Title
a. Receive and accept an oral report from the Prescribe Safe Initiative regarding initiative efforts and outcomes for the county; and
b. Direct staff to identify funding in the amount of $14,400 for two years of disposal costs of unwanted medication for six safe medication disposal sites at $1,200 per site per year.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Receive and accept an oral report from the Prescribe Safe Initiative regarding initiative efforts and outcomes for the county; and
b. Direct staff to identify funding in the amount of $14,400 for two years of disposal costs of unwanted medication for six safe medication disposal sites at $1,200 per site per year.
SUMMARY/DISCUSSION:
U.S. sales of prescription opioid drugs for medical use began to rise dramatically starting in 1999. While these drugs have therapeutic benefit, their use can lead to accidental overdose and long-term addiction if risks are not carefully managed through patient education and oversight. Patients, their families, and the surrounding community can be impacted. Prescriptions that are stronger than needed, in greater quantities than necessary, or duplicate other prescriptions; a combination which can all lead to dangerous outcomes for patients. Nationally, opioid sales, prescription opioid related deaths, and admissions for opioid addiction treatment all increased dramatically over the last 20 years. Opioid prescription drug misuse can lead to substitution of heroin for prescription drugs once prescriptions run out. There has been a particularly sharp rise in heroin overdose deaths in the United States since 2010.
Counties have begun to respond to the epidemic by developing local response efforts through collaboratives. Prescribe Safe Monterey County was formed in 2014 by Monterey County law enforcement, administration of the four Monterey County hospitals, and led by local Emergency Department physicians in response to concerns about prescription medication misuse in our county. Prescribe Safe Monterey County brings together over 18 local agencies and organizations with goals and actions to support, educate, and provide resources for our residents, physicians and patients on the dangers of prescription drugs, the safe use of prescription medications, safe and effective pain management options, and to increase access to treatment for opioid addiction in Monterey County.
Prescribe Safe Monterey County has been instrumental in promoting local use of the California Prescription Drug Monitoring Program and database, developing and distributing educational materials, developing complementary therapies and pain management options for multiple specialties, promoted and supported diversion control and overdose reversal medication distribution and use efforts, and has conducted youth education outreach with local schools. The efforts in Monterey County have seen improved opioid misuse related outcomes for county residents. The opioid prescribing rate decreased 14% from 2015 to 2017. The Opioid Emergency Department Visit rate decreased steadily since 2015. Also, since 2015, deaths from prescription opioid overdose decreased 47% to 1.6/100,000 residents in 2017. Buprenorphine prescriptions in the county are used to gauge the expansion of medication-assisted treatment (MAT). The annual buprenorphine prescribing rate in 2017 was 17.9 per 1,000 residents. This represents a 11% increase in buprenorphine prescribing from 2015. Successes in Monterey County are being used as examples for other counties interested in starting their own local initiatives to combat this alarming and deadly epidemic. Efforts to date have occurred largely through in-kind efforts by all agency and organization personnel.
The State of CA recently passed SB 212 that would preempt a local ordinance on safe medication disposal. SB 212 is expected to take effect January 1, 2021. During the October 2018 HHHS committee meeting, Ezequiel Vega, Assistant Director of Health, reported that in the near future there may be a funding gap between the time now and the time SB212 for safe medication disposal sites is implemented. One area that will require finding a sustainable funding source is the pick-up and disposal of controlled medication disposal bins at several convenient sites in the county where community members can dispose of unwanted controlled and non-controlled prescription drugs. The Health Department is requesting funding for the pick-up and disposal of 6 collection bins at a total of $14,400 for two years and covers the costs for up to 8 disposal visits per bin which are located in South County (Gonzales, Greenfield, Soledad and King City and Salinas). The funding is currently being provided by a grant obtained by Community Hospital of the Monterey Peninsula (CHOMP) but funding will expire before SB 212 funding is available. If this request is approved, the Health Department will administer the Board approved funds within its Behavioral Health appropriation unit (4000-HEA012-8410) which has enough appropriations in the FY 2018-19 adopted budget and will add appropriations and revenues to its FY 2019-20 requested budget.
This work supports the following Monterey County Health Department 2018-2022 Strategic Plan initiative: 1) Empower the community to improve health; 2) Enhance community health and safety through prevention; and 3) Ensure access to culturally and linguistically appropriate, customer-friendly, quality health services. It also supports nine of the ten essential public health services, specifically: 1) Monitor health status to identify and solve community health problems; Inform, educate, and empower people about health issues; 4) Mobilize community partnerships and action to identify and solve health problems; 5) Develop policies and plans that support individual and community health efforts; 6) Enforce laws and regulations that protect health and ensure safety; 7) Link people to needed personal health services and assure the provisions of health care when otherwise unavailable; 9) Evaluate effectiveness, accessibility, and quality of personal and population-based health services; and 10) Research for new insights and innovative solutions to health problems.
OTHER AGENCY INVOLVEMENT:
No other agency was involved in development of this report.
FINANCING:
Depending on the Board’s direction, funding up to $14,400 annually ($1,200 per year times 6 take-back locations) could be funded by the County or County partners. If this request is approved, the Health Department will administer the funds within its Behavioral Health appropriation unit (4000-HEA012-8410) which has enough appropriations in the FY 2018-19 adopted budget and will add appropriations and revenues to its FY 2019-20 requested budget.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
Check the related Board of Supervisors Strategic Initiatives:
☐ Economic Development:
• Through collaboration, strengthen economic development to ensure a diversified and healthy economy.
☐ Administration:
• Promote an organization that practices efficient and effective resource management and is recognized for responsiveness, strong customer orientation, accountability and transparency.
☒ Health & Human Services:
• Improve health and quality of life through County supported policies, programs, and services; promoting access to equitable opportunities for healthy choices and healthy environments in collaboration with communities.
☐ Infrastructure:
• Plan and develop a sustainable, physical infrastructure that improves the quality of life for County residents and supports economic development results.
☐ Public Safety:
• Create a safe environment for people to achieve their potential, leading businesses and communities to thrive and grow by reducing violent crimes as well as crimes in general.
Prepared by: Rose Moreno, Management Analyst, x4716
Approved by: Elsa Jimenez, Director of Health, x4526
Attachment:
PowerPoint presentation is on file with the Clerk of the Board