Assembly Select Committee on Select Committee on Fentanyl, Opioid Addiction, and Overdose Prevention

All right, I think we are going to gather. Okay, 1 minute. All right, we are going to get started. Do I need to do anything to signal that we're starting or we just go ahead and do it? Okay. All right. Well, good morning, everyone, and welcome, colleagues, honored guests, and Members of the Viejas Band of Kumiyai Indians. As chair of the Select Committee on Fentanyl, Opioid Addiction and Overdose Prevention, I want to welcome you all to this important gathering. My name is Matt Haney.

I represent Assembly District 17, which is in San Francisco, and I'm very proud to be here with three of my colleagues who will each have the opportunity to introduce themselves and share some opening remarks. Before I get started, I want to give a special thank you to our hosts, the viehas Band of Kumiyai Indians, and to the Tribal Council leaders. Thank you so much for having us here.

It is our great honor to be hosting this with you and to be able to learn from you and your incredible efforts. I want to thank all of the tribes who contributed to this hearing, including the Tule River Tribe of California. I know their vice chairman, Nieto and Tribal Project Manager Martinez are here. And we appreciate your openness to testify alongside Viejas on this issue and your willingness to share your experiences with us.

Today, we come together to shed light on a pressing, urgent issue that has deeply affected everyone in California and deeply affected tribal communities the devastating impact of fentanyl and opioid addiction. In our attempt to understand and address this crisis, it is crucial to recognize the unique experiences and challenges faced by tribal communities. As inheritors of a rich cultural heritage, the tribal communities in our state have thrived in harmony for countless generations.

However, the emergence of this insidious opioid crisis has disrupted the very fabric of their close knit community, as it has other tribal communities nationwide. In California, data from the California Department of Public Health shows that 7,175 opioid related overdose deaths in the state occurred in 2021. In 2022, the CDC reported that the American Indian and Alaskan Native populations had the highest drug overdose death rates in both 2020 & 2021 at rates of 42.5 and 56.6 deaths per 100,000 persons.

This includes a 33% increase in drug overdose deaths from 2021 through from 2020 to 2021. Each of those individuals who lost their lives had family, friends, and loved ones who continue to suffer from those losses. Tribal communities are disproportionately, experiencing an increase in overdoses as compared to other groups, and the data shows that this is stemming from polysubstance use.

According to CDC, this is primarily caused by unintentional polysubstance use, which is when a person takes drugs mixed or cut with other substances like fentanyl without their knowledge. Although the state doesn't have complete data from 2022 or 2023, information shared during the March Roundtable on the Impacts of Fentanyl and overdoses convened by the California Native American Legislative Caucus showed fentanyl usage has surged even higher in some tribal regions over the past year.

And I want to take a moment to acknowledge the leader of that roundtable, my good friend Assemblymember James Ramos, who isn't here today, but sends his regards and his support and has done tremendous work to address the overdose crisis in tribal communities. Today we will delve into the realities faced by the Kumiyai people and other tribal communities and the remarkable resilience they have shown in the face of this crisis.

It is a testament to the strength that they have not only confronted this challenge head on, but also have begun to develop innovative solutions to combat it. After our panel discussion, Members of the committee will have the opportunity to tour the Revived Pathway Center in El Cajon, just 15 minutes from here. This center was first conceived as a proactive first step in addressing addiction in this community.

Through a combination of traditional healing practices, community outreach programs, and collaboration with medical professionals, we are forging a path together towards healing and recovery. Their commitment to restoring balance and well being within their community is inspiring and serves as a beacon of hope for other tribal communities facing similar struggles. What we have learned during the March roundtable is having a regional treatment clinic in areas close to tribal land is of utmost importance in combating the opioid and fentanyl crisis.

The impacts of addiction no no boundaries and tribal communities are particularly vulnerable in the devastating effects of these substances. Establishing recovery clinics in close proximity to tribal lands provides essential services and support that are tailored to the unique needs and cultural sensitivities of the community. Tribal residents should not have to wait two to 3 hours for help or travel 50 to 100 miles to a recovery center.

By investing in regional treatment clinics, we not only demonstrate our commitment to the well being empowerment of tribal communities, but we also pave the way for a brighter future where healing and hope can flourish. As we navigate through this journey together, it is imperative that we foster greater understanding, empathy and support for the tribal communities. By recognizing the unique challenges they face both in healthcare and also in the legal system.

We can work collaboratively to develop comprehensive solutions that not only address addiction statewide, but also honor their cultural heritage and strengthen the fabric of the community. There will be three panels today, and our speakers will come from a wide variety of backgrounds. This includes tribal leadership, impacted community Members, law enforcement and tribal health care providers. Each panel will come up together to testify, and after the witnesses are finished providing their testimony, Members of the committee may ask questions at the end of that panel.

After the hearing, there will be an opportunity for public comment from Members of the public who are here today. We are not accepting public comment over the phone today, but you can submit written testimony to the committee at Assemblymember Haney at Assembly CA gov. This email is also on our website.

I do want to say and though this hearing is focused specifically on the impact of overdose and opioid addiction and fentanyl in tribal communities, this is an epidemic that is impacting every single corner of our state, every single city, every single county. It does not know sovereign boundaries, it does not know county boundaries, it does not know political party.

And it is imperative that we come together and learn from each other, learn what we are doing, learn where the investments are needed and work collaboratively to address every aspect of this crisis. Whether that's emergency interventions to make sure people can reverse overdoses when they happen, access to treatment and recovery for people who want to get off of these deadly drugs, and law enforcement efforts to stop the flow of these drugs coming into our communities.

To begin with, we are committed as this committee to address all of these issues and partnering closely with tribal communities throughout the state to be able to develop solutions. And I hope that the outcome of this hearing is legislation, proposals, investments and a strong partnership that truly saves lives. With that, I want to open it up to my colleagues to allow them the opportunity to provide for any opening remarks and then we will move forward to the panels.

I know that Assembly Member Patterson wanted to say a few words and then I'll turn it to my other colleagues as well. And just to remind folks, you have to hit the button here in order to speak.

First of all, I thank the Chair for the opportunity of being here and also for being on the committee. We are obviously learning the depth and the scope of this tragedy and it is hitting so many of us and those we care about, including our Native American communities. So I appreciate the opportunity that the AHAs band of Kumi Indians have provided for us to be here and to be part of this in their terrific venue.

This is an area that is dear to me because Fresno, California, by its centralized location and it's being triangulated by some of the most traveled interstate freeways in California, is a place for fentanyl distribution and we have seen a huge rise. And as a result, Fresno County has put together what is called the Fort Team. This is the Fentanyl Overdose Response Team. And as a direct result of what Fresno County has been able to do, which is take healthcare workers, they will be in our hospitals.

And when there's an overdose that happens and there a death, we are able to have cooperation with law enforcement to trace back that episode and try to find where the supplies are coming from and who are supplying them. We have put together Idiomatic, appropriate social media and public service so that young people will be attracted to the message. It's called "One pill can kill".

We also have our professionals in trying to get people off of their addiction, and they are ready as a part of this response team as well. And so a year ago, I put together a Bill, and I want to thank the Members here just passed universally, it was basically a Fentanyl overdose response team that set up these pilot projects in six areas of California. Two in Northern California, two in Central California, two in Southern California.

And what it does is it encourages counties to apply for a share of $5 million a year in state funding to organize and put together their own edition of the Fort team. And the Cdbhd is going to be providing applications. And so I wanted to make sure that this area and those of you here knew that Southern California does include the San Diego area, and if you're interested in it, to communicate with my office.

And we are in the process of helping other regions understand the comprehensive and cooperative solution approach here. And shortly those grants will be going out and people will be applying for them. As I said, six pilot projects will share $5 million. That's about 833,000 for each of those operations. Although we have built it around Fresno's, organizational and cooperative and comprehensive approach, it is not limited to that. It is open rather, to those who have experiences on the ground here, obviously in our tribal communities.

And so I welcome the opportunity to let you know that this is something that we're learning, that what is necessary here is comprehensive, cooperative approaches. It's multileveled, multifaceted and built around the particular needs of the regions in which these Fentanyl dealers are operating. And so I appreciate the opportunity to be here. We are serious about making this not only our personal priorities, for obvious reasons, but for legislative purposes. We need understanding. We need wisdom. We need partners, we need compassion.

And together, I think we can start to turn the tide on this. At least I'm hoping and praying we can do that.

Thank you, Assembly Member, Assemblymember Alvarez, thank.

You very much, and want to welcome my colleagues to San Diego, my native county and the one I'm proud to represent in our Legislature. There's not a lot of things there's a lot of things that scare me as a father, father of a middle schooler and an elementary school kid, as it does to anybody who has children. Very few things scare me as much as Fentanyl and our Fentanyl crisis.

And I want to thank my colleague, chairman of this committee, Mr. Haney, because when I got elected in June of last year and we sat down and we had a chance to talk about our priorities, this is something that I know has been a priority of his from the day he got to the Legislature. And it's something he's been focusing on and these hearings are significantly moving the ball on the issue of Fentanyl.

And I want to thank him for the leadership on that and I want to thank our hosts. Obviously, we have a history here in San Diego that when crisis occurs, we come together and we figure out how to problem solve. One of the most well known crises that we've faced in San Diego are the fires. The wildfires that unfortunately started, I think to be highlighted here in San Diego in the early 2000 s and now unfortunately are part of our state too regularly.

But that was a crisis that occurred and that impacted our community entirely. And our tribal community was very impacted. And one of the lessons learned, and one of the things that I've seen that we've been able to do well as a region is to make sure that our fire protection is something that was analyzed. We saw the crisis, we saw where we had the weaknesses and what we needed to do to be more successful.

And we came together as a region and in true partnership with our tribal nations, have created a safer community. I'm looking forward to this conversation leading us in the same way to that goal of ensuring that the resources that we have throughout San Diego County that often, too often don't reach our tribal communities does not happen when it comes to us fighting this crisis. As my colleague Mr. Patterson noted, there are resources and steps that are being taken and led by people like him and others.

And when we're looking to distribute resources to bring programs to make sure that we're doing what we need to do to address this, we never forget the communities that are too often forgotten in our tribal nation communities. So that's what I'm looking forward to today.

We need to continue to that dialogue and to make sure that when these decisions are being made, whether they're resources, funding, or other laws that need to probably come online to fight this crisis, that we acknowledge that our tribal community partners must be at the table and must be part of that decision making. So I appreciate in advance the testimony being provided today by our panels and by those who speak. Thank you very much, Mr. Mr. Chair.

Thank you. Assembly Member Shivo.

Thank you. I want to thank the Chair for including me. I'm actually not officially on the select committee, the Fentanyl Select Committee, but it's a really important issue in my community. I represent Assembly District 40, which is the Santa Clarita Valley and the north San Fernando Valley. And our community, like all communities in California, have really been hit hard by this crisis. And too often it's actually been in our schools where we've been seeing the effects and deaths happening. And it's heartbreaking.

As a mother, I also have a middle schooler and it's terrifying to think what she's going to be facing and imagining what parents have been going through who have been losing their children. It's one of the reasons that I'm co authoring AB 19, which would require Narcan to be in all schools as a life saving measure when these crises happen. And it's one of the reasons I wanted to be here today, because this is such an important issue.

I know our tribal communities too often are on the front lines of addiction crisis and this one being the most recent and the most deadly. Unfortunately, having worked for a tribe and seeing the important work that tribes do, I'm very excited to hear the solutions and initiatives that you're putting forward that we can learn from and hope that these can be lessons that we can take back to Sacramento and really figure out policy that can benefit our whole state.

This is a crisis that we take very seriously and I know there's many bills this year to address this, to really put forward solutions that we need. And I think for me, I want to make sure that we're focusing on solutions that work. I think that there can sometimes be a lot of energy put into band Aid solutions or solutions where you're saying that you're doing something, but it doesn't actually have the impact that it needs to, to really make a difference.

And so we're, I think, looking forward to hearing solutions that are working, that are making an impact and really understanding what can we focus our resources on, what can we focus our policy making on where it's going to actually save lives and have the impact that we need. We don't want to be spinning our wheels, we don't want to be wasting time on something like this and we certainly don't want to just give lip service and not produce.

And so I'm very interested in making an impact here. I'm interested in really solving this issue and making sure that we have the resources in tribal communities and throughout California to save lives and to tackle this crisis like we need to. Thank you.

Thank you so much and thank you to all three of you for being here. This would normally be a day when each Member is back in their home district and so it really says a lot about each of your commitment to working on solutions on this issue and partnering with tribal communities that you're spending your time here. I also want to recognize that there are staff from Assembly Member Waldron's district. She had a number of staff who were here.

She had to be out of or in her district. Sorry she had to be in Sacramento today, but we are in her district now as well. We want to recognize and thank her for her partnership. She's been a tremendous leader on this issue and a partner I know to Viejas as well with that.

And I also want to say this is being recorded and we're going to be sharing this with all of our colleagues and fellow Members as well, and really hope that this conversation leads to a lot of action and solutions and partnership as we move forward. So with that, I want to move and get started and introduce our first panel, who is going to discuss the impact of the opioid epidemic from the Tribal community perspective.

And for this panel, we have John Chrisman, chairman of the Viejas Band of Kumeyaay Indians, and Danielle Espinoza, who is an Impact community Member here in Vajas. Chairman Chrisman, again, thank you so much for hosting us and for your leadership. We are very honored to be here today. And with that, please begin.

Thank you, Assemblymember Haney, Patterson, Schaivo and Alvarez, for taking the time. This effort seems to be more grassroots and also for us, but also community wide. So to see the representatives here, another Tribal Nation county, state representatives, it means that we are all trying to work together to collaborate, to come to some sort of solution for this problem. These individuals, we've had an addiction problem my whole life. I've been in an adult leadership since 1991.

I was in leadership during the whole methamphetamine crisis and saw that this is my third tenure now or my third stint on council, this time as chairman, in looking at the greater community and looking at all of our Members. We've had between alcohol and drug issues my whole life. But looking into the ayes of a meth addict versus the fentanyl is way different. I said it in a previous testimony when I testified at the Capitol.

When you're looking into the ayes of these people now, there is somewhat more psychosis. They can't hear you. We sit down. As council, we are in the community. We have 300, roughly counting the children. We have 350 Members, but then we have the other family Members, so a little closer to 400. And all of us, all seven Members of the tribe are always in the community. We have various events, but then when we go to help these people, we have a system.

So we provide health insurance. We even have a representative to place these people, but they have to want to go, and they can check out. Well, as this progresses and we see these people and see what they're doing, and some of it's kind of crazy, but we try and we say, can we place will you agree to go in? We'll take care of your home. We'll take care of anything. And they don't always agree.

We have had some casualties to this since 2018, I think there's been a total of five deaths in the community, overdoses. We have some near deaths that were brought back by Narcan. Luckily, that's available. And we actually have a machine where you can get it in the community, placed out there like a vending machine. And so we're trying everything we possibly can.

Within this last year, we've opened up a wellness center more to the grassroots for the community of Viejas to go and talk about these issues. It could be the first contact where somebody could go in, sit down with somebody and then be placed to the next facility. In that case, we're looking towards our new one that we are opening in town, one Together Solutions or I'm sorry, revived pathway, excuse me. And this will open for anonymity purposes for the community so they can leave here.

Because when you go to the wellness center, everybody knows what you're doing there usually, although we've tried to model that differently for different grassroots campaigns, but some of these things are embarrassing. So we try to let them do that and then to be placed in inpatient treatment, it does not always work.

So collaborating today means that we all agree that we all need this is bigger than just all of us, than the state, than the tribe and the county that we need to do this as a whole to try to come to some sort of solution for all of us to save some people that succumb to these casualties of this war that we're in. Some of these actions that we've taken, they seem like they're effective, but then they're not enough.

And so we are looking for your help, for your input for the state and how we can resolve this issue as we press on. There are other issues, these people, sometimes the elements that bring them here. With the tribe here, we're 45 minutes from the international border, so we're going to see the effects of the trafficking of these drugs a little worse than some other communities to the north. So it is a crisis for us to see this and to see for where I live.

I'm off the beaten path. Where I live, it's hard to find my house, but I see these individuals walking down the road with backpacks where my daughter walks. So it is close to home for me. And what can we do? We're in a public loss 280 state. We have a security force to observe and report. We cannot arrest these people. We can call, but then some of them slip through and some of these people are bringing these drugs onto our community.

So there's multiple facets of this that we have issues of problems with addiction and trying to keep these people out of here. Also, I thank you for taking the time. In addition to that, the start of our wellness center was done by a grassroots effort. In the events of these where we had lost individuals, we started a grassroots sort of community meeting where we would potluck food in and sit and talk about this amongst ourselves.

Had some pretty good participation, but I wanted to there's a precursor for introducing a tribal Member, Danielle Espinosa, that she was one of the catalysts of that. In addition to that, one of the first things that came from that was that we passed a resolution by our General membership that a drug offense, whether it be dealing, using or whatever, goes from zero to 100 in our fine system, which is the only sort of sanction that we can impose as a tribe to our Members.

So you do this, you clearly abuse this ordinance. You are fine to the highest order that we can find you. And we did that as a community, as one sort of measure to try to battle this whole crisis that we're in with that. I'd like to introduce Danil Espinosa to give her testimony.

Halka, hello and thank you for coming. Um, back in 2020, when COVID first started, I lost my son and everything was shut down. My son had come out of rehab and was going to another rehab to get a job, and he was really happy. He was saying that he got this and he had left the rehab with the wrong guys. Something happened at the other rehab. He was in the wrong place at the wrong time. He used again.

He was clean and he overdosed heroin, and he didn't have an ID. So during COVID everything was shut down. They didn't know who to contact. So they got in touch with tribal Chairman Chris Men. They heard that he was from Vajas. They called. The casino was shut down. So security went to tribal office. And we had already been working myself and Tribal Council trying to see what we could do to stop the drugs out here. All the young kids are overdosing.

Every week there's two or three overdoses and come from a big family. All my nephews almost all my nephews are using. If it's not meth, it's fentanyl, it's blues, it's whatever. They can get their hands on it and they can get it very freely out here. I mean, they can have it dropped off outside of their gate or whatever. So it's really a big problem. And I've seen it when my kids were growing up. I have seven children and they were all in their teens.

And fentanyl these drugs that are out and the kids are overdosing. I went to the chairman and asked him what we could do. So we did start gathering the people seeing coming together, trying to build relationships, trying to get strong as a community and see what we could do. But anyway, my son was using really bad at that time and I knew something had to be done and I knew something was going to happen.

And tribal chairman came to my house two days later after he had passed and know they have Ruben's body. And I was just we were already trying to see what we could to well, I told myself I would try to help out here with the rest of the kids out here, but it's still an ongoing thing. They still can get the drugs. They're losing their minds out here. These drugs. Just take them.

It's not like back in the day when I was growing up, you had a big party. Everybody's there, you're laughing. They go by themselves, and they just get high, and they don't care about anything. So the solutions I don't know. We're trying to bring the people together and see what we can do to help our children. There's some way we could stop the drugs from coming into this country. Maybe like long term rehab. Not just two weeks a month.

We need at least a year in rehab. They go to rehab, they get out, they fall right back into the same stuff. We need professional mental health people that can help. I know mental health is another big issue out here. You I it's just huge. It's a real crisis, and it's sad to see the broken families from the drugs out here.

Thank you, Chairman Christman and Ms. Espinoza, thank you so much for being here and for your courage and sharing. And I'm so sorry for your loss. Committee Members, if you have any questions or comments for this committee or sorry for this panel.

Thank you, Denielle, for sharing your story. Again, I think the chairman was alluding to some work that you are doing. And I know sharing a story must be quite overwhelming. But just curious if you can share a little bit more about some of that work you talked about coming together.

Tell me more about, if you can, about what exactly are you doing as you're coming together in this grassroots effort and what are you hoping it leads to in terms of a space to accomplish the goal of reducing the impacts? I assume please turn let me answer.

So she was the catalyst on the first grassroots, we were having these nights where we would have a potluck dinner and that we would get together and discuss this crisis as it stands, some other things too, but mostly having to do with this crisis itself. And how are we going to come about this? What did come from that was that resolution for the finding process on specific drug issues that we take that from. There is no leading up, no warning.

They violate, they are fined to the highest fines that we can administer. That was the first we were still meeting. And then it was also the beginnings of this other grassroots wellness center that is now open that we're having. And it's not just in wellness. We're trying to expand it into health, but also for talking circles that they're doing, men and women's and things of that nature. And that is working as we speak. We're hoping to expand it even more.

We're hoping to take more grant funds to make that a little more robust for the general health of our community, not just in drugs, but everything else in wellness and health and everything, because we do have a lot of issues with different diabetes and other things, so we're looking to expand. But Denielle was very much the catalyst in that we sit down and we talk about this, that we go through this and we discuss it.

And so we actually went through and brought this to fruition to open this center to start with as the first contact for somebody needing help to sit down, talk to somebody. From there, we can try to channel them somewhere else where they can go into inpatient treatment if possible. It is something that they have to choose. So we cannot make them go, but this is our hands out to them.

One of the main things with us, because we are a very tight knit community, we are a small tribe, and we all have grown up together, all of us. So one of the messages that I let out was, look, because we had a series of deaths even over the years, I said, every time you guys do that, you take a chance. You get in a car under the influence, you know, we're with you. We are sitting there with you.

You just don't know it because we have to pick up the pieces. And so that is the main message to get across too. Not just to all of us, the elders of the group that want to fix the problem, but the youth that are doing this too.

Thank you.

Thank you. Thank you so much. And Ms. Espinoza, I can't even imagine. Thank you for sharing. I know you're saying that the programs are voluntary. What would you say is the acceptance rate? Do you have a sense of kind of how many folks are offered help and will take you up on it at this point?

It's still in its infancy stages. It is utilized. It is utilized. Probably, if I was to guesstimate, I'd say probably about maybe 25% of the community, maybe a little more. I know it's not 100% at this time. When we did have an opening, there was quite a bit, a big turnout for that. So that was good to see. We have to get creative for more participation also, because we want to cover all facets, even the youth.

And what do you see are kind of barriers to participation or people coming in?

Well, that in turn is the precursor to the one outside Anonymity. If they are there for that, then they don't some people, they take their recovery personal, and they do not want everybody knowing their business. HIPAA laws and those things do sort of apply. But then if we can get them somewhere else where they can get the next step, then that's what we've done with the next one that's opening next month, hopefully.

Okay, thank you.

I have a few questions. And again, thank you so much for sharing and for your leadership. It sounds like one of the challenges is how to support young people who are falling into addiction and intervening at an early level, either with education or wellness services, mental health. Is that something that the wellness center is taking a proactive role with?

Or how do you think about educational efforts as it relates to young people to try to avoid them from getting into this situation or provide early intervention once they may start to become addicted or use these types of substances?

So before we actually took this step, former Chairman Pico, who was also my uncle, he was a longtime chairman here at Viejas, had gotten into the scientific approach and he was calling it warrior spirit. He had a panel here that sat in this very room for three days. But what they attributed to because he partnered with the Aces group and they attributed the sort of predisposition for this to childhood trauma.

And so they were talking about the actual chemical, sort of the chemical release that happens in the brain when they are faced with certain issues, that it predisposes somebody to actually go and self medicate or fight or flight all the way through. Well, he was attributing. They are now trying to tie that to the childhood trauma. Our stories on reservations are generational trauma all the way from the beginning through history and how things were sort of done.

The stories that I heard from my grandparents about how they were treated to the boarding school era all the way through when they first moved here, the bia agent that was supposed to administer the funds to do that, that they never got all of these things. The first groups that came here in 32 to move up here had no place to live, and 25% of them died. Witnessing that alone would trigger a number of things.

My grandfather, my both grandparents told me that in addition to that just Viejas's story alone, watching the cemetery be exhumed and be relocated right there as a child, what would that do to you? What would that do to anyone? So Chairman Pico's sort of method seemed a little more sensible about how that could be carried on and perpetuated.

If we have a whole series of events like that that are so traumatic, they're horrific, that nobody should see, but I knew people that saw those events and to witness some of that and then it's a vicious cycle with that. Poverty will be part of that. And we lived it. Those in our generation, we lived the poverty. We lived it. Luckily, we were able to find a way to provide more now for people, more for our people. But still, those scars from trauma still exist in our community. Very much so.

I wonder if you could speak a bit about the type of coordination and collaboration that exists. I would expect that there may be individuals who are part of the tribal community here who end up touching other systems, county law enforcement, maybe certain types of interventions are happening off of this area. And is there a coordination or collaboration that exists around this particular issue, either with the county or county health services or if someone within court systems?

In addition to that, I know one of the things that we're looking to hear is how we can work with tribal communities across the state on this issue. And I wonder if there has been dialogue between tribes about this issue and how you all can work together and share best practices.

So I sit on just literally 2 miles on the same road to where we are on Willows Road, the Southern Indian Health Council, our Indian Health Service Dollars are funneled there. That is a consortium of seven tribes that does the same thing. So we collaborate all through the month on a regular basis. I am the representative for the board and the vice chairman serves as the alternate. We do do that amongst here.

I also sit on Southern California Tribal Chairman's Association where we do the same thing on a more global scale. In this region where you have a membership of about 34 tribes, we all have the same problem and there is one, I think, out of the state or at least out of the county, but we all are Public Law 280 in that it's a fine line with that. So some tribes can afford a police force but they are also limited.

Some tribes have other special duty officers that are able to do that. We have a security force. We have been in discussions at length since I have gotten back into office in 2019 with the Sheriff's Department and the county border supervisors on a regular basis. We are good with open dialogue because that didn't exist in the beginnings of my council tenure. So I think we will come to a resolution.

We have had a number of elected officials out here asking to help in this event or in this facility that's opening. There have been dialogue. There has been with the County Board of Supervisors and the sheriff and even the Oklahoma Police Department in efforts that we can collaborate and come to serve the community around there also. So it does exist now. It has not beared any fruit yet, so I have to be honest about that.

But we are working and so we keep having these discussions and we're hoping that we can have this dialogue and still I don't know that we'll eradicate it but at least provide some sort of solution to make the numbers go down. Exponentiously.

I know one of the things that you mentioned, Ms. Espinoza, is the possibility for a longer term set of treatment and opportunities to get people help so that they're not just cycling in and out. Wonder for both of you if you've seen opportunities for that. Is that something that referrals can be made from the wellness clinic or is there kind of a gap that you see in the type of treatment placements that people need? And maybe if there were things that you felt that would have made a difference for your son in particular that you think that we could provide for others.

Right now the rehab is through our tribal insurance and it only covers, I think at the most a month, which is not enough. I've seen other tribal Members that have gone out of the state to like Native American rehabs and then they've spent like six months a year there and they do very good. Yeah, we can get long term rehab.

With regard to the insurance itself. So what is the insurance? I guess it's not a law, but the insurance standard, it covers annually 30 days inpatient. And I've always said that it does not cover us completely. I've seen people wash out of that. They have to wait. And so even before this crisis, it was happening. But now it seems like it's intensified ten times, if not even more, with the Fentanyl crisis. Especially when you see these people and you look into their ayes, they need help.

They cannot process some things and they're seeing things and hearing voices and all of this. And they need time to get off of this drug, and it seems like it takes longer now. So if I could articulate one thing about that issue, they need more time and probably more help, some medication to help them Wean themselves off of that. Because with every drug addict that I've encountered, I've never had the issue myself. But there is a moment of clarity. They have a plan.

Most of them have a plan to go get sober or to get clean. And they're working towards that. It happens in steps for them sometimes. But with this new drug, I don't see any clarity that I've seen in looking into the ayes of these people. And we're there to help them. And so they do come to us.

Thank you. And some of the Members talked about some of the efforts that we've been taking at the state level. And there are, I believe, over 25 bills this session still moving, that we hope to get signed into law that relate to responding to the opioid epidemic. One of the things that I've focused on a lot in my work this year has been providing more opportunities for access to medication assisted treatment.

It really hits on what you're saying, which is that in order to even have that moment of clarity where we can reach someone often, we need to be able to help them deal with not only getting away from these deadly drugs, but being able to deal with the withdrawal symptoms that is causing their body to really force them to do nothing else but try to get that drug to be able to deal with those withdrawal symptoms. There are effective treatments for opioid addiction, buprenorphine, Suboxone.

This is a type of medication assisted treatment that can deal with those withdrawal symptoms and then can help to, over time, get individuals off of these deadly drugs entirely. So I have some legislation that would allow mobile pharmacies to carry these type of medications and other ways that we can lower barriers to access.

And so when we go to the clinic today, hopefully we can also have a dialogue about that and about the sort of partnership that can exist to make sure that the appropriate and most effective forms of interventions are as accessible as possible to tribal Members. With that, I want to thank both of you so much for being here and for your testimony and for your leadership.

And certainly you have our collective commitment to do everything that we can to respond to this epidemic and to save lives. Thank you so much. I now want to move on to our second panel, which is on law enforcement collaboration. And for this panel, we want to welcome the sheriff of San Diego County, Kelly Martinez and unrelated, Sabino Martinez, tribal project manager for the Tule River Tribal Council. Thank you so much for being here.

Sheriff Martinez, welcome to the committee, and thank you so much for being here. It's really a great honor to have you here as part of this effort, and thank you for your leadership, and we look forward to hearing your testimony. Thank you.

Sorry about that. Thank you. Thank you, Chair. And thank you, Assembly Members, for having me here today. This is just really not only an epidemic, but it's just horrific what's happening in our communities. San Diego has been hit very hard by fentanyl not only our tribal communities, but all of our communities. As a sheriff of San Diego County, I'm responsible for 4200 sq mi of unincorporated San Diego County public safety services for 18 tribal reservations, as well as nine contract cities.

I have responsibility for our jails and our courthouse security. As a sheriff, not only do I uphold public safety by removing the drugs from our communities, but I'm also absolutely committed to the victims of fentanyl addiction and fentanyl overdoses. In 2017, we were the First Department to investigate an overdose death as a homicide. That's now the model in San Diego County. We've been working with our district attorney and the US. Attorney's Office on prosecution of those cases. We've had a lot of success.

I have a border crime suppression team that's working very hard at the border with our federal, state, and local partners to stop fentanyl and other drugs and other crimes honestly from entering into our communities. We've seized just this year alone, almost 4 million fentanyl pills at the border. We seized millions of dollars. We see a lot of trafficking across the border, and it not only comes into San Diego communities, but it moves through our community and goes through the rest of the state, the nation.

In addition to that, something that law enforcement hasn't historically done is we really work hard on harm reduction. We were the first agency in the state to start distributing naloxone, and that was for heroin at the time. We now leave it behind. We have a law enforcement leave behind program in our county where if we identify a home that we're in or somebody wants naloxone, we freely give it out, no questions asked. That's working okay.

Last year, we had over 800 fentanyl deaths in San Diego County. We're probably on par to have about the same again this year. We respond, as I said, to overdoses when they call law enforcement. We don't go to all overdoses in our communities because a lot of times the response is a medical response. When we do respond to an overdose death, as I said, we investigate it as a homicide.

Yeah, I'm really just here to support our tribal communities today, but all of our communities are experiencing this. Your medication assisted treatment program, as you were talking about, it's very robust in our jail system. We're expanding that as we can. The piece that's sometimes missing is the transition of the community from the jails. Yes.

That connectivity is important to expand upon. I think we're working well with our HHSA partners. I have toured the facility in El Cajon that the Viejas is working on. It's going to be amazing once that gets up and running. I'm really looking forward to that opening and being part of not only a transition point for some of our people who are in custody, but also a center for our community Members to be able to walk in and get that. So thank you. I'm sure you have questions, but I'll end there.

Thank you so much, sheriff Martinez. I appreciate it. Mr. Martinez.

Hello. Good morning. Definitely hard to follow. Pleasure to meet you, Sheriff. Thank you, Chair. Thank you, Committee. So, on behalf of the Tule River Indian Tribe of California, what we are excited about is having the opportunity to be here. And thank you for the invitation to talk about law enforcement collaboration. It's key, it's critical. It's several of the comments that have been made this morning talking about developing this comprehensive plan. A strategy combined with expertise, whether it's public health, law enforcement, collaboration is going to be essential.

So prior to the global pandemic COVID-19 the Tule River Indian Tribe of California, we were engaged in the opioid epidemic. So the community early on was experiencing the presence. Prevalence of illicit drugs, overdoses were significant. And we are a very rural, isolated community underserved limited resources.

However, when we look at the vision and the goal of the community on behalf of the leadership, self governance, self resiliency, so the community has continued to be resilient despite the emergence of different threats, drugs that have made their way onto the reservation. So again, the opioid epidemic provided our community to really develop a comprehensive opioid response strategy.

How we were able to do that is by integrating our external stakeholders, internal stakeholders, and really allowing the government to define and prioritize what their vision is for the community. It first started with developing a substance use ordinance and that really set the precedents and defined the attitude and the vision of the governing body on what they were going to allow and entertain for the community.

Following that, we were able to develop our opioid response strategy integrating tribal government departments, Department of Public Safety, tribal police, fire, health center, emergency services with our ambulance, and also expanding upon that. Part of that strategy focused on capacity building, integrating the external stakeholders. As Mr. Chairman, you mentioned integrating federal, state, local law enforcement agencies beyond those within the community.

So we developed this comprehensive opioid response strategy and again pursued every opportunity to secure funding, to integrate services, exploring how to develop and establish medication assisted treatment, integrate programs, prevention, education base for the youth, and also increase in awareness on some of the different trends and threats related to fentanyl. So post pandemic COVID-19. Unfortunately, we are still resuming where we found ourselves with the opioid epidemic.

However, when we look at the data, the trends, the number of overdoses that have occurred within the community, it's increased significantly. So the need for information sharing, collaboration and integrating resources at all levels is going to be key. How can we be successful in building capacity, increase in our capabilities and the services that we provide to our community? By continuing to pursue funding, sustaining partnerships that were developed pre global pandemic and expanding upon those partners that are present today.

And I'm excited, I look forward to the opportunity to see the clinic following this meeting and integrating additional services that can provide substance misuse treatment. So, on behalf of the tribal police, they've been the spear, they've been the lead, and also developing a partnership, trying to expand information when it comes to threats and trends that we see, working with the community partners and really fine tuning the opioid response strategy that we did develop.

So, that's just kind of an overview of what we've done from a law enforcement collaboration perspective, but ultimately, what we're dealing with right now. As I look at the title of this gathering, we're talking about fentanyl, opioid addiction and overdose prevention.

So one key word that we've really prioritized is education because we do believe it's going to be generational and really providing the prevention, the education, the awareness on the impacts, focus on harm reduction and that way law enforcement, they can be part of that effort and takes the lead. Thank you.

Thank you so much to both of you for your leadership and that overview. I'm sure there are questions. Assembly Member Schiavo, I know you were.

Talking a little bit about the education piece of it and the youth education. Can you talk more about what that looks like and what that actually entails?

So, one of the key departments within the Tule River Tribal Government is our Future Generations Department and they've been instrumental in pursuing grants and opportunities to adopt and implement evidence based curriculums programs, focus on our youth. And again, their title, the Department, it's very unique, it's special, future generations. So looking for grants and opportunities, curriculums that can have that engagement, that interaction, and also operating the cultural component, whether it's language, whether it's basket making, bead making. So also integrating culture, part of the education, the prevention as well, all.

All right, I'll jump in then. So one of the things that you alluded to, Sheriff Martinez, is this issue of transitions from your custody to community care. And that's actually where we often have some of the biggest challenges, and unfortunately, where we end up losing a lot of people. We had a hearing, our first hearing of this committee a few months ago, and we looked at the data over the last few years of overdoses, and it's horrific.

When you look at the overall increases of overdoses, there's one exception, one place where overdoses have actually dramatically declined, and that's in custody, in prisons. In particular, in CDCR. And I imagine there's been similar efforts in our jails connected to our ability to enroll people when they come into custody. But then when they leave custody, especially if they don't continue the medication, it's actually incredibly dangerous.

If you're on a medication that is managing an addiction and you go off the medication, that's often the time when people are most at risk of overdoses. Can you talk a bit about how you think about those transitions, Sheriff, and if there are particular types of opportunities for collaboration with tribal communities, with the clinic that we're going to see this afternoon that you think could help with that transition?

Yeah, thank you for that. Certainly if someone's on MAT treatment in our custody, especially if it's a prolonged period, if they're in our custody for a prolonged period of time. The gap, I think, sometimes is when they're only in our custody for a short period of time, a couple of days or a week or two. We don't always have the connectivity to that individual. They're not as committed to the program. So when they get out, the transition isn't always as smooth.

We do have a pretty good system here in San Diego County, I believe, with the transitioning, for people who've been on the program for a while. And our MAT expansion has really been fairly recent, so we're still collecting data on that. Initially, we started it with women who were pregnant in our custody. We continued the MAT program there and took them to clinic. Now we're doing the treatment, and we have modules in our facilities that are MAT Modules.

So everyone in that module is in our Mat program. And so the transitioning, I think, will be smoother. But again, I think we have a real risk population, the ones who just recently come into our custody. And we do do voluntary urine screening now when people come into our custody so we understand what drugs they're on or what substance they're using, and we put them on withdrawal protocols immediately and get them into MAT as soon as we're able to. So it's been working pretty well.

In terms of people who have higher levels of need. I wonder, Mr. Martinez, if there are individuals who are really addicted at a level that they're really at a point of danger to themselves and you're really concerned for their safety. What sort of authority do you have as far as involuntary holds and do you do that yourself? Do you bring someone in to do that? This is an area as it relates to the tribal governments that I'm not as familiar with the authority around.

Obviously we have 5150s and you can hold somebody for 72 hours and this is something that sure the sheriff is very familiar with. We can also have two week holds. Is that something that you all are doing directly or is that those kind of involuntary holds something that comes up or are you really just when people need help looking more at how to offer them the type of treatment that would be most effective for them whether they want to accept it or not.

It would be exactly just you know, there's the comprehensive team that would come together. So integrating our Department of Public Safety, our health centers, behavioral health Department, and really working with the providers and public safety to really come up with and obviously, every case is unique, but collaboratively identifying what's going to be the best approach, but also based on the jurisdiction, it's temporary. And then working with the local authorities as well when it comes to transferring custody.

So it's really a collaborative effort in terms of how to find the best placement for somebody and what authority you have in that context.

Correct.

And do you have facilities near you or I know we're going know the Chairman Christman brought up their effort to have a wellness center on site and then this clinic that is nearby. Tell us a little bit about kind of the distance from where, how far people have to go to get help and kind of how you are confronting the issue of isolation.

So again, we are like most rural isolated about 16 miles from the nearest hospital. Services, placement, location, geography makes it pretty difficult to access care off site. However, internally utilizing our health center, our behavioral health Department and the services. So we don't have a wellness center that can do intake. However, we do have the counselors, we have the psychologists, we do have the providers that are there Monday through Friday that can receive patients and see them throughout the day. And in the event the need is greater they coordinate with local services or intake facilities to do transfer or care to provide care.

Great. Yeah, 16 miles is far from a hospital. Sheriff, shifting more to the law enforcement side of this and 4 million pills is just a mind blowing amount of drugs that we know, especially when each individual pill can kill somebody is just terrifying. I wonder if you could speak a bit more about what you see working in terms of either stopping these drugs from coming in or deterring people who are selling them. And then with that, what sort of support do you need?

We're up here as state officials. There are some areas I know, for example, in San Francisco, we're now having more support from the CHP coming in directly and coordinating with our sheriff and our police Department. There are efforts now to bring in federal assistant what would help you confront the folks who are bringing these drugs in and selling them.

Yeah, really the additional so we had this spring, we had the Blue Lotus operation, which was federal law enforcement came to San Diego County and we had a coordinated effort, a surge, which was I think we seized 4000 pounds of fentanyl during that two month period that was coming across the border. And that did have an effect. We had a reduction in overdoses in our communities during that time period. We saw some of the drug smuggling being diverted from our border.

So we know that we can have an effect when we enforce and do border and addiction. But not only that, we have body smugglers. We have high school students from our South County that are being solicited by cartels to bring drugs across because they know that anyone under 18, it's very difficult to prosecute federally for drug smuggling. So we do need the ability at the state level to enforce some of these laws.

We need to be able to do something with these kids that are being basically propositioned and brought into this lifestyle where they're being paid and they're bringing drugs across. We had one juvenile that was body packing. He had pills strapped to his body. He crossed the border, he went into a bathroom at our South County overdosed in the bathroom. And as they were providing aid, they opened his shirt and found all of the pills that were strapped to his body.

So we have these stories where kids are being involved. Children's Hospital has seen a 1600% increase in children that are being admitted into the hospital with fentanyl in their system. So they're being exposed in the home. We really need opportunities to make sure that our laws in the state of California are as strong as the federal laws in this area. So I really look forward to working with all of you on what that would look like.

One of the things along with that, I had our sheriff in San Francisco come forward and speak to me about some of the challenges within state law, even how we categorize or how we do bookings as it relates to fentanyl. Their concern was that fentanyl, despite being such more dangerous of a drug, in some cases grouped with other types of drugs, and how the bookings are done and things that really don't take into full consideration how much more dangerous this drug is.

Is that something that you're seeing? And I actually interested to hear more about what it means for you to investigate every overdose as a homicide. And what does that look like in terms of sort of resources going and trying to find where exactly this came from is not, I think, the usual practice. So what does that mean in terms of investigations? And is that something that is sort of leading to prosecutions in that way?

Yeah. Thank you for that. We've had 34 fentanyl overdose deaths in my jurisdiction so far this year, so I have the capacity with my staff to investigate each one of those. And what that means is we take a look at their cell phone. Sometimes it's simply a matter of looking at the cell phone to see who their dealer is and then backtracking to that dealer.

A lot of times with the way the laws are written, we have to really show a lot of intent on the part of the dealer, which is difficult, especially if we know they've been dealing for a while. So we have some investigative opportunities to be able to nail that down regionally. Some of the other agencies and our federal partners have formed what's called Team Ten, which is a collaborative group that investigates overdose deaths in primarily San Diego Police Department's jurisdiction.

But some of the other jurisdictions in our area that I don't oversee as far as booking into the jails. Yeah, fentanyl is a very different drug than what we've seen in the past. And speaking of that, a lot of our monies for enforcement are geared specifically towards methamphetamine, which historically, that was always the problem drug.

I think we need to rewrite some of those our CAL-MAT monies and some of those things that are used for enforcement and wire that so that it can be used for fentanyl enforcement as well, or any drug, because fentanyl might not be the last drug that we have this extreme of a problem with. So enforcement works, and I don't think we forget that in the equation of education and harm reduction, I think it's a three pronged stool, and we need to do all three.

Mr. Martinez, I don't know if there's anything you wanted to add on that. One thing that in terms of enforcement, is there anything that you all are seeing in terms of for you all, how and where people are accessing these drugs? One of the things that we've talked a lot about in this committee is the challenges of regulating and monitoring online activity.

I come from San Francisco, where people, unfortunately, often access these drugs right out on the street corner, there's open air drug markets that everyone can see when they come into our city and have devastating impacts. That's not how a lot of people throughout the state are accessing these drugs.

There are different ways, particularly with young people, different sorts of ways through social media, social networks and such that they're accessing these. Are either of you seeing that? And is there something that we can do, particularly in terms of for tribal communities to try to intervene there or enforce that more effectively?

So I think it's a combination of all everything that's mentioned, whether it's public source, community, family, off the reservation, so availability and accessibility, unfortunately it's there. So it's a combination of all the above.

Yeah, I would say that's very true. It's very easy to buy, not only online, so wherever we can explore that. But honestly, a fentanyl pill costs $0.60 right now. So the scale of this problem is huge and I think it's really impactful that all of us are coming together to work on it. So thank you.

Thank you again, thank you so much to both of you for your leadership and for you being here and for engaging with us on these solutions. And I'm sure we'll continue to partner with you as we move forward. Thank you so much.

Thank you.

We're going to move now to our third panel and we have Vice Chairman Nieto of the Tule River Tribe of California and Greg Greenberg, the Chief Medical Officer for one together solutions. Welcome. And I will ask Mr. Vice Chairman to start.

First of all, I'd like to thank the Viegas tribe for allowing me as another Native American, Indigenous person to be on their land. Mr. Chairman Christman and Espinoza for her testimony. It's hard for me as a native man or just a human being in general, to hear a woman cry and to see her hold back her tears. So I'm right with her on that and stopping this with you guys. And I appreciate you guys for putting this together.

I've seen Mr. Patterson on Channel 26 and the Fresno station and when he was talking about getting these drug dealers to fentanyl pushers to get life in prison, I watched that Bill and watched your Bill, sir, Mr. Haney, you guys putting these things together and I was disgusted that it didn't pass. I don't like politics when it comes to that because we're all in the same boat and this drug is a very evil drug. It's nothing like when I was growing up on the reservation.

My families were having birthday parties and parties in general, and as kids, we would sneak beer out of the ice chest. These kids nowadays, they're getting this fentanyl from everywhere. It's everywhere. You can't go anywhere without it. And they're making the drugs look like candy now. And so if a little baby picks that fentanyl up, they're pretty much done. But I'm here on the health part. Before I got on council, I used to run the TRAP program. It's called a Tule River Alcoholism Program.

And it's called the Tule River Alcoholism Program, it's because back in 1979 when it was started, alcohol was the drug of choice on our reservation and that was the only thing that was pretty much there. Nowadays, everything's there but fentanyl has wiped out alcohol, it's wiped out Marijuana, it's wiped out heroin, and it's wiped out crank and coke. And so those drugs hardly exist on our Res anymore because of fentanyl.

It's so cheap and it's so dangerous that, say the five of you, this is how the kids are doing it on our reservation. There's five of you, say you guys are all buddies. Mr. Alvarez would take the first hit and I forgot your name, Ma'am. But she would be next with the NarCan to make sure Mr. Alvarez, when he starts overdosing, to shoot the NarCan up. And so then she'd take her pill.

They'd just go along and they just keep NarCan each other until it gets back to the next person. And so if that person's not done, like, say, Mr. Alvarez, he was supposed to NarCan Mr. Patterson, if he's not done with this coming out of his overdose, then Mr. Patterson is probably going to overdose and either die or go to the that's. And they know that that's going to happen, but they're still taking this drug because it's so addictive to take.

If you're going to put down heroin and other drugs to take this pill, sometimes you wish they'd just go back to smoking weed or doing heroin or being on methadone. And it's pretty crazy that they know this pill could cause death and they still take it. And like Mr. Chairman Christman was saying, we have the res zombies.

We call them the Res zombies because there's nothing really we could do for them because they took so much fentanyl that they're basically in a 5150 state of mind. And we can't really help them with the TRAP program because we're not dual diagnosis for psychosis and other things. So with the clinic's help of sending our people to the people there for behavioral health that do a little bit more of that style, it's still not enough. It's still not enough to help our people.

They hang out everywhere. And it's sad because you want to help them, but you can't because they're not in the state of mind where they can recognize help or even recognize treatment because they're so far gone that all they're doing is looking for that next fix and chasing that high. And it's not a good thing. I started a boys club to start prevention. Back in the day. I had 40 boys in my club.

It's kind of hard to talk about it because I lost four of those boys to overdose, fentanyl overdose. I have three boys and a daughter, but those boys were like my sons, all 40 of them. And so when I lost the last one, he came to my house at 05:00 in the morning after he had overdosed and came from the hospital. He was brought to me by his auntie and his uncle that was married to her.

And he told me who was selling the fentanyl to him. And the guy that was selling the fentanyl to him was the guy that I grew up as my bro, as my friend that I played sports with. And I did everything with. And so I had to pick and choose to either go after this guy or let the rest of them die. So I had to disown my own friend and my own bro to try to fight this.

And so it wasn't a hard choice for me. Those boys meant a lot to me. At 05:00, I met this boy. He still had the overdose throw up on his sweater and his sweats, and by 03:00 that afternoon, he was gone. He passed away because he went home and got another pill and did it, and he did it by himself and no one was around and he passed away.

And so by the time I was going up there to see him, the ambulance and the fire truck was ready at his house and he was already gone. So sometimes you blame yourself for things that you can't control. And I always think if I'd have went up there sooner instead of taking my daughter to her baseball game or softball game, that he might still be alive, but you never know. But I still had to be a father to my kids, too. So it was hard.

It's still hard today. And that kid I had, Amy Arosco, me and her started discussions on our reservation because, like Ms. Espinoza, it was bothering us that these kids were passing away and she's the ante to this kid I'm talking about. So we started talking and we started trying to attack this for ourselves. And so that's why when you guys put these bills together, we was watching them like it was our sports team, you know what I mean?

And when they didn't pass, it was, like, devastating to us that it didn't pass. It was actually disgusting to me that something like that that seems so great. It didn't pass because of the politics that go with it. And that's what it was to me. It was like, how can that not pass? This drug is killing people. It's destroying our state. It's destroying everywhere. It is everywhere. It's not just on Indian lands, you know what I mean? It's everywhere.

Like I always say, we're not savages and settlers anymore. We're all neighbors and we're all in this same state together, you know what I mean? If this wipes out any town, it's just going to keep moving and moving. If I saw any reservation, it's just moving and moving. This is why I'm here, because I want to support this and help you guys fight this. Either to slow it down and put speed bumps in its way or it's going to destroy everybody.

And I hope whoever's listening really takes note to what everybody's saying here today and how bad this Fentanyl is, because they don't want their family Member to be buried over an overdose. And sometimes that's what it takes for someone to even recognize it when they're being doubtful about what's happening around them. But this is what Amy was coming with me to talk about her nephew passing away.

And this morning she told me she wasn't going to be able to make it and I didn't know why, but she sent me this message while we was coming over here from Saquon, and this is what she said. "I wish I was there today, but my pain is still too real. It was yesterday my nephew was taken. It was yesterday that I rode in the ambulance with him to the ER.

Prayer for all the families that have been affected by this explicit Fentanyl; prayer to you today to speak for us all. Thank you for the invite." And she sent a picture of her nephew on a cup. So I was telling Pam one day we was up in Sacramento, that we were just sitting there talking, waiting for our next thing to go into the next meeting for a water bill. And I started talking about this Fentanyl stuff.

And then after we got done talking about it, we ran into you in the lobby down there. And so that's when we was talking about this. And I'm glad you kept your word and invited us to be a part of this. That day I was talking to her about all this and this was going on.

So it really bothers me that our tribal members and also people I know in town that I grew up with, are all messed up, that they don't have no state of mind anymore. They're gone. They're not dead, but they're not alive either no more. And there's no way to help them because you give them all the medication now and all the treatment, but they're still never going to be the same. And that's pretty crazy to me and how cheap this drug is.

We're trading at home, they sell it for $10, so we're we're we're for that $10. When a kid or another person passes away, we're spending another $10,000 just to bury them. And then what do you put on the price for someone like Amy's pain? You know what I mean? Or someone like me? I started that boys club for prevention and then it got closed down because there was no funding for it.

And so those boys had nowhere to go, and so they ended up doing these pills and I couldn't save them all. I was watching them go down a road that I couldn't save them from. And four of them are gone now out of 40, and probably ten of them are still messed up. This is where I'm at with this, and I appreciate you guys more than you know, and I'm grateful and thankful to be here today to be a part of this.

And like I said, thank the Bas people chairman, Chrisman, for allowing us to use his land and his facility to have this today, and thank you guys also. But I think that's where I'm going to stop. And if you got questions for me, I'll answer them the best I can. Thank you.

And thank you for being here and for your work. And I'm sure that for many of those boys that you did get to work with, that you saved a lot of lives. So I'm very sorry about your loss, but we're very appreciative for what you have done. And please share our condolences and our respect and gratitude to Amy as well, and for her to have shared that message with us. Mr. Greenberg.

Thank you. Thank you for having me. And thank you for sharing that story too. I've been a physician for over two decades and I've been on the front lines of the opioid epidemic. So I've worked in emergency medicine for the past 19 years until last year. I've worked in addiction medicine for the past six years and I've watched the face of the opioid crisis get worse and worse. And particularly when fentanyl came into California, it's been devastating in the emergency department.

Over the last several years in particular, I've seen a lot of young people overdosing. I've pronounced a lot of young people dead. And the biggest problem that I see is barriers to treatment. Obviously, prevention is very important. My aspect, or my side of things is treatment. And our current paradigm that we have for outpatient treatment involves people with substance use disorder making appointments.

It's hard to make an appointment and keep an appointment when you have a substance use disorder, when you have a fentanyl addiction, methamphetamine addiction. So biggest thing we can do on our side is really trying to decrease those barriers. You'll see, when you go to revive. We're not a typical opioid truth program. A lot of our patients will be same day, walk in, get treated that same day.

We really try as much as we can to treat people when they have the time of need, when they come in, which is what we're doing with a clinic that I've been running in Ukiah as well. We're also going to provide urgent care type of services, basically medical services as well, and psychiatric services. It's very difficult to engage in treatment when you have untreated psychiatric disease. And so mental health treatment is very important as well.

From the standpoint, from my ask for this committee especially, is whatever we can do to decrease the barriers to us opening clinics and getting started, I think, is huge. So one of the things that we run into is we run into administrative hurdles. We're still waiting, just because of the nature of things, for DHCS, DEA to do the final inspection so that we can open the clinic. We're still waiting.

County contracts at our other clinic in Ukiah, we've been mired in difficulty getting county contracts as well. The current system, particularly in California, where the counties have to contract for the services that we provide, has been a significant barrier. We want to treat people every day that we're not open and not treating people. Unfortunately, people are dying, and we've seen this over and over. So as much as we can expand that access, the better.

And Mr. Haney, you've seen in your area, UC San Francisco is very good at providing access, providing comprehensive care, really decreasing the barriers to medication, assisted treatment, medications for opioid use disorder. Dr. Herring out of Highland has done a great job with that as well. And you do that as well. I've worked with the California Bridge program, which has been amazing with what they've done with California, with really providing access to opioid treatment for opioid use disorder.

Thank you. And just to be clear, so you all operate the clinic that we're going to see today, or you will operate?

Yeah. So I'm chief medical officer for One Together Solutions; Bob Kershner, who is our CEO, who basically designed all of this. The idea is to work with tribes to open opioid treatment programs. So our clinic in Ukiah was the first tribally owned opioid treatment program in California, and then Revival will be the second one. And we treat Alzheimer's. We treat not just tribal members. And with what we're doing is we're really trying to heal communities because we're not just treating a substance use disorder.

We're not just treating opioid use disorder. We're also treating hepatitis C. We're screening and treating for sexually transmitted infections. We're treating other infectious diseases and other complications that are related to it. And we're trying to really do whatever we can as far as preventative care as well.

Thank you. Colleagues. Any questions?

Thank you both for your work. And I know it's hard to see. I can't imagine what it's like to lose someone in your program. But as Chair Haney said, there's a whole lot of people still here and probably because of your work. So thank you for that. I'm curious if I know the program unfortunately wasn't able to continue, but I feel like there's always a struggle, and I know we have to do all the things, but it seems like at a certain level, stopping the flow completely seems impossible.

Right. To do that 100% right. We can do a lot like you said, put it speed bumps and so on the other end, that's why it feels like the prevention piece and stopping the demand is so important as well. And what did you feel in terms of when you had that program? Did you feel like it was an effective program?

Was it kids having a place to go and something to do and positive influence? Was it actually talk about drug prevention, about the impacts of it. What were the things that you did that you felt like were effective and made a difference while the program was going and that you think are important elements of future programs?

I think the program worked because I used to be those kids. I was a resident want to be militant, hating the world around me and the world off the reservation, thinking that's what made me Indian and made me Native American or Indigenous or whatever you want to call yourself instead of a human being. And my uncle, he was one of our leaders at the time, Philip Hunter Metz. I have to say Metz because he's gone.

And one day he told me, why you always act so rezzed out? Why do you have to be that way? Why can't you just leave people alone and let them be? And I was telling me, because my other uncle, he was an alcoholic. And I lived with my uncle who was a leader and didn't drink or use, and he was part of the TRAP program, bringing it there with another man named Joe Corrello Metz. And they were my greatest mentors at the time.

But my other mentor was my uncle that was an alcoholic that sat in the backyard and drank and talked about the United Snakes of America and all this other stuff, you know what I mean? And so that's how I was raised when my other uncle was gone, like, come down here now. Someone could be sitting with my boys like my other uncle was with me and telling me all the wrong stories to make me hate the world. And then one day he told me that.

Why was I like that? And I told him that. And then he told me, well, it's okay to be rezzed out, but as long as you're rezzed out, you're always going to only have the rez. You're never going to have nothing else. But if you're a human being, you can go anywhere in the world and still fit in, you can go anywhere. And so that's what I told these boys, and they always told me the rez is always going to be there.

America is not going to move it anymore. We're stuck here now in these granite hills with what we got, so go out there and see stuff, you know, go out there and see stuff before you can't no more. You know what I mean? That's what I told these boys. Don't let the Reds hold you here. It's always going to be here. One day, it's going to call you home whether someone passes away or you just want to come home because the river will call you back.

So I was doing prevention with them. Every six months, we'd go to Magic Mountain. I'd go paintball, and I'd let them pick wherever they wanted to go because we had the funding for it to do stuff like that. And so I had them drug testing with their parents consent or their guardians consent every week, and I'd randomly drug test them. I wouldn't tell them what day I was going to test them.

And they all agreed to it, signed the paper, and had their parents or their guardian sign it. And then they had to do five things in order to make the incentive trip possible for themselves. So they'd have to have good grades in school and be passing. They'd have to behave on the bus and not be having no write-ups on the bus. They'd have to stop talking to the gym director like she wasn't there for them because she was European descent pilgrim.

And so they was treating her pretty bad when I got there. And so they had to leave her alone. They had to call her by her name instead of calling her different names. And then they couldn't get in trouble at the gym that we was at, and they couldn't get in trouble nowhere else on the rez. And the last one was that we had to be in the same circle. All of us had to stand together.

And if anybody talked about each other, then they couldn't go on the trips. And that was the hidden agenda right there. And so they all agreed to it. And so that's how it worked. And so a lot of jealousy comes on native land. A lot of jealousy comes from things like that because you create the crabs-in-the-bucket type of atmosphere.

And so when kids or anybody in general envy you or think highly of you and they start wanting to see you all the time, people get jealous. That's what happened. These kids became my kids, and they were coming to me instead of their fathers. And some of the fathers got mad. And me being who I am, I really didn't care because I only cared about those kids. And now some of them are welders.

Some of them are still in school trying to get their bachelor's degrees, and then some of them are messed up from fentanyl, but not all of them failed. Even the ones that are on fentanyl are not failures because they're still standing and they're still above ground. And so that's why I still continue to try to help them. And that's why being on council, it's not about being on council. To be a leader, you still got to lead those that are broken.

You can't forget about them, because if you forget about them, what type of leader are you? That's why, man, just like you guys. You guys are leaders where you come from. And here you are trying to fight this. This is a pandemic itself. COVID is not nothing compared to this. People are losing their minds. People just lost their breath and lost their heartbeat and lost sense of smell and taste. But when you lose your mind, you lose all of that.

And so COVID is not nothing compared to fentanyl. To me anyways. That's why I think the voice club worked, because we was all the same. And then I taught them that the world's not a hateful place to be hating on. I taught him what my one uncle taught me and not what the other one taught me. So I think that's why it worked. And then you always have to have rules for something for it to work because otherwise it'll keep going back to the same spot.

There's always got to be some type of rule that keeps you in line. So that's why I made those things up, to have some kind of incentive for. Yeah.

Thank you. It sounds like it was a really impactful program, and I'm sure the impacts are still being felt for those kids who are in school and trying to make it. And for Dr. Greenberg, the clinic that we've seen today, can you talk a little bit more or-that we will be seeing today-can you talk a little bit more about how long it's been around and some of the work that it has been done there?

I know you talked about the other treatments that are happening as well, but in terms of fentanyl and opioids, the successes, challenges that you're seeing there.

Yeah. And Revive is not open yet. It will be opening early next month. We're still waiting for approval through DHCS, DEA, and all the other fun administrative things that we have to do. I have been medical director in our clinic in Ukiah, which is with a different tribe. And there we've really just tried to break the mold. We've taken most patients without an appointment. Over half of our admissions are patients that just walk in. We see them the same day, we get them treated.

And then on top of that, a lot of our patients have difficulty accessing care elsewhere. They often are stigmatized when they go to the emergency department or when they go other places and they're reluctant to go. And we see people with significant infectious complications like cellulitis, abscesses, and then other health issues as well. And one of the keys has also been treating the mental illness along with that.

So with the treating their psychiatric issues, same issue where people really don't access care very well, we've really found that we've had a lot more success where patients report significant improvements in their quality of life. We're working on trying to track that even better.

And then with Revive, we're implementing a quality of life kind of tool so that we can see what their quality of life is when they come to admission yearly and track not just becoming substance free, but in addition, tracking them, getting jobs, getting back into education, and then improving their quality of life in other realms. Because I can tell you 100 different stories of people getting their lives back together.

But we do practice in evidence based medicine and I want actual data to be able to show it too.

And when you say they come in for treatment, do you treat them that day? These are all outpatient treatment?

Yes. These are medications for opioid use disorder. So this is predominantly buprenorphine or Suboxone and methadone.

And you've seen success in outpatient treatment with those medications?

A huge amount, yes. So if you look at the statistics, because I'll go back to the data, because we love data, if someone goes and they get treatment, let's say we get them through the withdrawal period. So when it comes to using Suboxone or methadone, it's not just about the withdrawal. It also is about the dopamine reward center in their brain that gets them going back to using.

So even if we get them through withdrawal, if they're in a social program that doesn't involve medications, about 85% of people are failing within one month. If you look at medications for opioid use disorders, such as buprenorphine or methadone, patients who are retained in treatment, it's somewhere around 50% to 60%.

The studies, it's a little bit difficult, but you look at what a dramatic difference that is just with what happens in the brain when people are off of opioids, even when it's not withdrawal, they lose the power for most people to really be able to stop using. If you look at the numbers that 5 to 10% of people who are not on medications for opioid use disorder are still not using illicit opioids in about a year.

And so we have to work on what happens in the brain that actually leads to them continuing to use.

That is a significant difference. Thank you. Thank you.

I want to thank you both for being here and for your leadership. I know we're all looking forward to visiting the clinic, of course, even before it's fully opening, and really want to thank you, Mr. Vice Chairman, for your work and for being here.

And I know that this is clearly an issue that you have a lot of personal experience with and commitment to, and you have my commitment to work with you and everyone who's here to really confront these issues at the scale and with the urgency that they're being experienced. Thank you.

Yeah. I'd like to thank you again, all of you, for putting this together. VAOs again, like Chairman Christman and his tribe for allowing me to walk on their land today. I just want to say one last thing, is that it's pretty sad. As a leader, I should be at home. We're out of water right now, walking around with IHS with my chairman, working on a water crisis and working on our housing.

And instead this fentanyl push to get it off our reservation and to get it away from us is just as important as that. And that's the sad thing about this, that instead of working on those things to bring housing to our people so they can come home, I'm worried about these kids dying also and anybody else from our land. That's what I want people to understand is that, you know, that's how important this is to me.

It's right up there with those top two that I should be focused on as a leader instead of this drug. It's not a good drug. No drugs are good. But this one is just crazy to me. It baffles me how they're taking it and how they know they can die and they're still chanting it. But I thank you guys again.

I don't want to take up too much more time and ramble on, but I thank you for allowing me to be here and allow my tribe to participate and then the river supports you guys to the fullest. So thank you guys.

That didn't work. Now can you hear me? Thank you for having me here as well. And I also want to thank Viejas for building this clinic to hopefully help heal our community.

Thank you both. Again, I want to thank Viejas and the Tribal Council and the chairman, as well as Tule River for their participation in partnership on this hearing. I know we are going to spend some time this afternoon visiting the clinic, which was a big part of what we wanted to do to come here. And Mr. Vice Chairman, I think you said it best, nobody wants to be spending time focusing on this epidemic.

There are so many other things that we can do to solve other problems that everyone in our state and tribal communities are facing. But we do need to do so much more on this, and we are not doing enough anywhere. I can tell you in San Francisco that we are seeing tragically again this year. We are on pace to have over 800 overdose deaths in San Francisco. That will be the worst year on record for us.

And so this is something where there's no one, no city or county, no state is doing enough to confront this epidemic. And we have so much more that we have to do together. And I just think that this conversation underscored both the urgency, underscored where some of the need is where we aren't doing enough to get folks into the right level of treatment. We're not intervening early enough with young people.

We have to figure out how to stop these drugs from coming in to begin with and have an effective approach to accountability and transition between systems. So you certainly all have given us a lot to think about and to work on as we think about the investments that need to be made and the laws that need to be changed before I also open it up to my colleagues if they want to add any final remarks.

I do want to open it up if there's anybody here who does want to provide any public comment, we want to give that opportunity as well. And if there's anybody, they can come up. If there's not, that's fine too. And I know we're going to have a brief lunch and then step out and go and visit the clinic colleagues. Any final thoughts or anything? Mr. Patterson.

Yeah, as I said earlier, this is a very complex, very troubling, very difficult emergency in the state of California to deal with, whether it is here on tribal land or whether it is back home on the campus of Bullard High School with my high school kids. This is killing people. We keep saying, well, wouldn't be nice to be doing something else instead of this. Isn't this really important? If it is effecting our state, our most precious individuals in it?

Obviously, the complex interaction between supply, demand, there has to be some interdiction, there has to be some accountability. It has to be comprehensive as well. The treatment side is so very, very important and it is discouraging to hear that, even particularly on tribal lands, that some of that important, necessary intervention is somewhat difficult here. Also, we're learning that it has to be cooperative as well. And I just have to say this. I have sat through a number of these hearings.

I have worked with our fentanyl overdose team in Fresno County. I've heard the stories that shed some tears along with those who have shed tears. We've got to do a whole lot more than sitting here listening and nodding our heads. We have to act. And I really believe that we have to act holistically. But that does include, in some sets of circumstances, decision making by the Legislature that may be ideologically at this moment difficult to do.

And I'm talking about holding drug dealers accountable for purposely selling to the most vulnerable, something that kills them on the spot. You can apprehend a drug dealer with 3000, 4000 pills, but because the fentanyl weight is so little, best we can do is a misdemeanor. We need to be adjusting the kill power of fentanyl with some of the other opioids and the cocaine and the heroin that's out there.

If we really do believe that this is at a level that is excruciating and heartbreaking and very frustrating, then I think we need to be looking at what fentanyl is doing compared to the other drugs where we hold drug dealers accountable for selling them. And we don't do that with fentanyl. It's so heavy kill power, but such a lightweight. And so there's a lot of things we could be doing. I want to join with other members here in my commitment to working comprehensively and cooperative.

We understand it's complex. There are issues with the availability of addiction treatment. But at the end of the day, this is about supply and demand. And some of our most loved and precious individuals are so trapped by this addiction. And for those of us who don't have that addiction problem, that could happen to anybody, by the way. But to be free of that is wonderful. But when you're caught and you've seen it, it takes over an entire life.

And their existence is focusing on how do I get that next fix? Because there's something going on physically and mentally and emotionally that drags me back to the very thing that could kill me. And so I appreciate the chance to be here. I particularly appreciate the voices of those who have mentioned that their hearts have been broken by the brokenness of people that they loved because of what fentanyl has done. I am sick and tired of trying to understand the mindset of the dealer.

The mindset of the dealer is the bottom line: let's make money. And if it kills people, so what? That's incarnate evil. And there has to be an accountability for that kind of incarnate evil. But also we have to take into account the addiction and the treatment and the resources is necessary so that anyone who wants to try to break that cycle has people they can go to, has places they can go to, and stay there long enough to get to the other side of that darkness.

So I appreciate everybody's part in all of this, and I commit with the chairman to be a part of the solution in as comprehensive, complete, cooperative way as we possibly can. And I appreciate the voices from all of the sides to this complex matter for being here and speaking truth to us. Thank you.

Thank you, Mr. Patterson. Well said, Ms. Schiavo.

I just want to again thank the chair for bringing this together. Thank the VA husband and Tule for being here and all of the speakers and panelists today. I know we haven't figured it out, but I also think that there were a lot of glimmers of hope and successes that we can learn from and we know work.

And I think one of the things that I heard today also is that we need to make sure the resources are behind the things that are working and that people really have the support that they need to continue to do and build upon the things that we know will work. Beyond hearings like this, there's a whole lot happening at the statewide level.

And I know that Chairman Haney mentioned that there's around 25 bills that are moving forward this year that I think really run the gamut and are very comprehensive in their approach. And we know we need to do all the things. We need to do all the things around prevention, around stopping the flow, around making sure that there's accountability.

And I think that the series of bills coming forward that I hope will be successful, that I'm co authoring a bunch of them because we know how important this is to really tackle this issue as quickly as possible and make the biggest impact that we can possibly make. So we're in our last few weeks of session where these bills are going to be moving to the governor's desk. We're not going to stop pushing once it gets through our house.

We'll continue to push and make sure that they get that signature that they're needed to go into place and then also continue to push around budget items that are going to be helping to fund programs that are working and programs that are saving lives. And that's really what we want to do in the end. So, very committed to doing this work. Thank you for your work and your insight and hope to continue to partner on making a difference on this issue and saving lives. Thank you.

Thank you again to both of you and to Mr. Alvarez and Ms. Waldron. And on behalf of the committee, again, thank you to all of the witnesses, the attendees, to the Tribal Council. Thank you again for hosting us. I want to also thank my staff. This committee is something that we've taken on and has also been something that my office has really stepped up to take responsibility for.

And of course, a lot of that falls on the staff who has done tremendous work working with everyone here. Cassidy and Abigail from my staff are both here and really appreciate their work as well. So now we're going to adjourn this hearing and I know we're going to have lunch, which I think is right out there, and then we are planning to leave to go to visit the clinic, I think at around 1:00. Again, thank you so much, everyone.

We're really grateful to have held this hearing. This is really be the beginning or a continuation of a conversation that, as you heard up here, is going to lead to solution, is going to lead to action and investments, and will hopefully lead to some actions that save lives. Thank you again and this hearing is adjourned.