Backup Documents 10/11/2022 Item #16K6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 K b
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
** ROUTING SLIP**
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office JAK (� t✓ 1 p/6`2 _
4. BCC Office Board of County
Commissioners Ivt'16 M5/ Mk/ZZ
5. Minutes and Records Clerk of Court's Office
fDlii7Va ;ts PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above may need to contact staff for additional or missing information.
Name of Primary Staff Rosa Villarreal,Legal Assistant Phone Number 252-8821
Contact/Department Office of the County Attorney
Agenda Date Item was 10/11/2022 Agenda Item Number 16-K-6
Approved by the BCC
Type of Document(s) Interlocal Agreement between CC and City Number of Original 1
Attached of Marco Island Documents Attached
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature(instead of stamp)? N/A
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name;Agency;Address; Phone)on an attached sheet.
3. Original document has been signed/initialed for legality. (All documents to be signed by JAK Irv)
the Chairman,with the exception of most letters,must be reviewed and signed by the
Office of the County Attorney.)
4. All handwritten strike-through and revisions have been initialed by the County Attorney N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board.
5. The Chairman's signature line date has been entered as the date of BCC approval of the JAK/co
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's JAKI(�J
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
should be provided to the County Attorney Office at the time the item is uploaded to the
agenda. Some documents are time sensitive and require forwarding to Tallahassee within a
certain time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 10/11/22 and all changes made during JAK r(-It/ N/A is not
the meeting have been incorporated in the attached document. The County Attorney an option b.
Office has reviewed the changes,if applicable. this lice
9. Initials of attorney verifying that the attached document is the version approved by the JAK//r j N/A is no
BCC, all changes directed by the BCC have been made,and the document is ready for the an option for
Chairman's signature. this line.
Please Expedite and send
exectued copy to
I:Forms/County Forms/BCC Forms/ Rosa.Villarreal�colliercountyfl.gov 24.05;11/30/12;4/22/16;9/10/21
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COLLIER COUNTY INTERLOCAL AGREEMENT GOVERNING USE OF
REGIONAL OPIOID SETTLEMENT FUNDS
THIS INTERLOCAL AGREEMENT("Agreement") is made and entered into, by and between
Collier County, a political subdivision of the State of Florida, hereinafter referred to as the
"County," and the City of Marco Island, a municipal corporation of the State of Florida,
hereinafter referred to as the"City."
WHEREAS, a local, state and national crisis arose as a result of the manufacturing, distribution
and over-prescribing of opioids,and resulted in opioid abuse,misuse,overdoses,addictions,and
death throughout municipalities, counties, states, and the nation and contributed to the public
health emergency and crisis commonly referred to as the opioid epidemic;and
WHEREAS,Collier County and the municipalities therein are not immune from this nationwide
crisis; and
WHEREAS, the crisis has caused and is causing an undue strain on local government finances
to implement programing to combat the opioid epidemic, to mitigate the harmful effects of the
opioid epidemic in the community, and to increase educational campaigns to counteract mis-
information about the addictive nature and harmful effects of opioids; and
WHEREAS,opioid abuse rose throughout the United States,Florida has been hit especially hard;
and
WHEREAS, pharmaceutical companies involved in the supply chain including,but not limited
to,distributors,manufacturers,dispensing companies,and marketing agencies contributed to the
great harm suffered by the State of Florida and Collier County as a result of the opioid epidemic;
and
WHEREAS, as a result of litigation filed by the State of Florida and various local
governments against various pharmaceutical companies involved in the supply chain,
multiple defendants have begun to negotiate settlements; and
WHEREAS, the Attorney General for the State of Florida(hereinafter "Attorney General")
anticipates that Settlement funds will be distributed to the State of Florida over multiple years
as part of a global settlement,and not directly to the Cities and Counties;and
WHEREAS, the Attorney General has proposed entering into agreements with local
governments within the State of Florida to receive settlement funds. This agreement
(hereinafter referred to as the "State MOU"), as currently drafted, divides settlement funds
into three portions designated as City/County, Regional, and State funds; and
WHEREAS, it is anticipated that the State MOU will set forth the amount and manner of
distribution of City/County and Regional Settlement funds within Florida,the requirements
to receive and manage Regional funds, and the purposes for which Regional funds may be
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used. The current draft of the State MOU is attached hereto as Exhibit A, and Resolution
2021-136 approving in concept the State MOU by Collier County is attached as Exhibit B;
and
WHEREAS, the parties recognize that local control over settlement funds is in the best
interest of all persons within the geographic boundaries of Collier County and ensures that
settlement funds are available and used to address opioid-related impacts within Collier
County and the parties are committed to the County qualifying as a"Qualified County" and
thereby receiving Regional funds pursuant to the State MOU; and
WHEREAS,the State MOU requires that in order for Collier County to become a Qualified
County eligible to receive Regional Funding, there must be an interlocal agreement among
Collier County and Municipalities, as defined in the MOU, with combined population
exceeding 50% of the total population of the Municipalities within Collier County, with the
term"Municipalities"being defined for the purpose in this Agreement as those municipalities
with a population of 10,000 or more as required by the State MOU; or with population
less than 10,000 who were party plaintiffs; population for purposes of,the MOU is
determined by specific Census data; and
WHEREAS, historically, government-funded programming geared toward abating the
opioid crisis has been data driven based upon community impacts without regard to
governmental jurisdictional boundaries; and
WHEREAS, the parties recognize that it is in the best interest of the County and the Cities
to enter into this interlocal agreement to ensure Collier County is a "Qualified County" to
receive Regional Funding pursuant to the State MOU;
NOW,THEREFORE, in consideration of the covenants herein contained, and other good
and valuable consideration,the parties agree as follows:
Section 1: Definitions:
A. Unless otherwise defined herein, all defined terms in the State MOU are
incorporated herein and shall have the same meanings as in the State MOU.
B. "Collier County Regional Funding" shall mean the amount of the Regional
Funding paid to Collier County in its role as a Qualified County.
Section 2: Conditions Precedent:
This Agreement shall become effective on the Commencement Date set forth in Section 4,
so long as the following conditions precedent have been satisfied:
A. Collier County being determined by the State of Florida to qualify as a"Qualified
County" to _receive and disburse Regional Fund monies under the Allocation
Agreement;
B. Execution of this Agreement by the County and the governing bodies of the
[21-SHF-00250/1741408/1]
municipalities as required by the State MOU to enable Collier County to
become a Qualified County and directly receive Collier County Regional
Funding; and
C. Execution of all documents necessary to effectuate the State MOU in its final form;
and
D. Filing of this Agreement with the Clerk of the Circuit Court for Collier County
as required by Florida Statutes, Section 163.01.
Section 3: Execution:
This Interlocal Agreement may be executed in counterparts by the parties hereto.
Section 4: Term:
The term of this Agreement and the obligations hereunder commences upon the satisfaction of all
conditions precedent,runs concurrently with the State MOU,and will continue until one(1)year
after the expenditure of all Collier County Regional Funding, unless otherwise terminated in
accordance with the provisions of the State MOU. Obligations under.this Agreement which by
their nature should survive, including, but not limited to any and all obligations relating to
record retention, audit, and indemnification will remain in effect after termination or expiration
of this Agreement.
Section 5: Use of Settlement Proceeds:
A. Collier County Regional Funding will be used in accordance with the requirements
of the State MOU.
B. Collier County Regional Funding may be used to enhance current programs or
develop new programs. However,Collier County Regional Funding is not intended
to supplant current funding sources or general funds.
Section 6:Administrative Costs:
The County is responsible for administering the "Regional Funds" remitted pursuant to the
State MOU and, therefore County staff will provide support services including but not
limited to legal services,as well as contract management,program monitoring,and reporting
required by the State MOU. Accordingly, the County and City agree that the County is
entitled to the maximum allowable administrative fee pursuant to the State MOU. The
administrative fee will be deducted annually from the amount of available Collier County
Regional Funds, and the remaining Collier County Regional Funds will be spent as provided
in the State MOU and as provided herein. The City shall receive no more than its pro rata
share of Collier County Regional Funding, based on the Negotiation Class Metrics
provided for in the State MOU.
Section 7: Local Government Spending and Reporting Requirements:
To the extent that the local governmental entity receives Collier County Regional Funds
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directly from the County,any local governmental entity so receiving funds must spend such
funds for Approved Purposes and must timely satisfy all reporting requirements of the MOU.
Failure to comply with this provision may disqualify the local governmental entity from
further direct receipt of Collier County Regional Funds. Collier County, in its role as
Qualified County receiving Regional Funds that are appropriated for use by another local
governmental entity, is merely a "pass-through" vehicle for such funds, and the
responsibility to spend Regional Funds received on eligible programs and expenses is that
of the receiving local government and not Collier County, Florida.
Section 8: Non-Appropriation:
This Agreement is not a general obligation of the County. It is understood that neither this
Agreement nor any representation by any County official, officer or employee creates any
obligation to appropriate or make monies available for the purposes of the Agreement. The
obligations of the County as to funding required pursuant to the Agreement are limited to an
obligation in any given fiscal year to budget and appropriate from Collier County Regional
Funds annually which are designated for regional use pursuant to the terms of the State MOU.
No liability shall be incurred by the County beyond the monies budgeted and available for
the purpose of the Agreement from expected settlement funds. If Regional Funds are not
received by the County for any or all of this Agreement for a new fiscal period, the County
is not obligated to pay or spend any sums contemplated by this Agreement beyond the
portions for which Regional Funds were received and appropriated. The County agrees to
promptly notify the Cities in writing of any subsequent non-appropriation, and upon such
notice, this Agreement will terminate on the last day of the current fiscal year without
penalty to the County and all undistributed funds will be spent for programs previously
adopted.
Section 9: Indemnification:
City and the County shall be responsible for their respective employees' acts of negligence
when such employees are acting within the scope of their employment and shall only be
liable for any damages resulting from said negligence to the extent permitted by Section
768.28, Florida Statutes. Nothing herein shall be construed as a waiver of sovereign
immunity, or the provisions of F.S. § 768.28, by either Party. Nothing herein shall be
construed as consent by either Party to be sued by third parties for any matter arising out of
this Agreement. Collier County, Florida, is not responsible for the failure of City to spend
funds for Approved Purposes and in accordance with the allocation of such funds by Collier
County in its role as a Qualified County. To the extent allowed by law, City indemnifies and
will defend Collier County,Florida,with respect to any legal challenge of any nature related
to City's receipt and/or use of settlement funds,including any Regional Funds received by
City through and/or from Collier County.
Section 10: Severabilits
If any item or provision of this Agreement, or the application thereof to any person or
circumstances shall, to any extent, be held invalid or unenforceable, the remainder of this
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Agreement, or the further application of such terms or provision, shall not be affected, and
every other term and provision of this Agreement shall be deemed valid and enforceable to
the extent permitted by law.
Section 11: Amendments to Agreement:
This Agreement, or amendments hereto, shall be executed on behalf of each participating
jurisdiction by its duly authorized representative and pursuant to an appropriate motion,
resolution,or ordinance of each participating jurisdiction.This Agreement,or any amendment
thereto,shall be deemed adopted upon the date of execution by each authorized representative
and filing in the official records of Collier County,Florida.
Section 12: Filing of Agreement:
This Interlocal Agreement shall be filed by the County in the official records of Collier
County,Florida,within ten(10) days of its execution by all parties hereto.
Section 13: Governing Law
This Agreement shall be governed by the laws of the State of Florida. All legal actions to
enforce the Agreement shall be held in the Twentieth Judicial Circuit in and for Collier
County. No remedy conferred in this Agreement is intended to be exclusive of any other
remedy, at law or in equity, or by statute or otherwise. No exercise by any party of any
right, power, or remedy hereunder shall preclude any other or further exercise thereof.
Section 14: Complete Agreement, Modifications to Agreement:
This Agreement sets forth the entire agreement between the parties. There are no promises
or understandings other than those stated herein. None of the provisions, terms, or
conditions contained in this Agreement may be modified, superseded, or otherwise altered,
except by written agreement of the parties.
IN WITNESS WHEREOF,City and the County have signed and sealed this Interlocal
Agreement as set forth below.
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I 6 K 6
t4 / AS TO THE COUNTY:
Date: it of Octu i, 202-2
ATTEST: a BOARD OF CO ►TY COMMISSIONERS
Crystal K. Kinzel,Clerk of Courts COLLIER CO ', * 0 A
( --ikid,\tik-7-:,.. ‘ t n if
By: - --;:)A-ti ‘1.` 4, By: (. )' / 4.. #0,„•4°
Attest as to ChainnadePu erk Wil�,• i L. McDaniel,Jr.,Chairman
Appro r:, :'s 11 '+ ,,"and legality:
Ai
,.. ,A
Jeffrey'l' " 'I 7r,County Attorney
[21-SHF-00250/1741408/1]
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AS TO THE CITY OF MARCO ISLAND:
Attest:
Michael J.Sbe el C C eatr‹.
Erik Bre 1 z,Chairman
040,c1 '
Alan L.Gabriel,City Attorney
I21411F-00230/L74I4OM)
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PROPOSAL
MEMORANDUM OF UNDERSTANDING
Whereas, the people of the State of Florida and its communities have been harmed by
misfeasance, nonfeasance and malfeasance committed by certain entities within the
Pharmaceutical Supply Chain;
Whereas, the State of Florida, through its Attorney General, and certain Local
Governments, through their elected representatives and counsel, are separately engaged in
litigation seeking to hold Pharmaceutical Supply Chain Participants accountable for the damage
caused by their misfeasance, nonfeasance and malfeasance;
Whereas, the State of Florida and its Local Governments share a common desire to abate
and alleviate the impacts of that misfeasance, nonfeasance and malfeasance throughout the State
of Florida;
Whereas, it is the intent of the State of Florida and its Local Governments to use the
proceeds from Settlements with Pharmaceutical Supply Chain Participants to increase the amount
of funding presently spent on opioid and substance abuse education, treatment and other related
programs and services, such as those identified in Exhibits A and B, and to ensure that the funds
are expended in compliance with evolving evidence-based "best practices";
Whereas, the State of Florida and its Local Governments, subject to the completion of
formal documents that will effectuate the Parties' agreements, enter into this Memorandum of
Understanding("MOU")relating to the allocation and use of the proceeds of Settlements described
herein; and
Whereas, this MOU is a preliminary non-binding agreement between the Parties, is not
legally enforceable, and only provides a basis to draft formal documents which will effectuate the
Parties' agreements.
A. Definitions
As used in this MOU:
1. "Approved Purpose(s)" shall mean forward-looking strategies, programming and
services used to expand the availability of treatment for individuals impacted by substance use
disorders, to: (a) develop, promote, and provide evidence-based substance use prevention
strategies; (b) provide substance use avoidance and awareness education; (c) decrease the
oversupply of licit and illicit opioids;and(d)support recovery from addiction. Approved Purposes
shall include, but are not limited to, the opioid abatement strategies listed on Exhibits A and B
which are incorporated herein by reference.
2. "Local Governments" shall mean all counties, cities, towns and villages located
within the geographic boundaries'of the State.
3. "Managing Entities" shall mean the corporations selected by and under contract
with the Florida Department of Children and Families or its successor ("DCF") to manage the
000003/01288125_1
Exhibit A
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daily operational delivery of behavioral health services through a coordinated system of care. The
singular"Managing Entity" shall refer to a singular of the Managing Entities.
4. "County" shall mean a political subdivision of the state established pursuant to s.
1,Art. VIII of the State Constitution.
5. "Municipalities" shall mean cities, towns, or villages of a County within the State
with a Population greater than 10,000 individuals and shall also include cities, towns or villages
within the State with a Population equal to or less than 10,000 individuals which filed a Complaint
in this litigation against Pharmaceutical Supply Chain Participants. The singular "Municipality"
shall refer to a singular of the Municipalities.
6. "Negotiating Committee" shall mean a three-member group comprised by
representatives of the following: (1) the State; and (2) two representatives of Local Governments
of which one representative will be from a Municipality and one shall be from a County
(collectively,"Members")within the State. The State shall be represented by the Attorney General
or her designee.
7. "Negotiation Class'Metrics"shall mean those county and city settlement allocations
which come from the official website of the Negotiation Class of counties and cities certified on
September 11, 2019 by the U.S. District for the Northern District of Ohio in In re National
Prescription Opiate Litigation, MDL No. 2804 (N.D. Ohio). The website is located at
https://allocationmap.iclaimsonline.com.
8. "Opioid Funds" shall mean monetary amounts obtained through a Settlement as
defined in this MOU.
9. "Opioid Related" shall have the same meaning and breadth as in the agreed Opioid
Abatement Strategies attached hereto as Exhibits A or B.
10. "Parties"shall mean the State and Local Governments. The singular word "Party"
shall mean either the State or Local Governments.
11. "PEC"shall mean the Plaintiffs' Executive Committee of the National Prescription
Opiate Multidistrict Litigation pending in the United States District Court for the Northern District
of Ohio.
12. "Pharmaceutical Supply Chain"shall mean the process and channels through which
Controlled Substances are manufactured, marketed, promoted, distributed or dispensed.
13. "Pharmaceutical Supply Chain Participant" shall mean any entity that engages in,
or has engaged in the manufacture, marketing, promotion, distribution or dispensing of an opioid
analgesic.
14. "Population" shall refer to published U.S. Census Bureau population estimates as
of July 1, 2019, released March 2020, and shall remain unchanged during the term of this MOU.
These estimates can currently be found at https://www.census.gov
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15. "Qualified County" shall mean a charter or non-chartered county within the State
that: has a Population of at least 300,000 individuals and (a) has an opioid taskforce of which it is
a member or operates in connection with its municipalities or others on a local or regional basis;
(b) has an abatement plan that has'been either adopted or is being utilized to respond to the opioid
epidemic; (c) is currently either providing or is contracting with others to provide substance abuse
prevention, recovery,and treatment services to its citizens; and(d)has or enters into an agreement
with a majority of Municipalities (Majority is more than 50% of the Municipalities' total
population)related to the expenditure of Opioid Funds.The Opioid Funds to be paid to a Qualified
County will only include Opioid Funds for Municipalities whose claims are released by the
Municipality or Opioid Funds for Municipalities whose claims are otherwise barred.
16. "SAMHSA" shall .mean the U.S. Department of Health & Human Services,
Substance Abuse and Mental Health Services Administration.
17. "Settlement" shall mean the negotiated resolution of legal or equitable claims
against a Pharmaceutical Supply Chain Participant when that resolution has been jointly entered
into by the State and Local Governments or a settlement class as described in (B)(1) below.
18. "State" shall mean the State of Florida.
B. Terms
1. Only Abatement- Other than funds used for the Administrative Costs and Expense
Fund as hereinafter described in paragraph 6 and paragraph 9, respectively), all Opioid Funds shall
be utilized for Approved Purposes. To accomplish this purpose,the State will either file a new action
with Local Governments as Parties or add Local Governments to its existing action, sever settling
defendants, and seek entry of a consent order or other order binding both the State, Local
Governments, and Pharmaceutical Supply Chain Participant(s) ("Order"). The Order may be part
of a class action settlement or similar device. The Order shall provide for continuing jurisdiction of
a state court to address non-performance by any party under the Order. Any Local Government that
objects to or refuses to be included under the Order or entry of documents necessary to effectuate a
Settlement shall not be entitled to any Opioid Funds and its portion of Opioid Funds shall be
distributed to, and for the benefit of, the other Local Governments.
2. Avoid Claw Back and Recoupment-Both the State and Local Governments wish
to maximize any Settlement and Opioid Funds. In addition to committing to only using funds for
the Expense Funds,Administrative Costs and Approved Purposes,both Parties will agree to utilize
a percentage of funds for the core strategies highlighted in Exhibit A. Exhibit A contains the
programs and strategies prioritized by the U.S. Department of Justice and/or the U.S. Department
of Health & Human Services ("Core Strategies"). The State is trying to obtain the United States'
agreement to limit or reduce the United States' ability to recover or recoup monies from the State
and Local Government in exchange for prioritization of funds to certain projects. If no agreement
is reached with the United States, then there will be no requirement that a percentage be utilized
for Core Strategies.
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3. Distribution Scheme -All Opioid Funds will initially go to the State, and then be
distributed according to the following distribution scheme. The Opioid Funds will be divided into
three funds after deducting costs of the Expense Fund detailed in paragraph 9 below:
(a) City/County Fund- The city/county fund will receive 15% of all Opioid Funds to
directly benefit all Counties and Municipalities. The amounts to be distributed to
each County and Municipality shall be determined by the Negotiation Class Metrics
or other metrics agreed upon, in writing,by a County and a Municipality. For Local
Governments that are not within the definition of County or Municipality, those
Local Governments may receive that government's share of the City/County Fund
under the Negotiation Class Metrics, if that government executes a release as part
of a Settlement. Any Local Government that is not within the definition of County
or Municipality and that does not execute a release as part of a Settlement shall
have its share of the City/County Fund go to the County in which it is located.
(b) Regional Fund- The regional fund will be subdivided into two parts.
(i) The State will annually calculate the share of each County within the State
of the regional fund utilizing the sliding scale in section 4 of the allocation
contained in the Negotiation Class Metrics or other metrics that the Parties
agree upon.
(ii) For Qualified Counties, the Qualified County's share will be paid to the
Qualified County and expended on Approved Purposes, including the
Core Strategies identified in Exhibit A, if applicable.
(iii) For all other Counties, the regional share for each County will be paid to
the Managing Entities providing service for that County. The Managing
Entities will be required to expend the monies on Approved Purposes,
including the Core Strategies. The Managing Entities shall endeavor to
the greatest extent possible to expend these monies on counties within
the State that are non-Qualified Counties and to ensure that there are
services in every County.
(c) State Fund - The remainder of Opioid Funds after deducting the costs of the
Expense Fund detailed in paragraph 9,the City/County Fund and the Regional Fund
will be expended by the State on Approved Purposes, including the provisions
related to Core Strategies, if applicable.
(d) To the extent that Opioid Funds are not appropriated and expended in a year by the
State, the State shall identify the investments where settlement funds will be
deposited. Any gains, profits, or interest accrued from the deposit of the Opioid
Funds to the extent that any funds are not appropriated and expended within a
calendar year, shall be the sole property of the Party that was entitled to the initial
deposit.
}
4. Regional Fund Sliding Scale- The Regional Fund shall be calculated by utilizing
the following sliding scale of the Opioid Funds available in any year:
A. Years 1-6: 40%
B. Years 7-9: 35%
C. Years 10-12: 34%
D. Years 13-15: 33%
E. Years 16-18: 30%
5. Opioid Abatement Taskforce or Council - The State will create an Opioid
Abatement Taskforce or Council (sometimes hereinafter "Taskforce" or "Council") to advise the
Governor, the Legislature, Florida's Department of Children and Families ("DCF"), and Local
Governments on the priorities that should be addressed as part of the opioid epidemic and to review
how monies have been spent and the results that have been achieved with Opioid Funds.
(a) Size-The Taskforce or Council shall have ten Members equally balanced between
the State and the Local Governments.
(b) Appointments Local Governments - Two Municipality representatives will be
appointed by or through Florida League of Cities. Two county representatives, one
from a Qualified County and one from a county within the State that is not a
Qualified County, will be appointed by or through the Florida Association of
Counties. The final representative will alternate every two years between being a
county representative (appointed by or through Florida Association of Counties) or
a Municipality representative (appointed by or through the Florida League of
Cities). One Municipality representative must be from a city of less than 50,000
people. One county representative must be from a county less than 200,000 people
and the other county representative must be from a county whose population
exceeds 200,000 people.
(c) Appointments State -
(i) The Governor shall appoint two Members.
(ii) The Speaker of the House shall appoint one Member.
(iii) The Senate President shall appoint one Member.
(iv) The Attorney General or her designee shall be a Member.
(d) Chair - The Attorney General or designee shall be the chair of the Taskforce or
Council.
(e) Term-Members will be appointed to serve a two-year term.
(f) Support-DCF shall support the Taskforce or Council and the Taskforce or Council
shall be administratively housed in DCF.
(g) Meetings - The Taskforce or Council shall meet quarterly in person or virtually
using communications media technology as defined in section 120.54(5)(b)(2),
Florida Statutes.
(h) Reporting - The Taskforce or Council shall provide and publish a report annually
no later than November 30th or the first business day after November 30th, if
November 30th falls on a weekend or is otherwise not a business day. The report
shall contain information on how monies were spent the previous fiscal year by the
State, each of the Qualified Counties, each of the Managing Entities, and each of
the Local Governments. It shall also contain recommendations to the Governor,
the Legislature, and Local Governments for priorities among the Approved
Purposes for how monies should be spent the coming fiscal year to respond to the
opioid epidemic.
(i) Accountability - Prior to July 1st of each year, the State and each of the Local
Governments shall provide information to DCF about how they intend to expend
Opioid Funds in the upcoming fiscal year. The State and each of the Local
Government shall report its expenditures to DCF no later than August 31st for the
previous fiscal year. The Taskforce or Council will set other data sets that need to
be reported to DCF to demonstrate the effectiveness of Approved Purposes. All
programs and expenditures shall be audited annually in a similar fashion to
SAMHSA programs. Local Governments shall respond and provide documents to
any reasonable requests from the State for data or information about programs
receiving Opioid Funds.
(j) Conflict of Interest-All Members shall adhere to the rules, regulations and laws of
Florida including, but not limited to, Florida Statute §112.311, concerning the
disclosure of conflicts of interest and recusal from discussions or votes on
conflicted matters.
6. Administrative Costs- The State may take no more than a 5% administrative fee
from the State Fund ("Administrative Costs") and any Regional Fund that it administers for
counties that are not Qualified Counties. Each Qualified County may take no more than a 5%
administrative fee from its share of the Regional Funds.
7. Negotiation of Non-Multistate Settlements -If the State begins negotiations with
a Pharmaceutical Supply Chain Participant that is separate and apart from a multi-state negotiation,
the State shall include Local Governments that are a part of the Negotiating Committee in such
negotiations. No Settlement shall be recommended or accepted without the affirmative votes of
both the State and Local Government representatives of the Negotiating Committee.
8. Negotiation of Multistate or Local Government Settlements - To the extent
practicable and allowed by other parties to a negotiation, both Parties agree to communicate with
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members of the Negotiation Committee regarding the terms of any other Pharmaceutical Supply
Chain Participant Settlement.
9. Expense Fund -The Parties agree that in any negotiation every effort shall be made
to cause Pharmaceutical Supply Chain Participants to pay costs of litigation, including attorneys'
fees, in addition to any agreed to Opioid Funds in the Settlement. To the extent that a fund
sufficient to pay the entirety of all contingency fee contracts for Local Governments in the State
of Florida is not created as part of a Settlement by a Pharmaceutical Supply Chain Participant,the
Parties agree that an additional expense fund for attorneys who represent Local Governments
(herein "Expense Fund") shall be created out of the City/County fund for the purpose of paying
the hard costs of a litigating Local Government and then paying attorneys' fees.
(a) The Source of Funds for the Expense Fund- Money for the Expense Fund shall be
sourced exclusively from the City/County Fund.
(b) The Amount of the Expense Fund- The State recognizes the value litigating Local
Governments bring to the State of Florida in connection with the Settlement
because their participation increases the amount Incentive Payments due from each
Pharmaceutical Supply Chain Participant. In recognition of that value, the amount
of funds that shall be deposited into the Expense fund shall be contingent upon on
the percentage of litigating Local Government participation in the Settlement,
according to the following table:
Litigating Local Government Amount that shall be paid
Participation in the into the Expense Fund
Settlement (by percentage of from (and as a percentage
the population) of)the City/County fund
96 to 100% 10%
91 to 95% 7.5%
86 to 90% 5%
85% 2.5%
Less than 85% 0%
If fewer than 85% percent of the litigating Local Governments (by population)
participate,then the Expense Fund shall not be funded,and this Section of the MOU
shall be null and void.
(c) The Timing of Payments into the Expense Fund- Although the amount of the
Expense Fund shall be calculated based on the entirety of payments due to the
City/County fund over a ten to eighteen year period, the Expense Fund shall be
funded entirely from payments made by Pharmaceutical Supply Chain Participants
during the first two years of the Settlement. Accordingly, to offset the amounts
being paid from the City/County to the Expense Fund in the first two years,
Counties or Municipalities may borrow from the Regional Fund during the first two
years and pay the borrowed amounts back to the Regional Fund during years three,
four, and five.
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For the avoidance of doubt, the following provides an illustrative example regarding the
calculation of payments and amounts that may be borrowed under the terms of this MOU,
consistent with the provisions of this Section:
Opioid Funds due to State of Florida and Local Governments (over 10 to 18 years): $1,000
Litigating Local Government Participation: 100%
City/County Fund (over 10 to 18 years): $150
Expense Fund (paid over 2 years): $15
Amount Paid to Expense Fund in 1st year: $7.5
Amount Paid to Expense Fund in 2nd year $7.5
Amount that may be borrowed from Regional Fund in 1st year: $7.5
Amount that may be borrowed from Regional Fund in 2nd year: $7.5
Amount that must be paid back to Regional Fund in 3rd year: $5
Amount that must be paid back to Regional Fund in 4th year: $5
Amount that must be paid back to Regional Fund in 5th year: $5
(d) Creation of and Jurisdiction over the Expense Fund- The Expense Fund shall be
established, consistent with the provisions of this Section of the MOU, by order of
the Circuit Court of the Sixth Judicial Circuit in and for Pasco County, West Pasco
Division New Port Richey, Florida, in the matter of The State of Florida, Office of
the Attorney General, Department of Legal Affairs v. Purdue Pharma L.P., et al.,
Case No. 2018-CA-001438 (the "Court"). The Court shall have jurisdiction over
the Expense Fund, including authority to allocate and disburse amounts from the
Expense Fund and to resolve any disputes concerning the Expense Fund.
(e) Allocation of Payments to Counsel from the Expense Fund- As part of the order
establishing the Expense Fund, counsel for the litigating Local Governments shall
seek to have the Court appoint a third-neutral to serve as a special master for
purposes of allocating the Expense Fund. Within 30 days of entry of the order
appointing a special master for the Expense Fund, any counsel who intend to seek
an award from the Expense Fund shall provide the copies of their contingency fee
contracts to the special master. The special master shall then build a mathematical
model,which shall be based on each litigating Local Government's share under the
Negotiation Class Metrics and the rate set forth in their contingency contracts, to
calculate a proposed award for each litigating Local Government who timely
provided a copy of its contingency contract.
10. Dispute resolution- Any one or more of the Local Governments or the State may
object to an allocation or expenditure of Opioid Funds solely on the basis that the allocation or
expenditure at issue (a) is inconsistent with the Approved Purposes; (b) is inconsistent with the
distribution scheme as provided in paragraph 3, or(c)violates the limitations set forth herein with
respect to administrative costs or the Expense Fund. There shall be no other basis for bringing an
objection to the approval of an allocation or expenditure of Opioid Funds.
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Schedule A
Core Strategies
States and Qualifying Block Grantees shall choose from among the abatement strategies listed in
Schedule B. However, priority shall be given to the following core abatement strategies ("Core
Strategies")[, such that a minimum of_%of the [aggregate] state-level abatement distributions shall
be spent on [one or more of] them annually].'
A.Naloxone or other FDA-approved drug to reverse opioid overdoses
1. Expand training for first responders, schools, community support groups and families; and
2. Increase distribution to individuals who are uninsured or whose insurance does not cover the needed
service.
B. Medication-Assisted Treatment ("MAT") Distribution and other opioid-related treatment
1. Increase distribution of MAT to non-Medicaid eligible or uninsured individuals;
2. Provide education to school-based and youth-focused programs that discourage or prevent misuse;
3. Provide MAT education and awareness training to healthcare providers, EMTs, law enforcement,
and other first responders; and
4. Treatment and Recovery Support Services such as residential and inpatient treatment, intensive
outpatient treatment, outpatient therapy or counseling, and recovery housing that allow or integrate
medication with other support services.
C. Pregnant&Postpartum Women
1. Expand Screening, Brief Intervention, and Referral to Treatment ("SBIRT") services to non-
Medicaid eligible or uninsured pregnant women;
2. Expand comprehensive evidence-based treatment and recovery services, including MAT, for women
with co-occurring Opioid Use Disorder("OUD") and other Substance Use Disorder ("SUD")/Mental
Health disorders for uninsured individuals for up to 12 months postpartum; and
3. Provide comprehensive wrap-around services to individuals with Opioid Use Disorder (OUD)
including housing, transportation,job placement/training, and childcare.
D.Expanding Treatment for Neonatal Abstinence Syndrome
1. Expand comprehensive evidence-based and recovery support for NAS babies;
2. Expand services for better continuum of care with infant-need dyad; and
3. Expand long-term treatment and services for medical monitoring of NAS babies and their families.
As used in this Schedule A,words like"expand,""fund,""provide"or the like shall not indicate a preference for new or
existing programs. Priorities will be established through the mechanisms described in the Term Sheet.
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E. Expansion of Warm Hand-off Programs and Recovery Services
1. Expand services such as navigators and on-call teams to begin MAT in hospital emergency
departments;
2. Expand warm hand-off services to transition to recovery services;
3. Broaden scope of recovery services to include co-occurring SUD or mental health conditions. ;
4. Provide comprehensive wrap-around services to individuals in recovery including housing,
transportation,job placement/training, and childcare; and
5. Hire additional social workers or other behavioral health workers to facilitate expansions above.
F. Treatment for Incarcerated Population
1. Provide evidence-based treatment and recovery support including MAT for persons with OUD and
co-occurring SUD/MH disorders within and transitioning out of the criminal justice system; and
2. Increase funding for jails to provide treatment to inmates with OUD.
G. Prevention Programs
1. Funding for media campaigns to'prevent opioid use (similar to the FDA's "Real Cost" campaign to
prevent youth from misusing tobacco);
2. Funding for evidence-based prevention programs in schools.;
3. Funding for medical provider education and outreach regarding best prescribing practices for opioids
consistent with the 2016 CDC guidelines, including providers at hospitals (academic detailing);
4. Funding for community drug disposal programs; and
5. Funding and training for first responders to participate in pre-arrest diversion programs, post-
overdose response teams, or similar strategies that connect at-risk individuals to behavioral health
services and supports.
H.Expanding Syringe Service Programs
1. Provide comprehensive syringe services programs with more wrap-around services including linkage
to OUD treatment, access to sterile syringes, and linkage to care and treatment of infectious diseases.
I. Evidence-based data collection and research analyzing the effectiveness of the abatement strategies
within the State.
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Schedule B
Approved Uses
PART ONE: TREATMENT
A. TREAT OPIOID USE DISORDER(OUD)
Support treatment of Opioid Use Disorder(OUD) and any co-occurring Substance Use Disorder or
Mental Health (SUD/MH) conditions through evidence-based or evidence-informed programs or
strategies that may include, but are not limited to, the following:2
1. Expand availability of treatment for OUD and any co-occurring SUD/MH conditions, including all
forms of Medication-Assisted Treatment(MAT) approved by the U.S. Food and Drug Administration.
2. Support and reimburse evidence-based services that adhere to the American Society of Addiction
Medicine (ASAM) continuum of care for OUD and any co-occurring SUD/MH conditions
3. Expand telehealth to increase access to treatment for OUD and any co-occurring SUD/MH
conditions, including MAT, as well as counseling, psychiatric support, and other treatment and
recovery support services.
4. Improve oversight of Opioid Treatment Programs (OTPs)to assure evidence-based or evidence-
informed practices such as adequate methadone dosing and low threshold approaches to treatment.
5. Support mobile intervention, treatment, and recovery services, offered by qualified professionals and
service providers, such as peer recovery coaches, for persons with OUD and any co-occurring
SUD/MH conditions and for persons who have experienced an opioid overdose.
6. Treatment of trauma for individuals with OUD (e.g., violence, sexual assault, human trafficking, or
adverse childhood experiences) and family members (e.g., surviving family members after an overdose
or overdose fatality), and training of health care personnel to identify and address such trauma.
7. Support evidence-based withdrawal management services for people with OUD and any co-
occurring mental health conditions.
8. Training on MAT for health care providers, first responders, students, or other supporting
professionals, such as peer recovery coaches or recovery outreach specialists, including telementoring
to assist community-based providers in rural or underserved areas.
9. Support workforce development for addiction professionals who work with persons with OUD and
any co-occurring SUD/MH conditions.
10. Fellowships for addiction medicine specialists for direct patient care, instructors, and clinical
research for treatments.
11. Scholarships and supports for behavioral health practitioners or workers involved in addressing
OUD and any co-occurring SUD or mental health conditions, including but not limited to training,
2 As used in this Schedule B,words like"expand,""fund,""provide"or the like shall not indicate a preference for new or
existing programs. Priorities will be established through the mechanisms described in the Term Sheet.
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scholarships, fellowships, loan repayment programs, or other incentives for providers to work in rural
or underserved areas.
12. [Intentionally Blank—to be cleaned up later for numbering]
13. Provide funding and training for clinicians to obtain a waiver under the federal Drug Addiction
Treatment Act of 2000 (DATA 2000) to prescribe MAT for OUD, and provide technical assistance and
professional support to clinicians who have obtained a DATA 2000 waiver.
14. Dissemination of web-based training curricula, such as the American Academy of Addiction
Psychiatry's Provider Clinical Support Service-Opioids web-based training curriculum and
motivational interviewing.
15. Development and dissemination of new curricula, such as the American Academy of Addiction
Psychiatry's Provider Clinical Support Service for Medication-Assisted Treatment.
B. SUPPORT PEOPLE IN TREATMENT AND RECOVERY
Support people in treatment for or recovery from OUD and any co-occurring SUD/MH conditions
through evidence-based or evidence-informed programs or strategies that may include, but are not
limited to, the following:
1. Provide comprehensive wrap-around services to individuals with OUD and any co-occurring
SUD/MH conditions, including housing, transportation, education,job placement,job training, or
childcare.
2. Provide the full continuum of care of treatment and recovery services for OUD and any co-occurring
SUD/MH conditions, including supportive housing, peer support services and counseling, community
navigators, case management, and connections to community-based services.
3. Provide counseling, peer-support, recovery case management and residential treatment with access to
medications for those who need it to persons with OUD and any co-occurring SUD/MH conditions.
4. Provide access to housing for people with OUD and any co-occurring SUD/MH conditions,
including supportive housing, recovery housing, housing assistance programs, training for housing
providers, or recovery housing programs that allow or integrate FDA-approved medication with other
support services.
5. Provide community support services, including social and legal services, to assist in
deinstitutionalizing persons with OUD and any co-occurring SUD/MH conditions.
6. Support or expand peer-recovery, centers, which may include support groups, social events, computer
access, or other services for persons with OUD and any co-occurring SUD/MH conditions.
7. Provide or support transportation to treatment or recovery programs or services for persons with
OUD and any co-occurring SUD/MH conditions.
8. Provide employment training or educational services for persons in treatment for or recovery from
OUD and any co-occurring SUD/MH conditions.
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9. Identify successful recovery programs such as physician, pilot, and college recovery programs, and
provide support and technical assistance to increase the number and capacity of high-quality programs
to help those in recovery.
10. Engage non-profits, faith-based communities, and community coalitions to support people in
treatment and recovery and to support family members in their efforts to support the person with OUD
in the family.
11. Training and development of procedures for government staff to appropriately interact and provide
social and other services to individuals with or in recovery from OUD, including reducing stigma.
12. Support stigma reduction efforts regarding treatment and support for persons with OUD, including
reducing the stigma on effective treatment.
13. Create or support culturally appropriate services and programs for persons with OUD and any co-
occurring SUD/MH conditions, including new Americans.
14. Create and/or support recovery high schools.
15. Hire or train behavioral health workers to provide or expand any of the services or supports listed
above.
C. CONNECT PEOPLE WHO NEED HELP TO THE HELP THEY NEED (CONNECTIONS
TO CARE)
Provide connections to care for people who have—or at risk of developing—OUD and any co-
occurring SUD/MH conditions through evidence-based or evidence-informed programs or strategies
that may include, but are not limited to, the following:
1. Ensure that health care providers are screening for OUD and other risk factors and know how to
appropriately counsel and treat (or refer if necessary) a patient for OUD treatment.
2. Fund Screening, Brief Intervention and Referral to Treatment(SBIRT) programs to reduce the
transition from use to disorders, including SBIRT services to pregnant women who are uninsured or not
eligible for Medicaid.
3. Provide training and long-term implementation of SBIRT in key systems (health, schools, colleges,
criminal justice, and probation), with a focus on youth and young adults when transition from misuse to
opioid disorder is common.
4. Purchase automated versions of SBIRT and support ongoing costs of the technology.
5. Expand services such as navigators and on-call teams to begin MAT in hospital emergency
departments.
6. Training for emergency room personnel treating opioid overdose patients on post-discharge planning,
including community referrals for MAT, recovery case management or support services.
7. Support hospital programs that transition persons with OUD and any co-occurring SUD/MH
conditions, or persons who have experienced an opioid overdose, into clinically-appropriate follow-up
care through a bridge clinic or similar approach.
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8. Support crisis stabilization centers that serve as an alternative to hospital emergency departments for
persons with OUD and any co-occurring SUD/MH conditions or persons that have experienced an
opioid overdose.
9. Support the work of Emergency Medical Systems, including peer support specialists,to connect
individuals to treatment or other appropriate services following an opioid overdose or other opioid-
related adverse event.
10. Provide funding for peer support specialists or recovery coaches in emergency departments, detox
facilities, recovery centers, recovery housing, or similar settings; offer services, supports, or
connections to care to persons with OUD and any co-occurring SUD/MH conditions or to persons who
have experienced an opioid overdose.
11. Expand warm hand-off services to transition to recovery services.
12. Create or support school-based contacts that parents can engage with to seek immediate treatment
services for their child; and support prevention, intervention, treatment, and recovery programs focused
on young people.
•
13. Develop and support best practices on addressing OUD in the workplace.
14. Support assistance programs for health care providers with OUD.
15. Engage non-profits and the faith community as a system to support outreach for treatment.
•
16. Support centralized call centers that provide information and connections to appropriate services
and supports for persons with OUD and any co-occurring SUD/MH conditions.
D. ADDRESS THE NEEDS OF CRIMINAL-JUSTICE-INVOLVED PERSONS
Address the needs of persons with QUD and any co-occurring SUD/MH conditions who are involved
in, are at risk of becoming involved in, or are transitioning out of the criminal justice system through
evidence-based or evidence-informed programs or strategies that may include, but are not limited to,
the following:
1. Support pre-arrest or pre-arraignment diversion and deflection strategies for persons with OUD and
any co-occurring SUD/MH conditions, including established strategies such as:
a. Self-referral strategies such as the Angel Programs or the Police Assisted Addiction Recovery
Initiative (PAARI);
b.Active outreach strategies such as the Drug Abuse Response Team (DART) model;
c. "Naloxone Plus" strategies, which work to ensure that individuals who have received
naloxone to reverse the effects of an overdose are then linked to treatment programs or other
appropriate services;
d. Officer prevention strategies, such as the Law Enforcement Assisted Diversion (LEAD)
model; •
e. Officer intervention strategies such as the Leon County, Florida Adult Civil Citation Network
or the Chicago Westside Narcotics Diversion to Treatment Initiative; or
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f. Co-responder and/or alternative responder models to address OUD-related 911 calls with
greater SUD expertise
2. Support pre-trial services that connect individuals with OUD and any co-occurring SUD/MH
conditions to evidence-informed treatment, including MAT, and related services.
3. Support treatment and recovery courts that provide evidence-based options for persons with OUD
and any co-occurring SUD/MH conditions
4. Provide evidence-informed treatment, including MAT, recovery support, harm reduction, or other
appropriate services to individuals with OUD and any co-occurring SUD/MH conditions who are
incarcerated in jail or prison.
5. Provide evidence-informed treatment, including MAT, recovery support, harm reduction, or other
appropriate services to individuals with OUD and any co-occurring SUD/MH conditions who are
leaving jail or prison have recently left jail or prison, are on probation or parole, are under community
corrections supervision, or are in re-entry programs or facilities.
6. Support critical time interventions (CTI), particularly for individuals living with dual-diagnosis
OUD/serious mental illness, and services for individuals who face immediate risks and service needs
and risks upon release from correctional settings.
7. Provide training on best practices for addressing the needs of criminal-justice-involved persons with
OUD and any co-occurring SUD/MH conditions to law enforcement, correctional, or judicial personnel
or to providers of treatment, recovery, harm reduction, case management, or other services offered in
connection with any of the strategies described in this section.
E.ADDRESS THE NEEDS OF PREGNANT OR PARENTING WOMEN AND THEIR
FAMILIES,INCLUDING BABIES WITH NEONATAL ABSTINENCE SYNDROME
Address the needs of pregnant or parenting women with OUD and any co-occurring SUD/MH
conditions, and the needs of their families, including babies with neonatal abstinence syndrome (NAS),
through evidence-based or evidence-informed programs or strategies that may include, but are not
limited to, the following:
1. Support evidence-based or evidence-informed treatment, including MAT, recovery services and
supports, and prevention services for pregnant women—or women who could become pregnant—who
have OUD and any co-occurring SUD/MH conditions, and other measures to educate and provide
support to families affected by Neonatal Abstinence Syndrome.
2. Expand comprehensive evidence-based treatment and recovery services, including MAT, for
uninsured women with OUD and any co-occurring SUD/MH conditions for up to 12 months
postpartum.
3. Training for obstetricians or other healthcare personnel that work with pregnant women and their
families regarding treatment of OUD and any co-occurring SUD/MH conditions.
4. Expand comprehensive evidence-based treatment and recovery support for NAS babies; expand
services for better continuum of care with infant-need dyad; expand long-term treatment and services
for medical monitoring of NAS babies and their families.
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5. Provide training to health care providers who work with pregnant or parenting women on best
practices for compliance with federal requirements that children born with Neonatal Abstinence
Syndrome get referred to appropriate services and receive a plan of safe care.
6. Child and family supports for parenting women with OUD and any co-occurring SUD/MH
conditions.
7. Enhanced family supports and child care services for parents with OUD and any co-occurring
SUD/MH conditions.
8. Provide enhanced support for children and family members suffering trauma as a result of addiction
in the family; and offer trauma-informed behavioral health treatment for adverse childhood events.
9. Offer home-based wrap-around services to persons with OUD and any co-occurring SUD/MH
conditions, including but not limited to parent skills training.
10. Support for Children's Services—Fund additional positions and services, including supportive
housing and other residential services, relating to children being removed from the home and/or placed
in foster care due to custodial opioid use.
PART TWO: PREVENTION
F.PREVENT OVER-PRESCRIBING AND ENSURE APPROPRIATE PRESCRIBING AND
DISPENSING OF OPIOIDS
Support efforts to prevent over-prescribing and ensure appropriate prescribing and dispensing of
opioids through evidence-based or evidence-informed programs or strategies that may include, but are
not limited to, the following:
1. Fund medical provider education and outreach regarding best prescribing practices for opioids
consistent with Guidelines for Prescribing Opioids for Chronic Pain from the U.S. Centers for Disease
Control and Prevention, including providers at hospitals (academic detailing).
2. Training for health care providers regarding safe and responsible opioid prescribing, dosing, and
tapering patients off opioids.
3. Continuing Medical Education (CME) on appropriate prescribing of opioids.
4. Support for non-opioid pain treatment alternatives, including training providers to offer or refer to
multi-modal, evidence-informed treatment of pain.
5. Support enhancements or improvements to Prescription Drug Monitoring Programs (PDMPs),
including but not limited to improvements that:
a. Increase the number of prescribers using PDMPs;
b. Improve point-of-care decision-making by increasing the quantity, quality, or format of data
available to prescribers using PDMPs, by improving the interface that prescribers use to access
PDMP data, or both; or
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c. Enable states to use PDMP data in support of surveillance or intervention strategies, including
MAT referrals and follow-up for individuals identified within PDMP data as likely to
experience OUD in a manner that complies with all relevant privacy and security laws and rules.
6. Ensuring PDMPs incorporate available overdose/naloxone deployment data, including the United
States Department of Transportation's Emergency Medical Technician overdose database in a manner
that complies with all relevant privacy and security laws and rules.
7. Increase electronic prescribing to prevent diversion or forgery.
8. Educate Dispensers on appropriate opioid dispensing.
G. PREVENT MISUSE OF OPIOIDS
Support efforts to discourage or prevent misuse of opioids through evidence-based or evidence-
informed programs or strategies that may include, but are not limited to, the following:
1. Fund media campaigns to prevent opioid misuse.
2. Corrective advertising or affirmative public education campaigns based on evidence.
3. Public education relating to drug disposal.
4. Drug take-back disposal or destruction programs.
5. Fund community anti-drug coalitions that engage in drug prevention efforts.
6. Support community coalitions in implementing evidence-informed prevention, such as reduced
social access and physical access, stigma reduction—including staffing, educational campaigns, support
for people in treatment or recovery, or training of coalitions in evidence-informed implementation,
including the Strategic Prevention Framework developed by the U.S. Substance Abuse and Mental
Health Services Administration (SAMHSA).
7. Engage non-profits and faith-based communities as systems to support prevention.
8. Fund evidence-based prevention programs in schools or evidence-informed school and community
education programs and campaigns for students, families, school employees, school athletic programs,
parent-teacher and student associations, and others.
9. School-based or youth-focused programs or strategies that have demonstrated effectiveness in
preventing drug misuse and seem likely to be effective in preventing the uptake and use of opioids.
10. Create of support community-based education or intervention services for families, youth, and
adolescents at risk for OUD and any co-occurring SUD/MH conditions.
11. Support evidence-informed programs or curricula to address mental health needs of young people
who may be at risk of misusing opioids or other drugs, including emotional modulation and resilience
skills.
12. Support greater access to mental health services and supports for young people, including services
and supports provided by school nurses, behavioral health workers or other school staff, to address
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mental health needs in young people that (when not properly addressed) increase the risk of opioid or
other drug misuse.
H. PREVENT OVERDOSE DEATHS AND OTHER HARMS (HARM REDUCTION)
Support efforts to prevent or reduce overdose deaths or other opioid-related harms through evidence-
based or evidence-informed programs or strategies that may include, but are not limited to, the
following:
1. Increase availability and distribution of naloxone and other drugs that treat overdoses for first
responders, overdose patients, individuals with OUD and their friends and family members, individuals
at high risk of overdose, schools, community navigators and outreach workers, persons being released
from jail or prison, or other members of the general public.
•
2. Public health entities provide free naloxone to anyone in the community
3. Training and education regarding naloxone and other drugs that treat overdoses for first responders,
overdose patients, patients taking opioids, families, schools, community support groups, and other
members of the general public.
4. Enable school nurses and other school staff to respond to opioid overdoses, and provide them with
naloxone, training, and support.
5. Expand, improve, or develop data tracking software and applications for overdoses/naloxone
revivals.
6. Public education relating to emergency responses to overdoses.
7. Public education relating to immunity and Good Samaritan laws.
8. Educate first responders regarding the existence and operation of immunity and Good Samaritan
laws.
9. Syringe service programs and other evidence-informed programs to reduce harms associated with
intravenous drug use, including supplies, staffing, space, peer support services, referrals to treatment,
fentanyl checking, connections to care, and the full range of harm reduction and treatment services
provided by these programs.
10. Expand access to testing and treatment for infectious diseases such as HIV and Hepatitis C resulting
from intravenous opioid use.
11. Support mobile units that offer or provide referrals to harm reduction services, treatment, recovery
supports, health care, or other appropriate services to persons that use opioids or persons with OUD and
any co-occurring SUD/MH conditions.
12. Provide training in harm reduction strategies to health care providers, students, peer recovery
coaches, recovery outreach specialists, or other professionals that provide care to persons who use
opioids or persons with OUD and any co-occurring SUD/MH conditions.
13. Support screening for fentanyl in routine clinical toxicology testing.
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PART THREE: OTHER STRATEGIES
I. FIRST RESPONDERS
In addition to items in sections C, D, and H relating to first responders, support the following:
1. Educate law enforcement or other first responders regarding appropriate practices and precautions
when dealing with fentanyl or other drugs.
2. Provision of wellness and support services for first responders and others who experience secondary
trauma associated with opioid-related emergency events.
J. LEADERSHIP,PLANNING AND COORDINATION
Support efforts to provide leadership, planning, coordination, facilitation, training and technical
assistance to abate the opioid epidemic through activities, programs, or strategies that may include, but
are not limited to, the following:
1. Statewide, regional, local, or community regional planning to identify root causes of addiction and
overdose, goals for reducing harms related to the opioid epidemic, and areas and populations with the
greatest needs for treatment intervention services; to support training and technical assistance; or to
support other strategies to abate the opioid epidemic described in this opioid abatement strategy list.
2. A dashboard to share reports, recommendations, or plans to spend opioid settlement funds; to show
how opioid settlement funds have been spent; to report program or strategy outcomes; or to track, share,
or visualize key opioid-related or health-related indicators and supports as identified through
collaborative statewide, regional, local, or community processes.
3. Invest in infrastructure or staffing at government or not-for-profit agencies to support collaborative,
cross-system coordination with the'purpose of preventing overprescribing, opioid misuse, or opioid
overdoses, treating those with OUD and any co-occurring SUD/MH conditions, supporting them in
treatment or recovery, connecting them to care, or implementing other strategies to abate the opioid
epidemic described in this opioid abatement strategy list.
4. Provide resources to staff government oversight and management of opioid abatement programs.
K. TRAINING
In addition to the training referred to throughout this document, support training to abate the opioid
epidemic through activities, programs, or strategies that may include, but are not limited to, the
following:
1. Provide funding for staff training or networking programs and services to improve the capability of
government, community, and not-for-profit entities to abate the opioid crisis.
2. Support infrastructure and staffing for collaborative cross-system coordination to prevent opioid
misuse, prevent overdoses, and treat those with OUD and any co-occurring SUD/MH conditions, or
implement other strategies to abate'the opioid epidemic described in this opioid abatement strategy list
(e.g., health care, primary care, pharmacies, PDMPs, etc.).
L. RESEARCH
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Support opioid abatement research that may include, but is not limited to, the following:
1. Monitoring, surveillance, data collection, and evaluation of programs and strategies described in this
opioid abatement strategy list.
2. Research non-opioid treatment of chronic pain.
3. Research on improved service delivery for modalities such as SBIRT that demonstrate promising but
mixed results in populations vulnerable to opioid use disorders.
4. Research on novel harm reduction and prevention efforts such as the provision of fentanyl test strips.
5. Research on innovative supply-side enforcement efforts such as improved detection of mail-based
delivery of synthetic opioids.
6. Expanded research on swift/certain/fair models to reduce and deter opioid misuse within criminal
justice populations that build upon promising approaches used to address other substances (e.g. Hawaii
HOPE and Dakota 24/7).
7. Epidemiological surveillance of OUD-related behaviors in critical populations including individuals
entering the criminal justice system, including but not limited to approaches modeled on the Arrestee
Drug Abuse Monitoring (ADAM) system.
8. Qualitative and quantitative research regarding public health risks and harm reduction opportunities
within illicit drug markets, including surveys of market participants who sell or distribute illicit opioids.
9. Geospatial analysis of access barriers to MAT and their association with treatment engagement and
treatment outcomes.
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I 6
FLORIDA OPIOID ALLOCATION AND
STATEWIDE RESPONSE
AGREEMENT
BETWEEN
STATE OF FLORIDA DEPARTMENT OF LEGAL AFFAIRS,
OFFICE OF THE ATTORNEY GENERAL
And
CERTAIN LOCAL GOVERNMENTS IN THE STATE OF FLORIDA
This Florida Opioid Allocation and Statewide Response Agreement (the "Agreement") is
entered into between the State of Florida (`State") and certain Local Governments ("Local
Governments" and the State and Local Governments are jointly referred to as the "Parties" or
individually as a"Party"). The Parties agree as follows:
Whereas, the people of the State and its communities have been harmed by misfeasance,
nonfeasance and malfeasance committed by certain entities within the Pharmaceutical Supply
Chain; and
Whereas,the State,through its Attorney General, and certain Local Governments, through
their elected representatives and counsel, are separately engaged in litigation seeking to hold many
of the same Pharmaceutical Supply Chain Participants accountable for the damage caused by their
misfeasance,nonfeasance and malfeasance as the State; and
Whereas, certain of the Parties have separately sued Pharmaceutical Supply Chain
participants for the harm caused to the citizens of both Parties and have collectively negotiated
settlements with several Pharmaceutical Supply Chain Participants; and
Whereas, the Parties share a common desire to abate and alleviate the impacts of that
misfeasance,nonfeasance and malfeasance throughout the State; and
Whereas, it is the intent of the State and its Local Governments to use the proceeds from
any Settlements with Pharmaceutical Supply Chain Participants to increase the amount of funding
presently spent on opioid and substance abuse education, treatment, prevention and other related
programs and services, such as those identified in Exhibits "A" and "B," and to ensure that the
funds are expended in compliance with evolving evidence-based"best practices;" and
Whereas, the State and its Local Governments enter into this Agreement and agree to the
allocation and use of the proceeds of any settlement described herein
Wherefore, the Parties each agree to as follows:
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A. Definitions
As used in this Agreement:
1. "Approved Purpose(s)" shall mean forward-looking strategies, programming and
services used to expand the availability of treatment for individuals impacted by substance use
disorders, to: (a) develop, promote, and provide evidence-based substance use prevention
strategies; (b) provide substance use avoidance and awareness education; (c) decrease the
oversupply of licit and illicit opioids;and(d)support recovery from addiction. Approved Purposes
shall include,but are not limited to,the opioid abatement strategies listed in Exhibits"A"and"B"
which are incorporated herein by reference.
2. "Local Governments" shall mean all counties, cities, towns and villages located
within the geographic boundaries of the State.
3. "Managing Entities"shall mean the corporations selected by and under contract with
the Florida Department of Children and Families or its successor ("DCF") to manage the daily
operational delivery of behavioral health services through a coordinated system of care. The
singular"Managing Entity" shall,refer to a singular of the Managing Entities.
4. "County" shall mean a political subdivision of the state established pursuant to s. 1,
Art. VIII of the State Constitution.
5. "Dependent Special District" shall mean a Special District meeting the requirements
of Florida Statutes § 189.012(2)..
6. "Municipalities" shall mean cities, towns, or villages located in a County within the
State that either have: (a) a Population greater than 10,000 individuals; or (b) a Population equal
to or less than 10,000 individuals and that has either (i) filed a lawsuit against one or more
Pharmaceutical Supply Chain Participants; or (ii) executes a release in connection with a
settlement with a Pharmaceutical Supply Chain participant. The singular "Municipality" shall
refer to a singular city,town, or village within the definition of Municipalities.
7. "`Negotiating Committee" shall mean a three-member group comprised by
representatives of the following: (1)the State; and (2) two representatives of Local Governments
of which one representative will be from a Municipality and one shall be from a County
(collectively,"Members")within the State. The State shall be represented by the Attorney General
or her designee.
8. "Negotiation Class Metrics" shall mean those county and city settlement allocations
which come from the official website of the Negotiation Class of counties and cities certified on
September 11, 2019 by the U.S. District for the Northern District of Ohio in In re National
Prescription Opiate Litigation; MDL No. 2804 (N.D. Ohio). The website is located at
https://allocationmap.iclaimsonline.com.
9. "Opioid Funds" shall mean monetary amounts obtained through a Settlement.
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10. "Opioid Related" shall have the same meaning and breadth as in the agreed Opioid
Abatement Strategies attached hereto as Exhibits "A"or"B."
11. "Parties" shall mean the State and Local Governments that execute this Agreement.
The singular word "Party" shall mean either the State or Local Governments that executed this
Agreement.
12. "PEC" shall mean the Plaintiffs' Executive Committee of the National Prescription
Opiate Multidistrict Litigation pending in the United States District Court for the Northern District
of Ohio.
13. "Pharmaceutical Supply Chain" shall mean the entities, processes, and channels
through which Controlled Substances are manufactured, marketed, promoted, distributed or
dispensed.
14. "Pharmaceutical Supply Chain Participant" shall mean any entity that engages in, or
has engaged in the manufacture, marketing, promotion, distribution or dispensing of an opioid
analgesic.
15. "Population" shall refer to published U.S. Census Bureau population estimates as of
July 1,2019,released March 2020, and shall remain unchanged during the term of this Agreement.
These estimates can currently be found at https://www.census.gov. For purposes of Population
under the definition of Qualified County, a County's population shall be the greater of its
population as of the July 1, 2019, estimates or its actual population, according to the official U.S.
Census Bureau count, which was released by the U.S. Census Bureau in August 2021.
16. "Qualified County" shall mean a charter or non-chartered County that has a
Population of at least 300,000 individuals and: (a) has an opioid taskforce or other similar board,
commission, council, or entity (including some existing sub-unit of a County's government
responsible for substance abuse prevention, treatment,and/or recovery)of which it is a member or
it operates in connection with its municipalities or others on a local or regional basis; (b) has an
abatement plan that has been either adopted or is being utilized to respond to the opioid epidemic;
(c)is, as of December 31, 2021, either providing or is contracting with others to provide substance
abuse prevention, recovery, and/or treatment services to its citizens; and (d) has or enters into an
interlocal agreement with a majority of Municipalities (Majority is more than 50% of the
Municipalities' total Population)related to the expenditure of Opioid Funds. The Opioid Funds to
be paid to a Qualified County will only include Opioid Funds for Municipalities whose claims are
released by the Municipality or Opioid Funds for Municipalities whose claims are otherwise
barred. For avoidance of doubt,the word"operate"in connection with opioid task force means to
do at least one of the following activities: (1) gathers data about the nature, extent, and problems
being faced in communities within that County; (2) receives and reports recommendations from
other government and private entities about activities that should be undertaken to abate the opioid
epidemic to a County;and/or(3)makes recommendations to a County and other public and private
leaders about steps, actions, or plans that should be undertaken to abate the opioid epidemic. For
avoidance of doubt, the Population calculation required by subsection (d) does not include
Population in unincorporated areas.
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17. "SAMHSA" shall mean the U.S. Department of Health & Human Services,
Substance Abuse and Mental Health Services Administration.
18. "Settlement"shall mean the negotiated resolution of legal or equitable claims against
a Pharmaceutical Supply Chain Participant when that resolution has been jointly entered into by
the State and Local Governments or a settlement class as described in(B)(1)below.
19. "State" shall mean the State of Florida.
B. Terms
1. Only Abatement- Other than funds used for the Administrative Costs and Expense
Fund as hereinafter described or to pay obligations to the United States arising out of Medicaid or
other federal programs, all Opioid Funds shall be utilized for Approved Purposes. In order to
accomplish this purpose, the State will either: (a) file a new action with Local Governments as
Parties; or(b)add Local Governments to its existing action, sever any settling defendants.In either
type of action,the State will seek entry of a consent judgment,consent order or other order binding
judgment binding both the State and Local Governments to utilize Opioid Funds for Approved
Purposes ("Order") from the Circuit Court of the Sixth Judicial Circuit in and for Pasco County,
West Pasco Division New Port Richey, Florida (the "Court"), except as herein provided. The
Order may be part of a class action settlement or similar device. The Order shall provide for
continuing jurisdiction by the Court to address non-performance by any party under the Order.
2. Avoid Claw Back and Recoupment - Both the State and Local Governments wish
to maximize any Settlement and Opioid Funds. In addition to committing to only using funds for
the Expense Funds,Administrative Costs and Approved Purposes,both Parties will agree to utilize
a percentage of funds for the Core Strategies highlighted in Exhibit A. Exhibit A contains the
programs and strategies prioritized by the U.S. Department of Justice and/or the U.S. Department
of Health & Human Services ("Core Strategies"). The State is trying to obtain the United States'
agreement to limit or reduce the United States' ability to recover or recoup monies from the State
and Local Government in exchange for prioritization of funds to certain projects. If no agreement
is reached with the United States, then there will be no requirement that a percentage be utilized
for Core Strategies.
3. No Benefit Unless Fully Participating - Any Local Government that objects to or
refuses to be included under the Order or refuses or fails to execute any of documents necessary
to effectuate a Settlement shall not receive, directly or indirectly, any Opioid Funds and its portion
of Opioid Funds shall be distributed to, and for the benefit of, the Local Governments. Funds that
were a for a Municipality that does not join a Settlement will be distributed to the County where
that Municipality is located. Funds that were for a County that does not join a Settlement will be
distributed pro rata to Counties that join a Settlement. For avoidance of doubt, if a Local
Government initially refuses to be included in or execute the documents necessary to effectuate a
Settlement and subsequently effectuates such documents necessary to join a Settlement,then that
Local Government will only lose those payments made under a Settlement while that Local
Government was not a part of the Settlement. If a Local Government participates in a Settlement,
that Local Government is thereby releasing the claims of its Dependent Special District claims,if
any.
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4. Distribution Scheme—If a Settlement has a National Settlement Administrator or
similar entity, all Opioids Funds will initially go to the Administrator to be distributed. If a
Settlement does not have a National Settlement Administrator or similar entity, all Opioid Funds
will initially go to the State, and then be distributed by the State as they are received from the
Defendants according to the following distribution scheme.The Opioid Funds will be divided into
three funds after deducting any costs of the Expense Fund detailed below. Funds due the federal
government, if any, pursuant to Section B-2, will be subtracted from only the State and Regional
Funds below:
(a) City/County Fund-The city/county fund will receive 15%of all Opioid Funds
to directly benefit all Counties and Municipalities. The amounts to be distributed to each
County and Municipality shall be determined by the Negotiation Class Metrics or other
metrics agreed upon,in writing,by a County and a Municipality,which are attached to this
Agreement as Exhibit "C." In the event that a Municipality has a Population less than
10,000 people and it does not execute a release or otherwise join a Settlement that
Municipalities share under the Negotiation Class Metrics shall be reallocated to the
County where that Municipality is located.
(b) Regional Fund- The regional fund will be subdivided into two parts.
(i) The State will annually calculate the share of each County within the State
of the regional fund utilizing the sliding scale in paragraph 5 of the Agreement, and
according to the Negotiation Class Metrics.
(ii) For Qualified Counties, the Qualified County's share will be paid to the
Qualified County and expended on Approved Purposes,including the Core Strategies
identified in Exhibit A, if applicable.
(iii) For all other Counties, the State will appropriate the regional share for
each County and pay that share through DCF to the Managing Entities providing
service for that County. The Managing Entities will be required to expend the monies
on Approved Purposes, including the Core Strategies as directed by the Opioid
Abatement Task Force or Council. The Managing Entities shall expend monies from
this Regional Fund on services for the Counties within the State that are non-
Qualified Counties and to ensure that there are services in every County. To the
greatest extent practicable, the Managing Entities shall endeavor to expend monies
in each County or for citizens of a County in the amount of the share that a County
would have received if it were a Qualified County.
(c) State Fund-The remainder of Opioid Funds will be expended by the State
on Approved Purposes, including the provisions related to Core Strategies, if applicable.
(d) To the extent that Opioid Funds are not appropriated and expended in a
year by the State, the State shall identify the investments where settlement funds will be
deposited. Any gains, profits, or interest accrued from the deposit of the Opioid Funds to
the extent that any funds are not appropriated and expended within a calendar year, shall
be the sole property of the Party that was entitled to the initial amount.
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I 6 K 6
(e) To the extent a County or Municipality wishes to pool, comingle, or
otherwise transfer its share, in whole or part, of Opioid Funds to another County or
Municipality, the comingling Municipalities may do so by written agreement. The
comingling Municipalities shall provide a copy of that agreement to the State and any
settlement administrator to ensure that monies are directed consistent with such
agreement. The County or Municipality receiving any such Opioid Funds shall assume
the responsibility for reporting how such Opioid Funds were utilized under this
Agreement.
5. Regional Fund Sliding Scale- The Regional Fund shall be calculated by utilizing the
following sliding scale of the Opioid Funds available in any year after deduction of Expenses and
any funds due the federal government:
A.Years 1-6: 40%
B.Years 7-9: 35%
C.Years 10-12: 34%
D.Years 13-15: 33%
E. Years 16-18: 30%
6. Opioid Abatement Taskforce or Council-The State will create an Opioid Abatement
Taskforce or Council (sometimes hereinafter "Taskforce" or "Council") to advise the Governor,
the Legislature, DCF, and Local Governments on the priorities that should be addressed by
expenditure of Opioid Funds and to review how monies have been spent and the results that have
been achieved with Opioid Funds.
(a) Size - The Taskforce or Council shall have ten Members equally balanced
between the State and the Local Government representatives.
(b) Appointments Local Governments - Two Municipality representatives will be
appointed by or through Florida League of Cities. Two county representatives, one from a
Qualified County and one from a county within the State that is not a Qualified County,will
be appointed by or through the Florida Association of Counties. The final representative
will alternate every two years between being a county representative (appointed by or
through Florida Association of Counties) or a Municipality representative(appointed by or
through the Florida League of Cities). One Municipality representative must be from a city
of less than 50,000 people. One county representative must be from a county of less than
200,000 people and the other county representative must be from a county whose population
exceeds 200,000 people.
(c) Appointments State-
(i) The Governor shall appoint two Members.
(ii) The Speaker of the House shall appoint one Member.
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(iii) The Senate President shall appoint one Member.
(iv) The Attorney General or her designee shall be a Member.
(d) Chair - The Attorney General or designee shall be the chair of the Taskforce
or Council.
(e) Term - Members will be appointed to serve a four-year term and shall be
staggered to comply with Florida Statutes § 20.052(4)(c).
(f) Support - DCF shall support the Taskforce or Council and the Taskforce or
Council shall be administratively housed in DCF.
(g) Meetings-The Taskforce or Council shall meet quarterly in person or virtually
using communications media technology as defined in section 120.54(5)(b)(2),
Florida Statutes.
(h) Reporting - The Taskforce or Council shall provide and publish a report
annually no later than November 30th or the first business day after November 30th,
if November 30th falls on a weekend or is otherwise not a business day. The report
shall contain information on how monies were spent the previous fiscal year by the
State, each of the Qualified Counties, each of the Managing Entities, and each of the
Local Governments. It shall also contain recommendations to the Governor, the
Legislature, and Local Governments for priorities among the Approved Purposes or
similar such uses for how monies should be spent the coming fiscal year to respond to
the opioid epidemic. Prior to July 1st of each year, the State and each of the Local
Governments shall provide information to DCF about how they intend to expend
Opioid Funds in the upcoming fiscal year.
(i) Accountability- The State and each of the Local Governments shall report its
expenditures to DCF no later than August 31st for the previous fiscal year. The
Taskforce or Council will set other data sets that need to be reported to DCF to
demonstrate the effectiveness of expenditures on Approved Purposes. In setting those
requirements, the Taskforce or Council shall consider the Reporting Templates,
Deliverables,Performance Measures,and other already utilized and existing templates
and forms required by DCF from Managing Entities and suggest that similar
requirements be utilized by all Parties to this Agreement.
(j) Conflict of Interest - All Members shall adhere to the rules, regulations and
laws of Florida including,but not limited to, Florida Statute §112.311, concerning the
disclosure of conflicts,of interest and recusal from discussions or votes on conflicted
matters.
7. Administrative Costs- The State may take no more than a 5% administrative fee
from the State Fund and any Regional Fund that it administers for counties that are not Qualified
Counties. Each Qualified County may take no more than a 5% administrative fee from its share of
the Regional Funds. Municipalities and Counties may take no more than a 5% administrative fee
from any funds that they receive or control from the City/County Fund.
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8. Negotiation of Non-Multistate Settlements -If the State begins negotiations with a
Pharmaceutical Supply Chain Participant that is separate and apart from a multi-state negotiation,
the State shall include Local Governments that are a part of the Negotiating Committee in such
negotiations. No Settlement shall be recommended or accepted without the affirmative votes of
both the State and Local Government representatives of the Negotiating Committee.
9. Negotiation of Multistate or Local Government Settlements - To the extent
practicable and allowed by other parties to a negotiation,both Parties agree to communicate with
members of the Negotiation Committee regarding the terms of any other Pharmaceutical Supply
Chain Participant Settlement.
10. Program Requirements- DCF and Local Governments desire to make the most
efficient and effective use of the Opioid Funds. DCF and Local Governments will work to achieve
that goal by ensuring the following requirements will be minimally met by any governmental entity
or provider providing services pursuant to a contract or grant of Opioid Funds:
a. In either performing services under this Agreement or contracting with a
provider to provide services with the Opioid Funds under this Agreement, the State and
Local Governments shall be aware of and comply with all State and Federal laws, rules,
Children and Families Operating Procedures (CFOPs), and similar regulations relating
to the substance abuse and treatment services.
b. The State and Local Governments shall have and follow their existing policies
and practices for accounting and auditing, including policies relating to whistleblowers
and avoiding fraud, waste, and abuse. The State and Local Governments shall consider
additional policies and practices recommended by the Opioid Abatement Taskforce or
Council. c.In any award or grant to any provider, State and Local Governments shall
ensure that each provider acknowledges its awareness of its obligations under law and
shall audit, supervise, or review each provider's performance routinely, at least once
every year.
d. In contracting with a provider, the State and Local Governments shall set
performance measures in writing for a provider.
e. The State and Local Governments shall receive and report expenditures, service
utilization data, demographic information, and national outcome measures in a similar
fashion as required by the 42.U.S.C. s. 300x and 42 U.S.C. s. 300x-21.
f. The State and Local Governments, that implement evidenced based practice
models will participate in fidelity monitoring as prescribed and completed by the
originator of the model chosen..
g. The State and Local Governments shall ensure that each year, an evaluation of
the procedures and activities undertaken to comply with the requirements of this
Agreement are completed.
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h. The State and Local Governments shall implement a monitoring process that will
demonstrate oversight and corrective action in the case of non-compliance, for all
providers that receive Opioid Funds. Monitoring shall include:
(i) Oversight of the any contractual or grant requirements;
(ii) Develop and utilize standardized monitoring tools;
(iii) Provide DCF and the Opioid Abatement Taskforce or Council with
access to the monitoring reports; and
(iv) Develop and utilize the monitoring reports to create corrective action
plans for providers, where necessary.
11. Reporting and Records Requirements- The State and Local Governments shall
follow their existing reporting and records retention requirements along with considering any
additional recommendations from the Opioid Abatement Taskforce or Council. Local
Governments shall respond and provide documents to any reasonable requests from the State or
Opioid Abatement Taskforce or Council for data or information about programs receiving Opioid
Funds. The State and Local Governments shall ensure that any provider or sub-recipient of Opioid
Funds at a minimum does the following:
(a) Any provider shall establish and maintain books, records and documents
(including electronic storage media) sufficient to reflect all income and expenditures of
Opioid Funds. Upon demand, at no additional cost to the State or Local Government, any
provider will facilitate the duplication and transfer of any records or documents during the
term that it receives any Opioid Funds and the required retention period for the State or
Local Government. These records shall be made available at all reasonable times for
inspection,review, copying, or audit by Federal, State, or other personnel duly authorized
by the State or Local Government.
(b) Any provider shall retain and maintain all client records, financial records,
supporting documents, statistical records, and any other documents (including electronic
storage media) pertinent to the use of the Opioid Funds during the term of its receipt of
Opioid Funds and retained for a period of six (6) years after its ceases to receives Opioid
Funds or longer when required by law. In the event an audit is required by the State of
Local Governments, records shall be retained for a minimum period of six (6) years after
the audit report is issued or until resolution of any audit findings or litigation based on the
terms of any award or contract.
(c) At all reasonable times for as long as records are maintained, persons duly
authorized by State or Local Government auditors shall be allowed full access to and the
right to examine any of the contracts and related records and documents, regardless of the
form in which kept.
(d) A financial and compliance audit shall be performed annually and provided to
the State.
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(e) All providers shall comply and cooperate immediately with any inspections,
reviews,investigations,or audits deemed necessary by The Office of the Inspector General
(section 20.055, F.S.) or the State.
(f) No record may be withheld nor may any provider attempt to limit the scope of
any of the foregoing inspections, reviews, copying, transfers or audits based on any claim
that any record is exempt from public inspection or is confidential, proprietary or trade
secret in nature; provided, however, that this provision does not limit any exemption to
public inspection or copying to any such record.
12. Expense Fund -The Parties agree that in any negotiation every effort shall be made
to cause Pharmaceutical Supply Chain Participants to pay costs of litigation, including attorneys'
fees, in addition to any agreed to Opioid Funds in the Settlement. To the extent that a fund
sufficient to pay the full contingent fees of Local Governments is not created as part of a Settlement
by a Pharmaceutical Supply Chain Participant, the Parties agree that an additional expense fund
for attorneys who represent Local Governments (herein "Expense Fund") shall be created out of
the City/County fund for the purpose of paying the hard costs of a litigating Local Government
and then paying attorneys' fees.
(a) The Source of Funds for the Expense Fund- Money for the Expense Fund
shall be sourced exclusively from the City/County Fund.
(b) The Amount of the Expense Fund-The State recognizes the value litigating
Local Governments bring to the State in connection with the Settlement because their
participation increases the amount of Incentive Payments due from each Pharmaceutical
Supply Chain Participant. In recognition of that value, the amount of funds that shall be
deposited into the Expense Fund shall be contingent upon on the percentage of litigating
Local Government participation in the Settlement, according to the following table:
Litigating Local Amount that shall be
Government Participation in paid into the Expense Fund
the Settlement(by from (and as a percentage
percentage of the population) of) the City/County fund
96 to 100% 10%
91 to 95% 7.5%
86 to 90% 5%
85% 2.5%
Less than 85% 0%
If fewer than 85% percent'of the litigating Local Governments (by population) participate,
then the Expense Fund shall not be funded, and this Section of the Agreement shall be null and
void.
(c) The Timing of Payments into the Expense Fund- Although the amount of
the Expense Fund shall be calculated based on the entirety of payments due to the
City/County fund over a ten-to-eighteen-year period, the Expense Fund shall be funded
entirely from payments made by Pharmaceutical Supply Chain Participants during the first
two payments of the Settlement. Accordingly, to offset the amounts being paid from the
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City/County Fund to the Expense Fund in the first two years, Counties or Municipalities
may borrow from the Regional Fund during the first two years and pay the borrowed
amounts back to the Regional Fund during years three, four, and five.
For the avoidance of doubt, the following provides an illustrative example regarding the
calculation of payments and amounts that may be borrowed under the terms of this MOU,
consistent with the provisions of this Section:
Opioid Funds due to State of Florida and Local Governments(over 10 $1,000
to 18 years):
Litigating Local Government Participation: 100%
City/County Fund (over 10 to 18 years): $150
Expense Fund (paid over 2 years): $15
Amount Paid to Expense Fund in 1st year: $7.5
Amount Paid to Expense Fund in 2nd year $7.5
Amount that may be borrowed from Regional Fund in 1st year: $7.5
Amount that may be borrowed from Regional Fund in 2nd year: $7.5
Amount that must,be paid back to Regional Fund in 3rd year: $5
Amount that must be paid back to Regional Fund in 4th year: $5
Amount that must be paid back to Regional Fund in 5th year: $5
(d) Creation of and Jurisdiction over the Expense Fund- The Expense Fund
shall be established, consistent with the provisions of this Section of the Agreement, by
order of the Court. The Court shall have jurisdiction over the Expense Fund, including
authority to allocate and disburse amounts from the Expense Fund and to resolve any
disputes concerning the Expense Fund.
(e) Allocation of Payments to Counsel from the Expense Fund- As part of the
order establishing the Expense Fund, counsel for the litigating Local Governments shall
seek to have the Court appoint a third-neutral to serve as a special master for purposes of
allocating the Expense Fund. Within 30 days of entry of the order appointing a special
master for the Expense Fund, any counsel who intend to seek an award from the Expense
Fund shall provide the copies of their contingency fee contracts to the special master. The
special master shall then build a mathematical model, which shall be based on each
litigating Local Government's share under the Negotiation Class Metrics and the rate set
forth in their contingency contracts,to calculate a proposed award for each litigating Local
Government who timely provided a copy of its contingency contract.
13. Dispute resolution- Any one or more of the Local Governments or the State may
object to an allocation or expenditure of Opioid Funds solely on the basis that the allocation or
expenditure at issue (a) is inconsistent with the Approved Purposes; (b) is inconsistent with the
distribution scheme as provided in paragraph,; (c) violates the limitations set forth herein with
respect to administrative costs or the Expense Fund; or(d)to recover amounts advanced from the
Regional Fund for the Expense Fund.There shall be no other basis for bringing an objection to the
approval of an allocation or expenditure of Opioid Funds. In the event that there is a National
Settlement Administrator or similar entity,the Local Governments sole action for non-payment of
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amounts due from the City/County Fund shall be against the particular settling defendant and/or
the National Settlement Administrator or similar entity.
C. Other Terms and Conditions
1. Governing Law and Venue: This Agreement will be governed by the laws of the
State of Florida. Any and all litigation arising under the Agreement,unless otherwise specified in
this Agreement, will be instituted in either: (a) the Court that enters the Order if the matter deals
with a matter covered by the Order and the Court retains jurisdiction; or (b) the appropriate State
court in Leon County, Florida.
2. Agreement Management and Notification: The Parties have identified the
following individuals as Agreement Managers and Administrators:
a. State of Florida Agreement Manager:
Greg Slemp
PL-01, The Capitol, Tallahassee, FL 32399
850-414-3300
Greg.slemp@myfloridalegal.com
b. State of Florida Agreement Administrator
Janna Barineau
PL-01, The Capitol,Tallahassee, FL 32399
850-414-3300
Janna.barineau@myfloridalegal.com
c. Local Governments Agreement Managers and Administrators are listed on
Exhibit C to this Agreement.
Changes to either the Managers or Administrators may be made by notifying the other Party
in writing,without formal amendment to this Agreement.
3. Notices. All notices required under the Agreement will be delivered by certified
mail, return receipt requested, by reputable air courier, or by personal delivery to the designee
identified in paragraphs C.2., above. Either designated recipient may notify the other, in writing,
if someone else is designated to receive notice.
4. Cooperation with Inspector General: Pursuant to section 20.055,Florida Statutes,
the Parties,understand and will comply with their duty to cooperate with the Inspector General in
any investigation, audit, inspection, review, or hearing.
12
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5. Public Records: The Parties will keep and maintain public records pursuant to
Chapter 119,Florida Statutes and,will comply will all applicable provisions of that Chapter.
6. Modification: This Agreement may only be modified by a written amendment
between the appropriate parties.No promises or agreements made subsequent to the execution of this
Agreement shall be binding unless express,reduced to writing, and signed by the Parties.
7. Execution in Counterparts: This Agreement may be executed in any number of
counterparts, each of which shall be deemed to be an original, but all of which together shall
constitute one and the same instrument.
8. Assignment: The rights granted in this Agreement may not be assigned or
transferred by any party without the prior written approval of the other party. No party shall be
permitted to delegate its responsibilities or obligations under this Agreement without the prior
written approval of the other parties.
9. Additional Documents: The Parties agree to cooperate fully and execute any and
all supplementary documents and to take all additional actions which may be reasonably necessary
or appropriate to give full force and effect to the basic terms and intent of this Agreement.
10. Captions: The captions contained in this Agreement are for convenience only and
shall in no way define, limit, extend or describe the scope of this Agreement or any part of it.
11. Entire Agreement: This Agreement,including any attachments,embodies the entire
agreement of the parties. There are no other provisions, terms, conditions, or obligations. This
Agreement supersedes all previous oral or written communications,representations or agreements
on this subject.
12. Construction: The parties hereto hereby mutually acknowledge and represent that
they have been fully advised by their respective legal counsel of their rights and responsibilities
under this Agreement, that they have read, know, and understand completely the contents hereof,
and that they have voluntarily executed the same. The parties hereto further hereby mutually
acknowledge that they have had input into the drafting of this Agreement and that, accordingly, in
any construction to be made of this Agreement, it shall not be construed for or against any party,
but rather shall be given a fair and reasonable interpretation, based on the plain language of the
Agreement and the expressed intent of the parties.
13. Capacity to Execute Agreement: The parties hereto hereby represent and warrant
that the individuals signing this Agreement on their behalf are duly authorized and fully competent
to do so.
•
13
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14. Effectiveness: This Agreement shall become effective on the date on which the last
required signature is affixed to this Agreement.
IN WITNESS THEREOF,the parties hereto have caused the Agreement to be executed by
their undersigned officials as duly authorized.
ST TE OF FLORIDA
2
11/15/2021
y: C-k‘IG.eCA DATED I�
Its: C / c lVerl Gke'neca i
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EXHIBIT A
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Schedule A
Core Strategies
States and Qualifying Block Grantees shall choose from among the abatement strategies listed in
Schedule B.However,priority shall be given to the following core abatement strategies("Core
Strategies")[,such that a minimum of_%of the[aggregate]state-level abatement distributions shall
be spent on[one or more of]them annually].
A.Naloxone or other FDA-approved drug to reverse opioid overdoses
1.Expand training for first responders,schools,community support groups and families;and
2.Increase distribution to individuals who are uninsured or whose insurance does not cover the needed
service.
B.Medication-Assisted Treatment("MAT")Distribution and other opioid-related treatment
1.Increase distribution of MAT to non-Medicaid eligible or uninsured individuals;
2.Provide education to school-based and youth-focused programs that discourage or prevent misuse;
3.Provide MAT education and awareness training to healthcare providers,EMTs,law enforcement,
and other first responders;and
4.Treatment and Recovery Support Services such as residential and inpatient treatment,intensive
outpatient treatment,outpatient therapy or counseling,and recovery housing that allow or integrate
medication with other support services.
C.Pregnant&Postpartum Women
1.Expand Screening,Brief Intervention,and Referral to Treatment("SBIRT")services to non-
Medicaid eligible or uninsured pregnant women;
2.Expand comprehensive evidence-based treatment and recovery services,including MAT,for women
with co-occurring Opioid Use Disorder("OUD")and other Substance Use Disorder("SUD")/Mental
Health disorders for uninsured individuals for up to 12 months postpartum;and
3.Provide comprehensive wrap-around services to individuals with Opioid Use Disorder(OUD)
including housing,transportation,job placement/training,and childcare.
D.Expanding Treatment for Neonatal Abstinence Syndrome
1.Expand comprehensive evidence-based and recovery support for NAS babies;
2.Expand services for better continuum of care with infant-need dyad;and
3.Expand long-term treatment and services for medical monitoring of NAS babies and their families.
As used in this Schedule A,words like"expand,""fund,""provide"or the like shall not indicate a preference for new or
existing programs. Priorities will be established through the mechanisms described in the Term Sheet.
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E.Expansion of Warm Hand-off Programs and Recovery Services
1.Expand services such as navigators and on-call teams to begin MAT in hospital emergency
departments;
2.Expand warm hand-off services to transition to recovery services;
3.Broaden scope of recovery services to include co-occurring SUD or mental health conditions. ;
4.Provide comprehensive wrap-around services to individuals in recovery including housing,
transportation,job placement/training,and childcare;and
5.Hire additional social workers or other behavioral health workers to facilitate expansions above.
F.Treatment for Incarcerated Population
1.Provide evidence-based treatment and recovery support including MAT for persons with OUD and
co-occurring SUD/MH disorders within and transitioning out of the criminal justice system;and
2.Increase funding for jails to provide treatment to inmates with OUD.
G.Prevention Programs
1.Funding for media campaigns to prevent opioid use(similar to the FDA's"Real Cost"campaign to
prevent youth from misusing tobacco);
2.Funding for evidence-based prevention programs in schools.;
3.Funding for medical provider education and outreach regarding best prescribing practices for opioids
consistent with the 2016 CDC guidelines,including providers at hospitals(academic detailing);
4.Funding for community drug disposal programs;and
5.Funding and training for first responders to participate in pre-arrest diversion programs,post-
overdose response teams,or similar strategies that connect at-risk individuals to behavioral health
services and supports.
H.Expanding Syringe Service Programs
1.Provide comprehensive syringe services programs with more wrap-around services including linkage
to OUD treatment,access to sterile syringes,and linkage to care and treatment of infectious diseases.
I.Evidence-based data collection and research analyzing the effectiveness of the abatement strategies
within the State.
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EXHIBIT B
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Schedule B
Approved Uses
PART ONE:TREATMENT •
A. TREAT OPIOID USE DISORDER(OUD)
Support treatment of Opioid Use Disorder(OUD)and any co-occurring Substance Use Disorder or
Mental Health(SUD/MH)conditions through evidence-based or evidence-informed programs or
strategies that may include,but are not limited to,the following:2
1.Expand availability of treatment for OUD and any co-occurring SUD/MH conditions,including all
forms of Medication-Assisted Treatment(MAT)approved by the U.S.Food and Drug Administration.
2. Support and reimburse evidence-based services that adhere to the American Society of Addiction
Medicine(ASAM)continuum of care for OUD and any co-occurring SUD/MH conditions
3.Expand telehealth to increase access to treatment for OUD and any co-occurring SUD/MH
conditions,including MAT,as well as counseling,psychiatric support,and other treatment and
recovery support services.
4.Improve oversight of Opioid Treatment Programs(OTPs)to assure evidence-based or evidence-
informed practices such as adequate methadone dosing and low threshold approaches to treatment.
5. Support mobile intervention,treatment,and recovery services,offered by qualified professionals and
service providers,such as peer recovery coaches,for persons with OUD and any co-occurring
SUD/MH conditions and for persons who have experienced an opioid overdose.
6.Treatment of trauma for individuals with OUD(e.g.,violence,sexual assault,human trafficking,or
adverse childhood experiences),and family members(e.g.,surviving family members after an overdose
or overdose fatality),and training of health care personnel to identify and address such trauma.
7. Support evidence-based withdrawal management services for people with OUD and any co-
occurring mental health conditions.
8.Training on MAT for health care providers,first responders,students,or other supporting
professionals,such as peer recovery coaches or recovery outreach specialists,including telementoring
to assist community-based providers in rural or underserved areas.
9. Support workforce development for addiction professionals who work with persons with OUD and
any co-occurring SUD/MH conditions.
10.Fellowships for addiction medicine specialists for direct patient care,instructors,and clinical
research for treatments.
11. Scholarships and supports for behavioral health practitioners or workers involved in addressing
OUD and any co-occurring SUD or mental health conditions,including but not limited to training,
2 As used in this Schedule B,words like"expand,""fund,""provide"or the like shall not indicate a preference for new or
existing programs. Priorities will be established through the mechanisms described in the Term Sheet.
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scholarships,fellowships,loan repayment programs,or other incentives for providers to work in rural
or underserved areas.
12. [Intentionally Blank—to be cleaned up later for numbering]
13.Provide funding and training for clinicians to obtain a waiver under the federal Drug Addiction
Treatment Act of 2000(DATA 2000)to prescribe MAT for OUD,and provide technical assistance and
professional support to clinicians who have obtained a DATA 2000 waiver.
14.Dissemination of web-based training curricula,such as the American Academy of Addiction
Psychiatry's Provider Clinical Support Service-Opioids web-based training curriculum and
motivational interviewing.
15.Development and dissemination of new curricula,such as the American Academy of Addiction
Psychiatry's Provider Clinical Support Service for Medication-Assisted Treatment.
B.SUPPORT PEOPLE IN TREATMENT AND RECOVERY
Support people in treatment for or recovery from OUD and any co-occurring SUD/MH conditions
through evidence-based or evidence-informed programs or strategies that may include,but are not
limited to,the following:
I.Provide comprehensive wrap-around services to individuals with OUD and any co-occurring
SUD/MH conditions,including housing,transportation,education,job placement,job training,or
childcare.
2.Provide the full continuum of care of treatment and recovery services for OUD and any co-occurring
SUD/MH conditions,including'supportive housing,peer support services and counseling,community
navigators,case management,and connections to community-based services.
3.Provide counseling,peer-support,recovery case management and residential treatment with access to
medications for those who need it to persons with OUD and any co-occurring SUD/MH conditions.
4.Provide access to housing for people with OUD and any co-occurring SUD/MH conditions,
including supportive housing,recovery housing,housing assistance programs,training for housing
providers,or recovery housing programs that allow or integrate FDA-approved medication with other
support services.
5.Provide community support services,including social and legal services,to assist in
deinstitutionalizing persons with OUD and any co-occurring SUD/MH conditions.
6. Support or expand peer-recovery centers,which may include support groups,social events,computer
access,or other services for persons with OUD and any co-occurring SUD/MH conditions.
7.Provide or support transportation to treatment or recovery programs or services for persons with
OUD and any co-occurring SUD/MH conditions.
8.Provide employment training or educational services for persons in treatment for or recovery from
OUD and any co-occurring SUD/MH conditions.
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9.Identify successful recovery programs such as physician,pilot,and college recovery programs,and
provide support and technical assistance to increase the number and capacity of high-quality programs
to help those in recovery.
10.Engage non-profits,faith-based communities,and community coalitions to support people in
treatment and recovery and to support family members in their efforts to support the person with OUD
in the family.
11.Training and development of procedures for government staff to appropriately interact and provide
social and other services to individuals with or in recovery from OUD,including reducing stigma.
12. Support stigma reduction efforts regarding treatment and support for persons with OUD,including
reducing the stigma on effective treatment.
13.Create or support culturally appropriate services and programs for persons with OUD and any co-
occurring SUD/MH conditions,including new Americans.
14.Create and/or support recovery high schools.
15.Hire or train behavioral health workers to provide or expand any of the services or supports listed
above.
C.CONNECT PEOPLE WHO NEED HELP TO THE HELP THEY NEED(CONNECTIONS
TO CARE)
Provide connections to care for people who have—or at risk of developing—OUD and any co-
occurring SUD/MH conditions through evidence-based or evidence-informed programs or strategies
that may include,but are not limited to,the following:
I.Ensure that health care providers are screening for OUD and other risk factors and know how to
appropriately counsel and treat(or refer if necessary)a patient for OUD treatment.
2.Fund Screening,Brief Intervention and Referral to Treatment(SBIRT)programs to reduce the
transition from use to disorders,including SBIRT services to pregnant women who are uninsured or not
eligible for Medicaid.
3.Provide training and long-term implementation of SBIRT in key systems(health,schools,colleges,
criminal justice,and probation),with a focus on youth and young adults when transition from misuse to
opioid disorder is common. .
4.Purchase automated versions of SBIRT and support ongoing costs of the technology.
5.Expand services such as navigators and on-call teams to begin MAT in hospital emergency
departments.
6.Training for emergency room personnel treating opioid overdose patients on post-discharge planning,
including community referrals for MAT,recovery case management or support services.
7.Support hospital programs that transition persons with OUD and any co-occurring SUD/MH
conditions,or persons who have experienced an opioid overdose,into clinically-appropriate follow-up
care through a bridge clinic or similar approach.
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8. Support crisis stabilization centers that serve as an alternative to hospital emergency departments for
persons with OUD and any co-occurring SUD/MH conditions or persons that have experienced an
opioid overdose.
9. Support the work of Emergency Medical Systems,including peer support specialists,to connect
individuals to treatment or other appropriate services following an opioid overdose or other opioid-
related adverse event.
10.Provide funding for peer support specialists or recovery coaches in emergency departments,detox
facilities,recovery centers,recovery housing,or similar settings;offer services,supports,or
connections to care to persons with OUD and any co-occurring SUD/MH conditions or to persons who
have experienced an opioid overdose.
11.Expand warm hand-off services to transition to recovery services.
12.Create or support school-based contacts that parents can engage with to seek immediate treatment
services for their child;and support prevention,intervention,treatment,and recovery programs focused
on young people.
13.Develop and support best practices on addressing OUD in the workplace.
14. Support assistance programs for health care providers with OUD.
15.Engage non-profits and the faith community as a system to support outreach for treatment.
16.Support centralized call centers that provide information and connections to appropriate services
and supports for persons with OUD and any co-occurring SUD/MH conditions.
D.ADDRESS THE NEEDS OF CRIMINAL-JUSTICE-INVOLVED PERSONS
Address the needs of persons with OUD and any co-occurring SUD/MH conditions who are involved
in,are at risk of becoming involved in,or are transitioning out of the criminal justice system through
evidence-based or evidence-informed programs or strategies that may include,but are not limited to,
the following:
1.Support pre-arrest or pre-arraignment diversion and deflection strategies for persons with OUD and
any co-occurring SUD/MH conditions,including established strategies such as:
a. Self-referral strategies such as the Angel Programs or the Police Assisted Addiction Recovery
Initiative(PAARI);
b.Active outreach strategies such as the Drug Abuse Response Team(DART)model;
c."Naloxone Plus"strategies,which work to ensure that individuals who have received
naloxone to reverse the effects of an overdose are then linked to treatment programs or other
appropriate services;
d.Officer prevention strategies,such as the Law Enforcement Assisted Diversion(LEAD)
model;
e.Officer intervention strategies such as the Leon County,Florida Adult Civil Citation Network
or the Chicago Westside Narcotics Diversion to Treatment Initiative;or
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f.Co-responder and/or alternative responder models to address OUD-related 911 calls with
greater SUD expertise
2.Support pre-trial services that connect individuals with OUD and any co-occurring SUD/MH
conditions to evidence-informed treatment,including MAT,and related services.
3.Support treatment and recovery courts that provide evidence-based options for persons with OUD
and any co-occurring SUD/MH conditions
4.Provide evidence-informed treatment,including MAT,recovery support,harm reduction,or other
appropriate services to individuals with OUD and any co-occurring SUD/MH conditions who are
incarcerated in jail or prison.
5.Provide evidence-informed treatment,including MAT,recovery support,harm reduction,or other
appropriate services to individuals with OUD and any co-occurring SUD/MH conditions who are
leaving jail or prison have recently left jail or prison,are on probation or parole,are under community
corrections supervision,or are in re-entry programs or facilities.
6. Support critical time interventions(CTI),particularly for individuals living with dual-diagnosis
OUD/serious mental illness,and services for individuals who face immediate risks and service needs
and risks upon release from correctional settings.
7.Provide training on best practices for addressing the needs of criminal-justice-involved persons with
OUD and any co-occurring SUD/MH conditions to law enforcement,correctional,or judicial personnel
or to providers of treatment,recovery,harm reduction,case management,or other services offered in
connection with any of the strategies described in this section.
E.ADDRESS THE NEEDS OF PREGNANT OR PARENTING WOMEN AND THEIR
FAMILIES,INCLUDING BABIES WITH NEONATAL ABSTINENCE SYNDROME
Address the needs of pregnant or parenting women with OUD and any co-occurring SUD/MH
conditions,and the needs of their families,including babies with neonatal abstinence syndrome(NAS),
through evidence-based or evidence-informed programs or strategies that may include,but are not
limited to,the following:
1.Support evidence-based or evidence-informed treatment,including MAT,recovery services and
supports,and prevention services for pregnant women—or women who could become pregnant—who
have OUD and any co-occurring SUD/MH conditions,and other measures to educate and provide
support to families affected by Neonatal Abstinence Syndrome.
2.Expand comprehensive evidence-based treatment and recovery services,including MAT,for
uninsured women with OUD and any co-occurring SUD/MH conditions for up to 12 months
postpartum.
3.Training for obstetricians or other healthcare personnel that work with pregnant women and their
families regarding treatment of OUD and any co-occurring SUD/MH conditions.
4.Expand comprehensive evidence-based treatment and recovery support for NAS babies;expand
services for better continuum of care with infant-need dyad;expand long-term treatment and services
for medical monitoring of NAS babies and their families.
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5.Provide training to health care providers who work with pregnant or parenting women on best
practices for compliance with federal requirements that children born with Neonatal Abstinence
Syndrome get referred to appropriate services and receive a plan of safe care.
6.Child and family supports for parenting women with OUD and any co-occurring SUD/MH
conditions.
7.Enhanced family supports and child care services for parents with OUD and any co-occurring
SUD/MH conditions.
8.Provide enhanced support for children and family members suffering trauma as a result of addiction
in the family;and offer trauma-informed behavioral health treatment for adverse childhood events.
9.Offer home-based wrap-aroupd services to persons with OUD and any co-occurring SUD/MH
conditions,including but not limited to parent skills training.
10. Support for Children's Services—Fund additional positions and services,including supportive
housing and other residential services,relating to children being removed from the home and/or placed
in foster care due to custodial opioid use.
PART TWO:PREVENTION
F.PREVENT OVER-PRESCRIBING AND ENSURE APPROPRIATE PRESCRIBING AND
DISPENSING OF OPIOIDS
Support efforts to prevent over-prescribing and ensure appropriate prescribing and dispensing of
opioids through evidence-based or evidence-informed programs or strategies that may include,but are
not limited to,the following:
1.Fund medical provider education and outreach regarding best prescribing practices for opioids
consistent with Guidelines for Prescribing Opioids for Chronic Pain from the U.S.Centers for Disease
Control and Prevention,including providers at hospitals(academic detailing).
2.Training for health care providers regarding safe and responsible opioid prescribing,dosing,and
tapering patients off opioids.
3.Continuing Medical Education(CME)on appropriate prescribing of opioids.
4.Support for non-opioid pain treatment alternatives,including training providers to offer or refer to
multi-modal,evidence-informed treatment of pain.
5.Support enhancements or improvements to Prescription Drug Monitoring Programs(PDMPs),
including but not limited to improvements that:
a.Increase the number of prescribers using PDMPs;
b.Improve point-of-care decision-making by increasing the quantity,quality,or format of data
available to prescribers using PDMPs,by improving the interface that prescribers use to access
PDMP data,or both;or
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c.Enable states to use PDMP data in support of surveillance or intervention strategies,including
MAT referrals and follow-up for individuals identified within PDMP data as likely to
experience OUD in a manner that complies with all relevant privacy and security laws and rules.
6.Ensuring PDMPs incorporate available overdose/naloxone deployment data,including the United
States Department of Transportation's Emergency Medical Technician overdose database in a manner
that complies with all relevant privacy and security laws and rules.
7.Increase electronic prescribing to prevent diversion or forgery.
8.Educate Dispensers on appropriate opioid dispensing.
G.PREVENT MISUSE OF OPIOIDS
Support efforts to discourage or prevent misuse of opioids through evidence-based or evidence-
informed programs or strategies that may include,but are not limited to,the following:
1.Fund media campaigns to prevent opioid misuse.
2.Corrective advertising or affirmative public education campaigns based on evidence.
3.Public education relating to drug disposal.
4.Drug take-back disposal or destruction programs.
5.Fund community anti-drug coalitions that engage in drug prevention efforts.
6. Support community coalitions in implementing evidence-informed prevention,such as reduced
social access and physical access,stigma reduction—including staffing,educational campaigns,support
for people in treatment or recovery,or training of coalitions in evidence-informed implementation,
including the Strategic Prevention Framework developed by the U.S. Substance Abuse and Mental
Health Services Administration(SAMHSA).
7.Engage non-profits and faith=based communities as systems to support prevention.
8.Fund evidence-based prevention programs in schools or evidence-informed school and community
education programs and campaigns for students,families,school employees,school athletic programs,
parent-teacher and student associations,and others.
9.School-based or youth-focused programs or strategies that have demonstrated effectiveness in
preventing drug misuse and seem likely to be effective in preventing the uptake and use of opioids.
10.Create of support community-based education or intervention services for families,youth,and
adolescents at risk for OUD and any co-occurring SUD/MH conditions.
11. Support evidence-informed programs or curricula to address mental health needs of young people
who may be at risk of misusing opioids or other drugs,including emotional modulation and resilience
skills.
12.Support greater access to mental health services and supports for young people, including services
and supports provided by school nurses,behavioral health workers or other school staff,to address
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mental health needs in young people that(when not properly addressed)increase the risk of opioid or
other drug misuse.
H.PREVENT OVERDOSE DEATHS AND OTHER HARMS(HARM REDUCTION)
Support efforts to prevent or reduce overdose deaths or other opioid-related harms through evidence-
based or evidence-informed programs or strategies that may include,but are not limited to,the
following:
1.Increase availability and distribution of naloxone and other drugs that treat overdoses for first
responders,overdose patients,individuals with OUD and their friends and family members,individuals
at high risk of overdose,schools,community navigators and outreach workers,persons being released
from jail or prison,or other members of the general public.
2.Public health entities provide free naloxone to anyone in the community
3.Training and education regarding naloxone and other drugs that treat overdoses for first responders,
overdose patients,patients taking opioids,families,schools,community support groups,and other
members of the general public.
4.Enable school nurses and other school staff to respond to opioid overdoses,and provide them with
naloxone,training,and support.
5.Expand,improve,or develop data tracking software and applications for overdoses/naloxone
revivals.
6.Public education relating to emergency responses to overdoses.
7.Public education relating to immunity and Good Samaritan laws.
8.Educate first responders regarding the existence and operation of immunity and Good Samaritan
laws.
9.Syringe service programs and other evidence-informed programs to reduce harms associated with
intravenous drug use,including supplies,staffing,space,peer support services,referrals to treatment,
fentanyl checking,connections to care,and the full range of harm reduction and treatment services
provided by these programs.
10.Expand access to testing and treatment for infectious diseases such as HIV and Hepatitis C resulting
from intravenous opioid use.
11.Support mobile units that offer or provide referrals to harm reduction services,treatment,recovery
supports,health care,or other appropriate services to persons that use opioids or persons with OUD and
any co-occurring SUD/MH conditions.
12.Provide training in harm reduction strategies to health care providers,students,peer recovery
coaches,recovery outreach specialists,or other professionals that provide care to persons who use
opioids or persons with OUD and any co-occurring SUD/MH conditions.
13.Support screening for fentanyl in routine clinical toxicology testing.
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PART THREE:OTHER STRATEGIES
I.FIRST RESPONDERS
In addition to items in sections C,D,and H relating to first responders,support the following:
1.Educate law enforcement or other first responders regarding appropriate practices and precautions
when dealing with fentanyl or other drugs.
2.Provision of wellness and support services for first responders and others who experience secondary
trauma associated with opioid-related emergency events.
J.LEADERSHIP,PLANNING AND COORDINATION
Support efforts to provide leadership,planning,coordination,facilitation,training and technical
assistance to abate the opioid epidemic through activities,programs,or strategies that may include,but
are not limited to,the following:
1.Statewide,regional,local,or community regional planning to identify root causes of addiction and
overdose,goals for reducing harms related to the opioid epidemic,and areas and populations with the
greatest needs for treatment intervention services;to support training and technical assistance;or to
support other strategies to abate the opioid epidemic described in this opioid abatement strategy list.
2.A dashboard to share reports,recommendations,or plans to spend opioid settlement funds;to show
how opioid settlement funds have been spent;to report program or strategy outcomes;or to track,share,
or visualize key opioid-related or health-related indicators and supports as identified through
collaborative statewide,regional,local,or community processes.
3.Invest in infrastructure or staffing at government or not-for-profit agencies to support collaborative,
cross-system coordination with the purpose of preventing overprescribing,opioid misuse,or opioid
overdoses,treating those with OUD and any co-occurring SUD/MH conditions,supporting them in
treatment or recovery,connecting them to care,or implementing other strategies to abate the opioid
epidemic described in this opioid abatement strategy list.
4.Provide resources to staff government oversight and management of opioid abatement programs.
K.TRAINING
In addition to the training referred to throughout this document,support training to abate the opioid
epidemic through activities,programs,or strategies that may include,but are not limited to,the
following:
1.Provide funding for staff training or networking programs and services to improve the capability of
government,community,and not-for-profit entities to abate the opioid crisis.
2. Support infrastructure and staffing for collaborative cross-system coordination to prevent opioid
misuse,prevent overdoses,and treat those with OUD and any co-occurring SUD/MH conditions,or
implement other strategies to abate the opioid epidemic described in this opioid abatement strategy list
(e.g.,health care,primary care,.pharmacies,PDMPs,etc.).
L.RESEARCH
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Support opioid abatement research that may include,but is not limited to,the following:
1.Monitoring,surveillance,data collection,and evaluation of programs and strategies described in this
opioid abatement strategy list.
2.Research non-opioid treatment of chronic pain.
3.Research on improved service delivery for modalities such as SBIRT that demonstrate promising but
mixed results in populations vulnerable to opioid use disorders.
4.Research on novel harm reduction and prevention efforts such as the provision of fentanyl test strips.
5.Research on innovative supply-side enforcement efforts such as improved detection of mail-based
delivery of synthetic opioids.
6.Expanded research on swift/certain/fair models to reduce and deter opioid misuse within criminal
justice populations that build upon promising approaches used to address other substances(e.g.Hawaii
HOPE and Dakota 24/7).
7.Epidemiological surveillance of OUD-related behaviors in critical populations including individuals
entering the criminal justice system,including but not limited to approaches modeled on the Arrestee
Drug Abuse Monitoring(ADAM)system.
8.Qualitative and quantitative research regarding public health risks and harm reduction opportunities
within illicit drug markets,including surveys of market participants who sell or distribute illicit opioids.
9.Geospatial analysis of access barriers to MAT and their association with treatment engagement and
treatment outcomes.
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EXHIBIT C
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RESOLUTION NO. 2021 - jab
A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY,FLORIDA,AUTHORIZING COLLIER COUNTY TO
JOIN WITH THE STATE OF FLORIDA AND OTHER LOCAL
GOVERNMENTAL UNITS AS A PARTICIPANT IN THE FLORIDA
MEMORANDUM OF UNDERSTANDING AND FORMAL AGREEMENTS
IMPLEMENTING A UNIFIED PLAN.
WHEREAS, Collier County has suffered harm from the opioid epidemic: and
WHEREAS, Collier County recognizes that the entire State of Florida has suffered harm
as a result from the opioid epidemic; and
WHEREAS,the State of Florida has filed an action pending in Pasco County,Florida,and
a number of Florida Cities and Counties have also filed an action In re: National Prescription
Opiate Litigation, MDL No. 2804(N.D. Ohio) (the"Opioid Litigation") and Collier County is not
a litigating participant in that action; and
WHEREAS, the State of Florida and lawyers representing certain various local
governments involved in the Opioid Litigation have proposed a unified plan for the allocation and
use of prospective settlement dollars from opioid related litigation; and
WHEREAS, the Florida Memorandum of Understanding (the "Florida Plan") sets forth
sets forth a framework of a unified plan for the proposed allocation and use of opioid settlement
proceeds and it is anticipated that formal agreements implementing the Florida Plan will be entered
into at a future date; and
WHEREAS, participation in the Florida Plan by a large majority of Florida cities and
counties will materially increase the amount of funds to Florida and should improve Florida's
relative bargaining position during additional settlement negotiations; and
WHEREAS, failure to participate in the Florida Plan will reduce funds available to the
State,Collier County, and every other Florida City and County.
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF
COMMISSIONERS OF COLLIER COUNTY, FLORIDA:
SECTION 1. That participation in the Florida Plan would be in the hest interest of the
Collier County and its citizens in that such a plan ensures that almost all of the settlement funds
go to abate and resolve the opioid epidemic and each and every city and county receives funds for
the harm that it has suffered.
SECTION 2. That the Collier County Board of County Commissioners hereby expresses
its support of a unified plan for the allocation and use of opioid settlement proceeds as generally
described in the Florida Plan, attached hereto as Exhibit"A."
in-sH F-OO25O/1642784/il
Exhibit B
16K 6
SECTION 3. That the Collier County Board of County Commissioners is hereby
expressly authorized to execute the Florida Plan in substantially the form contained in Exhibit"A."
SECTION 4. That the Collier County Board of County Commissioners is hereby
authorized to execute any formal agreements implementing a unified plan for the allocation and
use of opioid settlement proceeds that is not substantially inconsistent with the Florida Plan and
this Resolution.
SECTION 5. That the Clerk be and hereby is instructed to record this Resolution in the
appropriate record book upon its adoption.
SECTION 6. The Clerk of the Collier County Board of County Commissioners is hereby
directed to furnish certified copies pf this Resolution to:
Attorney General Ashley Moody Florida Association of Counties
c\o John M. Guard 100 South Monroe Street
The Capitol, PL-01 Tallahassee, FL 32301
Tallahassee, FL 32399-1050
•
SECTION 7. All resolutions inconsistent or in conflict herewith shall be and are hereby
repealed insofar as there is conflict or inconsistency.
SECTION 8. If any section, sentence. clause, or phrase of this Resolution is held to be
invalid or unconstitutional by any court of competent jurisdiction, then said holding shall in no
way affect the validity of the remaining portions of this resolution.
SECTION 9. This Resolution shall take effect immediately upon its adoption.
PASSED AND DULY ADOPTED by the Board of County Commissioners of Collier
County, Florida,this 22nd day of June ,2021.
AYPEST: BOARD OF COUNTY COMMISSIONERS
Crystal K KIniel,,'Clerk of Courts COLLIER O,yr Y, FLORID
`, -
By: is r ' `�(L��.• By: .
Atiezo �•
.7:' Clerk Penny Ta or, Chair
sign'ltiq only
Ap o ec.as to fclfm and legality:
Co en A. Kerins
Assistant County Attorne
t Z 1-SH F-00250/1642784/11
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EXHIBIT
8
PROPOSAL
MEMORANDUM OF UNDERSTANDING
Whereas. the people of the State of Florida and its communities have been harmed by
misfeasance, nonfeasance and malfeasance committed by certain entities within the
Pharmaceutical Supply Chain:
Whereas. the State of Florida. through its Attorney General, and certain Local
Governments, through their elected representatives and counsel. are separately engaged in
litigation seeking to hold Pharmaceutical Supply Chain Participants accountable for the damage
caused by their misfeasance. nonfeasance and malfeasance;
Whereas, the State of Florida and its Local Governments share a common desire to abate
and alleviate the impacts of that misfeasance, nonfeasance and malfeasance throughout the State
of Florida;
Whereas, it is the intent of the State of Florida and its Local Governments to use the
proceeds from Settlements with Pharmaceutical Supply Chain Participants to increase the amount
of funding presently spent on opioid and substance abuse education, treatment and other related
programs and services, such as those identified in Exhibits A and B. and to ensure that the funds
are expended in compliance with evolving evidence-based "best practices";
Whereas, the State of Florida and its Local Governments, subject to the completion of
formal documents that will effectuate the Parties' agreements. enter into this Memorandum of
Understanding("MOU")relating to the allocation and use of the proceeds of Settlements described
herein; and
Whereas. this MOU is a preliminary non-binding agreement between the Parties, is not
legally enforceable, and only provides a basis to draft formal documents which will effectuate the
Parties' agreements.
A. Definitions
As used in this MOU:
1, "Approved Purpose(s)" shall mean forward-looking strategies, programming and
services used to expand the availability of treatment for individuals impacted by substance use
disorders, to: (a) develop, promote, and provide evidence-based substance use prevention
strategies: (b) provide substance use avoidance and awareness education; (c) decrease the
oversupply of licit and illicit opioids; and(d)support recovery from addiction. Approved Purposes
shall include, but are not limited to, the opioid abatement strategies listed on Exhibits A and 13
which are incorporated herein by reference.
"Local Governments" shall mean all counties. cities, towns and villages located
within the geographic boundaries of the State.
3. "Managing Entities" shall mean the corporations selected by and under contract
with the Florida Department of Children and Families or its successor ("DCF”) to manage the
00003/1:112”125.)
•
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•
daily operational delivery of behavioral health services through a coordinated system of care. The
singular"Managing Entity" shall refer to a singular of the Managing Entities.
4. "County" shall mean a political subdivision of the state established pursuant to s.
1, Art. VIII of the State Constitution.
5. "Municipalities" shall mean cities, towns, or villages of a County within the State
with a Population greater than 10.000 individuals and shall also include cities, towns or villages
within the State with a Population equal to or less than 10.000 individuals which filed a Complaint
in this litigation against Pharmaceutical Supply Chain Participants. The singular "Municipality"
shall refer to a singular of the Municipalities.
6. "Negotiating Committee" shall mean a three-member group comprised by
representatives of the following: (1) the State; and (2) two representatives of Local Governments
of which one representative will be from a Municipality and one shall be from a County
(collectively,"Members")within the State. The State shall be represented by the Attorney General
or her designee.
7. "Negotiation Class Metrics"shall mean those county and city settlement allocations
which come from the official website of the Negotiation Class of counties and cities certified on
September 11, 2019 by the U.S, District for the Northern District of Ohio in In re National
Prescription Opiate Litigation, MDL No. 2804 (N.D, Ohio). The website is located at
https://allocationmap.iclaimsonline.com.
8. "Opioid Funds" shall mean monetary amounts obtained through a Settlement as
defined in this MOU.
9. "Opioid Related" shall have the same meaning and breadth ias in the agreed Opioid
Abatement Strategies attached hereto as Exhibits A or B.
10. "Parties" shall mean the State and Local Governments. The singular word "Party"'
shall mean either the State or Local Governments.
1 I. "PEC"shall mean the Plaintiffs' Executive Committee of the National Prescription
Opiate Multidistrict Litigation pending in the United States District Court for the Northern District
of Ohio.
12. "Pharmaceutical Supply Chain"shall mean the process and channels through which
Controlled Substances are manufactured, marketed, promoted, distributed or dispensed,
13. "Pharmaceutical Supply Chain Participant" shall mean any entity that engages in,
or has engaged in the manufacture, marketing, promotion, distribution or dispensing of an opioid
analgesic.
•
14.. "Population" shall refer to published U.S. Census Bureau population estimates as
of July I. 2019. released March 2020. and shall remain unchanged during the term of this .MOU.
These estimates can currently he found at hups://www.eensus.gov
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15. "Qualified County" shall mean a charter or non-chartered county within the State
that: has a Population of at least 300,000 individuals and (a) has an opioid taskforce of which it is
a member or operates in connection with its municipalities or others on a local or regional basis;
(b) has an abatement plan that has been either adopted or is being utilized to respond to the opioid
epidemic: (c)is currently either providing or is contracting with others to provide substance abuse
prevention,recovery, and treatment services to its citizens; and(d) has or enters into an agreement
with a majority of Municipalities (Majority is more than 50% of the Municipalities' total
population)related to the expenditure of Opioid Funds.The Opioid Funds to be paid to a Qualified
County will only include Opioid Funds for Municipalities whose claims are released by the
Municipality or Opioid Funds for Municipalities whose claims are otherwise barred.
16. "SAMHSA" shall, mean the U.S. Department of Health & Human Services,
Substance Abuse and Mental Health Services Administration.
17. "Settlement" shall mean the negotiated resolution of legal or equitable claims
against a Pharmaceutical Supply Chain Participant when that resolution has been jointly entered
into by the State and Local Governments or a settlement class as described in (8)(1) below,
g, "State" shall mean the State of Florida.
13. Terms
I. Only Abatement - Other than funds used for the Administrative Costs and Expense
Fund as hereinafter described in paragraph 6 and paragraph 9. respectively), all Opioid Funds shall
be utilized for Approved Purposes. To accomplish this purpose,the State will either file a new action
with Local Governments as Parties or add Local Governments to its existing action, sever settling
defendants. and seek entry of a consent order or other order binding both the State, Local
Governments. and Pharmaceutical Supply Chain Participant(s) ("Order"), The Order may he part
ofa class action settlement or similar device. The Order shall provide for continuing jurisdiction of
a state court to address non-perforniance by any party under the Order. Any Local Government that
objects to or refuses to be included under the Order or entry of documents necessary to effectuate a
Settlement shall not he entitled to .any Opioid Funds and its portion of Opioid Funds shall be
distributed to, and for the benefit of, the other Local Governments.
2. Avoid Claw Back Recoupment -Both the State and Local Governments wish
to maximize any Settlement and Opioid Funds. In addition to committing to only using funds for
the Expense Funds. Administrative Costs and Approved Purposes, both Parties will agree to utilize
a percentage of funds for the core strategies highlighted in Exhibit A. Exhibit A contains the
programs and strategies prioritized by the U.S. Department of Justice and/or the U.S. Department
of Health & Human Services ("Core Strategies"). The State is trying to obtain the United States'
agreement to limit or reduce the United States' ability to recover or recoup monies from the State
and Local Government in exchange for prioritization of funds to certain projects. If no agreement
is reached with the United States. then there will he no requirement that a percentage be utilized
for Core Strategies.
•
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•
3. Distribution Scheme - All Opioid Funds will initially go to the State, and then be
distributed according to the following distribution scheme. The Opioid Funds will be divided into
three funds after deducting costs of the Expense Fund detailed in paragraph 9 below:
(a) City/County Fund- The city/county fund will receive 15% of all Opioid Funds to
directly benefit all Counties and Municipalities. The amounts to be distributed to
each County and Municipality shall be determined by the Negotiation Class Metrics.
or other metrics agreed upon.in writing, by a County and a Municipality. For Local
Governments that arc not within the definition of County or Municipality, those
Local Governments may receive that government's share of the City/County Fund
under the Negotiation Class Metrics, if that government executes a release as part
of a Settlement. Any Local Government that is not within the definition of County
or Municipality and that does not execute a release as part of a Settlement shall
have its share of the City/County Fund go to the County in which it is located,
•
(b) Regional Fund- The regional fund will be subdivided into two parts,
(i) The State will annually calculate the share of each County within the State
of the regional fund utilizing the sliding scale in section 4 of the allocation
contained in the Negotiation Class Metrics or other metrics that the Parties
agree upon.
(ii) For Qualified Counties, the Qualified County's share will be paid to the
Qualified County and expended on Approved Purposes. including the
Core Strategies identified in Exhibit A, if applicable,
(iii) For all other Counties, the regional share for each County will be paid to
the Managing Entities providing service for that County. The Managing
Entities will be required to expend the monies on Approved Purposes,
including the Core Strategies. The Managing Entities shall endeavor to
the greatest extent possible to expend these monies on counties within
the State that are non-Qualified Counties and to ensure that there arc
services'in every County.
(e) State Fund - The remainder of Opioid Funds after deducting the costs of the
Expense Fund detailed in paragraph 9.the City/County Fund and the Regional Fund
will he expended by the State on Approved Purposes, including the provisions
related to Core Strategies, if applicable.
(d) To the extent that Opioid Funds are not appropriated and expended in a year by the
State, the State shall identify the investments where settlement funds will be
deposited. Any gains, profits, or interest accrued from the deposit of the Opioid
Funds to the extent that any funds are not appropriated and expended within a
calendar year, shall be the sole property of the Party that was entitled to the initial
deposit.
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4, Regional Fund Sliding Scale- The Regional Fund shall be calculated by utilizing
the following sliding scale of the Opioid Funds available in any year:
A. Years 1-6: 40%
£3, Years 7-9: 35%
C. Years 10-12: 34%
D. Years 13-15: 33%
E, Years 16-18: 30%
5, Opioid Abatement Taskforce or Council - The State will create an Opioid
Abatement Taskforce or Council (sometimes hereinafter "Taskforce"or"Council")to advise the
Governor, the Legislature, Florida's Department of Children and Families ("DCF"), and Local
Governments on the priorities that should he addressed as part of the opioid epidemic and to review
how monies have been spent and the results that have been achieved with Opioid Funds.
(a) Size-The Taskforce or Council shall have ten Members equally balanced between
the State and the Local Governments.
(b) Appointments Local Governments - Two Municipality representatives will he
appointed by or through Florida League of Cities. Two county representatives, one
from a Qualified County and one from a county within the State that is not a
Qualified County. will be appointed by or through the Florida Association of
Counties. The final representative will alternate every two years between being a
county representative(appointed by or through Florida Association of Counties) or
a Municipality representative (appointed by or through the Florida League of
Cities). One Municipality representative must be from a city of less than 50,000
people. One county representative must be from a county less than 200,000 people
and the other county representative must be from a county whose population
exceeds 200,000 people.
(c) Appointments State-
(1) The Governor shall appoint two Members.
(ii) The Speaker of the 1-louse shall appoint one Member.
(iii) The Senate President shall appoint one Member.
(iv) The Attorney General or her designee shall be a Member.
(d) Chair - The Attorney General or designee shall be the chair of the Taskforce or
Council.
(e) Term - Members will he appointed to serve a two-year term.
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(t) Support- DOT shall support the Taskforce or Council and the Taskforce or Council
shall be administratively housed in DCF.
(g) Meetings - The Taskforce or Council shall meet quarterly in person or virtually
using communications media technology as defined in section 120.54(5)(b)(2),
Florida Statutes.
(h) Reporting - The Taskforce or Council shall provide and publish a report annually
no later than November 30th or the first business day after November 30th, if
November 30th falls on a weekend or is otherwise not a business day, The report
shall contain information on how monies were-spent the previous fiscal year by the
State, each of the Qualified Counties, each of the Managing Entities, and each of
the Local Governments. It shall also contain recommendations to the Governor,
the Legislature, and Local Governments for priorities among the Approved
Purposes for how monies should be spent the coming fiscal year to respond to the
opioid epidemic.
(i) Accountability - Prior to July I st of each year, the State and each of the Local
Governments shall provide information to DCF about how they intend to expend
Opioid Funds in the upcoming fiscal year. The State and each of the Local
Government shall report its expenditures to DCF no later than August 31st for the
previous fiscal year. The Task force or Council will set other data sets that need to
be reported to DCF to demonstrate the effectiveness of Approved Purposes. All
programs and expenditures shall be audited annually in a similar fashion to
SAMI ISA programs. Local Governments shall respond and provide documents to
any reasonable requests from the State for data or information about programs
receiving Opioid Funds.
(j) Conflict of Interest- All Members shall adhere to the rules, regulations and laws of
Florida including, but not limited to, Florida Statute §1 12.311. concerning the
disclosure of conflicts of interest and recusal from discussions or votes on
conflicted matters.
6. Administrative Costs- The State may take no more than a 5% administrative fee
from the State Fund ("Administrative Costs") and any Regional Fund that it administers for
counties that are not Qualified Counties. Each Qualified County may take no more than a 5%
administrative fee from its share of the Regional Funds.
7, Negotiation of Non-Multistate Settlements -If the State begins negotiations with
a Pharmaceutical Supply Chain Participant that is separate and apart from a multi-state negotiation,
the State shall include Local Governments that are a part of the Negotiating Committee in such
negotiations. No Settlement shall be recommended or accepted without the affirmative votes of
both the State and Local Government representatives ol'the Negotiating Committee.
8. Negotiation of Multistate or Local Government Settlements - To the extent
practicable and allowed by other parties to a negotiation, both Parties agree to communicate with
16K 6
members of the Negotiation Committee regarding the terms of any other Pharmaceutical Supply
Chain Participant Settlement.
9. Expense Fund -The Parties agree that in any negotiation every effort shall be made
to cause Pharmaceutical Supply Chain Participants to pay costs of litigation, including attorneys'
fees, in addition to any agreed to Opioid Funds in the Settlement. To the extent that a fund
sufficient to pay the entirety of all contingency fee contracts for Local Governments in the State
of Florida is not created as part of a Settlement by a Pharmaceutical Supply Chain Participant,the
Parties agree that an additional expense fund for attorneys who represent Local Governments
(herein "Expense Fund") shall he.created out of the City/County fund for the purpose of paying
the hard costs of a litigating Local Government and then paying attorneys' fees.
(a) The Source of Funds for the Expense Fund- Money for the Expense Fund shall be
sourced exclusively from the City/County Fund.
(b) The Amount of the.Expense Fund- The State recognizes the value litigating Local
Governments bring to the State of Florida in connection with the Settlement
because their participation increases the amount Incentive Payments due from each
Pharmaceutical Supply Chain Participant. In recognition of that value, the amount
of fiords that shall he deposited into the Expense fund shall be contingent upon on
the percentage of litigating Local Government participation in the Settlement,
according to the following table:
Litigating Local Government Amount that shall be paid
Participation in the into the Expense Fund
Settlement (by percentage of from (and as a percentage
the population) ol) the City/County fluid
96 to 100% 10%
91 to 95% 7.5%
86 to 90% 5%
85% ?.5%
Less than 85% 0%
11' fewer than 85% percent of the litigating Local Governments (by population)
participate, then the Expense Fund shall not be funded,and this Section ofthe MOU
shall be null and void.
(c) The Timing of Payments into the Expense Fund- Although the amount of the
Expense Fund shall be calculated based on the entirety of payments due to the
City/County fund over a ten to eighteen year period, the Expense Fund shall be
limded entirely from payments made by Pharmaceutical Supply Chain Participants
during the first two years of the Settlement. Accordingly, to offset the amounts
being paid from the City/County to the Expense Fund in the first two years,
Counties or Municipalities may borrow from the Regional Fund during the first two
years and pay the borrowed amounts back to the Regional Fund during years three,
four, and five.
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For the avoidance of doubt. the following provides an illustrative example regarding the
calculation of payments and amounts that May be borrowed under the terms of this MOU,
consistent with the provisions of this Section:
Opioid Funds due to State of Florida and Local Governments (over 10 to 18 years): $1,000
Litigating Local Government Participation: 100%
City/County Fund (over 10 to 18 years): $150
• Expense Fund (paid over 2 years): $15
Amount Paid to Expense Fund in 1st year: $7.5
Amount Paid to Expense Fund in 2nd year $7,5
Amount that may be borrowed from Regional Fund in 1st year: $7.5
Amount that may be borrowed from Regional Fund in 2nd year: $7.5
Amount that must be paid back to Regional Fund in 3rd year: $5
Amount that must be paid back to Regional Fund in 4th year: $5
Amount that must be paid back to Regional Fund in 5th year: $5
(d) Creation of and Jurisdiction over the Expense Fund- The Expense Fund shall be
established, consistent with the provisions of this Section of the MOU, by order of
the Circuit Court of the Sixth Judicial Circuit in and for Pasco County, West Pasco
Division Nei Port Richey. Florida. in the matter of The State of'Florida, Wive of
the Attorney General, Department of Legal Affairs v. Purdue Pharniu f,.P., et al,
Case No. 2018-CA-001438 (the "Court"). The Court shall have jurisdiction over
the Expense Fund, including authority to allocate and disburse amounts from the
Expense Fund and to resolve any disputes concerning the Expense Fund.
(e) Allocation of Payments to Counsel from the Expense Fund- As part of the order
establishing the Expense Fund, counsel for the litigating Local Governments shall
seek to have the Court appoint a third-neutral to serve as a special master for
purposes of allocating the Expense Fund. Within 30 days of entry of the order
appointing a special master for the Expense Fund, any counsel who intend to seek
an award from the Expense Fund shall provide the copies of their contingency lee
contracts to the special master. The special master shall then build a mathematical
model,which shalt be based on each litigating Local Government's share under the
Negotiation Class Metrics and the rate set forth in their contingency contracts, to
calculate a proposed award for each litigating Local Government who timely
provided a copy of its contingency contract.
10. Dispute resolution- Any one or more of the Local Governments or the State may
object to an allocation or expenditure of Opioid Funds solely on the basis that the allocation or
expenditure at issue (a) is inconsistent with the Approved Purposes; (b) is inconsistent with the
distribution scheme as provided in.paragraph 3, or(c) violates the limitations set forth herein with
respect to administrative costs or the Expense Fund. 'There shall be no other basis for bringing an
objection to the approval of an allocation or expenditure of Opioid Funds.
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Schedule A
Core Strategies
States and Qualifying Block Grantees shall choose from among the abatement strategies listed in
Schedule B. However, priority shall be given to the following core abatement strategies ("Core
Strategies")[, such that a minimum of % of the [aggregate] state-level abatement distributions shall
be spent on:[one or more of] them annually].1
A. Naloxonc or other FDA-approved drug to reverse opioid overdoses
1,. Expand training for first responders. schools. community support groups and families; and.
2. Increase distribution to individuals who are uninsured or whose insurance does not cover the needed
service.
1B. Medication-Assisted "Treatment ("MAT-)") Distribution and other opioid-related treatment
1, increase distribution of MAT to non-Medicaid eligible or uninsured individuals;
2, Provide education to school-based and youth-focused programs that discourage or prevent misuse;
3. Provide MAT education and awareness training to healthcare providers, EMTs, law enforcement,
and other first responders; and
4. Treatment and Recovery Support Services such as residential and inpatient treatment, intensive
outpatient treatment, outpatient therapy or counseling, and recovery housing that allow or integrate
medication with other support services.
C`. Pregnant.& Postpartum Women .
1. Expand Screening, Brief Intervention. and Referral to Treatment ("SB1RT") services to non-
Medicaid eligible or uninsured pregnant women;
2. Expand comprehensive evidence-based treatment and recovery services, including MAT. for women
with co-occurring Opioid Use Disorder("OUD") and other Substance Use Disorder("SUD")/Mental
Health disorders for uninsured individuals for up to 12 months postpartum; and
3. Provide comprehensive wrap-around services to individuals with Opioid Use Disorder(DUD)
including housing. transportation.job placement/training, and childcare.
D, Expanding Treatment for Neonatal Abstinence Syndrome
1. Expand comprehensive evidence-based and recovery support for NAS babies;
2. Expand services for better continuum of care with infant-need dyad; and
3. Expand long-term treatment and services for medical monitoring of NAS babies and their families.
As used in this Schedule A.words like"expand.""fund;""provide"or the like shall not indicate a preference for new or
existing programs. Priorities will be established through the mechanisms described in the Term Sheet.
1 6 K 6 •
E. Expansion of Warm Hand-off Programs and Recovery Services
I. Expand services such as navigators and on-call teams to begin MAT in hospital emergency
departments;
2. Expand warm hand-off services to transition to recovery services:
3. Broaden scope of recovery services to include co-occurring SUD or mental health conditions. ;
4, Provide comprehensive wrap-around services to individuals in recovery including housing,
transportation,job placement/training, and childcare: and
5, Hire additional social workers or other behavioral health workers to facilitate expansions above,
F. Treatment for Incarcerated Population
1. Provide evidence-based treatment and recovery support including MAT for persons with OUD and
co-occurring SUD/MH disorders within and transitioning out of the criminal justice system; and
2. Increase funding for jails to provide treatment to inmates with OUD.
G. Prevention Programs
I; Funding for media campaigns to prevent opioid use (similar to the FDA's "Real Cost" campaign to
prevent youth from misusing tobacco);
2. Funding for evidence-based prevention programs in schools.;
3. Funding for medical provider education and outreach regarding best prescribing practices for opioids
consistent with the 2016 CDC guidelines, including providers at hospitals (academic detailing):,
4. Funding for community drug disposal programs; and
Funding and training for first responders to participate in pre-arrest diversion programs, post
overdose response teams. or similar strategies that connect at-risk individuals to behavioral health
services and supports.
H. Expanding Syringe Service Programs
1. Provide comprehensive syringe services programs with more wrap-around services including linkage
to DUD treatment, access to sterile syringes, and linkage to care and treatment of infectious diseases.
I. Evidence-based data collection and research analyzing the effectiveness of the abatement strategies
within the State,
•
2
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lilt 6
Schedule
Approved Uses
PART ONE: TREATMENT
A. TREAT OPIOID USE DISORDER (OUD)
Support treatment of Opioid Use Disorder (OUD) and any co-occurring Substance Use Disorder or
Mental Health (SUD/MH) conditions through evidence-based or evidence-informed programs or
strategies that may include, but are not limited to, the following
1. Expand availability of treatment for OUD and any co-occurring SUD/MH conditions, including all
forms of Medication-Assisted Treatment (MAT) approved by the U.S. Food and Drug Administration.
2. Support and reimburse evidence,based services that adhere to the American Society of Addiction
Medicine (ASAM) continuum of care for OUD and any co-occurring SUD/MII conditions
3. Expand telehealth to increase access to treatment for OUD and any co-occurring SUE/Nil
conditions, including MAT, as \yell as counseling, psychiatric support, and other treatment and
recovery support services.
4. Improve oversight of Opioid Treatment Programs (OTPs) to assure evidence-based or evidence-
informed practices such as adequate methadone dosing and low threshold approaches to treatment.
5. Support mobile intervention, treatment, and recovery services, offered by qualified professionals and
service providers, such as peer recovery coaches, for persons with OUI) and any co-occurring
SUD/MH conditions and for persons who have experienced an opiold overdose.
6. Treatment of trauma for individuals with OUD (e.g., violence, sexual assault, human trafficking, or
adverse childhood experiences) and family members (e.g.. surviving family members after an overdose
or overdose fatality), and training of health care personnel to identify and address such trauma,:
7. Support evidence-based withdrawal management services for people with OUD and any co-
occurring mental health conditions.
S. Training on MAT for health care providers, first responders, students, or other supporting
professionals, such as peer recovery coaches or recovery outreach specialists, including telementoring
to assist community-based providers in rural or underserved areas.
9. Support workforce development for addiction professionals who work with persons with OUI) and
any co-occurring SUD/M1-1 conditions,
10. Fellowships for addiction medicine specialists for direct patient care, instructors, and clinical
research for treatments.
I . Scholarships and supports for behavioral health practitioners or workers involved in addressing
OUD and any co-occurring SUE) or.mental health conditions, including but not limited to training,
2 As used in this Schedule B.words like"expand,-"fund.""provide"or the like shall not indicate a preference for new or
existing programs. Priorities will be established through the mechanisms described in the Term Sheet.
3
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scholarships, fellowships, loan repayment programs, or other incentives for providers to work in rural
or tmderserved areas.
12. [Intentionally Blank — to be cleaned up later for numberingl
13. Provide funding and training for clinicians to obtain a waiver under the federal Drug Addiction
Treatment Act of 2000 (DATA 2000) to prescribe MAT for OUD, and provide technical assistance and
professional support to clinicians who have obtained a DATA 2000 waiver.
14. Dissemination of web-based training curricula, such as the American Academy of Addiction
Psychiatry's Provider Clinical Support Service-Opioids web-based training curriculum and.
motivational interviewing.
15. Development and dissemination of new curricula, such as the American Academy of Addiction
Psychiatry's Provider Clinical Support Service for Medication-Assisted Treatment.
•
B. SUPPORT PEOPLE IN TREATMENT AND RECOVERY
Support people in treatment for or recovery from OUD and any co-occurring SUD/MH conditions
through evidence-based or evidence-informed programs or strategies that may include, but are not
limited to, the following:
1. Provide comprehensive wrap-around services to individuals with ()LID and any co-occurring
SUD/MH conditions. including housing. transportation. education,job placement,job training, or
childcare.
2.. Provide the full continuum of care of treatment and recovery services for OUD and any co-occurring
SUD/MH conditions, including supportive housing, peer support services and counseling, community
navigators, case management, and connections to community-based services.
3. Provide counseling, peer-support. recovery case management and residential treatment with access to
medications for those who need it to persons with OW) and any co-occurring SUD/MH conditions.
4. Provide access to housing for people with OUD and any co-occurring SUD/MH conditions.
including supportive housing, recovery housing, housing assistance programs, training for housing
providers, or recovery housing programs that allow or integrate FDA-approved medication with other
support services.
5. Provide community support services, including social and legal services, to assist in
deinstitutionalizing persons with OUD and any co-occurring SUD/MH conditions.
6. Support or expand peer-recovery centers, which may include support groups, social events, computer
access, or other services for persons with OUD and any co-occurring SUD/M11 conditions.
7. Provide or support transportation to treatment or recovery programs or services for persons with
OUD and any co-occurring SUD/M1-1 conditions.
8. Provide employment training or educational services for persons in treatment for or recovery from
OUD and any co-occurring SUD/MH conditions.
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9. Identify successful recovery programs such as physician, pilot, and college recovery programs, and
provide support and technical assistance to increase the number and capacity of high-quality programs
to help those in recovery.
10. Engage non-profits,faith-based communities, and community coalitions to support people in
treatment and recovery and to support family members in their efforts to support the person with COI.)
in the family.
11. Training and development of procedures for government staff to appropriately interact and provide
social and other services to individuals with or in recovery from OUD, including reducing stigma.
12. Support stigma reduction efforts regarding treatment and support for persons with OUD, including
reducing the stigma on effective treatment.
13. Create or support culturally appropriate services and programs for persons with OUD and any en-
occurring SUD/MH conditions, including new Americans.
14. Create and/or support recovery high schools.
15. Hire or train behavioral health workers to provide or expand any of the services or supports listed
above.
C. CONNECT PEOPLE WHO NEED HELP TO THE HELP THEY NEED (CONNECTIONS
TO CARE)
Provide connections to care for people who have — or at risk of developing —OUD and any co-
occurring SUD/MH conditions through evidence-based or evidence-informed programs or strategies
that may include. but are not limited to. the following:
1. Ensure that health care providers are screening for OUD and other risk factors and know how to
appropriately counsel and treat (or refer if necessary) a patient for OUD treatment,
2. Fund Screening. Brief Intervention and Referral to Treatment (SBIRT) programs to reduce the
transition from use to disorders. including SBIRT services to pregnant women who are uninsured or not
eligible for Medicaid.
3. Provide training and long-term implementation of SBIRT in key systems (health. schools, colleges,
criminal justice,and probation). with a lbcus on youth and young adults when transition from misuse to
opioid disorder is common.
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4. Purchase automated versions of SBIRT and support ongoing costs of the technology.
5. Expand services such as navigators and on-call teams to begin MAT in hospital emergency
departments,
6, Training for emergency room personnel treating opioid overdose patients on post-discharge planning,
including community referrals for MAT, recovery case management or support services.
7, Support hospital programs that transition persons with OUD and any co-occurring SUD/MH
conditions, or persons who have experienced an opioid overdose, into clinically-appropriate follow-up
care through a bridge clinic or similar approach.
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8. Support crisis stabilization centers that serve as an alternative to hospital emergency departments for
persons with OUD and any co-occurring SUD/MH conditions or persons that have experienced an
opioid overdose.
9. Support the work of Emergency Medical Systems, including peer support specialists,to connect
individuals to treatment or other appropriate services following an opioid overdose or other opioid-
related adverse event.
10. Provide funding for peer support specialists or recovery coaches in emergency departments, detox
facilities, recovery centers, recovery housing. or similar settings; offer services, supports, or
connections to care to persons with OUD and any co-occurring SLID/Mil conditions or to persons who
have experienced an opioid overdose.
I I. Expand warm hand-off services to transition to recovery services.
12. Create or support school-based contacts that parents can engage with to seek immediate treatment
services for their child; and support prevention, intervention, treatment, and recovery programs focused
on young people.
13, Develop and support best practices on addressing OUD in the workplace.
14. Support assistance programs for health care providers with MD.
15. Engage non-profits and the faith community as a system to support outreach for treatment.
16, Support centralized call centers that provide information and connections to appropriate services
and supports for persons with OUD and any co-occurring SUD/MH conditions.
D. ADDRESS THE NEEDS OF CRIMINAL-JUSTICE-INVOLVED PERSONS
Address the needs of persons with OUI) and any co-occurring SUD/MH conditions who are involved
in,are at risk of becoming involved in. or are transitioning out of the criminal justice system through
evidence-based or evidence-informed programs or strategies that may include, but are not limited to,
the following:
1. Support pre-arrest or pre-arraignment diversion and deflection strategies for persons with OUD and
any co-occurring SUD/MH conditions, including established strategies such as:
a. Self-referral strategies such as the Angel Programs or the Police Assisted Addiction Recovery
Initiative (PAARI);
b. Active outreach strategies such as the Drug Abuse Response Team (DART) model;
e. "Naloxone Plus" strategies, which work to ensure that individuals who have received
naloxone to reverse the effects of an overdose are then linked to treatment programs or other
appropriate services;
d. Officer prevention strategies, such as the Law Enforcement Assisted Diversion (LEAD)
model;
e. Officer intervention strategies such as the Leon County, Florida Adult'Civil Citation Network
or the Chicago Westside Narcotics Diversion to Treatment Initiative; or
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f. Co-responder and/or alternative responder models to address OLD-related 911 calls with
greater SUE) expertise
2. Support pre-trial services that connect individuals with OUD and any co-occurring SUI)/MH
conditions to evidence-informed treatment, including MAT, and related services.
3. Support treatment and recovery courts that provide evidence-based options for persons with OUD
and any co-occurring SUD/M11 conditions
4. Provide evidence-informed treatment, including MAT, recovery support, harm reduction, or other
appropriate services to individuals with OUD and any co-occurring SUD/MH conditions who are
incarcerated in jail or prison.
5. Provide evidence-informed treatment, including MAT, recovery support, harm reduction, or other
appropriate services to individuals with OUD and any co-occurring SUD/MH conditions who are
leaving jail or prison have recently left jail or prison, are on probation or parole, are under community
corrections supervision, or are in re-entry programs or facilities.
6. Support critical time interventions (CT1), particularly for individuals living with dual-diagnosis
OUD/serious mental illness, and services for individuals who face immediate risks and service needs
and risks upon release from correctional settings.
7. Provide training on best practices for addressing the needs of criminal-justice-involved persons with
OUD and any co-occurring SUD/MH conditions to law enforcement, correctional, or judicial personnel
or to providers of treatment, recovery, harm reduction, case management, or other services offered in
connection with any of the strategies described in this section.
E. ADDRESS THE NEEDS OF PREGNANT OR PARENTING WOMEN AND THEIR.
FAMILIES, INCLUDING BABIES WITH NEONATAL ABSTINENCE SYNDROME
Address the needs of pregnant or parenting women with OUD and any co-occurring SUD/MH
conditions, and the needs of their families, including babies with neonatal abstinence syndrome (NAS),
through evidence-based or evidence-informed programs or strategies that may include, but are not
limited to, the following:
1. Support evidence-based or evidence-informed treatment, including MAT, recovery services and
supports, and prevention services for pregnant women—or women who could become pregnant— who
have DUD and any co-occurring SUD/MH conditions, and other measures to educate and provide
support to families affected by Neonatal Abstinence Syndrome.
2. Expand comprehensive evidence-based treatment and recovery services, including MAT, for
uninsured women with MD and any co-occurring SLID/Mil conditions for up to 12 months
postpartum.
3. Training for obstetricians or other healthcare personnel that work with pregnant women and their
families regarding treatment of'DUD and any co-occurring SUD/M1I conditions.
4. Expand comprehensive evidence-based treatment and recovery support for NAS babies: expand
services for better continuum of care with infant-need dyad: expand long-term treatment and services
for medical monitoring of NAS babies and their families.
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5. Provide training to health care providers who work with pregnant or parenting women on best
practices for compliance with federal requirements that children born with Neonatal Abstinence
Syndrome get referred to appropriate services and receive a plan of safe care.
6. Child and family supports for parenting women with OUD and any co-occurring SUD/MH
conditions.
7: Enhanced family supports and child care services for parents with OUD and any co-occurring
SUD/MH conditions.
S. Provide enhanced support for children and family members suffering trauma as a result of addiction
in the family; and offer trauma-informed behavioral health treatment for adverse childhood events,
9. Offer home-based wrap-around services to persons with OUD and any co-occurring SUD/MH
conditions, including but not limited to parent skills training.
IQ. Support for Children's Services —Fund additional positions and services, including supportive
housing and other residential services, relating to children being removed from the home and/or placed
in foster care due to custodial opioid use.
PART TWO: PREVENTION
F. PREVENT OVER-PRESCRIBING .AND ENSURE APPROPRIATE PRESCRIBING AND
DISPENSING OF OPIOIDS
Support efforts to prevent over-prescribing and ensure appropriate prescribing and dispensing of
opioids through evidence-based or evidence-informed programs or strategies that may include, but are.
not limited to,the following:
1. Fund medical provider education and outreach regarding best prescribing practices for opioids
consistent with Guidelines for Prescribing Opioids for Chronic Pain from the U.S. Centers for Disease
Control and Prevention, including providers at hospitals (academic detailing),
2. Training for health care provider's regarding safe and responsible opioid prescribing, dosing, and
tapering patients off opioids.
3. Continuing Medical Education (CME) on appropriate prescribing of opioids.
4. Support for non-opioid pain treatment alternatives, including training providers to offer or refer to
multi-modal, evidence-informed treatment of pain.
5. Support enhancements or improvements to Prescription Drug Monitoring Programs (PDMPs).
including but not limited to improvements that:
a. Increase the number of prescribers using PDMPs;
b. Improve point-of-care decision-making by increasing the quantity, quality, or format of data,
available to prescribers using PDMPs, by improving the interface that prescribers use to access
PDMP data, or both; or
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c, Enable states to use POMP data in support of surveillance or intervention strategies. including
MAT referrals and follow-up for individuals identified within PDMP data as likely to
experience OUD in a manner that complies with all relevant privacy and security laws and rules.
6. Ensuring PDMPs incorporate available overdose/naloxone deployment data, including the United
States Department of Transportation's Emergency Medical Technician overdose database in a Manner
that complies with all relevant privacy and security laws and rules,
7. Increase electronic prescribing to prevent diversion or forgery.
8. Educate Dispensers on appropriate opioid dispensing.
G. PREVENT MISUSE OF OPIOIDS
Support efforts to discourage or prevent misuse of opioids through evidence-based or evidence-
informed programs or strategies that may include, but arc not limited to, the following:
I. Fund media campaigns to prevent opioid misuse,
2. Corrective advertising or affirmative public education campaigns based on evidence.
3. Public education relating to drug disposal.
4. Drug take-back disposal or destruction programs.
5. Fund community anti-drug coalitions that engage in drug prevention efforts.
6. Support community coalitions in implementing evidence-informed prevention, such as reduced
social access and physical access, stigma reduction - including staffing, educational campaigns, support
for people in treatment or recovery, or training of coalitions in evidence-informed implementation,
including the Strategic Prevention Framework developed by the U.S, Substance Abuse and Mental
Health Services Administration (SAMHSA).
7. Engage non-profits and faith-based communities as systems to support prevention,
8. Fund evidence-based prevention programs in schools or evidence-informed school and community
education programs and campaigns for students, families, school employees, school athletic programs,
parent-teacher and student associations, and others.
9. School-based or youth-focused programs or strategies that have demonstrated effectiveness in
preventing drug misuse and seem likely to be effective in preventing the uptake and use of opioids.
10. Create of support community-based education or intervention services for families, youth, and
adolescents at risk for OUD and any co-occurring SUD/MI-1 conditions,
11: Support evidence-informed programs or curricula to address mental health needs of young people
who may be at risk of misusing opiOids or other drugs, including emotional modulation and resilience
12. Support greater access to mental health services and supports for young people, including services
and supports provided by school nurses, behavioral health workers or other school staff, to address
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mental health needs in young people that (when not properly addressed) increase the risk of opioid or
other drug misuse.
H. PREVENT OVERDOSE DEATHS AND OTHER HARMS (HARM REDUCTION)
Support efforts to prevent or reduce.overdose deaths or other opioid-related harms through evidence-
based or evidence-informed programs or strategies that may include, hut are not limited to,the
following:
1. Increase availability and distribution of naloxone and other drugs that treat overdoses for first
responders, overdose patients, individuals with OUD and their friends and family members; individuals
at high risk of overdose, schools, community navigators and outreach workers, persons being released
from jail or prison, or other members of the general public,
2. Public health entities provide free naloxone to anyone in the community
3.Training and education regarding naloxone and other drugs that treat overdoses for first responders,
overdose patients, patients taking opioids, families. schools. community support groups, and Other
members of the general public.
4. Enable school nurses and other school staff to respond to opioid overdoses, and provide them with
naloxone,training, and support.
5. Expand, improve, or develop data tracking software and applications for overdoses/naloxone
revivals.
6. Public education relating to emergency responses to overdoses,
7, Public education relating to immunity and Good Samaritan laws.
8. Educate first responders regarding the existence and operation of immunity and Good Samaritan
laws.
9. Syringe service programs and other evidence-informed programs to reduce harms associated with
intravenous drug use, including supplies, staffing, space, peer support services, referrals to treatment,
fentanyl checking, connections to care, and the full range of harm reduction and treatment services
provided by these programs,
10. Expand.access to testing and treatment for infectious diseases such as HIV and Hepatitis C resulting
from intravenous opioid use.
11. Support mobile units that offer or provide referrals to harm reduction services, treatment,recovery
supports, health care, or other appropriate services to persons that use opioids or persons with OUD and
any co-occurring SUD/MH conditions.
12. Provide training in harm reduction strategies to health care providers, students, peer recovery
coaches. recovery outreach specialists, or other professionals that provide care to persons who use
opioids or persons with OUD and any co-occurring SUD/MH conditions.
13. Support screening for fentanyl in routine clinical toxicology testing,
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PART THREE; OTHER STRATEGIES
I. FIRST RESPONDERS
In addition to items in sections C, D. and VI relating to first responders, support the following;
I. Educate law enforcement or other first responders regarding appropriate practices and precautions
when dealing with fentanyl or other drugs.
2. Provision of wellness and support services for first responders and others who experience secondary
trauma associated with opioid-related emergency events.
J. LEADERSHIP, PLANNING AND COORDINATION
Support efforts to provide leadership, planning, coordination, facilitation, training and technical
assistance to abate the opioid epidemic through activities, programs, or strategies that may include, but
are not limited to, the following:
I. Statewide, regional, local, or community regional planning to identify root causes of addiction and
overdose, goals for reducing harms related to the opioid epidemic, and areas and populations with the
greatest needs for treatment intervention services; to support training and technical assistance: or to
support other strategies to abate the opioid epidemic described in this opioid abatement strategy list.
2. A dashboard to share reports, recommendations, or plans to spend opioid settlement funds; to show
how opioid settlement funds have been spent: to report program or strategy outcomes; or to track, share,
or visualize key opioid-related or health-related indicators and supports as identified through
collaborative statewide, regional. local, or community processes.
3. Invest in infrastructure or staffing at government or not-for-profit agencies to support collaborative,
cross-system coordination with the purpose of preventing overpreseribing,opioid misuse. or opioid
overdoses, treating those with OUD and any co-occurring SUD/M11 conditions, supporting them in
treatment or recovery, connecting them to care, or implementing other strategies to abate the opioid
epidemic described in this opioid abatement strategy list.
4. Provide resources to staff government oversight and management of opioid abatement programs.
K. TRAINING
In addition to the training referred to throughout this document, support training to abate the opioid
epidemic through activities, programs, or strategies that may include, but are not limited to, the
following:
1, Provide funding for staff training or networking programs and services to improve the capability of
government, community, and not-for-profit entities to abate the opioid crisis.
2. Support infrastructure and staffing for collaborative cross-system coordination to prevent opioid
misuse, prevent overdoses, and treat those with OUD and any co-occurring SUD/MH conditions, or
implement other strategies to abate the opioid epidemic described in this opioid abatement strategy list
(e.g., health care, primary care, pharmacies, PDMPs, etc.).
L. RESEARCH
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Support opioid abatement research that may include, but is not limited to, the following:
1. Monitoring, surveillance, data collection, and evaluation of programs and strategies described in this
opioid abatement strategy list.
2. Research non-opioid treatment of chronic pain.
3. Research on improved service delivery for modalities such as SKIRT that demonstrate promising but
mixed results in populations vulnerable to opioid use disorders.
4. Research on novel harm reduction and prevention efforts such as the provision of fentanyl test strips.
5. Research on innovative supply-side enforcement efforts such as improved detection Of mail-based
delivery of synthetic opioids.
6. Expanded research on swift/certain/fair models to reduce and deter opioid misuse within criminal
justice populations that build upon promising approaches used to address other substances (e.g, Hawaii
HOPE and Dakota 24/7).
7. Epidemiological surveillance of DUD-related behaviors in critical populations including individuals
entering the criminal justice systeni. including but not limited to approaches modeled on the Arrestee
Drug Abuse Monitoring (ADAM) system.
8. Qualitative and quantitative research regarding public health risks and harm reduction opportunities
within illicit drug markets, including surveys of market participants who sell or distribute illicit opioids.
9. Geospatial analysis of access barriers to MAT and their association with treatment engagement and
treatment outcomes.
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