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Home My WebLink About01-03-22 Study Session Agenda PacketSTUDY SESSION AGENDA CITY COUNCIL CITY OF WHEAT RIDGE, COLORADO 7500 W. 29th Ave. Wheat Ridge CO January 3, 2022 6:30 p.m. This meeting will be conducted as a virtual meeting and in person at 7500 West 29th Avenue, Municipal Building, if allowed to meet on that date per COVID-19 restrictions. Some members of the City Council or City staff will be physically present at the Municipal building for this meeting. The public may participate in these ways: 1. Provide comment in advance at www.wheatridgespeaks.org (comment by noon on January 3, 2022) 2. Virtually attend and participate in the meeting through a device or phone: • Click here to join and provide public comment • Or call +1-669-900-6833 with Access Code: 836 9375 7551 • Passcode: 951145 3. View the meeting live or later at www.wheatridgespeaks.org, Channel 8, or YouTube Live at https://www.ci.wheatridge.co.us/view Individuals with disabilities are encouraged to participate in all public meetings sponsored by the City of Wheat Ridge. Contact the Public Information Officer at 303-235-2877 or wrpio@ci.wheatridge.co.us with as much notice as possible if you are interested in participating in a meeting and need inclusion assistance. Public Comment on Agenda Items 1. Jefferson County Public Health Update 2. Liquor Licensees’ Festival Permit 3. Staff Report(s) 4. Elected Officials’ Report(s) ADJOURNMENT Memorandum TO: Mayor and City Council FROM: Patrick Goff, City Manager DATE: December 27, 2021 (for January 3, 2022 Study Session) SUBJECT: Jefferson County Public Health Update ISSUE: Jefferson County Public Health (JCPH) is a nationally accredited health department committed to promoting health and preventing injury and disease for the residents of Jefferson County, Colorado. JCPH monitors and diagnoses the health concerns within the communities of the County and promotes policies, practices and behaviors to assure County residents stay healthy. With the support, policy oversight and mandates of the Jefferson County Board of Health, JCPH staff implements numerous programs to: - Prevent and control contagious diseases and epidemics - Investigate health and safety hazards - Protect the environment - Prevent foodborne illness - Link people to health care services - Promote active living and healthy eating - Advocate and enforce laws that protect the health and safety of everyone JCPH staff will provide updates on the following health department programs at the January 3rd study session: 1. COVID – Christine Billings 2. Mental health and substance use treatment – Michael Miller, Sara Sweeterman and Amanda Davis 3. Food insecurity – Allyson Goto 4. Alcohol and substance use – Michael Miller 5. Housing 6. Vaping and tobacco – Katie Lazar and Donna Viverette ATTACHMENTS: 1. Jefferson County Substance Use Disorder Treatment Landscape 2. Drug Overdose Deaths – Colorado 3. Drug Overdose Deaths – Jefferson County 4. Addressing Youth Tobacco Use in Jefferson County 5. Youth Mental Health and Nicotine Use 6. Tobacco Policy Strategies to Promote Health Equity 1 July 1, 2020 Jefferson County Substance Use Disorder Treatment Landscape ATTACHMENT 1 2 Table of Contents Executive Summary 3 Methodologies and Findings 4-11 • Substance Use Disorder Resource Inventory • Survey • Key Informant Interviews o Gaps in substance use disorder continuum o Barriers to treatment Recommendations 11-13 Conclusion 13 Appendix 14-20 3 Executive Summary 1,062 Coloradans lost their lives from opioid-related overdose deaths in 2019. JCPH is committed to mitigating the impact of the opioid epidemic. JCPH has established three key focus areas: 1) increase access to SUD treatment services, 2) improve resource navigation, 3) expand overdose prevention efforts. In order to assess and systemically improve SUD treatment services, an environmental scan was conducted. This report aims for actionable, evidence-based recommendations to reduce gaps in the continuum of care and improve the overall SUD treatment landscape in Jefferson County. Three assessment methods were used to evaluate the current state of SUD treatment in Jefferson County, including: 1) An inventory of all SUD treatment resources within Jefferson County 2) A community-based survey 3) Fourteen key informant interviews. The three-part environmental scan converged on common themes, including gaps in the continuum of care and barriers to SUD treatment. These themes include: 1. Gaps in the Treatment Continuum ○ Lack of peer support programs ○ The need for high intensity residential treatment ○ The need for low cost and immediate treatment options 2. Barriers to SUD Treatment ○ Social determinants of health, primarily transportation ○ Stigma The report concludes with our recommendations to address the gaps and barriers in the SUD treatment landscape in Jefferson County. These recommendations include: ● Continue the utilization of telehealth for SUD treatment ● Apply for grant funding to expand peer support programs ● Create a centralized hub of SUD treatment resources to improve resource navigation ● Create a community safe space to support unsheltered individuals ● Expand detox and residential services in specific parts of the county Key Acronyms JCPH - Jefferson County Public Health SAMHSA - Substance Abuse and Mental Health Services Administration OUD - Opioid Use Disorder SUD - Substance Use Disorder MAT - Medication-Assisted Treatment OTP - Opioid Treatment Program OBOT - Office-Based Opioid Treatment SAP - Syringe Access Program 4 Introduction A nationwide epidemic of opioid overdose is ravaging our communities. In 2018, an average of 130 Americans died each day from an opioid overdose. Jefferson County, like the rest of the country, has been hit hard with over 285 opioid-related Emergency Department (ED) visits, 298 hospitalizations, and 106 opioid-related deaths per year. Additionally, the number of residents in Jefferson County who reported needing SUD treatment but not receiving it nearly doubled from 8.3% in 2017 to 15.8% in 2018 (Colorado Health Institute, 2018). During these unprecedented times it is more important than ever to focus valuable and scarce resources on behavioral health and SUD treatment. Increased stress, uncertainty, and isolation due to the COVID-19 pandemic is compounding the already grim epidemic of substance misuse in Colorado; while local numbers are not available, nearby communities report unprecedented increases in overdose deaths during COVID. Jefferson County residents have filed the most unemployment claims out of any other county in Colorado, leaving residents in need of mental health services. However, long intake processes, lack of access to affordable inpatient treatment, and lack of community-based support programs leave people in Jefferson County turning towards substances to cope. Reducing gaps in the continuum and barriers to SUD treatment in Jefferson County will help support citizens through these challenging times and will pave a successful path to recovery that is sustainable for the future. Methodology and Findings SUD Treatment Resource Inventory We conducted an extensive review of current SUD treatment resources in Jefferson County, including licensure data from Colorado Department of Public Health and Environment, Health Care Policy and Finance (Colorado Medicaid), and the Office of Behavioral Health as well as verification with community providers. Treatment resources were divided into broad categories that loosely follow the American Society of Addiction Medicine (ASAM) Levels of Care including outpatient counseling, residential treatment, and withdrawal management facilities, as well as medications for opioid use disorder and recovery residences. The inventory yielded several dozen SUD counseling services, 3 opioid treatment programs (OTPs), 43 buprenorphine providers, 7 residential treatment programs, 2 withdrawal OTP Programs vs. OBOT Programs OTP Programs provide patients with opioid agonist medication in addition to comprehensive rehabilitation and medical services, like methadone clinics. OBOT Programs provide outpatient treatment services that are outside the licensed OTPs, which typically includes the prescription of a MAT medication like buprenorphine. 5 management facilities (detoxes), and around 10 recovery residences. The inventory also demonstrated that the treatment resources are largely concentrated in the urban communities in Jefferson County (Lakewood, Arvada, Westminster, Littleton) while the more rural mountain communities do not have any resources at all (See Appendix A for Maps of Treatment Resources). Our inventory of several statewide SUD treatment resources identified several regional and treatment level-specific gaps in services throughout the continuum of care. The first identified gap in treatment access is the limited access to MAT, which is the use of FDA-approved medications to treat SUD. There are three FDA-approved medications prescribed for OUD, which are buprenorphine, methadone, and naltrexone. MAT is the gold standard of care for OUD treatment and is considered best practice. In Jefferson County, there are 3 OTPs located in the urban center of Jefferson County (Arvada, Littleton, and Lakewood). The treatment resource inventory also demonstrated a clear disparity in the number of treatment resources available in southern and western Jefferson County versus northeast Jefferson County, which borders Denver (Appendix A). Jefferson County would benefit from more office- based opioid treatment (OBOT) providers even in urban areas, and there are none at all in some rural areas like Evergreen and Conifer. In Jefferson County, there are currently 43 listed DEA-waivered buprenorphine prescribers who have the ability to prescribe MAT in OBOT programs, compared to Denver, which has 129 waivered prescribers. A recent Colorado survey found that between 2016 and 2017 only 54% of waivered prescribers wrote a buprenorphine prescription (CHI, 2018). Importantly, this rate has probably declined even further in the last 3 years due to incentives that increased waiver numbers but not prescribing. Providers may underutilize their prescribing abilities due to additional paperwork, time, and stigma (CHI, 2018). In comparison to Colorado as a whole, Jefferson County has a slightly above average rate of buprenorphine prescriptions, with around 37 prescriptions per year per 1,000 people over the age of 12. However, when compared to other counties such as Pueblo, which has a rate of over 85 prescriptions per 1,000 people over the age of 12, it is evident that Jefferson County could benefit from MAT expansion. What is an X Waiver? Physicians who are interested in prescribing Buprenorphine to patients with OUD can apply for an X Waiver through SAMHSA. The waiver enables providers who apply and complete an 8-hour training the ability to administer Buprenorphine in an office setting. Each waivered prescriber can prescribe to 30 patients in the first year and then has the potential to increase their prescribing capacity to 100 after a year and 275 after another year. 6 Another gap in the SUD treatment continuum is the lack of MAT in jails in Jefferson County. While Jefferson County was granted $60,000 from the Colorado Department of Human Services Office of Behavioral Health to continue or initiate MAT treatment in county jails, Jefferson County does not have a comprehensive MAT program to serve incarcerated people. A recent study out of North Carolina found that recently released inmates are 40 times more likely to die from an opioid-related overdose in the two weeks following their release. In order to reduce deaths from opioid-related overdoses, it is imperative that those who are released from jail have access to SUD treatment, including MAT, before they are discharged. Encouraging more providers with their X Waivers to prescribe buprenorphine, particularly in rural areas, and starting people on medications prior to leaving incarceration would help to close the gap in treatment resources between Jefferson County and other parts of Colorado. The gold standard for MAT in jails is Rhode Island, which offers all three FDA-approved medications to all incarcerated people with OUD. However, even in Colorado, Arapahoe, Denver, and Larimer Counties all have excellent MAT programs that offer continuation for all medications as well as inductions for buprenorphine. These programs each serve hundreds of people each year, decreasing overdose risk and improving people’s connections to treatment and recovery. In addition to outpatient MAT, high intensity services such as residential and withdrawal management can be difficult to access. While Jefferson County has greater access to such services than rural counties, there are still areas of the county where such services are distant. Littleton, Golden, Morrison, and smaller towns like Conifer, Evergreen, and Aspen Park are all at least 30 minutes from a withdrawal management facility. Furthermore, 6 of the 7 residential facilities are located in Wheatridge or Lakewood, with one in Littleton. Adding a residential facility in western Jefferson County and a withdrawal management facility would help ease the regional shortages for these areas as well as for neighboring Douglas County. Financial barriers to SUD treatment were also identified through the inventory process. For example, Colorado’s state Medicaid program does not currently cover residential treatment, which inhibits those of lower socioeconomic status from accessing the full SUD continuum of care. However, in accordance with House Bill 18-1136, Colorado’s Medicaid program will begin to cover residential treatment for SUD starting in January of 2021. This policy change will help to reduce financial barriers associated with accessing SUD treatment throughout the state. While the state’s Medicaid program is expanding coverage of services, many of the treatment programs identified in Jefferson County may choose not to accept Medicaid. Fortunately, the Jefferson Center is creating a residential program in the northern part of the county that will accept Medicaid. Despite this, the county could still benefit from another publicly accessible residential option. 7 Surveys We conducted a cross-sectional survey of 76 interdisciplinary professionals including law enforcement, public health professionals, health care providers, recovery support staff, and community members located in Jefferson County. The Jefferson County SUD Treatment Resource Survey consisted of 18 questions regarding demographics, barriers to treatment, and perception of SUD treatment resources. The survey was open for two weeks and had a completion rate of 46% (35/76). Survey responses were then analyzed and themes identified. Three major gaps and barriers were identified consistently by survey respondents, including 1) the need for peer recovery support and community-based programs, 2) the need for immediate, low cost treatment options (especially for those covered by Medicaid), and 3) the need for higher-intensity treatment resources like withdrawal management, recovery residences, and residential treatment. These findings suggest that funding and future policy on SUD treatment in Jefferson County should be focused on closing gaps in the continuum of care related to residential treatment and recovery services, as well as addressing socioeconomic barriers to treatment. We also compared the results from Jefferson County to the results from the same survey conducted in a rural county in Northwest Colorado. This comparison highlighted the differences in gaps and barriers between metropolitan and rural communities, which will enable Jefferson County to better understand the specific SUD needs of both its urban and rural communities. The main differences were more participants in the rural communities reported SUD as a major concern, but fewer reported OUD as a major concern than Jefferson County. This finding indicates that Jefferson County could benefit from target interventions for OUD. Additionally, more participants in rural Northwest Colorado cited concerns over other people in the community finding out about their treatment than participants in Jefferson County. Furthermore, Northwest Colorado residents more frequently cited negative experiences with 8 healthcare professionals as a barrier to treatment than Jefferson County respondents. This finding indicates that stigma in Jefferson County may be lower than in rural areas, although this is still a major concern. Key Informant Interviews: We conducted 14 key informant interviews to gain firsthand insight into the SUD treatment landscape in Jefferson County. JCPH provided a list of professionals from various disciplines including behavioral health, criminal justice, social services, and people in long-term recovery to comment on SUD treatment resources, barriers, and areas for improvement. The semi- structured interview guide consisted of an introduction, nine questions, and next steps. Interviews were analyzed for common themes that were referenced by multiple interviewees. Theme 1: Key Gaps in the SUD Treatment Continuum Residential SUD treatment The most commonly identified gap in the SUD treatment continuum was a lack of access to residential treatment, medical detox, and recovery residences. The state’s Medicaid program does not cover the cost of these services. Seven of the participants mentioned that lack of Medicaid coverage for these services contributes to a major gap in the care continuum because patients cannot afford to pay out of pocket for these services. Many patients have to enter intensive outpatient care rather than residential due to this lack of coverage. In an attempt to close this gap in the continuum of care, Colorado’s Medicaid program will begin covering residential treatment services in January of 2021. However, it will not cover the cost of recovery residences. Additionally, many recovery residences are abstinence-based, meaning patients cannot be on medication-assisted treatment (MAT) while in the program and may be removed for relapsing. Eight of the participants stressed the importance of recovery residences to the SUD treatment continuum of care because they provide support for patients as they transition from treatment into recovery. "Anything residential is kind of a mess, whether it be social detox, medical detox, or inpatient stay." Participant 12 9 Another contributing factor is the lack of withdrawal management facilities in Jefferson County. There is only one “social detox” in Jefferson County as well as one “medical detox,” but Medicaid does not cover medical detox. The lack of detox is particularly acute for people in the southern part of the county, who may have to travel to Aurora for detox. The availability of residential treatment mirrors that of withdrawal management. Two participants discussed sending patients to receive residential treatment in Pueblo because the facilities in Jefferson County were full. This inability to access residential SUD treatment services reduces the overall quality of care available for patients in Jefferson County. Peer support The lack of available peer support programs was identified by four of our participants as a gap in Jefferson County’s continuum of care. Peer support workers help people stay in recovery through empowerment and shared experience. They also extend the reach of SUD treatment beyond the clinic (SAMHSA, 2020). Peer workers are emerging as an important part of the SUD treatment and recovery continuum. Five of our interviewees suggested developing more peer support programs at existing facilities and in the community to address this gap in the continuum. In order to do this, more sustainable funding for peers will be needed-- currently, Medicaid pays as little as $21 per hour for these services, less than half of peer hours are billable, and the only organizations that can bill for peer services are OBH-licensed programs. Therefore, determining a route to sustainability for peer services is imperative in Jefferson County and beyond. Theme 2: Psychosocial Barriers to SUD Treatment Social Determinants of Health Social determinants of health, particularly transportation, are major barriers for those seeking SUD treatment. Eight of the interview participants identified lack of access to safe and reliable transportation as a barrier to SUD treatment. There are resources available in Jefferson County to help address transportation issues like the free Medicaid ride, which will provide transportation to and from treatment. However, three of our participants cited that this service is unreliable at times. Others still cited non-medical transportation, such as inability to get to work, as another barrier to recovery. "One of the gaps we have all been discussing for a long time is the residential gap, Medicaid patients can go to a detox to get clean but then they are just left to go to an IOP or outpatient services, which is not enough to help people get sober." Participant 3 10 Transportation time is also another major barrier to treatment, especially in rural communities like Conifer and Evergreen, where patients may have to travel nearly an hour each way to receive treatment. Four of our participants mentioned an unexpected solution to the transportation problem that has stemmed from the response to COVID-19, which is the use of telehealth to deliver SUD treatment. One participant stated they have had fewer no-show appointments since all services have been moved online. Another participant even discussed patients participating and being more open during virtual appointments than in person. The expanded use of telehealth in SUD treatment presents a possible solution to reduce the barrier caused by lack of transportation. Participants also identified socioeconomic status as a barrier to receiving and maintaining SUD treatment. Seven of our interviewees stated they work primarily with people of lower socioeconomic status. Research shows that socioeconomic status is positively correlated with healthcare coverage, safe housing, and reliable transportation. All participants cited cost or underinsurance as a major barrier to receiving treatment. Two participants, who work with unsheltered individuals, described absence of stable housing as the largest barrier for those in their community seeking SUD treatment. With a lack of stable housing comes other challenges related to resource navigation due to the inability to access the internet to find treatment. The social determinants of health, like low socioeconomic status and transportation, play a major role in one's ability to access and successfully enter SUD treatment services, all of our participants suggested future policies and programs to address these social determinants of health. Stigma While some participants acknowledged that stigma associated with SUD and treatment is lower than it used to be, all participants cited stigma as a major barrier to treatment. Participants discussed stigma at different levels in the SUD treatment landscape. Two participants discussed systemic stigma which stems from the suburban culture of Jefferson County, as the quote to the right illustrates. Another participant discussed the stigma and distrust felt by many people with SUDs towards the insurance and medical community. Others mentioned self-stigma and "Most of the people I work with do not feel they can access or tap the resources that are there. There is not a lot of navigation in that system." Participant 6 "We have one day shelter for unsheltered individuals to go during the day, but it takes a lot of heat from the community. There is a culture of "not in my backyard" since Jefferson County is more suburban and affluent than other areas." Participant 9 11 shame associated with receiving treatment and being in recovery. Each participant recognized stigma as a primary barrier to recovery and the need to mitigate the effects of stigma to encourage persons with SUD to seek treatment. Recommendations Based on the findings from the environmental scan we recommend the following actions for JCPH and its partners to take in the next months. These recommendations are in temporal order: 1. Advocate for continued utilization of telehealth for SUD treatment The COVID-19 pandemic has resulted in the increased utilization of telehealth for behavioral health and SUD treatment. Several key informants reported having fewer “no-show” appointments and increased engagement during treatment. This discovery suggests that continued expansion of telehealth services may be an innovative solution to address the barrier of transportation, which nearly all of our key informants identified as a major barrier to receiving and maintaining SUD treatment. Some of the key changes to Medicaid’s telehealth guidelines stemming from COVID-19 include: ● Allowing out-of-state-licensed providers limited ability to provide behavioral health services in Colorado ● Expanded coverage of telehealth services for behavioral health services-- services like intensive outpatient are now covered through telehealth ● No geographic restrictions on provider location via telehealth through the remainder of the public health emergency. 12 Some of the changes made temporarily for COVID were recently enshrined into state law, but some of the more impactful changes listed above are likely to return to normal after the state of emergency ends. We recommend advocating for the continued use of telebehavioral health at both the state level through both HCPF and the Department of Insurance. 2. Apply for grant funding for peer support programs Apply for grant funding to support expansion of peer support programs throughout the county. This will help JCPH to address the lack of peer support programs available to those with SUD in Jefferson County. These programs meet people where they are at in the treatment and recovery process and help to encourage and empower those seeking treatment. In addition to grant funding, advocacy with legislators, state Medicaid, and commercial insurers is needed to make peer recovery services sustainable. 3. Create a centralized hub for SUD treatment resources In order to improve SUD treatment resource navigation, we recommend a centralized hub with all available SUD treatment resources including counseling services, OTPs and OBOTs, medical and social detoxes, residential programs, and recovery residences be housed on the JCPH website. This hub would be designed and maintained by the county but would also include significant provider input so that people can easily access the most up-to-date information needed to make an informed decision regarding their treatment options. This hub should be kept up to date and revised every month to ensure the most accurate information is included as programs close, expand services, or open. An excellent example of a locator is Eagle Valley Behavioral Health’s “Find a Therapist” website, featuring updated pictures, locations, insurance information, and focal areas. 4. Community-based social services program Several key informants discussed the need for intermediate drop-in spaces, such as living rooms or day shelters, in order to give unhoused people with SUD a place to go during the day. These programs help to re-enfranchise people through exposure to peers, social services, and treatment options. This could start with the Community Connections Center (C3) to expand on their work providing insurance help, virtual court, and mental health services, which will allow patients to better navigate the criminal justice system and will familiarize them with SUD treatment resources. JCPH, in partnership with C3, should work to expand their services to include a “safe space” where those with SUD can come to feel a sense of belonging and community. Expanded services for C3 could include peer recovery support, group counseling, community programming, 13 and sexually transmitted infection testing. The goal of this center will be to create a community to provide support and services to people with SUD in Jefferson County. 5. Address gaps in the continuum of care As found in both the inventory and interviews, there are specific gaps in higher-intensity services within Jefferson County. With only one social and one medical detox facility, Jefferson County is on the lower end of large counties in the state for detox capacity. While Adams and Arapahoe have only 2 as well, smaller Pueblo has 2, Larimer has 3, Boulder has 3, and El Paso has 4. Furthermore, the total bed count of 35 is very low; a single facility in Denver has 20% more capacity than all of Jefferson County. A southern detox, perhaps in Littleton, could help increase capacity and spacing. While Jefferson County has 7 residential facilities, 2 of those are for individuals involved in the criminal justice system and another 2 are not available to public payers, leaving West Pines as the only residential facility in Jefferson County that accepts public payers (New Beginnings is on the border of Arapahoe and Jefferson Counties). Given the documented shortages of local residential treatment, the county could benefit from at least one more publicly accessible residential. Expanding recovery residences to match residential capacity would also be beneficial. Conclusion With the increased stress brought on by the COVID-19 pandemic, it is key to have the necessary treatment resources to support people with SUD during these times. Advocating for continued use of telehealth for behavioral health will decrease some of the largest barriers to receiving and maintaining SUD treatment, like transportation. By creating a centralized hub with all of Jefferson County's treatment resources and crisis call center, those looking to start treatment will be able to easily navigate treatment resources to quickly find the information they need to begin treatment. Closing the gap in peer support programs will help support and mentor those looking to start SUD treatment and will encourage those currently in treatment to stay in treatment. Providing people with SUD a safe place to go to feel like a part of a community will help to meet people where they are in the treatment process and provide much needed mental and emotional support during and beyond these times. These recommendations will help to close gaps in the continuum of care and reduce barriers to SUD treatment to better support the people of Jefferson County. 14 Appendix Appendix A: Maps of Treatment Resources inside and outside Jefferson County, Colorado Map 1. Jefferson County Substance Use Disorder Treatment Resources 15 Map 2. SAMHSA Buprenorphine Providers in Jefferson and Surrounding Counties 16 Appendix B: Referral sheets (4 pages) Jefferson County Public Health Buprenorphine Program Referrals SUD Counseling (outpatient/ intensive outpatient) *Blue text denotes that the practice accepts Medicaid Program Name Address/Phone Services Solace Counseling Services 6655 West Jewell Avenue, #100 Lakewood, CO 80232 (303) 975-1922 IOP, DUI, Monitoring National Institute for Change 3225 S Wadsworth Blvd #T, Unit T Lakewood, CO 80227 (303)231-0090 Adult, Adolescent, Drug Court Spanish Clinic LLC 4200 Morrison Rd Unit 8 Denver, CO 80219 (720) 335-6651 DUI, DV, Relapse Prevention, Youth Servicios de la Raza 3131 W. 14th Ave. Denver, CO 80204 (303) 458-5851 DUI, CBT, IOP Mile High Behavioral Health Care 3460 S. Federal Blvd. Sheridan, CO 80110 (303) 825-8113 Monitoring, DUI, IOP, DBT, SSC Creative Treatment Options 7585 West 66th Avenue Building C Arvada, Colorado 80003 (303) 467-2624 1410 Vance Street, #204 Lakewood, CO 80228 (303) 467-2624 Monitoring, DUI, IOP, DBT, SSC CAPS Mental Health and DUI Services, LLC 1100 W. Littleton Blvd. Suite 320 Littleton, CO 80120 (303) 495-2550 DUI, Family 17 Jade Recovery Inc. 255 South Routt Street Medical Plaza 3, Suite 265 Lakewood, Colorado 80228 (833) 523-3669 Sober living as well A.B. Counseling 1949 Wadsworth, Suite 206 Lakewood, CO 80214 (303) 237-3599 DUI, Probation, Sex Offender Jefferson Center for Mental Health 5801 W Alameda Ave, Lakewood, CO 80226 (303) 425-0300 9485 W Colfax Avenue Lakewood, CO 80215 (303) 425-0300 13600 W. 2nd Place Lakewood, Colorado 80228 (303) 425-0300 3595 South Teller St. Lakewood, CO 80235 (303) 425-0300 DUI, Probation, IOP, DBT MAT Clinics Front Range Clinic 1410 Vance Suite 201 Lakewood, CO 80214 (720) 636-6537 Jefferson County Public Health 645 Parfet Rd. Lakewood, CO 80215 (303) 232-6301 Syringe access available onsite Stride 7495 W. 29th Ave Wheat Ridge, CO 80033 (303) 360-6276 11005 Ralston Rd, #100-G Arvada, CO 80004 (303) 360-6276 Counseling required and available onsite Andrew Leifer 1202 Bergen Pkwy Suite 211 Evergreen, CO 80439 (303) 674-6074 Also addiction psych, groups Magnolia 1850 Race St. Denver, CO 80206 18 (303) 209-5115 Road to Recovery 393 S. Harlan St. #103 Lakewood, CO 80226 (303) 434-8484 Soon to become Front Range Clinic Denver Health STEP 301 W. 6th Ave Pavilion G Denver, CO 80204 303-602-1893 adolescents Denver Health 4545 Navajo St. Denver, CO 80211 (303) 602-6700 Pregnant and parenting women Opioid Treatment Program (Methadone Clinic) Addiction Research & Treatment Services (ARTS) - Westside Center for Change 6303 Wadsworth Bypass Arvada, CO 80003 (303) 935-7004 OTP methadone, buprenorphine, XR-NTX, AUD treatment Denver Recovery Group 8790 West Colfax Avenue Lakewood, CO 80215 (720) 750-8137 72 East Arapahoe Rd Littleton, CO 80122 (720) 283-3055 OTP methadone, buprenorphine, XR-NTX VCPHCS XII LLC, Behavioral Health Group 8402 Clay Street Westminster, CO 80031 214-365-6126 OTP methadone, buprenorphine, OBOT Residential Treatment Centers and Recovery Residences *Medicaid will pay for residential starting January 2021. Until then, Signal Behavioral Health may pay for residential stays. Many of these providers also have outpatient programs. Golden Peak Recovery (3.7) 2305 S Fenton Dr. Lakewood, CO 80227 (720) 885-9503 Self-pay or commercial only The Raleigh House of Hope (3.5) 6870 W 52nd Ave, Ste 103, Arvada, CO 80002 (720) 603-1151 Also sober living 19 Sobriety House (3.5) 121 Acoma St. and other locations Denver, CO 80223 720-381-4337 Also sober living New Beginnings 191 E. Orchard Ave #A Littleton, CO 80121 (720) 473-7106 Also sober living West Pines (3.5, 3.7) 3400 N. Lutheran Pkwy Wheat Ridge, CO 80033 (303) 467-4080 Also medical detox Valley Hope (3.7) 22422 E. Main St. Parker, CO 80138 (303) 841-7857 Community Reach Center (3.7) 8801 Lipan St. Thornton, CO 80260 (303) 853-3500 ARTS- The Haven (3.5) 3630 Princeton Ave. Denver CO 80236 303-734-5000 Pregnant and parenting women Mile High Behavioral Health-Aspen (3.5) 4242 Delaware St, Denver, CO 80216 (303)426-7848 Pregnant and parenting women Pathfinders Recovery Center Colorado 12157 West Cedar Drive Lakewood, CO (877) 646-0781 EMDR Juust Living 1629 Simms Lakewood CO 720-290-5715 LGBTQ+. co-ed Red Rocks Recovery Center (sober living) 12567 W Cedar Dr, #100 Lakewood, CO 80228 (855) 908-0071 Sober living, IOP, family, outpatient Sandstone Care 7555 E Hampden Ave #103, Denver, CO 80231 (720) 420-7444 Young adults Step Denver 2029 Larimer St. Denver, CO 80205 (303) 295-7837 People experiencing homelessness 20 Monarch Lakewood, CO- Several homes (877) 835-1545 Men’s and women’s Mile High Sober Living 1470 Clayton St, Denver, CO 80206 Several homes in Denver (720) 445-5729 Also IOP Detox JCMH (social) 4643 Wadsworth Blvd. Wheat Ridge, CO 8033 (303) 425-0300 Also houses crisis services West Pines Behavioral Health (medical) 3400 Lutheran Parkway Wheat Ridge, CO 80033 (303) 467-4080 Denver Health and Hospital Authority - Denver CARES (medical) 1155 Cherokee St Denver, CO 80204-4507 (303) 436-3500 Also has level 3.1 residential Yuma5 Weld552 Washington 5 Teller80 Summit54 Sedgwick 8 San Miguel 12 San Juan * Saguache 16 Routt51 Rio Grande 55 Rio Blanco 17 Pueblo702 Prowers30 Pitkin37 Phillips 8 Park48 Ouray11 Otero58 Morgan56 Montrose 87 Montezuma 65 Moffat37 Mineral * Mesa449 Logan57 Lincoln 12 Las Animas 88 Larimer 825 Lake24 La Plata 125 Kit Carson 16 Kiowa* Jefferson 1,540 Jackson 5 Huerfano 45 Hinsdale * Gunnison 27 Grand28 Gilpin14Garfield137 Fremont178 Elbert 55 El Paso 2,091 Eagle80 Douglas443 Dolores 8 Denver3,000 Delta84 Custer12 Crowley 13 Costilla 19Conejos36 Clear Creek 24 Cheyenne *Chaffee 56 Broomfield 127 Boulder806 Bent19 Baca9Archuleta25 Arapahoe1,798 Alamosa 66 Adams1,652 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022 0 500 1000 1500 Frequency 1,477 764 739 728 807 838 839 870 653 351 880 619 912 601 406 444 974 1,072 516 1,012 497 Total number of drug overdose deaths due to any drug per year 15,999 Total number of drug overdose deaths among Colorado residents: 0K 2K 4K 6K 8K 10K Male Female Missing or unknown * 6,369 9,630 Sex 0K 1K 2K 3K 4K Less than 1 year 1 through 4 years 5 through 14 years 15 through 24 years 25 through 34 years 35 through 44 years 45 through 54 years 55 through 64 years 65 through 74 years 75 through 84 years 85 and above Missing or unknown * 107 194 646 2,352 4,053 3,811 3,377 1,393 39 15 10 Age groups 0K 2K 4K 6K 8K 10K 12K 14K Non-Hispanic White White Hispanic Black or African American American Indian or Alaska Native Asian or Pacific Islander Other or unknown 11,957 2,600 832 237 131 242 Race and ethnicity 0K 5K 10K Currently Married Single Divorced Widowed Missing or unknown 4,311 6,285 4,526 623 254 Marital status 0K 10K 20K Yes No Missing or unknown 127 14,220 1,652 Veteran status Learn more about the data and its sources.Want to provide feedback or report an error? Select geographical viewCounty of residence Select drug poisoning categoryDrug overdose - any drug Enter years or move sliders to selectAll values Abc Counts of drug overdose deaths due to any drug in Colorado, 2000-2020 Home ATTACHMENT 2 Yuma5 Weld552 Washington 5 Teller80 Summit54 Sedgwick 8 San Miguel 12 San Juan * Saguache 16 Routt51 Rio Grande 55 Rio Blanco 17 Pueblo702 Prowers30 Pitkin37 Phillips 8 Park48 Ouray11 Otero58 Morgan56 Montrose 87 Montezuma 65 Moffat37 Mineral * Mesa449 Logan57 Lincoln 12 Las Animas 88 Larimer 825 Lake24 La Plata 125 Kit Carson 16 Kiowa* Jackson 5 Huerfano 45 Hinsdale * Gunnison 27 Grand28 Gilpin14Garfield137 Fremont178 Elbert 55 El Paso 2,091 Eagle80 Douglas443 Dolores 8 Denver3,000 Delta84 Custer12 Crowley 13 Costilla 19Conejos36 Clear Creek 24 Cheyenne *Chaffee 56 Broomfield 127 Boulder806 Bent19 Baca9Archuleta25 Arapahoe1,798 Alamosa 66 Adams1,652 Jefferson 1,540 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022 0 50 100 150 Frequency 156 72 69 78 79 8164 86 58 91 91 36 50 49 98 47 43 100 103 4445 Total number of drug overdose deaths due to any drug per year 1,540 Total number of drug overdose deaths among Colorado residents: 0 200 400 600 800 1000 Male Female Missing or unknown * 638 902 Sex 0 100 200 300 400 Less than 1 year 1 through 4 years 5 through 14 years 15 through 24 years 25 through 34 years 35 through 44 years 45 through 54 years 55 through 64 years 65 through 74 years 75 through 84 years 85 and above Missing or unknown * 10 27 63 209 372 359 335 162 * * * Age groups 0K 1K Non-Hispanic White White Hispanic Black or African American American Indian or Alaska Native Asian or Pacific Islander Other or unknown 1,268 205 21 17 10 19 Race and ethnicity 0 500 Currently Married Single Divorced Widowed Missing or unknown 405 616 437 66 16 Marital status 0K 1K 2K Yes No Missing or unknown 4 1,410 126 Veteran status Learn more about the data and its sources.Want to provide feedback or report an error? Select geographical viewCounty of residence Select drug poisoning categoryDrug overdose - any drug Enter years or move sliders to selectAll values Abc Counts of drug overdose deaths due to any drug in Colorado, 2000-2020 Home ATTACHMENT 3 Addressing Youth Tobacco Use in Jefferson County Problems Persist, Policy Options Exist Data Source: 2019 Healthy Kids Colorado Survey JCPH can provide the sources that support recommended policies upon request. Document Updated 12-17-20 5.2% used cigars, chewing tobacco, hookah or bidis in the past 30 days Current County Rates Among Youth 26% used vape products in the past 30 days Reduce youth access and use of tobacco by enacting a local tobacco retail licensing policy to help prevent illegal sales of tobacco products. of students saw ads for vape products in the past 30 days 77.4% 12th grade 11th grade 10th grade 9th grade 4.1% smoked cigarettes in the past 30 days of students reported that it would be sort of easy or very easy to get vape products if wanted % of students who used vape products in the past 30 days by grade 63.8% TOBACCO TARGETS YOUTH of students who smoke used menthols in the past 30 days 27.9% Reduce exposure to secondhand smoke and vapor by protecting the public’s right to clean air with a strong local smoke and vapor-free policy. Smoke/vapor-free policies also reduce normalization of tobacco use among youth. Eliminate the appealing incentives that entice youth to begin using harmful and addictive flavored tobacco products by enacting a local policy that restricts the sale of flavored tobacco products. Lower overall tobacco product consumption and youth smoking/vaping initiation by advancing a local tobacco pricing strategy. Do more to address tobacco-caused health inequities by combining the policy options listed above for a more comprehensive approach to tobacco control. For questions or for more information, contact: Katie Lazar, Tobacco Policy Specialist Jefferson County Public Health klazar@jeffco.us Local Policy Options to Address Youth Tobacco Use ATTACHMENT 4 September 2021 COLLIDING CRISES Two health crises among youth — a mental health crisis and a vaping epidemic — pose increasing threats to a generation of young people. They are also linked in ways many may not realize, according to a body of peer-reviewed studies. Both crises have intensified during the COVID-19 pandemic. Even before the pandemic, 70% of young people said anxiety and depression were a major problem among peers in their community, according to a Pew Research Center report.2 Since then, the problem has gotten worse, as the prevalence of depression and anxiety symptoms in youth has doubled compared to before the pandemic.9 Alongside this mental health crisis, youth e-cigarette use — driven by products that quickly deliver highly-addictive nicotine — has remained at epidemic levels, with one in five high school students vaping in 2020, according to the National Youth Tobacco Survey. In the time since that survey, national e-cigarette sales have risen to record highs and the risks of vaping have become more apparent, as evidence shows it can harm lung health and may put users at greater risk of contracting COVID-19.17 While it is well known that nicotine harms developing brains, including by making young people more susceptible to addiction,1,6 lesser known are the worrying connections between nicotine and mental health. Though nicotine has not been found to directly cause mental health conditions and more research is needed, numerous peer-reviewed studies reveal troubling links, including clearly established research that shows nicotine can worsen symptoms of depression and anxiety. Colliding Crises: Youth Mental Health and Nicotine Use While it is well known that nicotine harms developing brains, including by making young people more susceptible to addiction, lesser known are the worrying connections between nicotine and mental health. Many young people turn to nicotine to alleviate stress, anxiety, and depression, but it may be making them feel worse ATTACHMENT 5 2September 2021 COLLIDING CRISES Research shows several connections between nicotine and mental health: >Nicotine can worsen anxiety symptoms11 and amplify feelings of depression.12 >Current e-cigarette users have double the odds of having a diagnosis of depression compared to those who have never vaped, according to a 2019 JAMA study of nearly 30,000 current e-cigarette users.15 Frequent vaping is tied to even higher odds (2.4x) of having a diagnosis of depression compared to never users. >Using e-cigarettes can worsen symptoms of depression, based on the results of a study of nearly 2,500 ninth graders who had never previously used e-cigarettes or combustible tobacco. >Using e-cigarettes at a higher frequency was associated with higher depressive symptoms — including feeling sad or having crying spells — a year later.12 >Current e-cigarette users had 1.67 times higher odds and former e-cigarette users had 1.52 times higher odds of reporting at least 1 day of poor mental health in the past month compared to never users.15 >Trace metals found in vape liquid may play a role in the potential link between vaping and depression.15 >Vaping is significantly associated with higher levels of ADHD symptoms, based on a 2019 study of college students.20 Using e-cigarettes as an adult also had nearly twice the odds of association with cognitive complaints — having serious difficulty concentrating, remembering, or making decisions — compared to those who had never used e-cigarettes.2 Many misinterpret the effects of tobacco products as a stress reliever. Indeed, Truth Initiative surveys show a large majority of young people who have used e-cigarettes started vaping to lessen feelings of stress, anxiety, or depression, and many continue vaping to cope with these feelings. Though they may be looking to nicotine for relief, many young people are unaware that vaping may make their symptoms worse. The common misconception that nicotine relieves stress, anxiety, and depression, may be rooted in the cycle of nicotine withdrawal. Irritability, anxiety, and depression are some of the symptoms of nicotine withdrawal, and using nicotine relieves these symptoms temporarily. It’s critical to recognize that the cycle of nicotine Before the COVID-19 pandemic, 70% of young people said anxiety and depression were a major problem among people their age in the community they live in, according to a 2019 report from Pew Research Center.2 Since then, the problem has gotten worse: Depression and anxiety are up: ›The prevalence of depression and anxiety symptoms in youth globally has doubled compared to before the pandemic, with 1 in 4 experiencing clinically elevated depression symptoms and 1 in 5 experiencing clinically elevated anxiety symptoms.9 ›1 in 5 college students say their mental health has significantly worsened due to COVID-19. ›More than half (56%) of young people (18-24) reported symptoms of anxiety and/or depressive disorder in December 2020. ›One-quarter (25%) of young people (18-24) reported having seriously considered suicide in July 2020. Mental Health and COVID-19 3September 2021 COLLIDING CRISES Many tobacco users believe tobacco products can relieve stress or anxiety.3 They might be interpreting the ability of the products to curb the symptoms of nicotine withdrawal as a beneficial effect on mental health, according to research on the effects of quitting smoking on mental health published in 2014.3 According to the paper, smokers experience irritability, anxiety, and depression when they have not smoked for a while,7,8 feelings which are relieved by smoking.10 The cycle of symptoms followed by relief from smoking can create the perception that smoking has psychological benefits.3 withdrawal, subsequent nicotine use, and alleviation of symptoms all starts with nicotine addiction in the first place. [See side bar “The illusion of nicotine as a stress-reliever” below]. In addition, the tobacco industry has invested significant resources in marketing that connects tobacco use with mental well-being, stress-relief, relaxation, and pleasure. [See side bar “How Big Tobacco has linked nicotine and mental health” page 5]. Given these two factors – the cycle of nicotine withdrawal combined with tobacco industry marketing – it’s no wonder that people have misconceptions about the role nicotine plays in mental well-being. Published research on nicotine and mental health, combined with Truth Initiative survey data, point to an urgent need to increase awareness of the connections between youth vaping and mental well-being. YOUNG PEOPLE VAPE NICOTINE-CONTAINING E-CIGARETTES TO TRY TO COPE Truth Initiative surveys reveal that many young people cite feelings of stress, anxiety, or depression as reasons they start and continue vaping.14,5 > Overwhelming majority started vaping to decrease stress, anxiety, or depression: 81% who had used e-cigarettes said they started vaping to decrease stress, anxiety, or depression, according to an August 2021 survey of 1,000 people between ages 15 and 24.5 The illusion of nicotine as a stress-reliever 78% of those who vaped before COVID-19 are vaping either the same or more during the pandemic Image courtesy of Stanford Research Into the Impact of Advertising. 4September 2021 COLLIDING CRISES > More than half of vapers use e-cigarettes to cope: 50.3% of frequent vapers – those who vaped 20 or more days in the past month – reported that they need to vape to cope with stress or anxiety, according to Truth Initiative continuous tracking data from June 2021.14 In a separate study, when respondents were asked about the advantages of e-cigarette use, one of the most frequently listed advantages was “relaxation and stress relief.”18 > 78% of those who vaped before COVID-19 are vaping either the same or more during the pandemic.5 As many young people return to in-person learning, 70% report that they anticipate seeing young people vape at similar or higher rates as they go back to school.5 > Many tobacco users believe smoking reduces stress or anxiety. (See sidebar “The illusion of nicotine as a stress-reliever,” page 3). YOUNG PEOPLE WHO VAPE ARE UNAWARE THAT VAPING CAN WORSEN MENTAL HEALTH CONCERNS While young people may use e-cigarettes as a coping mechanism, they aren’t always aware of the negative role e-cigarette’s primary component — nicotine — can play in mental health. According to Truth Initiative Continuous Tracking Online (CTO) survey findings, most vapers are unaware of the mental health effects of vaping: only 44% of frequent vapers agreed that vaping can worsen anxiety and irritability, compared to 61% of those who don’t vape, according to data collected in June 2021.14 More than twice as many frequent vapers (45%) agreed that it is OK to vape for stress relief compared to non-vapers (20%).14 Similar patterns exist for survey respondents with any past 30-day use of e-cigarettes. The results suggest that, aside from not knowing that vaping can exacerbate mental health concerns, e-cigarette users are instead using them to cope with anxiety and stress, potentially worsening mental health in the long term. QUITTING VAPING CAN IMPROVE MENTAL HEALTH Quitting smoking is linked with lower levels of anxiety, depression, and stress, as well as improved positive mood and quality of life compared with continuing to smoke, according to a 2014 meta-analysis of 26 studies about smoking and mental health published in the British Medical Journal.3 “I started vaping during my sophomore year of high school. Vaping affected my mental health by making me feel like I was controlled by nicotine. I couldn’t go anywhere without it, and that started making me anxious. There was always a feeling in the back of my mind that was telling me I should have quit sooner and that I shouldn’t have become addicted.” – Cashmir “Quitting vaping had the most positive impact on my life. it helped my mental health so much and I became more productive. I haven’t always been feeling sick and nauseous. I feel so much better mentally and physically.” – Lacie “Quitting vaping had a very positive impact on my life, especially being an athlete. I feel better, I perform better, and my mental health is better. Vaping affected me in more ways than you can imagine. I went from having panic attacks and being paranoid, to having a sound mind and the ability to suppress my anxiety.” – Ethan 5September 2021 COLLIDING CRISES The tobacco industry has invested significant resources to connect tobacco with mental well-being, including giving away cigarettes to psychiatric facilities, supporting research that positions cigarettes as a way to self-medicate, and using stress relief themes in marketing. One prominent theme used in their tobacco advertising is that “smoking can help solve some personal and emotional problems by relieving stress and promoting relaxation,” according to the National Cancer Institute’s 2008 report on the role of media in tobacco use.4 This theme can be seen in many tobacco ads, from early Camel ads that picture people relaxing with a cigarette which reads: “It’s a psychological fact, pleasure helps your disposition. For more pure pleasure — have a Camel,” to the long-running Newport marketing campaign featuring the tagline “Pleasure” and images that associate cigarettes with care-free fun. Many e-cigarette brands are now tapping into themes of stress relief and mental well-being as well, including the popular disposable e-cigarette brand Puff Bar, which during the pandemic marketed its product as a way to “stay sane,” advertising it as “the perfect escape from back-to-back zoom calls, parental texts, and WFH stress.” How Big Tobacco has linked nicotine and mental health Images courtesy of Stanford Research Into the Impact of Advertising. 6September 2021 COLLIDING CRISES Similarly, there is emerging evidence of a link between quitting vaping and improvements in mental health symptoms. Truth Initiative survey data show support for this link between quitting nicotine-containing e-cigarettes and improved mental health outcomes.5 > 90% of those who quit said they felt less stressed, anxious, or depressed > 47% of respondents who quit vaping reported that when they quit vaping they felt more in control > 78% of respondents who reported ever vaping but had not quit said they would feel better about themselves if they quit vaping Previous Truth Initiative research published in Preventive Medicine Reports show high interest in quitting among young people. A majority of current young e-cigarette users surveyed say they intend to quit, with one-third reporting a past-year quit attempt and 15% aiming to quit in the next month. Truth Initiative’s This is Quitting® (TIQ), the first-of-its-kind program from truth to help young people quit vaping, has helped more than 370,000 youth and young adults on their journey to quit vaping. Teens and young adults can text “DITCHVAPE” to 88709 and get immediate help. Parents of young people who vape can get support at BecomeAnEX.org. “Youth are experiencing a mental health crisis right now, and we’re glad that Truth Initiative is raising awareness around the fact that vaping nicotine can intensify anxiety and depression. Young people should consider this information when they make choices about using vape products. We’re committed to providing that information and we stand alongside Truth Initiative as a resource.” – Schroeder Stribling, president and CEO at Mental Health America “Equitable access to comprehensive, high-quality services and programs is key in supporting young people’s mental health and wellbeing. By shining a light on how nicotine can amplify feelings of anxiety and depression in youth—and offering proven-effective quit support programs like This Is Quitting — Truth Initiative is actively working to promote the mental health and wellbeing of America’s youth. We are happy to support and collaborate with them in this work. – Chuck Ingoglia, president and CEO at National Council of Mental Wellbeing Support for those experiencing mental health concerns Many resources exist for those concerned about their mental health, including immediate help for people experiencing crises: › Mental Health America offers an online mental health screening. The tests can help determine whether people are experiencing symptoms of a mental health condition. › The Suicide Prevention Lifeline connects callers to trained crisis counselors 24/7. They also provide a chat function on their website. Phone: 1-800-273-TALK (8255). › 24/7 Crisis Text Line: Text “HOME” to 741741 from anywhere in the U.S. to connect with a volunteer crisis counselor by text. 7September 2021 COLLIDING CRISES ACTION NEEDED The associations between youth vaping nicotine and mental health concerns add to the urgency to regulate and reduce youth access to e-cigarette products. As young people continue to weather the COVID-19 pandemic and cope with its attendant stressors on mental well-being, we must work to create a supportive environment that reduces the availability of products that exacerbate symptoms of depression and anxiety. Preventing the use of nicotine and helping those addicted quit is critical to helping to ensure today’s young adults are best equipped for the future. Policymakers and regulators must take steps to reduce the use of e-cigarettes, including: > Removing all flavored products: The FDA must act to remove from the market all non-tobacco flavors – including menthol – from all tobacco products, including cigarettes, e-cigarettes, little cigars, cigarillos, cigars, smokeless tobacco, and hookah. Federal actions to date to limit the marketing of e-cigarettes, including removing some pod- type flavored e-cigarette products, have proven insufficient to significantly reduce the alarming number of young people who use e-cigarettes. > Restrict nicotine levels: The FDA should limit nicotine levels of e-cigarettes by capping nicotine strength as is done in the EU and Canada. Truth Initiative supports restricting not only nicotine levels, but also the mechanism by which nicotine is delivered (e.g. restrictions on levels of nicotine salts), to reduce the amount of nicotine e-cigarettes deliver to the body. These restrictions will help reduce the addictiveness of the products. > Ensure a thorough and transparent pre-market review process: FDA needs to be transparent about both the review process and its enforcement of the regulations against those products and companies who are operating outside of the existing regulatory structure. This diligence is especially critical as the agency postponed its decisions on the pre-market reviews of the products that make up the largest share of the market. As the FDA continues its review process for these products, including JUUL, Vuse, blu, Logic, and NJOY, it must ensure a thorough and transparent process. Preventing the use of nicotine and helping those addicted quit is critical to helping to ensure today’s young adults are best equipped for the future. 8September 2021 COLLIDING CRISES > Restrict e-cigarette marketing to ensure it is aimed at adults: FDA must impose restrictions on all marketing, including social media marketing, to ensure e-cigarette advertising to be aimed at adults switching away from combustible tobacco. > Restrict access to adult smokers: FDA authorization of e-cigarettes should be accompanied by strict requirements that restrict access to adult smokers, including selling e-cigarettes in adult-only retail spaces, no self-service sales, and no in-store/window promotional signage near schools. > Internet sales: FDA should prohibit all non-face-to-face sales, along with internet sales of all tobacco products, including e-cigarettes. > Taxation: Federal, state and local tax-writing authorities should set taxes on e-cigarettes at a level sufficient to discourage youth use. FDA should prohibit all non-face-to-face sales, along with internet sales of all tobacco products, including e-cigarettes. 900 G Street, NW Fourth Floor Washington, DC 20001 202.454.5555 truthinitiative.org@truthinitiative REFERENCES 1 U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 years of Progress: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. 2 Pew Research Center, “Most U.S. Teens See Anxiety and Depression as a Major Problem Among Their Peers.” February 2019. 3 Taylor G, McNeill A, Girling A, et al. Change in mental health after smoking cessation: systematic review and meta-analysis. British Medical Journal 2014;348 4 Davis R, Gilpin E, Loken B, et al. Influence of tobacco marketing on smoking behavior. The Role of the Media in Promoting and Reducing Tobacco Use Tobacco Control Monograph 2008(19):211-91. 5 Truth Initiative Mental Health x Vaping Headline Survey Internal Data - August 2021. 6 ER Kandel. A Molecular Basis for Nicotine as a Gateway Drug. New England Journal of Medicine 2014;371(21):2038-39. doi: 10.1056/ NEJMc1411785 7 Hughes JR. Effects of abstinence from tobacco: valid symptoms and time course. Nicotine & Tobacco Research 2007;9(3):315-27. 8 Guthrie SK, Ni L, Zubieta J-K, et al. Changes in craving for a cigarette and arterial nicotine plasma concentrations in abstinent smokers. Progress in Neuro-Psychopharmacology and Biological Psychiatry 2004;28(4):617-23. 9 Racine N, McArthur BA, Cooke JE, et al. Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis. JAMA Pediatrics 2021 10 Parrott AC. Does cigarette smoking cause stress? American Psychologist 1999;54(10):817. 11 Kutlu MG, Gould TJ. Nicotine modulation of fear memories and anxiety: Implications for learning and anxiety disorders. Biochemical Published Online First: 2015/08/02] 12 Lechner WV, Janssen T, Kahler CW, et al. Bi-directional associations of electronic and combustible cigarette use onset patterns with depressive symptoms in adolescents. Preventive Medicine 2017;96:73-78. 13 The Impact of COVID-19 on Student Mental Health - April 2020 Survey Data [Available from: https://www.activeminds.org/ studentsurvey/. 14 Truth Initiative Continuous Tracking Online Internal Data - March 2019 - June 2021. 15 Obisesan OH, Mirbolouk M, Osei AD, et al. Association between e-cigarette use and depression in the behavioral risk factor surveillance system, 2016-2017. JAMA Network Open 2019;2(12):e1916800-e00. 16 Wang TW, Neff LJ, Park-Lee E, et al. E-cigarette use among middle and high school students—United States, 2020. Morbidity and Mortality Weekly Report 2020;69(37):1310. 17 Gaiha SM, Cheng J, Halpern-Felsher B. Association between youth smoking, electronic cigarette use, and COVID-19. Journal of Adolescent Health 2020;67(4):519-23. 18 Sangalang A, Volinsky AC, Liu J, et al. Identifying Potential Campaign Themes to Prevent Youth Initiation of E-Cigarettes. American Journal of Preventive Medicine 2019;56(2, Supplement 1):S65-S75. doi: https://doi.org/10.1016/j.amepre.2018.07.039 19 Bandiera FC, Loukas A, Li X, et al. Depressive symptoms predict current e-cigarette use among college students in Texas. Nicotine & Tobacco Research 2017;19(9):1102-06. 20 Bierhoff J, Haardörfer R, Windle M, et al. Psychological risk factors for alcohol, cannabis, and various tobacco use among young adults: a longitudinal analysis. Substance Use & Misuse 2019;54(8):1365-75. 21 Xie C, Xie Z, Li D. Association of electronic cigarette use with self- reported difficulty concentrating, remembering, or making decisions in US youth. Tobacco Induced Diseases 2020;18 22 Xie Z, Ossip DJ, Rahman I, et al. Electronic cigarette use and subjective cognitive complaints in adults. PLoS ONE 2020;15(11):e0241599. 23 Yuan S, Yao H, Larsson SC. Associations of cigarette smoking with psychiatric disorders: Evidence from a two-sample Mendelian randomization study. Scientific Reports 2020;10(1):1-9. 24 Siqueira LM. Nicotine and tobacco as substances of abuse in children and adolescents. Pediatrics 2017;139(1) More than 8 out of 10 youth who currently usee-cigarettes use flavored e-cigarettes. (National Youth Tobacco Survey, 2020) 9 out of 10 Black Americans who smoke use menthol- flavored cigarettes. (Giovino et al., 2013) Among teens and young adults who use tobacco,81% of teens, and 86% of young adults, report that the first product they tried was flavored.(Ambrose et al., 2015) The tobacco industry has spent decades – and billions of dollars – aggressively marketing menthol-flavored tobaccoproducts to hook and addict youth, low-income communities, LGBTQ+ communities and communities of color. Thehistorical targeting of Black and Brown communities by the tobacco industry has led to devastating, and preventable, death and disease. (Henley et al., 2016) Tobacco Policy Strategies to Promote Health Equity and Reduce Youth Tobacco Use Advance health equity by reversing decades of tobacco industry targeting offlavored tobacco products in communities of color Eliminate appealing flavors that entice youth to begin using addictive flavored tobacco products Ensure Equitable Enforcement of Policy Urgent public health policy interventions are needed to address youth use of and dependence on flavored tobaccoproducts. Although it was encouraging to see the FDA's April 2021 announcement about the future elimination of the sale of menthol cigarettes and flavored cigars, action will not be immediate and implementation may take over a year. Itis strongly recommended that municipalities not wait to take action as youth continue to get hooked on tobacco andgaps in health disparities continue to widen. As part of a flavored tobacco policy, adult e-cigarette users will still have access to non-flavored e-liquids and other non-flavoredtobacco products, and those wishing to quit will continue to have access to FDA-approved cessation therapies. Tobacco retail licensing (TRL) is an evidenced-based policy to reduce youth tobacco use that ensures that retailers are notselling tobacco to minors. These laws are part of a comprehensive approach to tobacco control which can reduce tobacco useacross diverse racial and ethnic groups and groups with different education and income levels. However, without thoughtfuldesign and implementation, unintended consequences of policies, including inequitable enforcement, can sustain existing or create new disparities. For example, retailers who do not speak English as a primary language – may not be adequatelyeducated about the new laws and could be fined for selling to minors. A well-implemented TRL policy should acknowledge, andwork to prevent, the possibility of inequitable enforcement strategies. It is recommended that municipalities identify sources ofdata that can help track unintended consequences such as inequitable enforcement that could affect small retailers, people of color, and youth. (Counter Tobacco, Health Equity and Point of Sale Tobacco Control Policy). Adults below the poverty level areapproximately more likely to use cigarettes, cigars and smokeless tobacco as adults who live at greater than twice the poverty level. (Marbin et al., 2021) 2X December 2021 Questions? Contact Katie Lazar | klazar@jeffco.usATTACHMENT 6 Memorandum TO: Mayor and City Council FROM: Jerry Dahl, City Attorney Patrick Goff, City Manager DATE: December 28, 2021 (for January 3, 2022 Study Session) SUBJECT: Festival Liquor Licenses ISSUE: Senate Bill 21-082 was signed by Governor Polis in 2021 allowing alcohol beverage license holders to hold festivals for alcohol beverage retail activity. To sponsor a festival, an applicant must obtain a permit from the state. C.R.S. § 43-4-404(1)(b)(I) conveys to the Wheat Ridge Liquor Board the authority to require a festival sponsor to obtain a local festival permit in addition to the state permit. Curiously, the statute allows any liquor licensee to apply for a festival permit, whether or not the licensee is located within the City. The Wheat Ridge Liquor Board has made clear its desire to require a local festival permit, under certain restrictions, and is seeking input from City Council on the attached resolution and Festival Permit Application. ATTACHMENTS: 1. Wheat Ridge Liquor Authority Resolution 2. Alcohol Festival Permit Application 3. Memo to Liquor Board from Assistant City Attorney Joseph Rivera, dated September 16, 2021 WHEAT RIDGE LIQUOR LICENSING AUTHORITY CITY OF WHEAT RIDGE, COLORADO RESOLUTION NO. 01-2021 TITLE: A RESOLUTION OF THE WHEAT RIDGE LIQUOR LICENSING AUTHORITY ESTABLISHING THE PROCESSES AND STANDARDS APPLICABLE TO A LOCAL PERMIT FOR A “FESTIVAL” PURSUANT TO C.R.S. § 43-4-404 WHEREAS, on May 28, 2021, the Governor of the State of Colorado signed into law Senate Bill 21-082; WHEREAS, Senate Bill 21-082 permits a Colorado liquor license holder (Licensee) to obtain a “festival permit” from the state licensing authority, and sell and serve alcoholic beverages at a location, other than the Licensee’s licensed premises. WHEREAS, Senate Bill 21-082 permits one, or more, Licensees to jointly participate in or sponsor a festival, with each participant permitted to sell and serve alcoholic beverages at a location, other than their licensed premises. WHEREAS, the state licensing authority’s rules and regulations relating to obtaining a “festival permit” are not sufficiently developed; and WHEREAS, C.R.S. § 43-4-404(1)(b)(I) conveys to the Wheat Ridge Liquor Licensing Authority (Liquor Board) the authority to require a “festival” sponsor to obtain a local permit (in addition to the state permit); and WHEREAS, Section 11-52.5 of the Wheat Ridge City Code conveys to the Liquor Board the authority to grant and refuse licenses and special permits and promulgate reasonable rules and regulations related thereto; NOW, THEREFORE, BE IT RESOLVED by the Wheat Ridge Liquor Licensing Authority, that: Section 1: The Liquor Board adopts the application packet attached hereto as Exhibit 1 (Alcohol Festival Permit Application). To obtain a permit for a “Festival” pursuant to C.R.S. § 43-4-404, an eligible Licensee must submit a completed permit application to the City of Wheat Ridge, in addition to the state permit. Section 2: The Liquor Board now presents this Resolution No. 01-2021 to the City of Wheat Ridge City Council for further review and approval. DONE AND RESOLVED this ____th day of December 2021 ATTACHMENT 1 _ Jerry DiTulllio, Chair, Wheat Ridge Liquor Licensing Authority ATTEST: Steve Kirkpatrick, City Clerk ALCOHOL FESTIVAL PERMIT APPLICATION This application must be filed with the City of Wheat Ridge Clerk’s Office 30 days prior to the Event being held on private property; 90 days prior to the Parks and Recreation Department if being held on city property All Information must be printed legibly in ink or typewritten. Applicant Entity Name (Legal): _________________________________________________ Trade Name of Applicant (dba): ________________________________________________ State Liquor License Number: _______________ License Type: _____________________ Business Phone Number: _____________________ Contact Number: _________________ Business Address: __________________________________________________________ Business Owner Name: _________________________ Ph. number: __________________ Email: ___________________________________________ Name On-Site Registered Manager : ___________________________________ Manager Phone Number (local): _______________________________________ Email:______________________________________ Festival Location: __________________________________________________ Festival Date (specific per event): ___________________Time: ________________ Attach a copy of Possession Authorization, Lease or signed letter to the applicant Attach a List of Participating, Allowed Liquor Licensees – Include License #, Responsible person, contact email and phone # of that person. (See pg. #4) Attach a copy of the control plan (See guidelines below) Attach a copy of the approved zoning compliance notice The Applicant hereby attests and affirms that the following are true: ( ) The application packet contains participants and that at least one of those participants holds a current liquor license, whose facility is located in the City of Wheat Ridge. ( ) The applicant and festival participants all hold City of Wheat Ridge sales tax accounts ( ) Any required amplified noise permits have been issued or applied for ATTACHMENT 2 ( ) There are no previous histories of liquor violations in the past 3 yrs. by the applicant or festival participants for level three violations. As defined by 1 C.C.R. 203-2 Reg. 47-603 D. ( ) No alcohol containers are allowed to be removed from the premises by consumers. These containers include opened or sealed and indifferent of being allowed by State Law. ( ) The person purchasing, holding or consuming alcohol beverages will be properly I.D. checked with required bracelet, being over the age of 21 yrs. and shall not be intoxicated or a habitual drunkard. ( ) All vendors shall have snacks and/or food available for sale or free to the public, during all festival hours. ( ) The Festival must be completed, and all attendees must be out of the premises by 10pm. ( ) Applicant acknowledges that fines can be up to $1000 per event, in aggregate if no one entity is found in violation of liquor laws or rules and $500 per event, if one entity is found. The Applicant hereby applies to the City of Wheat Ridge Liquor Licensing Authority (LLA) for the following Alcohol Beverage Festival Permit and pays the non-refundable fee of $300.00 Total fee: $________________ Date: ______________________ Applicant Signature: ______________________________ Print Name: ___________________ BELOW THE LINE FOR CITY USE ONLY __________________________________________ ______________ Approved: Chair of the Liquor License Authority Board Date ___________________________________________ Attest: Deputy City Clerk City of Wheat Ridge Control Plan Guidelines These guidelines are being provided as a reference to help assist applicants in providing a control plan for alcohol beverage festival applicants and participants alike. Note: Each item of the control plan should be given in a detailed description of the process. Attach a separate sheet. Boundary of requested premises: Describe and list the details of the premises (show bars, service stations, etc., including the boundary and how the permitee will control the requested premises. Acceptable control features include temporary fencing, stanchions, visible chains, or rope to mark the area. Provide a bold, outlined diagram. Proper Signage: These to include minor warning signs, no alcohol beverages past this point, and no outside alcohol beverages allowed past this point. Size of signage required as listed in C.R.S. 44-3-901(10)(a)(II)(A) Ingress and Egress: Describe the control of persons arriving and leaving (ingress and egress) the festival, this to include making sure alcohol is not brought onto or removed from the premises. Are there going to be bag checks, clear bag requirements, etc.? Hours of Operation: Detail the hours of operation for the premises and what action will be taken to cease alcohol sales prior to closing. Hours of Festival cannot go past 10pm. On-Premises Security-ID: List the security group or company that will be provided by you, for the event. Describe in detail the I.D. check process, submit certification that those individuals checking I.D.’s are properly T.I.P.S. trained, and when the I.D. checks are approved, what type of wrist bracelets will be placed on the customers. List at least one licensed permitee or participant manager who will be on-site through-out the festival date(s) or time(s). Proper Zoning: All locations must be properly zoned and in compliance with local zoning, health and building codes, these to include sanitary toilets on premises. (see below) The Event Coordinator is responsible for contracting with portable toilet companies for the event. Please use this planning chart as a guideline. How to use the planning chart: - Determine how long your event will last. - Determine approximately how many people will attend your event. - With this information, use the chart to calculate the number of portable toilets needed to accommodate your event. Number of Hours for the Event 1 2 3 4 5 6 7 8 9 10 # of People Attending Units Needed 1-50 1 1 1 1 2 2 2 2 2 2 50-100 2 2 2 2 2 3 3 3 3 3 100-250 3 3 3 3 4 4 4 6 6 6 250-500 4 4 4 4 6 6 8 8 8 8 500-1,000 4 5 6 7 7 8 8 8 9 9 1,000-2,000 6 10 12 13 14 14 14 15 15 15 NOTE: ALL ALCOHOL BEVERAGE FESTIVALS THAT WILL TAKE PLACE UPON CITY-OWNED, LEASED OR CONTROLED AREAS, MUST SUBMIT THE SPECIAL EVENT PACKET TO THE PARKS AND RECREATION DEPARTMENT WHERE ADDITIONAL RENTAL FEES, DAMAGE DEPOSITS MAY APPLY AND MAY VARY UPON SIZE OF EVENT PARTICIPANTS. List of participating businesses (Attach a separate sheet if needed) Name Email License Number License Type Person Responsible Phone Number Name Email License Number License Type Person Responsible Phone Number Name Email License Number License Type Person Responsible Phone Number Name Email License Number License Type Person Responsible Phone Number Name Email License Number License Type Person Responsible Phone Number Name Email License Number License Type Person Responsible Phone Number Oath Of Applicant I declare under penalty of perjury in the second degree that this application and all attachments are true, correct, and complete to the best of my knowledge. I also know that it is my responsibility and the responsibility of my agents and employees to comply with the provisions of Articles 3, 4, and 5 of Title 44, Colorado Revised Statutes, as amended and the Ordinances of the City of Wheat Ridge, insofar as the same may be applicable which affect my license or permit. Authorized Signature Print Name Title Date Page 1 of 2 MEMORANDUM To: City of Wheat Ridge Liquor Board From: Joseph Rivera, Assistant City Attorney Regarding: Processes and Standards Applicable to a Local Permit for a C.R.S. § 43-4-404 “Festival” Date: September 16, 2021 As you know, SB 21-082 conveyed to liquor licensees the opportunity to sponsor a festival (Festival). SB 21-082 is codified (mostly) at C.R.S. § 43-4-404. Attached. To sponsor a Festival, an applicant must obtain a permit from the state. To obtain a state permit, an applicant must (1) specify the licensed premises, (2) file the application at least ten (10) days before the event, and (3) pay the $25 application fee. C.R.S. § 43-4-404(1)(b)(I) conveys to the Wheat Ridge Liquor Board the authority to require a Festival sponsor to obtain a local Festival permit (in addition to the state permit). The Wheat Ridge Liquor Board has made clear its desire to require a local Festival permit. The next step for the Liquor Board is to provide guidance on the following proposed permit standards and requirements: 1. Should local Festival permits be limited to persons holding a valid City of Wheat Ridgeliquor license? •The Liquor Board may limit eligibility to existing City of Wheat Ridge licensees, or not. 2. Should the number of licensees permitted to participate in/sponsor a Festival be limited?If so, how? •C.R.S. § 43-4-404(2) provides the following guidance: “The licensee that holds thefestival must file the application for the permit, but other licensees may jointly participateunder the permit issued to the licensee that applied for the permit.” The Liquor Boardmay limit the number of licensees jointly participating in a Festival, or not. 3. Should the number of Festivals permitted be limited to a number less than nine (9)? ATTACHMENT 3 Page 2 of 2 • C.R.S. § 43-4-404(1) (c) allows “up to, but no more than, nine festivals during the twelve months after the festival permit is issued.” The Liquor Board may limit the number of permissible Festivals to a number less than nine, or not. 4. Should Festival sponsors be required to obtain a local permit for each Festival? • C.R.S. § 43-4-404 contemplates one application for multiple festivals. The Liquor Board may require separate permits for each Festival, or not. 5. Which food service requirements apply to the Festival? • C.R.S. § 43-4-404 (9) permits several different types of license types to sponsor festivals, and each license type has a different food requirement. Which food requirement should prevail, and why? 6. What is the process to approve a Festival permit? • Under C.R.S. § 43-4-404 (1) (c) (4), the state licensing authority may deny a festival permit or supplemental application for any of the following reasons: (a) a documented history of violations of the Colorado Liquor Code by any participating licensee; (b) the filing of an incomplete or late application; or (c) a finding that the application, if granted, would result in violations of the Colorado Liquor Code or the applicable city code. 7. Should the Festival permit require adherence to the City’s special events process and standards? • C.R.S. § 43-4-404(1)(b)(I) conveys to the Wheat Ridge Liquor Board the authority to establish Festival permit requirements. Please find attached the City’s “Special Event Guide.” The City’s special events are administered by the City’s Parks and Recreation staff, and guided by the attached guide, which establishes processes and standards for liquor service, trash and clean up, food and retails sales, security, amplification, portable toilets, and other important event planning details. § 44-3-404. Festival permit--rules, CO ST § 44-3-404 © 2021 Thomson Reuters. No claim to original U.S. Government Works.1 West's Colorado Revised Statutes Annotated Title 44. Activities Regulated by the Department of Revenue Alcohol and Tobacco Regulation Article 3. Alcohol Beverages Part 4. Classes of Licenses and Permits C.R.S.A. § 44-3-404 Formerly cited as CO ST § 12-47-403.5 § 44-3-404. Festival permit--rules Effective: September 7, 2021 Currentness (1)(a) A person listed in subsection (9) of this section may file a festival permit application with the state licensing authority. The applicant must: (I) Specify the licensed premises for the first of the festivals to be held; (II) File the application at least ten business days before the festival is to be held; and (III) Include a twenty-five dollar annual processing fee with the application filed with the state licensing authority. (b)(I) A local licensing authority may create a local permit for festivals; except that a limited winery licensee or winery licensee need not obtain a local permit to participate in or hold a festival. If a local licensing authority does not create a local permit under this subsection (1)(b), an applicant need not obtain a local permit under this subsection (1)(b) to conduct festivals. (II) If a licensee is applying for both a festival permit and a special event liquor permit issued under article 5 of this title 44, the licensee need not apply for any local permit established in accordance with subsection (1)(b)(I) of this section. (c) If a festival permittee notifies the state licensing authority and the appropriate local licensing authority of the location of and dates of each festival at least ten business days before holding the festival, the permittee may hold up to, but no more than, nine festivals during the twelve months after the festival permit is issued. (2) The licensee that holds the festival must file the application for the permit, but other licensees may jointly participate under the permit issued to the licensee that applied for the permit. (3) Notification of all subsequent festivals shall be by supplemental application, as approved by the state licensing authority. § 44-3-404. Festival permit--rules, CO ST § 44-3-404 © 2021 Thomson Reuters. No claim to original U.S. Government Works.2 (4) The state licensing authority may deny a festival permit or supplemental application for any of the following reasons: (a) A documented history of violations of this article 3 or rules issued under this article 3 by any participating licensee; (b) The filing of an incomplete or late application; or (c) A finding that the application, if granted, would result in violations of this article 3 or rules issued under this article 3 or violations of the laws of a local government. (5) After the issuance of an initial festival permit, all supplemental applications that are complete and filed in a timely manner are deemed approved unless the state licensing authority provides the permittee with a notice of denial at least seventy-two hours prior to the date of the event. (6) Notwithstanding any other provision of this article 3, the permittee and participating licensees are authorized to use the licensed premises jointly to conduct alcohol beverage tastings and to engage in the same retail sales of alcohol beverages that the permittee and participating licensees are authorized to conduct at their licensed premises. A festival permit does not authorize the permittee to use the licensed premises for more than seventy- two hours for any one festival. (7) If a violation of this article 3 occurs during a festival and the licensee responsible for the violation can be identified, the state or local licensing authority may charge and impose appropriate penalties on the licensee. If the responsible party cannot be identified, the state licensing authority may send a written notice to every licensee identified on the permit application and may fine each the same dollar amount, which fine must not exceed twenty- five dollars per licensee or two hundred dollars in the aggregate. A joint fine levied pursuant to this subsection (7) does not apply to the revocation of the licensee's license under section 44-3-601. (8) A joint fine levied pursuant to subsection (7) of this section shall not create or increase civil liability under section 44-3-801(3) for a participating licensee or create joint liability for such a licensee. (9) This section applies to a person licensed under section 44-3-402, 44-3-403, 44-3-407, 44-3-411, 44-3-413, 44-3-414, 44-3-417, 44-3-422, or 44-3-426. (10) The state licensing authority may adopt rules necessary to implement and administer this section. Credits Relocated and amended by Laws 2018, Ch. 152, § 2, eff. Oct. 1, 2018. Amended by Laws 2021, Ch. 195, § 2, eff. Sept. 7, 2021. § 44-3-404. Festival permit--rules, CO ST § 44-3-404 © 2021 Thomson Reuters. No claim to original U.S. Government Works.3 C. R. S. A. § 44-3-404, CO ST § 44-3-404 Current through legislation effective September 7, 2021 of the First Regular Session of the 73rd General Assembly (2021). Some statute sections may be more current. See credits for details. End of Document © 2021 Thomson Reuters. No claim to original U.S. Government Works. April 2021 Special Event Guide 1 | P a g e Special Event Guide Thank you for your interest in hosting an event in the City of Wheat Ridge. Wheat Ridge hosts a large number of special events throughout the calendar year and these events help make Wheat Ridge a special place to live and play. To help event organizers understand the special event permitting process, the City created this special event guide as a reference prior to completing the special event application. The Parks & Recreation Department’s Grant & Special Project Administrator will be your point of contact throughout the process, answering all your questions, coordinating all your approvals internally, and issuing your permit. You can reach Brandon by calling 303-231-1307 or emailing baltenburg@ci.wheatridge.co.us. The success of your event relies upon you providing complete and detailed information. Our role is not to plan your event, but to help you with the application, approve required permits, and head off any potential problems. We look forward to helping you obtain the required approval for your event and thank you for choosing the City of Wheat Ridge as your preferred location. A Special Event Permit Application must be completed for any event that creates a large impact on the City, is four hours or longer in length, involves closure of a street, park or trail, requests exemption from the City noise ordinance, significantly diminishes public enjoyment of a public space, or serves and/or sells alcohol. The Special Event Permit Application includes various forms needed to plan an event. Please submit only the forms applicable to your event. 1. Procedure For all events, the first step to applying for an event permit is to meet with Brandon to go through a review process to determine if the event is a good fit for the community, event tier, and possible City cost recovery charges. The City requires new and returning event to permit applications be submitted at least 90 days prior to the event date. (Note that without 90 days prior notice, some permits may not be obtainable for your event.) Please do not submit the special event application without ALL of your required forms, the non-refundable application fee, security deposit, estimated City cost recovery charges, and any other helpful information. You will be contacted when your application April 2021 Special Event Guide 2 | P a g e review has been completed by all appropriate City departments and/or if your application requires additional information or modification. If your event will be serving alcohol, note the additional fees required as written in the application. Alcohol permits and charges should be submitted directly to the Deputy City Clerk at least 90 days in advance. If your event will be serving food, please provide a copy of your food permit once Jefferson County Public Health has issued it. If your event application is approved, you will receive notification and the appropriate permits. Your event planner or main contact person will need to have all permits and documentation with them during the event as proof of authorization. Following the event, the City will invoice the event for any additional expenses that may have been incurred by the City (and have not already been paid for) or by forfeiture of applicant’s responsibility. The applicant will have a post event meeting scheduled with the Parks and Recreation Analyst to discuss the event and pay for any additional City expenses. The City may also return all or part of the damage deposit at this meeting. 2. Fees and Charges Application Processing Fee Events pay a non-refundable application processing fee proportion to the level of work required, which is directly related to the size, type, scope and duration of the event. For purposes of determining the processing fee and security deposit, events shall be classified by the City according to the following tier criteria. Non-Refundable Application Processing Fees Tier 1 $150 Tier 2 $100 Tier 3 $50 City Sponsored No Fee Tier 1 events are defined as an event that meets one or more of the following criteria: large, entire day or multi-day event, requesting closure of a street or intersection, anticipated attendance in excess of 3,000 people, selling or serving alcohol for more than 4 hours, and requesting exclusive use of a City park or trail. Tier 2 events are defined as an event that meets one or more of the following criteria: requesting street or intersection closures, having anticipated attendance of between 1,000- 3,000 people, selling or serving alcohol for less than 4 hours, requesting use of a City park or trail. April 2021 Special Event Guide 3 | P a g e Tier 3 events are defined as an event that meets one of more of the following criteria: small, requesting no closures of street or intersections, less than 4 hours, anticipated attendance less than 1,000 people, no alcohol, or not using of a park or trail that interferes with public enjoyment. City Sponsored Events are events that have a commitment of sponsorship or partnership from the City of Wheat Ridge. The fees associated with these events shall be negotiated as part of the sponsorship agreement. Wheat Ridge City Council will determine event sponsorships during the budget process for the upcoming year. Such agreement may include waiver of some or all of the fees. Event organizers can contact Brandon for more details. Other Fees Each event has financial responsibility for all direct costs including: A) Professional security in areas of alcohol sale and consumption B) Any required on-site security C) On-site traffic management D) Trash and recycling during and after the event E) Sanitary facilities F) Delivery, installation, breakdown, and removal of barricades The City event policy includes a cost recovery model for City services incurred due to events. Event fees assessed by the City will be determined based on the requirements of the event which include costs associated with street closures, police needed for off-site enforcement around or at the event, closing of parks and other facilities, including revenue loss at facilities, locating utility lines, inspecting structures, use of electricity at City facilities, and other services requested or required by the City and/or other agencies. A representation of fees can be found below. Estimated fees will be paid when submitting the special event application. There are other fees that may be associated with your event depending on the details of the event and costs incurred by the City. Department Costs Task Reason Estimated Cost or Lost Revenue Police Staff Security and Traffic Control Safety $45/hr/officer Police Marked Car Security and Traffic Control Safety $5/hr/car Parks Park maintenance, event set-up and trash removal Required for event operations $22/hr/person Community Development Inspect structures, bleachers, and power sources Safety $30/hr Public Works Street Closure Barricade Setup and Removal Safety and Community Impact $52/hr Public Works Hang/Remove Overhead Banners Advertising the Event $1,060/banner Public Works Bus Shelter Advertising Advertising the Event $810 for all shelters Public Works Street and/or Parking Lot Sweeping Safety and Event Operations $55/hr Sales Tax Supervisor Business License and Sales Tax Filing Required for Event Operations $40/hr Parks and Recreation Utilities Locate Safety/Damage $22/hr Parks and Recreation Staking in a park Safety/Damage $50 flat fee Parks and Recreation Turning On/Off Irrigation Required for event operations $20/hr/person Parks and Recreation Supply Electricity Required for event operations $5/hr flat fee Parks and Recreation Garbage Collection and Extra Recepticles Sanitation Varies Parks and Recreation Shelter Rental Lost Revenue Lost Revenue $200/day Parks and Recreation Anderson Pool Lost Revenue Lost Revenue $1200/day Parks and Recreation Athletics Lost Revenue Lost Revenue $35/hr April 2021 Special Event Guide 4 | P a g e Damage Deposit Applicants are required to pay a damage deposit to cover the cost of cleanup or damages to City property as a result of the event. Deposit amounts are determined by event tier and are based on potential damage to a park, trail, or any other facility associated with the event. The damage deposit must be paid when submitting the event application. The remaining damage deposit will be returned at the post event meeting. Damage Deposit Fee Tier 1 $500 Tier 2 $300 Tier 3 N/A City Sponsored Negotiated 3. Alcohol Special events that include alcohol sales require use of the Police Department’s resources and restrict personnel scheduling. These events require a significant police presence and planning on the part of the Police Department. Events that sell or consume alcohol must hire professional security and control perimeter enforcement for alcohol areas. Volunteers may be used to supplement private security personnel. The Wheat Ridge Police Department will review event applications to determine the specific requirements needed for alcohol approval. Alcohol Standards: • Egress and ingress from the area of alcohol service must be clearly defined by approved barrier types and controlled access by professional security. • Event organizers must abide by all local and state statues related to the service or sale of alcohol at a special event and must be in possession of a Special Event Liquor Permit at all times during the event. The Application for an Alcohol Permit must be submitted separately to the Deputy City Clerk with payment. Note the additional City fee of $50/day for alcohol listed in the application payable to the City of Wheat Ridge. The Special Events Liquor Permits are processed by the City Deputy Clerk who can be reached at (303) 235-2816. 4. Inspections Prior to the event, Code Enforcement, Fire District, Community Development, and other staff may conduct walk-throughs to ensure compliance. 5. Termination The City may terminate a special event if it is in violation of any law or ordinance, if it endangers any person, if it threatens the peace, or if it creates unmanageable problems for public safety. April 2021 Special Event Guide 5 | P a g e 6. Trash and Clean Up Applicant is responsible for the cost of additional dumpsters and trash receptacles. The City may coordinate this through the current collection franchise. The applicant is responsible for clean-up and may be billed for staff clean-up labor. 7. Tents/Canopies Pop-up tents are preferred. If a tent or canopy exceeds 400 square feet, approval is required from the local Fire District(s). Any tent under which cooking will occur must have a fire-retardant certificate. 8. Advertising No advertising or distribution of flyers, posters, etc. may take place until the special event has been approved. An Advertising Request Form must be submitted and approved by Public Works to hang overhead banners, light pole banners, or advertise at bus shelters and other locations. If staking is required, there is an additional $50 fee required for on- site park staff location assistance and approval. 9. Food and Retail Sales Event Organizers must inform the City of food vendors. Only approved food vendors may participate in the event. Food Vendors are required to attach the following: ▪ Colorado State Food Retail License ▪ State Sales Tax Account Number with the Department of Revenue ▪ Jefferson County Public Health Certificate Approving Temporary Retail Food Service Retail or non-food sales must have a Wheat Ridge Business and Tax License. 10. Street Closures A Request for Street Closure Form must be submitted and approved by Public Works. Public Works may schedule a street closure meeting for traffic control. Park roads may not be closed. 11. Insurance Certificate of Insurance must have a minimum liability limit of $1 million per occurrence and name the City of Wheat Ridge and its employees as additionally insured. 12. Amplification The use of amplification, music, microphones, and generators is not permitted in any park prior to 8am. The Director of Parks and Recreation may allow noise ordinance exceptions in certain situations described on the permit. 13. Special Structures The use of bleachers, stages or other structures must meet current safety standards and have an inspection and permit issued through the Community Development Department. 14. Portable Toilets April 2021 Special Event Guide 6 | P a g e The Event Coordinator is responsible for contracting with portable toilet companies for the event. Please use this planning chart as a guideline. How to use the planning chart: - Determine how long your event will last. - Determine approximately how many people will attend your event. - With this information, use the chart to calculate the number of portable toilets needed to accommodate your event. Number of Hours for the Event 1 2 3 4 5 6 7 8 9 10 # of People Attending Units Needed 1-50 1 1 1 1 2 2 2 2 2 2 50-100 2 2 2 2 2 3 3 3 3 3 100-250 3 3 3 3 4 4 4 6 6 6 250-500 4 4 4 4 6 6 8 8 8 8 500-1,000 4 5 6 7 7 8 8 8 9 9 1,000-2,000 6 10 12 13 14 14 14 15 15 15 For questions or to request a Special Event Permit Application, please contact Brandon Altenburg, Grant & Special Project Administrator, at the Parks and Recreation Department at 303-231-1307 or by email at baltenburg@ci.wheatridge.co.us.