The Opioid Crisis: California Takes Action

We spend significant time and energy responding to the ongoing opioid crisis in the United States. In this article, we’ll direct that time and energy toward the opioid crisis in California, and how we can best help people in California diagnosed with opioid use disorder (OUD).

In fact, helping people with opioid use disorder is one of our primary priorities. We offer treatment and support to people with opioid use disorder who struggle with other substance use disorders (SUD), including people who engage in the disordered use of alcohol, amphetamines, cocaine, marijuana, benzodiazepines, other substances of misuse, and co-occurring mental health disorders.

However, opioid use disorder and fatal opioid overdose present a significant and immediate risk to millions of people in the U.S. The harm caused by opioid addiction and opioid overdose – all overdose, for that matter – is hard to overstate. Data from the last several years can demonstrate the harm caused in a way words can’t.

Fatal Opioid Overdose and Any Fatal Drug Overdose, 2019-2021

• 2019:
  • 50,178 people died of opioid overdose
  • 67,697 people died of drug overdose
• 2020:
  • 69,061 people died of opioid overdose
  • 78,056 people died of drug overdose
• 2021:
  • 73,453 died of opioid overdose
  • 107,306 people died of drug overdose

Those numbers are shocking. Since 1999, drug overdose deaths have increased by 537 percent, and opioid overdose deaths have increased by 812 percent. That’s why we call it a crisis. That’s why the past two presidents – President Trump and President Biden – used the bully pulpit to promote a national response to the opioid crisis, and mobilized considerable resources to mitigate the significant harm caused by the crisis. You can read the White House Proclamations here and here.

The fact that both administrations – opposite in almost every policy area – agreed on the facts about the crisis and how to address it speaks volumes, and tells us that we need to work together to solve this crisis.

This article is about the impact of the opioid crisis on the State of California, where we operate 40 treatment centers. We’ll share data on two California counties:

• Humboldt County, where we operate Aegis Treatment Centers Eureka in the town of Eureka
• Shasta County, where we operate Aegis Treatment Centers Redding in the town of Redding.

We’ll discuss the impact of the crisis in those two counties, but what we’ll focus on the significant statewide response to the opioid crisis in California, which began in 2014. California has led the way in a unified response to the crisis, prioritizing awareness, treatment, and harm reduction. We’ll discuss their response in detail.

First, though, we’ll offer an overview of the opioid crisis in the U.S. – because understanding the big picture will help contextualize the situation in California.

Brief Summary: The Opioid Crisis in the U.S

The Centers for Disease Control (CDC) describes the opioid crisis as unfolding in three distinct phases, each with distinct characteristics. Each phase contributed to our current situation in different ways. Here’s how the CDC defines these three phases:

Phase 1:

This phase was the direct result of an increase in prescriptions for opioid medication that started in the early 1990s. This increase led to a surge in fatal overdoses nationwide that continued through 2010.

Phase 2:

This phase began around 2010, when regulators increased restrictions on long-term prescriptions for opioid medication. This led to what we now call the prescription to addiction phenomenon. In the absence of medication, many people with OUD who used prescription medication resorted to illicit drugs such as fentanyl or heroin. As a result, rates of fatal overdose continued to rise.

Phase 3:

This phase began in 2012-2013. It’s driven by the presence of fentanyl in the illicit drug supply. The DEA reports that fentanyl is “…present in all 50 states, and that drug traffickers mix this drug with other types of drugs – powder and pill form – to increase addiction and attract repeat buyers.”

Now, in the year 2022, we’re in Phase 4 of the crisis. This phase is different. It’s defined by polysubstance misuse, which is using two or more illicit drugs at once, an increase in the use of stimulants, and an increase in the presence of co-occurring disorders in people with opioid use disorder. Experts also report that the stress and uncertainty of the COVID-19 pandemic contributed to the unique components of Phase 4 of the opioid crisis.

That’s how the opioid crisis happened, and how we ended up where we are today, with overdose rates still trending upward.

Now let’s take a look at the data from those two counties in California: Humboldt County and Shasta County.

The Opioid Crisis in California: County-Level Facts and Figures

One thing you’ll read below – after we share this county-level data – is that California created a data dashboard to help providers, citizens, and policymakers understand the size and scope of the opioid crisis. The dashboard includes data on prescriptions, overdose rates, and treatment. We’ll share the data on overdose and treatment.

First, Humboldt County, where we operate Aegis Treatment Centers Eureka:

Opioid Overdose Rates:

• 2010
  • Humboldt: 16.23 deaths per 100,000 residents
  • California: 4.93 deaths per 100,000 residents
• 2021:
  • Humboldt: 35.15 deaths per 100,000 residents
  • California: 78 deaths per 100,000 residents

Treatment:

• In Humboldt County, prevalence of treatment with medication-assisted treatment increased by 15% between 2018 and 2021.

Those figures indicate that between 2010 and 2021, overdose deaths in Humboldt County increased by 117 percent, while overdose deaths across California increased by 240 percent. The treatment numbers for Humboldt County show a slow increase in prevalence of MAT – but this increase does not match the increase in overdose, which means there’s a significant need to expanded MAT in Humboldt County.

Now let’s look at the data for Shasta County, where we operate Aegis Treatment Centers Redding:

Opioid Overdose Rates:

• 2010
  • Shasta: 52 deaths per 100,000 residents
  • California: 4.93 deaths per 100,000 residents
• 2021:
  • Shasta: 33 deaths per 100,000 residents
  • California: 78 deaths per 100,000 residents

Treatment:

• In Shasta County, prevalence of treatment with medication-assisted treatment increased by 33% between 2018 and 2021.

Those numbers tell us that between 2010 and 2021, overdose deaths in Shasta County increased by 134 percent, which is significantly below the rate of increase for the state of California. The treatment numbers for Shasta County show a significant increase in prevalence of MAT – and in contrast to Humboldt County, this increase exceeds the percent increase in overdose, which means the MAT expansion efforts – which you’ll read about below – appear to be effectively increasing the MAT treatment in Shasta County.

We chose Humboldt and Shasta because they’re rural counties, far in the northern part of the state, and represent populations and regions that are often left behind when we talk about California. When people talk about California, they often focus on the Bay Area, Los Angeles, and San Diego. But the opioid crisis does not have a geographic agenda, and does not discriminate between designations like rural and urban, or high and low socioeconomic status: the crisis is everywhere in the U.S., and everywhere in California, including two of the most remote counties in the state.

Now let’s take a look at the steps the State of California took – and is still taking – to address the opioid crisis.

How California Responded: SOS Workgroups Create and Implement Effective Programs

California – like Ohio – organized a statewide response to the opioid crisis earlier than most states.

In 2014, the California Department of Public Health (CDPH) formed the Statewide Opioid Safety (SOS) Workgroup to guide their response. The SOS includes 40 public and private entities convened to brainstorm and implement collaborative programs to address opioid misuse, addiction, and overdose deaths. In addition, the SOS Workgroup has created supporting task forces that include local and non-government entities.

In 2015, the SOS Workgroup began implementing the various strategies they devised during their planning sessions. Let’s take a look at those strategies now.

Statewide Strategies in California: Eight Action Steps to Address the Opioid Crisis

1: Strengthen Statewide Collaboration

• Task Forces. The SOS Workgroup created four task forces to mitigate the harm caused by the opioid crisis. These task forces included:
  • Communication Task Force:
    • Developed public messaging to warn citizens about the dangers of opioids and the safe use of pain medication
  • Data Task Force:
    • Increased access to key data related to the opioid crisis, including prescription information and overdose statistics
  • Treatment Task Force:
    • Addressed gaps in access to naloxone and medication-assisted treatment
  • Maternal/Neonatal Task Force:
    • Created standards and best-practice policies for pregnant women with OUD
  • New Policies. The SOS Workgroup created a comprehensive policy framework to guide the ongoing response to the opioid crisis. The policy framework prioritized the following statewide needs:
    • Prevention of opioid misuse
    • Management of appropriate use of opioid medication for pain
    • Treatment for opioid use disorder, including:
      • Medication-assisted treatment (MAT)
      • Overall treatment infrastructure
      • Stigma reduction
      • Harm reduction
    • Prevention of overdose fatality:
      • Increasing access to naloxone
      • Establishing needle exchange programs
      • Establishing safe injection sites

2: Promote Safe Prescribing

• Monitoring Programs. In 2016, California launched a prescription drug monitoring program called the Controlled Substance Utilization Review and Evaluation System (CURES).
• Initially, the CURES program allowed providers to:
  • Search a patient database to monitor prescriptions for controlled substances
  • Communicate directly with providers about concerns regarding prescriptions
  • Receive daily alerts on patients who reach prescription thresholds, as well as:
    • Patients with multiple prescribers
    • Patients with high-dose opioids
    • Daily opioids prescriptions that exceed 90 days
  • In 2018, California enhanced this program, and renamed it CURES 2.0. Cures 2.0 require providers to consult the CURES database in the following situations:
    • Upon initial prescription, order, administration, or dispensation of a controlled substance, unless the substance is exempt from CURES
    • At least 24 hours, or one business day, before taking any action related to prescribing, ordering, administering, or dispensing a controlled substance, unless the substance is exempt from CURES
    • In advance of prescribing a substance previously exempt
    • When a controlled substance is part of a treatment plan, providers must consult CURES at least once every six months

3: Build Community Capacity

• Harm Reduction. The SOS Workgroup directed enhanced support for harm reduction programs across the state. Harm reduction, in California, revolves primarily around syringe service programs (SSPs) and drug takeback programs.
  • SSPs: There are now over 60 SSPs in more than 35 counties in California, with plans for new programs across the state
    • All SSP sites provide participants with information on overdose prevention, naloxone access, access to treatment for substance use disorder, and access to necessary social services
  • Drug Disposal:
    • California partners with Drug Enforcement Agency (DEA) drug disposal programs to ensure the safe disposal of unused or expired prescription medication
    • The California Department of Consumer Affairs (DCA) and Board of Pharmacy created a medication disposal site locator listing pharmacies that can and will take back unused or expired prescription medication
  • Over 21,000 patients in California now receive harm reduction services
• Community Coalitions. The SOS Workgroup supported the California Health Care Foundation in developing a the California Opioid Safety Network (COSN), a program designed to help individual communities address the opioid crisis.
  • The COSN launched California Overdose Prevention Network (COPN):
    • COPN programs serve over 33 million people across California, which makes it the largest overdose prevention network in the U.S.

4: Expand Medication Assisted Treatment (MAT)

• The SOS Workgroup created two large-scale, statewide programs to increase access to MAT for people with OUD:
  • MAT Expansion Project 1.0:
    • Initiated a statewide hub and spoke program designed to “improve, expand, and increase access to MAT services.”
    • Initiated the Addiction Treatment Starts Here: Primary Care program, which provided resources for 40 primary care centers to launch or improve MAT programs in the primary care context
  • MAT Expansion Project 2.0:
    • With funding from the Substance Abuse and Health Services Administration (SAMHSA), this program enhanced all programs in MAT Expansion Project 1.0
    • Funding for MAT Expansion Project 2.0 prioritized the following at-risk populations:
      • Tribal
      • Rural
      • Pregnant women
      • Youth
    • Since its inception, the California MAT Expansion Project has achieved the following:
      • Initiated MAT for over 100,000 new patients with OUD
      • Initiated SUD treatment for over 11,000 patients with stimulant use disorder
      • Funded over 30 projects and created more than 600 access points to MAT

 5: Increase Access to Naloxone

• Under the umbrella of the MAT Expansion Projects, providers have:
  • Distributed over 1,000,000 naloxone kits to 2,500 organizations in 58 counties
  • Reversed over 55,000 overdoses

6: Address Priority Populations in High-Risk Settings

• Under the umbrella of the MAT Expansion Projects, state and local officials have increased MAT and SUD treatment access in:
  • 37 county jail systems
  • 12 tribal health programs
  • 22 sites for at-risk youth
  • 10 mental health and substance use disorder treatment clinics

7: Promote Public Education and Awareness

• Increase Public Messaging. The SOS Workgroup expanded funding for public relations campaigns related to the opioid crisis:
  • Since 2015, California reports over 1.2 billion impressions (views) of opioid awareness ads across the following platforms:
    • TV
    • Radio
    • Billboards

8: Translate Data into Actionable Information

• The SOS Workgroup, in collaboration with the California Department of Public Health (CDPH), Injury and Violence Prevention Branch (IVPB), the Office of Statewide Health Planning and Development (OSHPD), Department of Justice (DOJ), and the California Health Care Foundation (CHCF), created the California Opioid Overdose Surveillance Dashboard. The dashboard gives the public, as well as providers, access to four type of data:
  • Opioid and drug overdose deaths
  • Drug and opioid-related emergency department (ED) visits
  • Opioid and drug-related hospitalizations
  • Opioid prescription information

We have to recognize that California has the right idea: their approach is all of the above. Awareness, education, and advocacy share budget space with treatment, prevention, and prescription monitoring. While all the states in the U.S. have programs to address the opioid crisis, California – because of the comprehensive nature of their response – can serve as a template for the rest of the nation.

A Focus on Community

When we talk about the people we want to help, we talk about people diagnosed with substance use disorder. We support people in recovery from all drugs of misuse, from alcohol to opioids. That means we focus on the individuals in treatment.

But when we talk about the people treatment helps, we always talk about individuals, families, and communities. That’s because the opioid crisis – and addiction in general – affects not only individuals, but their families and the communities they live in. When an individual heals, the family heals, and, by extension, the community heals.

What we’d like to point out about California’s response is the focus on communities:

• Harm reduction services reach 21,000 people a year
• Overdose prevention programs reach 33 million people a year
• MAT programs support over 100,000 people each year

The way they reach all those people is by bringing the services to them. The MAT expansion program has over 30 active projects and 600 points of contact for individuals to access evidence-based treatment for opioid use disorder. They’ve created programs for people who live on tribal lands, people who are incarcerated, pregnant women, and at-risk youth – because they’re in need and they can benefit from treatment and support.

The response in California earns high praise from us, because it aligns with our mission and purpose.

We bring people the treatment they need when they need it the most. We offer the latest evidence-based treatment, in the way that works best for individuals, in their actual lives, in the place they need it the most: their communities.