[1. Briefing by the San Antonio Metropolitan Health District regarding the final report and accomplishments of the Joint Opioid Overdose Prevention Task Force. [Erik Walsh, Deputy City Manager; Colleen M. Bridger, MPH, PhD, Director, Health]]
[00:00:07]
>> CLERK: WELCOME TO THE CITY COUNCIL B SESSION OF SEPTEMBER THE 19TH, 2018.
>> CLERK: MAYOR, WE DO HAVE A QUORUM.
>> MAYOR NIRENBERG: GOOD AFTERNOON, EVERYONE.
WELCOME TO OUR CITY COUNCIL B SESSION AGENDA.
WE HAVE ONE ITEM ON THE AGENDA AND THAT IS FROM THE SAN ANTONIO METROPOLITAN HEALTH DISTRICT.
>> SCULLEY: THANK YOU, MAYOR AND COUNCIL.
TODAY'S AGENDA IS A JOINT BRIEFING ABOUT THE JOINT OPIOID OVERDOSE PREVENTION TASK FORCE.
AND AS BACKGROUND, THE TASK FORCE WAS ESTABLISHED JUST ABOUT ONE YEAR AGO, IN AUGUST OF 2017 BY MAYOR NIRENBERG AND BEXAR COUNTY JUDGE NELSON WOLFF TO ADDRESS THE OPIOID OVER DOSE IN BEXAR COUNTY.
THE NUMBER OF DEATHS DUE TO OPIOID HAS QUADRUPLED ACROSS THE COUNTRY OVER THE LAST 20 YEARS AND TO ADDRESS THIS ISSUE THE TASK FORCE CONVENED MORE THAN 20 MEMBERS FROM PUBLIC HEALTH, PHARMACEUTICAL, FIRST RESPONDERS AND PUBLIC SCHOOL DISTRICTS, AS WELL AS SOCIAL SERVICE AGENCIES UNDER THE LEADERSHIP AND COHOSTING OF -- FORMER MEMBER AND LEADER WITHIN OUR METROPOLITAN HEALTH DEPARTMENT.
THESE INDIVIDUALS MET OVER THE PAST YEAR TO MAKE PROGRESS ON THE MAIN OBJECTIVES.
WE'RE PLEASED TO SHARE WITH YOU TODAY THE WORK OF THE COLLABORATIVE GROUP, AND I DO WANT TO THANK THE COCHAIRS, DR. BRIDGER AND DR. ALSAP FOR THEIR WORK AS WELL AS THE LOCAL HEALTH COMMUNITY THAT SPENT TIME TO TALK ABOUT THE ISSUE AND OFFER THEIR SUGGESTIONS.
SO WITH THAT, LET ME INTRODUCE DR. BRIDGER WHO'S GOING TO KICK OFF THE PRESENTATION.
SHE'LL BE JOINED BY HER COCHAIR DR. BRIAN ALSAP TO REPRESENT THE COUNTY'S PERSPECTIVE.
I'D NOTE THAT T.J. MAYS, JUDGE WOLFF'S CHIEF OF STAFF IS ALSO HERE THIS AFTERNOON.
T.J., WELCOME BACK TO CITY HALL.
AND OF COURSE THOSE WHO ARE HERE ON THE ISSUE WILL BE ABLE TO ANSWER QUESTIONS OF THE COUNCILMEMBERS.
>> MAYOR NIRENBERG: THANK YOU, SHERYL.
DR. BRIDGER, I'M SORRY, I NEED A BRIEF POINT OF PERSONAL PRIVILEGE.
IT IS THE FINAL BIRTHDAY OF THE DEAN OF THE CITY COUNCIL, THAT E H WILL CELEBRATE IN THESE CHAMBERS.
[LAUGHTER] THAT WAS DENISE'S JOKE, NOT HIS FINAL BIRTHDAY, BUT HIS FINAL BIRTHDAY REY SALDAÑA'S WHO'S BIRTHDAY IS ACTUALLY TODAY, SO WE SHOULD SING HIM A HAPPY BIRTHDAY.
>> MAYOR NIRENBERG: NO SPEECH.
THERE IS CAKE UP THERE, AND ALSO ICE CREAM IN THE FREEZER.
>> DR. BRIDGER: NO, THAT WAS FUN, THANK YOU.
THANK YOU FOR THIS OPPORTUNITY TO PRESENT.
AS THE CITY MANAGER MENTIONED, I AM JOINED TODAY BY THE COCHAIR OF THE TASK FORCE, DR. BRIAN ALSAP AND JUDGE WOLFF'S CHIEF OF STAFF, T.J. MAYS.
T.J. WILL JOIN ME AT THE END OF THE PRESENTATION, AND THEN BRYAN AND T.J. AND I ARE ALL HERE TO ANSWER QUESTIONS.
SO WE'RE GOING TO TRY TO KEEP THE PRESENTATION, ITSELF PRETTY SHORT, BECAUSE WE ANTICIPATE THAT YOU WILL HAVE QUESTIONS, AND WE WANT TO BE ABLE TO ANSWER THOSE.
WHEN I WAS HERE EARLIER TODAY, THERE WAS A REMOTE.
SO THIS WAS THE JOINT OPIOID OVERDOSE PREVENTION TASK FORCE.
AND WE WERE CONVENED TO ADDRESS THE GROWING DEATHS DUE TO OPIOID OVERDOSE.
JUST TO GIVE YOU A LITTLE BIT OF BACKGROUND ABOUT THE
[00:05:02]
OPIOID EPIDEMIC SINCE 1999, THE NUMBER OF OVERDOSE DEATHS HAS QUADRUPLED, AND WHEN WE LOOK AT THIS EPIDEMIC AND COMPARE IT TO TWO OTHER EPIDEMICS THAT HAVE KILLED A TREMENDOUS NUMBER OF AMERICANS, WHEN YOU LOOK AT CAR CRASHES IN 1972, WHICH WAS WHEN THE PEAK OF DEATHS OCCURRED, OR HIV IN '95, WHICH IS WHEN THE PEAK OF DEATHS OCCURRED, OPIOIDS KILLED MORE AMERICANS IN 2016 THAN EITHER OF THOSE EPIDEMICS.RIGHT NOW ABOUT 100 AMERICANS DIE EVERY DAY FROM AN OPIOID OVERDOSE, AND AMERICA'S LEADING CAUSE OF ACCIDENTAL DEATH IS NOW DUE TO OPIOIDS.
WHEN YOU LOOK A LITTLE BIT CLOSER, YOU LOOK AT BEXAR COUNTY, WE KNOW THAT BEXAR COUNTY RANKS THIRD IN PER CAPITA OF DEATHS DUE TO OPIOID OVERDOSES, BUT ALSO WE KNOW THAT BEXAR COUNTY IS NUMBER ONE WHEN IT COMES TO BABIES BORN ADDICTED TO SUBSTANCES OR NEONATAL ABSTINENCE SYNDROME.
IN FACT, 1/3 OF ALL OF THE BABIES BORN WHO ARE SUFFERING FROM NEONATAL ABSTINENCE SYNDROME ARE BORN HERE IN BEXAR COUNTY.
ONE OF THE OTHER STATISTICS THAT WE LOOKED AT WHEN WE WERE STARTING THIS TASK FORCE IS HOW MANY OF OUR PHYSICIANS AND DENTISTS ARE REGISTERED TO USE THE PRESCRIPTION MONITORING PROGRAM.
SO THIS IS A PROGRAM THAT WILL BECOME MANDATORY A YEAR FROM NOW, AND SO VOLUNTARILY YOU CAN SEE THERE AREN'T -- LESS THAN HALF OF PHYSICIANS AND LESS THAN A QUARTER OF DENTISTS ARE REGISTERED TO USE THIS DATABASE.
AND THIS DATABASE ALLOWS THEM TO LOOK UP BY PATIENT THE OPIOID PRESCRIBING AND FILLING PRACTICES OF THE -- RAN AND OFTEN, ESPECIALLY OUR DENTAL CLINICS, THEY WOULD WRITE A PRESCRIPTION FOR AN OPIOID AND THE PATIENT WOULD COME BACK THE NEXT DAY AND SAY THEY LOST THE PRESCRIPTION.
THEY WERE ABLE TO PULL UP THE DATABASE, LOOK UP THE PATIENT'S NAME AND SAY, MRS. SMU FILLED THAT PRESCRIPTION AT WALGREENS YESTERDAY AT 12:04.
AND SO THAT HELPED DEAL WITH ANY DRUG-SEEKING BEHAVIOR.
SO LET'S FIRST TALK ABOUT WHAT IS AN OPIOID.
SO AN OPIOID IS A SUBSTANCE THAT ACTS ON SPECIFIC RECEPTORS IN THE BRAIN THAT ONLY REACT TO OPIOIDS.
AND WHAT HAPPENS WHEN YOU FLOOD THE BRAIN AND FLOOD THOSE RECEPTORS WITH OPIOIDS IS A LESSENING OF PAIN, BUT ALSO A LESSENING OF RESPIRATION, AND SO WHEN YOU OVERDOSE ON AN OPIOID, YOUR RESPIRATION GOES DOWN TO THE POINT WHERE YOU STOP BREATHING, AND SO THAT IS THE MOST COMMON CAUSE OF DEATH.
IT CAN BE ADDICTIVE, IT'S NOT ADDICTIVE FOR EVERYBODY, BUT IT CAN BE ADDICTIVE.
OPIUM, OF COURSE, WE'VE ALL HEARD OF OPIUM, WE'VE ALL SEEN REFERENCES TO THE USE OF OPIUM GOING BACK THOUSANDS OF YEARS, AND THERE ARE PRESCRIPTION OPIOIDS, LIKE OXYCOTTON THAT YOU'RE FAMILIAR WITH.
THERE'S SYNTHETIC OPIOIDS LIKE FET NEL THAT YOU'RE HEARING MORE AND MORE ABOUT AND I'M GOING TO TALK A LITTLE BIT MORE ABOUT THAT, AND THEN THERE ARE THE ILLEGAL OPIOIDS LIKE HEROIN THAT YOU BUY ON THE STREET.
WELL, NOT YOU, BUT ONE CAN BY ON THE STREET.
SO WHEN YOU LOOK AT HOW THE EPIDEMIC HAS CHANGED OVER TIME, THIS IS A CURVE THAT SHOWS BACK IN 2000 WHERE WE SAW MOST OF THE DEATHS.
AND YOU CAN SEE THE CURVE IS RELATIVELY SKINNY, THE BULK OF THE DEATHS HAPPENING BETWEEN 40 AND 50 YEARS OF AGE, AND THIS IS PRIMARILY DUE TO PRESCRIPTION OPIOIDS.
YOU THEN FAST-FORWARD TO 2008, YOU CAN SEE THE CURVE IS GOING UP HIGHER, AND IT'S STARTING TO DEVELOP A HUMP, SO THAT IT HAS TWO PARTS.
AND IF YOU LOOK AT THE NEXT SLIDE, YOU CAN SEE WHERE THERE IS A SECOND WAVE, SO AMONG THE YOUNGER INDIVIDUALS, WE'RE STARTING TO SEE DEATHS, AND THAT'S PRIMARILY DUE TO HEROIN AND FENTTY NEL AND YET WE STILL SEE THAT SECOND INCREASE IN DEATHS AMONG THE OLDER POPULATION DUE TO THE PRESCRIPTION OPIOIDS.
ADDITIONALLY WE PRESENT THIS SLIDE BECAUSE SOME PEOPLE COULD LOOK AT THIS A SLIDE AND SAY, WELL, YOU KNOW WHAT? WE REALLY DON'T HAVE A PROBLEM IN TEXAS, SO WHY ARE YOU TALKING TO US ABOUT THIS.
AND I COUNTER THAT BY SAYING THAT TEXAS IS ONE OF THE FEW
[00:10:03]
STATES IN THE U.S. THAT ALLOWS NONPHYSICIANS TO BE CORONERS TO DETERMINE CAUSE OF DEATH.AND SO WHAT WE HAVE ARE ELECTED OR POLITICALLY APPOINTED INDIVIDUALS WHO ARE FILLING OUT THE DEATH CERTIFICATE INFORMATION, AND SOMETIMES IT'S IN THEIR BEST INTEREST TO BE A LITTLE BIT VAGUE ABOUT THE CAUSE OF DEATH.
AND SO WHAT -- THE PROBLEM TEXAS HAS IS NOT A LACK OF OPIOID OVERDOSES, THE PROBLEM THAT TEXAS HAS IS A LACK OF DATA ABOUT OPIOID OVERDOSES.
AND, AGAIN, I REFERENCE YOU BACK TO THE NEONATAL ABSTINENCE SYNDROME.
WE KNOW THERE IS A PROBLEM BECAUSE WE KNOW HOW MANY BABIES ARE BEING BORN ADDICTED TO SUBSTANCES BECAUSE THEIR MOMS WERE ADDICTED TO SUBSTANCES DURING THE PREGNANCY.
SO JUST A REAL QUICK LOOK AT HOW DID WE GET HERE.
AND IT BASICALLY STARTED WITH A SENTENCE IN A LETTER, IN A MEDICAL JOURNAL, THAT SAID THAT OPIOIDS WERE NOT ADDICTIVE.
THEN THAT SENTENCE WAS CITED IN HUNDREDS OF PEER-REVIEWED JOURNALS AS IF IT WERE A POINT OF FACT, AND THEN WE SAW MASS PRODUCTION OF PRESCRIPTION OPIOIDS LIKE OXYCONTIN AND MASS MARKETING OF THOSE PRESCRIPTION OPIOID, AND SO ONE THING JUST BUILT ON THE NEXT THING, BUILT ON THE NEXT THING.
COMBINE THAT WITH THE PRESSURE THAT PHYSICIANS ESPECIALLY WERE FEELING BECAUSE PEOPLE WERE TALKING ABOUT PAIN BEING THE FIFTH VITAL SIGN.
AND I DON'T KNOW IF ANY OF YOU EVER WENT TO THE HOSPITAL OR TO THE EMERGENCY ROOM BETWEEN, LIKE, THE MID '90S TO EVEN FIVE YEARS AGO, BUT EVERYWHERE YOU LOOK, THERE WAS INFORMATION ABOUT WHAT IS YOUR PAIN LIKE? HOW ARE YOU FEELING? TALK TO US IF YOU'RE IN PAIN.
WHEN YOU GOT YOUR PATIENT SATISFACTION SURVEY WHEN YOU WERE DISCHARGED FROM THE HOSPITAL, IT ASKED, WAS YOUR PAINAD QUATLY -- PAIN ADEQUATELY TREATED? SO WE CREATED THE EXPECTATION THAT YOU WOULD HAVE A PAIN-FREE EXPERIENCE WHEN YOU WENT TO THE HOSPITAL.
THAT ALSO ADDED TO THE PRESCRIBING OF OPIOIDS AND ADDED TO THE PROBLEM.
THEN WE HAD PILL MILLS THAT POPPED UP ON EVERY STREET CORNER WHERE YOU COULD GO IN ON A WALK-IN BASIS AND YOU COULD PAY CASH FOR PAIN PILLS, WHICH WERE OPIOIDS.
AND ULTIMATELY WHAT WE SAW WAS AS PEOPLE STOPPED BEING ABLE TO ACCESS PRESCRIPTION DRUGS, THEY THEN TURNED TO STREET DRUGS, HEROIN AND FENTANYL.
SO LET'S TALK A LITTLE BIT ABOUT FENTANYL.
SO IT'S EASIER TO GET, AND IT'S OFTEN CHEAPER THAN PRESCRIPTION OPIOIDS.
AND FOR THE MOST PART, THE FENTANYL ON THE STREET IS ELICITLY MANUFACTURED, MOSTLY IN CHINA AND MEXICO.
I LOVE THIS GRAPHIC, BECAUSE IT SHOWS YOU THE VERY TEENY TINY PILL IS MORPHINE, THE NEXT ONE IS HEROIN, AND SO YOU CAN SEE HEROIN IS TWO TIMES AS STRONG AS MORPHINE, AND YOU CAN SEE FENTANYL IS 100 TIMES AS STRONG AS MORPHINE.
AND THEN WE HAVE A THING CALLED CARFENTANYL, AND IT'S AN ELEPHANT TRANQUILIZER, AND IT IS OUT ON THE STREET AS WELL.
AND IT IS 10,000 TIMES STRONGER THAN MORPHINE.
AND SO YOU CAN START TO UNDERSTAND HOW PEOPLE WHO ARE CREATING THESE PILLS, THESE FENTANYL PILLS IN THEIR BASEMENTS MIGHT NOT GET THE DOSAGE EXACTLY RIGHT, AND THAT'S WHY WE'RE SEEING SUCH AN INCREASE IN DEATHS DUE TO LACING HEROIN WITH FENTANYL, LACING OTHER DRUGS WITH FENTANYL, TO MAKE THEM MORE ADDICTIVE, BUT THEY'RE NOT -- THEY'RE NOT CHEMISTS, THEY DON'T KNOW WHAT THEY'RE DOING AND SO THEY GET THE DOSE WRONG.
SO WHEN WE STARTED TALKING ABOUT WHAT ARE WE GOING TO DO ABOUT THIS PROBLEM, WE DID SOME RESEARCH AND FOUND WHAT OTHER COMMUNITIES WHO WERE AHEAD OF US IN THIS EPIDEMIC WERE DOING AND WHAT THE RESEARCH WAS SHOWING WAS HAVING AN EFFECT.
AND LIKE EVERYTHING, OR AT LEAST EVERY PUBLIC HEALTH THING, IT'S REALLY A COMBINATION, A SYNERGIES TICK -- SINNER GISTIC STEP WE NEED TO TAKE IN ORDER TO REALLY WRAP OUR ARMS AROUND THIS ISSUE.
WHAT WE FOUND FROM THE LITERATURE, WE NEED TO REDUCE OPIOID PRESCRIPTIONS, WE NEED TO -- AUDIO] -- WE NEED PROVIDER
[00:15:11]
EDUCATION AND BETTER ACCESS TO TREATMENT.SO IN JUNE 2017, JUDGE JUDGE WOLFF AND MAYOR NIRENBERG CONVENED THE JOINT OPIOID OVERDOSE PREVENTION TASK FORCE AND THE GOAL OF THIS TASK FORCE WAS TO ADDRESS THE INCREASE IN OPIOID OVERDOSE DEATHS.
IT WAS -- WE SPENT A LOT OF TIME TALKING ABOUT WHAT WOULD BE THE FOCUS OF THIS TASK FORCE BECAUSE OPIOID USE DISORDER IS A HUGE PROBLEM, SUBSTANCE USE DISORDER, WE TALKED ABOUT METH, WE TALKED ABOUT SYNTHETIC MARIJUANA, WE TALKED ABOUT A NUMBER OF DIFFERENT ISSUES, AND WHAT WE DECIDED WAS DURING THIS ONE-YEAR PERIOD, IF WE COULD FOCUS ON DEATHS DUE TO OPIOID OVERDOSE, WE WOULD BE ABLE TO START TO MAKE A DENT IN THIS PROBLEM.
WE HAD OUR FIRST MEETING IN AUGUST, AND HAVE MET REGULARLY SINCE THEN.
THIS IS A PICTURE OF THE PRESS CONFERENCE AUGUST 8TH ANNOUNCING THIS TASK FORCE AND WE HAD BOTH THE MAYOR AND THE JUDGE THERE TO SPEAK PUBLICLY ABOUT THAT.
AND AS THE CITY MANAGER MENTIONED, WE HAD MORE THAN 30 MEMBERS REPRESENTING ALL OF THOSE DIFFERENT ASPECTS OF THIS PROBLEM.
SO BASED ON THE RESEARCH THAT WE DID, WE HAD FOUR WORK GROUPS, AND THOSE FOUR WORK GROUPS FOCUSED ON ON THAT LOCKS IN, COMMUNITY EDUCATION, PROVIDER EDUCATION AND TREATMENT.
WE DID A LOT OF OTHER WORK, THOUGH, OUTSIDE THE WALLS OF THE TASK FORCE, SO SOME OF THE THINGS THAT WE ALSO DID, DR. ALSAP AND I DID A JOINT OP ED TO KICK THIS OFF.
WE ALSO PARTICIPATED ON AN EXPRESS-NEWS TOWN HALL PANEL ON OPIOID OVERDOSE DEATHS.
WE DID INTERVIEWS FOR MULTIPLE APPROXIMATELY NEWSES -- MULTIPLE NEWS PROGRAMS, TV PROGRAMS, T.J. WAS INSTRUMENTAL IN CREATING THE WEBSITE SPECIFIC TO OPIOID OVERDOSE DEATHS.
AND FINALLY IN THE ONE YEAR WE WERE WORKING TOGETHER, WE WERE ABLE TO SECURE $11 MILLION IN OUTSIDE GRANT FUNDS TO PUT TOWARDS ADDRESSING THIS PROBLEM.
SO LET'S LOOK AT THE SPECIFIC WORK THAT WE DID.
IN THE NALOXONE WORK GROUP, WE WORKED REALLY HARD TO EXPAND ACCESS TO NALOXONE, BOTH TO TRADITIONAL FIRST RESPONDERS AND NONTRADITIONAL FIRST RESPONDERS.
SO, FOR EXAMPLE, TRADITIONAL FIRST RESPONDERS INCLUDES OUR SAPD OFFICERS, OUR SHERIFF'S DEPUTIES AND OTHER MUNICIPAL LAW ENFORCEMENT TO TELL YOU BY THE END OF SEPTEMBER, EVERY SINGLE SAPD OFFICER WITH A BADGE WILL HAVE TRAINED IN AND KNOW HOW TO USE NALOXONE IF THEY COME ACROSS A PERSON THEY SUSPECT IS SUFFERING FROM AN OVERDOSE.
WE ARE ALSO MONITORING THE USE OF NALOXONE IN THE COMMUNITY, SO THAT WE CAN BE ABLE TO SAY WE'VE ADMINISTERED 17,000 DOSES OF NALOXONE THUS SAVING 10,000 PEOPLE'S LIVES.
WE ALSO -- THIS TASK FORCE WAS VERY MUCH FOCUSED ON MAPS.
AND SO YOU'LL HEAR ME TALK ABOUT A NUMBER OF DIFFERENT MAPS THAT WE CREATED, ONE OF THE FIRST MAPS WE LOOKED AT WAS WHERE IS EMS BEING CALLED AND ADMINISTERING NALOXONE? WHERE IS THE HIGHEST USE OF NALOXONE HAPPENING? AND WE USED THAT INFORMATION TO TARGET SOME OF OUR INFORMATION.
I MENTIONED NONTRADITIONAL FOLKS BEING TRAINED IN HOW TO ADMINISTER NALOXONE.
THE COUNTY HAS PROVIDED TRAINING TO THEIR BIBLIOTECH STAFF BECAUSE WE KNOW FROM THE LITERATURE THAT A LOT OF PEOPLE ARE OVERDOSING IN LIBRARY RESTROOMS. AND SO WE'RE GETTING THEM TRAINED, AS WELL AS A LOT OF HARM-REDUCTION FOLKS AND, YOU KNOW, PARENTS OF KIDS WHO ARE, YOU KNOW, DEALING WITH SUBSTANCE USE DISORDER, TO HAVE IT ON HAND JUST IN CASE.
REALLY TRYING TO GET NALOXONE OUT INTO THE COMMUNITY.
SO SECOND GROUP I WANT TO TALK ABOUT IS THE PROVIDER EDUCATION WORK GROUP.
SO ONE OF THE CHALLENGES THAT WE IDENTIFIED WAS THAT DEPENDING ON WHEN YOU WENT TO MEDICAL SCHOOL, YOU GOT DIFFERENT TRAINING ON HOW TO PRESCRIBE, WHEN TO PRESCRIBE, WHETHER THEY WERE GOOD, WHETHER THEY WERE BAD AROUND OPIOIDS.
AND SO WE HAVE A CROSSWALK THAT CAN HELP PROVIDERS GO FROM WHERE THEY ARE IN THEIR TRAINING, DEPENDING ON WHEN IT HAPPENED --
[00:20:03]
AUDIO] -- IN THE UNITED STATES, YOU DON'T NEED TO BE WAIVERRED TO PRESCRIBE AN OPIOID, BUT YOU DO NEED TO BE WAIVERRED, WHICH MEANS YOU HAVE TO GET SPECIAL APPROVAL AND GO THROUGH EXTRA TRAINING IN ORDER TO PRESCRIBE MEDICATION-ASSISTED TREATMENT.SO WHAT WE FOUND WAS THAT THERE WEREN'T A LOT, AND CERTAINLY NOT ENOUGH PROVIDERS IN THE COMMUNITY WHO WERE WAIVERRED TO PROVIDE MAT, AND SO WE WORKED WITH UT HEALTH TO DEVELOP THIS WEBSITE.
U I'M SUPER EXCITED TO ANNOUNCE SOMETHING THAT I THINK EVEN BRYAN AND T.J.
MAY NOT KNOW, WHICH IS THAT THE STATE IS ACTUALLY WORKING WITH US, INSTEAD OF HAVING IT BE -- GET WAIVERRED SA, IT'S GOING TO BE GET WAIVERRED TEXAS.
THEY ARE GOING TO FUND UT HEALTH TO PROVIDE THE WAIVER TRAINING FOR THE ENTIRE STATE OF TEXAS, SO THAT WE HAVE MORE PHYSICIANS TRAINED.
AND THAT'S A THEME THAT WE'RE SEEING FROM OUR TASK FORCE IS THE STATE IS WATCHING WHAT WE'RE DOING, AND THEN THEY'RE REPLICATING IT AND THEY'RE GROWING IT ACROSS THE STATE AND MAKING IT A STATEWIDE INITIATIVE.
SO WE'RE ALSO HELPING TO GET THE WORD OUT ABOUT THE FACT THAT THIS TIME NEXT YEAR THE PRESCRIPTION MONITORING PROGRAM WILL BE A REQUIREMENT FOR PHYSICIANS TO USE, AND NOT JUST INFORM THEM OF THAT FACT, BUT ALSO HELP THEM UNDERSTAND HOW THEY CAN USE THAT TO REALLY INTERACT IN A BENEFICIAL WAY WITH THEIR PATIENTS.
SO THE COMMUNITY EDUCATION WORK GROUP, AGAIN I SAID FUN WITH MAPS.
SO WE MAPPED PERMANENT DRUG DROPOFF LOCATIONS.
SO WHEN WE FIRST STARTED THIS TASK FORCE, WE KNEW THAT A COUPLE OF TIMES A YEAR, THERE WERE SOME DRUG TAKEBACK OPPORTUNITIES THROUGH SAWS AND THROUGH OUR SOLID WASTE DEPARTMENT, BUT THOSE WERE, YOU KNOW, TWO, THREE TIMES A YEAR, AND REALLY REQUIRED A LOT OF PAYING ATTENTION AND GETTING OUT AND DOING SPECIAL THINGS.
AND SO WE KNEW THAT THE EVIDENCE SAID ONE OF THE BEST THINGS TO DO IS TO HAVE PERM 90 DRUG DROPOFF LOW -- PERMANENT DRUG DROPOFF LOCATIONS SO WHENEVER IT'S ON MY MIND THAT I NOW HAVE THIS UNUSED BOTTLE OF OPIOIDS, I COULD JUST GO SOMEWHERE AND DROP THEM OFF.
SO THIS MAP REPRESENTS ALL OF THE PERMANENT DRUG DROPOFF LOCATIONS IN THE CITY. IT'S A COMBINATION OF PHARMACIES AND THERE ARE THREE SAPD SUBSTATIONS THAT ARE PROVIDING IT.
SO THE MAJORITY OF THESE DRUG DROPOFF LOCATIONS ARE 24/7, AND YOU WALK IN, YOU DROP OFF YOUR DRUGS, YOU WALK OUT, NO QUESTIONS ASKED WE ALSO, AND WE HAVE SOME SHOW AND TELL FOR YOU, HAVE THROUGH THE HELP OF SACOTA, WHO HAS BEEN AN INCREDIBLE PARTNER WITH US, HAVE DETERA, AND I DON'T KNOW IF YOU JUST WANT TO PASS THOSE AROUND.
SO THERE'S A REALLY COOL THING CALLED DETERA.
AND BASICALLY, THEY ARE THESE LITTLE PACKETS, AND YOU PUT YOUR DRUGS IN THERE, YOU ADD WATER, YOU SEAL IT, YOU SHAKE IT UP, AND PRESS TO CHANGEO, IT'S NO LONGER DANGEROUS FOR THE ENVIRONMENT AND YOU CAN THROW IT AWAY IN YOUR TRASH, WHICH IS AWESOME.
IT HELPS PEOPLE NOT DUMP THEM DOWN THE TOILET, WHICH, IS, OF COURSE, BAD FOR THE FROGS, WE DON'T WANT THAT.
AND IT DEACTIVATES ALL THE BAD STUFF IN THOSE DRUGS.
SO SACOTA HAS BEEN INCREDIBLE ABOUT HAVING THESE AVAILABLE AT ALL THESE DIFFERENT EVENTS THEY GO TO AND HELPING TO SPREAD THE WORD.
SO WHAT WE KNOW IS THAT IF YOU DON'T HAVE THE DRUGS LYING AROUND IN YOUR MEDICINE CABINET, THEY'RE LESS LIKELY TO FALL INTO THE WRONG HANDS LIKE TEENAGERS OR OTHER PEOPLE WHO COME INTO YOUR HOUSE, AND SO WE'RE REALLY TRYING TO GET THE WORD OUT TO GET RID OF UNUSED PRESCRIPTION DRUGS.
SACOTA ALSO DEVELOPED A YOUTH PREVENTION TOOLKIT AND VIDEOS, SHARED THAT WITH REGION 20 AND OTHER ORGANIZATIONS WHO WORK WITH YOUTH, SO THESE WERE VIDEOS THAT WERE DEVELOPED BY THE YOUTH TO HELP THE YOUTH UNDERSTAND THAT IT'S DANGEROUS TO TAKE OTHER PEOPLE'S PRESCRIPTION DRUGS.
WE DID A TREATMENT MAP FOR THE COMMUNITY, WHICH I'M GOING TO SHOW YOU IN A LITTLE BIT, AND THEN VARIOUS COMMUNITY TRAININGS.
[00:25:08]
SO FINALLY THE TREATMENT WORK GROUP.WE DIDN'T REALLY KNOW ALL THE DIFFERENT SUBSTANCE USE -- GROUP MAPPED, SO I THINK THAT THE TREATMENT MAP, LOOK AT THAT.
YOU CAN GO ONTO MULTIPLE DIFFERENT WEBSITES THROUGHOUT THE COMMUNITY AND BRING THIS MAP UP, AND YOU CAN SEE -- YOU CAN CLICK ON A TREATMENT FACILITY NEAR WHERE YOU ARE AND IT BRINGS YOU TO THAT PLACE'S WEBSITE AND LETS YOU SEE THE SERVICES THAT ARE AVAILABLE AND A LITTLE BIT MORE INFORMATION.
WE REALLY DO WANT TO CONTINUE TO WORK ON THIS AND MAKE IT MORE INTERACTIVE AND MORE USER-FRIENDLY, BUT THIS IS THE FIRST TIME THE CITY OF SAN ANTONIO AND BEXAR COUNTY HAVE HAD IN ONE PLACE ALL OF THE DIFFERENT TREATMENT OPTIONS FOR SUBSTANCE USE DISORDER.
SO NOW, IF THE WIZARD OF OZ COULD TAKE ME BACK TO MY PRESENTATION... LOVE IT.
ONE OF THE UNEXPECTED CHALLENGES THAT WE DEALT WITH WAS THE FACT THAT THERE ARE SOME EMERGING TREATMENT OPTIONS, AND EVERYBODY WANTED TO BE ON THIS MAP.
AND SO WE WERE PUT INTO A POSITION OF SAYING, EITHER WE HAD TO VET TREATMENT OPTIONS OR WE HAD TO FIND SOMEBODY ELSE WHO WOULD VET THESE TREATMENT OPTIONS, AND WE DECIDED TO SAY, IF YOU ARE APPROVED BY SAMSA, BY THE FEDERAL GOVERNMENT AS AN EVIDENCE-BASED TREATMENT PROGRAM, YOU WILL BE ON THIS MAP.
OTHERWISE, YOU WILL NOT BE ON THIS MAP, BECAUSE THERE ARE SOME SNAKE OIL SALESMEN OUT THERE TRYING TO GET PEOPLE TO DO TREATMENT THAT WE DON'T KNOW WHETHER OR NOT IT WORKS.
WE ALSO -- WE'RE INVOLVED IN SEVERAL LEGISLATIVE INITIATIVES, SO YOU CAN SEE THIS IS THE BACK OF MY HEAD, THE BACK OF T.J.'S HEAD, AND THE BACK OF LIEUTENANT LUCIAS' HEAD, THE THREE OF US WENT BACK AND TESTIFIED TO THE TEXAS HOUSE SELECT COMMITTEE ON OPIOIDS, WHICH WAS A GREAT EXPERIENCE.
WE ALSO WERE INVITED BY REPRESENTATIVE MENHARES TO PROVIDE WRITTEN RECOMMENDATIONS FOR THE SELECT COMMITTEE REPORT, AND THEN COUNCILWOMAN VIAGRAN JOINED US ON THE SA TO D.C.
TRIP, WHERE SHE AND I MET WITH THE TEXAS DELEGATION AND SOME FEDERAL AGENCY LEADERS TO LET THEM KNOW ABOUT OUR TASK FORCE AND THAT WE WERE READY TO MOVE FORWARD WITH OPPORTUNITIES TO ADDRESS THIS ISSUE.
SO I WANT TO TALK REAL QUICK ABOUT TWO COMPLIMENTARY INITIATIVES THAT HAVE ARISEN AS A RESULT OF THE WORK WE'RE DOING WITH THE TASK FORCE.
FIRST IS, AS I MENTIONED, NEONATAL ABSTINENCE SYNDROME IS AN ISSUE HERE IN SAN ANTONIO, SO WE HAVE A GROUP THAT IS WORKING ON THAT.
THEY HAVE IDENTIFIED TREATMENT AND RECOVERY OPTIONS FOR THESE MOMS, AND WE ARE REALLY EXCITED TO ANNOUNCE THAT IN COLLABORATION WITH CROSS POINT, WE ARE WORKING WITH THEM AS THEY CONVERT PRIOR HOUSE FROM A MORE GENERIC RECOVERY HOUSE TO ONE THAT'S SPECIFIC TO NEONATAL ABSTINENCE SYNDROME.
SO THAT IS A REALLY GREAT OUTCOME.
AND THEN THE SECOND COMPLIMENTARY INITIATIVE IS THE SYRINGE SERVICES PROGRAM.
RECOGNIZING THAT PEOPLE WHO ARE GETTING THEIR OPIOIDS BY INJECTING DRUGS ARE ALSO PUTTING THEMSELVES AT RISK OF HEPATITIS C AND HIV.
WE WORKED REALLY CLOSELY WITH THE JUDGE, BEXAR COUNTY IS THE ONLY ENTITY IN THE STATE OF TEXAS THAT IS ALLOWED TO OFFER SYRINGE SERVICES PROGRAMS. WE'RE BASICALLY -- WHERE BASICALLY YOU CAN TAKE IN USED NEEDLES AND GIVE OUT CLEAN NEEDLES TO PEOPLE IN ORDER TO REDUCE THEIR RISK OF COMMUNICABLE DISEASE.
SO WE HAVE HAD TWO EVENTS SPECIFIC TO THAT.
ONE IS TO LET PEOPLE KNOW THAT SYRINGE SERVICES PROGRAMS ARE LEGAL HERE IN BEXAR COUNTY, AND THE SECOND IS TO HELP PEOPLE WHO WANT TO START OPERATING THESE PROGRAMS. A LOT OF FAITH-BASED ENTITIES WANT TO OFFER THIS TYPE OF SERVICE, AND SO WE HELD A HOW-TO, HOW TO START THESE PROGRAMS AND SERVICES, WHAT -- HOW DO YOU CONNECT TO THE OTHER RESOURCES IN THE COMMUNITY THAT ARE BENEFICIAL.
SO THIS IS A PICTURE OF WHAT OUR WEBSITE LOOKS LIKE, AND
[00:30:02]
OUR -- WHAT'S NEXT IS THAT IN ADDITION TO CONTINUING THE RELATIONSHIPS THAT WE'VE DEVELOPED AS A RESULT OF THIS TASK FORCE, WE THINK THAT WE NEED TO START LOOKING AT SUBSTANCE USE DISORDER, MENTAL HEALTH PREVENTION AND TREATMENT MORE BROADLY.UP HERE, BECAUSE HE IS GOING TO DO AN AMAZING JOB OF CLOSING THIS AND GIVING OUT ALL OF THE ACKNOWLEDGMENTS, WHERE ACKNOWLEDGMENTS ARE DUE, AND THEN DR. ALSAP --
I REMEMBER ABOUT THREE OR FOUR YEARS AGO I WAS SITTING IN A MEDICAL FOUNDATION MEETING WHERE JOE CRYER, WHO WE -- JOE KRIER WHO WE ALL KNOW AND LOVE WAS SUBMITTING A STRATEGIC PLAN.
DR. ALSAP WAS ON THAT AND I KNOW MARIJUANA YOU WERE -- MAYOR NIRENBERG, YOU WERE ON THAT, TOO.
WE CAN COME TOGETHER AND SOLVE BIG PROBLEMS. WE SAW IT YESTERDAY.
AND WE'RE GOING TO NEED TO FOR ECONOMIC DEVELOPMENT, FOR TRANSPORTATION, FOR HEALTHCARE.
SO THIS IS A GREAT EXAMPLE OF INSTITUTIONS COMING TOGETHER TO ADDRESS A PUBLIC HEALTH ISSUE.
JUDGE WOLFF ASKED ME TO APPEAR ON HIS BEHALF AND THANK YOU, THE CITY OF SAN ANTONIO, FOR YOUR ROLE IN FACILITATING WHAT WE BELIEVE HAS BEEN EXHIBIT A ON HOW INSTITUTIONS THE COLLABORATE TOGETHER TO TRANSFORM OUR COMMUNITY.
SEAN KENNEDY, OUR CHAMBER CHAIR, HAS MADE THIS YEAR A YEAR OF TRANSFORMATIONAL COLLABORATION AND I THINK WE'VE SEEN IT IN ACTION RIGHT HERE.
WE WANT TO PUBLICLY THANK A FEW PEOPLE BY NAME, AND BEAR WITH ME, BECAUSE THERE ARE SO MANY GOOD PEOPLE DOING GOOD WORK ON THIS.
FIRST, MAYOR NIRENBERG, FOR YOUR PARTNERSHIP ON THE TASK FORCE AND FOR YOUR LEADERSHIP OF OUR CITY.
COUNCILWOMAN GONZALES, NO ONE'S BEEN A BETTER ADVOCATE FOR THE WEST SIDE OF SAN ANTONIO.
THIS ISSUE HITS THE 78207 ZIP CODE WORSE THAN ANY OTHER ISSUE -- WORSE THAN ANY OTHER ZIP CODE, AND I KNOW THAT THIS ISSUE IS NOT ALONE IN THAT EQUITY CONCERN THAT THIS COUNCIL IS ADDRESSING.
COUNCILMAN REY SALDAÑA IS THE IGR CHAIR.
THE IGR COMMITTEE LAST WEEK SENT FORWARD TO COUNCIL STATE LEGISLATIVE AGENDA THAT INCLUDES ADVOCACY FOR MORE PREVENTION AND TREATMENT.
IN FACT, THE CHAMBER OF COMMERCE IS GOING TO ADD THAT TO THEIR STATE LEGISLATIVE AGENDA, TOO.
SO WE'RE GOING TO HAVE A UNITED FRONT, THAT THIS IS A PRIORITY, NOT JUST FOR THE COUNTY, BUT FOR THE CITY, BUT THE BUSINESS COMMUNITY AS WELL.
I WANT TO THANK CITY MANAGER SHERYL SCULLEY, JUST A TOP-SCALE TAF.
DR. BRIDGER IS A ROCK STAR IN THE PUBLIC HEALTH.
JUST YESTERDAY ROBERT WOOD JOHNSON FOUNDATION, WHICH IN HEALTH CIRCLES IS A REALLY BIG DEAL.
AND IT'S A BIG DEAL FOR US AT THE COUNTY, SO THANK YOU DR. BRIDGER.
CHIEF MCMANUS AND CHIEF HOOD, WONDERFUL OPERATIONS ALL THE WAY AROUND.
EMS CHIEF STRINGFELLOW WERE A PLEASURE TO WORK WITH, ALWAYS ANSWERED THE CALL, JEFF COYLE YOU AND YOUR TEAM, PARTICULARLY CHRISTINE WRIGHT, SALLY AND MEGAN DODGE, REALLY AGGRESSIVE INTERGOVERNMENTAL RELATIONS EFFORT WAS NECESSARY TO MAKE THIS HAPPEN.
SHE SAID $11 MILLION IN GRANT MONEY COMING TO OUR COMMUNITY, THAT DOESN'T HAPPEN BY ACCIDENT.
WE WANTED THIS TASK FORCE TO ADDRESS THESE PROBLEMS WITHOUT ASKING YOU FOR FY '19 BUDGET MONEY AND THE ONLY WAY TO DO THAT WAS AN AGGRESSIVE AND COORDINATED INTERGOVERNMENTAL EFFORT.
SO THANK YOU, JEFF, FOR YOU AND YOUR TEAM.
UNIVERSITY HEALTH SYSTEM, THE CEO, GEORGE HERNANDEZ AND OF COURSE OUR TASK FORCE COCHAIR, CHIEF MEDICAL OFFICER BRIAN ALSAP.
EVERY DAY THEY WORKED TO PROVIDE QUALITY AFFORDABLE CARE TO ALL BEXAR COUNTY RESIDENTS.
WE WANT TO THANK JALIN BURLY FOR THE CENTER OF HEALTHCARE SERVICES, THEY FIGHT THIS BATTLE DAY IN AND DAY OUT AND THEY'RE DOING SO IN AN ENVIRONMENT WHERE FEDERAL AND STATE FUNDING IS EVEN MORE AND MORE SCARCE EVERY YEAR.
WE HEARD ABOUT DR. JENNIFER POTTER WHO PUT TOGETHER THE SUBSTANCE USE SYMPOSIUM, THE GET WAIVED TAM CANE IS -- CAMPAIGN IS NOW STATEWIDE.
MARK YOUR CALENDAR, THERE'S GOING TO BE ANOTHER SUBSTANCE USE SYMPOSIUM, THIS IS GOING TO BE A SUSTAINABLE EFFORT TO KEEP OUR COMMUNITY TALKING TO EACH OTHER.
ON NOVEMBER 3RD, DR. POTTER IS DOING A -- [LAUGHTER]
>> WE'VE ALL BEEN THERE, COUNCILMAN.
ON NOVEMBER 3RD, DR. POTTER IS DOING A TED TALK ON FIGHTING THE OPIOID EPIDEMIC, AND I KNOW COUNCILMAN SALDAÑA, YOU JUST DID A TED TALK TOO, SO WE'LL LOOK FORWARD TO SEEING THAT.
[00:35:01]
CLEVELAND IN FIGHTING THE NEONATAL ABSTINENCE SYNDROME, SHE'S PUT TOGETHER WHAT IS CALLED A NEONATAL ABSTINENCE SYNDROME COLLABORATIVE.WE'RE SITTING THERE WITH YOUNG WOMEN WHO HAVE HAD THEIR CHILDREN TAKEN AWAY FROM THEM, THEY'RE TRYING TO MAKE A BETTER LIFE FOR THEIR FAMILIES AND THERE ARE A LOT OF ROAD BLOCKS IN THEIR WAY.
DR. LISA CLEVELAND MEETS WITH THEM EVERY MONTH.
REPRESENTATIVE JARAS FOR HER ADVOCACY ON HER BEHAVE.
PRICE WHOSE A CHAIRMAN OF THE COMMITTEE WE WERE TESTIFYING IN FRONT OF HE CALLED OUR TASK FORCE A STATEWIDE MODEL FOR INTERAGENCY COLLABORATION.
SPEAKER STRAUSS, APPOINTED REPRESENTATIVE MENJARES TO THIS COMMITTEE.
LISA RAMIREZ, IF YOU HAVEN'T MET HER, I HOPE YOU DO GET TO MEET HER ONE DAY. SHE'S ONE OF THE MOST DEDICATED CIVIL SERVANTS YOU'LL EVER MEET.
SHE'S BEEN AN EXCELLENT PARTNER.
DR. BRIDGER SHOWED THAT TREATMENT MAP, THERE WASN'T BEFORE THIS TASK FORCE A RESOURCE FOR SOMEONE WHO'S IN CRISIS JUST TO GOOGLE REAL QUICK TO FIND A RESOURCE FACILITY.
THE ATTORNEY GENERAL'S GOTTEN INVOLVED AND IS GOING TO SCALE OUR SEARCHABLE TOOL STATEWIDE.
OUR ENTIRE CONGRESSIONAL DELEGATIONS, PARTICULARLY LLOYD DOGGETT AND HIS STAFF, WE TALK EVERY WEEK ABOUT THE OPIOID BILL GOING THROUGH THE CONGRESSMENT THEY'RE GOING TO BE VOTING ON AN APPROPRIATION BILL NEXT WEEK.
THAT MONEY AS WE'VE SEEN CAN COME STRAIGHT TO OUR COMMUNITY.
RECENTLY, JUDGE WOLFF AND MAYOR NIRENBERG SIGNED A LETTER IN SUPPORT OF THE STOP ACT WHICH WILL ADDRESS THE FENTANYL ISSUE, AND IT PASSED THE HOUSE AND PASSED THE SENATE.
SO THANK YOU, MAYOR NIRENBERG AND JUDGE WOLFF FOR YOUR LEADERSHIP ON THAT.
THE BIGGEST FENTANYL RING IN THE COUNTRY WAS BEING RUN IN NORTHWEST SAN ANTONIO.
IT'S NOT A NATIONAL CONCERN ONLY, IT'S A LOCAL CONCERN AS WELL.
AND LAST, BUT CERTAINLY NOT LEAST WE WANT TO THANK ABIGAIL MOORE FROM SOCATA.
THEY FOUGHT ON MULTIPLE ORDINANCES.
JUST THIS MONTH, ABIGAIL WAS INVITED BY THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION TO SPEAK ABOUT THE TASK FORCE IN WASHINGTON AT NATIONAL RECOVERY MONTH.
NATIONAL MODEL FOR INTERAGENCY FOR COLLABORATION TO ADDRESS THE OPIOID EPIDEMIC.
THERE ARE MANY OTHERS TO THANK, BUT I DO WANT TO BE RESPECTFUL OF YOUR TIME.
AND I WANT TO WRAP UP ON THE CONCEPT OF INTERAGENCY COOPERATION, I LOOKED BACK THIS MORNING AT JUDGE WOLFF'S FIRST ADDRESS AS COUNTY JUDGE, 2001, COUNCILMAN SALDAÑA, YOU AND I, THINK, WERE FRESH MEN IN HIGH SCHOOL AT THAT TIME, HE SAID THE CITY AND COUNTY ARE NOT COMPETITORS, WE MUST WORK TOGETHER TO FULFILL OUR OBLIGATIONS TO OUR CONSTITUENTS.
WE'RE GOING TO CONTINUE TO DO THAT ON ECONOMIC DEVELOPMENT, ON HEALTH, ON TRANSIT AND HE'S LOOKING FORWARD TO WORKING WITH EACH AND EVERY ONE OF YOU.
THANK YOU, AND THANK YOU FOR YOUR SERVICE TO OUR COMMUNITY.
>> DR. BRIDGER: SO WITH THAT, WE ARE HERE TO TAKE ANY QUESTIONS THAT YOU HAVE.
>> MAYOR NIRENBERG: THANK YOU VERY MUCH, DR. BRIDGER AND T.J. FOR THE PRESENTATION.
I JUST WANTED TO TAKE A BRIEF PRIVILEGE AND SAY MY OWN THANK YOUS.
T.J. MAYS WAS MY CHIEF OF STAFF IN DISTRICT EIGHT, AND I REMEMBER SEVERAL YEARS AGO SITTING UP IN MY OFFICE TALKING ABOUT A PERSONAL STORY HE HAS HAD WITH PEOPLE THAT HE CARED ABOUT SUFFERING FROM, YOU KNOW, OPIOID ADDICTION, NOT ENDING VERY WELL.
AND SO I KNOW THIS HAS BEEN A PERSONAL PURSUIT FOR YOU FOR A NUMBER OF YEARS.
I'M THRILLED BEYOND BELIEF TO SEE THE WORK THAT YOU'VE DONE AND TURNING WHAT HAS BEEN A PERSONAL STORY OF TRAGEDY INTO SOMETHING THAT'S GOING TO EFFECT NOT JUST SAN ANTONIO AND BEXAR COUNTY, BUT THE STATE OF TEXAS AND EVEN BEYOND THAT.
YOU HAVE MY GRATITUDE FOR TURNING THAT INTO ACTION, AND, YOU KNOW, BEYOND THE OPIOID ISSUE, THE DEMONSTRATION THAT YOU'VE CLEARLY OUTLINED IN TERMS OF COLLABORATION BETWEEN THE CITY AND THE COUNTY WELL DEMONSTRATED AND ONE OF THE MOST IMPORTANT ISSUES THAT WE CAN BE COLLABORATING ON.
DR. BRIDGER, ALSO MY GRATITUDE FOR CONTINUING TO TELL US WHAT WE DON'T WANT TO HEAR ABOUT OUR COMMUNITY, THAT IS YOUR JOB IN MY OPINION, AND YOU'RE DOING IT QUITE WELL.
>> MAYOR NIRENBERG: BUT ALSO BEING LAUDED IN THE PROCESS, AND I DO WANT TO UNDERSCORE SOME OF THESE THINGS THAT HAVE ALREADY BECOME OUTCOMES FROM THIS WORK.
DID I HEAR YOU CORRECTLY, $11 MILLION IN GRANTS FROM FEDERAL AND STATE ON THIS ISSUE?
[00:40:01]
QUESTION AS IT RELATES TO THAT IN JUST A MOMENT.BUT ALSO THERE'S ALREADY BEEN GREAT DEMONSTRATION OF BEST PRACTICES IN DISPOSAL OF DRUGS, OPIOIDS IN PARTICULAR, EDUCATION OF PROVIDERS IN TERMS OF PRESCRIPTION OPIOID, BUT ALSO THE GET WAIVERRED TEXAS, GET WAIVERRED SAN ANTONIO, GET WAIVERRED TEXAS PROGRAM.
I JUST REALLY HAVE ONE QUESTION.
I CAN SEE WHERE SOME OF THIS IS GOING, AND IT'S BEEN A LONG TIME COMING.
I'M GLAD THAT WE'RE GETTING AHEAD OF THIS BEFORE IT BECOMES CRISES AS WE'VE SEEN IN MIDDLE AMERICA AND ON THE COASTS.
AND I REMEMBER FIVE YEARS AGO SITTING IN MY FIRST NATIONAL LEAGUE OF CITIES MEETING WHERE THEY NAMED THIS ONE OF THE -- AUDIO] -- AND I'M GLAD WE'RE HERE NOW.
BUT IN TERMS OF WHERE WE GO NEXT, WHAT ARE THE NEXT STEPS, PARTICULARLY AS ITNTS THT WE'VE ACQUIRED AND MAKING SURE THAT WE ADDRESS SOME OF THE LEADING INDICATORS? AND I VIEW ONE OF THOSE LEADING INDICATORS TO BE THE FACT THAT OUR COUNTY IS LEADING IN THE NUMBER OF OPIOID-ADDICTED BIRTHS.
>> DR. BRIDGER: SO WE WERE CONVENED AS A TASK FORCE FOR ONE YEAR TO ADDRESS THIS VERY SPECIFIC ISSUE, AND WE'VE TALKED A LOT ABOUT, OKAY, SO WHAT DO WE DO NEXT? WHERE DO WE GO FROM HERE? AND WE FEEL LIKE THE REGULARS -- RELATIONSHIPS THAT WERE CULTIVATED AS A RESULT OF THIS REALLY GREAT WORK WILL CONTINUE.
AND SO WE ARE RECOMMENDING THAT PERHAPS WE LOOK A LITTLE BIT FURTHER UPSTREAM AND LOOK AT SUBSTANCE USE DISORDER IN GENERAL AND START TO HAVE THAT CONVERSATION WITH, YOU KNOW, COUNCIL'S REQUEST, COMMISSIONERS COURT REQUEST, WE'RE NOT EXACTLY SURE WHAT THAT LOOKS LIKE, BUT THAT WOULD BE OUR RECOMMENDATION RIGHT NOW.
AND AS IT RELATES TO THE EXECUTE FOR OF THE GRANTS, THOSE ARE GOING TO BE IN LINE WITH THE FRAMES YOU JUST MENTIONED AND HOW IS THAT GOING TO WORK WITH THE TASK FORCE ITSELF THAT'S ALL ASSOCIATED WITH THOSE ORGANIZATIONS AND THEY'RE PERFECTLY CAPABLE OF MAKING THAT WORK.
>> MAYOR NIRENBERG: THANK YOU VERY MUCH.
I ALSO WANT TO THANK OUR COLLEAGUE COUNCILWOMAN GONZALES FOR BEING OUR COUNCIL LIAISON ON THE TASK FORCE, DR. BRIDGER AND ALSO OUR GRATITUDE TO JUDGE WOLFF AS WELL.
>> VIAGRAN: THANK YOU, DR. BRIDGER VERY MUCH, AND I WANT TO THANK EVERYONE FOR THE COLLABORATIVE EFFORT.
AND I THINK WHAT T.J. HAD MENTIONED, SAN ANTONIO IS A GREAT REPRESENTATION OR EXAMPLE OF COLLABORATION, ALL THE DIFFERENT ENTITIES WORKING TOGETHER AND BEING A UNITED FRONT WHEN WE'RE GOING TO THE STATE OR THE FEDERAL LEVEL.
I DO HAVE A QUESTION, YOU HAD THE WEBSITE UP.
THE WIZARD OF OZ WEBSITE, WHERE IS THAT? WHAT IS THAT WEBSITE?
>> DR. BRIDGER: SO THE BEST PLACE TO FIND IT IS ON THE SOCATA WEBSITE, CORRECT? AND YOUR WEB ADDRESS IS SOCATA.ORG.
WE'RE WORKING NOW TO CROSS LINK IT ON OTHER WEBSITES.
WE'RE WORKING ON GETTING IT ON OUR WEBSITE.
I DON'T KNOW IF IT'S ON THE HEALTH DEPARTMENT'S WEBSITE? NOT QUITE YET.
SO THIS IS HOT OFF THE PRESS, BUT YOU CAN DEFINITELY FIND IT AT SOCATA.ORG.
>> VIAGRAN: I KNOW WE'VE BEEN COLLABORATING THROUGH OUR HOMELESSNESS TASK FORCE PROJECTS AND MANY OF THE FAITH-BASED COMMUNITIES ARE ENGAGED WITH OUR HOMELESSNESS OUTREACH AND SO WE ARE ALL IDENTIFYING WHAT IS IT THAT THOSE CHURCHES OR PLACES OF WORSHIP ARE DOING AND WHICH CHURCHES ARE COVERING WHERE AND WHAT ARE THE OTHER OPPORTUNITIES? SO YOU'RE -- WHEN YOU'RE TALKING ABOUT THE SYRINGE EXCHANGES OR THE SAFE SYRINGES, THOSE ARE THINGS THAT Y'ALL ARE WORKING WITH OUR HOMELESSNESS OUTREACH AS WELL, BECAUSE IT'S ALL INTERCONNECTED SOMEHOW?
>> DR. BRIDGER: YES, ABSOLUTELY.
>> VIAGRAN: THANK YOU VERY MUCH.
I JUST WANTED TO MAKE SURE THAT WAS PART OF IT.
BECAUSE ONE OF THE TOOLS THAT WE'RE SEEING IS MANY OF THE RESIDENTS ARE JUST SCARED OF WHAT'S HAPPENING AND OBVIOUSLY BECAUSE MANY PEOPLE ARE -- SO MAYBE YOU CAN SHARE WITH US IF WE DO HAVE RESIDENTS WHO SEE PEOPLE OUT ON THE STREET WHO ARE IN -- AND I'M TAKING JUST OF THIS PART, NOT OF THE OVERALL MASSIVE [INDISCERNIBLE] WE HAVE OF OPIOID ADDICTION, THAT COULD
[00:45:01]
BE ANYBODY AND IS ANYBODY AND EVERYBODY, BUT WHEN YOU DO SEE THAT IN SOME OF OUR NEIGHBORHOODS AT STREET CORNERS OR LOITERING, WHAT IS IT THAT YOU RECOMMEND THAT WE DO? CALL THE POLICE OR CALL WHO?>> DR. BRIDGER: SO IF YOU SEE SOMEBODY WHO YOU THINK MIGHT BE OVERDOSING.
>> DR. BRIDGER: CALL 9-1-1, BECAUSE THAT'S A LIFE AND DEATH SITUATION.
WE WANT TO MAKE THAT CLEAR FOR ALL OF OUR RESIDENTS WHO HAVE THOSE QUESTIONS.
SO I THINK THIS IS A GREAT STEP, AND I'M REALLY PROUD TO HEAR WHAT WE'RE DOING WITH THE STATE AND HOW THE STATE IS STEPPING IN, AND I'M NOT SURPRISED THAT SAN ANTONIO IS ALSO LEADING BY EXAMPLE.
SO THANK YOU VERY MUCH, MAYOR.
>> MAYOR NIRENBERG: THANK YOU, COUNCILWOMAN VIAGRAN.
>> GONZALES: [INAUDIBLE] WHERE DID THOSE -- WHERE DID IT GO? I HEARD $11 MILLION IN GRANTS BUT I DIDN'T HEAR WHAT IT WENT TO FUND.
>> DR. BRIDGER: SO I'M GOING TO HAVE MY FOLKS HELP ME.
ABOUT 4.5 MILLION WENT TO UT HEALTH FOR NO LOCKS -- NALOXONE TRAINING AND DISTRIBUTION.
>> GONZALES: SO LET ME JUST ASK YOU ONE QUESTION: THAT IS A DRUG THAT IS ADMINISTERED WHILE SOMEBODY'S OVERDOSING.
>> GONZALES: AND ALL OF OUR EMS AND POLICE, PEACE OFFICERS HAVE IT WITH THEM.
>> DR. BRIDGER: SO BEFORE THE TASK FORCE, EMS HAD IT, BUT POLICE -- EXCEPT FOR THE MTAC, LIKE 20 OFFICERS THAT WERE MEDICALLY TRAINED, NONE OF THE POLICE OFFICERS HAD IT.
SO AS A RESULT OF THE WORK WE DID WITH THE TASK FORCE, NOW ALL OF THE SAPD OFFICERS WILL ALSO HAVE NALOXONE.
AND THAT'S IMPORTANT BECAUSE, AGAIN, WHEN YOU'RE SUFFERING FROM AN OPIOID OVERDOSE, YOU STOP BREATHING, SO WAITING THREE, FOUR, FIVE MINUTES FOR AN AMBULANCE TO ARRIVE ON SCENE, IF THE POLICE OFFICER CAN BE THERE IN ONE IS A MATTER OF LIFE AND DEATH.
BECAUSE THEY HAD PRESENTED TO US, I REMEMBER ASKING THIS SPECIFIC QUESTION, DID THE EMS HAVE SUFFICIENT SUPPLY, AND THEY SAID THEY HAD MORE THAN ENOUGH.
SO WAS SUPPLY EVER A CONCERN OR WAS IT JUST SIMPLY FINANCIAL AS TO WHY NOT EVERYBODY HAD IT? OR MAYBE IT'S TRAINING.
>> DR. BRIDGER: SO THE -- THERE WAS A BIT OF AN EDUCATIONAL OPPORTUNITY AROUND POLICE OFFICERS ADMINISTERING MEDICATION, AND SO WE REALLY HAD TO SHOW OTHER EXAMPLES OF WHERE THIS WAS HAPPENING AND HAVE A LOT OF REALLY GREAT CONVERSATIONS ABOUT DID THIS PUT THE OFFICERS AT ANY SORT OF RISK.
AND RECOGNIZING THAT IF AN OFFICER OR IF I COME ACROSS SOMEBODY WHO I THINK IS OVERDOSING AND I ADMINISTER NALOXONE, IF THEY'RE NOT OVERDOSING, THE FACT THAT I'VE ADMINISTERED NALOXONE CAUSES THEM ABSOLUTELY NO HARM.
AND SO WE HAD TO DO A LITTLE BIT OF CONVERSATION AND EDUCATION AROUND THAT BEFORE THE POLICE OFFICERS FELT COMFORTABLE CARRYING MEDICATION AND ADMINISTERING IT.
GOGO AHEAD, AND THEN YOU SAID 4 MILLION WENT TO TRAINING AND TO --
>> DR. BRIDGER: SO HELP ME OUT WITH REST OF THE -- DR. ALSAP THANK YOU.
CAN WE REMEMBER OFF THE TOP OF OUR HEAD.
>> GOOD AFTERNOON MAYOR, COUNCILMEMBERS, CITY MANAGER SCULLEY, THE QUESTION WAS ABOUT 4.5 WENT TO TTOR, TEXAS [INDISCERNIBLE] OPIOID RESPONSE SPECIFICALLY DESIGNED TO GET NALOXONE INTO THE FIRST RESPONDERS AND THE COMMUNITY MEMBERS ALSO.
TO YOUR POINT EARLIER, IT'S NOT JUST WE HAD OUR EMS FOLKS WHO DID HAVE IT.
IN FACT, IT COMES IN VARIOUS FORMS, EMS EITHER USES AN INJECTABLE OR INTRAVENOUS, BUT THIS NASAL FORM IS REALLY WHAT MAKES IT MORE PALATABLE FOR THE GENERAL PUBLIC.
THAT WAS WHAT WAS PURCHASED IN MASS TO GET TO THE LARGEST COMMUNITY.
THE SECOND APPROACH WAS SPECIFICALLY FOR FIRST RESPONDERS, AND THE THIRD AMOUNT -- IT WAS ABOUT 10 MILLION OR JUST SHY OF 8 MILLION, AND THEN ABOUT 3 MILLION.
THE 3 MILLION ACTUALLY IS GOING TO BE GOING TOWARD THE NEONATAL ABSTINENCE SYNDROME PROJECT.
SO IN TOTAL OF ABOUT $11 MILLION THAT ARE COMING INTO THIS COMMUNITY TO DEAL WITH REVERSAL OF OVERDOSES AND TREATMENT AND MANAGEMENT OF -- AND PREVENTION OF MOTHERS WHO BECOME ADDICTED AND ADDRESSING THOSE CHILDREN.
AND SO -- THAT WAS WHAT MY NEXT QUESTION REGARDING THE
[00:50:02]
NEONATAL ABSTINENCE, SO I'LL START WITH THAT QUESTION AND I'M -- I'LL COME BACK TO YOU, DR. BRIDGER.SOLIS SAN ANTONIO CLEVELAND -- IS LISA HERE?
>> GONZALES: I WAS WONDERING, GOD, I DON'T THINK THAT'S LISA.
SO MY QUESTION, WE HAD MET A COUPLE OF TIMES ABOUT THE NEONATAL AND T.J. BROUGHT DR. CLEVELAND OVER TO TALK ABOUT THIS ISSUE, AND MY THOUGHT WAS JUST GIVEN THE SMALL NUMBER OF CHILDREN THAT WE COULD ADDRESS IT, YOU KNOW, THAT WE TALKED ABOUT TWO TO 300 BABIES BORN A YEAR.
YOU KNOW, SOMETIMES GIVEN THE LARGE SCOPE OF OUR CITY WE THINK WE CAN'T MAKE AN IMPACT.
BUT WHEN WE'RE TALKING ABOUT A SMALL POPULATION, I FEEL LIKE WE AS A CITY CAN GET TOGETHER AND RALLY AROUND THIS SMALL POPULATION, JUST LIKE WE DID FOR VETERAN HOMELESSNESS, JUST LIKE WE'VE DONE FOR CHILD ABUSE IN THE 07 ZIP CODE, AND NOW ALSO FOR THE NEONATAL ABSTINENCE SYNDROME.
FUNDING, AND SO DID THAT FUNDING TAKE CARE OF THAT -- THAT INCLUDED THE HOUSING AND THE TREATMENT? AND I THINK THAT WAS JUST 11 MOMS AND BABIES THAT THAT COULD TAKE CARE OF, OR WAS IT MORE?
>> I THINK IT WAS 15 WAS THE ORIGINAL TARGET.
AS A -- THE WORST END POINT, THE POPULATION'S RELATIVELY SMALL, BUT IF YOU THINK ABOUT WHAT'S UPSTREAM OF A CHILD THAT IS BORN WITH WITHDRAWAL SYMPTOMS TO A MOTHER WHO'S ADDICTED, THINK ABOUT THOSE WHO ARE BEHIND THAT IN TERMS OF WHO HAS SUBSTANCE ABUSE PROBLEMS AND WHO ALSO HAVE ACCESS TO EITHER OPIOIDS OR ELICIT HER RIN OR EVEN FENTANYL -- HEROIN OR EVEN FENTANYL NOW BECAUSE YOU CAN GET IT OVER THE WEB, SO THAT IS A LARGER ISSUE.
SO NOT ONLY MAKING TREATMENT AND HOME RESOURCES AVAILABLE FOR THOSE MOMS WHO ARE ALREADY IDENTIFIED AS GIVING BIRTH AND MAKING SURE THE KIDS SURVIVE, BECAUSE IN OUR NICU, WE SEE THESE BABIES, BUT ALSO TRYING TO IDENTIFY THOSE WHO ARE CURRENTLY HAVING ISSUES AND AREN'T IN ANY FORM OF TREATMENT.
>> GONZALES: SO FOR BOTH THE PRENATAL -- BECAUSE I KNOW THAT IN DR. CLEVELAND'S RESEARCH, THAT IT IS BEST FOR THE BABY AND THE MOTHER TO STAY TOGETHER, AND CURRENTLY THE ONLY OPTION IF A BABY WAS BORN ADDICTIVE WAS THAT IF THE BABY WAS IMMEDIATELY REMOVED AND THE MOTHER WAS LEFT WITH NO RESOURCES.
SO SHE'S NOT PUT IN TREATMENT, SHE'S NOT GIVEN ANY OPTIONS AND THE BABIES ARE TAKEN AWAY, AND THAT WAS LEADING TO TERRIBLE OUTCOMES FOR BOTH THE MOTHER AND THE CHILD.
SO GIVING THEM A PLACE TO GO TOGETHER THAT THEY CAN HEAL AND RECOVER FULLY TO TRY TO FULLY RECOVER, THAT DOES NOT INCLUDE MEDICAL EXPENSES, I SUSPECT TO TAKE CARE OF THE BABY WHILE THEY ARE IN HOSPITAL.
IT'S JUST FOR THE SERVICES AFTERWARDS?
>> YEAH, ALTHOUGH DEPENDING ON MOST CHILDREN IN TEXAS, EVEN THOUGH MEDICAID HAS NOT EXPANDED, MOST BABIES AND BABIES ARE COVERED FOR IN-HOSPITAL CARE.
THE CONCERN THAT YOU HAVE IS WHAT'S BEYOND THAT.
SO THE TREATMENT SERVICES WOULD BE COVERED, AND FOR A PERIOD OF TIME POST PAR TEM, MOM AND BABY STILL GET COVERAGE AS WELL, BUT THAT DOESN'T SOLVE THE LARGER ISSUE.
>> GONZALES: SO WHAT HAPPENS FROM THE LEGAL PERSPECTIVE BECAUSE THERE WAS A LEGAL COMPONENT THAT CPS WOULD AUTOMATICALLY REMOVE THE CHILD.
>> THERE'S A COUPLE OF ISSUES THERE.
ONE, THERE'S NOT A UNIFORM APPLICATION OF THE LAW FROM CPS OFFICER TO CPS OFFICER, SOMETIMES THE BABY WOULD BE TAKEN AWAY, SOMETIMES IT'S NOT.
WE REPRESENTED REPRESENTATIVE MENJARES EARLY E SHE SAID WHAT CAN WE DO AT THE NEXT LEGISLATIVE STATION TO CORRECT THIS PROBLEM AND WE'RE COLLABORATING WITH HER RIGHT NOW TO WRITE LEGISLATION TO SOLVE THAT SPECIFIC PROBLEM.
>> GONZALES: WHAT CAME UP IS WHO'S TESTED? RIGHT, SO ONLY WOMEN WHO WERE ON MEDICAID WERE TESTED, RIGHT? ONLY WOMEN -- I KNOW I'VE GIVEN BIRTH THREE TIMES RECENTLY, I WAS NEVER TESTED FOR OPIOIDS, AS FAR AS I KNOW.
SO HOW DO THEY DETERMINE WHO'S TESTED, GIVEN THE RANGE OF POTENTIAL COMPLICATIONS THAT A CHILD MAY OR MAY NOT EXPERIENCE?
>> ARE YOU ASKING WHO'S TESTED.
>> I'LL TELL YOU, LAURA MAYS IS MY WIFE, SHE WORKS FOR JEFF, SHE WAS NOT TESTED EITHER.
>> GONZALES: SO WHO'S GETTING TESTED.
THAT'S ONE THING WE SHOULD EXPLORE LEGISLATIVELY.
BECAUSE IF GIVEN MORE DISCRETION, THE AGENCIES WILL -- SO IF WE TAT -- ATTACK IT FROM THE LEGISLATIVE LEVEL, THERE WILL BE A LOT LESS CONFUSION DOWNSTREAM.
>> GONZALES: YOU KNOW, IT MAY BE BEYOND OUR PAY GRADE, BUT I HOPE THAT WE'LL ADDRESS THOSE ISSUES AS WELL, BECAUSE THERE WAS ALSO SOME DISCRIMINATION IN WHO WAS HAVING THEIR BABIES REMOVED.
>> SO I WILL SAY COUNCILWOMAN, THAT IN OTHER AREAS OF THE COUNTRY, SOME OF THE ONES THAT DR. BRIDGER
[00:55:02]
SHOWED OP THE MAP THAT ARE KIND OF THE EPICENTER FOR THIS, INAPPA LAY SHA, THERE ARE ROUTINE SCREENING OF PREGNANT WOMEN FOR OAPOIDS.THAT'S NOT NATIONWIDE, BUT LIKE ANY EPIDMMIC.
>> GONZALES: SO OTHER QUESTIONS I HAD WERE THE GRAPHS THAT YOU SHOWED.
I DON'T UNDERSTAND YOUR GRAPHS, COLLEEN.
HOW HAS THE EPIDEMIC CHANGED? WHAT IS THE PEAK AND THEN THE VALLEY.
YOU HAVE THAT KIND OF THREE TIMES.
THERE'S THE PEAK AND THEN IT COMES DOWN AGAIN.
>> SO BASICALLY IT'S SHOWING WHEN THE DEATHS ARE HAPPENING.
SO THIS FIRST ONE SHOWS THAT IN 2000 THE DEATHS WERE PRIMARILY OCCURRING AROUND 40 YEARS OF AGE.
AND THE Y AXIS IS THE NUMBER OF DEATHS.
AND IT'S JUST SHOWING THAT THIS IS GOING UP OVER TIME AND IT'S EXPANDING OVER TIME.
THANK YOU FOR CLARIFYING THAT, THOSE GRAPHS.
AND I THINK THE FINAL QUESTION THAT I HAVE -- MAYBE THE REST IS JUST COMMENTS.
YOU KNOW, MY RELUCTANCE TO -- WHEN I SAW THE TASK FORCE AND WHERE IT WAS MOVING -- AND I MENTIONED THIS TO YOU AND THE MAYOR THAT I THOUGHT IT WAS TOO PROFESSIONAL AND THAT IT WAS TARGETED MOSTLY AT THE MEDICAL INDUSTRY AND, OF COURSE, AT THE SAME TIME ONLY TARGETING OVERDOSES OR DEATHS.
AND I WAS VERY CONCERNED THAT THAT WOULDN'T HAVE AN IMPACT ON WHAT WE WERE SEEING IMMEDIATELY IN OUR COMMUNITIES, BECAUSE WHAT WE SEE A LOT, AND I CALLED JUST YESTERDAY 9-1-1.
I SAW A WOMAN PASSED OUT IN AUDIO].
SHE WAS PANTLESS FROM THE WAIST DOWN AND SHE HAD SCRATCHES ALL OVER HER BODY AND SHE WAS LYING ON THE FLOOR JUST A FEW BLOCKS AWAY.
AND I CALLED IMMEDIATELY 9-1-1 -- I'M SORRY.
I CALLED THE CHIEF BECAUSE I WAS CLOSE BY.
AND AS I APPROACHED HER I FELT NOT SAFE, AND SO I LEFT.
AND I'M SO HAPPY TO SEE THAT THERE IS MOVEMENT AND THAT WE WERE ABLE TO IMPACT PEOPLE IMMEDIATELY.
BECAUSE MY CONCERN WAS IT JUST TAKES TOO LONG AND WE DON'T HAVE TIME.
I MEAN, AND EVEN THE FACT THAT WE WERE TARGETING ONLY DEATHS CONCERNED ME AS WELL, BECAUSE WHAT IS HAPPENING TO THE PEOPLE HERE TODAY.
AND I WAS LOOKING FOR A LAW ENFORCEMENT COMPONENT AND I DIDN'T SEE THAT.
AND THEN PERHAPS I WAS WRONG IN THAT APPROACH THAT I FELT THAT THERE NEEDED TO BE A LAW ENFORCEMENT COMPONENT.
AND MAYBE THERE DOESN'T NEED TO BE A LAW ENFORCEMENT COMPONENT HANDLING IT THIS WAY.
IT SEEMS TO HAVE A REALLY GOOD IMPACT.
AND BY GETTING THE FUNDING WE NEED MAYBE THAT'S THE RIGHT RESPONSE VERSUS A KNEE-JERK REACTION TO HAVE GREATER POLICE INVOLVEMENT.
AND I WOULD JUST LOOK FORWARD TO HAVING MORE CONVERSATIONS ABOUT THIS SERVICE PROGRAM, ESPECIALLY AS WE'RE REDEVELOPING THE GUADALUPE PLAZA.
WE KNOW THAT WE'RE ACTIVELY NEEDING MORE PROGRAMMING THERE, BUT ONE OF THE ISSUES WE WERE SEEING IN THE PLAZA AND WHY PEOPLE FELT IT WAS SO UNSAFE IS BECAUSE THERE WERE NEEDLES EVERYWHERE.
I HAD GONE ON A MONDAY MORNING TO TAKE SOME PHOTOGRAPHS WITH MY CHILDREN.
WE WERE DOING OUR CHRISTMAS PICTURES AND THERE WERE NEEDLES EVERYWHERE.
I THOUGHT, SHOULD WE LEAVE? I DON'T THINK THIS IS SAFE.
WOULD A PROGRAM LIKE THIS RESOLVE -- PERHAPS RESOLVE SOME OF THE ISSUES OF HAVING NEEDLES THROWN IN PUBLIC SPACES?
BECAUSE FOR EVERY PLACE THAT'S GIVING OUT UNUSED NEEDLES WE'RE GOING TO HAVE THREE OR FOUR PLACES WHERE PEOPLE CAN RETURN USED NEEDLES.
THAT'S SOMETHING WE WANT TO MAKE SURE WE HAVE IN PLACE IS THAT INFRASTRUCTURE WHERE PEOPLE CAN BRING THE USED NEEDLES AND DROP THEM OFF.
>> AND I IMAGINE THERE'S OTHER PROGRAMS OUT THERE.
THERE'S SOME OTHER SERVICE ASSOCIATED WITH IT.
>> CONNECTION TO TREATMENT, YES, MA'AM.
>> GONZALES: WE'LL LOOK FORWARD TO EXPLORING THAT AS WE
[01:00:02]
DEVELOP ACTIVITY AROUND THE PLAZA.>> MAYOR NIRENBERG: THANK YOU, COUNCILWOMAN GONZALES.
>> SANDOVAL: THANK YOU, MAYOR.
DID ALL THREE COUNCILWOMEN GO IN A ROW? THAT'S RARE.
I WANT TO THANK COUNCILWOMAN GONZALES FOR YOUR WORK ON THE TASK FORCE AND YOU, DR. BRIDGER.
IT SOUNDS LIKE YOU HAVE HAD A SUCCESSFUL YEAR.
I DO -- I THINK SOMEONE EXPRESSED THE THOUGHT OF WHAT'S GOING TO HAPPEN NOW.
SOME OF THE WORK WILL BE CARRIED ON BUT I THINK THE REAL CONCERN IS HOW DO WE KNOW WE'RE STILL MAKING PROGRESS AUDIO].
DO YOU HAVE ANY RECOMMENDATIONS ON HOW WE CAN DO THAT? LIKE A REPORT TO COUNCIL.
>> TJ LOOKS LIKE HE HAS AN IDEA.
>> SANDOVAL: THANK YOU TOO, TJ.
SO IN JUNE OF THIS YEAR THERE WAS A GRANT THAT THE COUNTY APPLIED FOR THAT WOULD FUND A FULL-TIME EMPLOYEE WHO WOULD WORK ON THIS ONLY.
AND I WAS HOPING THAT WE WOULD HAVE GOTTEN WORD FROM THE JUSTICE DEPARTMENT WHETHER WE GOT THAT GRANT BEFORE 2:00 TODAY, BUT WE HAVE NOT.
SO PLAN A IS WE HAVE A FULL-TIME EMPLOYEE WORKING AT THE COUNTY WHOSE JOB IT IS TO DO WHAT I HAVE BEEN DOING FOR A YEAR, WHICH IS A FULL-TIME JOB.
AND THEN, YOU KNOW, KIND OF PLAN B IS WE CONTINUE TO MEET SORT OF THE PRINCIPLES FROM ALL THESE AGENCIES WHO ARE REALLY ACTIVE.
AS THIS MONEY FLOWS IN FROM WASHINGTON WE NEED TO BE COORDINATED.
AND WE HAVE SORT OF A HANDSHAKE AGREEMENT AMONGST THOSE ENTITIES THAT WE ARE GOING TO GET TOGETHER ON A CONFERENCE CALL IF WE NEED TO.
>> THE ONLY THING I WOULD ADD TO THAT, COUNCILWOMAN, THERE'S A SMALLER METRIC TO FOLLOW.
OBVIOUSLY WE SEE A REDUCTION IN THAT, THAT'S GREAT.
BUT I WOULD ALSO LIKE TO SEE SOME OF THE LEADING INDICATORS THAT WE HAVE DEVELOPED.
CAN WE HAVE MORE OF THOSE TREATMENT CENTER AVAILABLE? IS THAT SITE READILY AVAILABLE TO PEOPLE? ARE PEOPLE USING THE DROP BOXES THAT WE'RE NOW PUTTING OUT ON THE STREETS.
AT THE CLINICAL/PROVIDER LEVEL, ARE THEY USING THE PDMP? CAN WE MEASURE SOME OF THE PRESCRIPTIONS BEING AUDIO] THAT I BELIEVE WILL CONTINUE IRRESPECTIVE OF THAT AND I THINK VERY IMPORTANT THAT COULD BE SHARED WITH COUNCIL OR COMMISSIONERS COURT OR OTHERS.
I WAS GLAD TO HEAR THAT ALL OF PD HAD BEEN TRAINED ON THE USE OF NALOXONE.
I THINK THAT'S GREAT PROGRESS.
AND SO NOW THEY HAVE ENOUGH TO CARRY WITH THEM ALL OF OUR OFFICERS, SAPD --
>> SANDOVAL: BY THE END OF DECEMBER.
I GUESS THAT'S SOMETHING WE'LL HAVE TO BE BUDGETING FOR IN FUTURE YEARS?
>> SANDOVAL: WE'RE OKAY FOR NOW?
>> THERE'S PLENTY OF GRANT FUNDING FOR NALOXONE.
IT'S AN EVIDENCE-BASED INTERVENTION THAT EVERYBODY'S ON BOARD WITH.
AND SO THERE'S AN INCREASE IN FUNDING COMING FROM THE FEDERAL GOVERNMENT SPECIFIC TO NALOXONE.
SO I THINK WE'LL BE IN A GOOD POSITION TO BRING THOSE GRANT DOLLARS IN FOR THE MEDIUM FUTURE.
>> SANDOVAL: CAN YOU TELL ME THE NUMBERS AGAIN.
HOW MANY INTERVENTIONS HAVE WE HAD WITH NALOXONE IN THE PAST YEAR AS A RESULT OF THE WORK OF THE TASK FORCE?
>> HOW MANY DOSES OF NALOXONE? WE DON'T KNOW THAT YET.
>> WELL, THE ORIGINAL ORDER WAS FOR 25,000 DOSES.
WE WANT TO MAKE SURE THAT FIRST RESPONDERS HAVE IT.
BUT COMMUNITIES THAT HAVE DEALT WITH THIS HAVE THOSE IN THE HANDS OF TRAINED COMMUNITY MEMBERS.
SO THE EXAMPLE THAT WAS MENTIONED EARLIER BY THE COUNCILWOMAN THAT SOMEONE -- THAT'S WHAT SAVES LIVES IS SOMEONE WHO KNOWS THAT INDIVIDUAL AND HAS ACCESS TO THAT MEDICATION.
THAT BUYS YOU ENOUGH TIME TO REVERSE THE EFFECTS OF A WITHDRAWAL.
THAT PERSON WILL SURVIVE BY THE TIME AN AMBULANCE GETS THERE.
IN MANY AREAS OF THE COUNTRY WHERE THEY HAVE DONE THIS IT'S ANOTHER STANDARD PRACTICE WHEN YOU PRESCRIBE OPIOIDS, PARTICULARLY FOR LONG-TERM PAIN OR CHRONIC PAIN.
IF IT'S INDICATED TO ACTUALLY PRESCRIBE NARCAN WITH THAT.
YOU'RE ACTUALLY GIVING THAT SAME ANTI-DOTE TO SOMEONE, OR AT LEAST A FAMILY MEMBER WHO ACTUALLY KNOWS HOW TO USE IT.
I ALSO WANT TO ASK A LITTLE BIT ABOUT THE NEONATAL ABSTINENCE SYNDROME.
EVEN THOUGH WE'RE THIRD IN THE NUMBER OF DEATHS, WAS THAT STATEWIDE FROM OVERDOSES, WE ARE
[01:05:02]
NUMBER ONE WHEN IT COMES TO THE SYNDROME.WHY DO YOU THINK THAT DISPARITY IS THERE?
>> WELL, AGAIN, REMEMBER NEONATAL ABSTINENCE SYNDROME DOESN'T ALWAYS RESULT IN DEATH.
SO WHAT THAT SAYS TO ME IS WE HAVE A HIGH RATE OF SUBSTANCE USE DISORDER AMONG OUR ENTIRE POPULATION.
AND SO THAT'S WHY I'M HOPING WE CAN LOOK MORE UPSTREAM AT SOME OF THE PREVENTION AND TREATMENT OPTIONS THAT ARE JUST SPECIFIC TO SUBSTANCE USE DISORDERS IN GENERAL AND BROADEN THE SCOPE A LITTLE BEYOND JUST THOSE FOLKS WHO ARE OVERDOSING TO THOSE FOLKS WHOSE LIVES ARE BEING DICTATED BY THEIR NEED TO FIND SUBSTANCES.
IS THAT STATISTIC A RATE OR IS IT ABSOLUTE NUMBERS FOR NEONATAL ABSTINENCE SYNDROME .
THE RATE PUTS US AT THE HIGHEST BUT ALSO ONE-THIRD OF THE TOTAL BIRTHS TO THESE BABIES ARE HAPPENING HERE IN BEXAR COUNTY.
SOMETHING I DIDN'T UNDERSTAND IS YOU MENTIONED A FEE WAIVER WAS REQUIRED IN ORDER TO PROVIDE TREATMENT.
IT SEEMS COUNTERINTUITIVE TO ME THAT YOU WOULD NEED A -- NOT A FEE WAIVER, SORRY.
IT WAS ONE OF THE THINGS HOPEFULLY TO BE ADDRESSED IN THE FEDERAL LEGISLATION, WHICH HAS NOT BEEN FINALIZED.
BOTH THE HOUSE AND SENATE HAVE PASSED THEIR VERSIONS BUT THEY HAVE TO GET TOGETHER AND RECONCILE.
ONE OF THOSE IS TO REMOVE THIS WAIVER REQUIREMENT.
IF I WANTED TO POTENTIALLY PRESCRIBE SOMETHING, THERE'S THREE DRUGS THAT ARE USED IN TREATMENT OF SUBSTANCE ABUSE DISORDER FOR OPIOIDS.
THE ONE PEOPLE THINK ABOUT ARE METHADONE.
THAT'S SOMETHING YOU CAN OPEN UP AND DO ON YOUR OWN.
THEY'RE VERY STRICT IN TERMS OF HOW THEY ARE MANAGED APPROPRIATELY SO.
THE MOST COMMON FORM BEYOND THAT THAT IS BEING USED BY PROVIDERS IN COMMUNITIES IS USING A DRUG CALLED SABOXONE.
YOU STILL NEED A WAIVER TO USE THIS DRUG.
YOU HAVE TO HAVE A CERTAIN AMOUNT OF TRAINING AND GET A CERTIFICATE AND SO FORTH.
AND YOU NEED TO BE COMMITTED TO MAKING SURE YOU HAVE ADDITIONAL RESOURCES AVAILABLE, LIKE COUNSELING, RATHER THAN JUST PRESCRIBING MEDICATION.
THE BENEFIT THAT HAS OVER METHADONE, INSTEAD OF HAVING TO GO TO A METHADONE CLINIC ONCE A DAY FOR THE DURATION OF MY TREATMENT, I CAN GET TWO WEEKS, SIX WEEKS, MAYBE EVEN TWO MONTHS OF A SUPPLY DEPENDING ON THE NATURE OF MY DISORDER, AND IT MAKES IT EASIER TO DISTRIBUTE THAT.
YOU CAN IMAGINE THE BENEFITS IN A RURAL COMMUNITY.
A LOT OF THOSE ISSUES WERE IN A RURAL COMMUNITY.
IT'S HARD TO GET TREATMENT IF YOU HAVE TO GO TO A PLACE THAT'S 100 MILES AWAY.
HOPEFULLY THE FEDERAL LEGISLATION IS GOING TO REMOVE THAT REQUIREMENT SO THAT PROVIDERS CAN ACTUALLY PRESCRIBE THIS IN MUCH WIDER CAPACITY.
AND SO IT'S AVAILABLE MUCH MORE BROADLY IN THE COMMUNITY.
THERE ARE SOME AREAS OF THE COUNTRY THAT HAVE DONE THIS WHERE THEY HAVE INITIATED SABOXONE IN EMERGENCY DEPARTMENTS AND THERE ARE OTHER PRIMARY CARE PROVIDERS THAT WANT TO DO THIS.
IT'S A BARRIER TO DOING THE RIGHT THING.
I'M HOPEFUL THAT THE FEDS CAN GET RID OF THAT BECAUSE IT OPENS THE WINDOW FOR US TO TREAT IT.
>> SANDOVAL: GLAD TO SEE -- IS THAT PART OF OUR LEGISLATIVE AGENDA AS WELL?
DR. BRIDGER, YOU MENTIONED THE TASK FORCE BEING ONE THAT LIKE TO USE MAPS.
THEY GIVE US INFORMATION WE DON'T ALWAYS SEE WITH TABLES AND CHARTS.
YOU DIDN'T SHOW US THE MAP OF DISTRIBUTION OF CALLS FOR SERVICES ASSOCIATED WITH THIS.
I JUST WANT TO KNOW WHAT YOU GLEANED FROM THAT.
>> SO THAT MAP HELPED US UNDERSTAND THE EXTENT TO WHICH IT'S BEING USED AND THAT THERE ARE A FEW HOT SPOTS THROUGHOUT THE CITY WHERE IT'S BEING USED MORE.
AND SO THIS WILL HELP US AS WE CONTINUE TO THINK ABOUT, ESPECIALLY TREATMENT SERVICES, HELP THE CENTER FOR HEALTHCARE SERVICES, FOR EXAMPLE, IF THEY ARE DECIDING WHERE TO PLACE THEIR NEXT TREATMENT FACILITY TO PUT IT IN THOSE AREAS THAT SEEM TO HAVE THE HIGHEST NEED.
AND IF YOU WOULD LIKE THOSE MAPS I'LL GET THEM FOR YOU.
>> SANDOVAL: WOULD LOVE TO SEE IT.
[01:10:01]
>> MAYOR NIRENBERG: THANK YOU, COUNCILWOMAN SANDOVAL.
>> COURAGE: IT'S COMMENDABLE THE WORK YOU'VE DONE SO FAR.
I THINK IT'S REALLY ADDRESSING THE PROBLEM THAT WE'RE SEEING WITH OPIOIDS VERY DIRECTLY.
I'M WONDERING, THOUGH, HOW MUCH WE'RE LOOKING AT USING OTHER PARTNERS IN THIS.
FOR EXAMPLE, THERE'S A LOT OF WHAT WE CALL DELEGATE AGENCIES, A LOT OF NONPROFITS THAT ARE WORKING IN RELATED AREAS.
AND ALSO WE'VE LOOKED AT THIS FROM BEXAR COUNTY AND THE CITY OF SAN ANTONIO.
BUT WHAT ABOUT ALL OF THE OTHER CITY AND COMMUNITIES THAT HAVE THEIR OWN POLICING DEPARTMENTS, THINGS LIKE THAT.
ARE WE WORKING THROUGH AACOG TO BRING THEM IN TO A PARTNERSHIP ARRANGEMENT AND FOLLOWING THROUGH ON ALL OF IT?
>> THE SHORT ANSWER IS YES, BUT TJ IS GOING TO GIVE YOU A LITTLE MORE DETAIL.
JUDGE WOLFF WOULD BE NOT HAPPY IF I DIDN'T SAY THIS.
HE MEETS WITH THE MAYORS AND CITY MANAGERS OF ALL 27 SUBURBAN CITIES IN BEXAR COUNTY ON A QUARTERLY BASIS.
MEAGAN DODGE USUALLY ATTENDS ON BEHALF OF THE CITY.
AND WE HAVE BRIEFED THEM AND THEIR POLICE CHIEFS ABOUT ALL OF THE NARCAN FUNDING THAT'S AVAILABLE, ABOUT TASK FORCE, ABOUT WHAT ROLE THEY COULD PLAY, AND ALSO THE SCHOOL DISTRICTS HAVE BEEN INVOLVED TOO.
SO WE ARE CONSTANTLY REACHING OUT TO THE ENTITIES THAT YOU HAVE DESCRIBED.
THANK YOU, COUNCILMAN COURAGE.
DR. ALSAP AND DR. BRIDGER, TJ, THANK YOU VERY MUCH FOR THE PRESENTATION.
>> MAYOR NIRENBERG: THAT'S IT?
[Executive Session]
IN TERMS OF PRESENTATIONS THIS AFTERNOON, BUT WE DO HAVE A SHORT EXECUTIVE SESSION.>> MAYOR NIRENBERG: THANK YOU.
THE TIME IS NOW 3:30 P.M. ON THIS 19TH DAY OF SEPTEMBER, 2018.
PURSUANT TO THE AUTHORITY GRANTED BY CHAPTER 551 IN THE TEXAS GOVERNMENT CODE, TEXAS OPEN MEETINGS ACT, THE CITY COUNCIL WILL NOW RECESS INTO EXECUTIVE SESSION TO DISCUSS ECONOMIC DEVELOPMENT NEGOTIATIONS PURSUANT TO TEXAS GOVERNMENT CODE SECTION 551.087, ECONOMIC DEVELOPMENT.
THE PURCHASE, EXCHANGE, LEASE, OR VALUE OF REAL PROPERTY PURSUANT TO TEXAS GOVERNMENT CODE SECTION 551.072, REAL PROPERTY.
SETTLEMENT OFFER IN A LAW STYLED LAILSON V. CITY OF SAN ANTONIO PURSUANT TO TEXAS GOVERNMENT CODE SECTION 551.071, CONSULTATION WITH ATTORNEY.
* This transcript was compiled from uncorrected Closed Captioning.