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Receive an overview of the proposed implementation plan for Opioid Settlement Funds awarded to Solano County for the expansion of substance use services for the remediation of opioid use disorder and other allowable abatement activities
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Published Notice Required? Yes ___ No _X_
Public Hearing Required? Yes ___ No _X_
DEPARTMENTAL RECOMMENDATION:
The Department of Health and Social Services recommends that the Board of Supervisors receive an overview of the proposed implementation plan for Opioid Settlement Funds awarded to Solano County for the expansion of substance use services for the remediation of opioid use disorder and other allowable abatement activities.
SUMMARY:
In recent years, state and local governments have targeted pharmaceutical companies and distributors with legal claims stemming from actions that fueled the opioid addiction epidemic. A class action lawsuit was filed against pharmaceutical and drug distribution companies that alleged the manufacturers of prescription opioids grossly misrepresented the risks of long-term use of those drugs and distributors failed to properly monitor suspicious orders of the prescription drugs, which contributed to the opioid addiction epidemic and overdoses.
California joined multiple national lawsuits against manufacturers, distributors, and other entities responsible for aiding the opioid epidemic and has received awards from opioid judgements and anticipates receiving additional funds from future judgments. Opioid settlement allocations to Solano County must be expended on opioid remediation that includes high-impact abatement activities delineated by the State Department of Health Care Services (DHCS). Health and Social Services (H&SS), Behavioral Health Division, is coordinating efforts with the H&SS, Public Health Division prevention team and Drug Safe Solano, the county Opioid Coalition, to ensure abatement strategies align with evidence-based practices to expand and enhance substance use disorder (SUD) prevention, intervention, harm reduction, treatment, and recovery services.
FINANCIAL IMPACT:
Solano County Behavioral Health anticipates receiving $2.7 million, to be paid in installments through 2031, for the Janssen Settlement; $9.5 million, to be paid in installments through 2038, for the Distributors Settlement; and $149,572 over two years for the Mallinckrodt Settlement. To date, Solano County has received $2.4 million in opioid settlement funds.
In addition to funds allocated directly to Solano County, six cities within Solano County were allocated opioid settlement allocations. Cities were given the option to either elect a direct payment or redirect funds to the County, as follows:
• Benicia: reallocated Janssen Settlement and Distributors Settlement to Solano County
• Fairfield: elected direct payments for Distributors Settlement and reallocated Janssen Settlement to Solano County
• Suisun: reallocated Janssen Settlement and Distributors Settlement to Solano County
• Vacaville: elected direct payments for Janssen Settlement and Distributors Settlement
• Vallejo: elected direct payments for Janssen Settlement and Distributors Settlement
Solano County Behavioral Health will include budget adjustments associated with the implementation plan for Opioid Settlement Fund (OSF) allocations and a request for positions to support remediation activities as part of the Health and Social Services FY2023/24 Midyear Report submittal. As additional settlement amounts become known, H&SS will update the implementation plan and provide the Board with updates. Future appropriations and estimated revenue will either be requested concurrent with the implementation plan or in a subsequent budget cycle.
The costs associated with preparing the agenda item are nominal and absorbed by the Department’s FY2023/24 Working Budget.
DISCUSSION:
On July 21, 2021, announcements were made regarding proposed settlements with opioid manufacturer Janssen (Janssen Settlement) and three distributors, McKesson, Cardinal Health, and AmerisourceBergen (Distributors Settlements). California is expected to receive approximately $2.05 billion from the settlements.
In February 2022, Mallinckrodt Pharmaceuticals, a generic opioid manufacturer, confirmed that the company was filing for bankruptcy and reached an agreement to address their opioid litigation with multiple states, including California. The agreement stipulates that $1.6 billion will be provided to states to use for opioid abatement, with approximately $14.7 million of those funds awarded to California. Additional bankruptcies from other opioid manufacturers, including Endo Pharmaceuticals and Purdue Pharmaceuticals L.P., are still pending.
In late 2022, two additional pharmaceutical manufacturers, Allergan and Teva, and three pharmacy chains, CVS, Walgreens, and Walmart, announced settlements. In California, Teva is anticipated to pay up to $3.34 billion over a 13-year period and Allergan up to $2.02 billion over a seven-year period. CVS, Walgreens, and Walmart are expected to pay up to $4.9 billion over a 10-year period, up to $5.52 billion over a 15-year period, and up to $2.74 billion over a six-year period, respectively. Allocations to Solano County from these settlements are not yet known.
Current Solano County Behavioral Health Services
On May 12, 2020, the Board authorized participation in the California Department of Health Care Services (DHCS) Organized Delivery System (ODS) pilot for substance use treatment services under Medi-Cal and a master service agreement with Partnership HealthPlan (PHP) to oversee the delivery of services under the program. On July 1, 2020, Solano County entered a contract with DHCS to participate in the ODS, referred to as the Drug Medi-Cal Regional Model, and simultaneously, entered into a master agreement with PHP to oversee implementation of related federal and state requirements and expand providers to enhance substance use disorder services. PHP’s service model includes Solano County and six other PHP counties. This regional model has proven to be fiscally sound as substance use treatment is known to positively impact other high-cost healthcare services and outcomes. This approach creates a comprehensive service benefit designed to more rapidly meet the needs of individuals with substance use disorders and integrate them with mental health care services.
Under the Drug Medi-Cal Organized Delivery System (DMC-ODS), services include all State Plan services and expanded federal reimbursement for multiple levels of residential treatment, early intervention services, two levels of intensive outpatient services, case management, medication-assisted treatment, withdrawal management, and others. Additionally, DMC-ODS is a federally required managed care plan. Solano County, in partnership with PHP, successfully implemented the DMC-ODS regional model with more than 2100 Solano beneficiaries served, with a total of 201,289 visits from July 2020 to June 2023. In addition, there have been 12 providers added to the network since its inception.
Expansion of Substance Use Disorder Services with Opioid Settlement Funds
The Centers for Disease Control and Prevention estimates that nearly 110,000 Americans died from drug overdoses in 2022; of these, an estimated 84,000 (76%) involved opioid drugs. According to the Solano County Sheriff / Coroner’s Office, there were 103 overdose deaths in 2023, as compared to 63 in 2022 in Solano County. Of the overdose deaths in 2023, 66 included Opioids (Fentanyl and/or others) with 14 due to Fentanyl alone; and 76 included stimulants (Methamphetamine, cocaine and/or others) with 31 due to Methamphetamine alone.
The continued loss of life and other impacts on the health and well-being of the community due to opioids underscores the need for increased efforts to expand access to substance use disorder treatment services, harm reduction, and prevention efforts. The opioid overdose epidemic can trace its origins to the overprescribing of opioid drugs beginning in the 1990s. This resulted in state, local, and tribal governments bringing lawsuits against pharmaceutical and drug distribution companies and alleging that the manufacturers of prescription opioids grossly misrepresented the risks of long-term use of those drugs for persons with chronic pain, and distributors failed to properly monitor suspicious orders of those prescription drugs, which contributed to the current opioid epidemic.
California has named the Department of Health Care Services (DHCS) as the oversight and monitoring entity for funds received through the opioid settlements, pursuant to the California State-Subdivision Agreements. DHCS priorities for the use of these funds are referred to as High Impact Abatement Activities (HIAA) and no less than fifty percent (50%) of the funds are to be used for one or more of the following:
1. Behavioral Health Continuum Infrastructure Program grantee match funds
2. Infrastructure for new or expanded substance use treatment
3. Addressing the needs of communities of color or vulnerable populations
4. Diversion
5. Youth prevention
6. Naloxone purchase and distribution
DHCS is responsible for administering Medi-Cal specialty mental health and DMC substance use services, which is provided through county mental health plans. Solano Behavioral Health, in partnership with Public Health, will be responsible for expenditure reporting, quarterly and annual services reporting, as well as contracts for disbursements, monitoring, data analysis, and programmatic oversight and services related to the OSF.
Solano Behavioral Health has led community engagement processes to identify priority uses for these funds in alignment with the HIAA requirements. Solano Behavioral Health engaged local advisory boards in July 2022 for discussion of priorities as well as local city managers to determine intentions around the redistribution of funds from city to county. A community survey was disseminated to all county staff, contractors, newsletter subscribers, city managers for their distribution, and posted on social media. Upon receipt of the general consensus on activities, an internal workgroup was formed with Health and Social Services’ Behavioral Health Division and Public Health Division, and Solano County’s Opioid Coalition, Drug Safe Solano, in supporting a cohesive local strategy to outline activities further.
In March 2023, Drug Safe Solano hosted a member discussion on funding priorities and on December 15, 2023, Solano Behavioral Health presented the initial fund proposal to members and community participants during the Drug Safe Solano Regional Overdose Prevention Symposium. On January 16, 2024, Solano Behavioral Health staff presented the Opioid Settlement Fund proposal to the Behavioral Health Advisory Board.
As a result, Solano Behavioral Health proposes the opioid settlement funding be focused on three areas allowable under the High Impact Abatement Activities (HIAA) 1-6 referenced above, as defined by DHCS:
1) Treatment: Solano Behavioral Health will manage the implementation of medication-assisted treatment (MAT) and opioid use disorder (OUD) and substance use disorder (SUD) treatment across the county, and contractor-operated behavioral health services. The expansion of infrastructure and staffing will increase coordination with partners and focus on access/outreach, screening/assessment, linkages, etc. Workforce incentives and certification funds to expand staffing needed to provide treatment and support through increasing Medi-Cal certified peer support recovery coaches and staff who are certified drug addiction counselors. A major focus will be on the integration of MAT with the county-operated Behavioral Health and Family Health Services clinics, and others, to ensure primary care prescribers offer, sustain, and promote MAT. Solano Behavioral Health will ensure screening integration with mobile crisis intervention teams and law enforcement roles with involuntary holds in light of LPS reform (SB 43). A population of focus will include unhoused residents (MAT will be offered during homeless outreach psychiatric Street Medicine) and the justice-involved population, such as those exiting jails needing continuation of MAT or those on diversion. Opioid settlement funds will support expanded services within contractors, including a local Behavioral Health Continuum Infrastructure Program (BCHIP) grantee starting construction of a new SUD residential facility and withdrawal management (Detox) center, and support operation costs for SUD housing. (High Impact Abatement Areas: 1, 2, 3, 4)
2) Harm Reduction: Funds will support expansion of services provided by the County's Opioid Coalition, Drug Safe Solano. Operations and areas of focus include expanded Drug Safe Solano strategic planning, identification of SUD/OUD gaps and priorities for Solano County, increased Narcan distribution and training, and supervision of substance use navigators who are providing access to MAT and recovery services in Solano County. Additionally, there will be the development of a Mobile Harm Reduction Program (syringe exchange and OUD support team) to facilitate community access to these services. Finally, the implementation of a Youth Outreach Program focused on harm reduction, in coordination with community partners, will support events and activities, training student volunteers to use and administer Narcan, and increasing community education on SUD/OUD harm reduction. (High Impact Abatement Areas: 2, 3, 5, 6)
3) Prevention: The Solano Public Health prevention team will increase supports that aim to reduce use and misuse of opioids in the community. Interventions will include staff support around health education strategic planning and intentional outreach to youth through the Solano County Office of Education and coordination with schools and partners for increased awareness, knowledge of access points, and information around treatment programs. Target audiences will include youth in schools from elementary to college, education for caregivers, school personnel, school resource officers, and to the community around prevention and early intervention. Furthermore, data analysis around overdoses, misuse, demographics and city analysis/mapping for targeted marketing and prevention work. Prevention funds will be braided with other funding sources, i.e., Substance Abuse Block Grant (SABG) funding, to increase focus on OUD and youth across all school districts. (High Impact Abatement Areas: 3, 5)
H&SS, Behavioral Health will be including new position requests as part of the Department’s FY2023/24 Midyear Report. Positions will be needed to meet reporting requirements and to manage and support the expansion of substance use services, which includes outreach, education, and treatment to mitigate the impacts of the opioid crisis in the county.
ALTERNATIVES:
The Board may choose not to receive an overview of the proposed plan for the use of opioid settlement funds awarded to Solano County to expand substance use disorder services and perform other allowable opioid abatement activities; however, this is not recommended as these funds are intended to provide remediation of the opioid crisis, and will be used toward prevention, treatment, recovery, and harm reduction.
OTHER AGENCY INVOLVEMENT:
H&SS, Behavioral Health Division, worked with various city and community partners, local advisory boards, Drug Safe Solano, and the Public Health Division on identifying services and supports to address opioid remediation.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION