Confronting surge in overdose deaths, supervisors make plans for opioid settlement money

San Diego County officials are making plans to tackle opioid addiction and overdoses, using $100 million the county expects to receive from settlements with drug manufacturers.

On Tuesday, Oct. 25, the Board of Supervisors unanimously approved an opioid settlement framework that would fund counseling for overdose survivors, expand treatment for opioid addiction, provide housing and other services for people with substance use disorders and create a system for safe disposal of unused prescription drugs.

The county is fighting several lawsuits against opioid manufacturers, seeking damages for the public health costs of opioid addiction and deaths. County officials didn’t provide additional details on the status of the lawsuits or exactly how much they anticipate from each, but Board Chair Nathan Fletcher said the county expects to receive the first payment of about $4 million in November.

Although that’s a small portion of the total they anticipate, board members decided to develop programs now so they will be in place when the county receives the remaining funds in subsequent years.

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“What we are proposing in our framework is to kickstart a substantial investment” in opioid treatment and prevention, Fletcher said.

In addition to problems caused by prescription opioids, the county has seen a sharp uptick in overdose deaths from illicit forms of the powerful synthetic opioid fentanyl. Those deaths surged from 151 in 2019 to more than 800 in 2021, according to county authorities. In June, the county declared illegal fentanyl a public health crisis.

The first phase of the program would expand medication-assisted treatment programs for opioid addiction and add services such as mental health therapy and housing for people with substance use disorders.

Through a 24-hour peer-support program called the Relay model, the county would dispatch peer advocates to hospitals to counsel patients who survive overdoses, to persuade them to enter treatment before they resume drug use.

“With Narcan, we have so many near-misses, but there’s nothing after the near-misses,” San Diego County District Attorney Summer Stephan said, referring to naloxone, the drug administered to reverse opioid overdose. “We actually hear from our paramedics that they respond to the same person again and again.”

The county plan would expand treatment for people dealing with substance use in jails and would provide prenatal and postpartum care for women with opioid addiction.

And it would work to prevent fatal overdoses by distributing naloxone or other similar drugs, creating education programs to discourage opioid use and distributing prescription drug disposal bags to all households in an effort to reduce the number of opioids found in homes.

Many people addicted to heroin or other street drugs started by taking prescription opioids that were prescribed to other family members, Fletcher said. By destroying unused drugs, families can prevent that abuse, he said. Drug disposal bags have been used successfully in other states, including Ohio, West Virginia and New York, and have reduced the unused drugs kept in home medicine cabinets, he said.

Michaela Blackmon, who said her sister died of a fentanyl overdose last year, spoke in support of the program, but added that it must provide resources not only to patients dealing with addiction but also to families supporting them.

“Substances cause a literal hijacking of the brain, but you see substance use is always about more than just the substance; it’s trauma, it’s mental health, it’s homelessness,” Blackmon said. “Families need help. We need education. We need training and programs that are readily available and accessible.”

Others urged the county to deter addiction before it starts with prevention programs for children and teens.

Several speakers said the county, which is expanding its marijuana licensing program, must restrict marijuana advertising and dedicate funding to enforcing age limits, arguing that underage marijuana use can increase the risk of other substance use disorders.

A speaker from Rady Children’s Hospital noted that the county’s framework is aimed at adults dealing with long-term addiction and that there is no “playbook” for pediatricians treating children affected by opioids.

She called for programs to address the drugs’ impacts on children, including infants born to addicted mothers and children at risk of substance use because of childhood trauma or peer problems.