 Good afternoon, and welcome to the Vermont House Human Services Committee. Today is Tuesday, March 8th, and the first part of our afternoon discussion is on H711, an act relating to the creation of the Opioid Settlement Advisory Committee and Opioid Abatement Special Fund. And a good portion of this, what we're focusing on, is the section on the advisory council, and we will be hearing from, I want to say, interested players, people who, in fact, do the work, and then we will be hearing from Josh Diamond, the Deputy Attorney General from the Attorney General's Office, who was involved in the legal settlement, and Monica Hutt, who's the Chief Prevention Officer from the Governor's Office. So we'll start with Grace Keller. Grace, welcome. Thank you so much for having me. I'm glad to be here. I'm Grace Keller. I'm the program coordinator at Howard Center Safer Covery. For those who don't know, Safer Covery is Vermont's oldest and largest syringe service program, and oldest and largest community-based distribution of naloxone. And most recently, we started one of the country's first low-barrier buprenorphine programs set in a syringe exchange or embedded. So I come at it from the perspective of people who are supporting people who are actively using, people who are relapsing, and people who are in early recovery, and, namely, unfortunately, people who are most likely to overdose and or suffer other harms such as endocarditis that may be fatal. So when we're talking about abatement, really my focus, unfortunately for all of my staff, is really about keeping people alive, getting them into treatment, supporting them to stay in treatment. But as a frontline person and frontline team, we really are seeing probably the most overdose deaths in the state. And really, I've been in my job for 14 years, so I've never witnessed overdose deaths the way we are seeing them now. And for us, we're a statewide organization because we're the only full-time syringe exchange. So people do come from all over the state to access services. We had somebody from Bennington in recently. And I also represent Howard Center. And Howard Center has multi-layers of treatment and support for people who are using opioids, like we have a hub and a spoke. A spoke has multiple different sites. Safe Recovery is one of them. And a social detox and counseling and all different layers of support. So I'm here also able to talk about that. And on behalf of Vermont Care Partners. So I think that's pretty much a description of what I do. And really when I'm thinking about abatement, I really think that we need to focus. And I know everybody here does on the people that are that are that we're losing. One of the things that's happened recently that's really hit home is a lot of the people that we've lost overdose recently our parents. So also when we talk about prevention, the best thing we could be doing for the next generation is keeping their parents alive and getting access to treatment for for those kids and those families because it's really been very devastating. And I want to also highlight that overdose isn't the only way we lose people in this epidemic. We had a woman call our office who was very close to us who struggles with a lot of things and she was having trouble breathing. My staff called an ambulance for her and she got to the hospital and was almost just was blue and very close to death from endocarditis. So really I think that's what I represent sitting here is the people who are really meeting with and touching the the people who are most at risk for for fatal consequences of the opioid epidemic. I think that's probably a good start if people want to ask questions. Grace I will just ask you one question if you were able to look at the composition of the opioid settlement advisory council advisory committee and whether you had any comments about whether from your perspective the voices necessary to be at the table were at the table. Great question. So I do think I have had a chance to look at it. I've had quite a bit of time to think about it and I think we we are where we can even with all the positions that aren't designated as such we should really be focusing on getting individuals with lived experience and namely lived experience from opioid use disorder. I know in this state we do a good job of elevating voices of people in recovery but also trying to maybe find a way to engage people who are actively struggling and actively at risk and their families. So I think while I know there's a prescribed position that is for someone with lived experience I think in the best way we can making recommendations and prioritizing people who are living through this or who are in recovery is a really good way to go and the people who are most at risk for dying are injection drug users are people exiting treatment and jails and are you know people who the system isn't actually engaging currently other than at certain service programs but there are quite a few people in the state that aren't accessing any services so I think we need to find a way to get those voices and I know that it probably seems daunting to add spots but I think if we could be adding some spots really focused on the people who are doing the frontline work and the people who are who are suffering in their families I think that would be great or the other option that and people who know me know that I'm not really into layers of bureaucracy but having maybe a panel of lived experience experts that could make recommendations to the committee where it's all focused on on lived experience or some way to elevate those voices because I think at least in my work the best policy and the best work at safe recovery comes from listening to our clients comes from having really good access to the population and comes from really you know going through it with people so I think we really need to find a way to elevate those voices as best we can thank you thank you grace I appreciate appreciate that um why don't we go on to right now why don't we go on to um uh Peter um Espin Espin shade very good yes great thank you all and thanks for having me here today I'm Peter Espin shade I'm the president of the Vermont Association for Mental Health and Addiction Recovery we are also known as Recovery Vermont which is one of our core programs we train the recovery workforce in Vermont we advocate for those in recovery and we pilot and innovate new recovery programs throughout the state I've been in my position for nine years I'm a member of the former opioid coordination council I'm a current member of the Vermont substance use disorder prevention council and prior to that I worked at the Vermont Community Foundation doing grant making uh in education and health care the more important than that for this conversation is I'm a person in long-term recovery I was addicted for years to poly substances including uh prescription opioids I used to be able to get as many opioid refills as I wanted from my doctor but I know that you all have heard those stories before and they have been too common what excites me is the promise of recovery and recovery is about now what now what are we going to do to move forward as a state in this case with this opioid settlement and recovery is exciting people do move forward recovery is the norm not the exception according to the CDC about 75 percent of folks with substance use disorder reconnect to happy and healthy lives of recovery I think that the h711 as it's written is pretty good and strong the way it's structuring the council and the funding recommendations it seems to correspond with what we're seeing in the field the voices of those with lived experience statewide perspectives on recovery prevention and medicated assisted treatment which I think is paramount some of the good talk we've already heard about from grace and others on what we call harm reduction syringe exchange and naloxone distribution and putting all of that in an evidence based and accountable structure I think things are structured well in the bill the way it's written and obviously we'd love to be part of the conversations moving forward I guess my two cents on things as they are written as I would recommend all of us to view the term abatement a little more broadly than we might conventionally we see the term abatement throughout this bill and at least in our shop we view abatement as far less than sort of lessening the impact of something but about lessening the impact of something on one's complete lives so we're not talking about abatement simply of use of substances but abating the impact of the opioid epidemic on our daily lives and that's what recovery is all about it's about reconnecting people to happy and healthy lives through things like employment like the recovery friendly workplace initiative through recovery residences through recovery centers and programs and I would love to see this committee and these funds focused on moving the state forward by abating the past impacts of the opioid epidemic and getting these beautiful hard-working Vermonters in recovery back into work back into their lives reconnected with families and reconnected with their communities you know the opposite of addiction is connection and I think that this settlement and this council and these funds can be a nice step towards reconnecting us to lives that are better and healthier and more family and community focused so thanks and I'll take any questions now or later whatever works for you all thank you I'll just do a quick turn around the table to see if there's a question right now thank you thank you we will get back and now we have Joyce McKean president of the remote association of county judges you might need to tell us what that is because you're not normally in front of us right so thank you very much chairman pew and the committee thank you very much for having me here today I'm Joyce McKean I'm an assistant judge in orange county and I am president of the association which represents the assistant judges and the formal name of it is the associate the vermont association of county judges and but we are the assistant judges association just in case people aren't completely clear assistant judges have two very distinct functions and one of them is that we are the executives for the count for county government small though it may be the two assistant judges two per county are in charge of the county budget and then we also have a judicial function I'm not here today in regards to our judicial function I'm here today to speak to the fact that as the executives for county government we are the individuals who were contacted by the attorney general's office regarding the opioid settlement agreement because as part of that agreement certain subdivisions as they are and as per the language of the agreement are eligible for discrete funds and 12 of vermont's 14 counties are eligible subdivisions and as such would have been eligible to directly receive some portion of the settlement proceeds deputy attorney general josh diamond who i know i believe is here today or will be contacted us because the the counties don't directly have a mechanism to disperse those kinds of funds you know counties in other states have wide variety of functions they may be running jails and clinics and treatment centers under their own umbrella that doesn't happen in vermont and so the state has asked the counties to essentially sign over our designated portion of the settlement funds to be pooled with with the state funds so that they can be effectuated to the best use around the state and the assistant judges agree to that and we're happy to do that but we do have a vested interest in making sure that the funds are distributed widely throughout the state we know that there is no corner of vermont that is untouched by the opioid epidemic some you know locations are more harder hit than others and the assistant judges as a whole are not advocating in any way for some sort of equal distribution but we're very pleased that the current language of the bill does include one representative of the assistant judges on the advisory council which is something that we very much would like to do i also want to say just quickly to the again because i think assistant judges sort of fly underneath the radar i don't think people know a lot about individual assistant judges assistant judges come from many walks of life currently we have three attorneys we have former municipal administrators educators we come from bookkeepers we come from many walks of life and as such i think that there are any one of a number of assistant judges who could perform as a member of the advisory council very well bring their full life experience to that and then also represent county government as as one component of that so i'm happy to take any questions again i understand that we're sort of you know not everybody knows everything that we do but i'm i'm here mostly to say to express my thanks that the assistant judges were given a slot on the advisory council and to let everybody know that we're fully prepared to step up and i know that we can find a good candidate for our position so i'm happy to take questions now or um at any other time thank you um Joyce thank you um we may end up having more questions for you and others especially and as it relates to perhaps our our our our mutual misunderstanding or understanding about the um uh i'm going to call it the pot of money and which pot of money is being referenced in this bill which then always brings me up to the question now is what's happening to quote unquote the other two pops and maybe that needs to be referenced somewhere statutorily or um and that's probably part of a discussion that i'm seeing that um drash diamond um and um monica hot on the side here and i'd ask you to come you're you get to testify now and i don't know whether um you want to do this in tandem with um monica or um yeah whatever is the committee's whatever works i have a feeling we may end up having a discussion why don't i just sit here i'm going to sit there okay um madam chair members of the committee joshua diamond deputy attorney general thank you for the opportunity today to talk about h711 and um i know i've been here before at least remotely giving you an overview of the distributor and j and j settlements um i do believe that this legislation with one small nitpick that i'll i'll share with you captures the requirements that are needed and this is really as i understand it to effectuate that bucket of money there are three buckets just to recap one goes to our localities our cities and towns the counties were also uh able to access that but as judge mckiman said um we've asked them to assign that over to the abatement bucket uh so uh that money could be used most effectively um and um what the settlement documents require they don't really require for uh the municipal locality's bucket there's a state bucket as long as that money's used for remediation purposes broadly um that's fine but the the mechanics of the abatement bucket are spelled out in the settlement documents and this legislation enables that and most important is this concept that there will be this advisory panel that will give guidance about how the money should be spent and that the makeup of that panel must be in equal parts both state representatives and locality representatives which is a function of the settlement that involved many cities towns and counties not so much in vermont but nationally who will also sued and wanted to have access to some of those monies for local spending on projects towards opioid abatement and so that's why it's there that's why there needs to be legislation to effectuate that and we believe that uh the latest draft accomplishes what is required of the settlement agreements i will note that you have probably heard in the headlines that there may be a settlement with Purdue pharma and the Sacklers there's still some hoops that we need to go through to make that happen but if all goes well this framework could also be applied to those settlements as well um at least as written um the one technical tweak that i have to recommend is found on page seven uh line 12 um is this the draft that is on our web page um what is the time and state stamp with the draft? This is draft 3.1 as of three seven twenty two seven forty six i believe it's what is on the web page as opposed to what is my hardcover and in the last and second sentence of that paragraph a1 it reads the opioid abatement special fund shall consist of all abatement account fund monies dispersed by the national abatement account fund administrative to the department um and i i think we probably could live with that language but technically i wanted to let everyone know that the technical term for that fund administrator is the national settlement fund administrator that's the language used in the settlement agreement so i i offer that as a technical um edit for your consideration um can you remind us of where that is page seven line 12 i would i would ask that um ray you make a note of that because legislative council has had to step out in terms of that yeah so those are my remarks happy to answer any questions that you all may have i'm sorry mr diamond can you repeat that the national settlement fund administrator strike abatement account that's page seven line 12 yes lines three and four as well that same page yes so what's the proper term now national settlement fund administrator yeah absolutely that's what this is for okay so every place are you suggesting sir that every place where it says national abatement accounts even when it's just referring to the fund should it say settlement no okay only one is referring to the administrator correct okay just wanted to be clear about that thank you um one of the things that i um heard actually from um in the testimony from grace was the importance of connecting the importance in terms of whether it's the advisory council or who how to elevate the voices of um both i want to say like a better term frontline workers people who are on the ground as well as um individuals who are currently um experience who are currently living with um a probably an IV drug use um issue and i'm wondering if it isn't as part of the membership um after powers and duties of the advisory council there is a shell shall consult with and the dimension there is of the substance misuse advisory council which is the you know the structure within the department of health but rat and whether to then instead of saying and other stakeholders in between there somehow um reference and grace i'm looking to you and to others something more specific you know around people on the ground and and that grace would that sort of help you but that does not help you would that address your concern yes i think i think it would um i just i just know that the best the best programming and the best um ways to help people is really especially in harm reduction comes right out of the people who are suffering and i think unfortunately for us in vermont with the opioid epidemic changing so much looking at things like fentanyl and you know we're really losing people mainly to fentanyl overdose it's not really any longer as much heroin overdose i think we need to have our finger on the pulse of people who are dealing with it currently or very recently um because i think everything adapts and changes so much right now and we need to be nimble and move quickly so i do think that that does um that does that that is a good way to look at it it's i think unfortunately i'm hoping we get to a place where the we're not losing people at this rate but it's it's really uh what's on my mind and what i think abatement really is is where where my mind goes is like let's keep people alive and and get them into treatment and then we can figure out a lot of other things um but i've just um i've never i've never had clients die on this right at this rate my staff is it's it's just absolutely devastating and and when you're there for 14 years and at with harm reduction you know because of the lack there's no judgment people come in and report in throughout their lifespan so i hear their successes i hear where they're struggling i know their kids often or their parents and um and we're losing people people who've had long-term recovery and are relapsing and so during those dangerous points i really think um elevating the voices of the people who are at those dangerous points and the people that are have the best access to them did you want to say something i uh these are important policy considerations and i think it falls you know those type of edits okay consistent with the settlement okay okay um um i guess you know looking particularly grace at you and peter if you have uh ideas or thoughts about phrases or um how to how to do that i'm as i'm listening to you i'm going oh does that mean consult with organizations that do harm reduction provide harm reduction activities um i i'm i am thinking and maybe i'm thinking erroneously to just put in and consult with people who are active drug users won't necessarily get us what we want because they won't know how to find them you know so i would be looking looking for um unless oh do we have we have an editor clear good afternoon everyone um monica hotam the chief prevention officer it's so nice to be back here um so madame chair i might suggest that perhaps you use language like um demonstrate consultation with individuals with lived experience and then however the committee seeks to do that whether that's through a program um or uh or a specific site or a specific organization but it's maybe that's just the way to make sure that we're making sure that that happens um that's a great that's a great idea and i think what um right now we do not have um our wordsmith i.e legislative council um is not here um but will be at some point today or tomorrow that you might ever and um to throw out some ideas to her and have her connect um but so one of your ideas is to say um and demonstrate consultation with individuals with lived experience and then i i think it leaves it open in terms of maybe how the committee does that but then they can speak to that directly in the in the plan i might um i might offer what we heard if not today in some conversation that um the concept of lived experience is very broad um and that what i um that if my brother my sister my neighbor my spouse that that is my lived experience or maybe i'm a social worker and i work with that is my lived experience and i think what i am hearing from both peter and grace and others is that um the lived experience is that the individual themselves um is is actively um or is actively either utilizing um or is actively in um in recent recovery yeah um because what some of what i'm hearing grace say is that they're right now with some of the what is happening um there are some tension points where folks are um where the possibility of relapse is pretty strong um it's great sense that's make me wonder if a of a group like this already exists and if not why and i kind of want to turn to grace um and wondering i know uh on the ground you're able to have that consultation with folks who are coming in and utilizing your services but is there a community action group um that has been formed around looking at substance use and especially the overdose crisis um thanks that's a good question so there it's kind of a interesting answer there are there quite a few um and there you know there there's nuance to all of them i do see that i'm in you know a lot of meetings you know there's a comm stat group for burlington um there's comm stat subcommittees like i am the chair of the um overdose prevention site committee uh there are state meetings i'm sure that we'll hear about too there's a intervention treatment and recovery meeting that uh peter i believe and i both go to um so and i think in all in lots of communities there are i don't know if there's an exact um committee on really that specific population of people who are really right in the beginning of early recovery or who are actively using um so i think that that's might might be different and and um representative pure um is is correct in um in that it's hard to find people who are actively using that feel safe i don't necessarily think we have that structure set up in vermont right now but i think it's one of those things we need to change and really elevate those voices um you know and and i do think some family members especially family members who have lost people um are people that we could focus on like mothers and fathers and and and children you know really direct family members i think would be would be really good and i think also not just to inform the council but to sit on it if we can you know look at those spots and really focus those spots even the ones that aren't directed to be lived experience to to get those voices in those spots and have you know multi point of um criteria to meet that just so that we can make sure that they're they're actually at the table because i know a lot of people who would be willing to do that um and then again like you said just people who are right on the ground with it i think you know one of safe recovery statistics that i'm proud of and i'm not saying that it would be us but any of the syringe exchanges or designated agencies is that we distributed 59 percent of the state um Narcan in 2020 and there are 84 other programs so there are programs that are really on the front lines of opiate use um and and overdose so just looking at that and looking to people who've been doing that work um and like i said doesn't have to be me i'm just really trying to focus it on the people that are touching people that are are dying soon thereafter or um and really trying to figure out how to get to that that group of people and how to get that group of people to trust trust our providers and i think that that's something that we all need to focus on is who who has that access thank you and i see that um peter you've wanted to step in yeah i just want to want to echo what monica and grace were saying i think this is an important issue that um may need to be clarified in the bill the whole issue of lived experience and who has it and who can claim it and whose voices should be at the table the challenge as you know is substance use disorder is a chronic condition um so we're going to see different folks struggling at different points with their substance use disorder or their opioid use disorder um and i think individuals with direct lived experience are crucial i think the harm reduction community is crucial and um you know perhaps grace and i can put our heads together today and and provide some suggested language to um clarify this point that we seem to be in agreement on um that that would be we would we would welcome that and i'm going to put a time frame we hope to be voting this bill out we're hoping to buy tomorrow at this time that we will have voted the bill out um um so so we yes we want your um ideas but this is like you know final exams are tomorrow and we need to do it yeah thank you we got it thank you madam chair um i just wanted to ask something that i think is an important point of this to pick out as far as membership of the committee and i'm looking at the latest draft so it would be on page three line 15 j that it's not looking at two individuals with lived experience of opioid use disorder including at least one of them whom is in recovery um maybe that's something we've already discussed but appointed by the governor and i wanted to just kind of look at some of the other things we have you know the assistant judge is appointed by the vermont association of judges um the person with experience providing substance misuse programming is appointed by the substance misuse oversight advisory council so i'm just wondering if there's another entity that could be recommended other than the governor to to appoint these individuals with lived experience it might be hard to for the i mean i don't want to speak for but i'm seeing a nod by someone from the governor's office that that might be a challenging yeah i feel like that's a very reasonable question and i don't know who to suggest to recommend but i think that that makes sense to identify an alternate individual to make that appointment you have five hours since we have a brief amount of time if i might put something out there and hear people's feedback um two individuals with lived experience we've talked about the importance of recovery people in recovery and also people with current use um my understanding is that syringe service programs have a lot of interaction with people with current use and that um i mean i mean bam har is with us today i don't know if you feel comfortable standing for you know selecting an individual uh with experiences in recovery but i'll potentially select those two organizations i don't think there's a syringe service program coalition necessarily but perhaps there can be a agreement there we'd be happy to so the second one including at least one of whom is in recovery and based on what and i will ask ledge council if it is needed but i think um we are not talking about in recovery from alcohol um it says opioid use in the in the language lived experience oh okay including okay two okay never mind i didn't read it it's not good yeah that's opioid use disorder is specified yeah okay for a person in recovery so if that person in recovery if maybe um the verman association of people of it's mental health and recovery yes um and without do you have individuals who identify as being in recovery of opioid use disorder yeah yes we do yeah that's all i have to you know and not that they have to be a member okay um representative mcfaun you have your hand up thanks madam chair um did you you just said something um and and now i now i went out of my mind so i was trying to figure out how you could be in recovery and still using it's two different individuals we're looking for one person i mean um you people with lived experience one of whom is in on recovery and one of whom is actively using okay and if i may ask uh and remember i'm not an expert on this what do we expect to get um from somebody who is actively using what what what constructive stuff do we get there um i'll take a stab and then i might ask um grace and um too and and perhaps i will ask grace to respond first because that was one of your comments you began with that yeah i think um you know with people who are actively using currently um they they're navigating systems and they have the inside view of of what we're all trying to do here and helping people um access services in a way that makes sense to them and giving people a menu of options that that might that individual might choose to stay to take to stay safer but to also reach recovery so i think really they are the experts um in in this system that we're all trying to trying to make happen so they know what it's like to call a place and not get a call back and they know what it's like to be really scared that they were going to die because they might have overdosed but i think that that that kind of you know and i think also thinking about other disease models if we if this was a committee for cancer we would really want somebody who's on the committee that's suffering with cancer i think that these are the experts that we need to look at i see why it it may give people pause but i also think um when you work directly with these folks they they're they're incredible resources they're survivors they've tried many different things they pan the horizon for what's safe and what works for them and i think that it's an invaluable it would be an invaluable service or we could do somebody in early recovery but i think um you know either one it's just more getting more people who are who are dealing with the system because we don't you know i've been in the system for 14 years i've sat next to people who are doing all the work to try and get to recovery but i have not been that person and i think that that's really what we what we really need to get at is is what where are our gaps where where are where is the stigma where are the shame you know what what experience are people having i hope that's a good enough an answer that helps um i think from knowing these folks myself they're just uh they're just a very very good resource for what what we need and they may very well be i'm just wondering if we can't get that same information from somebody who um is let's say still in recovery but has been in recovery for a while quite a while um uh like yourself peter that's what i'm i i think at least me anyway if i'm sitting down at a table and somebody's across from me and they're high right now and i'm and i get peter across the table from me and i'm not trying to cast any dispersion on anybody but i think i'm going to get a lot more from a clear mind in terms of what can be done to somebody that's experienced it got to that point and uh i would say successful at that point in their recovery as opposed to somebody who's um taken the drugs right now and i'm not saying that that is the best way to do it or not um topper i think you're gonna be topper i have a representative mcbaugh and i think you raise a a thoughtful point and in terms of if someone comes to a meeting high they're not going to be very helpful um what we learned last year and the year before was that there were people who um were not high all the time um and in fact we're trying maybe to um to get to trying to stop and couldn't and couldn't because of barriers or couldn't because they weren't sure they trusted whatever and so that um there may be a both end um but clearly you know um someone coming to or us relying on the um solely on the input of someone who was actively high at the moment um may not be that um helpful to us although it may provide us with some information as to why and what's happening thank you um i saw um peter i saw your hand go up yeah jet jet just to piggyback on the on the both end you know i think um grace brings up some really important points is that folks who are have at minimum recently been working through the system bringing a really important voice uh recovery is a lifelong process it is a chronic condition it is analogous to diabetes or cancer and um its recovery is not a simple journey and um at minimum it would be nice to possibly specify folks in early recovery so we know folks who've who are just entering into their their recovery and who are intimately familiar with what they and their communities might need in terms of abatement and immediate services um you know recovery as we've been discussing is is not just sobriety it's not just stopping use it's that kind of reconnection to uh to a better life that makes recovery successful frankly so thanks thank you and grace i see your hand up and then um yes i grace first well lastly i will just sort of wrap that part up i um you know i think that really it doesn't necessarily have to be somebody who's really struggling with chaotic use right now like peter mentioned somebody who's in early recovery or tempting recovery i mean i think we also have people in the system that like i think my co-worker who's testified for your group is in 12 years of recovery she waited two years on a waiting list in vermont she's struggled with overdose she's been in recovery a long time she's interfacing in the syringe exchange with people so i think we have a lot of different resources for people who are in recovery and quite frankly a lot of the people that i work with at safe recovery are in recovery they um you know just stay with safe recovery throughout the lifespan because we work with people whether they're using or not um but i think that's a that would be a really good way to look at this is is maybe early recovery or people who are most affected also they're family members and i don't think it has to be necessarily just for these two positions my hope would be that we're looking at each one of these positions to see if there's a candidate that has lived experience um you know even from cities i mean i think we have so many resources and um you know i know personally parents who've lost kids that fought the system too that went through the system and couldn't make it work and really suffered the worst consequence that we are looking to abate so i think that's that would be my hope is that we are really trying to tap into this in every center that we can but we would be happy to be participating in that process we do have access to the largest amount of people who are struggling with opioid use disorder really and so i'm happy i know peter said too that um if you're looking for people uh we are a trusted source in that population and have good access thank you um and judge you had your hand up sure and it just um a really small point um first of all i do want to thank both peter and grace for bringing their shared experience of working in the community here today i think that what they've had to say is really valuable um but i did the one small change i wanted to make was that i think that the language i somebody and i can't i apologize i don't know who read it from the bill um there is no such thing as the association of judges so the language for the appointment of the assistant judge should be the vermont association of county judges that's correct that's okay all right good i just wanted i just wanted to make make sure um and uh thank everybody again for the for the good work that you're doing it's so important so thank you all thank you and uh grace is in the will i'm sorry represent my hand now it's the assistant judge appointed by the vermont association of county judges good um uh folks um i realize on our agenda it says that we're going to go to a different topic but everyone is right here and if people can stay it would seem to make sense katie for you to go over the draft and for us to do that piece and i those of you who are on um who came to testify you are welcome to stay on as we go through um the draft but if you do not want to please don't feel like you have to stay on we really appreciated your your commentary okay thank you i need to go off to another court hearing so thank you to the committee and to all the witnesses i appreciate it thank you very much thank you um um monica hot and just i mean if you can stay for the next i believe we have um katie for the next half an hour oh okay until i mean that's an hour whatever you need oh thank you um monica could you move sort of like a council could come it just seems like to break it up seems silly hello okay we're in office of legislative council uh i have draft 3.1 pulled up on my screen i'll give everyone a second to catch up so um there've been some changes since the last time you saw the bill i tried to really keep track of all the changes and highlight them in yellow so you'd be able to see them and um probably as you go through it um we've had some changes or some suggestions while um while you were elsewhere so it seemed like a good thing to okay so if you remember this is renaming the existing chapter 93 treatment of opioid addiction making it a broader title opioid use disorder everything that had been in this chapter is moved to sub chapter one and we're creating a new sub chapter two specific to the opioid settlements the first section of the bill is a purpose statement um the language the first sentence is the same since the last time you seen it the purpose of the sub chapter is to comply with any opioid litigation settlements to which the state or municipalities within the state or a party regarding the management expenditure of money is received by the state and this new sentence recognizes that there are multiple plots of money within the settlements and that what we're focusing on is the abatement money so while an opioid litigation settlement may designate a portion of the monies for local or state use this sub chapter applies to only monies from the abatement account. Can we stop right there and can I double check something with um Josh Diamond um the fact that that some of them suck the fact that what the assistant judge was talking about about some of their money being put into the abatement account is that based on this language is that okay yes that is consistent okay can I ask a question yeah um uh so the assistant attorney general spoke to the potential for additional settlement for the other lawsuit is is this language broad enough that it would cover both that's the goal um that it's a broad generic sort of language and I'll look to Josh to make sure he doesn't have anything to add on that. So um we're still working through the final settlement document so we're going to have to renew the sacrosanct. Inceptionally it's consistent. Could there be a tweet that's needed by the time this gets to the Senate possibly but as it looks it looks consistent. Thank you. Okay so next that brings us to the top of page two this is the opioid settlement advisory committee um there have been some changes in this section um so I'll skip to subsection b which is the membership of the committee and if you remember we have to have that equal split the local um and state representation um so there was a new state um representative added in subdivision f a primary care prescriber with experience providing medication assisted treatment within the blueprint for health hub and spoke model appointed by the executive director of blueprint to provide a statewide perspective on the provision of MAT services. If I may enter this was a direct um suggestion from the medical society um as one of the groups who was asked to comment on this um okay and then next change is subdivision j believe last time was just an individual with lived experience so now subdivision j reads two individuals with lived experience of opioid use disorder including at least one of whom is in recovery appointed by the governor to provide a statewide perspective of living with opioid use disorder. We can stop over there um the appointed by the governor seems to be unrealistic um and the um including one of which one of whom is in recovery appointed by um V-A-M-H-A-R my association of mental health and recovery V-A-M-H-A-R um the um individual um I don't know whether it is sort of should both of them be be um or or they were going to um I believe um um some of the people who testified um both from safe recovery and from V-A-M-H-A-R we're going to perhaps provide us with an idea of who the second one could be okay um and um with I have a wondering um there is at the beginning of this whole list um of of folks a to reflect the diversity of Vermont in terms of gender race etc um there was a suggestion that um if at all possible we not limited people with quote unquote lived experience to just those two but that in consideration of some of the other positions that um and so whether there's any way of putting that in the beginning um Grace you have your hand up is that a legacy hand or a new comment it might be um but I yes I think it would be really great if we could pick one of them and have Peter pick one because I think we do see different populations and we want it reflected in the population you know in the population that we serve so I would I would love to have um uh help with that love to be able to help with that if that's um something you guys are amenable to I think it would be great I'm sure we'll we'll put that there in the second you know one by V-M-H and one by safe recovery representative McFawn thanks Madam Chair um diversity and um statewide perspective how do we are we going to be able to get that by having these two agencies that I hear now I noticed that we had several other people that were going to testify recovery partners of Vermont and others I'm just wondering is that going to happen I I don't know because I'm not familiar with either one of these um I will I will ask Peter and Grace to speak to their ability to um spot where are you located I guess that's my first question and in what population do you serve okay area of the state I can go first um so safe recovery is located in Burlington but we also just got a mobile van that will be serving Chittenden rural Chittenden Franklin and Grand Isle but since we are the only um service program that's full time in the state we see people from every county in the state we actually have a client we have 5 000 members we have a client from every county in the state so we really are statewide we oftentimes have people driving from Rutland and you know we have some from Bennington even so uh you know we do I think the last statistic I saw was that over 30 percent of our clients come from outside of Chittenden County so that's something we would and we could work with Peter just to make sure that we're targeting different parts of the state for sure if that's helpful and Peter you have your hand up yeah we are a statewide organization based in Montpelier we uh place an emphasis on rural areas we are now working in partnership with HRSA on focusing on 11 rural areas in Vermont with a four-year focus on the LGBTQ community the BIPOC community and um pregnant women who suffered from opioid use disorder and new moms and new parents with opioid use disorder and many of those populations appear to be in this bill as well that makes me feel good I think you can fulfill the bill thank you thanks um top uh Brookstone McFawn is your is that a legacy and I'm trying to get it down um I'm looking at that view on still so I think what could work can tell me if you like it or not um and it would read and shall reflect the diversity of Vermont in terms of gender, race, age, ethnicity, sexual orientation, gender identity, disability status and socio-economic status and ensure inclusion of persons or individuals with lived experience of opioid use disorder order wherever possible whenever possible perfect okay okay great and then okay so we were on J J and then K was the assistance judge appointed by the Vermont Association of County Judges to represent the local interest and then in subdivision L we've updated the number for local appointments to 10 so with the 10 and L and then the one local appointment in K that's 11 local appointments so that balances out the 11 state appointments um and I just want to um I'm sorry um I which has someone from the UVM from the statewide perspective on academic research um we uh uh Wendy um bringing her last name from the University of Vermont um sent us an email saying that they were fine and that they in fact would be able to do that because they have some they have two two sort of institutes focused on research and um she it's UVM and UVMMC so they'll figure it out the only other change in that subdivision L is um 10 individuals each employed by or in ages of a different city or town so that's new language I'm sorry how many people are in that now 10 it says okay so I thought we needed to have a 50-50 split yeah so non-voting member doesn't count but I count 12 above that's why count K the county judge as a local person I see okay that gives the 11 11 and 11 yeah okay all right I got it thank you sorry okay and then there are some changes subsection C powers and duties the advisory committee shall consult with the substance misuse advisory council and other stakeholders to identify spending priorities as related to opioid use disorder prevention intervention treatment and recovery services and harm reduction strategies for the purpose of providing recommendations to the governor department of health and general assembly I'm prioritizing spending from the special fund then we go on to list specifically what the committee shall consider that hasn't changed and we're gonna stop you right here part of what you missed part of that conversation um what we were hearing from the providers um from from both grace and peter was the importance again the importance of people on the ground and the importance of people with lived experience and so um in addition to saying shall consult with the substance misuse advisory council you know comma and then sort of like one idea or somehow fit in one one idea monica your idea was to um I think I wrote um and down straight consultation with individuals with direct lived experience that was one little addition to start us own it a little bit more and then we get open in terms of how the council or the committee actually solicits and and collects that information but I didn't have a chair reflect individuals working on the front lines I just look we urge you say that yeah I mean that those were the two things that I sort of heard from um both in testimony today that was important to elevate those voices and um so to sort of call those out as other stakeholders kind of thing and um I think grace and peter you have you know five hours if you have an idea um but somehow to call out you know what I mean I guess you don't say people on the ground workers on the ground or direct service workers um for professionals direct support professionals there dsp is often well or frontline workers frontline yeah um um and if nobody has an objection it'd be great if the group of individuals that we're speaking of right now can be placed before the advisory council it's being the oh their order in this order okay nothing nothing without us about nothing about us without us yes right if they're placed first that would be and and josh we will make sure that um I'll return just oh okay okay so just a list would be fine but just order it I guess I'm going to step on the demonstrate consultation left if I could just say the advisory committee shall consult with individuals with direct lived experience um frontline support professionals the substance misuse advisory council and other stakeholders just list does that does that meet what we're looking for yeah okay I mean I think that um perhaps the views of demonstrate was um trying to indicate some strength to um you know oftentimes we get reports about things that say oh we consulted with and you know they talk to one person um and um so I think what we were trying to do is to indicate or sometimes we have a plan yes we have a plan to consult plan to consult in that um okay got it demonstrate consultation it is um okay so then in subsection e the presentation section so there is some concern that the settlement said um that the advisory committee has to sort of directly present to the designated agency which is in this case the department of health so this has been reworded a bit to make sure that that presentation is going directly to the department of health but also that the general assembly is hearing exactly what um is being presented by the advisory council so annually the advisory council is to present its recommendations for expenditures from the special fund established pursuant to this chapter to the department of health and concurrently submit its recommendations in writing to the appropriations committees and committees of jurisdiction go ahead oh I just was thinking I maybe we haven't gotten to it yet wherever we the national settlement fund administrator we have to change that we haven't gotten that they haven't gotten there yet I was thinking like I started seeing an abatement and then I'm like oh my brain started going like and I'm like okay representative garrifano will tell you about that okay and subsection f subdivision four there's a change you can't see there is a sentence that said the committee had to meet at least four times a year um but we already said it in subdivision two they have to meet at least quarterly but not more than six times per calendar year so I struck that sentence and I think that is it for the 47 72 and that brings us to top of page seven this is the designation of the lead state agency um so this has the department of health serving as the lead state agency and single point of contact for submitting requests for funding to the national abatement account fund administrator that's where it is and this is where the language is so it's the national settlement account fund administrator so oh just strike abatement and then add settlement instead of national abatement okay national settlement account fund administrator national settlement yeah there's no account oh there's no account I didn't have it madam chair can I bring us back to page six just very quickly yes you can bring us back that's why we're all here I'm just actually this is a really simple question I'm wondering about May 1st for the first meeting just feeling the pressure of being March already in the way that all of these clinics is happening I just don't want to start a legislation that we're already off I just don't want to let you just pass the bill that says the report was due March 1st even that date was originally selected there is the idea that we're going to be drawing down the money right away and now we're talking about having to go through an appropriation process so that sense of urgency with the May 1 date was to start drawing down the money as quickly as possible and certainly the committee should meet before the money is given I think there's no formation period but yeah a suggestion um I think I think I would I would think would make sense for the committee to start meeting in the summer because I think it takes some time to collect all this information and the feedback so I think sometime in the summer so June 1st uh July 1st oh please no one's here in July you know that for the advisory committee that's true for the advisory committee well you're on it and you're going to be on it happy really July for sure I'm open I just think they is setting us up to fail to start and I keep that it's like the difference June 15 June 1st is already split the difference between May 1st and July 1st it's not like we can't start working on this already right knowing what's coming March so I'm I'm sure that the parties that we've been hearing from today will be thinking about how to identify you know get representation and all of that kind of stuff so we are saying May 1st, June 1st, June 15th, July 1st I'd go with July 1st just because it's the beginning of the year and it's on or before right I always say June 30th and then anytime before that because it's just the end of the fiscal year yeah all those in favor of now what is the one we're doing on or before June 30th raise your hand all those opposed okay well I think on or before June 30th oh why did you say Jack I refer to uh the wisdom oh Topper you have your hand up the whole time yeah Madam Chair it's for two purposes one is opposed to vote and the other is I have a question okay the advisory committee uh this is on page 5 line 17 it says there they'll present their recommendations for expenditures to the Department of Health and then to the committees should the Health Care Committee also get that report at this point in time it is the committees of jurisdiction and the committee of health health committee does not have jurisdiction of substance use but of course you know maybe it's to say the committees of jurisdiction no okay I just I just mentioned it because the report's going to the Department of Health and that's what and they report to us Topper the Department of Health reports to us most of the time except when it doesn't and Diva reports to the um the health committee except when it doesn't okay on this particular case to refer to us okay okay thank you for the question you're welcome okay for back to page seven we've updated the administrator to the national settlement fund administrator and I believe that's twice it's online 12 and is it online three and four mm-hmm best three and four and 12 um and then approved request shall be dispersed to the state for deposit into the special fund established in the next section um and I'm pausing because I'm thinking about the word state and I think we left it as department yeah so I'm wondering if state dispersed to the state should be to the department because that's who's getting the money line four and I think that'd be consistent with line 12 dispersed to the department okay I had actually asked you to switch it to me because I felt like that was how yes well you did changed it and then we changed it back I have to you changed it back down below but did you change it back in this section so you asked for state right I did two places one yeah and I only changed it and one correct so that's what I'm trying to correct now so I changed it online 12 back to department correct and I haven't changed it your feedback but we didn't okay um so I'm gonna move along to the next section 4774 before you do Katie just uh can the can the department receive directly these monies from this settlement yes that's what the settlement directs the settlement says that it has to go to the designated lead agency which in this case is a health department I could but okay it says it has to go to and my point is usually when these kinds of money so then I thought that it would go to the state and then be transferred to the department it's a small item that it's not a big deal with me I just want to make sure we get the money my understanding was it had to flow to the designated agency yep okay flow to the designated agency so 4774 the special fund um I see this is the second place where the change has to be made with the administrator so I a one for creating the special fund um and it's established and managed pursuant to language in um title 32 and it's administered by the department of health the special fund shall consist of all abatement account fund monies dispersed by the national settlement fund national settlement fund administrator to the department and in subdivision two the department is to include a spending plan oh so the last time you saw this we had this preliminary approval process so this cuts that out and instead what's happening this is sort of how decisions are made and money is drawn down from the national fund so the department is to include a spending plan informed by the recommendations of the advisory committee as part of its annual budget submission and once approved the department is to request to have the funds formally released from the national abatement accounts fund the department is to disperse monies from the special fund uh pursuant to the process outlined in title 32 and then language that disbursements from the opioid abatement special fund shall supplement and not supplant or replace any existing or future local state or federal government funding for infrastructure program supports and resources including health insurance benefits federal grant funding medicaid and medicare funds so this just essentially says this is coming through the regular state budgeting process kind of yes sort of like arpa yeah and then in subsection b we have the list of what um oh topper um representative mcfaun yes i'm having trouble with these things on the bottom of my screen i just want to let tristan know that it's flowing thank you representative fun okay subsection b this list how um what the appropriate expenditures are from the special fund and there is new lead-in language to kind of qualify the types of um the types of expenditures and to specify that they have to be related to opioid prevention intervention treatment recovery harm reduction and evaluation activities and similarly in subdivision b2 instead of just saying support for individuals and treatment recovery indicate from opioid use disorder otherwise it doesn't have that tie in um yeah so um my one concern about that that one particular section is that as peter and earlier there are individuals that suffer from high substance use addiction and i wouldn't want anything which to inadvertently eliminate somebody who might that might be just taking treatment or recovery services for both opioids and alcoholics and so i'm just i don't i don't have parts words but i'm just i'm wondering about about does it have to say from opioid use disorder in that one section when the rest of the administration is really clear about that does that create a limitation that we don't i mean i think it raises a question i'm interested um mr. diamond what you think a lot of the directions that a lot of the organizations that we're working with are trying more and more to offer somewhat substance agnostic services harm reduction and recovery and so what a sort of recommendation to go to one of those organizations how do you necessarily parse out that this is for opioid specific funding it's a question that i think the settlement documents and sexual reflective decisions contemplates how much the treatment of the current diagnosis is as long as one of those tied back to it so i think by having the lead in and paragraph e that talks about opioid um maybe you don't really need it to reference again in sort of section two but there has to be a nexus somewhere that opioids but co-occurring this is referenced so if i'm understanding correctly that lead in specifically saying following opioid prevention intervention etc etc should cover that any of the money is used because i i even looked to the third one connecting individuals who need help to the help needed um i would not want to have to put opioid next to each and every one of those but making sure that it specifically is addressing that concern because i mean that's i mean i just keep as a counter or whatever i keep reading these documents from the model opioid litigation principles for the use of funds from the opioid litigation and cautions based on how states misuse the tobacco settlement funds and everything they talk about is um opioids this is the the overdose epidemic um and so there may be co-occurring adorbs but that i mean i think that covers i mean i think that is covered within this one when we talk about services and supports related to it i think sorry i mean i think that that's i mean that so i say that's my head the way i look at things when we're talking about effective treatment um we're not when we're talking about effective treatment for opioid disorder yes there is the medical treatment but there's also the social treatment there's also the structural changes that need to you know whether it's housing or whether it what you know there's all those things is is what this money i think can be used for and you're you don't think that and you're concerned that it narrows it i was great certainly raised the question feeling concerned with that one number two there just limited it a little bit too much because there are individuals who will most of them really oh i see what you're saying okay okay okay i see what you're saying so take that out because it's already in the yeah that makes sense okay one too but that's treatment uh by you so that's different i guess okay no that makes sense to me what about other people yeah okay um so there are no other changes in this list um b2 thank yes and then subsection c um the middle of page nine this list um kind of goes on to give priority so subsection b sort of is an expansive list this is kind of the the scope of what these funds can be used for and within that subsection three says excuse me c says um a priority is given for these very specific purposes and these are all pretty much coming directly from the settlement so the settlement and this is to both you and to um josh diamond the settlement documents not only outline this laundry list but they say in this laundry list then we have some priorities i would not read the set of priorities as prescriptive okay i think the language is fine as it is okay i think the tense is that when the request comes to the settlement fund administrator they're going to look to us to make sure it's approved our calls within the four corners of the subject areas and they're going to release the money i don't think there's going to be a high degree scrutiny as to whether it needs priority one or priority four and it's not within priority one or four four you know that to four just don't envision that help and i i hear that the priorities are not prescriptive but i i think back to testimony that we have before break and the worry about kind of this prevention drain and having that be in the priority section but not having the prevention of overdose death be in our priority section i feel like that is a primary concern at least for myself when we look at the overdose crisis here in the state right now so not saying that prevention programs needs to come out of a priority but i would love to see the addition of preventing overdose death in our in our priority section is that allowable it is in the section above oh no i mean i i'm surprised by the settlement i guess that would be my question yeah this is where i've been a stereo concept and it was already told us that was a priority bnc come almost forward out of this settlement um tense that's my hesitation and answering again i think if the advisory committee and the money committee set aside all concluding that they want prioritize prevention of death as to where the first dollars were to uh or the way to hopefully um contingencies i i highly doubt there's going to be any objection from the settlement on administrator to making sure that that dollar one goes to those prevention i wonder i'm sorry no you go right ahead i wonder if there's anywhere in the bill that we can reference that so we're not dependent on waiting to see if the advisory committee chooses to prioritize that given that the prioritization that we have already is prescribed by the settlement agreement is there any other place that we can address the prevention of death well it's it's number eight uh no yeah it's it's not no sorry it's on page oh the number eight on page eight line 17 preventing overdose deaths and other harms i also i'm there it's just listed as a use of the money and not prioritize okay i'm wondering in subsection see that lead in language priority for expenditures for the special fund shall be given to the following i wonder if there's a way to sort of leave that concept right in the lead in language as sort of sort of like overarching for all the priorities next question is how to do that um well i think the listing of some of those early ones um the intent is to prevent overdose deaths i mean you know it's it's listing out strategies for actually preventing the deaths as opposed to you know saying the language do you know what i'm saying like then the lock zone stuff and um training for first responders i mean all those things are meant to prevent death without saying those words i think but i mean i understand what you're saying if there's a way to leave in there um and i look to mr. diamond because i don't know if there is a way to i i think it may be chooses to say and see one the prevention of deaths i don't think that that would create a violation of the four corners of that i would just point out that in the priority list i was just going through each of the numbers and the first one is in the priority section the first one is is um related to niloxone which is one of our most effective death prevention strategies and then number eight in the list of priorities is around expanding the service program which is another really specific harm reduction strategy to prevent death so i feel like it is very well i feel like that concept is well represented in the priority areas in addition to strategies i'm not sure if that satisfies what you're what you're trying to get at but it is definitely there yes and i'm not arguing that the strategies are not present what if we said something and see priority for expenditures from the opioid abatement special fund shall be aimed at reducing overdose overdose deaths including the following or hopefully something a little more helpful but i would kind of get us there i'd feel about for me that same and did you just say including the following kati i did but i'm open to it no i i like including the following because that leaves it open to i mean other things as research progresses as treatment progresses as prevention progresses they're going hopefully the other things that get added to the toolkit and the way this is it just is a finite list because it just says shall be the following so i like your language better okay um and then the other changes in subsection c were sort of i think editorial changes um correcting misspelling um so subdivision seven on page 12 supporting prevention programs um the editors were unhappy that it didn't start with a verb so i added supporting and i think maybe i had prevent instead of prevention and then in subdivision seven c funding for healthcare provider education and outreach regarding best prescribing practices for opioids consistent with current department of health and cdc guidelines so adding um department of health guidelines there i think that was it that was it okay kati thank you um for for doing the walkthrough and for getting some of our input um folks you all have seen it and so her and we'll be coming back tomorrow for anyone who can be and tomorrow after lunch tomorrow after lunch and grace grace you have your hand up i'm sorry i just want to make sure that um my charge with peter's um accurate so what you'd like to see from us before tomorrow is language about um uh consulting with lived experience and um that's that's right okay and and not so much about our two agencies choosing that's already in it's more about engaging people with lived experience right and if you have a different way if you have a better way um of saying it then than what we have now come to that would you know would take your um input okay thank you so much for letting me ask that yeah no no thank you thank you for your participation um as i said our goal is um tomorrow let's hear someone it's on there somewhere um um our goal is to take it um up after lunch um and so if um um grace if you and peter could give something to lady um as soon as possible but um 11 um that would be um great and because she what she might end up doing is is showing it to us in two forms and then we can make a decision um so what i would ask um everyone around the table and people who are listening is that but what is now on our website with a few tweaks is looks like what we will be voting on there hasn't been some real substantial changes um and it will be what pretty much what we'll be voting on um as soon as we have a new you know a new draft we'll make that available but read it read it with a fine tooth comb um and if you have questions or comments um please provide them uh to me you can continue can email uh duly tucker j tucker at ledge le g dot state dot vt dot us or apu at ledge dot state dot vt dot us okay thank you thank you katie and now you can get there on time all right thank you everyone um thank you both thank you thank you um and um seriously you know we're looking to you to look at this again through a fine tooth comb and this is as we say at the beginning of the process because it does have to go to appropriations we will be doing an informal drive-by of to government operations because there is a committee and they always have to see those um and all of that will happen quickly um and um then it goes to the senate i am presuming that this will be a bill that will pass both the committee and the house so um that okay thank you thank you very much pleasure working with you thank you um uh thank you grace and peter thank you for having us okay yeah bye um committee it is only three o'clock um i want to say let's take a short break and then with with the help of my friends i will we will go over what we have thus far as a draft of the reach-up bill and we will do that um because tomorrow um in preparation for tomorrow which is um so let me let's take a 10 minute break and we'll come back and we will get to our reach-up um uh topper we're going to take a 10 minute break and then come back and talk about reach-up