Gov. Gavin Newsom, spend that $6.4 billion from Prop. 1 on treatment that works

Hey, Gov. Newsom — whew! You must be so relieved that Proposition 1 squeaked by. California will have $6.4 billion more to spend on mental health and homelessness — wow! — but, honestly, a lot of city official-types down this way were hoping against hope you’d fail.

Now they’re holding their breath, especially here in Orange County, America’s ground zero for addiction treatment fraud. They’re fervently hoping that California does this right. That means not spending more money on more of the same old same old, which we know doesn’t work very well — which is to say, those six-bed, private-pay, insurance-money fueled, 30/60/90-day addiction treatment programs, usually found in tract homes in residential neighborhoods, often overseen by “recovered” users with fresh sobriety and no physician in sight.

We’ve told you about so many people who’ve died in these facilities for lack of proper, or really any, medical care. Please, please, not more heartbreak! How about treating addiction as the life-threatening medical condition it is, and spending our billions on what we know works best?

To that end, come with us to Dallas, where we’ll be reporting from the American Society of Addiction Medicine’s annual conference this weekend. We’ve got full access to all the sessions where the best and brightest hash out the latest and greatest — a perk that comes with ASAM’s recognition of the Southern California News Group’s work on this issue over the last seven years.

Since the Affordable Care Act mandated that addiction treatment be covered by health insurance, drug overdoses have more than doubled.

In 2014, before the mandate took effect and ne’er-do-wells flocked to the addiction treatment gold rush, there were 4,521 overdose deaths in California.

In 2022, after the mandate took effect and despite new laws and crackdowns, there were 11,002 overdose deaths, according to data from the U.S. Centers for Disease Control and the California Department of Public Health.

Yes, fentanyl happened. But we’re clearly doing something wrong. We clearly need to do something better. California needs a more medical, professional, comprehensive, well-regulated treatment system to prevent tragedies and save lives.

Only slightly more than half of treatment facilities offered any kind of medication-assisted treatment, the gold standard in care, according to data from the Substance Abuse and Mental Health Services Administration.

Can’t we make them do better?

Non-medical

So many people have taken their loved ones to licensed treatment homes thinking they’re full-fledged medical facilities. They’re not. In California, licensed addiction treatment facilities are expressly non-medical (though they can have a doctor consult, often from afar; docs are not on staff).

We told you about Henry Lehr, who bolted from a licensed Newport Beach detox in the dead of night in a paranoid delirium, forced his way into a nearby home and was shot and killed by the terrified man inside. He was 23.

We told you about Frankie Taylor, who overdosed and died in his closet despite living in a licensed Anaheim rehab. His parents still don’t know how he got the drugs that killed him, or from whom, and officials have too much to do to find out. He was 19.

We told you about Dean Rea, who was booted from a star-powered rehab in Palm Springs after he got high in his room. Alone, with deadly pills in his pocket. No one reached out to his mom, who had left only minutes before – and he overdosed and died behind a nearby gas station. He was 22.

We’ve told you about Matthew Maniace and Terri Darling and James Dugas and so many more like them – real people loved by real families who desperately needed a higher level of care than they got. We’ll be telling you about even more of them in coming weeks and months, as California’s plans for Prop. 1 money crystallize.

Folks who enter licensed rehabs are supposed to see a doctor within 24 hours in California. But this requirement appears to be blown off with alarming regularity. Many of the dead never made it to a doctor, dying even before those 24 hours were up, their families have said.

Back to the expressly non-medical rehab bit. They usually have only six beds. How can anyone afford the critical staff needed to oversee the deadly dangers of detox with only six beds? When they’re in tract homes in residential neighborhoods? The scale and setting just don’t make sense.

Addiction treatment may be the only slice of the healthcare universe where folks in public programs have a far better shot at success than those in luxury, private-pay, insurance money-driven programs. Why? Because public programs must embrace medication-assisted treatment, the gold standard still rejected by too many private programs. Because they spend public money and are much more closely monitored by public officials. Because they’re not sold as sober-vacation destinations to lure users from far and wide — and often paying for airline tickets if folks’ insurance is good — as so many luxury rehabs are.

No carrot, no stick

Forgive folks for being nervous about what’s going to come out of Prop. 1.

With the best of intentions, voters passed Proposition 47 a decade ago, reducing a great many drug-related offenses from felonies to misdemeanors. That kept a great many low-level drug offenders out of jail. The money saved on incarceration was supposed to pay for effective addiction treatment, among other things, reformers said.

Since then, there has been an interesting, and perhaps tragic, convergence of events. Drug offense arrests plunged 85%, while overdose deaths more than doubled.

The great treatment didn’t materialize.

Look. No one wants folks struggling with addiction stuck in prisons or institutions. Traditional hospitalization is out, too — it was nixed decades ago because it’s so expensive. But with this new $6.4 billion, can’t California forge some sane, effective middle ground? Can’t it scale up treatment centers with enough beds to support real medical staff and professional oversight? There are only a handful of addiction treatment hospitals in our entire state of nearly 40 million people.

We’ll be talking to experts about all this over the next few days. Suffice to say that addiction isn’t “cured” in 30 or 60 or 90 days. It’s a lifetime condition, the experts say, and sobriety can take many years to attain. California must acknowledge this reality and set up long-term solutions — supportive housing, job and life skills, counseling, peer support, medical expertise — that last for years, not days or months, giving people a real chance to succeed. Orange County is taking big steps in the right direction with its BeWell campuses, but we need so many more.

Despite myriad new laws passed in the wake of SCNG’s coverage over the past seven years, the story on the street remains much the same. I can still open a rehab in California and charge insurance companies thousands of dollars a day, which should terrify us all.

Source: Orange County Register