTED IN ANNUAL ALLOCATION OF
TWENTY MILLION DOLLARS OVER AND
ABOVE WHAT THAT COUNTY RECEIVED
THROUGH STATE AND FEDERAL
FUNDING.
TREATMENT ON DEMAND WAS NOT JUST
INCREASING EXISTING SERVICES BUT
IT USED TO COMMUNITY PLANNING
PROCESS. TO DESIGN NEW AND
INNOVATIVE APPROACHES TO
UNDERSERVED POPULATIONS NEW
PRACTICES -- AND ALSO TO ENHANCE
THE EXISTING SERVICES SO WE
COULD PROVIDE CO OCCURRING
SERVICES FOR EXAMPLE IN
INTEGRATED WAYS WHICH ARE ONLY
NOW BECOMING THE NORM FROM STATE
AND SAID FEDERAL FUNDING
RESOURCES.
IN -- THEN SUPERVISOR GAVIN
NEWSOM IN NINETEEN NINETY SEVENS
CONCEIVED AND SPONSORED LOCAL
LEGISLATION TO ESTABLISH OFFICE
BASED OPIATE TREATMENT PROGRAMS
WHICH AT THE STATE. FOR
MEDICATION ASSISTED TREATMENT
THROUGH THE ORGANIZED DELIVERY
SYSTEM -- OTHER INNOVATIVE
PROGRAMS WERE MOBILE METHADONE
SERVICES METHADONE VAN IN
NINETEEN NINETY NINE WE BECAME
ONE OF THE FIRST CALIFORNIA
COUNTIES TO BEGIN DRUG OVERDOSE
PREVENTION EDUCATION PROGRAMS.
IN NINETEEN NINETY NINE IT
REALLY WAS JUST EDUCATION WE
WORK WITH FAMILY MEMBERS WE
WORKED WITH -- PEOPLE WHO USE
DRUGS TOGETHER TO TEACH WHAT
WERE THE SIGNS AND WHAT SHOULD
YOU DO WHEN YOU SAW SYMPTOMS OF
AN OVERDOSE WASN'T UNTIL TWO
THOUSAND AND THREE THAT WE WERE
ABLE TO START A PILOT PROGRAM.
TO DISTRIBUTE NALOXONE PILOT WAS
SO SUCCESSFUL WE SHORTLY STOP
THE PILOT BEGAN JUST
DISTRIBUTING INJECTABLE LE LAC
SOUND -- THROUGHOUT THE COUNTY
IN TWENTY TEN WE WERE ABLE TO
BEGIN USING THE INTRANASAL --
METHOD TO REVERSE OF ADDRESSES
WHICH IS NOW VERY COMMON COMMON
BUT IT WAS SORT OF ROCKET
SCIENCE BACK THEN -- AND THAT
REALLY EXPLODED THE NUMBERS OF
PEOPLE WHO AVAIL THEMSELVES OF
THE OF THE ABILITY TO HAVE.
OVERDOSE PREVENTION KIDS BECAUSE
PEOPLE ARE MUCH MORE COMFORTABLE
WITH IT WITH THE SCORE DINA.
A LITTLE BOTTLE THAN THEY ARE
MESSING WITH AN INJECTABLE
SUBSTANCE SO SAN FRANCISCO
ACTUALLY WENT FROM A POINT OF
HAVING -- FIVE NON FATAL
OVERDOSES IN THE EMERGENCY ROOM
EVERY SINGLE DAY WITH AN AVERAGE
OF A DEATH EVERY OTHER DAY IN.
NINETEEN NINETY NINE TWO
THOUSAND TWO LESS THAN A DOZEN --
IT IN MORE RECENT YEARS THE STEM
THE TIDE OF THE OPIATE OVERDOSE
DEATH -- INCIDENTS IN SAN
FRANCISCO FOR AWHILE BUT NOW
THEY'VE BEEN OVERCOME WITH THE
INFLUX OF TECHNOLOGY AND THE
DEATH RATES ARE STARTING TO
CLIMB AGAIN.
BUT WE DID SHOW THAT IF YOU PUT
IT OUT THERE PEOPLE WILL USE IT
AND YOU CAN REDUCE.
DEATHS AND AND PEOPLE CAN TAKE
CONTROL OF THAT WHETHER IT'S A
FAMILY MEMBER OR SOMEONE WHO'S
JUST A BYSTANDER.
A MANAGER IN AN SRO HOTEL.
AN RA IN A COLLEGE DORM AND A
SOMEONE WHO IS KNOWN MANY MANY
PEOPLE WHO HAVE DIED FROM OPIATE
OVERDOSE IS I APPLAUD THE
STATE'S WORK TO HELP GET THAT
PROGRAM OUT THERE -- IN TWO
THOUSAND AND SEVEN UNIVERSAL
HEALTH CARE CAME THROUGH IN SAN
FRANCISCO IN THE FORM OF HEALTHY
SAN FRANCISCO.
AND THE THE VAST ARRAY OF
TREATMENT SERVICES THAT HAD BEEN
DEVELOPED FROM SCRATCH FOR TEO
DD FOR THE TREATMENT ON DEMAND
PROGRAM BECAME BROADLY AVAILABLE
FOR EVERY EVERY PERSON BECAUSE
EVERYBODY HAD INSURANCE THAN IN
SAN FRANCISCO.
THAT PREDATED OF COURSE THE
AFFORDABLE CARE ACT WHICH BRINGS
IN THE OPPORTUNITIES THAT --
MISS CAN'T SO SUCCINCTLY
SUMMARIZED -- FOUR AND A HALF
YEARS AGO I LEFT SAN FRANCISCO
FOR FAMILY REASONS AND MOVED TO
SANTA BARBARA AND IT'S A VERY
DIFFERENT ENVIRONMENT AND I JUST
WANNA CONTRAST FOR YOU.
THE DIFFERENCE BETWEEN A WELL
FUNDED DEDICATED COUNTY AND A
MEDIUM SIZE COUNTY WHICH
REFLECTS A LOT OF THE KNEES
NEEDS OF THE SMALLER COUNTIES.
AND FRONTIER COUNTIES AS WELL.
WHEN YOU'RE COMPLETELY RELIANT
ON THE STATE AND FEDERAL FUNDS
TO THE SAP THE BLOCK GRANTS AND
DRUG MEDI CAL THERE IS NO ROOM
TO INNOVATE THERE IS NO
CREATIVITY AND THERE IS A LOT OF
PRESSURE?
FROM EXISTING FORCES SO THE WORK
FORCE AND LOCAL POLITICS PLAYS A
BIG ROLE IN MANY OF THESE
COUNTIES.
THERE IS A STIGMA AS YOU HEARD
EARLIER AGAINST SOME OF THE
TREATMENT MODALITY SPECIFICALLY
NARCOTIC TREATMENT PROGRAMS
CONTINUE TO BE.
ANATHEMA -- FOR A TRADITIONAL
SUBSTANCE ABUSE PROVIDERS SOME
POLITICIANS AND OF SOME MEMBERS
OF THE CRIMINAL JUSTICE SYSTEM
AS WELL ALTHOUGH MA T. IS NOW
BEING.
A REALLY PROMOTED IT BY CDC ARE
WITH THE SUPPORT OF OTHER PARTS
OF THE STATE.
OF ADDITIONALLY PEOPLE ARE NOT --
WILLING TO OVERCOME THEIR
PREJUDICES AND BIASES AGAINST
QUOTE UNQUOTE SUBSTITUTING ONE
DRUG FOR ANOTHER IN EMBRACING
EVIDENCE BASED PRACTICES.
SO GETTING METHADONE TREATMENT
GETTING BUPRENORPHINE TREATMENT
GETTING THOSE KINDS GETTING EVEN
GETTING THE LOCKS ON OUT TO FAR
FLUNG REGIONS OF THE STATE IS
REALLY CHALLENGING BECAUSE YOU
HAVE TO OVERCOME THAT STIGMA
BARRIER FIRST.
BUT THEN YOU ALSO HAVE TO COVER
IT GET OVER THE EXPENSE.
THE DRUG MEDI CAL BENEFITS PRIOR
TO THE AFFORDABLE CARE OUT WAS A
VERY LIMITED BENEFIT IT AT
OUTPATIENT TREATMENT.
IT HAD PERRY NEEDLE RESIDENTIAL
AND IT HAD METHADONE AND THAT
WAS IT SO LOOKING AT THE
ORGANIZED DELIVERY SYSTEM WHICH
HAS THIS WEALTH OF AND VARIETY
OF DIFFERENT -- INTERVENTIONS IS
A MASSIVE UNDERTAKING FOR MEDIUM
SMALL AND FRONTIER COUNTIES THAT
HAVE NOT DON'T HAVE THE
INFRASTRUCTURE TO DO THAT THING
EVEN IN A MEDIUM SIZE SIZE
COUNTY LIKE SANTA BARBARA.
WE REALLY HAD TO CONSIDER HOW WE
WERE GOING TO BE ABLE TO FUND
THE BOARDING CARE COSTS
ASSOCIATED WITH RESIDENTIAL
TREATMENT BECAUSE THAT WASN'T
SOMETHING THAT IS FUNDED UNDER.
THE DRUG MEDI CAL DOLLAR.
WE'VE WE'VE WORKED IT OUT WE ARE
TRYING TO DO IT -- BUT AS AS
SMALLER COUNTIES THAN OURS LOOK
AT THAT AND THEY RECEIVED VERY
LITTLE UNDERSTAFFED E. AND
SOMETIMES THEIR DRUG MEDI CAL
EXPENSES.
WOULD BE -- REVENUES TO BE LESS
THAN A HUNDRED THOUSAND DOLLARS
IT'S JUST AN IMPOSSIBLE TASK FOR
THEM TO HAVE THE KIND OF
INFRASTRUCTURE THEY NEED TO DO
THAT.
SO.
COUNTIES REALLY NEED TO HAVE
CREATIVE AND FLEXIBLE MODELS
GOING FOR AS WELL AS FUNDS TO
HELP INNOVATES THESE PRACTICES
BECAUSE IT TRULY IS STARTING
FROM SCRATCH.
AND SOME OF THESE PLACES --
TWENTY FIVE COUNTIES HVE OFF
INTO THE ORGANIZED DELIVERY
SYSTEM AND A NUMBER OF OTHERS
WOULD LIKE TO BUT THEY JUST
DON'T THEY JUST LACK THE ABILITY
TO BE ABLE TO DO THAT -- SOME OF
THAT ONE ONE APPROACH IS COME UP
WITH A DIFFERENT MODEL WHERE A
HEALTH PLAN WOULD KIND OF MANAGE
THE WHOLE BENEFIT FOR A NUMBER
OF DIFFERENT COUNTIES.
I UNDERSTAND THAT SOUGHT IS
MOVING FORWARD AND THAT'S THE
KIND OF CREATIVE AND FLEXIBLE
THINKING THAT NEEDS TO HAPPEN TO
BRING THESE THESE IMPORTANT
SERVICES THROUGHOUT THE STATE.
EVEN SO YOU'RE GOING TO HAVE A
VERY DIFFICULT TIME GETTING.
ENOUGH PEOPLE IN ALL REGIONS OF
THE STATE TO SERVE THIS
POPULATION.
THE WORK FORCE -- THE MEETING
THAT YOU HAD PREVIOUSLY WAS
RIGHT ON TARGET IN LESS WE TAKE
PEOPLE WHO ALREADY LIVE THERE
AND FOCUS TRAINING TO GET THEM
TO BE TRAINED IN THESE IMPORTANT
HEALTHCARE PROFESSIONS.
YOU'RE NEVER GOING TO HAVE
ENOUGH PEOPLE TO PROVIDE THE
CARE YOU NEED NOT JUST FOR
SUBSTANCE ABUSE BUT ALSO MENTAL
HEALTH PRIMARY CARE ALL OF THOSE
THINGS.
SO WORKFORCE DEVELOPMENT
PROGRAMS ARE VERY IMPORTANT.
AND THAT WAS ACTUALLY ONE OF THE
THINGS THAT TREATMENT ON DEMAND
IN SAN FRANCISCO FUNDED INITIAL
IF THEY STARTED A SUBSTANCE
ABUSE.
CERTIFIED COUNSELOR PROGRAM FOR
PEOPLE WHO ARE IN RECOVERY THAT
WANTED TO HAVE KIND OF A
PROFESSIONAL CERTIFICATE THEY
FUNDED THAT AT CITY COLLEGE THE
PROGRAM IS STILL IN PLACE.
AND WHEN IMAGES SAY CAME OUT IN
TWO THOUSAND AND FOUR THEY
FUNDED A MENTAL HEALTH
CERTIFICATE PROGRAM AS WELL SO
THOSE KIND OF PROGRAMS IN THE
SMALLER COMMUNITY COLLEGES CAN
REALLY HELP PEOPLE.
ON THE GROUND LEVEL INCLUDING
PIER STAFF BEGIN TO GAIN THE
SKILLS THAT THEY NEED TO ADVANCE
IN THIS PROFESSION AND BECOME
PROFESSIONALS -- OTHER OTHER
PROBLEMS THAT -- COUNTIES HAVE --
OUR THAT WOULD BENEFIT FROM THE
WORK FORCE WOULD BE IF YOU
INCENTIVIZE MORE.
THE SMALLER AREAS IF YOU MADE IT
EASIER TO WORK OFF YOUR STUDENT
LOANS IN THE REALLY TINY PLACES
YOU WILL GET MORE PEOPLE THAT
WILL GO THERE AND THEY WILL
PROBABLY STAY ONCE THEY GET
THERE -- BUT WE'RE NOT A WE'RE
WE'RE DOING KIND OF A BLANKET
AND SEND IT IN SEC.
AN INCENTIVE THERE WE GO
INCENTIVE -- AND OF MY I THINK
THAT IF.
IF YOU -- WE DO SELECT THE WORK
FOR SHORTAGE AREAS BUT A
WORKFORCE SHORTAGE AREA IN
ALPINE OR DEL NORD IS VERY
DIFFERENT THAN WORK FOR SHORTAGE
AREA.
I HAVE WORKED FOR SHOULD IT
THERE IS A MY COUNTY BUT I ALSO
HAVE OTHER AREAS THAT ARE NOT
WORK FOR SHORTAGE AREAS.
SO -- THE OTHER THING THAT'S
DIFFICULT FOR US IS THAT THE NEW
EXPANDED DRUG MEDI CAL BENEFIT
COMES WITH A LOT OF REQUIREMENTS
AND COUNTIES REALLY DO WANT TO
COMPLY WITH THOSE REQUIREMENTS.
BUT AGAIN IF YOU DON'T HAVE THE
INFRASTRUCTURE IN YOU DON'T HAVE
THE STAFFING YOU RUN THE RISK OF
NOT HAVING YOUR PROVIDERS
ADEQUATELY TRAINED TO PROVIDE
THE BENEFITS IN THE WAY THAT
THEIR DECIDE -- SO WE REALLY
NEED TO HAVE A LOT OF TECHNICAL
ASSISTANCE ESPECIALLY FOR
COUNTIES THAT NEVER HAD DRUG
MEDI CAL BEFORE.
AN EVEN COUNTIES THAT DID HAVE
DRUG MEDI CAL THIS IS SUCH A
HEAVY LIFT TO ADD ALL OF THESE
NEW SERVICES.
IF WE'RE ABLE TO HAVE REGIONAL
MODELS IN FACT IN MY COUNTY I'VE
CONTRACTED WITH AN OUT OF COUNTY
RESIDENTIAL PROVIDER BECAUSE I
KNEW I DIDN'T QUITE HAVE ENOUGH.
VOLUME THERE TO SERVE EVERYONE
THAT WAS GOING TO NEED
RESIDENTIAL TREATMENT IN THE
PROVIDERS THAT RESPONDED TO THE
R. P. THAT I HAD TO ISSUE.
SO AGAIN MORE FUNDING -- TO HELP
THAT BECAUSE THE DRUG MEDI CAL
HAS NETWORK ADEQUACY
REQUIREMENTS THERE ARE QUITE
STRICT IN TERMS OF TIME AND
DISTANCE STANDARDS.
AND SO WHEN YOU DON'T HAVE THE
PROVIDERS IN THAT COUNTY AND
YOU'RE REALLY REALLY BIG.
HARD TO MEET THOSE STANDARDS
HARD TO COMMIT TO BEING PART OF
IT YES WHEN YOU'RE WHEN YOU'RE
KIND OF SETTING YOURSELF UP FOR
FAILURE UNLESS YOU CAN SOMEHOW
MAGICALLY PRODUCE THE WORK FORCE.
TO DO THE WORK OR COME UP WITH
REGIONAL MODELS WERE YOU CAN
REFER PEOPLE TO GET THE SERVICE
IF YOU'RE NOT ABLE TO HAVE IT.
DIRECTLY WITHIN YOUR COUNTY --
OTHER THINGS THAT WE HAVE
CONCERN ABOUT -- SPEAKING FOR
THE OTHER COUNTIES.
IS THAT -- ALTHOUGH THE
ORGANIZED LABOR SYSTEM IS AN
INCREDIBLE OPPORTUNITY FOR
FEDERAL FUNDING -- IT'S JUST NOT
EASY TO DO AND WE NEED TO HAVE
THE THE LEVEL OF SUPPORT TO MAKE
SURE THAT WE CAN OVERCOME THESE
BARRIERS AND REALLY HAVE IT GO
FAR BEYOND THE TWENTY FIVE
COUNTIES THAT HAVE ALREADY OPTED
IN. TO THAT.
WE