In SOR III, California will continue efforts under the Medication Assisted Treatment (MAT) Expansion Project to implement and expand evidence-based treatment for opioid use disorder (OUD). Priority populations include Black, Tribal/Urban Indian, Hispanic/Latinx, and LGBTQI+ communities, people experiencing homelessness, people in criminal justice settings, and youth. Over the lifetime of the project, California will directly serve about 50,000 clients (25,000 each year) and impact 300,000 individuals (150,000 each year) through prevention and education.
Overdose death rates in the state of California have increased rapidly in the wake of the COVID-19 pandemic (Kiang et al. 2022). As of the end of 2020, the rate of all drug-related overdose deaths rose to 21.6 deaths per 100,000 residents, a 44.3 percent increase over the prior year (CDPH 2022). While opioids were involved in the greatest proportion of drug-related overdoses (61.9 percent), psychostimulants were involved in nearly half (49.5 percent). This may be driven, in part, by the increasing presence of synthetic opioids, like fentanyl, in stimulants and other drugs (Shover et al. 2020). There is an urgent and growing need to address the health and safety of California residents who use all drug types, especially fentanyl.
SOR III projects and activities will be implemented across the state with an emphasis on areas with the highest rate and volume of overdose deaths. Activities will focus on where individuals with substance use disorders (SUD) are routinely present, such as primary care, hospitals, SUD treatment providers, and justice involved settings. Increasing access to and use of services across the continuum of care – from prevention through treatment and recovery – will be a priority. However, several barriers remain to realizing this vision, including access to MAT. This is a concern in rural areas of the state, but many urban areas still lack capacity to treat all individuals with an OUD. Stigma also continues to pose barriers to referrals and engagement in treatment for individuals with OUD. Effective education for the justice-involved system, courts, child welfare, health system, behavioral health workforce, and SUD providers continues to be an effective method to combat stigma and engage clients into services.
California has the following objectives under SOR III: 1) Expand access to MAT through strategic access points; 2) Address health inequities by providing OUD treatment to specific populations (Black, Tribal/Urban Indian, Hispanic/Latinx, and LGBTQI+ communities, people experiencing homelessness, people in criminal justice settings, and youth); 3) Expand overdose prevention activities to prevent opioid, fentanyl, and methamphetamine misuse and overdose deaths; and 4) Expand access to evidence-based harm reduction approaches, including overdose education, access to naloxone, counseling, and referral to treatment for OUD and SUD.
California’s SOR III projects will use evidence-based practices, including FDA-approved medications, counseling, and peer recovery supports. DHCS will work with county governments, health providers, community organizations, foundations, and other key partners as part of a collaborative effort. The grant will continue to focus on reducing stigma, improving coordination of funding streams, creating project sustainability, and increasing awareness of the effectiveness and availability of treatment for SUD.
Note: All references can be found in Attachment 8 – Needs Assessment.