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CITY USE OF OPIOID SETTLEMENT FUNDS
FUNDING AND MANAGEMENT AGREEMENT
BETWEEN
THE CITY OF MUSKEGON
AND
THE COUNTY OF MUSKEGON
THIS AGREEMENT made and entered into by and between the CITY OF MUSKEGON,
a municipal corporation and political subdivision of the State of Michigan, 990 Terrace St,
Muskegon, Michigan 49442, hereinafter referred to as the “City’), and The County of
Muskegon (hereinafter referred to as the “Recipient”). Collectively, the signatories are referred
to as the Parties, and individually, as a Party.
RECITALS:
WHEREAS, the City has received and will continue to receive funding from defendants
of the national opioid litigation (the “Opioid Litigation’) and the resulting settlement of which the
City was participant. The City’s claims formed part of the basis of the national settlement and
payments to plaintiffs from defendants, with some payments scheduled to continue until ca. 2040
(“Settlement Payments’). The Opioid Litigation parties have agreed to the described Settlement
Payments subject to the ongoing financial viability of each of the Opioid Litigation defendants.
The Opioid Litigation settlement provides for the Settlement Payments to be expended for
enumerated treatment and prevention programs and services; and
WHEREAS, the Recipient developed and adopted a Plan of Implementation (the “Plan”)
that prescribes how it will allocate the settlement funds for programs, services, targeted
audience, intended outcomes and entities who will receive funding. Prior to adopting the Plan,
the Recipient received input and review of the Plan from outside third parties and concurrence
on the Plan; and
WHEREAS, the City has determined that the Recipient has the capacity to initiate and
coordinate programs eligible for the use of Settlement Payments; and
WHEREAS, the Recipient operates or collaborates with a variety of programs for which
opioid settlement funds can be used, and possesses the expertise or connections necessary to
utilize the funds most efficiently; and
WHEREAS, the City has determined to grant funding to the “Recipient” and the funding
will be directed to the Recipient's Opioid Settlement Funding grant program. Eligible
organizations shall use the funds to support the development, implementation, enhancement, or
expansion of opioid prevention, harm reduction, treatment, and recovery programs and services
for the benefit of City of Muskegon residents (the “Program’). Funding will be provided in amount
not less than Five Hundred and 00/100 Dollars ($500.00) on a quarterly basis (the “Award
Amount’); and
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WHEREAS, no more than five percent (5%) of the Award Amount shall be allocated by
Recipient toward its administrative expenses, including reporting requirements; and
WHEREAS, the City has determined that the Program is consistent with the abatement
strategies set forth in the Opioid Litigation settlement List of Opioid Remediation Uses, attached
hereto as Exhibit B (originally marked Exhibit “E” in the settlements); and
WHEREAS, the Parties understand and acknowledge by executing this Agreement the
City will not provide additional funding in excess of the Award Amount, and any costs of the
Program, including any overruns or other expenses not expressly agreed to in writing prior to
the expenses being incurred, will not be a liability on the part of the City, and will be the sole
responsibility of the Recipient; and
WHEREAS, the Recipient, a qualified and experienced provider of the services herein.
NOW, THEREFORE, for and in consideration of the mutual covenants hereinafter
contained, IT IS HEREBY AGREED as follows:
1. Term and Termination. This Agreement shall commence on its effective date and
continue until it expires or is terminated as provided for herein.
A. Effective Date. This Agreement shall become effective on the date (the “Effective
Date’) that all of the following has occurred: (i) the approval of the Plan by the Board of
Commissioners of the Recipient; (ii) the approval by the governing body of the City; (iii)
the execution by an authorized officer of the City; and (iv) the execution by an authorized
officer of the Recipient.
B. Term and Expiration. This Agreement shall commence on the Effective Date.
This Agreement shall expire with no further action on behalf of the parties when the Plan
has been implemented by the Recipient, all allowed costs have been paid by the City to
the Recipient, and the Award Amount has been spent; provided, no additional extension
of this agreement for continued services and requisite funding award has been executed
by the Parties. The Parties may extend this Agreement for additional terms as outlined in
an amendment to this Agreement.
C. Termination without Cause. The City or the Recipient may terminate this
Agreement without cause by providing thirty (30) days written notice to the other Party.
D. Termination for Cause. Either Party may immediately, upon written notice to the
other Party, terminate this Agreement for cause if the other Party is in breach of any
provision hereof or is in breach of any provision of Applicable Law, including the failure of
the City to provide all necessary assistance the Recipient requires to comply with the
provisions of its related regulations and any reporting of program and service data.
2. Scope of Services. The services the Recipient shall provide shall be as set forth
in the attached Exhibit
A. The attached Exhibit
A is incorporated by reference into this Agreement
and made a part thereof. In the event there are conflicting terms and conditions between Exhibit
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A and this Agreement, the terms of this Agreement will prevail.
The Recipient may elect to enter into sub-recipient agreements with other qualified
entities. If it elects to provide some or all of the services by way of sub-recipients, the Recipient
shall enter into contractual agreements incorporating the requirements contained herein.
If the Recipient intends to use Award Funds for administrative expenses, they must be
included in Exhibit A. No more than five percent (5%) of the Award Amount shall be allocated by
Recipient toward its administrative expenses, including reporting requirements.
3. Compensation. It is expressly understood and agreed the total compensation the
Recipient is to receive under this Agreement for the services performed shall not exceed the
Award Amount. Further, it is understood that the Award Amount shall equal the Settlement
Payments.
The Award Amount shall be used by Recipient solely for the purposes set forth in this
Agreement and must directly benefit residents of the City of Muskegon. The Award Amount may
not be used to benefit non-residents. Recipient understands that the Settlement Funds are not
in the City's control and may not be received on a predictable schedule. Award Amount may be
lower than anticipated depending on the financial viability of defendants in the Opioid Litigation.
Payment by the City to the Recipient is subject to the availability of funds as determined
by and in the sole discretion of the City.
4. Future Funding. City is not, as a result of entry into or performance by either party
under this Agreement, obligated to provide future grants, program-related investments, or other
financial or technical support to Recipient, or to extend the relationship with Recipient in any
respect, or to engage in any other transaction or relationship with Recipient. Recipient
acknowledges that City has not made to Recipient any representations, promises, or assurances
about future funding or other support.
5. Reports. Recipient shall provide the City timely and reasonable access to all data
and information in the Recipient's possession or control related to the Plan and/or necessary to
comply with this Agreement. This includes program evaluation and reporting on clients served,
including residency of clients, types of services, outputs, outcomes, daily counts, etc., as
determined by the City in its sole discretion. These types of reporting obligations related to the
Plan are required as the City works to measure successful outcomes and determine best uses
of Settlement Funds in ensuing years and to ensure that the Award Amount is used to solely
benefit City of Muskegon residents. Recipient shall provide the City or its designated agent(s)
information on program services related to Award Amounts. Failure to do so in an accurate and
timely manner may result in termination for cause.
6. Selection Committee. The City Manager or their designee, shall be entitled to one
(1) seat on Recipient's Opioid Settlement Funding Grant Committee.
7. Right of Audit. The City or its designee may audit the Recipient to verify
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compliance with this Agreement. The Recipient must retain and provide to the City or its
designee and/or auditor general upon request, all financial and accounting records related to
this Agreement through the Term of this Agreement and for three (3) years after the later of the
date of submission of the final expenditure report for the Award Amount. If an audit, litigation,
or other action involving the records is initiated before the end of the Financial Audit Period, the
Recipient must retain the records until all issues are resolved. This right of audit is limited to
matters within the scope of this Agreement unless there is a separate constitutional or statutory
basis for such audit. .
8. Right of Inspection. Within ten (10) calendar days of providing notice, the City and
its authorized representatives or designees have the right to enter and inspect Recipient's
premises or any other places where work is being performed under this Agreement or in any
location where records are kept related to the Project, and examine, copy, and audit all records
related to this Agreement. The Recipient must cooperate and provide reasonable assistance.
lf financial errors are revealed, the amount in error must be reflected as a credit or debit on
subsequent invoices until the amount is paid or refunded. Any remaining balance at the end of
this Agreement must be paid or refunded within forty-five (45) calendar days.
9. Recipient Monitoring. The Recipient will comply with the City’s policy for Recipient
monitoring, if any, and provide all required documentation upon request of the City including (1)
written responses for Recipient services provided, (2) all financial or non-financial reporting
requested by the City related to the Award, (3) written responses to internal control
questionnaires.
10. Compliance with the Law. The Recipient shall administer the program and provide
all the services to be performed under this Agreement in complete compliance with all applicable
Federal, State and local laws, ordinances, rules and regulations. The laws of the State of
Michigan will control in the construction and enforcement of this Agreement.
41. Applicable Law and Venue. This Agreement shall be subject to and construed in
accordance with the laws of the State of Michigan, without regard to any Michigan choice of law
rules that would apply the substantive law of any other jurisdiction to the extent not inconsistent
with, or pre-empted by Federal law.
In the event any disputes arise under this Agreement, it is understood and agreed that
any legal or equitable action resulting from such disputes shall be in Michigan Courts whose
jurisdiction and venue shall be established in accordance with the statutes and Court Rules of
the State of Michigan. In the event any action is brought in or is moved to a federal court the
venue for such action shall be the Federal Judicial District of Michigan, in the district and division
in which the City is located.
12. Independent Contractor. The employees, servants and agents of the Recipient
or the beneficiaries of the Award Amount shall in no way be deemed to be and shall not hold
themselves out as the employees, servants or agents of the City. The Recipient's employees,
servants and agents shall not be entitled to any fringe benefits of the City such as, but not limited
to, health and accident insurance, life insurance, paid vacation leave, paid sick leave or
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longevity. The Recipient shall be responsible for paying any salaries, wages or other
compensation due its employees for services performed pursuant to this Agreement and for the
withholding and payment of all applicable taxes, including, but not limited to, income and social
security taxes to the proper Federal, State and local governments. The Recipient shall carry
workers’ compensation insurance coverage for its employees, as required by law and shall
provide the City with proof of said coverage.
13. Nondiscrimination. The Recipient, as required by law, shall not discriminate
against a person to be served or an employee or applicant for employment with respect to hire,
tenure, terms, conditions or privileges of employment, programs and services provided, or a
matter directly or indirectly related to employment because of race, color, religion, national origin,
age, sex, sexual orientation, gender identity, height, weight, marital status, physical or mental
job or position
disability unrelated to the individual's ability to perform the duties of the particular
or political affiliation. The Recipient shall include the language of this assurance in all
subcontracts for services covered by this Agreement. Breach of any provisions of this section
shall be regarded as a material breach of this Agreement.
14. Indemnification and Hold Harmless. The Recipient shall, at its own expense,
protect, defend, indemnify and hold harmless the City, and its elected and appointed officers,
employees and agents from all claims, damages, costs, law suits and expenses, including, but
not limited to, all costs from administrative proceedings, court costs and attorney fees that they
may incur as a result of any acts, omissions or negligence of the Recipient or any of its officers,
employees, agents or subcontractors which may arise out of this Agreement. This includes any
repayment which may be required in the event any portion of the Award Amount is not spent in
conformance with this Agreement or the limitations of Exhibit B such that the City is required to
return or forego any portion of the Settlement Payments.
The Recipient’s indemnification responsibilities under this section shall include the sum
of damages, costs and expenses which are in excess of the sum paid out on behalf of or
reimbursed to the City, its officers, employees and agents by the insurance coverage obtained
and/or maintained by the Recipient pursuant to the requirements of this Agreement.
45. Insurance. The Recipient shall purchase and maintain insurance not less than the
limits set forth below. All coverage shall be with insurance companies licensed and admitted to
do business in State of Michigan and with insurance carriers acceptable to the City.
A. Workers’ Compensation Insurance. Workers’ Compensation Insurance including
Employers’ Liability Coverage in accordance with all applicable statutes of the State of
Michigan.
B. Commercial General Liability Insurance. Commercial General Liability Insurance
on an “occurrence basis” only with limits of liability of not less than ONE MILLION AND
NO/100 DOLLARS ($1,000,000.00) per occurrence and/or aggregate combined single
limit, personal injury, bodily injury and property damage. Coverage shall include the
following: (1) Broad Form General Liability Endorsement or equivalent if not in policy
proper; (2) Contractual Liability; and (3) Products and Completed Operations.
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C. Motor Vehicle Liability. Motor Vehicle Liability Insurance, including Michigan No-
Fault Coverage, with limits of liability of not less than FIVE HUNDRED THOUSAND AND
NO/100 DOLLARS ($500,000.00) per occurrence, and/or aggregate, combined single
limit, bodily injury and property damage. Coverage shall include all owned, non-owned
and hired vehicles.
D. Additional Insured. The Commercial General Liability Insurance as described
above shall include the following as “Additional Insured’; the City, and all of the City’s
elected and appointed officials, employees and volunteers, all boards, commissions
and/or authorities and board members including employees and volunteers thereof. Said
insurance shall be considered to be primary coverage to the Additional Insureds, and not
contributing with any other insurance or similar protection available to the Additional
Insureds whether said other available coverage be primary, contributing or excess.
E. Deductibles and SIRs. The Recipient shall be responsible for paying any
deductibles and self-insured retentions (SIRs) in its insurance coverages.
F. Cancellation Notice. Workers’ Compensation Insurance, Commercial General
Liability Insurance and Motor Vehicle Liability Insurance as described above, shall include
on their certificates of insurance, which are to be submitted to the City as required below,
an endorsement stating the following: “It is understood and agreed that thirty (30) days
advance written notice of cancellation, non-renewal, reduction and/or material change
shall be sent to: City, [address].” In the event the Recipient's insurer
refuses to provide such an endorsement the Recipient shall be responsible for providing
the required notice.
G. Proof of Insurance. The Recipient shall provide to the City at the time this
Agreement is returned by it for execution, with two (2) copies of certificates of insurance
for each of the policies mentioned above. If so requested, certified copies of policies shall
be furnished.
16. Waivers; Remedies. No delay on the part of any of either Party in exercising any
right, power or privilege hereunder shall operate as a waiver thereof, nor shall any waiver on the
part of the either Party of any right, power or privilege hereunder operate as a waiver of any
other right, power or privilege hereunder, nor shall any single or partial exercise of any right,
power or privilege hereunder preclude any other or further exercise of any other right, power or
privilege hereunder. The rights and remedies herein provided are cumulative and are not
exclusive of any rights or remedies which the parties hereto may otherwise have at law or in
equity.
In the event the Recipient is in breach of any provision of Applicable Law, or misuses the
Award Amount funding in any way, it shall immediately, upon written demand from the City,
repay all of the funds previously received pursuant to this Agreement.
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17. Modifications, Amendments or Waiver of Provisions of the Agreement. All
modifications, amendments or waivers of any provision of this Agreement shall be made only by
the written mutual consent of the parties hereto.
148. Assignment or Subcontracting. Neither Party may assign, subcontract, or
otherwise engage any subrecipient to coordinate programs eligible for the use of the Award
Amount, without advance written consent of the other Party.
19. Purpose of Section Titles. The titles of the sections set forth in this Agreement
are inserted for the convenience of reference only and shall be disregarded when construing or
interpreting any of the provisions of this Agreement.
20. Complete Agreement. This Agreement, the Exhibits A and B, and any additional
or supplementary documents incorporated herein by specific reference contains all the terms
and conditions agreed upon by the parties hereto, and no other agreements, oral or otherwise,
regarding the subject matter of this Agreement or any part thereof shall have any validity or bind
any of the parties hereto.
21. Survival Clause. All rights, duties and responsibilities of any party that either
expressly or by their nature extend into the future, including warranties and indemnification, shall
extend beyond and survive the end of the Agreement ‘s term or the termination of this
Agreement.
22. Invalid/Unenforceable Provisions. If any clause or provision of this Agreement is
rendered invalid or unenforceable because of any State or Federal statute or regulation or ruling
by any tribunal of competent jurisdiction, that clause or provision shall be null and void, and any
such invalidity or unenforceability shall not affect the validity or enforceability of the remainder
of this Agreement. Where the deletion of the invalid or unenforceable clause or provision would
result in the illegality and or unenforceability of this Agreement, this Agreement shall be
considered to have terminated as of the date in which the clause or provision was rendered
invalid or unenforceable.
23. Force Majeure. Any delay or failure in the performance by either Party hereunder
shall be excused if and to the extent caused by the occurrence of a Force Majeure. For purposes
of this Agreement, Force Majeure shall mean a cause or event that is not reasonably foreseeable
or otherwise caused by or under the control of the Party claiming Force Majeure, including acts
of God, fires, floods, epidemics, explosions, riots, wars, hurricane, sabotage terrorism,
vandalism, accident, restraint of government, governmental acts, injunctions, labor strikes, that
prevent the claiming Party from furnishing the materials or equipment, and other like events that
are beyond the reasonable anticipation and control of the Party affected thereby, despite such
Party's reasonable efforts to prevent, avoid, delay, or mitigate the effect of such acts, events or
occurrences, and which events or the effects thereof are not attributable to a Party's failure to
perform its obligations under this Agreement.
24. Non-Beneficiary Contract. Nothing expressed or referred to in this Agreement is
intended or shall be construed to give any person other than the Parties to this Agreement or
their respective successors or permitted assignees any legal or equitable right, remedy or claim
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under or in respect of this Agreement, it being the intention of the Parties that this Agreement
and the transactions contemplated hereby shall be for the sole and exclusive benefit of such
Parties or such successors and permitted assignees. The Recipient's suppliers or providers are
not considered the Recipient's assignees and are not third-party beneficiaries.
25. Notice. Any and all correspondence or notices required, permitted, or provided
for under this Agreement to be delivered to any Party shall be sent to that Party by either
electronic mail with confirmation of receipt or by first class mail. All such written notices shall be
addressed as provided below. All correspondence shall be considered delivered to a Party as
of the date that the electronic confirmation of receipt is received (if notice is provided by
electronic mail) or when notice is deposited with sufficient postage with the United State Postal
Service. A notice of termination shall be sent via electronic mail with confirmation of receipt or
via certified mail to the address specified below. Notices shall be mailed to the following
addresses:
lf to City: City Manager
933 Terrace St.
Muskegon, Mi 49440
With Copy to:
City Attorney
Parmenter Law
601 Terrace St.
Muskegon, MI 49440
If to Recipient: Public Health - Muskegon County
1903 Marquette Avenue, S101
Muskegon, MI 49442
26. Counterparts. This Agreement may be executed in one or more counterparts,
each of which shall be deemed to be an original and all of which together shall constitute one
and the same instrument. The exchange of copies of this Agreement and of signature pages by
facsimile or PDF transmission shall constitute effective execution and delivery of this Agreement
as to the parties hereto and may be used in lieu of the original Agreement for all purposes.
Signatures of the Parties hereto transmitted by facsimile or PDF shall be deemed to be their
original signatures for all purposes.
27. Entire Agreement. This Agreement sets forth the entire agreement between the
Parties and supersedes any and all prior agreements or understandings between them in any
related to the subject matter of this Agreement. It is further understood and agreed that the
terms and conditions of this Agreement are contractual and are not a mere recital and that there
are no other agreements, understandings, contracts, or representations between the Parties in
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any way related to the subject matter of this Agreement, except as expressly stated in this
Agreement.
28. Certification of Authority to Sign Agreement. The people signing on behalf of
the parties to this Agreement certify by their signatures that they are duly authorized to sign this
Agreement on behalf of the party they represent and that this Agreement has been authorized
by the party they represent.
THE AUTHORIZED REPRESENTATIVES OF THE PARTIES HERETO HAVE FULLY
EXECUTED THIS AGREEMENT ON THE DATE AND YEAR FIRST ABOVE WRITTEN.
CITY OF MUSKEGON COUNTY OF MUSKEGON
By: Kenneth
pon ae
Johnson, Mayor
By: “Atyh Lore
(Signature)
City of Muskegon Name: Kathy Moore
pate:_[(-96-J99Y Title: _Public Health Director
Date: eile cee!
wy QDR
Ann Meisch, Clerk
City of Muskegon
Date: //-26 - op Y
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Exhibit A
Scope of Work
. Funding will be provided, from the City to the Recipient, in an amount not less than Five Hundred
and 00/100 Dollars ($500.00) on a quarterly basis (the “Award Amount’).
. The Recipient shall direct the Award Amount to the Recipient's Opioid Settlement Grant funding
program each eligible grant year, unless notice is provided to terminate the Agreement.
. Eligible organizations shall use the Award Amount to support the development, implementation,
enhancement, or expansion of opioid prevention, harm reduction, treatment, and recovery
programs and services for the benefit of City of Muskegon residents.
. No more than five percent (5%) of the Award Amount shall be allocated by the Recipient to the
administrative expenses, including any reporting requirements, of the Recipient's Opioid
Settlement Grant funding program.
. The Recipient shall provide to the City an accounting report of the grant program. The report shall
include, but not be limited to, total funds awarded, name of the grantee, category of assistance,
target audience, project summary and amounts approved.
. The Recipient shall include the City on the Recipient's Opioid Settlement Funding Grant
Committee to review and select applications originating from the City of Muskegon, as well as
annually review the grant program.
. The City may audit the Recipient to verify compliance with this Agreement.
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Exhibit B
List of Opioid Remediation Uses
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”).
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.
MEDICATION-ASSISTED TREATMENT (“MAT”)
DISTRIBUTION AND OTHER OPIOID-RELATED
TREATMENT
1. Increase distribution of MAT to individuals who are
uninsured or whose insurance does not cover the needed
service;
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. Provide 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 and with other
support services.
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 cooccurring Opioid
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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 OUD, including housing, transportation, job
placement/training, and childcare.
D. EXPANDING TREATMENT FOR NEONATAL
ABSTINENCE SYNDROME (“NAS”)
1. Expand comprehensive evidence-based and recovery
support for NAS babies;
2. Expand services for better continuum of care with infantneed dyad; and
3. Expand long-term treatment and services for medical
monitoring of NAS babies and their families.
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
placemeni/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.
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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
Schedule B
Approved Uses
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:
PART ONE: TREATMENT
A. TREAT OPIOID USE DISORDER (OUD)
Support treatment of Opioid Use Disorder (“OUD”) and any co-occurring Substance Use
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Disorder or Mental Health (“SUD/MH”) conditions through evidence-based or evidence-
informed programs or strategies that may include, but are not limited to, those that:
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.
Support and reimburse evidence-based services that adhere to the American
Society of Addiction Medicine (“ASAM”) continuum of care for OUD and any
cooccurring SUD/MH conditions.
Expand teleheaith 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.
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.
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.
Provide 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.
Support evidence-based withdrawal management services for people with OUD
and any co-occurring mental health conditions.
Provide 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.
Support workforce development for addiction professionals who work with
persons with OUD and any co-occurring SUD/MH conditions.
10. Offer fellowships for addiction medicine specialists for direct patient care,
instructors, and clinical research for treatments.
11. Offer scholarships and supports for behavioral health practitioners or workers
involved in addressing OUD and any co-occurring SUD/MH or mental health
conditions, including, but not limited to, training, scholarships, fellowships, loan
repayment programs, or other incentives for providers to work in rural or
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underserved areas.
12. 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.
13. Disseminate 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.
14. Develop and disseminate new curricula, such as the American Academy of
Addiction Psychiatry’s Provider Clinical Support Service for Medication—
Assisted Treatment.
SUPPORT PEOPLE IN TREATMENT AND RECOVERY
Support people in 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 programs or strategies that:
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.
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.
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.
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 mediation with other support services.
Provide community support services, including social and legal services, to assist
in deinstitutionalizing persons with OUD and any co-occurring SUD/MH
conditions.
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.
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Provide or support transportation to treatment or recovery programs or services
for persons with OUD and any co-occurring SUD/MH conditions.
Provide employment training or educational services for persons in treatment for
or recovery from OUD and any co-occurring SUD/MH conditions.
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. Provide 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.
CONNECT PEOPLE WHO NEED HELP TO THE HELP THEY NEED
(CONNECTIONS TO CARE)
Provide connections to care for people who have—or are 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, those that:
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.
Fund SBIRT programs to reduce the transition from use to disorders, including
SBIRT services to pregnant women who are uninsured or not eligible for
Medicaid.
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.
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Purchase automated versions of SBIRT and support ongoing costs of the
technology.
Expand services such as navigators and on-call teams to begin MAT in hospital
emergency departments.
Provide training for emergency room personnel treating opioid overdose patients
on post-discharge planning, including community referrals for MAT, recovery
case management or support services.
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.
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.
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.
ADDRESS THE NEEDS OF CRIMINAL JUSTICE-INVOLVED PERSONS
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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, those that:
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:
1. Self-referral strategies such as the Angel Programs or the Police Assisted
Addiction Recovery Initiative (“PAARI’);
2. Active outreach strategies such as the Drug Abuse Response Team
(“DART”) model;
3. “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;
4, Officer prevention strategies, such as the Law Enforcement Assisted
Diversion (“LEAD”) model:
5. Officer intervention strategies such as the Leon City, Florida Adult
Civil Citation Network or the Chicago Westside Narcotics Diversion to
Treatment Initiative; or
6. Co-responder and/or alternative responder models to address OUD-related
911 calls with greater SUD expertise.
Support pre-trial services that connect individuals with OUD and any cooccurring
SUD/MH conditions to evidence-informed treatment, including MAT,
and related services.
Support treatment and recovery courts that provide evidence-based options for
persons with OUD and any co-occurring SUD/MH conditions.
Provide evidence-informed treatment, including MAT, recovery support, harm
reduction, or other appropriate services to individuals with OUD and any cooccurring
SUD/MH conditions who are incarcerated in jail or prison.
Provide evidence-informed treatment, including MAT, recovery support, harm
reduction, or other appropriate services to individuals with OUD and any cooccurring
SUD/MH conditions who are leaving jail or prison or have recently left
jail or prison, are on probation or parole, are under community corrections
supervision, or are in re-entry programs or facilities.
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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.
Provide training on best practices for addressing the needs of criminal justiceinvolved
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.
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, those that:
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.
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.
Provide training for obstetricians or other healthcare personnel who work with
pregnant women and their families regarding treatment of OUD and any cooccurring
SUD/MH conditions.
Expand comprehensive evidence-based treatment and recovery support for NAS
babies; expand services for better continuum of care with infant-need dyad; and
expand long-term treatment and services for medical monitoring of NAS babies
and their families.
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 NAS get referred to appropriate services and receive a plan of safe care.
Provide child and family supports for parenting women with OUD and any cooccurring
SUD/MH conditions.
Provide enhanced family support and child care services for parents with OUD
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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 cooccurring
SUD/MH conditions, including, but not limited to, parent skills
training.
10. Provide 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
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. Funding medical provider education and outreach regarding best prescribing
practices for opioids consistent with the 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. Providing Support for non-opioid pain treatment alternatives, including training
providers to offer or refer to multi-modal, evidence-informed treatment of pain.
5. Supporting enhancements or improvements to Prescription Drug Monitoring
Programs (“PDMPs’), including, but not limited to, improvements that:
1. Increase the number of prescribers using PDMPs;
2. 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
3. Enable states to use PDMP data in support of surveillance or intervention
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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. Increasing electronic prescribing to prevent diversion or forgery.
8. Educating dispensers on appropriate opioid dispensing.
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. Funding media campaigns to prevent opioid misuse.
2. Corrective advertising or affirmative public education campaigns based on
evidence.
3. Public education relating to drug disposal.
A. Drug take-back disposal or destruction programs.
5. Funding community anti-drug coalitions that engage in drug prevention efforts.
6. Supporting 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. Engaging non-profits and faith-based communities as systems to support
prevention.
8. Funding 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.
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10. Create or 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 mental health needs in young people that
(when not properly addressed) increase the risk of opioid or another drug misuse.
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. Increased 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, schools, community navigators and outreach
workers, persons being released from jail or prison, or other members of the
general public.
2. Public health entities providing 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. Enabling school nurses and other school staff to respond to opioid overdoses, and
provide them with naloxone, training, and support.
5. Expanding, improving, or developing 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. Educating 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
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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. Expanding access to testing and treatment for infectious diseases such as HIV and
Hepatitis C resulting from intravenous opioid use.
11. | Supporting 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. Providing 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 cooccurring
SUD/MH conditions.
13. | Supporting screening for fentanyl in routine clinical toxicology testing.
PART THREE: OTHER STRATEGIES
FIRST RESPONDERS
In addition to items in section C, D and H relating to first responders, support the
following:
1. Education of 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.
LEADERSHIP, PLANNING AND COORDINATION
Support efforts to provide leadership, planning, coordination, facilitations, 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, and to support training and technical assistance and other
strategies to abate the opioid epidemic described in this opioid abatement strategy
list.
2. A dashboard to (a) share reports, recommendations, or plans to spend opioid
settlement funds; (b) to show how opioid settlement funds have been spent; (c) to
report program or strategy outcomes; or (d) to track, share or visualize key opioidor
health-related indicators and supports as identified through collaborative
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statewide, regional, local or community processes.
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.
Provide resources to staff government oversight and management of opioid
abatement programs.
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, those that:
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.
Support infrastructure and staffing for collaborative cross-system coordination to
prevent opioid misuse, prevent overdoses, and treat those with OUD and any
cooccurring 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.).
RESEARCH
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.
Research non-opioid treatment of chronic pain.
Research on improved service delivery for modalities such as SBIRT that
demonstrate promising but mixed results in populations vulnerable to
opioid use disorders.
Research on novel harm reduction and prevention efforts such as the
provision of fentany! test strips.
Research on innovative supply-side enforcement efforts such as improved
detection of mail-based delivery of synthetic opioids.
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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).
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.
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.
Geospatial analysis of access barriers to MAT and their association with
treatment engagement and treatment outcomes.
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