California Health Care Foundation report highlights substance use disorder

The California Health Care Foundation (CHCF) released its first ever almanac report on Substance Use Disorder in California this week.  The report analyzes recent data from across the state to provide an overview of the problem and strategies being used to address the disease.

The investigation found that while about 8 percent of Californians met criteria for substance use disorder, but only 10 percent of people with a substance use disorder received any type of treatment.  This lack of treatment impacts health care costs, mortality, the workforce, and social services throughout the state.

While the rate of any substance use disorder was high, the report found that alcohol dependence was by far the most prevalent with accounting for approximately 6.4 percent of use compared to 3.9 percent for all other substances.

Other key findings include:

  • Substance use disorders are most prevalent among young adults 18 to 25, occurring at nearly twice the state average rate;
  • Alcohol and drug use often begins early in life. By 11th grade, more than half of California students have used alcohol and almost 40 percent have used marijuana;
  • Alcohol accounted for more nonfatal emergency department visits than all other drug diagnoses combined;
  • The number of heroin-related emergency department visits in California more than tripled between 2006 and 2017.

The report also highlighted disparities in substance use disorder treatment in the state. For example, though alcohol dependence is the most common substance use disorder in the state, it only represented one fifth of those admitted into treatment, while amphetamines and heroin accounted for a combined 55 percent of treatment admissions.

The report notes that public payers account for the greatest share of SUD treatment spending. Federal Substance Abuse Prevention and Treatment Block Grant and the Medi-Cal program fund most public substance use disorder services in California with counties providing the majority of treatment services to Medi-Cal enrollees and uninsured individuals. Currently, California is midway through its 1115 waiver re-design of the treatment system delivery model known as Drug Medi-Cal. Early evaluations of the model show promise with expansion planned to 21 counties.  However,  limitations on services covered and reimbursement rates are proving challenging.