NATIONAL SHERIFFS ASSOCIATION. Combating the Opioid Epidemic

Transcription

1 NATIONAL SHERIFFS ASSOCIATION Combating the Opioid Epidemic

2 ABOUT THE NATIONAL SHERIFFS ASSOCIATION Chartered in 1940, the National Sheriffs' Association is a professional association dedicated to serving the Office of Sheriff and its affiliates through police education, police training, and general law enforcement information resources. NSA also created the National Center for Jail Operations to address those issues specific to our nation s jails. There are currently over 3,000 sheriffs nationwide. Our membership base includes over 20,000 individual members, including sheriffs, deputies and other law enforcement officers, public safety professionals, and concerned citizens.

3 MEETING WITH THE PRESIDENT The nation s sheriffs have been called upon by President Trump to propose solutions for the opioid epidemic that has affected nearly every community across the country. On February 7, 2017, President Donald J. Trump met with the executive leadership of the NSA in the Oval Office to discuss the nationwide challenges sheriffs are facing while attempting to manage our country s opioid epidemic, particularly as it relates to crime and jail administration/inmate management. All attending parties acknowledged there are insufficient resources available to local jurisdictions to combat this epidemic and that jails have become default detoxification units, drug treatment centers and warehouses for individuals with opioid use disorders.

4 NSA EXECUTIVE DIRECTOR, JONATHAN F. THOMPSON If Not Us, Who? If Not Now, When? In the past year, law enforcement has regained the full support of the federal government As we look to the future, we hope to continue to work with our partners to solve big problems, and there is no bigger issue than the opioid epidemic. Last year, it became evident that citizens rely heavily upon law enforcement to solve this problem, but we can t do it alone. There needs to be a clear strategy that brings together local partners from every level of society; everyone should have a stake in this effort, and we need to bring them together.

5 HOW NSA IS CURRENTLY ADDRESSING THE OPIOID EPIDEMIC

6 OHIO STAKEHOLDERS ROUNDTABLE SEPTEMBER 22, 2017 HOSTED BY NSA AND THE BUCKEYE STATE SHERIFFS ASSOCIATION NSA s 2017 Initiative attempted to answer who would be charged with solving this crisis? Decided the best place to look for answers was in Ohio, the most effected state in the country. The Ohio Roundtable, hosted by sheriffs, convened more than 75 stakeholders assembled for an exchange of ideas in search of answers. Stakeholders present included: sheriffs, local officials, schools, business/retail outlets, hospitals, treatment centers, halfway houses, jails, faith groups, first responders, and other law enforcement agencies. Senator Sherrod Brown (D-OH); ONDCP Acting Director Richard Baum, and staff from Attorney General Jeff Sessions office were also in attendance. Two panels: Traditional Problems Nontraditional Solutions: What is Your Agency Doing to Address the Opioid Crisis? Nontraditional Problems with Traditional Solutions: How is the Opioid Epidemic Impacting Private Industry and What Are You Doing to Address It?

7 OHIO STAKEHOLDERS ROUNDTABLE SEPTEMBER 22, 2017 HOSTED BY NSA AND THE BUCKEYE STATE SHERIFFS ASSOCIATION Consensus: There is a dire problem WE need to solve together; EVERYONE was ready to do their part in putting our communities back together. NSA gathered the information and reported back to the President s Commission on Combating Drug Addiction and the Opioid Crisis with 10 broad recommendations. Our hope is that our findings could assist them in adopting a strategy to combat the crisis. The 10 broad recommendations, with specific actions that must be considered at the local, state, and federal levels, are as follows: 1. Community Solutions 2. Focus on Prevention 3. Support Jails and Prisons 4. Assist First Responders, Law Enforcement, and Partners 5. Requirements and Support for Prescribers and Medical Partners 6. Improve Treatment Availability 7. Assistance with Policy Issues across Government 8. Funding Vital Resources 9. Business/Unions 10. Federal Government Cannot Solve Alone

8 COMMUNITY SOLUTIONS There is no magic bullet to solve the opioid epidemic. We must look beyond law enforcement and create a comprehensive approach with local communities and state and federal government. EXAMPLE: The Franklin County (OH) Opiate Action Plan identified four pillars/goals to approach the Opioid Crisis: 1. Prevention and Community Education: Prevent opiate abuse and addiction; 2. Healthcare and Risk Reduction: Reduce opiate-related deaths; 3. Treatment and Support: Expand access and decrease wait time; and, 4. First Responders and Law Enforcement: Improve community safety.

9 FOCUS ON PREVENTION We need to address the cultural shift to educate our next generation on the dangers and risks heroin and other opioids. Recommend the Secretary of Education require schools to implement K-12 drug prevention programs; Schools consider implementing treatment assistance and diversion programs without risk of permanent home removal; Support before and after-school awareness programs for kids, parents, educators, and caregivers; Track and report annually the number of children in foster care as a result of a parent or guardian's opioid addiction; State and local governments and non-governmental organizations support increased education to public, victims, families, officers, and inmates to raise awareness of the dangers of opiates and ultimately as bridge to treatment.

10 SUPPORT JAILS AND PRISONS The nation's jails have become de facto mental health and addiction treatment facilities and there is a need for evidence-based approaches for correctional technical assistance and training. Additional funding and support for the Department of Justice (DOJ), including the National Institute for Corrections (NIC), the Office of Justice Programs (OJP), and the Substance Abuse and Mental Health Services Administration (SAMHSA), for the development of and funding to support Medication Assisted Treatment (MAT) programs; Track and provide metrics of in-custody MAT programs; MAT programs should consider comprehensive and long-lasting substance abuse programs using existing pharmaceutical offerings (i.e., naltrexone, methadone, or Suboxone) immediately upon release from custody; Create reentry programs that offer a seamless community transition, including referrals for substance abuse counseling and recovery support navigation; Build MAT programs that include additional treatment and recovery resources immediately upon release from custody; Crisis Intervention Training (CIT) for all officers and deputies.

11 ASSIST FIRST RESPONDERS, LAW ENFORCEMENT, AND PARTNERS Provide additional technical support for law enforcement in the arrest and prosecution of drug traffickers; Provide support for development of a Drug Trafficker Registration Program, mirroring current Sex Offender Registration Programs nationally; Create diversion programs which first responders can use in lieu of incarceration; Fund naloxone programs for all first responders, not just law enforcement; Aid states in the development of drug courts for substance abusers; Support Rapid Engagement Specialists for addicts, family, and friends to provide counseling and treatment; Encourage broader "Good Samaritan" legislation to allow immunity for notifying law enforcement of overdosing individual; Double federal manpower, technical, and financial support for narcotic and homicide detectives and task forces investigating the opioid supply source; Support retail merchants who oppose increasing thresholds for felony retail theft.

12 REQUIREMENTS AND SUPPORT FOR PRESCRIBERS AND MEDICAL PARTNERS Requirements and support are needed for Automated Prescription Reporting Systems, prescription disposal requirements, and guidelines; Educational requirements are needed for medical students regarding treatment options to address acute and chronic pain; Support needed for new detox protocols by jail medical providers regarding assessments and detox withdrawal management.

13 IMPROVE TREATMENT AVAILABILITY Offer grants or discretionary funding to address transportation and child care treatment barriers for local communities; Give consideration to needle exchange programs.

14 ASSISTANCE WITH POLICY ISSUES ACROSS GOVERNMENT Opioid epidemic crosses over all Federal agencies; Establish national clearinghouse for workable solutions and best practices.

15 FUNDING VITAL RESOURCES Consider Operation Stonegarden-equivalent grants and discretionary dollars for treatment and naloxone for first responders and law enforcement; Investigative support to identify and reduce the supply of opioid distribution; Re-entry wraparound programs in the community; Additional resources to support training and technical assistance to effectively engage and assist individuals with opioid use disorders and the development of data-driven tools with measurable deliverables (or identifiable metrics); Funding to support federal and national partners, including the Department of Justice, and groups such as the Addiction Policy Forum which provides policy guidance to local communities about addiction.

16 BUSINESS/UNIONS The opioid epidemic impacts employee behavior and creates challenges for employers to find and maintain a viable and productive workforce. Employers suffer because they cannot hire people who can successfully pass required drug tests and employee absenteeism due to opioid addiction; Business owners should improve drug testing and counseling programs to keep employees and workplaces safe, including training staff on administering naloxone in the event an employee or customer overdoses.

17 FEDERAL GOVERNMENT CANNOT SOLVE ALONE Federal mandates burdening law enforcement alone will not solve this problem; One-size-fits-all solutions don't exist; We cannot arrest our way out of this crisis; Every element of society must participate in the solution; Private sector, academia, and non-profits must be part of local solutions; Set and use metrics for federal government and hold agency heads accountable for reporting to the public progress, successes, failures, and solutions.

18 WHITE HOUSE OPIOID EVENT In October of 2017, National Sheriffs Association Officials joined President Trump and law enforcement officials, victims of drug abuse, and treatment specialists at an Opioid Crisis Event held at the White House. At the event, President Trump declared the U.S. Opioid Crisis to be a public health emergency. We can be the generation that ends the opioid epidemic. NSA s President, Sheriff Harold Eavenson, and Executive Director, Jonathan Thompson, issued a joint statement: Bringing together all the different government entities and partners to address this crisis is the right approach, because this cannot be just a law enforcement solution. We need an all-of-the-above strategy. That is why sheriffs have been and will continue to bring people together in their communities and states to address this epidemic, and come up with proper solutions.

19 MICHIGAN OPIOID CONFERENCE NOVEMBER 30, 2017 HOSTED BY NSA, THE MICHIGAN SHERIFFS ASSOCIATION, THE MICHIGAN ASSOCIATION OF CHIEFS OF POLICE, AND THE PROSECUTING ATTORNEYS ASSOCIATION OF MICHIGAN Goal: To duplicate the Ohio Roundtable to bring the appropriate stakeholders together collaboratively, to combat a widespread issue. Similar to the Ohio Stakeholders Roundtable, there were numerous individuals representing a wide variety of the public and private sectors, including law enforcement executives, state health officials, judicial officers, pharmaceutical representatives, and nonprofit organizations, among others.

20 WASHINGTON D.C. STAKEHOLDERS ROUNDTABLE MAY 3, 2018 HOSTED BY NSA AND THE DANIEL MORGAN GRADUATE SCHOOL OF NATIONAL SECURITY GOAL: Bring federal and national partners together and expand the lens beyond law enforcement. Community Problem-Community Solution

21 WASHINGTON D.C. STAKEHOLDERS ROUNDTABLE MAY 3, 2018 HOSTED BY NSA AND THE DANIEL MORGAN GRADUATE SCHOOL OF NATIONAL SECURITY In attendance were DHS Secretary Kirstjen Nielsen, U.S. Attorney General Jeff Sessions, and President Trump s Counselor, Kellyanne Conway

22 WASHINGTON D.C. STAKEHOLDERS ROUNDTABLE MAY 3, 2018 HOSTED BY NSA AND THE DANIEL MORGAN GRADUATE SCHOOL OF NATIONAL SECURITY Kellyanne Conway - WHOLE GOVERNMENT APPROACH Solution Set: Simultaneously Address: Education and Prevention Treatment and Recovery Law Enforcement and Interdiction Other topics discussed: HIPAA-Crisis Exemption Medicaid Waivers Crisis Next Store Take Back Day Interdict Act HIDTA in all 50 States Dark Net Destruction MS 13 Gangs Disruption of the Illicit Drug Flow on our Nation s Borders

23 KELLYANNE CONWAY

24 PROJECT SAFE NEIGHBORHOODS

25 CONFRONT THE PRESCRIPTION DRUG PROBLEM

26 SPECIFIC GOALS

27 OPIOID RESOURCE LIBRARY NSA created a Opioid Resource Library that compiles all the documents from the three Roundtables, as well as other documents submitted by our partners.

28 OPIOID EPIDEMIC INITIATIVE NSA also created its Opioid Epidemic Initiative as a one-stop-shop for information on various opioid-related programs and funding opportunities, including: Bureau of Justice Assistance s Comprehensive Opioid Abuse Site-based Program (COAP) Fentanyl Safety Recommendations for First Responders Surgeon General s Advisory on Naloxone and Opioid Overdose Handling of Suspected Drugs (Video) Naloxone Use in the Management of Opioid Overdose Adapt Pharma s Roll Call Training Video to Educate Law Enforcement on NARCAN Stopping the Opioid Crisis Begins at Home Medication Assisted Treatment in Correction Settings Infographic Fighting Opioid Abuse flyer

29 NSA COLLABORATIONS Purdue Pharma L.P. Alkermes Inspiration Grant Recipient in both 2017 and 2018 Promising Practice Guidelines for Jail-Based Medication-Assisted Treatment Webinar: Implementing Medication Assisted Treatment Programs in Jails National Association of Triads, Inc. Drug Enforcement Committee White House National Security Council

30 PURDUE PHARMA L.P. In November 2015, the National Sheriffs Association (NSA) partnered with Purdue Pharma L.P. to provide free-of-charge naloxone overdose kits and training to law enforcement agencies across the country. Purdue provided $850,000 to fund the kits and training. To date, NSA has trained more than 1,000 law enforcement officers and command staff to administer naloxone. Furthermore, NSA has distributed over 1,700 2-dose kits of naloxone aerosol. Specifically, NSA has provided naloxone overdose kits to 39 law enforcement agencies covering 21 states. Finally, and most importantly, data collected in the project s first 26 months document that the NSA and Purdue partnership has saved more than 175 lives.

31 ALKERMES INSPIRATION GRANTS Medication Assisted Treatment in Justice Involved Populations NSA was awarded an Alkermes Inspiration Grant in 2016 and again in The overarching goals of the 2016 project were twofold: (1) To mount a nationwide campaign to heighten awareness among law enforcement of the escalating opioid addiction/overdose crisis, and; (2) To introduce sheriffs and jail administrators nationwide to Medication Assisted Treatment (MAT) as an evidenced-based practice to address this crisis, specifically within their jail settings. The 2017 project will develop a national Compendium of Model MAT Programs for Opioid Use Disorder in Jails to serve as a primer for sheriffs and jail administrators who are searching for practical examples and peer mentors to help them win the support of state and local policymakers, their correctional staff and treatment providers, and the local citizenry to establish as well as successfully implement MAT programs in their jails.

32 PROMISING PRACTICE GUIDELINES FOR JAIL-BASED MEDICATION-ASSISTED TREATMENT NSA partnered with Advocates for Human Potential, Inc.; experts from multiple federal agencies including the National Institute of Corrections (NIC), Bureau of Justice Assistance (BJA), and the Substance Abuse and Mental Health Services Administration (SAMHSA); national professional organizations; and individual experts and practitioners to develop and disseminate guidelines for implementing MAT programs as a standard of care for substance use disorder treatment in jail settings. These guidelines have been developed to help institutional and community correctional agencies ensure access to MAT for individuals with alcohol and opioid use disorders, under probation supervision, when they enter jail before trial or after being sentenced, and when they are released into the community. Research has begun to show that adding MAT to the treatment of individuals involved in the criminal justice system not only increases the likelihood of successful treatment, but also reduces recidivism.

33 WEBINAR: IMPLEMENTING MEDICATION ASSISTED TREATMENT PROGRAMS IN JAILS Middlesex County, Massachusetts did not let failure stop them when tackling opioid addiction issues. They learned from what did not work in the first design of their MATADOR (Medication Assisted Treatment and Directed Opioid Recovery) Program to reboot, improve services, and achieve promising results. The program employs a unique opioid and heroin addiction treatment model that deploys the use of an injectable form of a non-habit forming, long lasting medication that blocks the effects of opioids. Medication is combined with counseling /programming to address the substance abuse issues. Sheriff Koutoujian defines the success of the program by a person that is in compliance with counseling and programs. Recording available:

34 NATIONAL ASSOCIATION OF TRIADS, INC. Law Enforcement, Senior Volunteers, Community programs partner to reduce crimes targeting older adults 32 States: 680 Triad Programs: 17,000 Volunteers Participates in DEA s National Drug Takeback Events to remove unwanted meds from homes

35 DRUG ENFORCEMENT COMMITTEE Chair: Sheriff Keith R. Cain, Daviess Co., KY, Vice Chair: Sheriff Mike Milstead, Minnehaha Co., SD Staff Liaison: Ed Hutchison Mission: Provide a forum to discuss and address the complex issues sheriff s offices face when combating illegal drugs Goal: Committed to the aggressive enforcement of drug laws, uniting the many voices of sheriffs into one Objectives: Identify current and emerging trends in drug use, prevention, education, and treatment programs; Provide timely and practical advice regarding enforcement activities; Create networks of professionals within states; and Provide guidance based on promising practices and successful programs.

36 INNOVATIVE SUBSTANCE USE PROGRAMS AND ACTION BY OUR NATION S SHERIFFS The nation s opioid epidemic has affected every level of society and demographic. The criminal justice population has been greatly impacted by the epidemic. It is estimated that nearly two-third s of the nation s 2.3 million inmates in jails and prisons have a substance use disorder. According to a 2016 study published in Medical care, opioid misuse-abusedependence, and overdose resulted in $7.7 billion in criminal justice-related costsnearly all of which were borne directly by state and local governments. The burden has fallen largely on the shoulders of law enforcement - despite inadequate resources, they continue to do everything possible to keep our communities safe.

37 INNOVATIVE SUBSTANCE USE PROGRAMS AND ACTION BY OUR NATION S SHERIFFS Sheriffs must be innovative and many are using their own budgets for innovative enforcement models, investigations, education, programming, treatment and soft hand offs to the community. Examples include: Naloxone (medication that reverses an opioid overdose) Efforts are being made to authorize all LE and First Responders to carry Naloxone. Warm Hand Off programs where individuals who have overdosed are put in contact with individuals in the community to assist them in seeking treatment. (York County) No Questions Asked (Essex County MA; Charlotte County FL) ANGEL program-any individual who enters a sheriff s office, who requests help for their substance use disorder are immediately screened for participation in a treatment program. They are not arrested or charged if they are in possession of drugs or drug paraphernalia Sign agreements and are immediately transported by LE to a treatment facility.

38 INNOVATIVE SUBSTANCE USE PROGRAMS AND ACTION BY OUR NATION S SHERIFFS Our Nation s Jails: The All Sheriffs Authority met Wednesday, May 2, 2018 at the U.S. Department of Justice s National Institute of Corrections to address the impact of the opioid epidemic on the nation s jails, with the goal of developing a call to action for a community-based strategic partnership comprised of local government and community stakeholders In 2016, jails reported 10.6 million jail admissions. Although data is not yet available on the reported drug dependency of the current jail admission population, comparatively, out of the almost 13 million local jail admissions occurring annually as of 2009, showed an estimated 63 percent of people sentenced to a local jail suffer from drug dependency or abuse. Rural jails are experiencing a significant increase in inmates with drug addiction disorders.

39 INNOVATIVE SUBSTANCE USE PROGRAMS AND ACTION BY OUR NATION S SHERIFFS Our Nation s Jails Rural communities face unique challenges. Sheriffs in urban settings generally have a denser approximation of addiction-based service providers and a larger tax base, which generate more funding streams. Rural communities, however, face the hardship of fighting a growing opioid epidemic in jails without fiduciary, operating and programmatic support. Sheriff Ben Wolfinger, President of the Western States Sheriffs Association, highlights the following to illustrate the dynamic: Lack of wrap around programs in communities. Major metropolitan areas frequently offer various services related to addiction, but the travel distance for rural communities to take advantage of metropolitan resources is commonly hundreds of miles away. Lack of medication-assisted treatment (MAT) programs and the personnel to administer and effectively operate these programs. Lack of well-resourced and fully trained community partners to adequately transition clients to other important addiction

40 INNOVATIVE SUBSTANCE USE PROGRAMS AND ACTION BY OUR NATION S SHERIFFS Jails: Medication-Assisted Treatment FDA has approved three medications: Buprenorphine (pill and non-pill) Methadone Naltrexone (extended release injectable) According to the National Institute on Drug Abuse, it costs six times more to incarcerate an individual than it does to cover the cost of a treatment program. NIC has identified jails throughout the United States as Centers of Innovation with model MAT programs. (Middlesex, Franklin County, Sacramento) Mediations are expensive. Medicaid and Insurance Coverage are Challenging HARP (Heroin Addiction Recovery Program-Chesterfield VA) pay for their program out of their own budget Expanded Medicaid States make insurance coverage eligible for inmates in the inmate is in a jail for temporary periods. Jails help inmates complete paperwork while in jail so once released they can be enrolled in Medicaid or apply for private insurance. Medicaid coverage for inmates to be suspended rather than be terminated so that their benefits restart automatically upon release.

41 INNOVATIVE SUBSTANCE USE PROGRAMS AND ACTION BY OUR NATION S SHERIFFS Asset Forfeiture Educate on the importance of asset forfeiture as a tool to thwart and damage criminal enterprise. Property is not forfeited without due process. NSA President Sheriff Harold Eavenson is an advocate and subject-matter expert. In his home state of Texas, Article 59 of the Code of Criminal Procedure, requires that the state must prove that the assets to be forfeited. including money derived from, used, or intended to be used for criminal activity. There must be a preponderance of evidence provided to the prosecuting attorney sufficient for a district judge to award the assets to the filing agency. At the federal level, the burden of proof rests on the defendant; he or she must prove that the seized property is legitimate. 14 states have passed legislation requiring a conviction before assets can be forfeited. Many LE officials believe that such restrictive legislation benefits the drug cartels and is detrimental to law enforcement s mission. It is understood fact that drugs go north and money goes south. If a conviction is required to prove that the money is an instrument in an illegal enterprise, it is usually returned to the drug trafficker or cartel by default. (Ellis County Example) There are those who have abused asset forfeiture but we need to find ways to minimize the abuse rather than award the drug cartels and deprive law enforcement of the option of asset seizure. We should be focusing on fixing the rare exceptions of abuse of due process rather than hurting 98% of those who are doing it the right way for the right reasons.

42 INNOVATIVE SUBSTANCE USE PROGRAMS AND ACTION BY OUR NATION S SHERIFFS ERAD (Electronic Recovery and Access to Data) NSA has recently partnered to employ technology to detect sums of drug money encoded on prepaid cards, gift cards, hotel keys, etc., which are being used to launder money tied to illegal or illicit activities. (IRS: Prepaid cards are the currency of criminals. ) Allows law enforcement officers to investigate payment cards in seconds and alerts financial institutions before the cards can be used. Criminal Interdiction Unit NSA President, Sheriff Harold Eavenson (Rockwell, Texas) The Criminal Interdiction Unit in Texas was the concept of Sheriff Skinner and other Texas Sheriffs. Six counties initially made up the original unit of local law enforcement agencies that partnered together, with two new counties soon to join. Working together, in the past 3 ½ months, the unit has successfully removed over 6.2 million dollars (street value) of drugs off the streets. It has exceeded all of their expectations and thus far, is a strong indicator of the magnitude of the problem.

43 INNOVATIVE SUBSTANCE USE PROGRAMS AND ACTION BY OUR NATION S SHERIFFS Our Nation s Sheriffs have a host of creative and innovative programs throughout the United States to combat the Opioid Epidemic. Please visit our website to see many of the programs currently in place.

44 INNOVATIVE SUBSTANCE USE PROGRAMS AND ACTION BY OUR NATION S SHERIFFS NSA collaborates with federal, state, local and tribal law enforcement partners to achieve a holistic approach to border security. We must disrupt the flow of illicit drugs coming into our country. We must support the administration s commitment to protecting the border security. We need continued and increased financial support for law enforcement. We need tougher sentencing for fentanyl dealers.

45 NSA RESOLUTIONS : National Sheriffs' Association Supports the Use of Non-Narcotic Evidence-Based Medication-Assisted Treatment (MAT) for Opioid Dependence in County Jails : National Sheriffs' Association Opposes Drug Importation Legislation which Jeopardizes Law Enforcement's Ability to Protect the Public Health and Endangers the Safety of Law Enforcement and Other First Responders : National Sheriffs' Association Supports Efforts to Improve Access to Abuse-Deterrent Opioids : National Sheriffs' Association Supports Efforts of the Drug Recognition Expert (DRE) Section of the International Association of Chiefs of Police

46 WAYS TO SUPPORT OUR NATION S SHERIFFS AND TO WORK COLLABORATIVELY Support efforts to authorize all law enforcement and first responders to carry naloxone; Support sheriff s deputies to carry naloxone kits in the court room; Support protocols and crosstraining of the judicial officials and deputies in the event of an overdose in the courtroom; Support No Questions Asked - ANGEL programs; Support MAT programs in our nation s jails; Support reentry with soft hand-off programming in the community; Support Tele-Health options in our rural communities; Support jails in rural areas to advance pre- and post-trial correctional drug treatment and reentry programming, including medication-assisted treatment. Support providing naloxone to inmates upon release from jail; Support Medicaid waivers or legislation to suspend versus terminate Medicaid coverage for inmates so that their benefits restart automatically upon release;

47 WAYS TO SUPPORT OUR NATION S SHERIFFS AND TO WORK COLLABORATIVELY Support collaborative discussions regarding the challenges with short-term jail stays: Collaborate on the implication of opioids and short term jail stays and those experiencing active withdrawal (probation violators; weekenders etc.) Support collaborative discussions regarding ordering individuals into jail-based programming; Support the establishment of protocols for the pregnant opioid user; Support the participation of sheriffs on Drug Court panels for a multidisciplinary approach discussion; In regards to Asset Forfeiture, we ask for your support that a conviction should not be mandated to prove that the money is an instrument in an illegal enterprise for the assets to be forfeited.

48 WAYS TO SUPPORT OUR NATION S SHERIFFS AND TO WORK COLLABORATIVELY Support sheriffs with their Town Halls to educate their constituencies on the opioid epidemic; Support the take back medicine disposals established within sheriffs agencies; Support for disrupting the flow of illicit drugs coming across our borders; Support aggressive prosecution and sentences for fentanyl cases; Support our sheriffs as they seek needed resources and funding; And your continued collaboration as we seek new solutions to counter the opioid epidemic with our nation s sheriffs and all of our federal, national and private partners.

49 On behalf of our nation s sheriffs, we stand ready to partner with you. Thank you for your time and your continued support.