##VIDEO ID:5Tu1RtjHDbA## e e e e e e e [Music] w [Music] so people don't but so people don't want to spring time again good afternoon and welcome to the Board of Health meeting October 7th 2024 please note this meeting is being recorded and will be available shortly Hereafter for scheduled an on demand viewing on any smartphone or tablet if anyone else is recording this meeting please notify the chairman pursuant to Governor Hy's March 29th 2023 signing of the acts of 2023 extending certain covid-19 measures adopted during the state of emergency suspending certain provisions of the open meeting law until March 31st 1 2025 this meeting of the chadam Board of Health is being conducted in person and via remote participation every effort will be made to ensure that the public can adequately access the proceedings as provided for in the order a reminder that persons who would like to listen to this meeting while in progress may do so by calling the phone number 1 158 945 4410 conference ID 4671 154 994 pound or join the meeting online via our mic Microsoft teams Link in the posted agenda while this is a live broadcast and simoc cast on Channel TV chadam TV channel 8 and 1072 despite our best efforts we may not be able to provide realtime access we will post a record of this meeting on the town's website as soon as possible um and now I'll turn the meeting over to our chairman Dr Noble Hansen thank you it shall be the policy of this board to conduct its meetings under the open meetings law so as to encourage public participation whenever time permits and as part of agenda item discussions we have three things on our agenda today but first let's establish a quorum and when I call your name please uh say present Carol Boyce present dick Edwards present Ron Broman yeah and myself noble Hansen I'm here um uh so we've established a quorum we have uh there were three things on the agenda Naran training education with Alicia Morrison she unfortunately had a last minute uh emergency and had to cancel so she won't be here today Judy will try to fill us in on some of the uh Naran training information and then a discussion with Stephanie brot co-founder and CEO of Behavioral Health Innovations bhi and then a discussion with Michael L PR L prior uh chadam EMS uh fire captain um and I will Judy has kind of put this together so I will turn it over to her and she can uh tell us um what we have in front of us hi so um it's unfortunate that we can't have the the Narcan training and education but as you know we have uh put a few uh Naran or naloxone boxes up around town um and they are being there stocked by um the aid support group of Cape Cod um right now they're on in town buildings um at the fish Pier um at the community center and here at the annex um and we've done some trainings with town Personnel so that they know uh what it's all about and how to use it if if it if it h if anything occurred and they needed it um we've also supplied those buildings with extra Nar can that they can um restock them should someone take some which is perfectly acceptable because it's there for the public to use um and we're trying to destigmatize the the issues around um substance use addictions um so I I can't do the training uh but so I won't go into that but just one question so so these are open to the public and anyone can come in and take the Naran uh and take it home to to to use themselves or to have it you know should they be concerned or um they're in a workplace or they have a family member and they're concerned and they want to keep it um it's perfectly fine is there a list of where the boxes are right now they're just there's three in town um we use some um Public Health excellent uh our regional work group a health health agents work group um money to purchase the three and I I'm hoping to get a couple more and put them in a couple other locations in town so they're at the fish Pier they're at the community center and one here outside this meeting room at the annex so they're they're outside where the public can access them or the one at the fish Pier is outside um the one at the community center is up is at the desk so they would only be accessible while the building is open the same here so y on I I'd like to thank you for doing this really you know if it saves one person and what's in uh chatam here it's well worth it really I mean being a teacher in class during the drug culture time I used to see some kids in pretty rough shape and there was never never anything like that to help them you know we just had to get an ambulance come over and do whatever right but uh well we're trying to we're trying as I said to to you know make people understand um the situation and destigmatize the the whole issue around substance use um and there's opioid funding um from pharmaceutical companies that the town has received and we'll be receiving over $300,000 um over the next 15 years so we're using that for this type of work and and making an effort to you know bring you guys up to date and the town as well so I'm hoping that we can do this um training again we did do one for the town and recorded it I'm not sure if channel 18 has been playing it or not or it's not channel 18 anymore but um chadam TV so hopefully they if they've been playing it it's it's a good training there's a lot of good information so um so we'll we'll Prov we'll provide that again hopefully soon um so I do you want to move on to the next yeah yeah go ahead uh bhi so um I just want to introduce Stephanie biot as co-founder and CEO over Behavioral Health Innovation she's got programming um in the monoy schools and schools around uh Cape Cod and I thought that this would be a good um topic I know that you've had some interested in knowing what's going on in our schools on this topic of substance use and she um has also received some of our opioid funding uh in Grants uh in the past two two fiscal years so are we are we done with Naran uh for now just wanted to make the point that throughout my career I had patients who were using drugs and Naran was useful but the great majority of those patients were taking in heroin injectable or or or snorted you and that was the way people were getting these overdoses of uh narcotics but today uh the latest problem is the drug cartels are making counterfeit pain pills oxycodone and peret oxycontin uh and they're lacing them with fentanyl because fentanyl's pretty cheap to make and and and and that's extraordinarily dangerous because that can be extremely potent so you can just take what you think is a perco set and end up with a major overdose and and and need Naran so it's not just people that are that are using right heavy drugs you know not heroin injectable drugs but but but if if you if you get addicted to an oral uh pain pill because you were taking it getting them out of your mother's Medicine Chest and ran out and you go out on the street and buy some quote peret that it looks like percocet but it may well be a uh yeah it's very scary a drug that comes from one of these drug cartels that's manufactured uh and contains Fentanyl and a little bit of fentanyl can be extraordinary even like firemen and policemen and things have to be extraordin careful uh around the because just a tiny little bit of fentanyl can create a huge overdose problem so that's I think one of the problems that has been creating this this issue over the last you know 10 years um hopefully we're going to start getting a handle on this soon yes I'll just say uh next month uh Judy will give the community health uh survey results uh and then some shortly after that we'll have a Community Health Services Forum um because a lot of community um health problems morph into community services and we'll try and get this anaran training education uh person back and talk at that session so we don't miss out on it I think right and and to that uh extent Stephanie is kind of under that umbrella as well as someone providing um valuable services in in our community so we all set to it sure absolutely yeah it's nice to meet you all I'm Stephanie briy the co-founder and CEO of Behavioral Health innovators and um our mission is to create a Continuum of supports uh especially for young people and youth um who are struggling with substance use and mental health challenges um with the aim toward uh ensuring that they have a full and productive life and um I'll start just with some background uh even though you've probably read in the latest news that the overdose uh numbers have gone down a little bit nationally obviously there's still a crisis so the um dph commissioner said it's hard to find Hope in the numbers in 2023 there were 112,000 in a 12month period That's overdose deaths um and to your point um I forget your name but to your point uh it it is from the fentanyl the fentanyl is being cut into all of the drugs because it is cheaper so it's being cut into cocaine and it's being cut into um some of the drugs that you know are out there that people have been used to using and now they're no longer safe so um what he says too is though the deaths are leveling off um we're leveling off at the highest numbers so it's still a very jarring number to have to report every 6 months so it's over 2,000 this year in um Massachusetts and focusing on the youth because that's really what we're trying to do get up stream of the addiction problem before they need the Naran to get them when they are first starting um we have to look at like zoom out and look at the environment that we're all living in so today's youth grow up in an environment that's saturated with the recreational use of cannabis um and Massachusetts is making a lot of money in tax sales and gross sales for cannabis um but but it's still something that if you're uh looking from a seventh graders perspective you see um many many people buying cannabis lots of information about it even on the front page of the Cape Cod Times not long ago excuse me was a a gummy bear a cannabis gummy bear leased with THC and it looked just like a regular gummy bear so they very um as you all know you can think back to when you were young or your children or grandchildren they they're like sponges and they take everything in um so youth substance use treatment there's very few um adolescents with substance use problems that receive treatment I said 88.7% age 12 to 17 have a substance use issue in the past year that was 2022 data only 5% sought treatment um 2% did not seek treatment and 97% do not seek treatment or think they should get it so there's and there's very little um treatment for psychological problems that are connected to their substance use this is from the um from naida the National Institute for drug addiction Services unintentional drug overdose death rates among us youth aged 15 to 19 it's boys um and it's the highest and it's it's rising so that's more um you know more proof really for us that we need to get into the schools and we need to get to the kids a lot sooner rather than trying to play catchup when they're in their 20s or 30s and now we have um this simultaneous use so this is young adults simultaneous use of alcohol and marijuana it's now linked to more drinking and more negative alcohol consequences and more hours being high so these statistics they say they're specifically related to the simultaneous use use of both alcohol and marijuana rather than simply the amounts con consumed so there's this synergistic effect between both of them and that's also what we're seeing happening in the schools so one of the programs that um the town of chadam through its opioid remediation fund is um supporting in part is our Pass Program so this um started as a positive alternative to school suspension that's what pass stands for and it's now called the positive alternatives for student support so it's open to students facing suspension but also to students not yet facing suspension who need some support outside of school this is just some of the curriculum from um the past program and I'll I'll walk you through kind of a day in the life of uh past so say you're David Alexander who's the assistant principal over at monoy Regional High School and you have a student um either that was caught vaping in the bathroom or is having um a lot of anxiety something happened at home and they can't focus so he'll call up um and ask if that student could attend pass which is is being held for high schoolers at the Centerville Rec building in Barnstable and um he has uh we Supply David with DART bus passes so the student has transportation from home to pass and then back to school so it typically passes 5 days it's from 9 to 2 it's during the school day students have their Google Classroom uh laptops all of their homework and schoolwork is done in real time and we partner with Outer Cape Health Services to provide a clinical assessment for anxiety depression substance use trauma and suicidality so part of the um experience that pass you arrive you usually typically it's the academics that G get um focused on first but we also have all of the social emotional kind of supports that the students need and there's a program director that runs these psycho educational groups with the clinician from OU Cape health services and the students start set setting their goals one I think it says get good grades um basic kind of supports so the approval for the program is um really Universal from the students to the parents uh the students what we've seen the golden kind of nugget in all of it is they are much more uh ready to self-identify as having mental health or substance use issues and they don't say it like that but they're they're going to unbottle their um anxieties and their struggles much more readily outside of the school setting which isn't to say there's anything wrong with the schools it's just that it's it's like going to Fresh Air Camp they get out of uh the school environment they're with kids from other schools and there's an opportunity to talk with people that seem like they're in hot school Personnel um and really care to hear what's going on with them so some of the metrics to date 232 students have attended the high school Pass Program uh since we launched in May 2022 65% of that 232 presented with a substance use challenge 80% presented with mental health challenges and 56% presented with both and then the um metric that for me is the uh one that tugs at my heartstrings the most is so these are high school students um only 33% of those students were receiving Services before they came to pass so they were being suspended or they were white knuckling it um for all the these years without any services so over the next two years we're going to grow the capacity of past to serve more students 16 schools now send students to the high school and middle school pass programs we open the Middle School P Pass Program on October 1st this year we expect to have about 75 students can you say how do the students come into this program do they um how do these students come into the program do they self-refer they all identified by the principal Administration or good question uh so thank you for that um the ones that are facing a suspension the school is required to have a meeting uh and at that meeting they offer them either their suspension so for Vaping for any substance use it's usually 10 days out of school um and they offer pass which is 5 days so there's a little carrot in in that for them so that they can um you know be G ly nudged to take that option it also doesn't count as a suspension on their record and the school does not have to report it to desie the Department of Elementary and secondary education as a suspension do patients I mean the kids self refer do you I mean is it all do it all come from the school administration it all comes through the schools the schools are equal Partners in the program so it's the adjustment counselors assistant principles parents that have heard about the program have to go through their school district to come to program and of those 16 schools that send now weham which is in Plymouth County Nantucket which is in Nantucket County are sending kids to this program in Centerville because there's no program for them uh where they are in addition to the Past program we started another program in 201 18 so about four years before we launch pass called the alternative peer group program and this is for um young people aged 13 to 17 with a history of substance use it's free we partner with Duffy Health Center in terms of um the clinical aspect of that program they oversee the licensed clinician there's a youth behavioral health specialist a recovery coach peer mentor uh and a a supervisor this program that we started bhi started in 2018 just on our own just doing our own fundraising is now funded in part by um Des uh by uh the Division of Youth and youth services up in Massachusetts so it's a state Grant A Bess Grant Bureau of substance use and Addiction Services Grant um that partially funds the APG program the reason we're bringing this slide up now is remember go back to the past metrics the um 65% of students are identified at past that have substance use problems they can be plugged right into this program so again the mission of bhi is to create that Continuum of supports so these kids aren't just identifying identified and dropped they're identified and referred over to the APG program for a six-month program and in that program I should say the metrics there and I don't have them up 88% of the students that attend that program achieve their recovery goals and then six months out of that program after completing the program uh 44% still identify as being in recovery so again this is the Continuum of supports um you know we've talked about a lot of it but the idea is not to supplant what's happening in schools but to augment what's happening in schools and um particularly mono high school has been um in integral partner in not only implementing the program but also in creating the program um the schools that are sending middle middle school students now and this is fifth sixth and seventh because most high schools on the cape have eighth grade part of their high school so the fifth sixth and seventh graders are coming from Dy Falmouth bar conable monoy and nset and we anticipate that program is going to grow and it was really the administrators or the school that said this is great that you've got this for high school kids but we know the students that need support when they're in middle school so can you have a program like this for the middle schoolers scho School administrators point out School administr just point out the kids that should be in this program to to you or guide the kids in your director to our program director yes it's a Google form they fill out a referral form for any student we they give us 25 they don't have to be in trouble that they can just be ad sense that they need help exactly that they need the program and a lot of times it's kids that the school has been trying you know over and over and over again to support and it's just getting them out of the school environment really and back into um an environment where they're they're more comfortable to share yes uh do you also include uh marijuana in this program do you all absolutely you do includ it in you know because there so much changed now over the years you know it's yeah any of those substances for schools and their school policy books that it's all suspension kind of warranted but you know we don't really deal with with with the marijuana use we we're basically the ones that say uh you're in trouble how can we help you not you're in trouble how can we punish you so the whole point of pass and it was the brainchild of a woman up in the NorthShore who started pass back in 20 18 Michelle Linsky who's the principal of the recovery High School up there um she she's the one that said it's just it's not only not only does suspension not work for this population and again you saw the numbers of the things the these kids are facing it's harmful it actually harms it harms them so it's to get um really address that issue which is a whole Juvenile Justice kind of issue but then it's also to open our arms up and it was gen police the um principal at monoy that said why do I have to wait until they're going to be suspended I know these kids need help so we get them sooner before the infraction are there areas that you serve that uh have more of a problem than others are there certain the the majority of students are coming from barneville high school and that's not to say they have more issues the the youth Behavioral Health survey that the the schools doing Monomoy releases monomo numbers for vaping marijuana all that exceed the state limit so they're all having the same kind of problems um are there any more questions about either program and you can go to our website and look at more I do want to make a plug though for um we're having an event at Dy high school it's Thursday evening 630 p.m. this week October 10th and it's called real talk and it's about youth mental health challenges and we've partnered with an organization called the quell Foundation um and they have a documentary and it's portraits of life with mental illness and it's from the Youth and Young Adult perspective and it's free of charge and we invite everyone um to come watch this documentary and I'll end with saying we had three counselors in um chadam and harwit to review the film before we decided to show it and they said not only um should everyone see the film everyone needs to see the film thank you very much thank you now do you interact with this recovery coach um uh position that's new I guess the recovery coach here yeah um I know the clinician that you hired here Diane Nash and I she's told me about the recovery coach is that Kelly yes yes I haven't met her but I've heard great things about her right so Diane Nash is um our full-time Behavior adult Behavioral Health clinician and then we have um a a recovery coach um being supported by the opioid remediation funds who is here one day a week um Kelly Conley and she comes to us through Outer Cape Health Services um and they work very closely together and with other staff in town um including our next speaker uh we meet one monthly and we go over um issues with with folks in town what what's going on and who needs help and we try and provide services as needed okay thank you all right thank you thank you other questions from the board any any questions from um there's no one online so okay all right great thank you very much thank you thank you very much thank you Stephanie that was great do you want to move on so um our next speaker is uh Mike L priori is our chatam EMS captain and as I said he works very closely with our mental health Team and um you would asked you know what what it looked like in town the issue um and I thought he would be helpful in providing us some of that information so great yeah thank you thanks for having me I appreciate your time uh I don't have a fancy PowerPoint presentation I just have a little bit of data for you guys as far far as the town of chadam um what I have here is back to 2019 when we started keeping track um of our Narcan administration at the fire department I have some numbers um progressing over the years to kind of show some Trends so in 2019 um Naran was administered 10 times 2020 it was given 13 times 2021 it was given 26 times 2022 17 2023 was 8 and 2024 we already up to 11 um the year is obviously not complete but that's the data we have so far um obviously some of those years are to be expected given other trends that we had at the time there was a downtick in 2023 but we have seen that come back up in 2024 um we have also seen an increase in the dose administered uh of Narcan over the years which would correlate with some of the increased potency and some of the drugs that we're seeing obviously in the Emergency Medical Services we don't have as much data as far as blood work that they get at the hospital we don't necessarily have access to that um what I will say is not every Naran Administration correlates directly with um an overdose and not every overdose presents with Naran administered so this is just the data that we have it's not by any means all-encompassing um I think it's great that we have public access to Narcan now I think that definitely present some newer problems one of the issues being um narcan's halflife is significantly shorter than most of the drugs that it's designed to treat so what I would say is encourage people to continue to call 911 for help if they believe they need it because if they are administered Naran at home and they're not seen for further treatment there's the possibility that Narcan can wear off um and they can re overdose with what's in their system already so I think as much as that is a great thing to have in town we want to make sure we encourage people to to not shy away from calling emergency services if they need help I think that's still a resource they should utilize and like Judy said try and decrease the stigma around overdoses and just encourage people to get the help that they need so short speech um I'm keeping track of this stuff we try and track Trends as much as we can but if you guys have any questions I'm happy to answer them so are you're using the nasal our can we have the ability to give it nasally but we can also give it um intravenously as well so it depends on the situation and the nature of the call we can give it both ways so U you try to determine what the what it was that they talk to determine so the Nar Administration for us is typically based on a very specific protocol we're trying to treat respiratory depression so we can't we can give it if we believe there is an overdose but we try and reserve it for someone who needs it in order to breathe um sometimes as a blanket treatment if we're not sure if there is evidence of an nodose or suspicion of it we will give it typically that's the nasal dose we give it first because we don't have to establish an IV first um so that's the easiest way and the quickest way for us to give it um other times if we have somebody who is overdosed and is still breathing if they uh their respiratory rate goes down further we will administer it via IV so it kind of depends on the provider on the call and what they believe is the most appropriate and do you uh frequently have to give a second second dose not frequently no it does happen um what I have seen is we do have a larger more concentrated dose so the initial dose is anywhere from4 to 2 milligrams we have a larger dose of 4 milligrams and that has been given more frequently um in the past two years typically that's associated with more severe respiratory depression or a suspicion of a higher overdose depending on what they find on scene and in chadam um what uh drugs are the primary drugs that you're being called to so we don't typically have access to that data um we don't get to know after the fact um whether the police take that stuff or whether they do blood work in the hospital I don't have access to what they find in the blood work or what they find on scene they don't tell you no most of the time people people are very hesitant to tell us what they took if they took anything at all um they're I believe is still the stigma that they're going to get in trouble so they're less likely to report to us exactly what they took it does happen but it's not as common so you're just seeing someone who has respiratory depression correct and and assuming it might be narcotic related n because it really doesn't have any significant yep yeah the one thing we want to be cautious of is if we give it and it's possible to give naranda somebody and they could go into withdrawals um if they're significantly dependent but it really is a very benign drug for us to give that has a really positive outcome most of the time but the indicator for us is respiratory depression but if the crew see signs of paraphernalia or somebody calls us and says they overdosed this is what they took then we'll give it and it and it can't hurt the people if you give it and they're not overdosing it's pretty benign as you said relatively so yes there very few risks now so do you give different initial doses how do you determine the initial dose you might give someone you so we have a dose range in our protocols um that we can give based on clinical presentation how severe we believe their respiratory depression is how long they've been down for how much we believe they've taken typically there's a standard dose of 2 milligrams that we give because that's how it comes and it's easy to give quickly um but we do have the ability to titrate that based on the clinical impression of the so it's kind of subjective judgment on your part based on the whole thing absolutely all right and then um so if you're called is the police also called Always or it depends so medical calls don't always come in the same so it doesn't always come in as this is a narcotic overdose it may come in as somebody's sleepy somebody's unresponsive the dispatch reason is different the police often times come to assist us with calls if it is coming in as an overdose typically they do if it comes in as a general medical and unknown medical they may if they have units of available so it depends on the nature of the information we're given at dispatch um we can also request them to the scene if we believe it's necessary to have them there whether it be for the patient or for us um but it it all depends on the call itself so so you may so you might be called and treat somebody but you're not obligated to call the police not necessarily matter what you think really um the police do have a reporting database that they use to uh to encourage services for people so they have a system they enter data into for fatal and non-fatal overdoses that they can help coordinate Services after the fact for people if they want them um but that's not something I have access to that's a separate service that they do and then where are most of these cases are they in private homes are they outside or mostly they're in mostly they're in private residences um there's no correlation to location or or anything like that but that's typically when we find people as in homes we don't usually do a lot of um of digging when we get there as to whether it's a rental or a permanent residence or a temporary residence it's but most of the times it is in somebody's home yes and do do you see repeat repeat cases we do it's not it's not but we do yes and then are you obligated to refer for treatment or is that something the police do or how does that work no so so the way we work in EMS is we have a little bit of a we have rules governing what kind of information we can share as far as medical records so we can refer people for services if we have their permission to do so we can also notify um our substance abuse we can notify Kelly and she can reach out to them and say hey would you like some help and that can also be done by social workers at the hospital once they get admitted or treated there right so that' be something the hospital social workers we do you know suggest yeah we primarily focus on the patient care getting them stable into the hospital but we do if we have the time or the ability to talk to them and discuss hey would you like to get some help we do have some resources we can refer to them yes sir what what's the rate of response uh in terms of minutes uh with the nasal versus the IV that you give typically it depends it and it's hard to tell because obviously it depends on how much they've taken um how long ago they've taken it usually we see effects 30 seconds to to a minute maybe even a little bit longer 2 minutes 3 minutes depending um but it usually is a fairly quick effect um we do we can deliver manual ventilations in the meantime if we need to to support their respirations until the drug takes effect if it doesn't we can give them another dose but it's usually a relatively quick interaction so the nasal also works quickly yeah nasal is preferred because of the ease of administration how quick it is for us to you know typically if we go out to a call we can have that ready to administer already before we even get there and once we get there we can do an assessment and if we determine it's necessary they can administer it pretty much right away and what percentage of the people that you treat with Naran uh are are taken to the emergency room or most of them most of them um typically 6% or I would say it's higher than that probably closer to 80 um most of the time when we administer it there is a lag time so in that lag time we typically package them we check their vitals we do other treatments and we get them in the truck and ready to go um and usually once they become alert they're already on the way to the hospital and they don't argue as much about going not everybody wants to go um and if you know if they're alert and oriented they have the right to refuse treatment and transport if they want to so that's something that we deal with that that can be difficult as well um as far as we can't kidnap people we can't really take people against their will so if they're able to make decisions and we can't take them so if somebody is in respiratory distress they're in danger of dying of anoxia and you give them Naran and 2 minutes later they're fine they can say I don't want to go to the hospital yeah it's B it's based off their mental capacity if they have the mental capacity to refuse care they can refuse care so then you stay around for a while to make sure it's not going to we can't stay if we're not invited if they say get out of my house we have to get out um and again that kind of goes back to my my concern with the that oh home Narcan presenting some new challenges of people administering Naran you know they become responsive and they breathe and they say they're fine and maybe their friends leave and then they re overdose and now they're home alone have you had to be called back um we haven't recently it has happened in the past but not in the past few years so so if a patient is not really ventilating or you know moving air can you can you give a nasal Naran yes yeah we can give intranasal drugs even if they're not breathing and then we can breathe for them Y and then I know you don't know statistics from other towns but you have a sense of the relative number of cases in adjacent towns you know Dennis harsh it's difficult to say everybody tracks it differently again I'm looking specifically at the administration of Narcan which may not directly correlate to a specific overdose it's just how often it was administered um busier towns typically it's a direct correlation the busier the town is the more overdoses they deal with um the bigger cities The Villages always have usually a higher incidence but that's just because they have a higher volume of calls have you ever been called to one of the schools not to my knowledge no right no so the the uh the nasal it's not like a an asthma inhaler it it's absorbed right through the nasal mucosa right the don't have to bre take a breath basically there's a little foam tip you put on there and as you put push through it converts it to a Mist then it's absorbed directly in the mucosa so it doesn't have to be inhaled in the training that we didn't have today she does um say much of of what Mike has just presented um that you can give a second dose if after 2 or 3 minutes the person starts to overdose again um there also people are concerned about uh liability um there a Good Samaritan law in Massachusetts so you're not liable if you give it it's not going to hurt them even if they're not overdosed but um that's always a concern as well as doing um CPR and um you know rescue breathing um but we we do stress that 911 should be called First and um that's the most important message I think in all this is to make sure that even if you're you're administering the Naran you should call 911 for backup so you you never leave Naran for them to self-administer they but they can come to one of the Town buildings down yeah they can come down and get it they can get it over the counter most of the um well over the counter most of thees are offering it over the counter now without a prescription um and there is a program in Massachusetts to have people come to a fire station and get it we haven't started it yet but we are looking into it um as far as access to if they wanted to come in and get Naran we have what's called a leave behind Narcan protocol available to us we just have to is is there a charge if you buy it over the counter or get it over the counter I I don't know if if um if citizens go get it over the counter if they are charging for it um I'm not sure exactly how that works so I think I think there is a fe yes yeah do you as far as the question do we have an age range I do not at the moment I know that we don't see numbers typically below 18 but it is usually between 20 and 50 is the most common age range okay great other questions from the board any any questions from the U no right and okay great uh thank you very much thank you thanks Mike okay that's uh all we have today our you know Narcan training session was had to be canceled um so I would just uh ask the board any any um old business or issues that people want to bring up can I um yeah Jud just remind folks that we do have a drivethru flu and covid Clinic uh this week um October 9th from 10 to 12 at the DPW and you can go to the town's website to the health division page and click on the flu Clinic uh link and you can register right online through that and if you have any issues um You can call the this um Center for active living or the health department we would help register if you're having issues I was told by someone that you can just walk in without an appointment that's that's not U uh the way it's supposed to work right so you said oh you don't have to make an appointment just walk in uh we prefer if you have an appointment um because they ask you all those questions when you register right I mean we if it if it comes to it we can we can probably register people on site but um it just kind of mucks up the works it's it's much easier and flows better if people register ahead of time and it's flu and covid flu um and we have the high strength flu you give them at the same time different if they want them yep if they want them yeah or same arm if they want you have the choice of the regular flu or the high high strength yes I believe so yep age or or you Choice uh I think it's age I think it's 60 and over you get the high strength or imuno compromise right right U but you may have more side effects yeah I not sure about that but yeah um so we do have the the clinic on the 9th which is 10 to 12 if people can't get to that we do have another clinic on the 16th same routine go online register for it that one is from 3:00 to 5:00 p.m. so same place uh at the uh DPW drive through um 221 CW road so there two two opportunities okay anything else uh and then I we're our first meeting in November we're going to have the community health survey Judy survey uh report uh for us and then uh probably the second meeting in November we'll have a little Forum on community services with somebody from the Council of Aging and Leah lacrosse from our works for the town and does that and uh somebody from the fishing Alliance Services fishing partnership yes is fishing partnership so those three people will sort of uh do that sort of thing that'll be good I think um can I ask Judy uh since the U short since the the new regulations went through has there been a decrease in the number of variance applications for uh uh additional bedrooms and and uh it seems we haven't had a lot lately yeah I think it it seems to be yeah I can't I could have to look and see what the numbers look like between this year and last year um It's relatively new um the last since you mean the change January the number of bedroom you know the you're not allowed to get a a sixth bedroom if you already have five bedrooms on yeah I I mean I would say it has affected that um but I'd have to look at the numbers uh after a year I'll really be able to compare them um but it's only been really since like March so um but I do get a lot of calls from Engineers clarifying oh if someone has five bedrooms and they're on a 40,000 foot lot can I add another bedroom and I say no then two of them know they know now I mean there yeah they they're they're starting to understand yeah it seems been a there have been fewer good so all right um anything else old new business okay then we have minutes from uh September 23rd does anybody have any additions or changes uh if not I can get a motion to approve I'll make a mo I'll make a motion to approve in a second I'll second and then we can probably take a Voice vote all in favor of approving the minutes of September 23rd say I I I opposed okay so those minutes pass and I think that is probably all we have for today that's it so if I take a motion to adjourn the meeting I'll make a motion in a second second and then all in favor of adjourning the meeting say I I opposed okay meeting is adjourned we will turn our mics off [Music] the e