 Terrific. So good morning. This is Senate Health and Welfare Committing Meeting of January 17th. This morning, we're going to take a little bit of time to begin, as I say sometimes, to begin to launch to commence to go forth on prevention, because I know that prevention is a huge concern in here and outside, particularly where mental health, substance use disorder, and other behaviors that interfere with our health care system and tend to keep people from being as happy as they should. So, and I know that each of you has expressed an interest in one or more prevention effort in this state, and we will get to some of those. So there's a recent report out on obesity. There are reports out on tobacco, on PFAS and consumer products, prevention for mental health, illness, and prevention for substance use disorders, including opioids. A few years ago, I'm going to just take a minute, if you don't mind, our Chief Prevention Officer, and just talk historically, and then I know that you can fill in my gaps. Thank you, Michael. And so, as long ago as 2001, we developed what's known as the Coalition for Healthy Activity, Motivation, and Revention programs in the state, where we work with our American Heart Association, the Cancer Society. They are local businesses and others in an effort to promote health and wellness and prevent obesity. That was the initial and heart disease. So that one went forward. It has become sort of diffuse, and greater interest has taken place in prevention overall, because the more we invest in prevention, the more we save later on in terms of chronic health care issues. And so, just to walk up to last session, and Senator Hardy and I were here, and well, before we get to that last session, we did put in place a Prevention Council in the Department of Health, and when David is in Englanders, and he can help bring us up to speed on what that council is doing. It's a cross-cutting council across state government, and has a leader embedded in the Department of Health. And at the same time, we brought forward our wonderful Chief Prevention Officer, who is here with us today. Last year, we had the benefit of the Attorney General's Settlement for Prescription Opioids, and there was a huge settlement document that came out. And as I read it, it decided that, you know, the Legislature needs to be involved, and how do we spend $94 million, or eighty-four whatever it is. So we did meet Monica and I, and others in the Governor's Office, met and talked about how to put together a group, the advisory group that was embedded in the, in the settlement, and Senator Hardy is on that advisory group, which is a good thing. And so the, that group is meeting and talking about how do we spend, you know, $84 million over 15 years in prevention. I hope you'll talk a little bit about that as well. But, so that's happening, and then in addition, the AG has found another settlement for prescription drug. Overuse from the pharmaceutical companies. So additional funds will be coming to us, and I don't know how those will be sorted out. I haven't read that settlement yet. So there's a lot going on in terms of prevention. There are folks who believe that, you know, and we each believe that each step of the way, prevention, intervention, treatment, and recovery, each of those stage is important and we need to invest in each one. Today, we're just getting a step into some of the issues around prevention that our Chief Prevention Officer is involved in. And I hope you'll also talk about S197, that little, I don't know if you can, but we can pick that up another time. I forget what act it is. Okay. So thank you for allowing me to digress for a minute, but these, all of these issues are important. They will land on our table, and we're going to have to make decisions about how we want to handle the bills and the legislation that we see and give recommendation to the full Senate. So thank you for being here. Why don't we introduce ourselves for the, for you, and then we'll have you introduce yourself for the record. Dave Rieck, Senator from Rollin County, SQ2. I'm a team member of Kulick, Senator from Wyvern-Brownington, from Jenin Central. Terry Williams, Senator from Rollin District. I'm trying to remember. I think we live near each other. We do. We can just around that corner. Yes, I live in Williston. For the record, I'm Monica Hutt. I'm the Chief Prevention Officer for the state of Vermont. Just for your benefit and for this committee's benefit, I do have a little bit of a doable because I sit in the governor's office and I'll talk about that a little bit. I'm also the liaison for the governor to the Agency of Human Services. So as you know, every agency has a connection to the governor's office through a specific staff person. Kendall is overall, overall of us. The one ring to rule them all kind of person. But each of us have a portfolio. And so for me, the Agency of Human Services is my connection. And that makes sense because I've been in this role for just a little bit under two years and spent the last 15 years at the Agency of Human Services working in various departments. Most recently as the commissioner for the Department of Disability, Aging and Independent Living. So I have a lot of background in human services and he was in the community at the Howard Center before that. So happy to talk human services whenever you'd like. But specifically today to talk a little bit about my role, but Senator Lyons asked me to, there's something on the screen behind me, right? Not yet, okay. Alex, if you want it on the screen, I'm not sure if I should sort of gesture. Alex, can you get that? That's perfect. There it is. Your PowerPoint is up there. Great. Alex, could you go to the next slide, please? Of course. Thank you. So, although the title of the testimony is specific to substance use and misuse prevention, Chair Lyons asked me to speak a little bit to my role, which she did just a little bit, but I can elaborate a little bit more. And to talk about the cannabis funding and the opioid settlement funding, because I think part of the conversation is how do we reinforce and focus on prevention, especially in light of all of the other pressures. And as Senator Lyons said, when you're thinking specific to substances, but it's true across many other issues, you're always looking at treatment and interventions and how to get people to the next step. And sometimes prevention gets short shrift when we're thinking about it, because it just doesn't rise to the top when you've got a crisis in front of you. So just have that conversation a little bit with you. Go ahead, Alex. Can you advance? Yes. Is that? You tell me when you'd like to screen with the gesture. Okay, perfect. So, as Chair Lyons said, the role of the Chief Convention Office was actually created in 2019. And I stepped into the role in 2020 at this point in time. And the act itself, although the initial drive, and I believe that the impetus was specific to substance use disorder, and really looking at how we can prevent that, the legislature was very far reaching and far thinking as they created this position. And so they talked about things like chronic disease and health. And even really referenced kind of wellness. So rather than talking about prevention, how do we focus on wellness for Vermonters? I mean, that's everything from housing and transportation and childcare, which I know you're going to be delving into substance use disorder and child welfare. All of the things, all of those social determinants that go into somebody's health and well-being or contribute negatively to someone's health and well-being. So the legislation is enormous, which is the most fun any job could be, because it allows you and gives you the ability to think about things really broadly. It also can make you feel a little bit ineffective, because how can one person solve all of those problems. But the beauty of it is that the Agency of Human Services, the Department of Education, or the Agency of Education, all of our state agencies are working on prevention at some level. You know, everything from making sure that state parks are accessible and available to the work that we do in school and education, to the work that the Agency of Human Services is doing. State government is really all about making Vermonters as good and as healthy and as stable and vital as they want and can be. That's the role of all of ours. So it's easy to make the connections, even though, again, the devil is in the details when it comes to the funding. So I have the luxury of being able to think about improving the well-being of Vermonters all the time. Can you talk very briefly, I don't know if you can do that later on, about your perspective on the social determinants of health? Absolutely. Yeah, if you want to do that now. I can do that right now. Actually, if you switch to the next slide. Okay. This keeps getting longer. This is the document that I use for myself, the way that I sort of define the role for myself. And I just keep adding to it. And I will also just say, because I started life as an English teacher, there is an error in there. In the last paragraph, it's supposed to be critical activity. And as soon as I saw it, I thought, oh, I hate when I make mistakes like that. And of course, I feel compelled to call myself out because, you know, once an English teacher, I was an English teacher. I was an English teacher, I appreciate that. Did my student teaching a student teaching advice that I appreciated? So social determinants of health. And what does that mean? People talk about that and act like we all know that. But really the social determinants of health are basically all the inputs into our lives, right? So what does transportation look like? What does our housing look like? Where does our water come from? What kind of childcare are we able to offer? Where are our kids going to school? You know, what are we able to access in terms of either exercise to keep us healthy or therapy if we're somebody to talk with if we're feeling distressed? What's our frame network look like? What are the relationships in our lives that make us happy and keep us well? And I don't mean to sound polyanna, but what we really have come to understand scientifically and data-wise is that all those things contribute to our physical health and our mental health and actually create this whole package. And it makes a difference. And you know, that got really clear to me. I have to say that the time that I spent, and Senator Lyons has heard me say this a million times, but the time that I spent at the Department of Disabilities, Aging and Independent Living and thinking about wellness as we get older, you know, and watching my parents age and watching the kind of impact of hearing and hearing loss on your mental and physical health as you get older, on your balance and your core strength in terms of whether you fall and break a hip or don't fall and break a hip. All of those things go all the way back to how you are as a child and the inputs that come in there is your food nutrition. You know, is your food nutritional? Does it keep you healthy? Does it make you strong? Are you accessing the medical care that you need? A lot of people don't have the resources or even the time, even if they have insurance, to get to the doctor for the preventative stuff. So they go when they're sick and the doctor tells you all the things that you should have been doing to prevent these. And you think, well, you know, I could have done all those things, but I didn't have the time where I couldn't get off the work or I had to balance, you know, all of my family obligations and so no, I don't exercise 30 minutes a day even though I'm supposed to. We know that that's the right thing to do, but trying to get to that. And one of the, and I'll talk about it a little bit more when I get to it, and I already can hear myself talking faster because I get very energized about this. I know. I do that when I get David's time. David's time, so I can do whatever I like. One of the things that, one of the coalitions that I sit on is the Health Equity Advisory Commission, and we'll talk about that a little bit more. But again, looking at health and well-being and the inequities for certain populations in our state is another kind of component. So those social determinants of health are essentially the environment around you, both your personal environment and your physical environment and how it contributes to your health and well-being. And I can certainly give you lots more information about that. I suspect that as a committee this is something you're very familiar with, but I found some really great basic information because even when you're doing it every day, sometimes it gets to be really overwhelming when you use phrases over and over again. You say, or it again and again and again, and all of a sudden you don't really know what it means. Social determinants of health is kind of like that. That's why I asked you to put that up for you a little bit. Thank you. And I'll send you. I found a couple of really simple definitions. Actually, I have one taped above my desk because it helps me to be a little bit simpler because as you hear I get a little verbose and expansive in my thinking. So this is a great description of the work. And actually, Senator, one of the things that you had asked me to speak to was the difference between my role as the chief prevention officer and the difference with the role of the chief violence prevention officer. Oh, thank you for doing that. Yes. Yeah. So Dee has come in to state government most recently. She would be delighted, I'm sure, to come in and testify. She's very operational in her focus on violence prevention. She's doing a tremendous amount of work in school around school safety and preventing violence there, but also looking across our communities. And I am very cognizant of our two senators from Rutland where Project Vision began, was born and took root. And that was another kind of a violence prevention, social determinants of health combination where people in cross Rutland County were really looking at, well, Rutland City, I guess, not Rutland County, but in Rutland, we're really looking at the link between violence and crime and our social service system and how we could bring those two together to be preventative. So I know that actually that Project Vision is being, maybe revitalized is the wrong word, but I know some new leadership is coming in. And Dee could speak to that a little bit more, but I think that that's really where her focus, she's looking at the nexus of crime and public safety and some of the human services work. And she and I have been working very closely together. She's a little bit more operational, and I had the luxury of being a little bit more the connected tissue across all of the good work that's already happening in state government. So just to speak to that. Thank you, that was helpful. Good, and she would be delighted to come in, actually. Yeah, definitely. If we may do that, there is a bill in, I think, I'm not sure where I was going to go, probably in the judiciary, but we'll be having joint meetings with the Judiciary Committee and that's a time to have her, maybe we'll have her come in here before that, or maybe I'll talk with the senator from Bennington about putting together a testimony of that. Yeah, absolutely. So I'm not going to read through all of this. You've got it in front of you and you can look through it, but I do think that the very last sentence is core to the conversation, and this is something that I know Senator Hardy has heard a lot as we're talking about it on the opioid settlement advisory council. How do you prioritize prevention? Where do you put it in the framework? And in a very real way, how do you fund it and not feel as if you're taking away from areas that need immediate attention? I think that that's the age-old conversation around prevention, and I've spent most of my time in my life really looking at interventions and treatment, the things that happen when something has already gone wrong. So I think trying to think about how we put it into place, but also recognizing that it's not... the health department has a way of talking about prevention where they talk about primary prevention and then secondary and then tertiary. And primary is really that educational work. But the reality is that pretty much everything that we do when we fund a housing program, when we support childcare, when we talk about after-school funding, those are all preventative. And that's how I really love for people to talk about it, really recognizing that the work that we're doing has a component of prevention and we don't have to be purists when we're talking about prevention. We have to recognize when we're investing in things that are preventative, whether that's preventative healthcare or preventative supports for kids and families. We're always trying to get ahead of the curve and most of the interventions that we're funding are prevention. And that's very true, especially when we're talking about substance use disorder and thinking about folks who cycle through, you know, with a substance use disorder, it's not atypical for somebody to relapse multiple times before they can truly be stable in their recovery. And that's part of the disease, like with any other disease. So preventing every single time, preventing overdose deaths is a part of prevention as well. I tend not to want to separate it because it makes people feel like one thing is fighting against the other and that's not our intention, I don't think. But measuring outcomes is also kind of... Critical. Touchy but critical. But absolutely critical. Because even the bad outcomes tell you something. Yeah, I think we have this fear of measuring because we think it's going to show us something isn't working. But frankly, learning that something isn't working is exactly what you need to do to make it work. If all of our outcome measurements were just successful, then I'm not sure what we'd be doing with ourselves. No, no, go ahead. Does your program monitor metrics, trends and such? Is that something you tend to offer? There are many programs in state government. So I don't have a program per se. I work with all of the existing programs and every program in state government should be monitoring outcomes, measures, metrics. Many, many moons ago, we adopted as a state this idea of results-based accountability, which is one of the ways that we monitor metrics. There are lots of other ways, but that's the one that I love because it's really simple to understand. So I haven't looked forward to your presentation, the metrics embedded in this presentation, is that something that follows on? No, I don't have them in here, but if we wanted to talk specifically about any program in state government, I could make sure that you got and we're able to look at some of the metrics. The Agency of Human Services in particular has a really beautiful dashboard, and I will send you the link to that just so that you can find it. If the Department of Health, when they come in, perhaps that's a question we'll add to their presentation. I'm happy to talk about that. You're simple to talk about this. Oh, absolutely. I'll send it to Alex and then he can get it to the credit. Yeah, that's the best way to do it. And so AHS has an overall dashboard, and then each of the departments also has a dashboard, so you can see what they're measuring. Also, you must be getting inundated right now with annual reports from everybody, and each of those should also have, I know for the Agency of Human Services specifically, we tend to embed those annual reports, and as you're getting your introductions, I absolutely ask those questions because we should be measuring. We are measuring. Could we measure different things? Maybe, and that's something always to think about because it shouldn't be static, right? Sasha, that was a very non-answer to your question. You told her. Is there any more questions? I do have a question about in terms of the opioid epidemic. Am I correct in saying that at least partially the opioid epidemic was caused by pharmaceuticals, by prescription drugs? Overprescribing. That has been dealt with at least partially with legislation correct so that that can't happen again. Yes, there's a prescription, there's a Vermont, I can't remember the acronym, but there's essentially a prescription management system that doctors have to believe into. And you may even see it in any visits to the ER for yourselves or family or friends where the doctors are much more cautious about what they're being prescribed and what they're going to send you home with. There's also a prescription drug detailing a group that is centered at the medical school. So when we look over the program and the detailing that goes on, it's not just the docs then it's also the drug companies that have really pushed their product and we know with the AG settlement had some of the unscrupulous things that have happened. That's a whole. It seems like a tragedy that should never have happened again and I just hope that it's almost like we have to protect ourselves from ourselves in this case because the system really failed us and I just hope that in terms of prevention folks really have their eye on holding those folks accountable making sure it doesn't happen again. Yeah and I think there actually are metrics and measures for the rate of prescribing the amounts of prescribing that are embedded in that I keep wanting to say it's BPM but that's probably not right. I should have monitored it. But it is. I know that we're not writing it. Senator, do you want to make a comment? Yeah and I also have a question. Should I wait till? If it's something coming up and hold it. So there is still work to be done in that area because as more drugs come on to the market and we're also seeing drugs that are for example right now there's a veterinary drug that's one of the major properties so yeah and so that's sort of outside of the system right now so it has been there's it hasn't been solved fully I would say. It's still an ongoing thing that we need to that the whole medical community broadly to excuse me to find needs to stay with. I have a question for you but I think I will let you finish and then I want to sure ask. And actually just to add to the position of prescription drugs I think that you're absolutely right Senator that initially it's making sure that the prescribing is happening but there are a lot of other steps after that too so education around drug disposal. Getting rid of it when you're not using it anymore giving it back letting it sit in your medicine cabinets is a whole other part of the process. We still have to look at that. Making sure that kids don't get hold of things so that you're not using it for some other purpose later on. And again based on the work that I did at Dale at the Department of Disabilities and Independent Living realizing that for older Vermonters the oh shoot I think of the word using prescription drug and combining it with other things changes as your body gets older your theology changes if you don't actually metabolize in the same way so certain drugs that may have been prescribed to you and like last time at dinner aren't going to have the same effect that they did when you were much younger and so trying to really pay attention to prevention all across the lifespan so that we aren't creating problems even later in life because people are just following the directions of their doctors or not necessarily thinking about or sharing information again it's one of those things that the doctors are telling them everything that you're doing or a euthymic amount you know sometimes you maybe exercise more and have less of a last one at dinner when I'm talking to my doctor than might be actual truth so realizing that it's important to say those things and making sure that's also part of our messaging and marketing because our bodies are changing and things happen differently depending on what's going on so the prescription piece is huge and I'll get off this page because I'll just keep talking about it so the next slide just taught very quickly and there are so many people that I wasn't able to list but so many partnerships that I am able to have across state government so you know thinking about the obvious suspect so the Vermont Department of Health and the Department for Children and Families the Department of Mental Health and the Department of Disabilities, Aging and Independent Living but also working with our Medicaid group the Department for Vermont Health Access I've had the opportunity to work over the last couple of years with the agency of natural resources when we think about conservation camps and our after school programs the Department of Looker and Lotteries we talk a little bit more about the cannabis funds and trying to make sure that we are approaching cannabis and then thinking about sports betting you know whether or not that becomes something that I think will here in Vermont how do we create prevention strategies around that before we launch it I will say I'll talk a little bit more about it regardless of how you may feel about the legalization of adult use cannabis Vermont is doing a really good job of moving very slowly very methodically very thoughtfully and trying to build safety strategies around it it is complicated it's complex I think with thinking about it but I think that Vermont I was in Portland Oregon a few years ago and I feel like Oregon didn't do a very good job with their legalization efforts and it was I thought a really great example of how not to do it in terms of how many retail establishments were available the licensing regulations which seemed really less thorough than they could have been I think Vermont is really working hard to do that and I think that the legislature has been really engaged and involved in every little decision and I think that that's critical because we don't want to create problems we've learned a lot from the other states we have and we continue to so there certainly will be some more things that you will see I think as a legislature this session come up because there's always going to be pressures and pushing so considering how we can continue to center prevention for youth in that conversation about whether it's appropriate and not appropriate for adults to very different populations that we need to think about separately so also working a little bit with the Department of Financial Regulation very much and very often with the agency of education and even the Department of Public Safety when we think of or not Public Safety but the Department of Public Service because even when we're talking about things like weatherization for older homes another area of prevention when you think about safety for older low income for moderates lots of community organizations different coalitions that I sit on as an executive member or as a member so the substance misuse prevention council is a group that I do sit on the health equity advisory commission I talked to you about that a little bit earlier really thinking about the disparate impacts on health for certain populations and the last legislation goes beyond race and ethnicity and asks us to look at the impacts of health or the poor health outcomes for people who are LGBTQ for homeowners with disabilities even for older homeowners so really trying to look at why are health outcomes for those populations including those individuals who are black indigenous people of color why does the data show us that they are less healthy than they should be here in this really amazing state and so looking at all of those populations the Opioid Settlement Advisory Committee as you spoke to Senator and Senator Hardy as a member of that as well and also the Vermont Interagency Afterschool Task Force so those are some of the key coalitions and committees that I work with or lead on and then there are others that have been in existence for a long time thinking about the kids tobacco program that's been going on that which was extremely effective with tobacco settlement funding and then the tobacco settlement funding has sort of gone down and the outcomes have decreased so it's a constant effort whatever you let go the gaps show us and the local prevention coalitions so that first group of community those local prevention coalitions exist across the state of Vermont there is a coalition connected to every community and last legislative session the legislature approved $3 million prevention funding specifically to go to those local prevention coalitions to really entrench and enhance the work that they're able to do the way that any local coalition like that works they kind of pop up and then die out depending on what funding they're able to get and so the intent of that $3 million was to stabilize those networks to create those coalitions to create a network in every community one coalition that would be stabilized in terms of its operational costs so that it could then look for grants but not always be looking for survival dollars which is how any really tiny organization like that tends to work so those dollars were one time last year we need to look to see what will happen in this year but eventually they will be funded with the cannabis revenue I'm going to talk about that in just a minute so and I know that Senator Westman and Representative no I'm thinking of his first name and I can't remember his last so I don't want to from Rotland Halla Moore Representative Representative Fagan get there that was his first name Representative Fagan and Senator Westman were really clear that they wanted to see those local prevention coalitions focusing on all substances so not just tobacco or just cannabis or just opioids but recognizing that when you're talking about that primary prevention and education both for kids and for adults in a community that you need to look across substances because one is often connected to another and some of the strategies are the same and some are different depending on the substance but to kind of silo tobacco cannabis from opioids is probably doesn't make sense when you're trying to really get at how are you trying to prevent the initial use and that's really what these coalitions do we've got lots of other programs and then pick up along the rest of the continuum does alcohol get put in there? absolutely yes absolutely so just to talk to you a little bit about next slide please thank you so I referenced this a little bit the cannabis sales tax revenue so ACRON 64 made adult use cannabis legal in the state of Vermont just as a side note I tend never to say recreational use just because I feel like that's a really funny message especially when you're trying to talk with kids that makes it sound really fun and again it's a choice but it's a choice that adults can make like with alcohol, like with tobacco it's a choice for adults to make for kids we don't want to talk about recreational so I always talk about adult use to just be super clear in my language so made adult use cannabis legal in the state of Vermont that law went into effect without the governor's signature and he was very clear that one of the key components was that if there was going to be revenue gained from this sales of cannabis across the state of Vermont that one of the primary areas of focus needed to be prevention so we're still waiting for the market really just opened up I believe in October is when the licenses for retail sales should start to be issued I encourage you to talk with JFO about the projections for it because they've been working really closely with the cannabis control board and with the consultant that was working with the cannabis control board to try to get to consensus on what do they expect the dollars to look like coming in from both sales tax and excise tax we will be doing that and just so folks know there is language and statute around prevention it's just that it isn't significantly defined so that's going to be a role that we play in defining how to use those funds and last year the statute was changed so that the money that was available for prevention which was a big deal to us in here we worked very hard to ensure there was language in that bill for prevention purposes but that what happened was after all expenses then or all costs then what's left over is prevention so originally we had 10% of revenue now that's been we don't know how that's been dropped down it is concerning because we will need a lot of resources for as you pointed out across the board it's not one many so we'll be looking at that as we get more data on fiscal actually that slide it speaks exactly what you just said senator on that next slide oh good yes that's okay there's a sales tax and an excise tax excise tax is actually 14% and 70% of that goes to the general fund and 30% actually to substance misuse and prevention but you were correct there was legislation last session that flipped the order of operations essentially so initially it was meant to be 30% of the excise tax off the top would go to substance misuse prevention and it has flipped now so that first the funding of the cannabis control board and its operational costs are funded from the excise tax and then the remaining amount 30% of that goes to substance misuse prevention it's not nothing I'm not at all trying to sound stingy or as if I don't want the board to exist I think it has a really important role in terms of regulating this entire huge body of work and in the licensing and the ensuring adherence to law I mean they have a big role to play but I hate to see any money not be dedicated to where it was and that actually was sunset in a couple of years and we're still waiting to see if the dollars look like 6% the entirety of the sales tax is actually dedicated to afterschool and summer programming so that's really exciting and again as I said earlier prevention not having to be named prevention in order to be preventative we know how important afterschool and summer programming for kids is and how preventative it is in their lives and so this is another form of prevention it just looks a little bit different it is far more active which is exciting and the next slide talks just a little bit about the opioid settlement fund and again you always hate to try to talk about something when somebody's in the room that knows as much about it as you do but the opioid settlement fund is specific to dollars that are garnered from settlements that the AG's office the attorney general's office negotiated it started with 3 settlements and I actually think we may be up to 5 to know what it is to do they keep coming so there were these original 3 settlements with distributors of opioids with the pharmaceutical companies and actually with the Sackler family and we structured the attorney general's office was prescient in their structuring of the settlement because it essentially is absorbing any new settlements that come our way into the structure that we created for the original 3 David Englander from the Vermont Department of Health will be able to tell you a little bit more about the actual dollars because we're kind of waiting they're held with a there's a single individual nationally that's managing all of these settlements for all of the states in terms of the money coming in from the United States and in the legislation last session I guess the same legislation that created the opioid settlement advisory committee created a process by which the Vermont Department of Health would work with the advisory committee to come up with recommendations those recommendations would go to the governor it would move through the governor's recommended budget so that the entire legislature could weigh in so we've got a process by which we can weigh in on the recommendations that are made through the settlement advisory council in terms of how we spend the dollars and Senator Hardy can attest to the fact that even now we're having these conversations about prevention versus treatment or intervention versus recognizing there are dollars to be spent and we can pick and choose the places that we put it to create a real continuum so that we're not leaving anything behind it's 18 years of funding so it's a really substantial amount of time and it's a pretty substantial amount of money I think in the first few years it will be three or four million but then it starts to accrue and become cumulative and so there will be money to be spent on mitigation of the opioid epidemic it also has settlement itself has probably four or five pages of allowable uses they're broad you can find lots of things in there but they are prescribed and so that's really the work of the advisory committees to sort through recommendations coming in where might they fit and what are we going to prioritize one of the things that is clear and all of that is that the towns that were first a part of the lawsuit so there were five towns I think but anyway so there is some local funding available so that becomes an issue for VLCT I think they're also on the advisory board so how that local funding gets distributed and then we don't want to have double-dipping triple-dipping overlapping initiatives so which is why that advisory committee so really important for the executive branch as well as for us yeah well I just argued John because I wanted to speak a little bit about the okay settlement fund and I know you've been attending those meetings or at least some of them because I've seen you on teams it seems easier to get into them yeah I was glad we finally met in person last time I was the one that pushed for that because I couldn't even see who was there yeah well especially teams because we're all used to so teams for us it's just it's hard anyway so I mean I know you mentioned it but the tension is between prevention and treatment and I will just I'm curious what you you started to talk about it a little bit with the primary secondary and tertiary treatment but I would love to hear you dig into that a little bit more because I think that the last meeting we looked at the Johns Hopkins principles of using the opioid settlement funds these are five principles about how to use the funds and the first one is to save lives like literally people are dying every day every week in our state and they are dying because we've got addicted to these drugs because of bad practices from pharmaceutical companies and others and in so many communities every single person knows somebody who's died it's tragic and I feel really strongly that we have to use these first and foremost to save lives now not long term prevention but saving lives right now and I also think that saving those lives right now is prevention and that's what I would love to hear you embed more in your conversation about prevention particularly when you think about people as part of a family or part of a community if you're saving that person's life you are also preventing somebody else the tragedy and the harm of losing a loved one a mother, a father a brother, a sister, whatever a niece, a nephew a friend so yeah I think that there needs to be more talk about prevention as saving lives right now not saving lives down 15 years because we've taught at kindergarten or not to smoke or whatever to save a mom's life right now we are preventing a child from having a tragic life and I couldn't agree more I think when I talk about prevention I also talk about preventing overdose deaths and that is prevention especially with substance use disorder I think maybe even more so than any other issue I've really looked at I feel like there are many different points along the continuum from when you might start to use some and then the commentator or end up with a substance use disorder through your treatment, through your interventions through your recovery there are multiple points where you can prevent it's almost like a we were talking about the interstate sort of an exit ramp on the interstate there are lots of places where those ramps have to be inserted so that you can get off that linear line and I think every one of those people who help us do that that's prevention, it's preventative I totally believe that what I worry about Senator Hardy is that we end up talking about it like it's completely bifurcated like we must say in life now we cannot talk about prevention I think it's yes and it's absolutely both somebody used the analogy last year and it really stuck in my head of a house that was on fire and we have to see the people that are in the house absolutely no argument there's 110% but I also don't want anybody walking in the back door of that burning house so how do we do both and is this the opportunity this is a lot of money that the state is going to see how do we figure out how to use it so that we are really trying to achieve both ends and not lose for winning, not sort of save lives now but create problems down the road I totally hear you and I think especially in the first few years of the settlement funds we have to put the fire out in the house that has to be especially because there are a lot of other funding sources for primary prevention that are already dedicated to opioid prevention and other substance use prevention and we can't use opioid settlement funds to displace other funds so that's actually in the legislation has to be additional it can't simply new use and there are so there are so many right now needs for primary harm reduction treatment of people who are addicted to substances that the yes and I agree but it has to be the yes first and that's where I'm hearing from the administration they're more on the and than the yes we'll get there I think this is a good discussion this is the kind of thing that we'll be bringing up as we go through any of our recommendations for budget for sure and then listening to what comes to us from the settlement because it will come here eventually and it's interesting too because the settlement dollars really do have to have a nexus to opioids that's one of the violations so you have to be able to make that connection but I would just I am not aware of a lot of other dollars other than that 3 million going to primary prevention and money at the agency of education for a work in schools there's not a lot of other money going to primary prevention and that might be totally appropriate but if there are other funding sources that you're aware of I haven't I'm not so maybe we'll get the department of health and yeah we had an AR meeting in I think October maybe September there was a whole slate of like a hour long presentation by the department of health of all the little tiny pots of money they have okay and a lot of it was going to prevention broadly defined yes yeah so we'll go back to this if you have the message here department of health it would be great to know primary secondary tertiary has it sugar off within the department we've got David to bring that in yeah so you know and then as you're talking about this obviously the prevention extends into recovery and how long does it take to recover right preventing you from going back so how many slips five seven nine we hear about people who are in recovery for years so having funds available to ensure recovery can be completed that's a part of prevention that saves lives so it all gets down to what we understand and what we know about addiction overall and I think back to my professional experience when I had a grant from ADAD when it was ADAD about working with a friend in social work to develop the first integrated course on we didn't call it substance use we called it drugs we built that and it spread across the universities and colleges in the state it's now completely different you know so when we talked about intervention we were talking about the mother who showed up at school to pick up her child and she smelled of alcohol and what do we do as a teacher or as you know or another parent so it's changed right so that will continue to change I also think just speaking to what Senator Hardy was bringing up if you save a life and a family remains intact because you've saved a life that's preventative for the children because they've got parents and they've got a more stable family it's all so connected I think it's just important and we have to make decisions but it's important to resist the urge to pit one part of the spectrum against the other because we do that at our own peril so trying to think about it more as a continuum which is much harder to hold in your head and frankly I have struggled with it but it's fun and then another area that I know you're really interested in Senator is the co-occurring mental health and substance use disorder issues and so really trying to dig it to that a little bit another area where prevention and wellness and health can be so impactful and to again ignore it and not address it just creates problems that you can't, a fire that you can't put out you'll probably see a bill related to that for the blueprint we're looking at that working with the administration on that as well as house healthcare so we'll see what happens where that lands but you're right so critically so that was I think the last slide is just me saying thank you for making sure that you have my contact information so oh good thank you it's been great questions for how we have her here yes for things you'd like to learn more about and I can directly to the actual experts I'm still zooming as I go but the budget summary which you alluded to a few minutes ago would be fascinating to understand where the buckets of money are we can probably get that directly or indirectly related to prevention and such well the budget summary I mentioned was specific to substance use disorder treatment and prevention and I'm sure David Englinder has that or yeah the commissioner of health and just so you know the timeline on the opioid settlement committee is not well aligned with the budget process so I don't know what the governor is going to have and obviously I don't know what he's going to have in his budget on Friday what he's going to say about it but the settlement committee has not made recommendations yet to the governor or obviously to us but we are I'm hoping that we do it at our next meeting which is probably early February but I'm trying to remember what the timeline for actually getting the money is going to be we have some we'll try to put that together that might be a good thing to talk about legislative later try and fix that timeline if we can the process will work beautifully for not this coming fiscal year the following fiscal year this one is tight but we should still be able to get it into the budget it's just going to not come with the governor's budget a little later the original the original settlement I think would allow for the executive branch to make all the decisions so the statute that we put in place put some interaction between executive branch and legislature which for me was critically important so yeah and the administration will support it I understand that it'll sort out it'll soon enough sort out we'll get there but we'll keep an eye on it I am as you might expect Madam Chair constantly saying we got to move faster the poor people no this is great thank you you're welcome so just to I want to make sure I remembered the things that I promised I'm just going to send you or send to Alex a link to the dashboard maybe get you a little bit of information about prescription monitoring system and some of the outcome data there and then let David Englander know that when he's healthy and well and he's back in the committee he wanted to speak to the presentation on the funding in the name of the division of substance use programs the funding presentation was there anything else that you wanted that I can just imagine about the primary secondary tertiary funding piece that would be important and you know that can be something that we post whatever he doesn't have to speak specifically to every single thing but just knowing that it's accessible for us and Alex can post whatever we need because there's a lot of interest in here I think at all this whole area and whatever bill we look at is part of this all right I will get all that to you and ask David to be prepared thank you so much Alex I think we can go offline we're good but we're not adjourned yet we'll just adjourn briefly tomorrow just I want to head up before we go offline thank you tomorrow we have the report the formal report on the financing study Alex will be sending along a link to the joint fiscal office where the report is going to be housed in the joint fiscal office so that it's easier to make corrections and add new drafts so it'll be that one place so you'll become familiar with linking up to that spend some time looking through the report we are very fortunate tomorrow morning we'll meet here we'll have household services with us on Zoom and the experts from Rand will come in and go through the report and then the second hour I should look at my agenda so I don't mess it up all the time from 9 o'clock to 10 o'clock we'll have that joint meeting and then at 10 o'clock they will come into our committee we'll probably take a little break in there between Zoom and they'll come into the committee here and be with us and then they'll go off to the house folks and the afternoon if you're on approach or finance they're going to do the same thing I'm going to get a double double shot it's just good we all need a little bit extra so they'll be talking about the bill and then on Thursday we'll have a committee discussion we'll have an opportunity and we'll meet with those folks yet again hopefully so it's a big report I read the draft early on and now I'm making my way through the finals about a hundred pages long don't be petrified there's a lot of need in the state to get to a place where we have comprehensive child care support where those child care centers are fully supported where families are supported and where businesses then can rely on work for us when kids are being cared for a lot of the report is based on child poverty levels and so up to 350% so I use the 300% where we currently have our child care financial assistance program and then the report shows how things might move ahead to 400% so and then how it would all be financed our decision in here will be on policies related to child care how it's administered, the government structure what we see as critical and important for supporting the administration through IT what's critical and important for supporting families for supporting child care centers and any discussion on licensure so there's a lot of policies that will contribute to the discussion about funding so it's going to feel like we're in the middle of they call it sausage making this is the time when we start talking about child care when the bill is introduced how it all fits together so please enjoy reading that this became such a critical issue for businesses and families during COVID the report itself is based on 2018-2019 data because that's the last full year of data before COVID and now we see that we're seeing economic changes we're seeing inflationary pressures we're seeing all kinds of other things so some of this is going to we're going to have to depend on economic experts in joint fiscal so zero to kindergarten in the report the pre-K in there there are some things that are not in there but simply read the report and then we'll have an opportunity to meet with folks ask questions which is a great opportunity that's it so now Alex let's go offline and we'll end our meeting there well thanks