SUBSTANCE ABUSE AND MENTAL HEALTH

SERVICES ADMINISTRATION

CENTER FOR SUBSTANCE ABUSE TREATMENT

NATIONAL ADVISORY COUNCIL

Friday,

June 23, 2006

Video Teleconference Room L-1057

Substance Abuse and Mental Health Services Administration

1 Choke Cherry Road

Rockville, Maryland

IN ATTENDANCE:

[Chair]{.underline}

H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM

Director

Center for Substance Abuse Treatment

1 Choke Cherry Road, Room 5-1015

Rockville, Maryland 20857

[Executive Secretary]{.underline}

Cynthia A. Graham, M.S.

Public Health Analyst

Center for Substance Abuse Treatment

1 Choke Cherry Road, Room 5-1036

Rockville, Maryland 20857

[Members]{.underline}

Anita B. Bertrand, M.S.W.

Executive Director

Northern Ohio Recovery Association

3746 Prospect Avenue

Cleveland, Ohio 44115

Kenneth A. DeCerchio, M.S.W.

Director

Florida Department of Children and Families

Substance Abuse Program

1317 Winewood Boulevard

Tallahassee, Florida 32311

Bettye Ward Fletcher, Ph.D.

President and CEO

Professional Associates, Inc.

Brandon, Mississippi 39047

Valera Jackson, M.S.

CEO

Village South/WestCare Foundation, Inc.

3180 Biscayne Boulevard

Miami, Florida 33137

IN ATTENDANCE:

Chilo L. Madrid, Ph.D.

CEO

Aliviane NO-AD, Inc.

7722 North Loop Road

El Paso, Texas 79915

Francis A. McCorry, Ph.D.

Director

Clinical Services Unit

Division of Health and Planning Services

New York State Office of Alcoholism

and Substance Abuse Services

501 7th Street

New York, New York 10018

David P. Peterson

Executive Vice President

Rockford Products

707 Harrison Avenue

Rockford, Illinois 61104

[C O N T E N T S]{.underline}

PAGE

Call to Order

H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM

Director, CSAT 5

Council Roll Call 5

Consideration of February 2-3,

2006 Council Minutes 7

Director\'s Report

H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM 8

Recovery Month Update

Michele Westbrook

Consumer Affairs Office

SAMHSA/CSAT\'s Office of the Director 22

Discussion 27

Council Roundtable 29

[P R O C E E D I N G S]{.underline} (11:38 a.m.)

DR. CLARK: This is the open session of the 46th meeting of the CSAT
National Council. It is called to order.

I\'d like you to know that since this is a teleconference meeting, the
possibility exists for minor interruptions if others decide to join the
meeting. To those of you who may be joining the meeting for the first
time, good morning and welcome to the open session of the 46th meeting
of the CSAT National Advisory Council.

Due to a scheduling conflict, we had to reschedule our original
face-to-face meeting to a teleconference meeting. We thought that since
we had not met with you since February, we should provide you with a
brief update on some of the activities that have been going on within
CSAT and SAMHSA since we last met.

Our very first item of business, of course, is role call. Please respond
when your name is called.

Anita Bertrand?

MS. BERTRAND: I\'m present.

DR. CLARK: Bettye Ward Fletcher?

DR. FLETCHER: Present.

DR. CLARK: Ken DeCerchio?

MR. DeCERCHIO: Present.

DR. CLARK: Melody Heaps?

MS. HEAPS: Present.

DR. CLARK: Val Jackson?

MS. JACKSON: Present.

DR. CLARK: Chilo Madrid?

MR. MADRID: Present.

DR. CLARK: Frank McCorry?

MR. McCORRY: Present.

DR. CLARK: Dave Peterson?

MR. PETERSON: Present.

DR. CLARK: And Judge Eugene White-Fish?

PARTICIPANT: He had to sign off.

DR. CLARK: He had to sign off. All right. And Eric Voth also signed off,
obviously. That\'s still enough for a quorum.

We\'re delighted to have each of you with us today. We are especially
delighted that Mr. David Peterson, our veteran member, is able to
participate in this meeting. Dave\'s term actually ended in November of
2005. However, Dave will be with us until his successor\'s appointment
is finalized.

So Dave, you are still a member of the council, and we are happy to have
you participate in this meeting today.

MR. PETERSON: Thank you.

DR. CLARK: We want to officially thank you for your valuable input and
contributions to CSAT and CSAT\'s advisory council. You will be
receiving a certificate of appreciation signed by Mr. Curie and myself
which reads, \"With appreciation for your outstanding tenure on the
Substance Abuse and Mental Health Services Administration\'s Center for
Substance Abuse Treatment National Advisory Council, and gratitude for
your tireless effort, support, advice, and insights to the benefit of
SAMHSA, the Department of Health and Human Services, and people we
serve.\"

Again, we thank you.

The floor is now open to vote on the minutes from the February 2nd and
3rd NAC meeting. I\'ll entertain a motion to adopt the minutes.

PARTICIPANT: So moved.

DR. CLARK: Is there any discussion?

(No response.)

DR. CLARK: May I get a vote? All those in favor?

(Chorus of ayes.)

DR. CLARK: Any opposed?

(No response.)

DR. CLARK: Did we have a second? I don\'t recall having a second, come
to think of it.

PARTICIPANT: I second it.

DR. CLARK: All right. It has been moved, seconded, and voted upon. The
minutes have been adopted.

There have been several developments at SAMHSA since our last meeting. I
guess the foremost issue is that, as some of you are aware, and all of
you will soon be aware, the Administrator of the Substance Abuse and
Mental Health Services Administration has tenured his resignation as of
August 5th of this year, which is roughly six weeks from now.

We are awaiting the appointment of his replacement. In the interim, we
do currently have Dr. Eric Broderick, who is the Acting Deputy
Administrator. Whether he will be appointed the Acting Administrator is
not clear. So once we get greater clarity on these matters, we will let
you know.

But I think that is the first item, because it means that there may be
some transitions in terms of administrative activities. Probably not
budget activities, but again, it would be idle speculation pending the
appointment of Mr. Curie\'s successor.

MS. HEAPS: Dr. Clark?

DR. CLARK: Yes?

MS. HEAPS: I don\'t know if this is the time. This is Melody speaking.

I think it would be a nice gesture if the council were to send a letter
to Mr. Curie thanking him for his service and his contribution of the
vision for recovery.

MS. JACKSON: I\'ll go ahead and second that motion.

DR. CLARK: It has been moved and seconded that a letter be sent to Mr.
Curie from CSAT\'s NAC thanking him for his program and his priorities.

MS. HEAPS: I would be happy, if you gave me a few weeks, to write a
draft that I could send to Cynthia to circulate. Anybody can edit it,
and then we\'ll send it.

DR. CLARK: A few weeks, did you say? Or a few days?

MS. HEAPS: A few weeks. I would have to have a few weeks.

DR. CLARK: Well, maybe somebody will help you. Remember, he only has six
weeks left.

MS. HEAPS: I know, I know. Does somebody else want to volunteer?

MS. JACKSON: Well, I could work on it. I could probably do it in maybe
ten days or so.

DR. CLARK: That works for me. That\'s what I was trying to point out,
that it is six weeks. So when I hear a few weeks ‑‑

MS. HEAPS: Yes.

MS. JACKSON: Why don\'t you just see if anybody else could email me any
particular thoughts as to how ‑‑ I think we have each other\'s emails,
don\'t we?

MS. HEAPS: Cynthia, maybe you could give us a list of all the emails?

DR. CLARK: We can do that.

THE REPORTER: Dr. Clark, excuse me. Could our participants on the phone
please identify themselves each time you speak? This is for the
transcriber. Thank you.

MS. JACKSON: All right. This is Val Jackson volunteering to do the
letter with input from people.

DR. CLARK: All right. We still haven\'t voted on this, but it sounds
like people want to do that. So all those in favor of sending a letter?

(Chorus of ayes.)

DR. CLARK: Anybody opposed?

(No response.)

DR. CLARK: Very good. So Val and Melody will coordinate that. I think
it\'s a great gesture. I agree with you, Melody, that Mr. Curie\'s
leadership has given us some framework, goals, and objectives, and a
language that cuts across centers and addresses the populations that we
serve. He will undoubtedly appreciate receiving that.

On June 13th, the full House Appropriations Committee approved an FY
\'07 spending bill for programs at the Departments of Labor, Health and
Human Services. Now, the full House hasn\'t voted on it.

PARTICIPANT: They may have by now.

DR. CLARK: They may have by now. They were waiting on this issue of
minimum wage, and that apparently was addressed yesterday when the House
rejected any changes at this juncture in time.

The committee proposal includes a \$3.343 billion program level for
SAMHSA. This is an increase of \$82.9 million, or 2.5 percent above the
FY \'07 President\'s budget request.

For CSAT\'s Programs of Regional and National Significance, CSAT would
receive \$326.7 million, representing a \$72 million cut from the last
year\'s PRN funding, and nearly \$48.7 million less than the
President\'s budget request.

The House Committee proposes to maintain the following programs at the
FY \'06 level. Homeless programs at \$34.4 million, minority AIDS at
\$63.1 million, and minority fellowship program at \$531,000.

Changes to program fundings include SBIRT, which would now get \$31.2
million for Screening, Brief Intervention, Referral, and Treatment.
Methamphetamine treatment programs would be \$25 million targeted toward
methamphetamine, and grantees may be able to use this for vouchers
should they choose, and \$3.7 million for congressional earmarks.

Of significance is no proposed funding for the new Access to Recovery
Program that is in the President\'s budget. The House Committee proposes
\$1.834 billion for the Substance Abuse Prevention and Treatment Block
Grant. This is roughly a \$75.4 million increase over the President\'s
request.

In total, CSAT\'s FY \'07 House Committee approved appropriation is
\$2.161 billion, an increase of \$3 million over the FY \'06, and a
\$26.7 million increase over the President\'s budget.

Due to the committee\'s action to not fund Access to Recovery and its
decision to redirect \$75.4 million to the SAPT block grant while
funding the meth initiative, the net effect is a restoration of non-ATR
PRNS funding.

As of now, the House bill is scheduled today, so we\'ll just have to
wait and see what they do. Remember, this is only the House side. The
appropriations bills have to be addressed by both chambers, and then it
has to be signed by the President, so this is just preliminary. So
we\'ll wait and see.

SAMHSA is supporting the President\'s budget and the President\'s ATR
initiative. There is some hope that perhaps ATR at the full floor will
be reinserted in the budget. Should that not happen, then we will have
to wait to see what the Senate does.

MS. HEAPS: Dr. Clark, I\'m sorry. Somehow the phone wiggled. I didn\'t
get the last three sentences or four sentences about what happened to
ATR. Melody Heaps asking.

DR. CLARK: Sure. In the House full committee, there is no funding for a
new cohort of ‑‑

MS. HEAPS: ATR?

DR. CLARK: ATR. Which would mean that should that be sustained by the
full House and then subsequently by the Senate, the bill which the
President will be presented would contain no new money for ATR, which
would be ‑‑

MS. HEAPS: Thank you. I got it now.

DR. CLARK: And I will now highlight developments in our program areas to
address the issue of methamphetamine.

As many of you are well aware, this issue of methamphetamine has gained
a tremendous amount of media attention and currency not only in rural
and frontier states, but on Indian reservations. We\'ve had meetings
with a number of tribal entities and tribal governing authorities, and
methamphetamine is a problem for them, as well as for a host of states
like Idaho, Montana, and Kansas.

CSAT\'s Division of State and Community Assistance, with the Division of
Services Improvement, recently convened two summits on methamphetamine.
The first summit was convened in Los Angeles on April 5th and 7th. The
second was in Orlando on May 23rd and 25th. The purpose of these two
summits of course was to provide single-state authorities with
subsequent information about methamphetamine treatment, epidemiology,
and strategies.

The summits were specifically designed for program administrators,
clinicians from the front-line treatment, and state agency staff
involved in developing, regulating, and funding methamphetamine
treatment. There were approximately 765 participants at the two summits,
including single-state directors, state agency staff, and others.

The major aim of the summits was to showcase evidence-based
methamphetamine treatment approaches and help participants better
connect science to practice, thus strengthening the likelihood of
positive outcomes for clients with methamphetamine problems.

In an effort to address the impact that methamphetamine has on children
and families, SAMHSA

co-sponsored a national methamphetamine in child welfare conference with
the Administration of Children and Families\' Children\'s Bureau on May
8th and 9th, entitled \"Methamphetamine: The Child Welfare Impact and
Response.\"

The 350 child welfare and substance abuse professionals present also
discussed how state child welfare systems are dealing with the influx of
more families into their systems as a result of methamphetamine abuse.
The conference provided a forum for CSAT to highlight the effectiveness
and treatment from methamphetamine and the need for a strong,
established collaborative partnership among treatment, law enforcement,
and child protective service agencies.

As you know, HHS has asked SAMHSA to address behavioral health factors,
including mental health, substance abuse, and suicide prevention, and
preparedness response and recovery efforts for all natural and
human-made disasters that occur across the nation.

In culmination of our responses to Hurricanes Katrina, Wilma, and Rita,
SAMHSA convened a disaster meeting on May 22nd to 24th, 2006 in New
Orleans entitled \"The Spirit of Recovery: All-Hazards Behavioral Health
Preparedness and Response: Building on the Lessons of Hurricanes
Katrina, Rita, and Wilma.\"

I served as the co-chair for the planning of this meeting, along with
Kathryn Power. The three meeting objectives were review lessons from
Hurricanes Katrina, Rita, and Wilma, identify opportunities for
consolidation of the ongoing response and behavioral health issues, and
strategize all-hazard preparedness efforts for future disasters, and
there was particular attention paid to the inclusion of substance abuse
treatment throughout the plenaries, breakout sessions, and state
planning meetings.

Each state, through the governor, was invited to select up to ten
participants with SAMHSA supporting five. In addition, national
organizations, selected tribes of those that were directly affected by
the hurricanes, and federal partners were invited.

There were over 700 participants. Six CSAT staff participated as
presenters, facilitators, and moderators. All the PowerPoint
presentations and some of the plenary videos will be available on the
Disaster Technical Assistance Center website by mid-June at
www.spiritofrecoverysummit.com.

We\'ll get you that, and it should be done by the end of this month.
Mid-July, actually. So we will get you the specific number, because we
know how web addresses are. One digit or letter off, and you are in
Neverneverland. So I want to make sure you get the right one.

Robert Lubran, the Director of the Division of Pharmacologic Therapies,
and Cheri Nolan, the Senior Advisor to the Administrator, participated
in the international conference \"The Health of a Nation and Fight
Against Narcoterrorism\" in Moscow, Russia on March 29th through the
31st. I also attended that meeting.

The purpose of the visit was to describe the United States regulatory
program for oversight of opioid treatment programs and SAMHSA\'s role in
the implementation of the Drug Treatment Act of 2000, permitting the use
of buprenorphine, either Suboxone or Subutex, in detoxification and
maintenance treatment of opioid dependence. I spoke to the attendees
about the impact of medication-assisted treatment and preventing the
transmission of HIV and other infectious disease.

The Department of Health and Human Services hosted a series of 11 tribal
consultation sessions across the country during the spring of 2006. The
tribal consultation took several forms, including a national budget
consultation session that focused on the health and human services
budget priorities of tribes, as well as regional consultation sessions
which were coordinated by HHS regional directors. Participants in the
sessions included tribal leaders from all federally recognized tribes,
representatives from HHS operational divisions, and SAMHSA and CSAT
staff.

Among all the consultation sessions, the highest priority for attention
was given to issues related to suicide prevention, alcohol abuse and
dependence, the widespread abuse and dependence on methamphetamine with
associated criminal justice and child welfare issues, and the concern
that tribes are having difficulty winning competitive grants.

SAMHSA has developed a draft tribal consultation policy which has been
distributed for comment, while the FY 2007 President\'s budget includes
almost \$3 million for a new American Indian/Alaska Native youth suicide
prevention initiative.

On March 16th through the 18th, SAMHSA sponsored a three-day conference
with the Therapeutic Communities of America in Washington, D.C., \"The
Road Home: The National Behavioral Health Conference on Returning
Veterans and Their Families,\" which brought together over 1,000
representatives of federal, state, public, and private service
providers. The participants sought to explicate the needs and challenges
of all veterans, particularly service members returning from Iraq and
Afghanistan, and increase coordination, linkages, and collaboration
across communities of service providers to address those needs.

We really stress that while the VA and DOD are the principle service
providers, there are a number of individuals for several reasons who
would receive care from community providers, and we wanted community
providers to be able to reinforce the safety net created by DOD and DVA.

DSCA offered a series of intensive trainings on motivational enhancement
therapy and cognitive-behavioral therapy for adolescent cannabis users,
five sessions. The primary aim of the two-day training was to provide
detailed guidance on how to implement this brief intervention model of
treatment in the participant\'s program. Seven such trainings will
occur. They started in April, and the last one will be later this month.
We anticipate about 230 people will be trained.

We are particularly pleased to share with you that the 2005 Recovery
Month television campaign has been in the top 3 percent by number of
plays among the 477 to 497 campaigns being monitored by Nielsen from
December 26th to April 30th. It ranked 11th out of 486 campaigns Nielsen
monitored, putting it in the top 2.2 percent.

The United States Senate has introduced a bill which includes a
provision that would significantly affect the 30-patient limit
established under the Drug Addiction Treatment Act with regard to
buprenorphine. Currently DATA, the Drug Addiction Treatment Act, limits
the number of patients that a physician can treat to no more than 30
patients at any one time.

The Senate bill is called S.2560, which would reauthorize the Office of
National Drug Control Policy. It includes a section that would amend the
Controlled Substances Act by permitting a physician with a DATA waiver
to submit a second notification to the Secretary of HHS to treat more
than 30 patients.

The Partners for Recovery initiative is sponsoring a national conference
for leaders of addiction services on July 24th and 25th. This conference
is to recognize the first year of graduates of the PFR/ATTC-sponsored
Leadership Institute being conducted at 13 ATTCs across the nation.

Joining the graduates will be members of the PFR Steering Committee, who
are themselves current leaders in the field of addiction prevention,
treatment, and mental health services. Opportunities for networking and
cross-fertilization among current and future leaders are planned
throughout the two-day event, and Maestro Benjamin Zander, conductor of
the Boston Philharmonic, has graciously accepted our invitation to give
a two-hour presentation on the topic of leadership.

On July 12th to 14th, SAMHSA, in partnership with the National Institute
on Drug Abuse and the National Institute on Alcohol Abuse and
Alcoholism, will host the 2006 National Conference on \"Women,
Addiction, and Recovery: News You Can Use,\" in Anaheim, California.
This two and a half day conference will advance the field of women\'s
substance abuse treatment by presenting the latest research and
discussing how it can be applied and implemented to improve clinical
services.

The Director\'s report will also be electronically transmitted to
members following this meeting, and will be available to anybody else
who wants it.

We are working with the Office of National Drug Control Policy to
co-sponsor meetings on methamphetamine. They will be holding regional
meetings, the first of which will be July 13th and 14th in Birmingham,
Alabama.

Recently, SAMHSA participated in NASADAD\'s annual meeting, where we met
with the single-state authorities, the prevention authorities, and
methadone authorities to discuss a wide range of issues directly
affecting states.

We also plan to have, at the end of July, a meeting with grantees on ATR
where we will discuss the progress ATR has made and the future of the
initiative.

So that is a lot of the stuff that we have been doing. Any questions?

(No response.)

DR. CLARK: No questions.

Michele Westbrook, are you there?

THE OPERATOR: Yes, sir, she is here. I will open up her line for her
presentation.

DR. CLARK: Open up those lines. Michele, are you there now? The line is
not open yet.

MS. WESTBROOK: Hello?

THE OPERATOR: Ms. Westbrook\'s line is open.

DR. CLARK: Since we will not have a face-to-face meeting before Recovery
Month, Michele Westbrook in our Office of Consumer Affairs is on the
line and will provide an update on the plans that are well underway for
2006 Recovery Month activities.

Michele?

MS. WESTBROOK: Hi. Good afternoon. How are you?

I just wanted to give you a real quick rundown on some of the things
that we\'re going to be doing in 2006 for anybody who is new. This is
going to be the (inaudible) year of the observance for National Alcohol
and Drug Addiction Recovery Month, and the 2006 theme is \"Join the
Voices for Recovery: Building Stronger, Healthier Communities.\"

September is the dedicated month for Recovery Month, and Recovery Month
highlights valuable benefits of substance abuse treatment, valuable
contributions of treatment providers, and promotes the concept that
recovery from substance abuse in all its forms is possible.

We have been working with hundreds of national and local organizations
across the country to come up with the theme and the materials that
we\'ll be using. We created 75,000 tool kits, which were delivered to
CSAT on May 23rd, and I\'m happy to say that we have less than 4,000
left in stock. So they are going fast and furious to get into the hands
of those who will be using them for Recovery Month events and
celebrations.

With a website, which is www.recoverymonth.gov, we have just been
notified that we won a Gold Screen Award of Excellence from the National
Association of Government Communicators. So we are happy to have that.
That was for the 2005 site, a 2006 award.

We have already had over 5 million hits on the site since January. So
people are out there. They\'re looking for information, they are trying
to decide about their lives, and they\'re looking for resources and at
the webcast, and downloading the tool kits.

We are having an average length ‑‑ people are spending about 20 minutes
and 28 seconds on the site per visit. So obviously, we are providing
information that they find useful, because they are staying and they are
coming back.

We have already 100 events posted online. The last time I checked, there
were 16 states that did not have events posted, and that has
dramatically dropped since then. We have been adding them by the day. I
probably have been doing about five or six a day now.

We have 10 proclamations from governors and mayors throughout the
country, and 29 Voices of Recovery posted. The Voices of Recovery are
people who have volunteered to tell their stories of recovery, whether
it be that they are in recovery or a family or friend. It\'s online, and
we have their full consent that says that they have agreed to be on
there. So 29 people are coming to tell their stores and share them, and
so we think that\'s wonderful.

The webcasts, we have produced already six to date. They have been
aired. We have another four more coming out. They air the first
Wednesday of each month. You can watch them online, download them, or
order them. They are panel presentations with four panelists and a host.
We go out and we do case studies and talk to people in the field. They
are used for educational purposes.

They are also used by cable markets. We are currently in more than 264
unique cable markets throughout the country and in about 14.6 million
households. When I say unique cable markets, what exactly we are talking
about is cable in Washington, D.C. Washington, D.C. has two cable
stations within the city that both play these webcasts. We count them as
one unique market. So there are more than 254 stations carrying them,
but we are in 254 markets.

We are initiating a new way of dissemination of the information by
starting podcasting. We have trailers that come up. It\'s kind of a here
is what you are going to see. It\'s an advertisement for the webcast.
They will be automatically downloaded to people\'s podcasts the last day
of the month. So for instance, if we get an initiative, it will come out
the last day of June for the July 5th presentation of the webcast.

So people will get that to remind them to watch it, and then the podcast
will automatically be downloaded when we get that into the technology.
So people will automatically receive these shows and not have to go
online anymore. That\'s a new technology by way of dissemination that
we\'re working with.

The public service announcements, Dr. Clark mentioned that CSAT in 2005
produced the top percentage for Nielsen, which we\'re extremely happy
about, and the new ones are coming out. They will be distributed to
television stations throughout the nation on June 28th, and the radio
will be distributed to stations on July 7th.

We have been in collaboration with the National Association of
Broadcasters to distribute the television and radio as well. They have
taken the Recovery Month tool kit, and they have made a director kit. So
that will go out to all the public service station directors to talk
about what is Recovery Month, why is it important for the local
community to get involved, and why is the media taking an active role.

They can order all of the PSAs from either NAB or through our
organization, and then they will also have a satellite downlink on their
website of the PSAs. So that is yet another way for us to distribute
these. They will all be tracked, so we\'ll have the numbers in place
shortly.

Another component of this year\'s Recovery Month is the sponsored event.
I am happy to say that we have the first annual Recovery Month Walk/Run.
That is being held on September 27th around the grounds of the SAMHSA
building at Choke Cherry. This is a new event that was planned by one of
the staff members in the Office of Consumer Affairs.

We are sponsoring three Recovery Rides in California, Ohio, and New
England. Anita Bertrand is handling the Ohio ride, and they are doing
that on September 30th, so thank you.

MS. BERTRAND: You\'re welcome.

MS. WESTBROOK: We are also doing 25 additional sponsored events. There
are 10 what we call (inaudible) events which are held throughout the
country. They are for the general population. They range from walks and
runs to forums, conferences, and exhibits. We have some art shows. We
also have 15 additional minority events, and those are through
contractors that handle minorities, such as for African American, Asian
Pacific, Hispanic, and Native American.

So we are fast and furiously running through 2006 to September. We just
did all of the artwork for 2007. So we are moving through this year and
moving onto next year. I look forward to talking to you at your next
meeting to tell you how wonderful 2006 ended up.

Does anybody have any questions?

MS. JACKSON: Val Jackson. I don\'t have a question, because I think what
you reported was very comprehensive. I really want to congratulate
SAMHSA, CSAT, and you and the folks who are working with you on the
continuation and expansion of Recovery Month.

I think that it is critically important for us to give our nod of
approval and participation as Anita is doing and I\'m sure several other
people are doing, because as we all know, we need a brand name called
\"recovery,\" and branding is all-important in this world. I think that
this will really help set that particular initiative.

I really thank you for your work, Michele.

MS. WESTBROOK: Thank you.

DR. CLARK: Any further comments on Recovery Month?

(No response.)

DR. CLARK: Well, thank you, Michele.

MS. WESTBROOK: Thank you.

DR. CLARK: And if there are Recovery Month activities within your state
or a nearby state, we hope you are able to participate.

With the ending of Michele\'s comments, we will enter a period for
public comment. If there are members of the public who wish to make
comments at this time, the operator will now take you out of the
listening mode. Please wait for the operator to announce you before
beginning to speak.

THE OPERATOR: +You want all of the public lines opened or just one at a
time, sir?

DR. CLARK: All of them.

THE OPERATOR: All right. All the lines are open. Ms. Alison Smith, Mr.
Malcolm Spicer, Ms. Nancy Clark, and Ms. Lorie Garlick.

DR. CLARK: Any public members with comments?

(No response.)

DR. CLARK: If there are no public members who have a comment, I want to
thank you for listening in and thank you for your participation. That
will take us then to the council roundtable. We don\'t want to close
this meeting without providing an opportunity for council members to
discuss issues that may be of concern to them.

Council members?

MS. HEAPS: This is Melody Heaps. Dr. Clark, I know you know, because
Theodora Binyan Taylor, our SSA Director, has been in touch with you.
The issue of heroin/fentanyl in Chicago is becoming an increasing public
health crisis.

Next month, Congressman Danny Davis tasked the Cook County medical
director, Cook County Hospital medical director, the head of the
Illinois ASAM, and some treatment people will be ‑‑ well, we\'ve called
a press conference to talk about it from a public health standpoint, and
also to ask for more money for treatment.

I just wondered if you could talk in general as to what your
interactions have been not only with Illinois, but with I guess Detroit,
St. Louis, Philadelphia, New York and maybe D.C. or some other city.
Maybe Boston. Are they experiencing this?

DR. CLARK: I\'m glad you raised that. We have actually been working in
concert with CDC, DEA, Office of National Drug Control Policy, and local
law enforcement and public health authorities in local jurisdictions.

We have been aware of this. We also sent out a broadside to our
grantees, to opioid treatment programs, and to state authorities
informing them about the phenomenon and encouraging those who have
contact with individuals who use heroin or who may know individuals who
use heroin to be aware that somebody is poisoning their heroin with
fentanyl.

As you know, one of the problems with fentanyl, especially as we have
subsequently determined that some of it is illegally made, is that it is
hard to use it as a ‑‑ to cut it, as it were. So what you get is a very
small amount which is very potent. The people selling it or giving it
away wind up killing people as a result of it because they can\'t just
boost the heroin, which is their apparent intent. What they wind up
doing is killing off their customers, which obviously is bad for their
business.

We had a meeting the Office of National Drug Control Policy convened,
and at that meeting, representatives from DEA, NIDA, CDC, and Department
of Justice, were all present. There was a subsequent meeting about a
week ago in Chicago. Law enforcement convened with the FBI, the DEA, and
others, local law enforcement, sheriffs and police, and we sent a staff
person to that meeting.

So we have been actively involved in highlighting discussion and making
sure that people were aware that this is happening. Some of you are also
aware that there was an arrest, a fairly broad arrest yesterday. Whether
these are the only individuals involved in the fentanyl/heroin debacle
or were they just part of it, we\'ll have to see. But I\'m glad to see
that people in Chicago are having such a meeting.

There are a number of issues involved in this. For instance, medical
examiners don\'t often check for fentanyl. Heroin overdoses are
generally treated as heroin overdoses. Detroit, it turned out that Wayne
County\'s medical examiner did periodic or random checks of other
narcotics and discovered the fentanyl connection. Then people went back
and looked at a number of other states of sudden death and discovered
that fentanyl was present.

So it involves Camden, New Jersey, Pittsburgh, Philadelphia, Detroit,
Chicago, and St. Louis, and apparently there was a network or a gang
that controlled that corridor and was producing this.

But anything that we can do within our resources, we are perfectly
willing to cooperate with respect to jurisdictions. We talked to
Michigan, we talked to Theodora Binyan. She was going to have a meeting.
We have offered our limited resources to support any subsequent
activity.

This is both a local and regional matter, but we all have to work
together. As we pointed out, that is what keeps us restricted to that
corridor, but some thinly veiled barriers. If we don\'t deal with this
collectively, then we\'ve got a much larger problem.

MS. HEAPS: Right. Just for a moment, I will be happy to send to you the
press release of the talking points so that you are aware of what is
happening here from a public standpoint, Dr. Clark.

The other issue for us in Chicago, and I don\'t know if this is true in
the other areas, and this is a sad thing to say, but part of the reason
that this has gotten such dramatic play is that young suburban youths
have been coming into the city and dying. The son of a police chief of
one of the suburban districts, suburban areas, died.

So it does allow us to get the message out that this is everybody\'s
problem. We are taking, while there is an immediate crisis of fentanyl,
we use the position that this is the drug of the day. There will be new
drugs to come, and until we deal with a broad-based policy that looks at
treatment for addiction and allows us to have support resources for it,
we are going to be constantly following new drug crises.

But yes, Theodora Binyan Taylor has been doing a wonderful job trying to
organize the community behind this. We have talked with the DEA. Our
concern from the DEA law enforcement is that some of us would like to
know, do they think that the gang distribution networks and the
manufacturing will subside, that this may be just a temporary phase, or
is this going to be a new market?

Some of the addicts on the street are actually seeking this drug out
because of its potency, I suppose because it gives such a powerful high
and they think the police are just saying all these bad things about
fentanyl when really there is nothing wrong with it. It is a real
problem.

DR. CLARK: And one of the other things that we\'ve been struggling with
here is how do you communicate with the addict on the street.

MS. HEAPS: Right.

DR. CLARK: And so we have involved peer groups in that dialogue, because
indeed what is logical to someone who is a non-user may not be logical
to someone who is a user. So we understand, and Theodora pointed out
that they initially put up fliers and had to take them down because the
fliers were functioning as magnets for people looking for the drug.

MS. HEAPS: Right.

DR. CLARK: We just need to figure out how to put this thing in proper
language, some social marketing, so that the language that we use when
we are telling people, you know, people are dying. It resonates with
them as opposed to, \"Let me get this stuff. It sounds good.\"

MS. HEAPS: Right. Exactly, and the concern I have, depending on how the
‑‑ and the DEA will be able to tell you this. I have asked that they at
least talk to us about whether, not only for our specific sector, but
whether the gang distribution see this as a potent enough project that
they are now going to try like we have done with other drugs, spread it
out. In other words, move to other sectors.

Certainly the corporate configurations of the gangs that are
distributing this are so sophisticated, that that is clearly possible.
So we are kind of holding our breath on that from a national standpoint.

DR. CLARK: Again, ONDCP, Scott Burns, has taken the leadership at ONDCP
to make sure that we have an interagency focus. Mr. Walters\' aide, Dave
Murray, just presented last week ‑‑ well, actually yesterday ‑‑ before
Representative Kennedy and Ramstad\'s meeting on methamphetamine and the
fentanyl overdose.

So again, we all are working in partnership, and I think that\'s the key
issue. So I appreciate your offer, and any ideas or suggestions that you
might have.

I\'m particularly interested in this communication issue. How do I
communicate with individuals whose motives may be paradoxical to my own,
and my own is a public health one, trying to make sure that people
don\'t die, as opposed to trying to figure out just how much to use so
that you don\'t die.

The problem with fentanyl is the unsophisticated person can\'t do that,
and then producers themselves are unsophisticated with that regard,
because it is hard to cut.

MS. HEAPS: There are two things, and then I will shut up about this. We
are having recovery people at the press conference to talk. Dr. Jennifer
Smith is the SBIRT director for Cook County Hospital. The SBIRT clients
have been affected by this. There have been at least 17 people who have
tried to get in treatment programs that are part of SBIRT and have not
been able to, and have had overdose experiences in the last few months.
So we\'ve got a real problem that affects all of us.

So I promise to keep you directly, I presume, informed, and send you
materials. Theodora knows all about this, and we are working in
conjunction with her.

DR. CLARK: And your point is well taken. I will make sure that my staff
is apprised of this. Anne Herron is here. Anything that we can
reasonably do, we will do, because again, we were alarmed initially. We
started doing what we could do.

We are also now hosting weekly phone calls with CDC and others who are
interested in dealing with this matter from the federal point of view.
But again, it requires a partnership that is local as well as federal.

Thank you very much for your offer.

MS. HEAPS: You\'re welcome. Let\'s keep it up. Thank you.

MS. BERTRAND: Dr. Clark, this is Anita.

DR. CLARK: Anita.

MS. BERTRAND: In our September meeting, can we have an update on this
matter?

DR. CLARK: Sure. We\'ll put it down on the agenda. Cynthia is writing
furiously.

MS. BERTRAND: Dr. Clark, as you know, I\'m going to have to sign off.
Thank you for allowing me to speak on this as well.

DR. CLARK: All right.

MS. BERTRAND: Thank you, everyone.

DR. CLARK: Anything else? Anybody else? Any other topics?

(No response.)

DR. CLARK: Well, I want to thank you. If I may repeat myself, I\'m
grateful for the advice and service you provide to CSAT. I hope that
when your terms of services end on the council, you will walk away
knowing that you\'ve made a valuable contribution to the field through
the CSAT National Advisory Council.

This council has been very helpful to us. I just want to tell you I
can\'t say enough that I have appreciated the kind of partnership that
we\'ve been able to forge over time.

I need to remind you that we do have another teleconference meeting
scheduled for August 30th for grant review only. We have six more
programs to review, and need to accomplish the review at the August
meeting.

The next face-to-face meeting is scheduled for September 20th and 21st.
Plans are underway for what promises to be an excellent meeting. We will
add Anita\'s request to that.

I want you to enjoy your summer, and remember we are here to serve you.

MS. JACKSON: This is Val. I think that we are supposed to have an
e-therapy conference call.

DR. CLARK: E-therapy is after this. So we will have that discussion
after this.

If there is no further business, I\'ll entertain a motion to adjourn.

PARTICIPANT: So moved.

PARTICIPANT: Second.

DR. CLARK: It has been moved and seconded that we adjourn. All those in
favor?

(Chorus of ayes.)

DR. CLARK: This meeting is adjourned. We will deal with subsequent
business shortly. Thank you.

(Whereupon, at 12:28 p.m., the meeting was adjourned.)