Despite the widespread prevalence of substance use in California, only a small portion of individuals with a substance use disorder (SUD) are receiving treatment, according to a recent California Health Care Foundation report. The report found that of the 9% of Californians (2.9 million individuals) aged 12 and older that met the criteria for an SUD, only 10% received treatment in the last year.
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The report provides an overview of the substance use disorder crisis as it currently stands in California and illustrates the health care system’s ability to combat this crisis. The report shows recent trends in SUDs and access to SUD treatment in the state, as well as highlights important data points regarding racial discrepancies.
Of the SUD population, 6% reported abuse of or dependence on alcohol, and about 4% reported abuse of or dependence on illicit drugs. The rate of SUDs among young adults (aged 18 to 25) was nearly twice the rate of adults aged 26 and older and three times that of adolescents.
Between 2010 and 2019, opioid prescriptions in California fell by 34%. According to the report, this can largely be attributed to state efforts aimed at reducing the use of prescription opioids, including a prescription drug monitoring program and opioid prescribing guidelines, as well as the California Medication-Assisted Treatment (MAT) Expansion Project aimed at increasing access to MAT for those with opioid use disorders.
Between 2019 and 2020, while the number of heroin-related emergency department visits in the state decreased, opioid emergency department visits increased by almost 60%.
The report further breaks down this data by race/ethnicity, showing that the rate of non-fatal, opioid-related emergency department visits was highest for Black Californians in 2020. The rate was highest for white Californians in the case of non-fatal heroin-related emergency department visits.
Amphetamine-related emergency department visits grew nearly 50% between 2018 and 2020, with the highest rate of non-fatal visits represented by Black Californians.
Drug-induced deaths in California have increased over the past two decades, and the rates of both alcohol and drug-induced deaths were more than two times higher among males than females. Californians of American Indian and Alaska Native descent had the highest death rates, with 34.3% being alcohol-induced and 39.2% being drug-induced.
Most opioid-related deaths rates have steadily risen since 2011. The death rate of any opioid use per 100,000 population increased from 4.8 deaths per 100,000 in 2011 to 7.9 deaths per 100,000 in 2019. The death rate from fentanyl overdoses increased from 0.3 deaths per 100,000 in 2011 to 3.8 deaths per 100,000 in 2019—a 10-fold increase.
The heroin death rate also rose steadily from 2011 to 2019, rising from 0.9 deaths per 100,000 to 2.2 deaths per 100,000. Prescription overdose deaths, however, decreased by 30% between 2011 and 2019.
The rates of opioid overdose deaths also varied greatly by county. The report notes that some of the highest rates of opioid overdose deaths in 2019 were in northern Californian counties. Lake County had an overdose death rate of 32 per 100,000, the highest rate of overdose deaths in the state. The second highest opioid overdose death rate (27 per 100,000) was in San Francisco County.
While prescriptions for drugs used to treat opioid use disorders, such as methadone and buprenorphine, increased significantly over the past decade, the report found that few commercial health maintenance organization (HMO) and preferred provider organization (PPO) members received alcohol or drug disorder treatment consistent with National Committee for Quality Assurance quality of care standards. About 40% of California HMO or PPO members with a substance use disorder went to an initial treatment visit within 14 days of diagnosis, but only about 13% received care beyond that.
For individuals with an SUD that did receive treatment, the majority of patients received outpatient services, including the majority of youth patients, while only 13% received residential care and less than 1% received hospital inpatient care. The number of SUD treatment facilities offering outpatient, residential, and hospital inpatient care increased from 2017 to 2019, with the number of facilities offering residential care increasing by 68%, and the facilities offering hospital care nearly doubling.
Licensed narcotic treatment programs (NTPs), which provide opioid MAT and detoxification services, were absent in 24 counties. The report states that “… People who receive methadone treatment typically attend NTPs every day—so proximity and access are critical.”
Over 120,000 people were treated in state and county-contracted SUD programs between 2017 and 2018. Men were more likely than women to access this treatment. Adults aged 26-35 had the highest admission rates of any age group, and American Indian and Alaska Native Californians had the highest admission rates of all racial/ethnic groups.
While alcohol remains the most common SUD in California, alcohol only represented 22% of admissions to state or county-contracted treatment programs. The majority (32%) of people admitted to these programs were amphetamine users.