The staff report summarizes the opioid epidemic facing Palm Beach County and provides recommendations to address it. Key points include: fatal opioid overdoses in the county increased 314% over five years; various agencies and systems are impacted, including increased Narcan use and costs, more criminal cases, and strain on first responders and jails; existing initiatives were reviewed but more action is needed; recommendations call for expanded prevention, treatment, public safety, and policy measures as well as improved coordination, data evaluation, and funding opportunities.

1. COUNTY STAFF REPORT
TO THE BOARD OF COUNTY COMMISSIONERS
April 4, 2017
PALM BEACH COUNTY
ADDRESSING THE OPIOID EPIDEMIC

2. • November 22, 2016 – Board directs staff to report back on opioid
epidemic including a review of the NLC/NACo Report, A Prescription for
Action: Local Leadership in Ending the Opioid Crisis.
• December 2016 – County Administration and staff meet with behavioral
health leaders
• January 9, 2017 – County staff contract with Ronik-Radlauer Group, Inc.,
to help develop Board response by:
• Identifying current initiatives in the County
• Analysis of the NACo/NLC Report
• Analysis of data
• Meeting with stakeholders
• Identification of strengths, weaknesses, and opportunities
• Analysis of root causes
• Developing initial recommendations
BACKGROUND

3. • Data
• Impact
OVERVIEW OF THE ISSUE
• Initiatives underway
• Review of reports with
recommendations
EXISTING RESOURCES
• Immediate short-term
• Long-term
RECOMMENDATIONS
TODAY’S PRESENTATION PROVIDES

4. Over the past five years these
overdoses have increased by:
314%
PALM BEACH COUNTY
FATAL
OPIOID OVERDOSES
592
307
189
161
143
0 200 400 600 800
2016
2015
2014
2013
2012

5. FENTANYL
Created in 1960
Up to 100 times
more potent
than morphine
CARFENTANIL
Created in 1974
10,000 times
more potent
than morphine
Anaesthetic for
elephants
ANALOGUES
Carfentanil
Sufentanil
Alfentanil
Remifentanil
Lofentanil
SYNTHETIC OPIOIDS
Used As Additives To Heroin
Spike The Potency
Contribute To Overdoses

6. DRUGS CAUSING DEATHS IN PALM BEACH COUNTY
0
50
100
150
200
250
300
350
2016201520142013201220112010200920082007
Oxycodone Fentanyl Heroin Cocaine Fentanyl analogues
NOTE: Represents drug instances not persons.
2016 is the first year the
Medical Examiner began
testing for and tracking
Fentanyl analogue drugs
such as Carfentanil

7. IN 2015
PALM BEACH COUNTY
LED THE STATE IN
OPIOID OVERDOSE
DEATHS WITH 305
NEXT WERE:
BROWARD 225
ORANGE 191
MIAMI 171
2016 PREDICTION
FATAL OVERDOSE
OCCURRED EVERY
2.5 HOURS OR
10 PER DAY

8. • Communities
• Families
• Law enforcement
• Fire Rescue
• Medical Examiner
• Hospitals
• Courts
• Jail
• Treatment Centers
• Those suffering
addictions
IMPACT OF THE OPIOID EPIDEMIC

9. 1281
1397 1390
1708
2045
143 161 189
307
592
0
500
1000
1500
2000
2500
2012 2013 2014 2015 2016
Total Cases Opioid Overdoses
IMPACT
PALM BEACH COUNTY MEDICAL EXAMINER
60% Increase in Total Cases
Fatal Opioid Overdoses:
2012 were 11% of caseload; 2016 increased to 28%
2012 were 75% of all Overdoses; 2016 increased to 85%

10. 2015 – 420
2016 – 2,598
In one year, Narcan
admissions increased by
519%
From 2012 to 2016
Narcan Costs increased by
1,041%
IMPACT
PALM BEACH COUNTY
FIRE RESCUE
2016 – 3,530
2017 THRU MARCH 15 – 401
NARCAN ADMISSIONS
OVERDOSE CALLS
2012 – $18,003
2016 – $205,346
NARCAN EXPENDITURES

11. January 2015 – February 2017
Total criminal court cases – all crimes = 78,997
Cases where opioid was primary charge = 2,425
• 3% of all court cases
• 0.2% are possession of opioids
Law enforcement arrests those selling and
manufacturing drugs much more than those
using drugs
Challenge to System:
Opioid use is masked in other
charges
IMPACT - CRIMINAL JUSTICE SYSTEM
POSSESSION,
117, 5% PURCHASE,
18, 0%
SALE OR SELL,
867, 36%
DISTRIBUTION,
22, 1%
TRAFFICKING, 263,
11%
SMUGGLING,
2, 0%
INTENT TO SELL,
MANUFACTURE
OR DELIVER,
1136, 47%
Criminal Court Cases
With Opioid Charge
As Most Serious Offense

12. IMPACT
PALM BEACH COUNTY
SHERIFF’S OFFICE
Law Enforcement Operations
• Increased calls for service for overdoses;
1,700 since May 2016
• Safety to officers of the strength of
Fentanyl and its analogues – now must
be tested by Crime Lab
• Additional resources and training for
Narcotics Agents
• Reduction in proactive activities of road
patrol due to time needed for overdose
investigations
• Diversion of the Gang Unit and Homicide
Unit from violent offenses to drug
activity and overdoses
Forensic Chemistry Unit
Positive Tests for Opioids 2015, 2016 & Projected 2017
606% Increase 2015 to 2016 in Fentanyl and Analogues
238% Projected Increase 2016 to 2017
0 500 1000 1500 2000 2500 3000
2017 Projected
2016
2015
Fentanyl & Analogues Heroin

13. IMPACT, CONTINUED
PALM BEACH COUNTY
SHERIFF’S OFFICE
Corrections Operations
• Medical treatment for detox
• Hospitalization requires transport and
24-hour deputy
• Challenges the resources and protocols
of the Corrections Emergency Response
Team within the jails
• Introduction of contraband
• Staff training for drug identification and
overdose symptoms
• Increase in transportation for court-
ordered release to treatment centers
0 200 400 600 800 1000
2016
2011
HEROIN JAIL BOOKINGS
2,803% Increase 2011 to 2016

14. • Heroin Overdose Task Force
• Sober Home Task Force
• NACo/NLC Report
RESOURCES AND EXISTING INITIATIVES

15. • Establish a mechanism for oversight county-wide
• Increase capacity to evaluate and report
• Foster regional cooperation
Leadership
• Create opportunities for community engagement
• Develop and expand opportunities for school-based efforts
• Develop opportunities to education healthcare personnel
• Expand community awareness of law enforcement and treatment
options
• Develop opportunities to educate family members and the
community
Prevention & Education
RECOMMENDATIONS

16. • Increase availability of medication-assisted treatment
• Increase capacity of service
• Established coordinated response for community integration after
hospital/jail discharge
• Establish guidelines to support harm reduction strategies
• Expand treatment resources to specialized priority populations
Treatment Capacity
• Expand diversion services to decrease criminalization
• Enhance strategies to address special needs
• Enhance strategies for responding
• Support the DEA, HIDTA and other efforts
Public Safety & Law Enforcement
RECOMMENDATIONS, CONTINUED

17. • Create mechanisms to address insurance issues
• Increase use of the Prescription Drug Monitoring Program
• Support Sober Home Task Force Recommendations:
• Advocate for improved licensing and certification of facilities/ services
• Create mechanisms to prevent and prosecute patient brokering
• Create mechanisms to prohibit deceptive advertising and punish with criminal
sanctions
• Create Opportunities for funding advocacy
Public Policy & Legislative Advocacy
• Create opportunities to support the development of:
• Certified sober homes
• Housing and emergency shelters
• Voucher Return Program of out-of-county clients
• Increased access to benefits, such as Medicaid
Ancillary Services
RECOMMENDATIONS, CONTINUED

18. • Create mechanisms to evaluate trends and emerging issues
• Create opportunities to expand licensing oversight of
providers and certification of sober homes
• Expand opportunities to strengthen and support the
workforce
• Create opportunities for evaluation of the efficacy of
implementation of the County’s initiatives
Evaluation & Monitoring
RECOMMENDATIONS, CONTINUED

19. Federal Government
• CARES Act
• CARA Act
• SAMHSHA Grants
• Department of Justice Grants
State Government
• Managing Entity
• Application for CARES Act funding
• Criminal Justice Mental Health & Substance Abuse
Reinvestment Act Grant
Local Funding
FUNDING
County Tax Dollars - Ad Valorem
Health Care District