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HomeMy WebLinkAboutStudy Session Agenda Packet 02-25-19 (Special) SPECIAL STUDY SESSION AGENDA CITY COUNCIL CITY OF WHEAT RIDGE, COLORADO 7500 W. 29th Ave. Wheat Ridge CO February 25, 2019 Upon adjournment from Regular Council Meeting Individuals with disabilities are encouraged to participate in all public meetings sponsored by the City of Wheat Ridge. Call Sara Spaulding, Public Information Officer 303-235-2877 at least one week in advance of a meeting if you are interested in participating and need inclusion assistance. Citizen Comment on Agenda Item 1. City Council District III candidate presentations 2. Liquor Code Amendments 3. Opioid Crisis in Wheat Ridge ADJOURNMENT Memorandum TO: Mayor and City Council FROM: Patrick Goff, City Manager DATE: February 20, 2019 SUBJECT: City Councilmember District III Presentations ISSUE: District III Councilmember Tim Fitzgerald resigned from his City Council seat effective February 10, 2019. In order to fill the District III vacancy, prospective candidates have been invited to present to City Council during the February 25, 2019 special study session. City Council is required to appoint the District III replacement within thirty days of resignation or by March 12, 2019. BACKGROUND: The Wheat Ridge City Charter addresses vacancies of elected officials as stated below: Sec. 4.5. - Vacancies. (a) A councilmember shall continue to hold his office until his successor is duly qualified. A council position shall become vacant whenever any councilmember is recalled, dies, becomes incapacitated, resigns, refuses to serve, or ceases to be a resident of the city or district from which elected, or is convicted of a felony. (b) Within thirty (30) days after a vacancy occurs on the council, the remaining councilmembers shall choose by majority vote a duly qualified person from the proper district to fill such vacancy… Sec. 4.4. - Qualifications. (a) No person shall be eligible to hold the office of a councilmember unless, at the time of his election, he is a registered elector, as defined by Colorado Revised Statutes, and is a resident of the district from which he is elected for a period of at least twelve (12) consecutive months immediately preceding the date of the election. City Charter, Wheat Ridge Code of Laws or Council Rules and Procedures do not address specific procedures for the appointment of elected officials. For this appointment, City Council allowed District III residents to apply for the position. On January 25, 2019, the application period for the District III councilmember position was opened, and it was closed on February 19. One application was submitted, which was determined to be eligible for the District III position. Staff informed the qualified respondent to prepare a brief presentation to City Council on February 25. The application and resume has been included as an attachment for City Council review. ATTACHMENTS: 1. Amanda Weaver Application and Resume ATTACHMENT 1 Attorneys at Law 710 Kipling Street, Suite 300 Lakewood, Colorado 80215 Main 303.493.6670 Fax 303.945.7960 MEMORANDUM To: Mayor & Council From: Gerald Dahl, City Attorney Jane Greenfield, Special Counsel Date: January 18, 2019 Re: Potential Liquor Code Amendments ______________________________________________________________________________ Background: In its last session, the Colorado legislature adopted a number of bills amending its liquor and beer codes and other related statutes, including the creation of a new Title 44 – Revenue – Regulation of Activities. This new Title contains the state’s revised liquor and beer codes, formerly located in Title 12, and necessitates updating and making conforming changes to the Wheat Ridge Code. Non-substantive and other uncontroversial revisions and the updating of new statutory references adopted over the last few years have been included in the attached ordinance, which will be placed on your agenda in the near future. However, the following four issues require discussion and direction of Council regarding whether/where these additional changes should be made to the code. Issues: 1. Prior to the passage of SB18-243, state law prohibited a retail liquor license holder to employ a person under twenty-one years old to sell or dispense alcohol beverages, other than 3.2% beer, unless that employee was supervised by another person, on-site, who was at least twenty-one years old. An employee over eighteen but under twenty-one was permitted to sell 3.2% beer. With the 2016 changes to the state’s Beer Code that eliminated the maximum alcohol content of beer, employees under twenty-one became permitted to sell these beverages1, some of which contain higher alcohol content than wine and other liquor. With the passage of SB18-243 and the recognition of the new Beer Code, the requirement that an under-21 year old employee had to be supervised by an over-21 year old person was deleted, but only for retail liquor store and liquor- licensed drugstore licensees. These types of licensees are still prohibited from allowing under-21 year olds from making deliveries of alcohol beverages off the licensed premises.2 All other types 1 Effective January 1, 2019. 2 §§ 44-3-901(6)(p)(III) and 44-4-106(1)(b), C.R.S. -2- of liquor licensees are still required to have on-site supervision, and tavern employees (bartenders) must still be 21 or older to serve alcohol. It is also still the law, § 44-3-301(8), C.R.S. that the following types of liquor license holders must either manage their premises themselves or employ a separate on-premises manager whose name is reported to state and local licensing authorities: fermented malt beverages, beer and wine, taverns, lodging and entertainment, clubs, art houses, and racetracks.3 The issue for discussion by Council is whether to make a further amendment to the Liquor Code in order to specifically require on-site supervision, by someone 21 or older, of liquor store sales personnel that are under 21 years old. 2. Wheat Ridge’s Code currently eliminates the 500-foot distance separation from schools for hotel and restaurant, beer and wine, brew pub, arts, and vintner’s restaurant licenses. The issue has been raised whether Lodging and Entertainment licenses should be added to this list. Because this type of license covers two different categories of use that may have very different impacts and operational characteristics, the Council may wish to consider adding lodging establishments to the exemption but keeping the 500-foot separation requirement for entertainment venues. The staff would recommend this approach for two reasons. First, hotel licensees are already exempt from the separation requirement and these would appear to have similar impacts to lodging establishments. Second, the definition of entertainment facility includes, but is not limited to, sports venues, video arcades, pool and billiard parlors, bowling alleys, and laser tag premises. Many of these venues would be attractive to students and school age children, and the sale of alcohol at these venues may not be desirable within the 500-foot buffer zone created by state law. Also, the Department of Revenue’s regulation leaves open the possibility that other types of sports and entertainment venues, as yet undefined, may fall into this category. Given the discretion that local licensing authorities are recognized as having, under Colorado case law, it would be possible to draft an amendment to the Wheat Ridge Liquor Code that would recognize the distinction between Lodging venues versus Entertainment venues, if the Council desires. 3. The next issue for discussion would be whether or not to prohibit alcohol beverage manufacturers from moving in next to a school. Because these types of liquor licensees receive their licenses from the state, not from the Wheat Ridge Liquor Licensing Authority, they do not fall under the statutory 500-foot separation requirement. Also, the state does not require public hearings or notices to be given prior to granting these types of licenses. This situation has created substantial neighborhood uproar in a few communities where a school was in close proximity to a newly-locating liquor manufacturer that had received a state license. 3 It should be noted that no definition of “manager” is provided in state law, nor is an age requirement specified. -3- Since the adoption of Wheat Ridge Ord. 1617, in April 2017, alcohol manufactures [micro- breweries, distilleries, wineries and their tap rooms] have been permitted by right to locate in C, I, and MU zones within the city. Ord. 1617 was adopted to accommodate or encourage these small manufacturers to locate within city limits by permitting these use categories in commercial zones. However, this could result in a state-licensed liquor manufacturer locating within 500 feet from a school without any notice to the neighborhood. If the Council wishes to avoid this situation arising, the best solution, both legally and politically, would be to make an amendment to the city’s zoning code (rather than the liquor code) that would require any application for a liquor manufacturer locating within 500 feet of a school to be reviewed as a Special Use rather than as a Permitted use. Such a change would clearly be defensible legally and would permit any neighborhood objections to be heard and resolved at a public hearing, while still maintaining the opportunities for such businesses to located by right in appropriate zones of the city when not being situated within 500 feet of a school. 4. The final issue is should owners of a Lodging and Entertainment license be added to Class G or Class T for the purpose of collecting the local occupation tax. Under current code, hotel and restaurant licensees are Class G operators, subject to a $900.00 annual tax. The ordinance, as proposed adds brew pubs, distillery pubs, and vintner’s restaurants to this category. Tavern licensees and other businesses with similar operating characteristics fall into the Class T category, subject to a $1300.00 annual tax. Currently, Wheat Ridge has not yet issued any Lodging and Entertainment licenses as they encompass a relatively new type of licensee created by the state legislature in 2016. The answer is dependent upon what one determines is the principal or primary business of the operator and the state’s definitions of the various types of licensees. One line of reasoning is that Lodgings [basically, hotels without restaurants] and Entertainment venues [e.g., bowling alleys, video arcades, etc.] that serve alcoholic beverages are more like Taverns, whose principal business as defined by statute is “the sale of alcohol beverages at retail for consumption on premises.” All three (taverns, lodgings, entertainment venues) are required to have “sandwiches or light snacks available for consumption” so in this respect they are similar. However, the other line of reasoning is that Lodgings or Entertainment venues are more similar to hotels, as their primary businesses are defined by statute as providing the public “with sleeping rooms and meeting facilities” or “sports and entertainment activities” and, like hotels, their sale of alcohol is secondary to their principal business. It is possible that businesses of this type might be planned for new development areas in the city. We believe that either position is defensible from a regulatory standpoint. The issue here is what the correct tax classification should be for this type of licensee. Conclusion: Discuss and provide direction on the foregoing Issues. Attachment: Draft ordinance CITY OF WHEAT RIDGE, COLORADO INTRODUCED BY COUNCIL MEMBER ___________ COUNCIL BILL NO. _______ ORDINANCE NO. _________ Series 2019 TITLE: AN ORDINANCE AMENDING SECTIONS 11-51, 1-52, 11-53, 11-56, 11-63, 11-64 AND 17-27 OF THE WHEAT RIDGE CODE OF LAWS CONCERNING THE LICENSING AND USE OF ALCOHOL BEVERAGES AND MAKING ADDITIONAL HOUSEKEEPING REVISIONS TO SAID CODE UPDATING STATUTORY CITATIONS TO CONFORM TO RECENT LEGISLATIVE CHANGES WHEREAS, the City of Wheat Ridge is a home rule municipality having all powers conferred by Article XX of the Colorado Constitution; and WHEREAS, pursuant to its home rule authority and C.R.S. § 31-23-101, the City, acting through its City Council (the “Council”), is authorized to adopt ordinances for the protection of the public health, safety or welfare; and WHEREAS, the Council has previously adopted laws governing the regulation of liquor licensing and consumption consistent with state law; and WHEREAS, the Colorado legislature has recently adopted bills amending the Colorado Revised Statutes as they pertain to its liquor code, beer code, and other related codes, and have adopted a new Title 44, entitled “Department of Revenue Activities Regulation Act," which requires conforming changes to the Wheat Ridge Code of Laws; NOW THEREFORE BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF WHEAT RIDGE, COLORADO: Section 1. Section 11-51 is amended to read as follows: Sec. 11-51. – Definitions. The following words, terms and phrases, when used in this article, shall have the meanings ascribed to them in this section, except where the context clearly indicates a different meaning: ALCOHOL BEVERAGE MEANS FERMENTED MALT BEVERAGES OR MALT, VINOUS, OR SPIRITUOUS LIQUORS; EXCEPT THAT ALCOHOL BEVERAGE SHALL NOT INCLUDE CONFECTIONERY CONTAINING ALCOHOL WITHIN THE LIMITS PRESCRIBED BY C.R.S. §25-5-410(1)(i)(II). ATTACHMENT 1 -2- Applicant means and includes: (1) If an individual, OR A HUSBAND AND WIFE, that person OR PERSONS making an application for a license under this chapter; (2) If a partnership, ALLthe partners, ANY OFFICERS, owning ten (10) percent or more of the partnership which is making application for a license under this chapter; (3) If a corporation, the president, vice-president, secretary, treasurer, the directors, managing OFFICer, and each stockholder owning ten (10) percent or more of the stock of the corporation. ; AND (4) IF AN ASSOCIATION, ORGANIZATION, OR COMPANY NOT LISTED ABOVE, ITS OFFICERS, DIRECTORS, AND ANY OF ITS MEMBERS OWNING A TEN (10) PERCENT OR MORE INTEREST THEREIN. Authority or licensing authority means the liquor licensing authority of the city. FERMENTED MALT BEVERAGE Beer, 3.2 percent means BEER AND ANY OTHER BEVERAGE OBTAINED BY THE FERMENTATION OF ANY INFUSION OR DECOCTION OF BARLEY, MALT, HOPS, OR ANY SIMILAR PRODUCT OR ANY COMBINATION THEREOF IN WATER CONTAINING NOT LESS THAN ONE-HALF OF ONE any fermented malt beverages as herein defined containing not more than three point two (0.5 3.2) percent of alcohol by VOLUME weight. Immediate family means spouse, mother, father, children, brothers, sisters, mother-in-law, father-in-law, brothers-in-law, or sisters-in-law. Investigator means a member of the Wheat Ridge Police Department. Malt liquors INCLUDES means beer and MEANS any other beverage obtained by the alcoholic fermentation of any infusion or decoction of barley, malt, hops or any other similar products, or any combination thereof, in water, containing NOT LESS THAN ONE-HALF OF ONE more than three point two(0.5 3.2) percent of alcohol by VOLUME weight. Manager includes the person or those persons who manage, direct, supervise, oversee and administer the acts, transactions and acts of servants of the establishments governed by this chapter. Medicinal liquors means any liquor sold by a duly licensed pharmacist or drugstore solely on a bona fide doctor's prescription. Operator means a person licensed by law to sell FERMENTED MALT BEVERAGES OR malt, vinous, or spirituous liquors, other than medicinal liquors, for beverage purposes at retail, and who is engaged at any time during the calendar year in such operation in the city. Spirituous liquors means any alcoholic beverage obtained by distillation, mixed with water and other substances in solution, and includes among other things brandy, rum, whiskey, gin, POWDERED ALCOHOL, and every liquid or solid, patented or not, containing AT LEAST ONE-HALF OF ONE PERCENT alcohol BY VOLUME and which IS are fit for use for beverage purposes. Any liquid or solid containing beer or -3- wine in combination with any other liquor, except as above provided IN THIS SECTION, shall not be construed to be FERMENTED MALT OR malt or vinous liquors, but shall be construed to be spirituous liquors. Vinous liquors means wines, INCLUDING SAKE, and fortified wines THAT: (1) CONTAIN NOT LESS THAN ONE- HALF OF ONE (0.5) PERCENT AND not MORE THAN exceeding twenty-one (21) percent of alcohol by volume; and (2) ARE PRODUCED shall be construed to mean alcoholic beverages obtained by the fermentation of the natural sugar contents of fruits or other agricultural products containing sugar. All other words and phrases used in this chapter shall have the meanings attached by the Colorado Statutes regulating the sale of ALCOHOL BEVERAGES liquor, or if not otherwise defined by law, as used in their common, ordinary and accepted sense and meaning. Section 2. Section 11-52 is amended to read as follows: Sec. 11-52. - Purpose. In pursuance of the authority conferred by C.R.S. Aarticles 3, 4 AND 5 46, 47 and 48 of Title 44 12, C.R.S., 1997 Volume, this chapter is enacted for the purpose of promoting the health, safety and welfare of the present and future inhabitants of the city by regulating, controlling and licensing the sale of malt, vinous or spirituous liquors and fermented malt beverages. Section 3. Subsection 11-53 (b) is amended to read as follows: Sec. 11-53. - Governance by state laws, rules and regulations. (b) Notwithstanding the provisions in subsection (a) to the contrary, the distance restrictions imposed by C.R.S. § 44-3-313(1)(d) 12-47-313(1)(d)(I) prohibiting the sale of ALCOHOL BEVERAGES malt, vinous or spirituous liquor within five hundred (500) feet of any public or parochial school or the principal campus of any college, university or seminary, are eliminated for all hotel and restaurant licenses, beer and wine licenses, brew pub licenses, DISTILLERY PUB LICENSES, arts licenses, and vintner's restaurant licenses issued pursuant to this article. Section 4. Section 11-56 is amended to read as follows: Sec. 11-56. - Alcohol beverage tastings. (a) Subject to the limitations of this section, alcohol beverage tastings are permitted within the city. For the purposes of this section "tastings" means the sampling of malt, vinous, or spirituous liquors that may occur on the premises of a retail liquor store licensee or liquor-licensed drugstore licensee by adult patrons of the licensee pursuant to the provisions of this section and C.R.S. § 44-3-301(10). Section 12-47-301 (10), C.R.S. (b) A retail liquor store or liquor-licensed drugstore licensee who wishes to conduct tastings may submit an application or application renewal for -4- that purpose to the liquor licensing authority. The applicant for a tastings permit shall state on the application the days and times that tastings will occur. The applicant shall give at least twenty-four (24) hours' prior notice to the CITY CLERK’S OFFICE AND THE police department of any deviations in the tastings schedule as set forth in the application. The liquor licensing authority may grant, grant with restrictions, or reject the application if the applicant fails to establish that he or she is able to conduct tastings without violating the provisions of this section, OR C.R.S. § 44-3-301(10) Section 12-47-310(10), CRS, or creating a public safety risk to the neighborhood. The liquor licensing authority shall establish its own application procedure and shall charge a reasonable application fee. The liquor licensing authority may delegate review and decision on the application to its clerk or administrative official. (c) Tastings ARE shall be subject to the following limitations: (1) Tastings shall be conducted only: a. BY A PERSON WHO: HAS by a person who has completed a server training program that meets the standards established by the liquor enforcement division in the department of revenue and IS who is either a retail liquor store licensee or a liquor-licensed drugstore licensee, or A REPRESENTATIVE, EMPLOYEE, OR AGENT OF THE LICENSED WHOLESALER, BREW PUB, DISTILLERY PUB, MANUFACTURER, LIMITED WINERY, IMPORTER, OR VINTNER’S RESTAURANT PROMOTING THE ALCOHOL BEVERAGES FOR THE TASTING; AND an employee of a licensee, and only on a licensee's licensed premises. b. ON A LICENSEE’S LICENSED PREMISES. (2) The alcohol BEVERAGE used in tastings MUST shall be purchased through a licensed wholesaler, licensed brew pub, LICENSED DISTILLERY PUB, or winery licensed pursuant to C.R.S. § 44-3-403 AT A COST THAT IS NOT LESS THAN THE LAID-IN COST OF THE ALCOHOL BEVERAGE Section 12-47- 403 CRS. (3) The size of an individual alcohol sample shall not exceed one (1) ounce of malt or vinous liquor or one-half (½) ounce of spirituous liquor. (4) Tastings shall not exceed a total of five (5) hours in duration per day, which need not be consecutive. (5) THE LICENSEE MAY CONDUCT Tastings shall be conducted only during the operating hours in which the licensee on whose premises the tastings occur is permitted to sell alcohol beverages, and in no case earlier than 11:00 a.m. or later than 97:00 p.m. -5- (6) The licensee shall prohibit patrons from leaving the licensed premises with an unconsumed sample. (7) The licensee shall promptly remove all open and unconsumed alcohol beverage samples from the licensed premises, or shall destroy the samples immediately following the completion of the tasting, OR STORE ANY OPEN CONTAINERS OF UNCONSUMED ALCOHOL BEVERAGES IN A SECURE AREA OUTSIDE THE SALES AREA OF THE LICENSED PREMISES FOR USE AT A TASTING CONDUCTED AT A LATER TIME OR DATE. (8) The licensee shall not serve a person who is under twenty-one (21) years of age or who is visibly intoxicated. (9) The licensee shall not serve more than four (4) individual samples to a patron during a tasting. (10) Alcohol samples shall be in open containers and shall be provided to a patron free of charge. (11) THE LICENSEE MAY CONDUCT Ttastings ONmay occur on no more than four (4) of the six (6) days from a Monday to the following Saturday, not to exceed one hundred FIFTY-SIX four (156 104) days per year. (12) No manufacturer of spirituous or vinous liquors shall induce a licensee through free goods or financial or in-kind assistance to favor the manufacturer's products being sampled at a tasting. The RETAIL LIQUOR STORE OR LIQUOR-LICENSED DRUGSTORE licensee shall bearS the financial and all other responsibility for a tasting CONDUCTED ON ITS LICENSED PREMISES. (D13) A violation of a limitation specified in this section, OR C.R.S. § 44-3- 301(10) Section 12-47-301(10) CRS or Section 12-47-801 (CRS) by a retail liquor store or LIQUOR-LICENSED drug licensee, whether by THE LICENSEE'S his or her employees, agents, or otherwise, shall be OR BY A REPRESENTATIVE, EMPLOYEE, OR AGENT OF THE LICENSED WHOLESALER, BREW PUB, DISTILLERY PUB, MANUFACTURER, LIMITED WINERY, IMPORTER, OR VINTNER'S RESTAURANT THAT PROMOTED THE ALCOHOL BEVERAGES FOR TASTING, IS the responsibility of, AND C.R.S. 44-3-801 APPLIES TO, the retail liquor store or liquor-licensed drugstore licensee THAT CONDUCTED who is conducting the tasting. (E14) A retail liquor store or liquor-licensed drugstore licensee conducting a tasting shall be subject to the same revocation, suspension, and enforcement provisions as otherwise apply to the licensee. (F) NOTHING IN THIS SECTION SHALL AFFECT THE ABILITY OF A COLORADO WINERY LICENSED PURSUANT TO C.R.S. § 44-3-402 -6- OR 44-33-403 TO CONDUCT A TASTING PURSUANT TO THE AUTHORITY OF C.R.S. §44-3-402(2) OR 44-3-403(2)(e). Section 5. Section 11-63 is amended to read as follows: Sec. 11-63. - Classification of operators. The business of selling at retail any FERMENTED MALT BEVERAGE OR three point two (3.2) percent beer, malt, vinous or spirituous liquor other than medicinal liquors for beverage purposes is hereby defined and separately classified as such occupation for the purpose of this chapter as follows: (1) Class "C" operators. All operators licensed to sell ALCOHOL BEVERAGES malt, vinous or spirituous liquors as clubs are Class "C" operators. (2) Class "D" operators. All operators licensed as retail stores to sell in original containers ALCOHOL BEVERAGES, malt, vinous or spirituous liquors for consumption off the premises shall be Class "D" operators. (3) Class "E" operators. All operators licensed as drugstores to sell ALCOHOL BEVERAGES malt, vinous or spirituous liquors in original containers for consumption off the premises shall be Class "E" operators. (4) Class "F" operators. All operators licensed to sell malt or vinous liquors only by the drink for consumption on the premises shall be Class "F" operators. (5) Class "G" operators. All operators who are licensed to sell ALCOHOL BEVERAGES beer, wine and spirituous liquors for consumption on the premises either as BREW PUBS, DISTILLERY PUBS, VINTNER'S RESTAURANTS, hotels AND/or restaurants shall be Class "G" operators. (6) Class "J" operators. All operators licensed to sell only FERMENTED MALT BEVERAGE three point two (3.2) percent beer shall be classified as follows: a. Class "J1" operators. All operators licensed to sell or selling FERMENTED MALT BEVERAGE three point two (3.2) percent beer for consumption off the premises of the licensee shall be Class "J1" operators. b. Class "J2" operators. All operators licensed to sell or selling FERMENTED MALT BEVERAGE three point two (3.2) percent beer for consumption on the premises of the licensee shall be Class "J2" operators. c. Class "J3" operators. All operators licensed to sell or selling three point two (3.2) percent beer for consumption both on and off the premises of the licensee shall be Class "J3" operators. -7- (7) Class "T" operators. All operators selling ALCOHOL BEVERAGES malt, vinous or spirituous liquors, by the drink, only for consumption on the premises; and such operators shall have available for consumption on the premises during business hours, sandwiches and light snacks; but they need not have meals available for consumption. Section 6. Section 11-64 is amended to read as follows: Sec. 11-64. - Amount of tax levied. There is hereby levied and assessed for each year an annual occupation tax upon the business of selling ALCOHOL BEVERAGES three point two (3.2) percent beer, malt, vinous or spirituous liquors, except medicinal liquors, in the city, as such occupation has been herein classified as follows: (1) For all Class "G" operators, nine hundred dollars ($900.00). (2) For all Class "F" operators, six hundred dollars ($600.00). (3) For all Class "D" operators, six hundred fifty dollars ($650.00). (4) For all Class "E" operators, six hundred dollars ($600.00). (5) For all Class "C" operators, nine hundred dollars ($900.00). (6) For all Class "J-1" operators, seven hundred dollars ($700.00). (7) For all Class "J-2" operators, seven hundred dollars ($700.00). (8) For all Class "J-3" operators, two thousand two hundred dollars ($2,200.00). (9) For all Class "T" operators, one thousand three hundred dollars ($1,300.00). Section 7. Section 17-27 is amended to read as follows: Sec. 17-27. – ALCOHOL Alcoholic beverages. (a) The storage, sale or consumption of any ALCOHOL BEVERAGE malt, vinous or spirituous liquors, as defined by the Colorado Liquor Code, is prohibited in any park, recreation area or recreation building within the city except as specifically provided herein or as may be authorized pursuant to a special event permit issued by the city in accordance with C.R.S., Aarticle 5 48, Ttitle 12 44. NOTWITHSTANDING THE FOREGOING, TThe consumption and/or storage of ANY fermented malt beverages is permitted in any park or recreation area within the city so long as, and only so long as, such fermented malt beverage has been purchased in a manner authorized, and is being consumed by persons permitted, by applicable state law. It shall be unlawful to sell any fermented malt beverage within any park or recreation area within the city unless such sales are made pursuant to a special event permit granted by the city and unless such sales are made in accordance with the Colorado Beer Code. -8- (b) Storage and consumption of fermented malt BEVERAGE and vinous liquor is permitted at the Wheat Ridge Senior/Community Center, the Wheat Ridge Recreation Center and the Richards-Hart Estate in conjunction with an event sanctioned and authorized by the director; and provided further that such alcoholic beverages are neither sold to, served to, or consumed by any person not authorized by the Colorado Liquor Code or the Code of Laws of the City of Wheat Ridge to possess or consume such alcoholic beverages. The director is hereby authorized to establish rules for serving and consumption of alcoholic beverages at the Richards-Hart Estate, the Wheat Ridge Senior/Community Center, and the Wheat Ridge Recreation Center. Section 8. The revisions described in Exhibit A, attached hereto and incorporated herein by this reference, shall be included in the codification of the Wheat Ridge Code of Laws in order to conform various cross-references to the Colorado Revised Statutes and to delete obsolete provisions. Section 9. Severability, Conflicting Ordinances Repealed. If any section, subsection or clause of this Ordinance shall be deemed to be unconstitutional or otherwise invalid, the validity of the remaining sections, subsections and clauses shall not be affected thereby. All other ordinances or parts of ordinances in conflict with the provisions of this Ordinance are hereby repealed. Section 10. Effective Date. This Ordinance shall take effect fifteen (15) days after final publication, as provided by Section 5.11 of the Charter. INTRODUCED, READ, AND ADOPTED on first reading by a vote of ___ to ___ on this ____ day of ____________, 2019, ordered published in full in a newspaper of general circulation in the City of Wheat Ridge, and Public Hearing and consideration on final passage set for ____________________, 2019 at 7:00 p.m., in the Council Chambers, 7500 West 29th Avenue, Wheat Ridge, Colorado. READ, ADOPTED AND ORDERED PUBLISHED on second and final reading by a vote of ___ to ___, this _____ day of ______________, 2019. SIGNED by the Mayor on this _____ day of ____________, 2019. ATTEST: Bud Starker, Mayor Janelle Shaver, City Clerk -9- Approved as to Form: Gerald E. Dahl, City Attorney First Publication: Second Publication: Wheat Ridge Transcript Effective Date: Published: Wheat Ridge Transcript and www.ci.wheatridge.co.us -10- EXHIBIT A to Wheat Ridge City Council Ordinance No. _______, Series 2019, Amending Sections 11-51, 1-52, 11-53, 11-56, 11-63, 11-64 and 17-27 of the Wheat Ridge Code of Laws Concerning the Licensing and Use of Alcohol Beverages and Making Additional Housekeeping Revisions to said Code Updating Statutory Citations to Conform to Recent Legislative Changes In addition to the revisions/updates to the Wheat Ridge Liquor code in Sections 11-51, 11-52, 11-53,11-56, 11-63, 11-64 and 17-27, the following code sections will be updated as follows: Sections Current reference Revised to Read 3-20(b) Title 12, Article 46 or Article 47 Title 44, Article 4 or Article 3 9-22. Definitions Bar Article 47 of Title 12 Articles 3 and 4 of Title 44 11-52.5(a), (f) and (h) articles 46, 47 and 48 of Title 12 Articles 3, 4 and 5 of Title 44 11-250. Definitions Alcohol beverage §§12-46-103 and 12-47-103 §§44-4-103 and 44-3-103 11-290(7) Article XVIII Section 14 of the Colorado Constitution Article XVIII Section 14 of the Colorado Constitution and C.R.S. §44-11-301 et seq. (concerning municipal authority to license and regulate medical marijuana) 11-291. Definitions Colorado Medical Marijuana Code Licensee Medical marijuana center Medical marijuana testing facility Medical marijuana-infused product manufacturer Optional premises cultivation operation C.R.S., tit. 12, art.43.3 §12-43.3-402 §12-43.3-402 §12-43.3-405 and 408(1)(a) §12-43.3-404 §12-43.3-403 C.R.S., Title 44. Article 11 §44-11-402 §44-11-402 §44-11-405 and 408(1)(a) §44-11-404 §44-11-403 11-298(b) §12-43.3-302 §44-11-302 11-400(f) §12-43.4-101 et seq. §44-12-101 et seq. 11-401. Definitions Colorado Medical Marijuana Code Colorado Retail Marijuana Code Article 43.3 of Title 12 of the Colorado Revised Statutes Article 43.4 of Title 12 of the Colorado C.R.S., Title 44. Article 11 C.R.S., Title 44, Article 12 -11- Licensee Medical marijuana center Medical marijuana testing facility Medical marijuana-infused product manufacturer Optional premises cultivation operation Retail marijuana cultivation facility Retail marijuana products manufacturer Retail marijuana store Retail marijuana testing facility State licensing authority Revised Statutes §12-43.4-401 §12-43.3-402 §12-43.3-405 and 408(1)(a) §12-43.3-404 §12-43.3-403 §12-43.4-403 §12-43.4-404 §12-43.4-402 §12-43.4-405 and §12-43.3-408(1)(a) §12-43.4-201 §44-12-402 §44-11-402 §44-11-405 and 408(1)(a) §44-11-404 §44-11-403 §44-12-403 §44-12-404 §44-12-402 §44-12-405 and §44-11-408(1)(a) §44-12-201 11-408(b) §12-43.4-412 §44-12-302 15-34. Definitions Proscribed act(s) –(2) --(9) --(10) --(11) gambling on premises, C.R.S. § 18-10- 102(7) §§12-46-101 and 12-47-101 §12-25.5-101 et seq. A violation of any provision of the Colorado Massage Parlor Code, C.R.S. § 12-48.5-101, et seq. gambling, C.R.S. § 18-10-102(2) §§44-4-101 and 44-3-101 §29-11.8-101 et seq. [DELETE – Massage Parlor Code has been repealed.] 16-127(h)(1) Article 46, 47 or 48 of Title 12 Article 3, 4 or 5 of Title 44 16-177(a)(4)a. and (d) Article 46, 47 or 48 of Title 12 Article 3, 4 or 5 of Title 44 16-227(a)(5) “WARNING” “AND ARTICLE 48.5 OF TITLE 12, COLORADO REVISED STATUTES” [DELETE as Colo. Massage Code has been repealed.] 16-235(2) C.R.S.Title 12, Article 59 C.R.S. Title 23, Article 64 17-42 Article 48, title 12 Article 5, Title 44 Page 1 of 10 Memorandum To: Mayor Starker and Fellow Members of City Council From: Zachary Urban, Wheat Ridge City Council Member, District II cc: Mr. Patrick Goff, City Manager and Mr. Daniel Brennan, Chief of Police Date: 2/18/2019 Re: Opioid Crisis in Wheat Ridge As a member of the Colorado Consortium for Prescription Drug Abuse Prevention I have closely followed Colorado’s response to the opioid crisis for the past several years. While the bulk of the response to this crisis needs to be handled at the State level, there are several steps we as a city can and should take. This document outlines the background, evidence, current resources, and next steps the City of Wheat Ridge should take to help alleviate the impacts from the current opioid crisis within the City of Wheat Ridge. BACKGROUND ON THE OPIOID ABUSE CRISIS The Colorado State Board of Pharmacy oversees the operation of the Colorado Prescription Drug Monitoring Program (PDMP). The PDMP is a secure database that collects prescription information on Schedule II-V controlled substances dispensed by Colorado pharmacies. The PDMP compiles information on patients, prescribers, pharmacies, and the medications dispensed. Prescribers and pharmacists registered with the Drug Enforcement Administration (DEA) and the PDMP can access prescription information to make informed decisions when writing or filling prescriptions to ensure appropriate prescribing and dispensing practices. For example, prescribers and pharmacists can check the PDMP before prescribing to see what substances their patient receives and avoid prescribing new medications that may have dangerous interactions with existing medications. Prescribers can also check the PDMP to make sure that their patient isn’t receiving multiple prescriptions from multiple prescribers and pharmacies. In Colorado, prescribers are not required to use the PDMP except when considering prescribing a refill to an opioid naïve patient for acute pain. The data collected from PDMP was used to provide the opioid related data found in this document, while the PDMP has published Jefferson County wide data reports, it does not publish zip code or city based reports. The United States Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) does track and publish Medicare Part D prescription data at the zip code level, this data is shown under the City of Wheat Ridge Specific Opioid Data section of this document. For more information: https://www.colorado.gov/pacific/cdphe/prescription-drug-data-profiles From 2013-2017, there were 158 prescription opioid-related overdose deaths in Jefferson County. This translates to a rate of 5.4 deaths per 100,000 Colorado residents. County rates varied widely throughout Page 2 of 10 Colorado. Between 2013 and 2017, Delta County had the lowest opioid death rate at 1.8 deaths per 100,000 residents and Conejos County had the highest with 13.6 deaths per 100,000. According to the CDC, some risk factors for prescription drug misuse include high-dose prescribing, multiple provider episodes, long duration opioids, and overlapping opioid and benzodiazepine prescriptions. Understanding these risk factors may help providers better assist their patients in pain management while also protecting their health and safety. Percent of Patients Receiving High Dosage Prescriptions Morphine is the standard measure for managing pain and is therefore used as a reference for calculating opioid prescription doses. Higher dosages are associated with an increased risk of opioid use disorder and overdose. In 2016, the Center for Disease Control and Prevention’s (CDC) prescribing guidelines recommended opioid dosages should not exceed 90 morphine milligram equivalents (MME) per day. Assessing dosage can help to identify problematic prescribing practices and patients who may be at risk for substance use disorders. 90 MME 60 mg oxycodone 90 mg hydrocodone 900 mg tramadol 30 mg oxymorphone 22.5 mg hydromorphone 20 mg methadone Table 1 Estimated Doses for Commonly Prescribed Opioids Rate of Multiple Provider Episodes (MPEs) The use of multiple prescribers and pharmacies is associated with high-risk drug-related behaviors and adverse events such as opioid abuse and overdose. The number of prescribers and pharmacies a patient visits is often used as a proxy measure for “doctor shopping” which is when a patient receives opioid prescriptions from five or more prescribers and pharmacies in a six-month period. The calculation for this measure has been updated and the data in Table 2 reflect the changes. Percent of Patients Prescribed Long-Acting/Extended Release (LA/ER) Opioids who were Opioid-Naïve Opioid naïve patients may be more vulnerable to adverse effects of LA/ER opioids such as slowed and difficulty breathing and overdose. Time-scheduled opioids are associated with greater total average daily dosages and increased risk for long-term use. Previously, CDC defined opioid naïve patients as those who did not fill an opioid prescription in the previous 60 days. In March 2018, a revised definition referred to opioid naïve patients as those who did not fill an opioid prescription in the previous 45 days. Percent of Patient Prescription Days with Overlapping Prescriptions Both benzodiazepines and opioids are central nervous system depressants that can compromise the respiratory system. Benzodiazepines enhance the effects of opioids so the concurrent use of benzodiazepines and opioids can increase the risk of adverse events such as drug interactions and overdose. This indicator measures the duration of overlapping prescriptions. Longer duration of overlapping prescriptions may raise concerns about potential drug interactions and resulting side effects. Table 2 includes the population-level indicators described. Data for these indicators were retrospectively updated for all the years to reflect the new definitions and allow for comparisons across all years of data. Page 3 of 10 Indicators 2014 2015 2016 2017 2014-2017 % of Change Patients receiving more than 90 MME (%) 11 9.2 9.1 8.5 23.2% Patients with MPE’s (rate/100,000 residents) 88.1 74.4 53.6 37.9 57 Patients prescribed LA/ER opioids who were opioid-naïve (%) 22.5 21.3 19 18.3 18.8% Patient prescription days with overlapping opioid prescriptions (%) 22.8 21.9 21.5 20.6 9.3% Patient prescriptions days with overlapping opioid and benzodiazepine prescriptions (%) 11.6 11 10.2 9.4 19.1% Table 2 High Risk Prescribing Practices and Patient Behaviors, Jefferson County, 2014-2017* *Schedule II-IV Controlled Substances, Excludes Buprenorphine drugs commonly used for treatment, Annual percentages are based on average of quarterly percentages, Data Source: Vital Statistics Program, CDPHE and the Colorado Prescription Drug Monitoring Program, DORA, Data Analysis by: CDPHE, 2018 CITY OF WHEAT RIDGE SPECIFIC OPIOID DATA The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Medicare Part D Opioid Prescriber Summary File, which presents information on the individual opioid prescribing rates of health providers that participate in Medicare Part D program. This file is a prescriber-level data set that provides data on the number and percentage of prescription claims (includes new prescriptions and refills) for opioid drugs, and contains information on each provider’s name, specialty, state, and ZIP code. This is the only publicly available dataset regarding opioid prescriptions. For more information visit: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and- Reports/Medicare-Provider-Charge-Data/OpioidMap.html 2016 Opioid Prescription Data for Zip Code 80033, Wheat Ridge, Colorado Map 1: This map displays the Medicare Part D opioid prescribing rate for 2016. The Part D opioid prescribing rate reflects the percentage of a prescriber’s total Part D claims that are opioid prescriptions. Map 1 Medicare Part D opioid prescribing rate for 2016 2016 Wheat Ridge Opioid Prescribing Rate: National: 5.35% State: 7.02% 80033 ZIP Code: 6.59% Opioid Claims: 30,520 Overall Claims: 463,461 Part D Prescribers: 352 Page 4 of 10 Map 2: This map displays the Medicare Part D opioid prescribing rate for extended-release opioids for 2016. The Part D extended-release opioid prescribing rate reflects the percentage of a prescriber’s opioid Part D claims that are extended-release opioid prescriptions. Map 2 Medicare Part D opioid prescribing rate for extended-release opioids for 2016 2016 Wheat Ridge Extended- Release Opioid Prescribing Rate: National: 6.92% State: 8.94% 80033 ZIP Code: 11.06% Extended-Release Opioid Claims: 3,377 Opioid Claims: 30,520 Part D Opioid Prescribers: 200 Map 3: This map shows the change in the Medicare Part D opioid prescribing rate from 2013 to 2016. Change in the opioid prescribing rate reflects the percentage point difference in the prescribing rate from 2013 to 2016. Map 3 Change in the Medicare Part D opioid prescribing rate from 2013 to 2016 2016 Wheat Ridge Percentage Point Difference in Opioid Prescribing Rate 2013 to 2016: National: -0.47% State: -0.50% 80033 ZIP Code: -1.08% Opioid Prescribing Rate: Year 2013: 7.67% Year 2016: 6.59% Opioid Claims: Year 2013: 31,532 Year 2016: 30,520 Overall Claims: Year 2013: 411,030 Year 2016: 463,461 Part D Prescribers: Year 2013: 342 Year 2016: 352 Page 5 of 10 Map 4: This map shows the change in the Medicare Part D opioid prescribing rate for extended- release opioids from 2013 to 2016. Change in the extended-release opioid prescribing rate reflects the percentage point difference in the prescribing rate from 2013 to 2016. Map 4 Change in the Medicare Part D opioid prescribing rate for extended-release opioids from 2013 to 2016 2016 Wheat Ridge Percentage Point Difference in Extended- Release Opioid Prescribing Rate 2013 to 2016: National: 0.80% State: 0.71% ZIP Code: 1.35% Extended-Release Opioid Prescribing Rate: Year 2013: 9.71% Year 2016: 11.06% Extended-Release Opioid Claims: Year 2013: 3,062 Year 2016: 3,377 Opioid Claims: Year 2013: 31,532 Year 2016: 30,520 Part D Opioid Prescribers: Year 2013: 196 Year 2016: 200 PUBLIC AWARENESS PROGRAMS ADDRESSING THE OPIOID CRISIS IN COLORADO Take Meds Seriously campaign The Take Meds Seriously campaign is a comprehensive statewide campaign focused on building awareness of what Coloradans can do to prevent prescription drug misuse and abuse. It emphasizes the importance of safe use, safe storage, and safe disposal of prescription drugs. The Take Meds Seriously campaign was created by the Colorado Consortium for Prescription Drug Abuse Prevention’s Public Awareness work group with funding from the Attorney General’s office and administered through the Governor’s office. The campaign developed many resources that can be used by communities that wish to address the opioid crisis. The assets include brochures, wallet cards, PSA videos, and social media materials. Access this resource by visiting www.takemedsseriously.org . Take Meds Back safe disposal awareness campaign Safe disposal of medication is vital to reduce the availability of prescription drugs that could be misused. The Take Meds Back campaign works to inform the public about how and where to safely dispose unused medication. The Colorado Department of Public Health and Environment collaborated with the Page 6 of 10 Colorado Consortium for Prescription Drug Abuse Prevention’s Public Awareness and Safe Disposal work groups to produce the campaign. Access this resource by visiting www.takemedsback.org . Wheat Ridge Based DEA Registered Public Controlled Substance Disposal Locations SCL Health Lutheran Pharmacy 8300 W 38th Ave, Suite T2-105 Wheat Ridge, CO 80033 Walgreen’s Pharmacy 4401 Wadsworth Blvd. Wheat Ridge, CO 80033 Kaiser Permanente Wheatridge Pharmacy 4803 Ward Rd Wheat Ridge, CO 80033 Access this resource by visiting https://apps.deadiversion.usdoj.gov/pubdispsearch How does a pharmacy become an authorized public controlled substance Disposal Location? Manufacturers, distributors, reverse distributors, narcotic treatment programs, hospitals/clinics with an on-site pharmacy, and retail pharmacies that desire to be collectors may do so by modifying their registration to obtain authorization to be a collector. Access this resource by visiting www.DEAdiversion.usdoj.gov . Once authorized, these entities are “authorized collectors.” Speak Now Colorado campaign The Speak Now Colorado campaign is an educational resource for parents and caregivers on how to start conversations and keep them going about the risks of alcohol, marijuana, prescription drugs, and other drugs among youth. It is managed by the Colorado Department of Human Services, Office of Behavioral Health and focuses on providing evidence-based information and resources to parents and caregivers regarding youth substance abuse prevention in Colorado. Access this resource by visiting www.speaknowcolorado.org/toolkits. Rise Above Colorado Rise Above Colorado is a drug abuse prevention organization focused on measurably impacting teen perceptions and attitudes about the risks of substance abuse. Its mission is to help youth make empowered, healthy choices. The organization has developed a classroom-based lesson called “Not Prescribed,” which provides middle and high school students with the science and the stories to understand the risks of misusing prescription drugs. This 45-minute standards-based lesson leverages personal testimony from teens and their families through a compelling video and provides educators with a science-based interactive presentation to facilitate conversation and learning. Access this resource by visiting www.notprescribed.org. I Rise Above is a Rise Above Colorado campaign that encourages teens to make healthy choices. Part of that campaign is the Straight Dope website, which was written by teens for teens. The site has information about commonly misused drugs, including prescription opioids, stimulants, and sedatives. Access this resource by visiting iriseaboveco.org/straight-dope. JP Opioid Interaction Awareness Alliance This Colorado-based alliance’s mission is to prevent lethal opioid drug interactions through community- based collaborations that focus on education, public awareness, and prevention. The alliance values research-based education and community-driven collaboration and is focused on humanizing the opioid epidemic in order to save lives. The alliance was created in 2012 to honor James Patrick (JP) Carroll who, not knowing the dangers, took an opioid with his commonly prescribed anti-anxiety medication and lost Page 7 of 10 his life due to the lethal interaction between the two drugs. Access this resource by visiting www.jpopioidalliance.org . GenerationRX The Ohio State University College of Pharmacy and the Cardinal Health Foundation partnered to create GenerationRx, a resource to teach people of all ages about the potential dangers of misusing prescription medications. Coalitions can use GenerationRX’s ready-to-use educational materials, which are designed to provide everything you need to make a presentation or offer a program in your community, school, or college. Access this resource by visiting www.generationrx.org WHAT CAN THE CITY OF WHEAT RIDGE DO TO HELP ALLEVIATE THIS CRISIS? • Promote the above mentioned public awareness campaigns. • Post the resources listed below on the City of Wheat Ridge website. • Continue to foster relationships between law enforcement, treatment centers and public health entities to enhance law enforcement diversions into treatment and recovery programs. • Consider amending Sec. 16-132 & 133. to conform with the Needle-stick Prevention C.R.S., §18- 18-428 and Drug Paraphernalia Law Exemption, C.R.S. §18-18-430.5 • Consider ways the City of Wheat Ridge can increase access to naloxone and safe syringe disposal. • Support House Bill HB19-1009 Substance Use Disorders Recovery Concerning supports for persons recovering from substance use disorders, and, in connection therewith, expanding a program in the department of local affairs that provides vouchers for housing assistance to certain individuals, requiring each recovery residence operating in Colorado to be licensed by the department of public health and environment, and creating the opioid crisis recovery fund. • Support Senate Bill SB19-008 Substance Use Disorder Treatment In Criminal Justice System Concerning treatment of individuals with substance use disorders who come into contact with the criminal justice system, and, in connection therewith, making an appropriation. Page 8 of 10 OPIOID ABUSE TREATMENT AND INFORMATIONAL RESOURCES FOR RESIDENTS OF WHEAT RIDGE: Treatment Resources Wheat Ridge based pharmacies listed as carrying Naloxone King Soopers Pharmacy 5301 West 38th Avenue Wheatridge, CO 80212 (303) 425-7455 Safeway Pharmacy 3900 Wadsworth Boulevard, Wheat Ridge, CO 80033 303-456-4413 Walgreens Pharmacy 4401 Wadsworth Blvd. Wheat Ridge, CO 80033 303-463-7719 CVS Pharmacy at Target 5071 Kipling St Wheat Ridge, CO 80033 303-209-1849 King Soopers Pharmacy 3400 Youngfield Wheat Ridge, CO 80033 (303) 238-7301 Walgreens Pharmacy 12700 W 32nd Ave. Wheat Ridge, CO 80033 303-237-4392 Access this resource by visiting the Naloxone Locator: stoptheclockcolorado.org Nearest Syringe Exchange Program Providers: https://www.pointswestjeffco.com/ or www.harmreductionactioncenter.org/ Colorado Crisis Services http://coloradocrisisservices.org/ Colorado Department of Human Services, Office of Behavioral Health LADDERS System https://www.colorado.gov/ladders State Resources Colorado Consortium for Prescription Drug Abuse Prevention http://www.corxconsortium.org Colorado Department of Human Services Opioid Treatment Programs https://www.colorado.gov/pacific/cdhs/opioid-treatment-programs-otps Colorado General Assembly’s Opioid and Other Substance Use Disorders Study Committee https://leg.colorado.gov/committees/opioid-and-other-substance-use-disorders-study- committee/2018-regular-session Colorado Department of Public Health and Environment's Opioid Overdose Prevention Program https://www.colorado.gov/pacific/cdphe/opioid-prevention Colorado Department of Human Services Office of Behavioral Health https://www.colorado.gov/pacific/cdhs/opioid-crisis-colorado-office-behavioralhealths-role-research- and-resources Statewide Training and Technical Assistance Substance Abuse Prevention Project http://obhpreventionservices.org/ Area Health Education Center http://www.ucdenver.edu/life/services/ahec/Pages/index.aspx National Resources National Academies of Sciences, Engineering, and Medicine Opioid Study http://nationalacademies.org/opioidstudy Substance Abuse and Mental Health Services Administration https://www.samhsa.gov/atod/opioids Centers for Disease Control and Prevention https://www.cdc.gov/drugoverdose/index.html National Institute on Drug Abuse https://www.drugabuse.gov/drugs-abuse/opioids Page 9 of 10 Substance Abuse Treatment Providers Near Wheat Ridge Street Address Suite Number City Phone Website Denver Family Therapy Center 4891 Independence Street Suite 165 Wheat Ridge 303-456-0600 www.denverfamilytherapycenter.com Jefferson Center for Mental Health 70 Executive Center Wheat Ridge 303-425-0300 www.jeffersonmentalhealth.org Odyssey Counseling 10900 West 44th Avenue Unit 140 Wheat Ridge 303-420-7898 www.odysseycounseling.com Jefferson Center for Mental Health 9595 West 49th Avenue Wheat Ridge 303-425-0300 www.jcmh.org Choices in Living Counseling Center 4485 Wadsworth Blvd Suite 206 Wheat Ridge 303-431-5664 choicesinlivingcounseling.com Center for Change 7651 West 41st Avenue Suite 201 Wheat Ridge 303-422-4126 www.centerforchange-co.com Jefferson Center for Mental Health 4643 Wadsworth Blvd. Wheat Ridge 303-463-7400 jcmh.org West Pines Behavioral Health 3400 Lutheran Parkway Wheat Ridge 303-467-4000 www.westpinesrecovery.org Jefferson Center for Mental Health 7495 West 29th Avenue Wheat Ridge 303-425-0300 www.jcmh.org Raleigh House of Hope 6870 West 52nd Avenue Suite 103 Arvada 720-484-4996 www.theraleighhouse.com Rebound Colorado LLC 5275 Marshall Street Suite 101 Arvada 720-361-2916 www.reboundcolorado.com Center for Change 1701 Kipling Street Suite 102 Denver 303-274-4200 www.centerforchange-co.com BI Inc 2099 Wadsworth Blvd. Denver 303-238-5755 www.georeentry.com/ All Seasons Counseling LLC 2099 Wadsworth Blvd Unit M Denver 303-927-8582 SeasonsEMDR.com Alternative Behaviors Counseling 1949 Wadsworth Blvd Suite 206 Denver 303-237-3599 www.abcounselingnorth.com Beyond Education Supportive Treatment 5800 West 38th Avenue Suite 5830 Denver 720-542-9524 bestduidenver.com Parker Froyd and Associates 8830 West Colfax Avenue Denver 303-202-0801 www.pfamhs.com Whitian House LLC 1439 Estes Street Denver 720-287-4461 whitianhouse.com University of Colorado/ ARTS 6303 Wadsworth Bypass Arvada 303-935-7004 www.artstreatment.com/ Creative Treatment Options 7585 West 66th Avenue Building C Arvada 303-467-2624 creativetreatmentoptions.com Creative Treatment Options 1410 Vance Street Suite 204 Denver 303-467-2624 creativetreatmentoptions.com Raleigh House 4952 Raleigh Street Denver 720-484-4996 www.theraleighhouse.com Jefferson Center for Mental Health 7828 Vance Drive Suite 100 Arvada 303-432-5650 www.jeffersonmentalhealth.org Arvada Counseling Center Inc 7850 Vance Drive Suite 280 Arvada 303-420-4494 www.arvadacounselingcenter.com National Institute for Change 1827 Federal Boulevard Denver 303-231-0090 www.nichange.com Page 10 of 10 Wheat Ridge based physicians authorized to treat opioid dependency with buprenorphine Access this resource by visiting: https://www.samhsa.gov/medication-assisted-treatment/physician- program-data/treatment-physician-locator First Name Last Name Address Tele. Angela Busse 3400 Lutheran Parkway West Pines 303-467-4000 Richard Craven 4251 KIPLING STUNIT 560 970-591-3233 Lori Greene 3400 Lutheran Parkway 303-945-9054 Maria Hoffman 3655 Lutheran Parkway Suite 408 303-467-4282 Amber Johnson 3400 Lutheran Parkway 303-403-6040 Mitushi Mishra 3400 Lutheran Parkway 561-506-6329 Stephanie Rozier 7495 W. 29th Avenue 303-360-6276 Walter Standridge 3400 Lutheran Parkway 303-467-2043 Jessica Viton 4851 Independence Street Suite 100 303-425-0300 Attachments: 1. Jefferson County Opioid Data 1 Both nationally and in Colorado, opioid use disorders have emerged as a significant public health concern. While prescription opioids can help people manage their pain, they also come with serious risks and potential complications. Prescription opioids should be prescribed and used carefully. These drugs are chemically similar to heroin and can increase the risk of addiction or overdose, even if taken as prescribed.1 This report summarizes fatal overdose trends, prescribing practices, and patient behaviors that may increase the risk of an overdose to better understand the scope of the opioid epidemic in Colorado. Figure 1: Opioid-Related Drug Overdose Death Rates, United States, 2000-2016 More than 63,000 Americans died from drug overdoses in 2016.2 Opioids (either prescription or heroin) were involved in two out of every three of these deaths.2 In the United States from 2015-2016, other synthetic opioid-related drug overdose death rates doubled from 3.1 deaths per 100,000 residents to 6.2.2 The rate of heroin- related drug overdose deaths and other commonly prescribed opioid-related overdose deaths increased by 20 percent and 10 percent respectively from 2015 to 2016 (Figure 1).3 In 2017, 1,012 Coloradans died due to drug overdose, and 57 percent of those deaths involved an opioid. Figure 2 shows overdose death rates by substance. From 2016-2017, opioid-related overdose death rates increased by 9 percent to 10.1 deaths per 100,000 residents; stimulant-related overdose death rates rose to 5.3 deaths per 100,000 residents, representing a 49 percent increase. Some of these increases in overdose deaths may be due to improved reporting of the specific drugs involved in fatal overdoses. In 2017, 85 percent of overdose deaths mentioned the specific drugs on the death certificate compared to 75 percent in 2013. Figure 2: Drug Overdose Death Rates, Colorado, 2000-2017 ATTACHMENT 1 2 Figure 3 highlights the trends for opioid categories. Rates for commonly prescribed opioid-related overdoses have remained steady over the past five years, with a non-statistically significant increase from 2016-2017 going from 4.5 to 5.2 deaths per 100,000 residents. While heroin-related rates declined slightly from 2016-2017, rates have significantly increased since 2013. In 2017, there were 3.9 deaths per 100,000 residents, which represents an increase of 76 percent from 2013. Synthetic opioid-related overdoses increased significantly between 2016 and 2017, with rates in 2017 estimated to be at 2.1 deaths per 100,000 residents. As mentioned in the previous paragraph, these increases in other synthetic opioids and heroin-related overdose deaths over the past five years could be due to improved reporting. Figure 3: Opioid-Related Drug Overdose Death Rates, Colorado, 2000-2017 From 2013-2017, there were 158 prescription opioid-related overdose deaths in Jefferson County. This translates to a rate of 5.4 deaths per 100,000 Colorado residents. Map 1 shows the opioid overdose rates by county for 2013-2017. County rates varied widely throughout Colorado. Between 2013 and 2017, Delta County had the lowest opioid death rate at 1.8 deaths per 100,000 residents and Conejos County had the highest with 13.6 deaths per 100,000. Map 2 displays these same rates by the 21 health statistics regions. CDPHE uses these regions to improve the ability to estimate rates in areas with small counts of drug overdose deaths. Between 2013 and 2017, 8 regions, primarily located in the Northeast and Southwest corners of the state (Regions 1, 5, 3, 9, 10, 12, 16 and 18), had significantly lower rates than the state average. Region 5 (Cheyenne, Elbert, Kit Carson, and Lincoln) had the lowest opioid-related death rate with 1.4 deaths per 100,000 residents. Region 20 (Denver), Region 14 (Adams) and Region 7 (Pueblo) all had statistically higher rates than the state average. Region 14 had the highest rate with 9.6 deaths per 100,000 residents. Jefferson County Prescription Opioid Death Statistics 2013-2017 Number of Prescription Opioid-Related Deaths: 158 Age-Adjusted Rate per 100,000 (CI): 5.4 (4.5,6.3) 3 Map 1: Prescription Opioid-Related Age-Adjusted Overdose Death Rates by County, Colorado, 2013-2017 Map 2: Prescription Opioid-Related Age-Adjusted Overdose Death Rates by Health Statistics Region, Colorado, 2013-2017 Additional state and county drug overdose death statistics can be found on the Vital Statistics Program website. 4 Heroin-related overdose deaths have increased by 77 percent from 2013-2017. In total, there were 881 heroin overdose deaths in Colorado, which translates to a state rate of 3.2 deaths per 100,000 residents from 2013-2017. Montrose and Garfield counties had the lowest heroin related death rates at 1.4 deaths per 100,000 residents and Conejos County had the highest rate with 10.7 heroin related deaths per 100,000 (Map 3). Map 3: Heroin-Related Age-Adjusted Overdose Death Rates by County, Colorado, 2013-2017 Map 4 shows the heroin death rates by health statistics region. Between 2013 and 2017, Region 10 (Delta, Gunnison, Hinsdale, Montrose, Ouray and San Miguel Counties) had the lowest heroin-related deaths with 0.6 deaths per 100,000 residents; in total, seven regions had statistically lower rates compared to the state (Regions 2, 3, 9, 10, 12, 18 and 19). Region 4 (El Paso), Region 20 (Denver) and Region 7 (Pueblo County) all had significantly higher rates compared to the state, and Region 7 had the highest rate with 9.6 deaths per 100,000 residents (Map 4). Map 4: Heroin-Related Age-Adjusted Overdose Death Rates by Health Statistics Region, Colorado, 2013-2017 For additional information related to heroin, refer to the 2018 Heroin in Colorado Report. 5 The Colorado State Board of Pharmacy at The Department of Regulatory Agencies (DORA) oversees the operation of the Colorado Prescription Drug Monitoring Program (PDMP). The PDMP is a secure database that collects prescription information on Schedule II-V controlled substances dispensed by Colorado pharmacies. The PDMP compiles information on patients, prescribers, pharmacies, and the medications dispensed. Prescribers and pharmacists registered with the Drug Enforcement Administration (DEA) and the PDMP can access prescription information to make informed decisions when writing or filling prescriptions to ensure appropriate prescribing and dispensing practices.4 For example, prescribers and pharmacists can check the PDMP before prescribing to see what substances their patient receives and avoid prescribing new medications that may have dangerous interactions with existing medications. Prescribers can also check the PDMP to make sure that their patient isn’t receiving multiple prescriptions from multiple prescribers and pharmacies. In Colorado, prescribers are not required to use the PDMP except when considering prescribing a refill to an opioid naïve patient for acute pain (SB18-022). System Features In 2014, Colorado legislators passed a bill that aligned Colorado’s PDMP with best practice strategies.6,7 The bill included: Mandatory Registration: Every Colorado pharmacist and licensed prescriber who registered with the DEA to prescribe controlled substances is required by law to register with the PDMP. Push Notices: DORA uses the PDMP to send educational “push notices” (also known as unsolicited reports) to prescribers and dispensers to flag overlapping prescriptions dispensed to patients from multiple prescribers and pharmacies. This allows prescribers to determine if those multiple prescriptions are appropriate for the individual patient. Information in the notices helps providers deliver optimal care for their patients. Delegates: Prescribers can assign up to three delegates from their health care team to access the PDMP on the prescriber’s behalf. This helps manage workflow and saves the prescriber time. Data Uploads: Pharmacies must upload prescription data on a daily basis no later than the pharmacy’s next regular business day for every controlled substance dispensed. This ensures that the data is accurate and up-to-date. System Updates In 2017, Colorado enhanced the PDMP to make prescription data more accurate, relevant and functional. The enhancements included: PDMP User Interface: Improvements were made to the user interface on the PDMP website to make it more user-friendly and ensure that prescription information is more accurate, timely and accessible. Prescriber Reports: As of August 2017, providers are required to add their specialty as part of registering for the PDMP, which allows them to receive quarterly reports summarizing their own prescribing history and aggregated prescribing history of the other prescribers within the same specialty. These reports raise awareness among prescribers about their own prescribing habits and promote responsible prescribing. Information in the reports helps providers deliver optimal care for their patients. Integration Capabilities: CDPHE and DORA are evaluating multiple ways to integrate the PDMP into existing health care systems and workflows by combining the PDMP with other clinical data and systems, such as electronic health records and health information exchanges. This will allow the prescribers to more easily access PDMP data in conjunction with a patient’s chart. Interconnect: This feature allows PDMPs from participating states to exchange prescription data across state lines to authorized requestors while enforcing each state’s data sharing rules. As a result, prescribers can know the total number of controlled substances dispensed to each patient and play a more informed role in the health and safety of their patients. 6 The PDMP is available to the following Colorado licensed individuals: pharmacists, physicians, physician assistants, advanced practice nurses, dentists, podiatrists, optometrists and veterinarians. Table 1 shows the number and type of providers who have accessed and requested a patient’s controlled substance information. Table 1: The Number of Users and Patient Searches by Provider Type, Colorado, 2017-2018 Provider Type Number of Prescriptions Dispensed 8/17-8/18 Number of Opioid Prescriptions Dispensed 8/17-8/18 Number of Registered PDMP Users 8/17-8/18 Number of Patient Searches 8/17-8/18 Dentist (DDS, DMD) 341,518 307,414 2,598 19,278 Medical Resident 17,475 10,418 440 11,866 Midwife with Prescriptive Authority 5,603 2,167 143 281 Nurse Practitioner 1,042,465 436,613 2,361 275,539 Optometrist 308 269 438 48 Pharmacist 4 2 5,074 919,388 Pharmacist's Delegate - - 97 54,743 Physician (MD, DO) 4,622,787 1,952,139 10,129 564,736 Physician Assistant (PA) 994,991 512,154 1,925 180,231 Podiatrist (DPM) 20,274 18,782 109 1,096 Prescriber Delegate 13,737 4,244 755 513,143 Veterinarian (DVM) 40,240 13,245 1,416 710 Source: Colorado Prescription Drug Monitoring Program, Department of Regulatory Agencies Although health care providers are the main users of the PDMP, other entities can also obtain information from the PDMP. Regulatory boards and law enforcement officers engaged in an active, authorized investigation with a valid court order or subpoena may request to access the data for individuals under investigation. Individual patients can also submit a request to receive a copy of their own information (Table 2). Table 2: Number of Searches by Search Type, Colorado, 8/2017-6/2018 Search Type Number of Searches Investigative 1,385 Self-look-up 4,362 Source: Colorado Prescription Drug Monitoring Program, Department of Regulatory Agencies The data in this section represent all controlled substance prescriptions dispensed to Jefferson County residents. Table 3 describes the general characteristics of these controlled substances. Table 3: Characteristics of Controlled Substance Prescriptions Dispensed, Jefferson County 2014-2017 Characteristics 2014 2015 2016 2017 Number of Prescriptions Dispensed 966,605 978,054 937,124 883,923 Number of Unique Patients 187,756 189,632 182,944 177,217 Number of Unique Prescribers 14,608 14,818 16,191 16,414 Number of Unique Pharmacies 928 837 999 1,049 In 2014 NPI was used to identify unique prescribers and pharmacies as DEA numbers were not available until 2015 Data Source: Colorado Prescription Drug Monitoring Program, Colorado Department of Regulatory Agencies Analysis by: Colorado Department of Public Health and Environment, 2018 7 This report categorizes controlled substances into five main classes: opioids (i.e. oxycodone), benzodiazepines (i.e. alprazolam), stimulants (i.e. amphetamine), sedatives (i.e. zolpidem) and muscle relaxants (i.e. carisoprodol). Figure 4 illustrates the amount of Schedule II-V controlled substances dispensed to Jefferson County residents from 2014-2017. Although the number of prescriptions has decreased, opioids continue to represent 47 percent of prescriptions dispensed. Opioids, benzodiazepines, and stimulants are the most prescribed drug classes dispensed to Colorado residents. Figure 5 shows prescription rates for the three most prescribed drug classes by year. From 2014 to 2017, opioid prescriptions decreased 12.2 percent, benzodiazepines decreased 19.5 percent and stimulants increased 16.0 percent. Variation in prescription rates by drug class is clear but there is also variation in prescription rates by patient demographics. Opioid prescription rates by patient gender and age group are available on the Consortium for Prescription Drug Abuse and Prevention (Consortium) data dashboard. 8 Opioids are powerful medications primarily used to treat pain. To provide meaningful guidance to prescribers and dispensers, the Colorado Dental Board, Medical Board, State Board of Nursing, and the Nurse-Physician Advisory Task Force for Colorado Healthcare created the 2014 Policy for Prescribing and Dispensing Opioids. In March 2018, all six of Colorado’s prescribing and dispensing boards (Dental, Medical, Nursing, Optometry, Podiatry, Pharmacy) adopted a revised Guidelines for Prescribing and Dispensing Opioids. To learn more about the revision process or the changes made to the new version, visit the Opioid Guidelines website. This section describes population level prescribing and dispensing data of opioid prescriptions dispensed to Jefferson County residents based on PDMP data. The data in Table 4 represent all opioid prescriptions dispensed to Jefferson County residents from 2014-2017. Table 4: Characteristics of Opioid Prescriptions Dispensed, Jefferson County, 2014-2017 Characteristics 2014 2015 2016 2017 Number of Prescriptions Dispensed 461,889 487,542 459,997 417,948 Number of Unique Patients 125,857 130,728 125,198 117,378 Number of Unique Prescribers 10,968 11,131 11,808 11,764 Number of Unique Pharmacies 759 675 839 871 Excludes buprenorphine drugs commonly used to treat opioid use disorder In 2014 NPI was used to identify unique prescribers and pharmacies as DEA numbers were not available until 2015 Data Source: Colorado Prescription Drug Monitoring Program, Colorado Department of Regulatory Agencies Analysis by: Colorado Department of Public Health and Environment, 2018 Figure 6 shows how Jefferson County residents paid for their opioid prescriptions. The top payment methods for opioid prescriptions are private insurance, Medicare, Medicaid, and private pay. 9 Residents in urban and rural counties have a similar amount of prescriptions per person as the state. Although prescription rates in frontier counties have decreased over time, they remain higher than the state rate (Figure 7). There are 17 types of opioid drugs in the PDMP: buprenorphine, butorphanol, codeine, dihydrocodeine, fentanyl, hydrocodone, hydromorphone, levorphanol, meperidine, methadone, morphine, opium, oxycodone, oxymorphone, pentazocine, tapentadol and tramadol. In Jefferson County oxycodone containing products were the most frequently prescribed medications in 2017. According, in 2017 opioids (oxycodone, hydrocodone, tramadol) represented the most prescribed drugs dispensed to Colorado residents. Figure 8 shows prescription rates for these most frequently prescribed opioids for Jefferson County residents. 10 According to the CDC, some risk factors for prescription drug misuse include high-dose prescribing, multiple provider episodes, long duration opioids, and overlapping opioid and benzodiazepine prescriptions.5 Understanding these risk factors may help providers better assist their patients in pain management while also protecting their health and safety. Morphine is the standard measure for managing pain and is therefore used as a reference for calculating opioid prescription doses. Higher dosages are associated with an increased risk of opioid use disorder and overdose. In 2016, the Center for Disease Control and Prevention’s (CDC) prescribing guidelines recommended opioid dosages should not exceed 90 morphine milligram equivalents (MME) per day.6,7,8 Assessing dosage can help to identify problematic prescribing practices and patients who may be at risk for substance use disorders. Table 5: Estimated Doses for Commonly Prescribed Opioids The use of multiple prescribers and pharmacies is associated with high-risk drug-related behaviors and adverse events such as opioid abuse and overdose. The number of prescribers and pharmacies a patient visits is often used as a proxy measure for “doctor shopping” which is when a patient receives opioid prescriptions from five or more prescribers and pharmacies in a six-month period.5,6 The calculation for this measure has been updated and the data in Table 6 reflect the changes. Opioid naïve patients may be more vulnerable to adverse effects of LA/ER opioids such as slowed and difficulty breathing and overdose. Time-scheduled opioids are associated with greater total average daily dosages and increased risk for long-term use.6 Previously, CDC defined opioid naïve patients as those who did not fill an opioid prescription in the previous 60 days. In March 2018, a revised definition referred to opioid naïve patients as those who did not fill an opioid prescription in the previous 45 days. The data in Table 6 are updated to reflect the changes. Both benzodiazepines and opioids are central nervous system depressants that can compromise the respiratory system. Benzodiazepines enhance the effects of opioids so the concurrent use of benzodiazepines and opioids can increase the risk of adverse events such as drug interactions and overdose.5,6 This indicator measures the duration of overlapping prescriptions. Longer duration of overlapping prescriptions may raise concerns about potential drug interactions and resulting side effects. 90 MME 60 mg oxycodone 30 mg oxymorphone 90 mg hydrocodone 22.5 mg hydromorphone 900 mg tramadol 20 mg methadone 11 Table 6 includes the population-level indicators described. Data for these indicators were retrospectively updated for all the years to reflect the new definitions and allow for comparisons across all years of data. Table 6: High Risk Prescribing Practices and Patient Behaviors, Jefferson County, 2014-2017 Indicators 2014 2015 2016 2017 2014-2017 % change Patients receiving more than 90 MME (%) 11.0 9.2 9.1 8.5 23.2 Patients with MPE’s (rate/100,000 residents) 88.1 74.4 53.6 37.9 57.0 Patients prescribed LA/ER opioids who were opioid-naïve (%) 22.5 21.3 19.0 18.3 18.8 Patient prescription days with overlapping opioid prescriptions (%) 22.8 21.9 21.5 20.6 9.3 Patient prescriptions days with overlapping opioid and benzodiazepine prescriptions (%) 11.6 11.0 10.2 9.4 19.1 Schedule II-IV Controlled Substances Excludes Buprenorphine drugs commonly used for treatment Annual percentages are based on average of quarterly percentages Data Source: Vital Statistics Program, CDPHE and the Colorado Prescription Drug Monitoring Program, DORA Data Analysis by: CDPHE, 2018 The misuse of prescription drugs is a multidimensional problem. The solution lies in a balanced approach where access to medications is preserved for those who will truly benefit from them to manage their pain, while also preventing dependence and addiction. However, while many people benefit from opioids for pain management, increased use of prescription pain relievers has led to increases in associated mortalities. In Colorado in 2017, opioid-related deaths represented 57 percent of total drug poisoning deaths. Mortality data in this report highlight the severity of the opioid overdose crisis and the continued need to monitor these trends and reduce opioid dependence, misuse, addiction and overdose. The PDMP is another critical tool in the fight to protect the health and safety of Coloradans. The information in the PDMP is useful in identifying prescribing practices and patient behaviors that can increase the risk of overdose. The data included in the PDMP can help organizations understand who is prescribing these medications, how many residents are filling prescriptions, what drugs are being dispensed and where. A balanced approach is needed to address prescription drug misuse to ensure patients have access to safe and effective pain management while reducing the number of people who misuse or overdose from prescription opioids. 12 Data in this report should be interpreted with caution for several reasons. Overdose deaths are complex and variation in death investigation practices may impact the measurement of overdose death rates. For example, coroners may or may not perform an autopsy and order toxicology tests. In cases where tests are ordered, the substances tested for and the types of tests performed may vary by coroner, region, or decedent. These overdose deaths all have an underlying cause of death that is acute drug poisoning. However, deaths involving multiple drugs makes it challenging and expensive to identify which of the various substances caused death. In addition, it can be difficult for CDPHE to confirm the data included on the death certificate or identify information gaps. Colorado does not have a central database repository of toxicology reports for unintentional overdose deaths. When no drugs are specified on the death certificate, CDPHE cannot determine whether the coroner did not test for drugs or whether test results were negative. The drug overdose rates involving a specific drug should be considered the minimum rate, as there may be additional deaths where the drug was involved but not specified on the death certificate. The interpretation of findings should take into account the increased specificity of the drugs listed on death certificates. Increases in overdose death rates may be due to improved reporting, actual increases in the data, or a combination of both. Additionally, the accuracy of the indicators based on PDMP data is limited by the completeness and quality of the data when entered into the system. One limitation of using the PDMP for population-level analyses is that it does not include contextual information about the patient’s diagnosis or the reason the provider prescribed the medication. For example, the PDMP does not collect information such as: provider specialty, the patient’s medical condition, if a patient took dispensed medications as prescribed, or if patients have a substance use disorder. Additionally, this report references specific thresholds using absolute values for indicators of high risk prescribing practices and patient behaviors. Using absolute values without any supplemental contextual information can result in identifying patients at risk for substance use disorder or overdose. However, not all individuals who breach the threshold are at risk for substance use disorder or overdose and those below the threshold may still be at risk. Therefore, interpretations of these measures are limited due to the lack of contextual information regarding the prescriptions. Lastly, many state and local public health agencies use hospital claims data for emergency department (ED) visits and hospitalizations to measure the trends in non-fatal overdoses and the impact they have on the community. These claims data are coded into a system called ICD-10-CM, which is a new system that is more detailed than the previous ICD-9-CM system. With the transition to ICD-10-CM, new standardized surveillance case definitions for overdose-related hospitalizations and ED visits are required. As a result, CDPHE staff, other public health agencies, and national partners are collaborating to determine which diagnoses codes should be used to classify someone as experiencing a drug overdose-related event. Once those recommendations are finalized, CDPHE will apply those definitions to Colorado’s discharge datasets and share updated ED and hospitalization trends using the new coding system. Until the new definitions are finalized, the most current morbidity data can be found on the Consortium data dashboard and are based on the ICD-9-CM definitions. CDPHE Opioid Overdose Prevention Program Violence and Injury Prevention-Mental Health Promotion Blog CDPHE Medication Take Back Program Drug Overdose Death Statistics CDC Opioid Prescribing Guidelines CDC MME Conversion files CDPHE Standing Orders website PDMP website Opioid and Other Substance Use Disorders Study Committee website Colorado Consortium for Prescription Drug Abuse Prevention Prescription Drug Data Dashboard Prescription Drug Misuse Prevention: Community Reference Guide Heroin in Colorado Report Take Meds Seriously Rise Above Colorado DORA Opioid Prescribing Guidelines Naloxone Standing Orders 13 1. Substance Abuse and Mental Health Services Administration (SAMHSA). Opioids. Accessed May 2018 from https://www.samhsa.gov/atod/opioids 2. Seth P, Scholl L, Rudd RA, Bacon S. Overdose Deaths Involving Opioids, Cocaine, and Psychostimulants - United States, 2015-2016. MMWR Morb Mortal Wkly Rep. 2018;67(12):349-358. 3. Centers for Disease Control and Prevention. Opioid Data Analysis and Resources. Accessed October 2018 from https://www.cdc.gov/drugoverdose/data/analysis.html. 4. Colorado Department of Regulatory Agencies (DORA). Prescription Drug Monitoring Program. Accessed May 2018 from https://www.colorado.gov/dora-pdmp 5. Centers for Disease Control and Prevention. Prescription Opioids. Accessed May 2018 from https://www.cdc.gov/drugoverdose/opioids/prescribed.html 6. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain - United States, 2016. MMWR Recomm Rep. 2016; 65(No. RR-1):1-49. DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1. 7. Centers for Disease Control and Prevention. Oral Morphine Milligram Equivalents Sept 2017. Accessed May 2018 from https://www.cdc.gov/drugoverdose/resources/data.html 8. Prescription Drug Monitoring Program- Training and Technical Assistance Center (PDMP TTAC). Morphine Milligram Equivalents Calculator. http://www.pdmpassist.org/pdf/bja_performance_measure_aid_mme_conversion_tool.pdf. Published May 1, 2013. Accessed January 19, 2016. 9. Substance Abuse and Mental Health Services Administration (SAMHSA). Medication-Assisted Treatment (MAT). Accessed May 2018 from https://www.samhsa.gov/medication-assisted-treatment 10. SAMHSA. Naloxone. Accessed May 2018 from https://www.samhsa Colorado Department of Public Health and Environment Violence and Injury Prevention-Mental Health Promotion Branch Opioid Overdose Prevention Unit https://www.colorado.gov/pacific/cdphe/opioid-prevention Email: cdphe_PDOinfo@state.co.us