GUEST VOICES: 2020 Fails to Supply the Demand for Opioid Treatment

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By Ramón Castellblanch, PhD

The COVID-19 pandemic aggravated the opioid epidemic, both in terms of supply and demand. In terms of the supply, we took a terrible hit in the number of programs to fight it. As of September, their revenues were down by over 20%. With those losses, more than half of these programs were not sure that they’d still be operating this spring.

At the same time, demand for substance use disorder (SUD) treatment skyrocketed under the COVID-19 pandemic. For the last three quarters reported, California’s opioid dashboard shows that opioid overdose deaths rose from 882 in the final quarter of 2019 to 1,255 in the second quarter of 2020, an increase of over 40%.

On the bright side, the state of California took some serious steps toward addressing the crisis. Its most notable achievement was in the area of funding SUD treatment. The enactment of SB 855 means that private insurers must cover it. At this beginning of this year, the state Department of Managed Health Care has directed the insurers to submit forms documenting their compliance by February 1.

The state also made gains in the delivery SUD treatment with the enactment of SB 803. This bill set up a program to certify peers of people with SUD to help them access SUD treatment. The federal government has found that peer support can make behavioral healthcare more effective. The Department of Health Care Services is required to promulgate requirements for counties to use in certifying peer support specialists next year.

Before certification, some peer counselors will be able to work in emergency departments this year under a budget appropriation to fund 200 substance use navigators (SUNs). These navigators are essential to helping individuals admitted to the hospital for acute SUD-related causes access long-term treatment and support services. The funding has recently been distributed to E.D.s across the state. The contractor hired to operate the program, California Bridge Program, has sub-contracted with the Vituity physician group to advise E.D.s on the training of SUNs and related tasks.

But much remains to be done. A bill to license outpatient alcoholism or drug misuse recovery or treatment programs receiving Medi-Cal managed care funds, cutting down on sometimes scandalous conditions, was vetoed. Advocates for more effective outpatient recovery programs are having another go in 2021, in the form of AB 77. Supervised drug injection sites have been found to reduce drug overdose, but efforts to authorize them at the state level continually stall out—most recently when a bill to allow such a site in San Francisco passed the state Assembly last year but died in the Senate. Proponents of supervised drug injection sites are trying again in the form of AB 57.

While the gap between those needing SUD treatment and the availability of such treatment may, in some ways, be widening, at least the effort to close it with more and improved SUD treatment appears to have gathered momentum.