Chair Fletcher & Supervisor Anderson Introduce Comprehensive Plan and Funding Framework to Tackle the Opioid Crisis in San Diego County

Chair Nathan Fletcher and Supervisor Joel Anderson of the San Diego County Board of Supervisors today announced details of the Opioid Settlement Framework they are asking the Board of Supervisors to approve on Tuesday, October 25. During a press conference this morning, some of the strategies they introduced included expanding access to Medically Assisted Treatment (MAT), putting “Wellness Advocates” in hospitals, providing wrap-around services and housing, drug disposal strategies and public information campaigns.    

“We have developed a comprehensive, evidence-based strategy to tackle the opioid epidemic in San Diego County,” said Chair Fletcher. “The Opioid Settlement Framework we are voting on next week was shaped by individuals and entities dedicated to treating people suffering with addiction. With this plan in-hand, once those settlement dollars start coming-in, we can quickly take action and put them to work to get people treatment and save lives.”

The County of San Diego is a party to the lawsuits against several opioid manufacturers. As much as $100 million in settlement funds could be received. Under the bi-partisan policy, if passed Tuesday, would be put into a trust to address the local opioid crisis. Instead of waiting for the money to be sent and then creating a plan, Chair Fletcher and Supervisor Anderson proactively engaged with the medical community, hospitals, first responders, social justice and equity advocates and drug treatment specialists to gather input. More than 200 people provided input that created this framework. 

“Opioid addiction has robbed too many San Diegans of our family, friends, and neighbors— and it’s time for the County to step up in a meaningful way,” said Supervisor Anderson. “I am proud to partner with Chair Fletcher to introduce this framework that has been the culmination of months of listening to medical experts and the community. Being proactive with the settlement funds we will receive could make the difference between life and death for those affected by this crisis.”

The Framework is structured to provide guidance on a two-phased implementation strategy. Certain programs should be implemented immediately as funds become available and other programs will require additional structures be put in place before they can be successfully implemented. 

Additionally, there is flexibility built into the Framework in the event there are updated guidelines on the use of these funds. Examples of the programs the Framework recommends funding include:

• Healthcare Integration
  • Medicated Assisted Treatment (Phase 1)
    • Expand services such as navigators and on-call teams to begin MAT in hospital emergency departments. 
    • Provide MAT education and awareness training to healthcare providers, emergency medical technicians (EMTs), law enforcement personnel, and other first responders.
    • Provide treatment and recovery support services such as residential and inpatient treatment, intensive outpatient treatment, outpatient therapy or counseling, and recovery housing that allow or integrate medication with other support services. 
  • Emergency Department Relay and Other Services (Phase 1)
    • Establish a 24/7 service called the ED Relay Model that dispatches “Wellness Advocates” to hospitals to meet patients in substance use crises. Wellness Advocates stay in contact with patients for up to 90 days and connect them to appropriate support services, including overdose prevention, harm reduction, substance use disorder treatment, social services, eligibility programs, and emergency housing. 
  • Therapies (Phase 1) 
    • Support contingency management services, cognitive behavioral therapy, and other evidence-based therapies for people with substance use disorders (SUD), opioid use disorders (OUD) (and/or any co-occurring mental health conditions). 
  • Justice Involved Persons (Phase 1)
    • Increase funding for jails to provide treatment to people who are incarcerated with OUD, with consideration of utilizing telemedicine.
    • Provide wrap-around services and connection to peer support specialists for people leaving incarceration.
    • Provide funding for a technology hub for medical information and data exchange between jails, County departments, community-based organizations, and health and hospital systems, which may include integration with the Community Information Exchange and Health Information Exchange. 
  • Pregnant & Postpartum (Phase 2) 
    • Expand comprehensive evidence-based treatment and recovery services, including MAT, for uninsured women with OUD and any co-occurring SUD/MH conditions for up to 12 months postpartum. 
• Harm Reduction & Prevention
  • Public Health Messaging Campaign (Phase 1)
    • Funding for media campaigns to prevent opioid use (similar to the Truth campaign to prevent youth from misusing tobacco).
    • Funding for evidence-based prevention programs in schools.
  • Drug Disposal (Phase 1)
    • Funding for community drug disposal programs. 
    • Delivery of drug disposal bags to all households in the County coupled with a public health awareness campaign on safe disposal. 
  • Opioid Antagonist Distribution (Phase 1)
    • Increased availability and distribution of opioid antagonists like Narcan and other drugs that treat overdoses for first responders, overdose patients, individuals with OUD and their friends and family members, schools, community navigators and outreach workers, etc.
    • Provide funding to implement a pilot program for paramedic use of buprenorphine in conjunction with naloxone which would also explore the establishment of overdose-receiving centers to provide a warm handoff for follow-up and wrap-around services. 
  • Treatment/Access to Treatment (Phase 1) 
    • Provide low-threshold evidence-informed harm reduction programs suitable to the geographic location, demographic considerations, and needs of the community including mobile services accompanied with wrap-around services to reduce harms associated with drug use.
  • Evaluation and Data (Phase 2) 
    • Explore the use of data tracking software and applications for overdoses and naloxone revivals.

• Social Supports & Services  
  • Wrap-Around Services (Phase 1)
    • Provide comprehensive wrap-around services to individuals in recovery, including housing, transportation, job placement/training, and childcare. 
    • Provide community support services through County partners and community-based organizations, including social and legal services, to assist in the reintegration of justice-involved persons with OUD and any co-occurring SUD/MH conditions.
    • Provide housing and supportive services for individuals with SUD/MH conditions that are involved in the CARE Court and other collaborative court systems. 
  • Rural Communities & Tribal Partners (Phase 1)
    • Fund and expand OUD/SUD prevention, education, and treatment services in rural communities.
    • Engage tribal and rural leaders on matters related to OUD/SUD efforts.
    • Address barriers to access for rural and tribal partners. 
  • Housing (Phase 2) 
    • Provide access to housing for people with OUD and any co-occurring or dual diagnoses SUD/MH conditions, including supportive housing, recovery housing, housing assistance programs, training for housing providers, or recovery housing programs that allow or integrate Federal Food and Drug Administration approved mediation with other support services.
  • Workforce Investments (Phase 2)
    • Support workforce development for addiction professionals who work with persons with OUD and any co-occurring SUD/MH conditions. 

In 2021, more than 900 San Diegans died from opioid related accidental overdoses, a 54 percent increase from the previous year.  In 2021, San Diego County recorded over 800 fentanyl-related overdose deaths. This marks over a 400 percent increase in two years, from 151 recorded deaths in 2019. 

In March during his State of the County Address, Chair Fletcher introduced the idea of developing the plan, and then in May together with Supervisor Anderson they launched a months-long process to develop the Framework.   

In early 2021, Chair Fletcher received support from a majority of his colleagues, to give the Behavioral Health Services team more authority to implement industry best practices to help San Diegans manage their addiction to opioids and other debilitating substances. In May of 2021, County Public Health Officer Dr. Wilma Wooten signed a Naloxone Standing Order to allow: 1.) Community organizations to distribute without a prescription to any person at risk of an overdose or to a family member, friend, or other person able to assist; and 2.) The administration of naloxone to a person suspected of experiencing an overdose by a family member, friend or bystander. And in December Chair Fletcher and the San Diego County Board of Supervisors voted 5 to 0 to move forward several harm reduction drug treatment projects being undertaken by the County’s Public and Behavioral Health Services. 

Signs of an Overdose

To determine if someone you know has overdosed on opioids, fentanyl or other drugs, the Centers for Disease Control and Prevention says to look for these signs:

• Small, constricted “pinpoint pupils”
• Falling asleep or loss of consciousness
• Slow, shallow breathing
• Choking or gurgling sounds
• Limp body
• Pale, blue gray or cold skin

Get help for Addiction

The County has inpatient and outpatient treatment services available throughout the region that can help San Diegans with substance use disorders. People seeking help should call the San Diego County Access and Crisis Line 888-724-7240 or 2-1-1 San Diego. Both resources are available 24 hours a day, seven days a week.