Call to Order and Roll Call
The 6th meeting of the SB 192 Implementation Oversight Committee was held on Monday, November 9, 2015, at 10:00 AM, in Room 169 of the Capitol Annex. Senator Christian McDaniel, Chair, called the meeting to order, and the secretary called the roll.
Present were:
Members: Senator Christian McDaniel, Co-Chair; Representative Denver Butler, Co-Chair; Senator Morgan McGarvey; Representatives David Floyd and Joni L. Jenkins.
Guests: Justice and Public Safety Cabinet Secretary J. Michael Brown, Executive Director of Kentucky Office of Drug Control Policy Van Ingram, Commonwealth Attorney of the 16th Judicial Circuit Hon. Rob Sanders, Kentucky Health Departments Association Director Scott Lockard, Lexington-Fayette County Health Department Director Dr. Rice Leach, Northern Kentucky Independent Health District Director Dr. Lynne Sadler, Louisville Metro Department of Public Health & Wellness Interim Director Dr. Sarah Moyer, Three Rivers District Health Department Public Health Director Georgia Heise, DrPH, St. Elizabeth Healthcare Emergency Department Nurse Manager Ashel Kreutzkamp, Ridge Behavioral Health Services CEO Nina Eisner, and Department of Criminal Justice Training Assistant Director for Training Operations Frank Kubala.
LRC Staff: Jon Grate, Jonathan Scott, Sarah Kidder, and Alice Lyon.
SB 192 Appropriations Report
Secretary J. Michael Brown of the Justice and Public Safety Cabinet and Executive Director Van Ingram of the Kentucky Office of Drug Control Policy discussed spending of $10 million in one-time funding through SB 192 for programs to combat prescription drug and heroin abuse in the state. $1 million has been allocated to provide or contract for substance abuse treatment or medically assisted treatment for non-state inmates with substance abuse disorders. Secretary Brown reported that the Cabinet has not received many applications from county jails, but four jails have been awarded funding of $500,000. $500,000 has been allocated to KY-ASAP programs in county jails or in facilities under the supervision of county jails that employ evidence-based behavioral health treatment or medically assisted treatment for inmates with substance abuse disorders. So far, the Justice Cabinet has transferred $250,000 to DOC for programming for state inmates in county detention centers, expanding two jail programs and opening six new programs.
SB 192 also allocated $1.5 million for the purchase of the extended-release opioid antagonist Vivitrol for use by inmates. A Vivitrol pilot program offered in four jails and estimated to serve 2,000 state and non-state inmates will also assist offenders in signing up with Medicaid or private insurance. Secretary Brown mentioned nine county detention centers which will be opening and expanding substance abuse programs, and through this funding, there will be 763 beds available in state prison substance abuse programs.
Secretary Brown also discussed the $2.6 million allocated to KY-ASAP through SB 192 to provide supplemental grant funding to community mental health centers (CMHCs) to offer additional substance abuse treatment resources. Ten out of fourteen CMHCs have been awarded funding for this purpose. KY-ASAP entered into a memorandum of agreement with the Cabinet for Health and Family Services’ Department of Behavioral Health to develop and evaluate Requests for Proposals and award funding. KY-ASAP was also provided $1 million to address neonatal abstinence syndrome through community substance abuse treatment providers which offer residential treatment services to pregnant women through programs that employ evidence-based behavioral health treatment or medically assisted treatment. Four programs in Louisville, Lexington, Northern Kentucky, and Eastern Kentucky received awards at $250,000 each.
SB 192 also specified $1.2 million for the Department of Public Advocacy’s Social Worker Program to create additional social worker positions to develop individualized alternative sentencing plans. This would create 22 social worker positions, a branch manager position, and administrative staff support position. So far, $600,000 has been transferred from the Justice Cabinet to the Department of Public Advocacy. SB 192 also allocated $1.2 million to the Prosecutors Advisory Council to enhance the use of rocket docket prosecutions in controlled substance cases, of which $600,000 has been transferred.
One million dollars was provided in SB 192 for KY-ASAP local boards. About $375,000 in competitive grants has been awarded to 37 local boards for opioid overdose prevention and treatment. The rest of the funds were used to supplement the budgets of each county’s local board, raising budget funds for each county to $15,500.
Secretary Brown stated that the projected estimates for the overdose rate in 2015 look grim based on high mid-year numbers. In the first half of 2015, there were 501 total overdose deaths reported, 154 of which involved heroin and 152 of which involved Fentanyl. The prevalence of Fentanyl has grown, and while it is often seen in combination with heroin, there are a growing number of cases where Fentanyl was the only substance used. Furthermore, although there has been a decline in the number of prescriptions for Fentanyl issued in Kentucky, the abuse rates remain high, indicating that it is being shipped in.
Aggravated Trafficking and Importation Crimes Created in SB 192
Honorable Rob Sanders, Commonwealth Attorney for the 16th Judicial Circuit, joined Mr. Ingram and Secretary Brown to discuss heroin-specific offenses created in SB 192. Mr. Ingram stated that between January 1, 2015 and October 20, 2015 the following cases relating to heroin were filed:
· Importing heroin: 49 charges, 44 cases
· Complicity to import heroin: one charge, one case
· Aggravated trafficking in a controlled substance, 1st degree: two charges, one case
· Complicity to aggravated trafficking in a controlled substance, 1st degree: three charges, three cases
· Enhanced aggravated trafficking in a controlled substance, 1st degree: two charges, two cases.
Overall, there were 57 total charges and 51 cases. As prosecutors and police officers become more familiar with these charges, Mr. Ingram stated that he expects to see an increase in their use.
Hon. Sanders spoke about some of the challenges faced when attempting to charge or prosecute in heroin trafficking. In cases of such crimes, charges might be dismissed in favor of federal charges because the 1000 gram amount for aggravated trafficking is set so high in Kentucky. The price to purchase heroin is also very high at $3,000 per ounce, and narcotics units have financial limitations in conducting operations; it is more likely that a federal narcotics unit would be better able to finance such operations. Furthermore, federal penalties of such crimes are higher than Kentucky penalties. Hon. Sanders recommended that, to make Kentucky law stronger, legislators should consider lowering the threshold for aggravated trafficking in a controlled substance. Another challenge is that it is difficult to prove a crime of importing a controlled substance. This could be ameliorated by greater surveillance on bridges. Responding to a question from Representative Floyd, Hon. Sanders spoke of the importance of training patrol officers on these charges.
Implementation of Needle Exchanges
Director Scott Lockard of the Kentucky Health Departments Association spoke about the growing needle exchange programs in Kentucky. He emphasized that there have been many community forums on implementing needle exchange, and there are currently three jurisdictions where needle exchange programs are fully operational in conjunction with public health officials and local government.
Dr. Rice Leach, Commissioner of Health at the Lexington-Fayette County Health Department, stated that a key issue at the Lexington needle exchange program is getting people into treatment. In an attempt to address this, everyone who comes to the program is provided a list of referral options. Since the beginning of the program on September 4, 2015, 104 total persons have been served with 52 return visits, 2,104 needles collected, 1,976 needles dispensed, five persons screened for HIV, and nine persons referred to clinics for STD/hepatitis testing. The program has had many successes, including community participation and donations, gradual growth, general acceptance by participants, and no behavioral incidents. Challenges are establishing on-site drug abuse consultation, coordinating with local substance abuse providers, increasing service sites, and finding resources to expand the program.
Dr. Lynne Sadler, Director of the Northern Kentucky Independent Health District, said a program is ready to execute upon the SB 192 mandated approval of one of the local governments in the area, but no fiscal court in the area has taken a vote to authorize needle exchanges. She stressed the importance of community support and the need for local education of the issue and the program.
Dr. Sarah Moyer, Interim Director of the Louisville Metro Department of Public Health and Wellness, provided testimony on the successes of the Louisville needle exchange program in its first four and a half months. Since June, the program has had 1,102 participants with 42 percent returning, 133 tested for HIV, 65 tested for Hepatitis C in the last 45 days, and 64 referred for drug treatment. The mobile site is not currently mobile, but a community site was opened two weeks ago.
Georgia Heise, DrPH, Public Health Director at Three Rivers District Health Department, said fiscal court approval in Pendleton County was easily achieved because everyone in the community has been affected by substance abuse in some way. Pendleton County’s program has been fully operational since September, but no one has participated yet. Ms. Heise attributed the lack of participants to poor education and misinformation about the program, and she stated that the three other counties in her district with pending programs are facing the same issues. Responding to a question from Representative Butler, Ms. Heise emphasized the importance of local boards and district boards in countering bad press and misinformation on the needle exchange programs.
Referrals to Treatment After Overdose
SB 192 requires hospitals which treat overdose victims to inform the person of local treatment options, and to make contact with providers on the patients’ behalf with the patients’ permission. Nina Eisner, CEO of Ridge Behavioral Health Services in Lexington, praised SB 192 for its emphasis on implementing care. However, she stated that providing local referrals for substance abuse treatment to is an issue because local treatment is not always available. Other barriers for treatment include: lack of transportation to treatment programs or facilities; lack of insurance coverage; and long waiting lists for treatment options. Furthermore, Ms. Eisner stated that treatment providers often face delays in receiving credentials from Medicaid managed care organizations, and when combined with other challenges, this can make providers reluctant to expand care.
Ashel Kreutzkamp, Emergency Department Nurse Manager at St. Elizabeth Healthcare, testified on the difficulties of getting patients from the emergency room (ER) to treatment facilities. Oftentimes heroin users come from families struggling with the same addictions which complicates treatment. St. Elizabeth Healthcare is conducting a research study which follows those treated at the ER for substance abuse to better individualize treatment options.
SB 192 also requires local health departments to follow up with those who call emergency services for help with overdoses when contact information is available. Mr. Lockard spoke on how to provide information to bystanders of overdose. Furthermore, he spoke about the low number of referrals to treatment in Northern Kentucky with only five referrals in two jurisdictions and three outreach attempts. One of the major challenges to increasing the number of referrals is the lack of clarity on which agency is to report the contact information.
DOCJT Trainings on Heroin
Frank Kubala, Assistant Director for Training Operations at the Department of Criminal Justice Training (DOCJT), spoke about the successes of heroin training in criminal justice. DOCJT provides entry-level and in-service training to about 11,000 students each year, including city and county police officers, sheriffs, deputy sheriffs, university police, airport police, law enforcement telecommunications, court security, and coroners. There are four Kentucky Law Enforcement Council approved Academies throughout the state located at the Kentucky State Police, Louisville Metro Police, Lexington Police, and DOCJT. Heroin-specific training began in 2013 and expanded in 2014 prior to SB 192. From 2013 to 2015, 4,716 officers received in-service heroin training, and 700 received heroin training in basic training. Upon passage of SB 192, an 8-hour course was created, and it has been taught 15 times across the state, once in each Area Development District. Topics of the course include detection and interdiction of heroin trafficking, the dynamics of heroin abuse, and treatment options for addicts. At the request of Mr. Ingram, psychological impacts of substance abuse and a legal overview were included. DOCJT has partnered with the University of Kentucky Injury Prevention and Research Center to obtain a four-year grant to provide additional training to officers on heroin and naloxone administration. This will include a four-hour embedded block on heroin topics and will be taught 20 times a year across the state for each of the next four years. This grant program will impact about 2,400 officers.
There being no further business, the meeting was adjourned at 10:57 AM.