all right welcome to the month of March Board of Health meeting for City Riv can everyone please stand for the Pledge of Allegiance Pledge aliance to the flag United States of America to the Republic for which it stands one nation under God indivisible Li great thank you so first I'll just introduce the uh Board of Health so my name is um Dr Drew bunker I'm the chair of the Board of Health and with me tonight um for the first time is Kathy Savage um she is a new board member um and uh we're gr glad to have her here tonight um if you don't mind just saying a few things okay thank you um as I said my name is Kathy Savage um I'm a Nur practitioner I've done a lot of volunteer work with the city during covid did a lot of the covid vaccines I'm also an active volunteer um for the food bank for the veterans lifelong resident excellent it's great to have you here um and then we have another board member who couldn't make it tonight new board member Vivien katano um she will also be starting and she'll be here next meeting next um introduction of uh other people here so Lauren Buck director of Public Health uh is here Paula suvita who is the Board of Health clerk we have K Anne salame salame you know I W for uh who is the sui program manager Nicole poo who is the mental health clinician and social worker for the city Riv also in attendance we have uh cheral Sabara who is a a lawyer with the U um who executive director and Senior staff St attorney with the Massachusetts Association of Health boards thanks for coming great so first uh thing we do is we approve the minutes from the last month's meeting so I I'm going to ask uh Kathy wasn't here last meeting but um oh you have the meeting minutes okay great okay so yeah so I I just want to um ask you if you approve the M uh meeting minutes from last month yes I approve of the minutes great thank you me as well all right next is going to be the uh Public Health communicable monthly report with Lauren Buck thanks Dr bunker um for the month of March uh just wanted to report some things about our influenza and Co numbers again as I usually do our influ influenza numbers are still high at 168 um those range from 2 months to 97 years old our Co numbers are declining as many uh cities and towns throughout Massachusetts are seeing we had 50 confirmed cases over the last month that range from 1 month to 966 years old I also just wanted to bring um forward one communicable disease that we saw over the last month brucelosis um it's a bacterial infection spread mostly from animals to people via unpasteurized dairy products symptoms may include joint and muscle pain fever weight loss and fatigue and treatment as antibiotics um I wanted to highlight that one as it's something we don't typically see here in R and just a reminder about the risk when you um ingest unpasturized dairy products uh finally some Public Health updates on March 18th 2024 the CDC issued a health alert uh Network advisory to alert Health Providers to the global and domestic increase in measles cases this has been on the news recently so I just wanted to make sure I talked about it and to provide recommendations about how to reduce the occurrence of new measles cases and outbreaks in the US firstly uh schools early childhood education providers and Healthcare Providers should work to ensure students are current with MMR vaccines the um the public health department is a provider of childhood immunizations and we work very closely with r Public Schools uh and so we are uh obviously making sure that we uh Target MMR very closely over the next couple of months secondly all us residents older than the age of 6month without evidence of immunity who are planning to travel internationally should receive MMR prior to departure and finally um Healthcare Providers should consider consider measles as a diagnosis in anyone with a fever uh and generalize U po popular rash with cough uh or conjuctivitis who has recently been abroad especially in countries with ongoing outbreaks uh secondly in March the Department of Public Health launched a Health Equity plan to address racism as a serious Public Health threat the Massachusetts Department of Public Health um they've launched a strategic plan to advance racial Equity the plan calls for among other objectives implementing a data Equity framework to address Health inequalities in Massachusetts reflected in all future key online dashboards and reports including data disaggregated by race and ethnicity supporting an all staff participation in a racial Equity training series with the goal of 80 85% of managers and 60% of non-managers completing this training improving dph's procurement systems um and establishing a dph cultural assessment racial Equity staff survey that will begin to measure what constitutes uh a collaborative and Equitable culture that allows staff to fully participate and belong so obviously this um this Health Equity plan is at the state level we're at the city level but I just wanted to highlight that as um it's an important measure that I think a lot of us are going to be moving toward in the next uh in the next several years finally in late February the CDC revealed that norovirus has been surging in the Northeast part of the US norovirus is a highly contagious illness that causes nausea and vomiting most common the most common transmission vehicle for norovirus is contaminated food while surveill so sorry while surveillance data show an increase in positive test results Nation Nationwide as is typical for norovirus during the winter months the northe Eastern United States have been hit especially hard with a 3-we average of 13.7% for positive neuro virus tests those tests have held above a 10% positive rate since December 23 basically the um Northeastern United States has been seeing a big increase in this specific type of illness I just wanted to remind everyone that proper handwashing during meal prep before and after using the bathroom is the best way to prevent the spread of Nora virus and that's it great thank you Lauren next we're going to do get a presentation from Cheryl Sabara good evening everyone thank you very much for having me um I was asked to come to the Board of Health meeting to speak about the legal Authority that Boards of Health have it's pretty unique in um the United States the amount of legal Authority that local Boards of Health have next slide please um as attorneys always say um I do not represent the city of Riv your city solicitor's office does that and I'm here to provide legal education and some technical assistance next slide so when we're looking at the legal authority to regulate public health and safety in Massachusetts we look specifically at chapter 111 section 31 chapter 111 is the section that of our law that deals with local public health and when you're looking at public health law in general the federal government really just provides minimum standards they're the floor we can go we can be stricter than the federal government we can't be less strict than the federal federal government but we can be stricter and if you look at um the cases from the Massachusetts Supreme Judicial Court which is the highest court in Massachusetts you will see consistently that the court has upheld the legal authority of boards of Health to make reasonable Public Health regulations and the the most recent one was actually from the town of Brookline this was passed wasn't done as a regulation it was done as a bylaw but the same rationale applies where and this was a decision just this month where s it a case called Six Brothers Inc versus the town of Brookline where the town of Brookline and I won't go into all the details it was a tobacco related case they basically um banned the sale of tobacco to anyone who was born after January 1st of 2000 um they were sued it went up to this to the SJC and the court upheld the law saying that the town could be stricter than the state law that prohibits the sale of tobacco to anyone under the age of 21 and the rationale for public health law comes from the same power that police and fire have to protect the health safety and Welfare of its residents but we don't always look at Public Health as having that same police power actually the zoning board has that police power zoning isn't just about where you should put a building because it looks better or not or whether it's commercial or residential they're there also to protect the um health safety and Welfare of its residents and we do that even at the expense of an individual's freedom and we also do that even at the expense of a business um a business has to yield to the Paramount power to protect public health and we need to do this balancing test constantly between privacy rights and public health um we regulate individual Behavior a lot we regulate it when we require motorcycle helmets we when we don't permit lead paint um we do in we do regulate personal Behavior at times next slide please and again as the I'm not going to go through this again um I will just mention that a public health regulation that a three member or five member board enacts stands on the same footing as a state statute a city council ordinance or a state regulation they're just as they're the same they're a law they're a law that the residents need to comply with and if you're going to challenge a law that the board of Hell passes the court will not substitute its judgment for the Judgment of the Board of Health um the Challenger has to prove that there is Absolut absolutely no conceivable ground upon which that regulation could be upheld and the best example of that is a case in um Cambridge back in the 80s where Arthur dittle came to Cambridge with the intention of building a plant that would manufacture chemical warfare weapons the Board of Health in Cambridge at the time enacted a regulation that prohibited the manufacturing of chemical warfare weapons Within the city of Cambridge Arthur D little sued there were three reports that were produced as a result of that suit one was done by the federal government because there were federal funds involved one was done by the city of Cambridge um the the health department and the other was done by Arthur G little and all three reports concluded that to a 99.9% degree of certainty there would be no public health risk with this business coming into the city um the Court ruled in favor of the city and the rationale was if the Board of Health thought there was a 0.1% chance of injury or danger to the residents and the workers in the city they had the authority to enct that regulation the court was not going to substitute its judgment for the Judgment of the Board of Health so that that's an example of the almost plenary powers that boards have to enact public health related regulations next slide please um and again they're not going to weigh the evidence or fine facts they're going to defer to the administrative body which is what the Board of Health is in this kind of a case next slide please um and when you're enacting a regulation um and you the plain meaning of the words in the regulation are what are what is is is what the board and the court will look at so an a reasonable person should be able to explain and understand the regulation that you've enacted this was a case in um the town of Yarmouth where Cumberland Farms sued the town because the town um fined Cumberland Farms for for having a flavored product which was against their local regulation the product wasn't explicitly labeled a product it was called Jazz um so the the board determined whether or not this product was actually flavored next slide so what the board did in order to make that determination is they did a Google Search and well we did the Google search for them um but they found you know all of these representations online that said Jazz has its own unique sweet flavor um the most popular flavors include Jazz next slide please and the Cumberland Farms claimed that and and we also smelled the product we opened it up and we smelled it and what the law says is that if the regulation said a flavored product is a product that has a taste or smell other than tobacco so we opened it up and we smelled it and it smelled really really sweet and citrusy when you smelled it so um the the Cumberland Farms claimed that that wasn't sufficient we didn't have any scientific evidence that it was a flavored product um and the Court ruled that that's fine you don't need science to tell you whether a product is flavored or not and Health Inspectors use FL use smell all the time to determine whether a restaurant has odors whether a a pool flotation device is smells like mildew waste receptacles we always we use our smell next slide please and I just put this in because I think it's does anyone remember who these guys are they were the tobacco industry executive swearing before Congress that nicotine was not addictive just thought I'd throw that in um so again what the court said was that you know all you need to do is determine whether or not it smells like something other than tobacco and you don't need a a scientist to determine that this just happened very very recently um we it happened last summer where the Chelsea Board of Health finded on a product called Newport non-menthol um and with we did the same thing we looked at the advertisements we looked at we taste you couldn't you can't really smell Menthol but you can taste it and we tasted it and it was minty and it tasted like Menthol um and Joan and Chelsea fined on the product and RJ Reynolds challenged it at a hearing and what the argument that um RJ Reynolds and their attorneys used was that as a matter of science the chemical that they use to create the Menthol taste you can't smell it or taste it it's a chemical that you just can't smell or taste next slide please um well I guess I should tell you the end because you're not here for the afternoon presentation so they they said but when you put that product into a cigarette it changes the taste of the cigarette but RJ Reynold said we basically didn't understand science well enough to um understand their argument and one of the members of the Board of Health is the chief pediatrician at Mass generals and and a professor at Harvard medical school and he begged to differ with the chemist that was there because of course they brought their own chemist um to testify at this hearing and he begged to differ with him and said I I think I understand science probably as well as you do and in any event Chelsea ended up ruling that yes this was a flavored product and RJ Reynolds did not appeal which we were very surprised about that but they didn't um another case which I really like and I won't bore you with all the details but we got a really good definition of what public health is from this case it was another tobacco case um and and what the court said in this case and it was about regulate prohibiting smoking in private clubs um and what the court said was public health isn't about geography the fact that the club is private really doesn't matter um it's about protecting the health of every member in the community and when you're looking at a private club it was such a disingenuous argument because they're regulated from door to dumpster they need a liquor license they need an occupancy permit um they need to comply with the local Li liquor Licensing Laws um so they are regulated and again we regulate um Behavior frequently and I will just tell you one thing that was funny the attorney that was arguing for the private clubs was asked about this specific you know we regulate private Behavior one of the justices said well we require smok detectors in homes and isn't that regulating personal Behavior and the attorney said well I have two responses to that number one that law is only enforced when you're selling your home you have to have a smoke detector certificate that says that the smoke detector works from the fire department and number two the reason for that law is to protect members of The General public that come into that home either to visit or you know you have a caterer or uh you have someone clean your house that's the rationale for that law I always thought the rationale for that law was if you were asleep and there was a fire the smoke would go into the smoke detector and wake you up so that you could get yourself and your family members out of the house but evidently I was wrong and this lawyer said that wasn't the purpose of it next slide please so there as I I've told you all of the legal Authority that you have to enact regulations however just because you can doesn't mean you should um and there are some things to consider consider and one is that are you prevented by any state or federal law and we call that preemption and then you're going to want to look at you know that balancing test that risk assessment a lot of our Public Health laws are there to protect um those that can't protect themselves a lot of times our laws are passed to protect youth or to protect the elderly or to protect those with special needs or or are we looking at something that's just a risk to an individual not that that's not important but are we looking at something that can be handled without a regulation that affects the entire city next next slide and again just because you can doesn't mean you should next so some of the things that you want to consider are that balancing test how many you know how what kind of a burden is this going to be to a resident in R is this reasonable and is the intervention going to be effective and the best example of this is a decision probably 20 years ago in Brooklyn where the health department the Board of Health wanted to pass a regulation that prohibited the use of cell phones in cars is that a reasonable Public Health regulation I would submit that it certainly is but how was the Board of Health going to enforce that I don't think they have vehicles me most boards don't some some do um but they don't have sirens on them and how are you going to determine whether someone was on their cell phone so it's a public health regulation but you you can't enforce it as a board of health and luckily you know SAR heads prevailed and they they didn't pass that and it was dealt with later by the state legislature with the police as the enforcing Authority which makes a heck of a lot more sense next slide so um in Massachusetts as I've said um we get our Authority well I didn't actually say this yet we you get your Authority directly from the legislature it doesn't come from city government it comes directly from the legislature pursuant to chapter 111 and section 31 is is the section that gives you the ability to pass local laws next slide please in addition chapter 111 has many other specific Authority that's granted to Boards of health and we're just going to look at two of them um you can see these and and you can look at chapter 111 and you'll see all of them but you have the specific authority to address nuisances and noisome trades as well as many others including the entire sanitary code which includes the housing code and the food code next slide so new is a really important one because um as you'll see here what the statute says what section 122 says is that the board shall examine into all nuisances sources of Filth and causes of sickness within its town which may in the Judgment of the Board of Health be harmful to Public Health and one of um there's a a book that those of us that went to law school had to read and Professor prer wrote in that book that there is perhaps no more in penetrable Jungle in the entire law than that which surrounds the word nuisance so here you are getting the big bucks to enforce the new to to determine whether something is a nuisance and then to get rid of it next next slide please so and and again if you do find a nuisance this is what you're supposed to do you're supposed to get rid of it and make regulations for it in your judgment I wish I had time to do my liability protection slides because You' feel much better when you know there is no liability that's going to attach for any judgments that you make but um and there is an exception for generally accepted farming procedures probably not terribly relevant in rever but it's always good to know next slide so do you have any guidance in determining how to find how to how to how to judge whether something is a nuisance or isn't a nuisance and it's a judgment call all the time and your judgment will be upheld your regardless of whether your judgment is reasonable or unreasonable if it's your judgment you're I shouldn't say it will be upheld you will be protected from liability because you have the right to pursuant the um discretionary function you have a right to make that judgment so you want to consider again some of the things that we considered earlier is the nuisance contained to one person or one house household um think about covid could the nuisance spread to neighboring individuals or households could it spread even further could it could spread out to um the the next slide please um and then you know you want to is there a real or potential health risk um I don't need to go through all of these you have this but but you're going to want to look at it at as how it affects Health um and frequently I don't I'm sure Lauren deals with this all the time but you know sometimes you may have two neighbors that are fighting with each other over I don't know water going on to one's land or noise that's keeping them up or lighting that's keeping them up um and and sometimes there may be a private cause of action for a nuisance between neighbors but does it rise to the level of a public health nuisance and these are the factors that you can consider when you're thinking about that next slide please so if you find a nuisance then as the law says you have to remove that so what normally happens is that you would issue your staff would issue a season assist order ordering the person to Abate the nuisance and um also have have them come before the board and explain how they're going to do that so that there's a plan there that you can approve um we have templates available that Lauren's aware of if if you need them for any reason next slide please noise trade is another one that is challenging for boards but is really um an effective strategy and this law says that any business that may result in a nuisance be harmful to people or harmful to their property which is really unique in the law we're not usually looking at property interests when we're looking at public health law um but not those kinds of business businesses can't be established in a location um unless the board assigns a location for that business now normally what happens here is that the business is already in the city and what the board does is it can put conditions on that business in other words you can't you have to be open just from s until five you know you can't if you're an auto body shop you can't be sanding um a car at 3: in the morning um those kinds of things next slide please um so and again the board would hold a hearing and and if you're doing this you want to consult with your zoning board because there are some zoning issues that come in there too um examples would be you know in this area auto body shops we had a situation in Somerville with uh car washing facility that washed large trucks in the middle of the night because that's when the trucks weren't on the road and that was creating a problem because it was a very dense neighborhood where this place was um situated um piggeries by definition are not noise are by definition noisome trades but if you have if they're on five acres or more they're farms and then we have to look at generally accepted farming procedures next slides we'll go very quickly um free range Piggery not in R um but that's what a free range Piggery would look like that's generally accepted next slide same thing next slide this is not a freerange Piggery this was actually a dump that had pigs where pigs lived and these brothers um were claiming that this was a farm next slide and then we're done with the piggeries okay next slide please okay so here's a manual that we we edited and this is was edited eight years ago so it need it definitely needs to be updated it was originally done by the Department of Public Health then um mahb edited it but it needs to be reviewed again but I just want to show you the breadth of the types of laws and regulations that you as a board of health are charged with enforcing next slide please so you'll see um this is a this is a book with several chapters and under each each chapter there are several sections that list the specific laws that you are charged with enforcing and you can see some of them right right on there next slide please and more um and then there are more because we don't have um some of the law we don't have the cannabis laws we don't have a lot of laws so there's a lot um and and we're going to just switch to inspections which you folks luckily have a staff that does um but the types of inspections that boards get involved in are either the periodic ones that are done like restaurant inspections or the complaint driven ones which are um complaint driven and they can be anonymous complaints as well and you would go to the property that's being complained about and if you're not let in um you can't bang the door down you have to get what's called an administrative search warrant next slide um we're going to talk about enforcement just for a minute um the easiest way to enforce is to call up an establishment and say your dumpster's overflowing could you please get it clean we're Boards of Health we're not why while we have the police power we're not the police we're about compliance not about punishment we just want to get to yes you know we want the situation cleaned up and that phone call may be all you need or that one visit may be all you need um if that doesn't work then we have the non-criminal disposition way of enforcing which is a civil ticket it it can only be up to $300 so it doesn't work with all things like tobacco sales first defent is $1,000 um and then we we have the ability to apply to file an application for a criminal complaint in District Court if someone's not um not if someone's not complying with your orders or with your regulations or with the food code or the housing code um and then we have obviously the health orders that are really letters sent to someone telling them to stop doing this um or come in and explain how you're going to stop doing it and then we do have the ability to suspend or revoke or refuse to issue permits and getting a permit is not a right it's a privilege so a board can suspend that permit or revoke a permit if assume after the The Violator has been offered um a hearing because they they need due process before you can take it away but you can take it away and then if all else fails you can um file a a either a civil or a criminal Criminal complaint in um either the district or the Superior or the housing court um next slide I would just say and this is my last slide and this was written by um a senior judge of the second Circuit Court of Appeals who has retired and you really want to be careful before you get to court the judicial system is the most expensive machine ever invented for finding out what happened and what to do about it so I always go back to we're about compliance not about punishment and if we can we want to stay out of court I mean we're seeing now how long court cases can actually drag out and I think that's it Paula and if there are any questions I'm happy to answer them but you're probably sick of hearing me I don't have any questions you no okay great thank you so much um so next is going to be a um presentation from the opiate abatement working group and Lauren is going to do that hi um so I'm here as the Director of Public Health and I have two colleagues coming up to present as well um we are from the public health department and we are wanted to present on the opio de batement fund strategies for the city of Rivier um we want you guys to ask us questions uh we are also doing this presentation to the city council just to make sure we are getting the word out about these funds to make sure people um have a chance to ask us questions and to just be transparent uh so first we'll introduce ourselves you guys know me I'm Lauren Buck I'm the director of Public Health hi I'm karanne cemi program manager for the sudhi office hi I'm Nicole poo I'm the mental health clinician for the sudh office and the public health department awesome and can is the yes okay great so uh first up I just wanted to give a very very brief overview of what the opioid crisis looks like here in Rivier the top bar graph is a representation of three cities us Chelsea and winr Chelsea is in blue we are in pink and uh winr is in green just to keep note about these statistics and I'll explain what they are um Riv is by far the largest city of these of the three cities and so although our opioid related overdose deaths are much higher than Chelsea and winther we also have a much higher population but as you can see as throughout the country throughout Massachusetts Rivier has seen an increase in opioid o overdose deaths over the last several years for 2020 we had a total of 21 for 2021 we had a total of 25 for 2022 we had a total of 30 which is obviously a very um a very scary big number we don't have official data for 2023 yet but what we do have is rever um police data and what we can say from those numbers is that we've estimated uh preliminary reports show that we had a total of 123 total overdoses in 2023 and 17 fatal overdoses obviously 17 is less than 30 but it's definitely 17 too many um and so the state will present uh official numbers later in the year but we we can use that number as a as kind of a guide next up so I wanted to give an overview of what the opio de batement funding actually is some people know about it and some people don't Massachusetts entered into litigation with opioid pharmacies manufacturers Distributors um because of deceptive business practices because there was a recognition that opioids were much more um of a problem than people were letting on the Distributors and manufacturers thees and uh basically um settlements came from these lawsuits in Massachusetts and how Massachusetts decided to split up these settlement funds was if you can see the bar graph in pink 60% of these funds are going straight to the state as part of the opioid recovery and Remediation fund so that sits with the state of Massachusetts 40% of the funds come to local um localities municipalities themselves we are one of 300 municipalities am I getting that right Cheryl 321 municip part of the shared service no in in Massachusetts 350 there you go thank you we are one of 351 municipalities not every municipality signed on but most of them did and so we get a share of the 40% um as part of the the settlement agreement we uh certain things um are required of us uh we the state would like us to make sure we're pooling funds if possible as part of the shared service model can explain that more but basically Chelsea Rivier and Winthrop are a shared Service public health collaborative um uh Rivier has chosen to make these monies available by appropriation which means whenever we decide we want to spend money from this fund we have to go to the city council to get it approved um and there's also a company that is contracted to oversee all the reporting and data for the state and for all the municipalities and that's JSI next slide definitely not going to read all of this but as part of the settlement agreement for the opioid funds as something that the city signed off on saying is that we can use for the following buckets this funding opioid use disorder treatment uh support for people in treatment and Recovery connecting people to care harm reduction Services addressing the needs of Criminal Justice involved persons and supporting pregnant or or parenting women and families including babies with NE neonatal abstinence syndrome and finally prevention preventing the misuse of opioids and implementation of prevention strategies so those are kind of the big bu that we can use this money for next slide this is a bunch of numbers but basically if I want to make sure we're transparent about what money we are anticipate in receiving what money we've already gotten and the total number that we'll receive as of 2038 for fi like the the total amount we'll receive for the city overall one thing that I just want to highlight here I won't go over the individual numbers is that you can see on the very right hand side of the screen maybe leth hand side of the screen for you guys the total every year all of these settlements are structured so that their lump the lump sums are much bigger in the very beginning and then they dwindle off in the in the um the consecutive years so you can see by by 2038 we our share of what we're getting is much less than what we have then what we'll be getting over the next several years you can go to the next slide so what has Riv actually spent I can do fiscal year 2023 and fiscal year 2024 and I can let you know that fiscal year 23 we didn't spend any money most cities and towns did not spend any of this money in fiscal year 23 or fiscal year 24 so we were a little bit ahead but fiscal year 23 we were just barely getting some of the money we didn't have City account Council appropriation we were still getting direction from the state in how to actually do the appropriation so we waited until fiscal year 24 in fiscal year 24 we spent in two categories um we spent for salary and benefits and then for miscellaneous goods and services we will talk more about that $10,000 Circle um as part of the presentation why we want to talk to you all about some of the the really fun initiatives good initiatives that we're doing with that $10,000 but you can also see in this slide that the total remaining balance as of March 2024 just checked in this uh this afternoon about that number is $432 490 there we go okay so um noted that this balance includes payments that were rewarded in March 2024 from Walgreens tevia allergen and Walmart so so uh so those are the companies that have settled there are still some pending settlements is that right Cheryl yes um there are still some pending settlements from other companies these are the ones that have settled and started their payments and just a quick note um we got money from uh CVS Walgreens Allergan and tevia at Walmart just in this month so very very new that we got those um those uh line items there all right next slide so obviously the goal is to make sure that the city spends this money effectively that we're meeting the needs and we have a long-term spending plan we don't want to spend this money year after year in short-term ways how are we doing that some of the things that Nicole and Ken will be able to talk about we funded an uh we started an opioid abatement working group we also want to communicate to the public so we're working on getting a website up up uh and running about this um funding obviously we want to communicate to the council and administration that what we're starting today with you all and we'll go to the city council as well and we'll try to do this at least annually to make sure you are all aware of what's going on we really want to focus on innovative ideas and like I just said the goal for the city of Rivier is to make sure we're have a long-term spending plan um and I'll pass it off to Nicole to talk about the opioid abatement working group hi everyone so the opioid abatement working group is part of the agreement that the city signed into that every Community who's getting these monies has to have to make decisions basically on where the money is going so it has to consist it has specific qualifications I guess of what it has to consist of um so concerned Community member Partners um MGH primary care doctor we have in here um family of people with lived experience so we have a bed parent um who lost her son to an overdose um people with lived experience either past or present so we have someone who who is actively using we have Outreach workers um community-based organizations such as health Innovations and healthy streets and people in Municipal departments like myself the sui Department we have school resource officers and um Lauren from the public health department um what this group does is we bring a multitude of like all of our different viewpoints because we all come from different areas of of expertise around opioid use disorder good thing this a practice um so we all have like different perspective different ideas um some people are more focused on prevention where other people are more focused on harm reduction and with this group we kind of are deciding what we're going to do with the money long term um we meet monthly and we started meeting last October so we've met every month since then um we keep minutes and agendas that eventually will be available on the city's website so that anyone can go in and look at what we're discussing and what we're talking about um the importance of having people with lived experience in this working group is that they'll be represented in the decision making and they're the ones that are really going through it or have gone through it um using you know opioids and the effects shortterm and longterm and on their families and loved ones um in the agreement it specifically says that the group must reflects the input of our communities of people who have personal experience with the opioid crisis of experts in treatment and prevention and of staff and organizations that are carrying out abatement work so everyone in the group fits into this category um we are ensuring that Rivier is also hearing these voices so we're going to have surveys with gift card incentives to give out to people so we can hear from the community as well so people who aren't directly in the working group um we're going to invite people to the working group meetings um to discuss Transportation assistance um Regular communication with our Outreach workers so we know what's going on in our homeless population communities and our opioid use disorder communities like I said we'll have a website coming and possible focus groups after our initial surveys next slide and then for the $10,000 that Lauren had talked about previously um we have voted and decided on what we're going to do with that $110,000 as the group um a thousand of it will be used for gift cards to give out to people who take the survey um $500 is put aside for a speaker to come in and talk to our working group so that we can eventually have longer term goals so maybe like a prevention speaker or a lived experience speaker something like that um $2,000 will be for six months worth of miscellaneous funds to be held by an outside agency so we won't actually be holding the money and giving it out and deciding where it goes a nonprofit that we work closely with will be holding that money and then $6,500 will be used towards noock boxes um and kenn's going to get into that and that's kind of our big project for the rest of this fiscal year so I'll give it to caran hi everybody uh so noock boxes what are they we have outdoor noock boxes indoor noock boxes what this is is it's an a cabinet to store nxone and when I say nxone other people might know it as Naran um so if you hear me say Naran in the lockone it's the same thing um so the outdoor boxes can hold 12 12 kits of nxone which means that would be 24 doses there are two doses in each box those are outdoor cabinets that can withstand the weather and hopefully vandalism hopefully there won't be vandalism but they're pretty sturdy and where these boxes will be is around the city so people are going to see these they will be around the community in um we have seven locations identified as of right now and still looking for a couple more um so they will be outside uh you might see one on Broadway you might see one down Shirley AV um different areas that we have identified as hotpots of where overdoses have taken place well done okay and the indoor boxes or far sorry the indoor boxes we are going to be utilizing to do B small business engagements where we can um Pres present to small businesses to uh encourage them to carry have an emergency overdose kit on their property uh next slide okay so noome is a medication how can it be out in public as of this year the FDA made Narcan a non-prescription medication this means that anyone can access Naran either by buying it at a pharmacy are obtaining it through a h Reduction Program the noock boxes are and extensive to our H Reduction Program and in R would it be dangerous for a child these are some frequently asked questions would it be dangerous for a child to get their hands on Noone nxone is rela is a relatively safe medication the benefits uh the benefits of the use for preventing opium overdo overdose deaths far outweigh the risk of the medication it is crucial to note that nxone is effective in reversing the effects of opioids but it will generally not harm someone if opiates are not present in their system naloxone is not a controlled medication it has no street value you cannot become addicted to it I just want to uh elaborate a little bit on that it is a nasal spray much like a floes there is no adverse effects well I mean I'm sure all medications have adverse effects I won't put that out there however it is a very safe medication if you do not use opiates it's not going to do anything it's just not if you do use opiates and you are using them regularly you can have adverse side effects such as vomiting sweating uh runny nose watery eyes you know some of the withdrawal symptoms because it does cause withdrawal symptoms to somebody who is using it regularly I just wanted to clarify that does this incen does this incen incentivize oh my God drug use Studies have shown that nxone access and distribution does not lead to more drug use or RIS or riskier drug use some Studies have actually shown the availability of nxone may lead to a decrease in opio use folks who are using opiates regularly do not want to use this medication they don't because they will go into withdrawals and they know that that's why it is recommended that you do not give this medication to somebody who is responsive um so that you don't put them into a opioid withdrawal if you do not have to the only time you would use this medication if somebody is unresponsive uh to stimuli and they do not want you to use it so it does not you know make them want to use more drugs okay next question what security measures will be in place and how will the knockaine be restocked so the sudhi office plans to monitor the an loock boxes closely and restock them from the stores weekly we have consulted with neighboring communities who have implemented this program over the last 6 months and they have experienced almost no issues with vandalism or inappropriate use we also work closely with Rivia PD and we'll update them with any of our issues or concerns okay all right and then our final slides are just uh a really exciting uh tool that we are using to place our nooon boxes and and that is we have a new overdose heat map that we were able to get onto our website this week um and so how do we decide where to put the boxes we can use two things we can use our overdose data to create a heat map and we can use our our frequent locations that we see in our syringe pickup request that we get through the 311 Department uh so an overdose heat map allows us to like have a physical geographical representation of where our overdoses are happening in the city of Rivier and it helps us locate where we need to place these boxes uh the map that I'm showing you is overdose data from 2022 you can go to the next slide and here we can see 2023 and 2024 we're only 3 months into 2024 obviously so it looks a lot different you can also on our our map combined all three years and obviously the the spots that are in yellow are the hottest areas and that has the most overdoses and the spots that are cooler tones have less overdoses and it's just a way that we can use to pinpoint the locations and this is what we will be using in our opio abatement working group uh to make sure we have the best locations for these boxes and that is it so please please we want you guys to ask us questions that you think the public would have concerns about city council would have concerns about um please fire away yes oh come you can come up and talk into the mic um how does one access the contents of the Box oh good question so I think what you're getting at is are they locked is there a code or anything like that um I'll have Ken explain a little bit more but they are just a cabinet that you open there's no um there's no qualifying system you can talk a little bit more about it yeah so they're basically just a a simple cabinet that holds a box so yes can somebody go in and take all the boxes of Noone sure if they take all the boxes of in the lock Zone then they must really need them so that's still going to save lives if they vandalize the Box okay then we'll replace it simple any other questions go ahead K yes are the box is going to be like well marked so the people know what they are and when are you thinking of in starting to install them yes so we're looking to purchase them at the beginning of next week in looking to install them in the very near future like May um as far as will they be noticeable yes so you will see a um almost like a purple sticker a big sticker where the boxes will be located and it will stay in the lock Zone here and you'll see the boxes and they're trying to we're working with DPW and they're going to try to put them on the uh what are they called ballards the ballards so the big yellow and if you if you look in the PowerPoint presentation at the very top there's an example it's a box on a light pole with a with like a sticker underneath that says in a lock zone so they should be noticeable we want people to notice them we don't want them necessarily hidden all that information is going to be on the website once we get everything put in place once every all the boxes are up on the website will'll have the locations of where they can be found so people can go on and see that yeah is there any training necessary to give nooon yes there's a very simple 10-minute Noone training um with just recognizing the signs and symptoms of an overdose and how to respond to it it's very simple I could give the training right here right now in less than 5 minutes that's how easy it is um so I know PE folks get you know afraid and don't do well in crisis situations but is very very simple procedure yes okay with the training is it going to be like maybe a pictogram or something on the inside door so people will know how to use yeah it's actually on the box the front of the box is going to tell you how to respond with three simple steps I think too and this is more for like us just as thought maybe we can do a mini or quick training on like Rivier TV and then link it on the website so that way people can go on and as they're looking at where the boxes are they can kind of train themselves quickly and people can always come into our office as well and stop in for a quick like five 10 minute talk and training on how to use it but it's fairly simple once you because I was going to ask you how are you advertising it through the city so that people will be aware of it sorry I just want to say um May 7th is actually fentol awareness day so we are going to I know I didn't know that either so we're going to do a Naran training and it will be on Rivier TV so be hopefully on that day so that folks know how to use it any other questions okay okay that's it thank you so much thank thank you thank you guys so uh next topic that we're going to discuss is the uh chicken keeping license uh renewal for igini victorin I'm gonna have Lauren take that over sure um so for to vote on for the board are three um licenses today one is for a renewal of a chicken keeping license which I'll talk to first iag gen victorin um she submitted for her on July 14th 2023 she passed her inspection on um March 5th 2024 and the public health and inspectional Department recommend that the board approve this license yes I approve the license yes okay I approved the license great our next one is for a renewal for a beekeeping license um all three of these licenses fall under our Urban farming regulations um just FYI where where they kind of what they have to do with inter terms of regulations for the Board of Health uh Damen DeMarco who runs Cowell well who operates Cowell Apiaries he submitted his renewal on February 10th 2023 he passed his inspection on March 21st 2024 he pass the inspection and the public health department and inspectional Department recommend that you improve approve that license yes I approve the license I also approved the license great last one um this is a new beekeeping license so we have two official beekeepers in rier this was submitted by Aldo GD olivaria uh the submission date was February 21st 2024 his inspection date was March 27th 2024 he passed inspection and the public health and inspectional Department recommend that the board approve the licenses yes I approve the license I also approve the license great thank you great thank you that concludes this uh meeting for this month thank you very much for