Facts, not fear.
Why we need to invest more in health-centered approaches to drugs.
The crisis demands urgency: overdose deaths remain near record levels in California
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12,436 Californians in 2023.
12,436 people died due to overdose during a single year in California.
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Marginalized communities are most impacted.
Overdose death rates among Black and Native Americans are twice as high as among White people, despite similar usage rates across races and ethnicities. People experiencing homelessness have a risk factor 38 times more than the general population.
— Cato Hernández, LAIST Health (CDC & CDPH data), October 2024
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over 200% rise in 5 years.
Overdose deaths in California have increased by more than 200% within the last 5 years, and more than 300% in the last 15 years.
CALIFORNIA LACKS SUFFICIENT ACCESS TO VOLUNTARY SUBSTANCE USE DISORDER TREATMENT
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Fewer facilities, longer waits.
Most treatment centers are routinely full or have long wait lists.
In addition, the number of residential substance use disorder treatment facility beds in California declined by over 12% from 2021-23.
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seeking care, but not getting treatment.
After an emergency department visit for alcohol and other drug use or dependence, about 95% of Medi-Cal members did not receive follow up care within seven days, and about 91% did not receive follow up within thirty days.
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"unable to receive" treatment.
20% of participants in the California Statewide Study of People Experiencing Homelessness who report current regular use of illicit drugs or heavy episodic alcohol use reported that they wanted treatment, but were unable to receive it.
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treatment is cost-prohibitive.
Of the substance use disorder treatment facilities in California, only around 40% offer no-cost treatment, and 60% do not accept Medicaid.
criminal legal system approaches increase harm and raise costs for californians
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Incarceration isn't treatment.
Most people do not receive treatment or counseling during incarceration.
Very few facilities offer methadone or buprenorphine, the gold standard medications for opioid use disorder (MOUD): less than 50% of jails and less than 10% of state prisons.
— Wang, “Chronic Punishment.”; Emily Widra, “Addicted to Punishment: Jails and Prisons Punish Drug Use Far More Than They Treat It,” Prison Policy Initiative, January 30, 2024. https://www.prisonpolicy.org/blog/2024/01/30/
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Incarceration increases risk of overdose.
While incarcerated, people die of drug or alcohol intoxication at staggering rates. Between 2001 and 2018, deaths from drug and alcohol intoxications in prisons and jails rose 600% and 400%, respectively.
For people recently incarcerated, risk of overdose is significantly higher following a period of abstinence in jail. Two weeks after release, people are on average more than 27 times more likely to die of opioid overdose than the general population.
— E. Ann Carson, “Mortality in State and Federal Prisons, 2001-2019 – Statistical Tables,” Bureau of Justice Statistics, December 2021; E. Ann Carson, “Mortality in Local Jails, 2000-2019 – Statistical Tables,” Bureau of Justice Statistics, December 2021.
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Mandatory isn't treatment.
Evidence shows that forced ‘treatment’ does not improve outcomes over voluntary treatment and may lead to higher rates of relapse, overdose, and infectious disease and future avoidance of healthcare services, when compared to voluntary treatment.
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incarceration creates barriers.
Housing and employment are understood as key factors for reducing problematic drug use.
Even spending just a few days in jail can cause someone to lose their housing, job, or transportation.
Felony convictions create significant, lifelong barriers to employment, housing, professional licenses, and connections with community.
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Billions of taxpayer dollars.
Punitive responses cost Californians billions in taxpayer money each year while diverting resources away from addressing root causes.
It costs around $133,000 to imprison one person for a year in California; all together, the state spends over $18 billion on its correctional system.
This does not include millions of dollars in costs to local communities, such as county jails, arrests, encampment sweeps, and other criminal legal system responses.
— Christian Henrichson et al., “The Price of Jails,” Vera Institute,May 2015.
— National Healthcare for the Homeless Council, “Impact of Encampment Sweeps.”
effective solutions preserve autonomy, provide a continuum of care, and center community.
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treatment that's accessible.
When care is available, attractive, and affordable, people will seek it.
Substance use disorder (SUD) treatment is associated with decreased overdose risk, convictions, and mental and physical problems. At the community level, SUD interventions and treatment are also associated with reductions in costs related to criminal activity.
Additionally, the longer someone stays in SUD treatment, the better outcomes they have. In order to maximize treatment efficacy, abstinence should not be a requirement for staying in a program.
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Services that reduce harm.
Harm reduction services are life-saving tools. In addition to treatment, harm reduction can include services like overdose prevention centers, naloxone distribution programs, and syringe service programs.
These services are proven to: save lives, curb the spread of infectious diseases, connect people with treatment and other services, and increase social connectedness.
Many of these services also benefit the communities where they exist. They can help reduce public drug use and debris. They also save money by reducing deaths, diseases, and emergency room visits, while increasing treatment uptake. These positive outcomes occur all while maintaining public safety.
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Policies that put housing first.
The Housing First approach connects people experiencing chronic homelessness with permanent housing along with ongoing supports and treatment. This approach prioritizes securing housing without other conditions.
Housing First policies can produce several positive outcomes, including: reduced homelessness and housing instability; reductions in arrests and bookings; decreased costs due to reduced shelter and emergency room use; and increased positive social and health behaviors, including goal-setting, success, and responsibility.
— Drug Policy Alliance, “Toolkit: Protecting Our Communities,” (September 2023).
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care based in community.
Communities with fewer community-based health services have higher incarceration rates. Increasing access to mental and drug use health providers and improving the affordability of care could help lower incarceration rates.
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Support, not sanctions.
Decriminalization, declining to prosecute, and dismissal have all reduced recidivism, maintained public safety, and lessened the the financial burden on taxpayers of arrests, court cases, processing, and incarceration.
No negative impact on public safety has been observed and 911 calls have not increased following decriminalization. Fatal overdoses have not increased.
Coupled with reducing or eliminating criminal penalties, policymakers must increase funding for addiction and mental health services. Without the fear of arrest, incarceration, and criminal records — which all lead to dire health impacts and barriers to employment, housing, public benefits, and education — people can better access services to remain healthy and improve overall community wellbeing.
— Drug Policy Alliance, “Decriminalize Drugs, Invest in Health Services.”