California is a large state with an extremely diverse population and a wide range of demographics. As such, is it is important for drug abuse treatment programs to be highly individual and cater to each specific population group and person individually. There are close to 2,000 licensed addiction treatment facilities in the state of California.
Drug abuse treatment is a largely unregulated field with many different methods and options to choose from when it comes to getting help. Research into the field of addiction is ongoing, and scientific methods and evidence continue to emerge as to what types of care are most effective for managing the disease of addiction.
As of September 2018, with the passage of SB 823, licensed rehabilitation facilities in California are expected to adopt the American Society of Addiction Medicine’s (ASAM) minimum standard of care as detailed in the ASAM Standards of Care for the Addiction Specialist Physician. Adhering to a standard that is medically based and evidence driven can provide a sense of security in treatment programs and the quality of care that will be provided. There are many options for drug abuse treatment in California based on where a person lives and what type of services may be optimal.
Getting help for drug addiction treatment in California is generally based on the residence of the individual. Drug abuse treatment programs are overseen by local County Mental Health Departments under the umbrella of the California Department of Health Care Services (DHCS).
Local County Health Departments will contract out to community-based providers to offer public behavioral health services, including treatment for substance abuse and addiction. These providers accept Medi-Cal, California’s Medicaid program that is open to all residents of the state who meet financial and eligibility requirements. Beneficiaries of Medi-Cal can obtain a drug waiver to cover costs associated with case management, inpatient treatment, medications, and recovery services. Under the waiver, California residents with limited financial means may be eligible for medically necessary inpatient rehab services — up to two 90 day stays per year with the option for a 30-day extension when needed. Private addiction treatment providers provide a high level of care for California residents. They often accept insurance and can work with families to set up budget-friendly payment plans.
There are many resources for treatment services in the state of California.
➢ Department of Health Care Services (DHCS): This organization provides information for California residents on where and how to access substance use disorder services.
➢ County Mental Health Plan (MHP): Local MHPs are responsible for providing information on Specialty Mental Health Services (SMHS) to individuals within the county who are beneficiaries of Medi-Cal.
➢ Behavioral Health Treatment Services Locator: This online and national tool can be used to pinpoint local treatment services by inputting a zip code and the type of services desired.
➢ California Society of Addiction Medicine (CSAM): A local chapter of the ASAM, CSAM supports local addiction treatment providers and the public by promoting prevention and treatment efforts.
➢ California Hub & Spoke System (CA H&SS): This is a directory of narcotic treatment programs (NTP) in California. CA H&SS is part of the California MAT (medication-assisted treatment) Expansion, which helps to increase access to buprenorphine for individuals battling opioid addiction via more local narcotic treatment program providers. These contracted treatment providers have to be currently in good standing and enrolled in Fee-for-Service Medi-Cal or Drug Medi-Cal.
➢ Alcoholics Anonymous (AA): There are multiple local chapters of AA spread throughout California. The main AA website has a locator tool where individuals can put in a zip code to find nearby meetings and chapters.
➢ Narcotics Anonymous (NA): Multiple NA chapters provide peer support group meetings and 12-step programming throughout California. Locals can use the online search tool to find the closest option.
➢ Community Alliances for Drug Free Youth (CADFY): This nonprofit organization provides prevention strategies and programs locally to minimize youth drug use and enhance healthy communities.
➢ California Opioid Safety Network (COSN): This is a group of local coalitions brought together by the California Health Care Foundation (CHCF) to minimize opioid abuse, addiction, and overdose.
Each county office in California can provide additional local resources on nonprofit organizations, community-based providers, and coalitions striving to promote drug-free, strong, connected, and healthy communities.
Stimulant drugs are some of the biggest drug threats in California. Drugs like methamphetamine are extremely prevalent in California due to its proximity to Mexico. Today, the majority of meth is being brought into the United States via the Southwest Border (SWB). Nearly three-quarters of all methamphetamine seized in the United States by law enforcement officials in 2015 was in California.
Prior to the Combat Methamphetamine Epidemic Act (CMEA) of 2005, meth was commonly made in rural areas of the Golden State and throughout America, often in super labs. The CMEA made it harder to obtain the precursor chemicals like pseudoephedrine and ephedrine (found in many over-the-counter cold medications) in bulk and pushed meth labs and manufacturing operations south of the border.
Around a third of reporting agencies cite meth as being the biggest drug threat in the region. Meth continues to be one of the biggest contributors and influencing factors in violent crimes, more than any other drug. In 9 out of 10 officer-involved shootings involving the LAPD in 2016, the decedent tested positive for meth. Meth is a drug that can quickly escalate a situation, and it is often involved in violent crimes and aggressive behaviors.
California has not been hit quite as hard by the opioid epidemic as other states. The National Institute on Drug Abuse (NIDA) publishes that there were 4.9 opioid-involved overdose deaths per 100,000 California residents in 2016 compared to the national average of 13.3 fatalities per 100,000 people. That being said, more than 2,000 Californians lost their lives to an opioid overdose that year.
Close to three-quarters of all opioid overdose deaths involved a prescription painkiller, per the Daily News. Heroin deaths have also spiked as prescription opioids become harder to get in recent years; heroin overdose deaths jumped up 57 percent between 2012 and 2016.
Another dangerous opioid drug rearing its head in California is fentanyl, an extremely potent synthetic opioid. Fentanyl is regularly laced into drugs like heroin, cocaine, and methamphetamine to stretch or cut the product and make it go further. It is highly addictive due to its level of potency.
Fentanyl is generally manufactured as a white powder, so it can be laced into or even substituted for other white powder drugs. In many parts of the country, such as the East Coast, fentanyl is commonly showing up in white powder heroin.
In California, heroin is typically of the black tar variety so fentanyl is more commonly found in cocaine and methamphetamine, the Los Angeles Times warns. Deaths involving fentanyl spiked from 256 in 2016 to 746 in 2016, which nearly triples the fatality rate involving the powerful opioid in just one year.
Fentanyl is an emerging drug threat, as individuals are often unaware it is even in the drugs they are taking. This can result in potentially life-threatening consequences. The California Department of Public Health is providing needle exchange programs in California with fentanyl test strips in order to detect the dangerous drug.
Proposition 64 was voted into law in November 2016, making California the fifth state to legalize recreational marijuana use in the United States. Making the drug legal to possess, use, buy, and even grow makes marijuana more accessible and potentially more readily available to a wider range of people.
Even with the statewide legalization of recreational marijuana, around half of California residents live in counties or cities that are blocking residential stores and delivery services from opening and prohibiting them in their region, the Los Angeles Times publishes. Marijuana may be legal for adult consumption in California, but it is actually not quite that easy to get legally. There still appears to be a thriving unregulated black market for the drug.
Legalization of marijuana sends the message that marijuana may be safer than other street drugs. Marijuana is still an addictive drug, however, as the Washington Post reports that around 9 percent of people who use the drug will struggle with addiction to it. The number jumps to 17 percent when marijuana use begins in adolescence.
While addiction rates involving marijuana are lower than for cocaine and alcohol, which sit at 15 percent, and heroin’s addiction rate of 24 percent, treatment admissions involving marijuana abuse and addiction are going up in northern California. As published by the California Health Care Foundation, around 8 percent of youth between the ages of 12 and 17 battled addiction in 2015, and close to half struggled with addiction involving marijuana. The majority of teens battling addiction in California in 2015 struggled with addiction involving alcohol. Around 14 percent of Californian adolescents between the ages of 12 and 17 reported past-month marijuana use while 21 percent of underage California residents between the ages of 12 and 20 reported consuming alcohol in the month prior to the survey. Alcohol and marijuana are the top two drugs of abuse by teenagers in California.
Some of the main ways that drug abuse and addiction are addressed in an area are through prevention methods and measures. If drug abuse can be headed off at the source before it begins, fewer people will struggle with addiction and drug abuse can be minimized in a region.
In California, there are several prevention efforts targeting drug abuse. The Statewide Opioid Safety (SOS) Workgroup, initiated by CDPH in 2014, aims to minimize opioid misuse and its consequences by promoting safe prescribing patterns and policies regarding opioid prescription medications; enhancing pain management techniques; educating the public on safe medication use, storage, and disposal of unneeded drugs; lowering heroin use rates; and expanding medically assisted treatment programs.
California has a prescription drug monitoring program called CURES 2.0 (Controlled Substance Utilization Review and Evaluation System) that tracks prescribing and dispensing patterns of controlled substances in an effort to cut down on possible diversion and abuse.
California’s statewide strategy for addressing the opioid public health crisis has five main components, as published by the Safe and Active Communities (SAC) Branch of the CDPH.
1. Safe prescription prescribing practices
2. Access to drug abuse and addiction treatment
3. Distribution of the overdose-reversal drug naloxone
4. Public education campaign
5. Interventions that are driven and informed by collected data
In 2018, the California Department of Health Care Services (DHCS) received a two-year federal grant, the State Opioid Response Grant, to improve access to treatment, enhance prevention efforts, and promote education dissemination in order to minimize opioid overdose deaths. In general, the California opioid overdose rate is lower than the national average, but in several northern California rural counties, such as Shasta and Lake counties, opioid overdose deaths rates are double or triple national averages.
In order to reduce the number of opioid overdose fatalities in California, the state has issued a standing order for naloxone that allows the medication to be dispensed without a prescription to people in need through a local pharmacy. Most Californian first responders carry the opioid antagonist, and it is also commonly stored in local schools. Starting in October 2018, qualified organizations in California will be able to request and obtain the nasal spray version of naloxone for free from DHCS through the Naloxone Distribution Project (NDP) funded by the Substance Abuse and Mental Health Services Administration (SAMHSA).
California also has a Good Samaritan law in place that absolves a person of any criminal liability in the event that they are trying to save a person from a drug overdose.
Addiction treatment and recovery support services in the state of California are managed at a local level through community-based providers that are either contracted through County Mental Health Departments or privately run. Public addiction treatment programs are often low cost or free to California residents who demonstrate financial hardship and medical need. Fee-for-service, or private providers provide high levels of privacy, comfortable accommodations, and many amenities for individuals and families to choose from.
Addiction treatment programs can provide the following services:
• Case management
• Treatment for co-occurring disorders
• Medication management
• Inpatient programs
• Outpatient services
• Group, family, and individual therapy
• Life skills trainings and educational programs
• Holistic and complementary treatment methods
• Relapse prevention and stress management programs
• Transitional services and sober living arrangements
• Peer support and 12-step programs
• Aftercare and recovery support services
In California, the Emergency Department (ED) MAT Bridge Program, through the California MAT Expansion Project funded by CHCF, increases access to medication-assisted treatment by using EDs to get individuals the help they need. This bridge can help to eliminate a potential treatment gap and get California residents struggling with opioid addiction into a treatment program faster. MAT programs provide buprenorphine and maintenance medications to individuals battling opioid addiction.
The Tribal Medication Assisted Treatment Project strives to provide the same for California residents who are Alaska Natives or American Indians.
Addiction treatment is individual, and each person will need to decide what type of program will be best suited to manage the disease and promote recovery. Primary care providers, mental health professionals, and substance abuse treatment providers can offer referrals, answer questions, and guide California residents into a drug abuse and addiction treatment program that will be optimal.