Faced with rising number of overdose deaths, watchdogs make plans to repay opioids

San Diego County officials plan to fight opioid addiction and overdoses by using $100 million the county expects to receive from settlements with drug manufacturers.

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

The county is fighting several lawsuits against opioid manufacturers seeking reimbursement for health care costs from opioid addiction and deaths. County officials did not provide additional details on the status of the claims or exactly how much they expect to receive from each, but board Chairman Nathan Fletcher said the county expects to receive the first payment of about $4 million in November.

Although this is a small part of the total amount that they expect, the board members decided to develop programs now so they will be in place when the county receives the remaining funds in future years.

“What we’re proposing in our framework is to start a significant investment” in opioid treatment and prevention, Fletcher said.

In addition to the problems caused by prescription opioids, the county has seen a sharp rise in overdose deaths from illegal forms of the powerful synthetic opioid fentanyl. The number of deaths has risen from 151 in 2019 to more than 800 in 2021, according to county officials. In June, the county declared illegal fentanyl a public health crisis.

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

Through a 24-hour peer support program called Relay modelthe county will send advocates to hospitals to counsel overdose patients to convince them to begin treatment before they resume drug use.

“We’ve had so many failures with Narcan, but there’s nothing after the failures,” said San Diego County District Attorney Summer Stephan, referring to naloxone, a drug given to reverse opioid overdoses. “We do hear from our paramedics that they answer the same person over and over again.”

The county’s plan would expand treatment for people dealing with substance use in jails and 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 to reduce the amount of opioids found in homes .

Many people addicted to heroin or other street drugs started by taking prescription opioids from other family members, Fletcher said. By destroying unused drugs, families can prevent such abuse, he said. Drug disposal bags have been used successfully in other states, including Ohio, West Virginia and New York, and have reduced the amount of unused medication stored 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 should provide resources not only to patients dealing with addiction but also to the families who support them.

“Substances literally take over the brain, but you see substance use is always about more than just substances; it’s trauma, it’s mental health, it’s homelessness,” Blackmon said. “The family needs help. We need education. We need training and programs that are accessible and affordable.”

Others urged the county to curb drug addiction before starting prevention programs for children and teens.

Several speakers noted the district is expanding its own Marijuana licensing programshould restrict marijuana advertising and allocate funding to enforce age restrictions, arguing that underage marijuana use can increase the risk of other substance use disorders.

A speaker from the Children’s Hospital Board noted that the county system focuses on adults with long-term addiction and that there is no “textbook” for pediatricians treating children with opioid addiction.

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