ALL RIGHT. I'M GOING TO START.
GOOD MORNING, WELCOME TO THE
SELECT COMMITTEE ON FENTANYL
OPIOID ADDICTION AND OVERDOSE
PREVENTION. MY NAME IS MATT
HANEY, CHAIR OF THE COMMITTEE. I
THINK WE MAY HAVE A FEW OF MY
COLLEAGUES JOIN US, AS THE
HEARING GOES ON, THIS IS A VERY
BUSY WEEK IN THE LEGISLATURE. SO
I KNOW SOME OF THEM HAD TO RUSH
HOME. BUT, WE'LL SHARE THE VIDEO
OF THIS VERY IMPORTANT COMMITTEE
WITH THE MEMBERS OF THE
COMMITTEE AND, AND MY COLLEAGUES
SO THAT THEY CAN LEARN FROM THE
EXPERTISE THAT WE HAVE GATHERED
HERE TODAY, THIS COMMITTEE WAS
FORMED FOR US TO BE ABLE TO,
DEVELOP SOLUTIONS TO CONFRONT
THE MOST DEADLY PUBLIC HEALTH
EPIDEMIC THAT IS FACING OUR
STATE, WHICH IS THE DRUG
OVERDOSE EPIDEMIC AND THE
EPIDEMIC OF OPIOID ADDICTION
MORE BROADLY, WE HAVE 2.5
MILLION AMERICANS WHO ARE
ADDICTED TO OPIOIDS. WE'VE LOST
HERE IN CALIFORNIA, OVER 10,000
PEOPLE JUST LAST YEAR TO
OVERDOSE. MOST OF THOSE FROM
OPIOID OVERDOSE. AND THIS IS A
CHALLENGE AND A CRISIS THAT IS
IMPACTING EVERY CORNER OF OUR
STATE. BUT IT IS NOT AN ISSUE
THAT IS CONCENTRATED IN SAN JOSE
OR SAN FRANCISCO. EVERY SINGLE
CITY, COUNTY, TOWN, REGION IS
BEING IMPACTED BY OPIOID
ADDICTION AND WE ARE IN
DESPERATE NEED OF SOLUTIONS
ÓRDENES SOLUTIONS THAT SAVE
LIVES, SOLUTIONS THAT HELP
PEOPLE GET INTO CARE AND
TREATMENT, AND SOLUTIONS THAT
LEAD TO US REVERSING THESE
EPIDEMIC BECAUSE SADLY, WHAT
WE'RE SEEING IS IT IT IS GETTING
WORSE IN CALIFORNIA EVERY YEAR,
MORE AND MORE PEOPLE ARE
BECOMING ADDICTED TO OPIOIDS,
AND MORE AND MORE PEOPLE ARE
DYING EVERY YEAR. AND THAT HAS
ESCALATED VERY RAPIDLY, IN
PARTICULAR OVER THE LAST FEW
YEARS. SO THIS COMMITTEE CAME
TOGETHER. IT'S A BIPARTISAN OAN
SELECT COMMITTEE TO DEVELOP
SOLUTIONS AND FIND AREAS FOR
COMMON GROUND, THERE HAS BEEN
AND THERE WILL CONTINUE TO BE
AND THERE SHOULD BE A LOT OF
CONVERSATION THÀNH AND A LOT OF
EFFORTS TO CONFRONT THOSE WHO
ARE BRINGING THESE ILLEGAL,
DEADLY DRUGS INTO OUR STATE, AND
INTO OUR COMMUNITIES. AND HOW TO
STOP THAT AND HOW TO HOLD PEOPLE
ACCOUNTABLE AND WE'VE HAD
HEARINGS AND BILLS THAT HAVE
FOCUSED ON THAT, WE'VE ALSO
FOCUSED A LOT ON, HOW TO ENSURE
THERE'S EMERGENCY INTERVENTIONS
THAT ARE AVAILABLE FOR PEOPLE SO
THAT WE CAN SAVE LIVES,
EXPANDING ACCESS TO NALOXONE,
EXPANDING ACCESS TO CRISIS
RESPONSE. BUT THIS PARTICULAR
HEARING IN MANY WAYS, FOR ME, IS
THE ONE WHERE WE SHOULD BE
PUTTING, DEFINITELY AS MUCH TIME
AS WE ARE PUTTING ON THOSE TWO
AREAS, AND ONE THAT I THINK DOES
NOT GET ENOUGH ATTENTION, DOES
NOT GET ENOUGH FOCUS, AND SHOULD
BE ONE WHERE EVERYONE ONE CAN
WORK TOGETHER TO SOLVE PROBLEMS
AND PUT FORWARD POLICY SOLUTIONS
. AND THAT'S ON THE AREA OF
EVIDENCE BASED TREATMENT FOR
THOSE WHO ARE EXPERIENCING,
OPIOID ADDICTION. I SAID THAT
THERE WERE 2.5 MILLION AMERICANS
WHO ARE ADDICTED TO OPIOIDS.
ONLY 1 IN 5 OF THOSE PEOPLE. ARE
ENROLLED IN LIFE SAVING,
MEDICATION ASSISTED TREATMENT. I
SET OUT AS PART OF THE WORK OF
THIS COMMITTEE TO MAKE SURE THAT
AS MANY OF MY COLLEAGUES,
HOPEFULLY ALL OF MY COLLEAGUES,
UNDERSTAND NOT JUST HOW TO SAY
BUPRENORPHINE, BUT WHAT IT IS
AND WHAT IT CAN DO AND WHAT WE
CAN DO AS POLICY MAKERS TO MAKE
SURE MORE PEOPLE HAVE ACCESS TO
IT. WE PASSED TWO BILLS LAST
YEAR TO HELP TEENAGERS HAVE
ACCESS TO CARE TO HELP MOBILE
PHARMACIES TO BE ABLE TO CARRY
BUPRENORPHINE. WE ALSO KNOW THAT
OUR STATE HAS SOME OF THE MOST
RESTRICTIVE POLICIES IN THE
COUNTRY. AS IT RELATES TO ACCESS
TO METHADONE, WHICH IS THE MOST
PROVEN, MEDICATION ASSISTED
TREATMENT FOR PEOPLE WITH OPIOID
ADDICTION. IF YOU ASK ANYWHERE
IN THE WORLD HOW THEY ARE
CONFRONTING OPIOID ADDICTION IN
THEIR IN THEIR, IN THEIR
COMMUNITIES, THEY WILL START
WITH METHADONE AS THE PRIMARY
WAY THAT THEY CONFRONT THIS,
THIS ADDICTION. AND
UNFORTUNATELY FOR CALIFORNIA, WE
KNOW THAT WE DON'T WE DO NOT
HAVE ENOUGH PEOPLE WHO SHOULD BE
AND CAN BE ENROLLED IN METHADONE
AND IN BUPRENORPHINE, HAVING
ACCESS TO THOSE TREATMENTS IF WE
WANT TO GET PEOPLE OFF OF DEADLY
DRUGS THAT WE KNOW CAN KILL THEM
AND ARE KILLING THEM, WE HAVE TO
MAKE IT A LOT EASIER TO GET ON
TO MEDICATION ASSISTED TREATMENT
THAT CAN SAVE THEIR LIVES AND
THAT HOPEFULLY, ULTIMATELY CAN
LEAD THEM TO BE ABLE TO WITHDRAW
FROM, THESE DEADLY DRUGS LIKE
FENTANYL ALTOGETHER. SO THAT'S
WHAT OUR GOAL IS OF THIS
COMMITTEE. HOW DO WE AS A STATE,
MAKE SURE PEOPLE HAVE MORE
ACCESS TO TREATMENT THAN THEY DO
TO DEADLY DRUGS LIKE FENTANYL?
HOW DO WE GET PEOPLE ONTO
TREATMENTS THAT CAN SAVE THEIR
LIVES? BUT UNFORTUNATELY, RIGHT
NOW, FAR TOO PEOPLE FIND
THEMSELVES FAR TOO MANY PEOPLE
FIND THEMSELVES STUCK IN
BUREAUCRACY, STUCK IN VARIOUS,
BARRIERS THAT THEY HAVE TO
CROSS, BEING DROPPED FROM
TREATMENT, GOING INTO ONE DOOR
AND HAVING TO START OVER AGAIN
AND AGAIN AND AGAIN. AND THE
RESULT IS THAT THEY NEVER GET
THE CARE AND TREATMENT THAT THEY
NEED AND DESERVE. SO WE HAVE
SOME INCREDIBLE EXPERTS HERE,
PEOPLE WHO HAVE FIRST HAND
EXPERIENCE WITH NAVIGATING THIS
SYSTEM, PEOPLE WHO ARE DOCTORS
WHO HELP TO SUPPORT PEOPLE IN
ENROLLING ON THESE TREATMENTS
AND STAYING ON THEM, AND OUR
LEADERS FROM THE STATE WHO ARE
ENSURING THAT WE ALIGN THE WORK
THAT WE ARE DOING HERE IN THIS
BUILDING AND IN SACRAMENTO WITH
THE NEEDS OF OUR COMMUNITIES,
INCLUDING OUR CITIES AND
COUNTIES. SO BEFORE I INTRODUCE
THE FIRST PANEL, A FEW
HOUSEKEEPING, WE WILL HAVE THREE
PANELS TODAY, WITNESSES OF EACH
PANEL WILL COME UP TOGETHER AND
PROVIDE THEIR TESTIMONY BY ORDER
OF INTRODUCTION. AFTER EACH
WITNESS HAS TESTIFIED. THE
MEMBERS OF COMMITTEE, THE
COMMITTEE MAY ASK QUESTIONS OR
TAKE THE OPPORTUNITY TO MAKE ANY
REMARKS. AND AT THE END OF THE
HEARING, THERE WILL BE AN
OPPORTUNITY FOR PUBLIC COMMENT
AND PUBLIC COMMENT WILL BE
LIMITED TO 30S PER PERSON. WE
ARE NOT ACCEPTING PUBLIC COMMENT
OVER THE PHONE TODAY, BUT YOU
CAN SUBMIT WRITTEN TESTIMONY FOR
ANYBODY WHO IS WATCHING OR WANTS
TO, AT ASSEMBLYMEMBER HANEY AT
ASSEMBLY CA.GOV. THIS EMAIL IS
ALSO ON OUR WEBSITE, BEFORE I
INTRODUCE THE FIRST PANEL, I
WANTED TO ALSO, WELCOME ASSEMBLY
MEMBER KALRA. AND I DON'T KNOW
IF YOU WANT TO PROVIDE ANY
INTRODUCTORY REMARKS BEFORE WE
START, THANK YOU SO MUCH,
SENATOR HANEY. I APPRECIATE YOU
TAKING THE LEAD ON THIS ISSUE
THAT I THINK A LOT OF
CALIFORNIANS, ARE AWARE OF.
THINK ABOUT, BECAUSE AS YOU
CORRECTLY STATED, IT'S IN EVERY
CORNER OF OUR STATE, I REALLY
APPRECIATE THE FACT THAT WE'RE
FOCUSING ON EVIDENCE BASED
SOLUTIONS, NOT FEAR BASED
SOLUTIONS. SOMEONE THAT WORKED
AS A PUBLIC DEFENDER FOR OVER A
DECADE, OVER FIVE YEARS, OF
WHICH I REPRESENTED INDIVIDUALS
IN DRUG TREATMENT COURT, DURING
KIND OF THE HEIGHT OF THE METH
EPIDEMIC, THERE'S NO DOUBT THAT
WE DO KNOW, WE DO KNOW THAT
THERE ARE SOLUTIONS THAT ARE
AVAILABLE BEALL, THAT ARE
OUTSIDE OF THE REALM OF MAKING
PAST MISTAKES. QUITE FRANKLY,
THE WAR ON DRUGS, WHERE
PARTICULARLY DURING, THE 80S AND
90S, THERE WAS A11 SIZE FITS ALL
SOLUTION THAT WAS NOT EVIDENCE
BASED, BUT WAS CERTAINLY A FEAR
BASED AND RAVAGED COMMUNITIES,
PARTICULARLY IN THE CASE OF, THE
80S AND 90S WITH OUR BLACK AND
BROWN COMMUNITIES, THE REALITY
IS THAT FENTANYL AND ADDICTION,
AFFECTS EVERYONE, REGARDLESS OF
THEIR RACE, REGARDLESS OF THEIR
INCOME LEVEL. ANYONE CAN FALL
INTO A CRISIS OF ADDICTION. AND
SO I'M REALLY GRATEFUL TO
EVERYONE THAT'S HERE TO HELP US
LEARN MORE ABOUT WHAT THE STATE
CAN DO, TO ENSURE THAT WE'RE
SETTING OURSELVES UP FOR SUCCESS
IN TERMS OF SAVING LIVES, IN
TERMS OF SAVING FAMILIES AND
MAKING SURE THAT THOSE THAT HAVE
FALLEN INTO THIS CRISIS OF
ADDICTION, HAVE THE TOOLS,
RESOURCES AND SUPPORT FROM THE
STATE AS WELL AS LOCAL
JURISDICTIONS, TO GET BACK ON
TRACK AND THEIR LIVES AND TO
ENSURE THAT WE HAVE SAFE AND
HEALTHY COMMUNITIES. THANK YOU.
ASSEMBLY MEMBER ORTEGA, I KNOW
YOU JUST WALKED IN, BUT I DON'T
KNOW IF THERE WAS IF THERE'S
ANYTHING YOU WANT TO SAY. OKAY.
WELCOME GREAT. WELL, WE WILL WE
WILL START WITH OUR FIRST PANEL,
AND TO START THE CONVERSATION ON
BARRIERS AND BENEFITS TO CARE. I
WANT TO INVITE AXEL KAMINSKY, A
GRADUATE STUDENT AT UC DAVIS WHO
IS CURRENTLY ENROLLED IN
TREATMENT. AND WE WANT TO THANK
YOU FOR BEING HERE. AXEL AND WE
DEEPLY VALUE YOUR PERSPECTIVE
AND WHENEVER YOU'RE READY, YOU
CAN BEGIN. AND YOU CAN JUST HIT
THE BUTTON THERE TO TURN THE MIC
ON. OH, AM I GOOD NOW? YES. ALL
RIGHT. AWESOME, SO THANK YOU,
ASSEMBLY MEMBER AND CHAIR HANEY,
FOR PUTTING TOGETHER, A GREAT
COMMITTEE THAT I THINK IS REALLY
IMPORTANT, I AM REALLY HAPPY TO
HAVE THE OPPORTUNITY TO, SHARE
MY PERSONAL EXPERIENCE, WITH
MEDICATION ASSISTED TREATMENT,
IN PARTICULAR, METHADONE, I
SHOULD HAVE SAID, FOR THE
RECORD, AND ANYONE WHO'S NOT IN
THE ROOM THAT WILL BE WATCHING
THIS, MY NAME IS AXEL KAMINSKY,
I BRING TO THIS COMMITTEE, I
THINK A PERSPECTIVE OF NOT ONLY
JUST THE METHADONE PATIENT, BUT
A FORMERLY INCARCERATED STUDENT
WHO STUDIES THE WAR ON DRUGS AND
CRIME, CURRENTLY, I'M PURSUING
MY GRADUATE DEGREE AT UC DAVIS
IN SOCIOLOGY. BEFORE THAT, I
EARNED MY LAW DEGREE AT UCSF,
AND MY BA AT UCLA. I WANT TO
ACKNOWLEDGE MY PRIVILEGES, I
RECOGNIZE THAT MY EXPERIENCE
MIGHT NOT BE THE MOST OR FULLY
REPRESENTATIVE OF ALL PEOPLE ON
METHADONE AND MEDICATION
ASSISTED TREATMENT, BUT I HOPE
THAT MY TESTIMONY OFFERS INSIGHT
INTO THE COMPLEXITIES AND
BARRIERS THAT ARE INHERENT IN
ACCESSING AND RECEIVING
MEDICATION ASSISTED TREATMENT IN
CALIFORNIA, BECAUSE IF I CAN'T
GET IT AND IT'S DIFFICULT FOR
ME, IT IS GOING TO BE DIFFICULT
FOR, PEOPLE WHO DON'T HAVE AND
ENJOY THE PRIVILEGES THAT I DO,
I STARTED USING HEROIN IN HIGH
SCHOOL, IT WAS AFTER A TRAUMATIC
CAR ACCIDENT THAT LEFT ME
PHYSICALLY, MENTALLY AND
EMOTIONALLY AND PAIN. I THINK IT
TOOK ME A COUPLE DECADES TO
REALIZE THAT I WAS
SELF-MEDICATING, AND UNDIAGNOSED
MENTAL AND PHYSICAL HEALTH
ISSUES, SO AFTER YEARS OF
CHAOTIC IV DRUG USE, I ENROLLED
IN METHADONE FOR THE FIRST TIME
IN 2011. SO IT'S BEEN 15 YEARS
THAT I'VE BEEN CONSISTENTLY ON A
CLINIC, THERE WAS NO LIKE,
MOMENT WHERE THE HEAVENS OPENED
UP OR SUDDENLY EVERYTHING FELL
INTO PLACE FOR ME. MY STORY IS A
LITTLE MESSIER THAN THAT, AND I
THINK MOST PEOPLE'S ARE, YOU
KNOW, NOT I GOT TREATMENT AND
THEN I GOT CLEAN AND, YOU KNOW,
END OF THE STORY, RIGHT? I MEAN,
IT SOUNDS GREAT, BUT THAT
DEFINITELY WAS NOT MY
EXPERIENCE. SORRY. IF YOU COULD
JUST BRING THE MIC OR A LITTLE
CLOSER. YEAH. THERE YOU GO.
SORRY. YEAH, IT'S. YEAH, A
LITTLE WEIRD. YEAH. SORRY. NO, I
WANT, I WANT YOU TO BE ABLE TO
HEAR SO, IT JUST WASN'T A CLEAN,
YOU KNOW, NARRATIVE ARC FROM
USING DRUGS TO NOT USING DRUGS
FOR ME. AND I THINK THAT
EXPERIENCE IS TRUE FOR MOST OR
MANY, PEOPLE. BEALL. SO FOR A
VARIETY OF REASONS, METHADONES
GOT KIND OF A BAD RAP, STIGMA
AND THE CRIMINALIZATION OF
PEOPLE WHO USE DRUGS HAS REALLY
RESULTED IN, ONEROUS REGULATIONS
AND BUREAUCRATIC HURDLES WITHIN
THE METHADONE SPACE THAT IMPEDES
ACCESS TO LIFE SAVING TREATMENT.
METHADONE PATIENTS ARE ALL TOO
FAMILIAR WITH THE FAILURES OF
THE CLINIC SYSTEM, AND THE
REGULATIONS THAT CONTROL OUR
LIVES AND HAMSTRING WELL-MEANING
CLINIC STAFF FROM ACTUALLY
HELPING PATIENTS, LOOSENING
THESE REGULATIONS, I BELIEVE,
WILL SAVE LIVES. STUDIES HAVE
SHOWN THAT METHADONE CAN REDUCE
OVERDOSES UP TO 80% IN CERTAIN
CASES. MY 15 YEAR TENURE NOW AS
A METHADONE PATIENT HAS EXPOSED
ME TO SOME OF THE SYSTEMIC
ISSUES, PATIENTS FACE, INCLUDING
STIGMA, LIMITED ACCESS AND
TRAVEL RESTRICTIONS, I THINK
THAT HAVING THESE MISCONCEPTION
SURROUNDING MEDICATION ASSISTED
TREATMENT REALLY, EXACERBATES
CGRTS FEELINGS OF SHAME, AND,
AND INADEQUATE AC AMONG
PATIENTS, I HAVEN'T HEARD TOO
MANY PEOPLE SAY THAT THEY'RE,
LIKE, PROUD TO BE ON A METHADONE
CLINIC. RIGHT. BUT YOU DO HEAR
PEOPLE ALL THE TIME TALKING
ABOUT AA NHÀ, THESE TYPES OF
MODALITIES WHERE, PEOPLE ARE
SOBER, ESSENTIALLY, AND I THINK
THAT REALLY NEEDS TO CHANGE
BECAUSE METHADONE IS A
MEDICATION JUST LIKE ANY OTHER
MEDICATION. WE DON'T GET WEIRD
ABOUT SOMEONE TAKING INSULIN,
YOU KNOW, OR THEIR BLOOD
PRESSURE MEDICATION, SO, SO EVEN
WITH ALL THESE REGULATIONS IN
PLACE, AROUND METHADONE, I THINK
AT A VERY BASIC LEVEL OF HEALTH
CARE PROVISION, CURRENTLY, MOST
CLINICS ARE FAILING TO PROVIDE
QUALITY PATIENT CARE FOR,
ENSURING DIGNITY AND RESPECT AND
ALSO PRIVACY FOR THE PATIENTS
WHO ARE IN TREATMENT, ME
PERSONALLY, ME, I'VE FACED
ISSUES WITH MY EMPLOYMENT AND
EDUCATION HAVING TO DOSE EVERY
MORNING MAKES GETTING TO WORK
REALLY DIFFICULT. I WAS ACTUALLY
LATE A LITTLE BIT HERE TODAY,
BECAUSE I GOT STUCK AT THE
CLINIC FOR 45 MINUTES, IT'S VERY
, I WOULD SAY IRREGULAR. YOU
CAN'T COUNT ON GETTING IN AND
OUT OF THE CLINIC, IN A SET
PERIOD OF TIME. WHICH WHICH
REALLY MAKES THINGS CHALLENGING.
CHALLENGING. IN FACT, FOR AN
ENTIRE YEAR, I WAS AT A CLINIC
IN THE BAY AREA THAT HAD ONLY
ONE DOSING NURSE FOR HUNDREDS OF
PATIENTS. PEOPLE WOULD LITERALLY
HAVE TEARS IN THEIR EYES IN LINE
BECAUSE THEY KNEW THEY WERE
EITHER GOING TO HAVE TO LEAVE
AND NOT GET THEIR DOSE AND GO TO
WORK, OR PROBABLY GET FIRED,
THAT I DON'T KNOW WHY I, I
PERSONALLY, STAYED AT THAT
CLINIC FOR AS LONG AS I DID
OTHER THAN MAYBE FEELING LIKE
THAT WAS THE BEST THAT WAS OUT
THERE OR OR WHAT I DESERVED. SO
I THINK WE HAVE TO REALLY DO A
LOT TO MAKE SURE THAT PATIENTS
ARE ABLE TO ACCESS THEIR
MEDICATION REASONABLY, LIKE ANY
OTHER MEDICATION, AND, AND IT'S
RIDICULOUS THAT PEOPLE HAVE TO
WAIT IN LINE FOR SOMETIMES 3 TO
4 HOURS TO, TO GET DOSED. OF
COURSE, THAT'S NOT THE AVERAGE
OR ANYTHING LIKE THAT, BUT IT
HAPPENS, OVER THE YEARS I HAVE
HAD ISSUES, WITHIN THE CLINIC,
I'VE BEEN THE KIND OF LIKE
PERFECT PATIENT. AND I'VE ALSO
BEEN THE PATIENT THAT, NONE OF
THE COUNSELORS WANT TO DEAL WITH
, SO I WAS REALLY ENCOURAGED TO
SEE IN THIS BILL, A CODICIL
SAYING THAT YOU CAN'T MAKE THE
MEDICATION CONTINGENT ON
COUNSELING. I, I'VE HAD
COUNSELORS HARASS ME. I'VE, HAD
COUNSELORS TRY TO BLACKMAIL ME
INTO DOING THEIR HOMEWORK. I'VE
HAD COUNSELORS ASK ME TO COMMIT
WHAT I THINK IS INSURANCE FRAUD.
I'M NOT SAYING ALL COUNSELORS
ARE BAD OR ANYTHING LIKE THAT.
THERE ARE PLENTY OF PEOPLE WHO
ARE TRYING TO DO GREAT WORK
WITHIN THE SYSTEM, BUT THERE IS
A CULTURE OF, I BELIEVE,
CORRUPTION AS IT CURRENTLY
STANDS. BECAUSE OF THE WAY
METHADONE IS SET UP, TRAVELING
IS INCREDIBLY DIFFICULT, JUST
THIS PAST SPRING BREAK, WHICH
WAS A COUPLE OF WEEKS AGO FOR
ME, I HAD TO FIGURE OUT HOW TO
GET DOWN TO LA TO VISIT FAMILY,
THERE, IN THEORY, ARE FEW
OPTIONS FOR METHADONE PATIENTS
TO COURTESY DOSE AT A DIFFERENT
CLINIC NEAR WHERE THEY'RE
THEY'RE VISITING, OR GET A
EMERGENCY EXCEPTION FOR TAKE
HOME DOSES IF YOU'RE LUCKY, BUT
IN PRACTICE, I THINK PATIENTS
KNOW THAT NOTHING AT THE
METHADONE CLINIC EVER GOES AS
PLANNED. IF YOU'RE INTERESTED IN
SEEING MURPHY'S LAW PLAY OUT IN
REAL LIFE, GO TO A METHADONE
CLINIC AND SIT THERE FOR A
WHILE. I'VE SET UP MY COURTESY
DOSE 2 TO 3 WEEKS IN ADVANCE,
CALLED THE CLINIC, CHECKED
EVERYTHING OUT. DID MY DUE
DILIGENCE TO MAKE SURE THAT I
WOULD BE ABLE TO RECEIVE MY
MEDICATION. AND WHEN I SHOWED UP
ON A WEEKEND, TO THE CLINIC,
WHICH WAS ONLY OPEN FOR ONE HOUR
ON A SATURDAY, IT WAS A REALLY
NARROW WINDOW, THEY TOLD ME THAT
THEY DIDN'T KNOW WHAT I WAS
TALKING ABOUT, AND THEY DID NOT
HAVE YOU KNOW, A WAY FOR ME TO
DOSE BECAUSE THE DOCTOR IS NOT
THERE ON THE WEEKEND BECAUSE
THEY'RE ONLY OPEN ONE HOUR. SO I
LEFT THERE WITH A SINKING
FEELING IN MY STOMACH AND A
DECISION TO MAKE. DO I GO GET
HIGH AND USE ILLEGAL DRUGS TO
FEEL BETTER OR DO I TOUGH IT OUT
AND DEAL WITH THE QUESTIONS FROM
MY FAMILY ABOUT WHY I'M MISSING
MY NIECE'S BIRTHDAY, THIS IS
COMMON FOR PEOPLE, TRYING TO
TRAVEL ON MEDICATION ASSISTED
TREATMENT. ALSO UNHOUSED PEOPLE
WHO DO NOT HAVE THE ABILITY TO
TRAVEL AWAY FROM THE CLINIC
BECAUSE THEY'RE TIED TO IT. A
LOT OF, MY CLINIC COHORT IN
STOCKTON ACTUALLY LIVE VERY NEAR
IN PARKS, VERY NEAR THE CLINIC
BECAUSE THEY CAN'T GO OUTSIDE OF
THE CITY LIMITS. YOU KNOW, IT'S
TOO RISKY. THEY WON'T BE ABLE TO
GET BACK IN AND GET DOSE FOR
THEIR MEDICATION. I COULD TALK
ALL DAY ABOUT WHAT'S WRONG WITH
THEIR CLINIC SYSTEM, BUT I LIKE
TO END ON WHAT I THINK IS RIGHT,
THE MEDICATION WORKS. IT'S BEEN
SHOWN TO REDUCE ILLICIT DRUG USE
BY A THIRD AND QUADRUPLE
TREATMENT RETENTION ON METHADONE
IS ALLOWED ME PERSONALLY TO
ACCOMPLISH A LOT IN MY LIFE. I
DEFINITELY WOULD NOT BE HERE
WITHOUT IT AS A TOOL, TO MANAGE
MY, MY, SUBSTANCE USE. AND I
THINK DESPITE ALL OF THE ISSUES
THAT I JUST RAISED WITH HOW IT'S
CURRENTLY DONE, I STILL THINK IT
WAS WORTH IT TO BE ON THIS
MEDICATION. BUT IT DOESN'T HAVE
TO BE THIS DIFFICULT TO ACCESS.
IT DOESN'T HAVE TO OPERATE THIS
WAY. WE HAVE EXAMPLES, AND I'M
SURE THE DOCTORS THAT ARE GOING
TO COME UP AFTER ME WILL TALK
SOME ABOUT THIS OF OTHER PLACES
WHO HAVE SUCCESSFULLY,
INSTITUTED METHADONE AT THE
PHARMACY LEVEL, ALLOWING HEALTH
CARE PROFESSIONALS NOT JUST
DOCTORS, ADVANCED HEALTH CARE
PROFESSIONALS, TO PRESCRIBE IT,
SO I REALLY URGE YOU ALL TO DO
EVERYTHING IN YOUR POWER TO
LIBERATE METHADONE BECAUSE YOU'D
BE CHANGING MY LIFE, AND I THINK
A LOT OF OTHER PATIENTS LIVES
FOR THE BETTER. IF YOU CAN DO
THAT. THANK YOU. I'D ALSO BE
OPEN TO ANY QUESTIONS ANYONE
HAVE. I KNOW I PROBABLY WENT
OVER TOO LONG. NO NO, IT WAS
GREAT. AND THANK YOU. THANK YOU
SO MUCH FOR BOTH YOUR YOUR
EXPERTISE AND YOUR ANALYSIS, BUT
FOR SHARING YOUR OWN PERSONAL
EXPERIENCE AND BEING SO, SO OPEN
WITH IT. IT'S MUCH APPRECIATED
AND AN ESSENTIAL PART OF THIS
CONVERSATION. THÀNH ASSEMBLY
MEMBER CALLER THANK YOU, MR.
CHAIRMAN. AND AXEL, THANK YOU
FOR SHARING, I KNOW THE HOW HARD
IT COULD BE AND TO BE ABLE TO DO
IT IN SUCH A PUBLIC FORUM TO
HELP INFORM US IS REALLY, VALUED
AND, ESPECIALLY HEARING YOUR
FIRST HAND EXPERIENCE, WHICH IS,
WHICH WAS OFFERED WITH SUCH
HUMILITY, AND IT SOUNDS LIKE TO
ME, YOU KNOW, ALL IN ALL, THE
POSITIVES MAY OUTWEIGH THE
NEGATIVES. HOWEVER, THE
NEGATIVES ARE ISSUES THAT WE
NEED TO CONTEND WITH. IT LOOKS
LIKE ACCESS, YOU KNOW, HOURS OF
OPERATION, QUITE POSSIBLY
CONNECTED, TO RESOURCES AND OR
ANY REGULATORY OBSTACLES PUT IN
PLACE. AND SO IT'S REALLY GOOD
FOR US TO KNOW THAT, BECAUSE I
THINK THAT'S PART OF THE
CONVERSATION IS WHAT DO WE NEED
TO DO, SO THAT THESE CLINICS ARE
OPEN MORE HOURS OR NOT, YOU
KNOW, UNDERSTAFFED, SO THAT AS
MANY PEOPLE THAT NEED THE
TREATMENT CAN GET IT. AND I
APPRECIATE YOUR RECOGNITION OF
THOSE WHO ARE UNHOUSED AND HOW
CHALLENGING IT IS FOR THEM JUST
TO GET AROUND TOWN, LET ALONE,
MAKE SURE THEY GET THEIR
TREATMENT AS WELL WHEN THEY
DON'T HAVE, THE ABILITY TO OR AT
LEAST IT'S MUCH HARDER FOR THEM
TO BE IN A SAFE ENVIRONMENT IF
THEY'RE IN A DIFFICULT MENTAL,
EMOTIONAL, AND PHYSICAL STATE OR
NOT HAVING ACCESS TO METHADONE.
SO THANK YOU SO MUCH FOR YOUR
INPUT. THANK YOU, THERE'S A
COUPLE THINGS I WANTED TO ASK
ABOUT AND GET YOUR PERSPECTIVE
ON, YOU KNOW, FROM YOUR OWN YOUR
OWN PERSONAL EXPERIENCE AND FROM
WHAT YOU'VE SEEN IN AND AROUND
THE CLINICS YOU KNOW, ONE OF THE
ONE OF THE THINGS THAT, DRIVES A
LOT OF THE REALLY RESTRICTIVE
POLICIES THAT THAT CALIFORNIA
AND ACTUALLY THE US GENERALLY
HAVE, IT'S SO OUT OF STEP WITH
HOW THE REST OF THE WORLD WHO
HAVE HAD SUCCESS. WE LOOK AT WE
TALK ABOUT PORTUGAL, WE TALK
ABOUT SPAIN, SCOTLAND. THESE ARE
THESE ARE PLACES THAT HAD VERY
HAVE HAD VERY SERIOUS, OPIOID
ADDICTION CHALLENGES AS WELL,
VERY WIDESPREAD, AND THEY THEY
RELIED HEAVILY ON METHADONE TO
BE ABLE TO ROLL, ROLL THAT BACK.
AND REALLY I TOLD THIS STORY A
FEW TIMES. I WENT TO MADRID AND
MET WITH THEIR FOLKS WHO ARE
RESPONSIBLE FOR RESPONDING TO
ADDICTION IN MADRID. AND THEY
AND I LOOKED AT THE REPORT THEY
GAVE ME, AND I SAID, I CAN'T
FIND ANYWHERE ON HERE, WHERE
YOU'RE REPORTING YOUR YOUR
OVERDOSE DATA. THEY SORT OF
LOOKED AT ME A BIT CONFUSED, AND
THERE WAS TRANSLATION AND BACK
AND FORTH. THEY SAID, WELL, WE
DON'T REALLY HAVE OVERDOSES IN
ANY SIGNIFICANT WAY THAT THAT WE
WOULD REPORT PEOPLE, SOME
PEOPLE, WHEN THEY'RE ALREADY IN
SOME TREATMENT FACILITIES AND
SUCH AND OLDER AND VERY, VERY
RARE TO HOW, HOW IS THAT
POSSIBLE? DO YOU NOT HAVE OPIOID
ADDICTION. AND THEY SAID NO, WE
DEFINITELY DO. BUT EVERYBODY WHO
IS ADDICTED TO OPIOIDS HERE IS
ABLE TO ENROLL IN METHADONE. AND
SO WE DON'T. AND THAT'S
SINGULARLY WHY WE DON'T HAVE,
OVERDOSES OF SIGNIFICANT
NUMBERS. AND, AND OF COURSE,
THEY DESCRIBED TO ME A VERY
DIFFERENT SYSTEM THAT THEY, THAT
THEY, THAT THEY HAVE. AND MY
RESPONSE TO THEM WAS, WELL, WE
APPROACH IT VERY DIFFERENTLY
BECAUSE METHADONE IS STILL
THOUGHT OF AND VIEWED ALMOST AS
A, AS A ADJACENT ILLICIT
SUBSTANCE ON, ON ITS OWN, AND I
WONDER IF YOU COULD SPEAK TO, TO
THAT ASPECT OF THAT AND HOW YOU
TALKED ABOUT THE STIGMA. BUT
WHAT YOU'VE SEEN, I MEAN, I
THINK THERE ARE A LOT OF PEOPLE
WHO VIEW METHADONE NOT ONLY WITH
A STIGMA, BUT ALSO AS SOMETHING
THAT THAT IS THAT IS VERY OFTEN
OR CAN BE SORT OF ABUSED OR SOLD
, YOU KNOW, ON THE STREET AND,
YOU KNOW, IS THAT SOMETHING I
MEAN, FOR THE PEOPLE THAT YOU'VE
COME ACROSS, IN THE CLINICS THAT
YOU'VE BEEN A PART OF AND SUCH,
IF YOU WOULD DESCRIBE KIND OF
HOW YOU VIEW THAT ISSUE AND THAT
CONCERN, WHICH I THINK IS ONE,
AS WE TALK ABOUT CHANGING HOW WE
THINK ABOUT METHADONE AND HOW TO
ACCESS IT, IT'S GOING TO BE
SOMETHING THAT COMES UP, IS ARE
WE PUTTING SOMETHING IN PEOPLE'S
HANDS THAT THEY COULD ABUSE, OR
THAT THEY COULD EVEN SELL
ILLEGALLY AND HAVE OTHERS ABUSE
AND SORT OF IF YOU WOULD KIND OF
SPEAK TO THAT CONCERN THAT I'M
SURE YOU'VE HEARD AS WELL. YEAH.
NO, ABSOLUTELY, I'M GLAD YOU
RAISED, YOU KNOW, AGAIN, THE
ISSUE OF STIGMA BECAUSE I, I
THINK IT IS ONE OF THE BIGGER
BARRIERS THAT WE'VE GOT TO GET
AROUND, IT COMES EXTERNALLY FROM
THE COMMUNITY, BUT ALSO FROM THE
CLINICS THEMSELVES, MANY, YOU
KNOW, PEOPLE WHO WORK IN THE
CLINIC, ARE HOSTILE TOWARDS THE
MEDICATION THAT THEY'RE, THEY'RE
PRESCRIBING, SO IT IS A WEIRD OR
ODD SITUATION WHERE THIS
MEDICATION HAS REALLY BEEN
VILIFIED AND, AND KIND OF
DEMONIZED, AS FAR AS ITS ABUSE
ABILITY, I MEAN, ALCOHOL IS
LEGAL AND IT DOES, YOU KNOW,
TONS OF DAMAGE, YOU KNOW, IN
TERMS OF LONG TERME, ORGAN
DAMAGE, CAUSED ALCOHOL RELATED
ACCIDENTS, LIKE, I THINK THE
ISSUE IS NOT THE SUBSTANCE BEING
HARMED FULL IN OF ITSELF, WHICH
I DON'T BELIEVE IT IS,
ESPECIALLY NOT WHEN IT'S
PRESCRIBED PROPERLY. YOU KNOW,
TAKEN AND MANAGED PROPERLY, BUT
RATHER THESE KIND OF CONTROLLING
IMAGES THAT WE HAVE OF WHAT A
METHADONE USER IS, RIGHT, THAT
ARE VERY RACIALIZED AND
PREJUDICED AND BIASED, AND SO I
THINK A LOT OF WORK NEEDS TO BE
DONE IN GETTING AWAY FROM, THESE
NARRATIVES ABOUT DRUG USERS AS
BEING BAD OR CRIMINAL OR, YOU
KNOW, DANGEROUS. S, THE
METHADONE ITSELF, IF, LIKE YOU
MENTIONED IN, IN YOUR
EXPERIENCE, FINDING THAT THERE
WAS NO OVERDOSES IS REALLY
EFFECTIVE AT LOWERING THE RISK
OF, OF OVERDOSE AND PATIENTS WHO
EVEN ARE STILL USING OTHER
ILLICIT DRUGS, AND ALLOWS THEM
THE OPPORTUNITY TO STOP, YOU
KNOW, EVENTUALLY, VÆ, MAKES THE
TRANSITION FROM USING ILLICIT
DRUGS TO NOT USING ILLICIT DRUGS
MUCH, MUCH EASIER AND MORE
LIKELY THAT THEY WILL STICK WITH
TREATMENT. SO YES, THERE'S A TON
OF STIGMA. I MEAN, YOU CAN READ,
CASES WHERE POLICE HAVE,
BASICALLY POSTED OUTSIDE OF
CLINICS AND, YOU KNOW, DONE,
TERRY FRISK AND THESE KINDS OF
THINGS, AND, YOU KNOW, IN OUR,
IN OUR MEDIA, I OFTEN SEE
METHADONE BEING DERIDED. SO IT
REALLY NEEDS A REVAMP, I THINK.
WELL, I AND I ONE OF THE THINGS
ABOUT IT IS, AS YOU'RE SAYING
THIS, I MEAN, PART OF THE
POLICIES THAT AS THEY EXIST TO
MAKE IT SO RESTRICTED, IT ALMOST
REINFORCE FORCES, THE STIGMA AND
IT'S AND IT'S AND IT'S ON TOP OF
THAT, THE POLICIES REQUIRE A
CERTAIN LEVEL OF VULNERABILITY
FOR THE PEOPLE WHO NEED TO
ACCESS IT, THAT THAT ALSO ADD TO
THE STIGMA WHEN PEOPLE ARE
FORCED TO LINE UP ON THE STREET
AND BE OUT THERE, YOU KNOW, WE
DON'T REQUIRE THAT FOR MANY
OTHER MEDICATIONS THAT I CAN
THINK OF THAT YOU HAVE TO STAND
OUT, YOU KNOW, ON THE STREET OF
WHICH SOME CAN LEAD FOR SOME
PEOPLE TO SORT OF ADD TO A
STIGMA AROUND IT BECAUSE THEY
FEEL LIKE IT'S SOMETHING BAD
THAT THAT FOLKS ARE DOING, AND,
AND I WILL SAY THIS, I THINK,
JUST THE LAST, LAST POINT, MAYBE
IF YOU'VE SEEN THIS, AT LEAST IN
SAN FRANCISCO, ONE OF THE THINGS
THAT HAPPENS IS THAT PEOPLE WHO
ARE SELLING OR USING, ILLEGAL,
ILLICIT DRUGS, ARE SURROUND THE
CLINIC AND, AND SOME PEOPLE WHO
ARE SELLING IT AND THEY SORT OF
CAN TARGET PEOPLE. I MEAN, IT'S
THE WORST POSSIBLE WAY TO HAVE
PEOPLE ACCESS, USE SOMETHING
THAT CAN GET THEM AWAY FROM
SOMETHING, WHEN YOU MAKE THEM SO
VULNERABLE AND MAKE THEM SO GO
THROUGH SO MANY DIFFERENT LOOP,
YOU KNOW, STEPS AND BARRIERS AND
EVERYTHING TO ACCESS, HELP AND,
AND SO I WONDER IF THAT'S
SOMETHING THAT YOU'VE SEEN AS
WELL, JUST THE WAY THAT WE FORCE
PEOPLE TO KIND OF CONSTANTLY
SHOW UP PHYSICALLY IN SUCH A
VULNERABLE WAY AND HOW THAT
IMPACTS PEOPLE. YEAH,
ABSOLUTELY. I THINK THERE'S A
MILLION LITTLE OPPORTUNITIES ON
THE WAY TO THE CLINIC TO FALL
OFF OF YOU KNOW, ACTIVE
TREATMENT OR, YOU KNOW, ACTIVE
RECOVERY. AND, IT CLINICS ARE A
DEPRESSING PLACE. IT'S NOT I DO
NOT LOOK FORWARD TO GOING THERE
EVERY DAY. YOU KNOW? SO, I DON'T
GET TREATED WELL THERE. I SEE
OTHER PEOPLE NOT TREAT IT WELL
THERE, SO IT IT IS A HARD THING,
A HARD THING TO DO. AND I THINK
IT'S REALLY, UNFORTUNATE THAT
THERE ARE SOME PEOPLE, MAYBE
TAKING ADVANTAGE. YOU KNOW,
SELLING DRUGS NEAR CLINICS AND
STUFF LIKE THAT, BUT IT HASN'T
BEEN MY EXPERIENCE THAT I'VE
SEEN A LOT OF THAT, YOU KNOW,
AGAIN, I CAN ONLY SPEAK TO THE
CLINICS THAT I'VE BEEN TO, WHICH
ACTUALLY IS QUITE A FEW, MAYBE
FIVE DIFFERENT CLINICS
THROUGHOUT THE STATE OF
CALIFORNIA. BUT JUST GOING THERE
AND BEING SUBJECT TO, LIKE, THE,
THE RIDICULE, THE
DEHUMANIZATION, THE BUREAUCRATIC
NIGHTMARE EVERY DAY DOES, WEAKEN
MY WILL, AND I'M SURE OTHER
PEOPLE'S WILL TO KEEP COMING
BACK. RIGHT. AND WE NEED TO HAVE
A IF THERE IS GOING TO BE A
CLINIC IN THE WAY THAT IT IS,
CONCEIVED OF NOW, IT NEEDS TO BE
A PLACE PEOPLE WANT TO GO. YEAH
WELL, AND I, I ALSO, YOU KNOW,
ONE OF THE THINGS ABOUT EVEN
JUST THE LANGUAGE THEY THAT WE
USE SOMETIMES WE, WE, WE EVEN
I'VE HEARD THIS BEFORE THAT THE
IDEA THAT IF YOU ARE NOT ON IF
YOU ARE ON METHADONE, THAT
YOU'RE NOT SOBER, YOU KNOW, SO
PEOPLE THINK THAT BASICALLY
YOU'RE DOING SOMETHING WRONG,
YOU'RE RIGHT. I MEAN, WE DON'T
WE DON'T TALK ABOUT ANY OTHER
MEDICATION IN, IN THAT WAY. AND
IN FACT, IT'S SOMETHING THAT
I'VE HAD TO REINFORCE AND, AND I
THINK THANKFULLY THEY'RE,
THEY'RE UNDERSTANDING THIS, THAT
EVEN IN OUR, IN OUR DRUG FREE
HOUSING, OUR SOBER HOUSING,
THOSE LIVING FACILITIES, THEY
THAT DOESN'T EXCLUDE PEOPLE WHO
ARE, WHO ARE ENROLLED IN
METHADONE OR BUPRENORPHINE
BECAUSE THOSE ARE MEDICATIONS
AND THAT'S THAT, THAT, THAT,
THAT YOU'RE STILL SOBER, YOU
KNOW, IN THAT IN THAT SENSE,
OBVIOUSLY PEOPLE CAN ASSESS FOR
THEMSELVES WHERE THEY WANT TO BE
ON THAT, ON THAT JOURNEY, BUT
THERE'S NOTHING, YOU KNOW, THAT
THEY SHOULD NEED TO BE
STIGMATIZED AROUND FOR THAT, I
WANT TO THANK YOU. YOU AXEL, WE
COULD HAVE A MUCH LONGER
CONVERSATION ABOUT THIS, AND IT
WAS REALLY, REALLY MEANINGFUL TO
START THIS HEARING WITH YOUR
PERSPECTIVE. AND I, I LOOK
FORWARD TO WORKING WITH YOU ON
MANY OF THESE ISSUES AND HELPING
TO ADDRESS, WHAT HAS BEEN,
UNFORTUNATELY, A PART OF YOUR
EXPERIENCE WITH THIS? BUT I ALSO
WANT TO CONGRATULATE YOU ON, ON
YOUR JOURNEY AND YOUR SUCCESS
AND, LOOK FORWARD TO READING ALL
THE BOOKS THAT YOU WRITE ABOUT,
ABOUT HOW WE'RE GOING TO DO
BETTER AS A, AS A STATE AND
COUNTRY ON THIS ISSUE. THANK
YOU. THANK YOU SO MUCH FOR, THE
COMMITTEE'S TIME. I REALLY
APPRECIATE THE WORK THAT YOU'RE
DOING. ABSOLUTELY. THANK YOU.
ALL RIGHT. I AM GOING TO MOVE
RIGHT ALONG TO OUR SECOND PANEL,
WE HAVE FIVE, THREE, ESTEEMED,
DOCTORS AND PROFESSORS, ALL
THREE HERE WITH US TODAY. I WANT
TO INVITE UP, DOCTOR LESLIE
SWAIN, AN ADDICTION MEDICINE
PHYSICIAN AND RESEARCHER AT UC
SAN FRANCISCO. DOCTOR AMY
MULLIN, PROFESSOR IN THE
DEPARTMENT OF EMERGENCY MEDICINE
AND CHIEF OF THE DIVISION OF
ADDICTION MEDICINE AT UC DAVIS
HEALTH AND DOCTOR LEE TROPE,
PEDIATRIC HOSPITALIST AT SANTA
CLARA VALLEY MEDICAL CENTER AND
AFFILIATED CLINICAL INSTRUCTOR
AT STANFORD UNIVERSITY. WE
WELCOME. THANK YOU. AND I
BELIEVE WE ARE GOING TO HAVE,
DOCTOR SWAIN START. THANK YOU,
CHAIRMAN JAMIE. AND THANK YOU.
DISTINGUISHED COMMITTEE MEMBERS.
MY NAME IS DOCTOR LESLIE SOON,
AND I NØ NÓ SOON, AND I'M AN
ADDICTION MEDICINE SPECIALIST
AND RESEARCHER AT UCSF. I TREAT
PATIENTS AND WITH SUBSTANCE USE
DISORDERS IN SAN FRANCISCO. AND
I ALSO CONDUCT POLICY RESEARCH
ON WAYS TO IMPROVE OUR SUBSTANCE
USE TREATMENT SYSTEMS. NEXT
SLIDE. SO I HOPE IT COMES TO NO
SURPRISE TO ANYONE THAT OUR
STATE IS IN THE MIDST OF THE
WORST OVERDOSE CRISIS IN HISTORY
. TO PUT THINGS IN PERSPECTIVE,
IN SAN FRANCISCO, WHERE I'M FROM
, WE HAD 257 DEATHS FROM COVID
IN 2020. IN COMPARISON, WE HAD
679 DEATHS FROM OVERDOSES IN
THAT SAME YEAR, ALMOST THREE
TIMES AS HIGH. THIS IS ONLY
INCREASED IN THE IN THE YEARS
SINCE WHERE WE HAD OVER 800
DEATHS IN THE LAST YEAR. SO THIS
OVERDOSE CRISIS IS ONLY
INCREASING. NEXT SLIDE. I ALSO
WOULD NOT SAY THAT OVERDOSES ARE
ONLY A SAN FRANCISCO CRISIS, BUT
A STATEWIDE CRISIS ALL ACROSS
CALIFORNIA. THE GRAPH ON THE
LEFT SHOWS FROM KAISER KAISER
FAMILY FOUNDATION THAT
CALIFORNIA PARALLELS THE REST OF
THE COUNTRY AND RISING OVERDOSE
DEATHS WITH 17.8 DEATHS OUT OF
EVERY 100,000 CALIFORNIANS IN
2021. AND AGAIN, THAT NUMBER IS
ONLY INCREASING FURTHER. THE MAP
ON THE RIGHT SHOWS THAT THE
COUNTIES MOST HARD HIT IN
CALIFORNIA ARE ACTUALLY NOT THE
SAN FRANCISCO'S OR THE LOS
ANGELES OF THE STATE, BUT RATHER
MORE RURAL AREAS, PARTICULARLY
IN THE NORTHERN REGION, WHERE
ACCESS TO TREATMENT AND
RESOURCES ARE MORE SPARSE. NEXT
SLIDE. SO WHAT ARE THE TREATMENT
OPTIONS FOR OPIOID USE DISORDER
IN THE UNITED STATES? WE HAVE
THREE FDA APPROVED MEDICATIONS
TO TREAT OPIOID ADDICTION,
INCLUDING METHADONE,
BUPRENORPHINE AND NALTREXONE.
AND ALL OF THESE THREE
MEDICATIONS WORK DIFFERENTLY ON
THE OPIOID RECEPTOR IN THE
BRAIN. WE KNOW THAT WHEN PEOPLE
STOP USING OPIOIDS, THOSE EMPTY
OPIOID RECEPTORS CAN LEAD TO
REALLY DISTRESSING WITHDRAWAL
SYMPTOMS. AND THESE MEDICATIONS
INTERACT AT THE RECEPTOR IN
DIFFERENT WAYS, ALL WITH THE
GOAL OF ALLOWING PEOPLE TO GO
ABOUT THEIR LIVES WITHOUT HAVING
TO THINK ABOUT WITHDRAWAL OR
CRAVINGS. METHADONE IS WHAT WE
CALL A FULL AGONIST OPIOID,
MEANING IT FULLY ACTIVATES THE
RECEPTOR JUST LIKE ANY OTHER
OPIOID. WHILE BUPRENORPHINE IS A
PARTIAL OPIOID AGONIST, MEANING
THAT IT PARTIALLY ACTIVATES THE
RECEPTOR. JUST LIKE KIND OF LIKE
A DIMMER SWITCH. TURNING THE
LIGHT ON HALFWAY. FINALLY,
NALTREXONE IS AN OPIOID
ANTAGONIST, MEANING THAT IT
FULLY BLOCKS THE RECEPTOR AND SO
THAT IT HAS NO OPIOIDS CANNOT
HAVE ANY EFFECT ON THE BODY. AND
IT SHOULD BE NOTED THAT
METHADONE AND BUPRENORPHINE ARE
ONLY THE MEDICATIONS THAT HAVE
BEEN SHOWN TO REDUCE DEATH,
WHEREAS NALTREXONE HAS SHOWN NOT
HAS NOT HAD THAT FINDING. NEXT
SLIDE. SO WE IN THE, WE HAVE
OVER FIVE DECADES OF EVIDENCE
SHOWING THAT METHADONE AND
BUPRENORPHINE WORK WHEN PEOPLE
ARE TAKING THESE MEDICATIONS.
ÓRDENES THEY HAVE ARE KNOWN TO
BE LESS LIKELY TO USE DRUGS,
HAVE LOWER CRIME RATES, INCREASE
QUALITY OF LIFE, HAVE ARE A MORE
ABLE TO PURSUE EMPLOYMENT AND
CONNECT WITH FAMILY AND LOVED
ONES. THESE MEDICATIONS ARE ALSO
LIFE SAVING WITH GREATER THAN
50% REDUCTION IN ALL CAUSE. ALL
CAUSE MORTALITY. BY COMPARISON,
AS A DOCTOR, I PRESCRIBE MANY
DIFFERENT MEDICATIONS AND OTHER
DRUGS LIKE STATINS FOR
CHOLESTEROL OR ASPIRIN FOR HEART
DISEASE AND METFORMIN FOR
DIABETES ONLY HAVE A 24 TO 33%
REDUCTION, WHICH IS ONLY HALF OF
HOW MUCH BUPRENORPHINE AND
METHADONE SAVE PEOPLE'S LIVES.
NEXT SLIDE. NEXT SLIDE. SO, NEXT
SLIDE PLEASE. SO WHAT WE KNOW IS
THAT BUPRENORPHINE IS EASIER TO
ACCESS. HOWEVER, IN THE ERA OF
FENTANYL, INITIATING
BUPRENORPHINE HAS ACTUALLY
BECOME MORE CHALLENGING BECAUSE
OF THE HIGH RISK OF CAUSING
SEVERE WITHDRAWAL SYMPTOMS WHEN
PEOPLE START TAKING THEM.
BUPRENORPHINE, HOWEVER, REMAINS
A VERY EFFECTIVE TOOL FOR
OPIOIDS. BUT TO ADDRESS THIS
CRISIS, WE REALLY NEED TO
LEVERAGE ALL AVAILABLE OPTIONS.
AND AS MENTIONED EARLIER,
METHADONE IS OUR OLDEST
MEDICATION TO TREAT OPIOID
ADDICTION AND IS HIGHLY
EFFECTIVE. HOWEVER, AS AXEL
KAMINSKY EARLIER SAID, THERE ARE
SIGNIFICANT RESTRICTIONS ON HOW
TO ACCESS THESE MEDICATIONS DUE
TO STATE AND FEDERAL POLICIES.
NEXT SLIDE. SO IN THE UNITED
STATES, METHADONE IS HIGHLY
REGULATED BY FEDERAL AND STATE
GUIDELINES, AS METHADONE CLINICS
NOT ONLY HAVE TO FOLLOW FEDERAL
RULES, THEY ALSO HAVE TO FOLLOW
STATE RULES AS WELL. ONE RECENT
STUDY FROM THE NEW YORK
UNIVERSITY FOUND THAT ACROSS ALL
STATES, CALIFORNIA IS ACTUALLY
ONE OF THE MOST RESTRICTIVE
STATES WHEN IT COMES TO STATE
REGULATIONS FOR METHADONE
TREATMENT. WHAT WE'VE LEARNED
FROM COVID 19 IS THAT DURING THE
COVID 19 PANDEMIC. NEXT SLIDE,
PLEASE. THE FEDERAL GUIDELINES
ACTUALLY LOOSENED METHADONE
RESTRICTIONS SO THAT PEOPLE WERE
ABLE TO GET MORE METHADONE AND
ACTUALLY SHELTER IN PLACE SAFELY
AT HOME. AND WHAT THE RESEARCH
FROM THE PAST FOUR YEARS HAS
FOUND THAT WHEN PEOPLE HAD
BETTER ACCESS TO METHADONE, THEY
WERE MORE LIKELY TO BE RETAINED
IN CARE. THEY HAD MORE, BETTER
IMPROVED QUALITY OF TREATMENT
FROM BOTH PATIENTS AND
CLINICIANS. AND IMPORTANTLY,
THERE WERE NO INCREASES FROM
OVERDOSES FROM METHADONE, AND
THIS IS FROM JAMA PSYCHIATRY,
INCLUDING DATA FROM THE CDC AND
THE NATIONAL INSTITUTE ON DRUG
ABUSE. AND SO IN EARLIER THIS
YEAR, THE BIDEN ADMINISTRATION,
THROUGH THE SUBSTANCE USE AND
MENTAL HEALTH SERVICES
ADMINISTRATION, CODIFIED THESE
REGULATIONS AS OF THIS MONTH,
HOWEVER, OUR FEDERAL REGULATIONS
, ARE IN DIRECT CONFLICT WITH
OUR FEDERAL GUIDELINES. AND SO
OUR CURRENT STATE LAWS ACTUALLY
PREVENT US FROM FOLLOWING THE
FEDERAL RULES. NEXT SLIDE. SO
FOR EXAMPLE, ONE PARTICULAR
METHADONE REGULATION, THÀNH THAT
IS DIFFERENT BETWEEN FEDERAL AND
STATE GUIDELINES ARE, TAKE HOME
METHADONE PRIVILEGES. SO AS
MENTIONED, PEOPLE ON METHADONE
HAVE TO GO TO A CLINIC EVERY
SINGLE DAY, OFTEN FOR LONG
PERIODS OF TIME BEFORE THEY'RE
ALLOWED THE PRIVILEGE OF A TAKE
HOME DOSE THAT THEY CAN TAKE AT
HOME. ACCORDING TO FEDERAL
REGULATIONS, THEY NOW, AS OF
THIS MONTH, PEOPLE ARE NOW
ALLOWED UP TO SEVEN DOSES OF
TAKE HOMES AS SOON AS THEY ENTER
TREATMENT. AND AFTER TWO WEEKS,
THEY ARE INCREASED TO TWO WEEKS
OF TAKE HOME DOSES. AND THEN
AFTER ONE MONTH OF TREATMENT,
THEY CAN IMMEDIATELY GET UP TO
ONE MONTH. AND SO THIS HUGELY
ALLOWS PEOPLE TO INCREASE THEIR
ACCESS TO MEDICATIONS. HOWEVER,
IN CALIFORNIA WE ARE STILL TIED
TO OLD RESTRICTIONS WHERE PEOPLE
STILL HAVE TO BE IN TREATMENT
EVERY DAY, SHOWING UP TO CLINIC
FOR THREE MONTHS BEFORE THEY CAN
EVEN GET ONE TAKE HOME DOSE. AND
SO THIS REALLY HIGHLIGHTS HOW WE
IN CALIFORNIA ARE ADDING ON
ADDITIONAL RESTRICTIONS THAT ARE
PREVENTING PEOPLE FROM GETTING
THE CARE THAT THEY NEED. NEXT
SLIDE. I THINK IT'S IMPORTANT TO
NOTE THAT THE FEDERAL
GOVERNMENT, THROUGH THE DRUG
ENFORCEMENT ADMINISTRATION, THE
AGENCY MOST RESPONSIBLE FOR
PUBLIC SAFETY AND REDUCING
DIVERSION, HAVE ACTUALLY MADE
ALSO NEW FEDERAL UPDATES,
INCLUDING IN 2021, INTRODUCING
THE 72 HOUR METHADONE RULE AND
SO THIS WOULD ALLOW HOSPITALS
AND CLINICS TO DISPENSE UP TO 72
HOURS SUPPLY OF METHADONE WHILE
PATIENTS AWAIT LINKAGE TO AN
OPIOID TREATMENT PROGRAM. SO IF
YOU ARE AN EMERGENCY DEPARTMENT
AND YOU WANT TO GET STARTED ON
METHADONE, HOSPITALS COULD GIVE
YOU THREE DAY SUPPLY WHILE YOU
AWAIT INTAKE AT A METHADONE
CLINIC. HOWEVER, AGAIN,
CALIFORNIA STATE LAW IS IN
CONFLICT WITH THIS ALLOWANCE AND
IT PREVENTS US AS DOCTORS FROM
BEING ABLE TO GIVE THIS TO THIS
NEW ALLOWANCE TO PATIENTS IN
2022, THE DRUG ENFORCEMENT
AGENCY ALSO ALLOWED PEOPLE TO
START IMPLEMENTING MOBILE
METHADONE, WHERE METHADONE VANS
CAN ACTUALLY DELIVER METHADONE
TO MORE RURAL AREAS. AND THIS IS
SOMETHING THAT I KNOW IS, IS
CURRENTLY BEING, LOOKED INTO BY
THE DEPARTMENT OF HEALTH CARE
SERVICES. AND SO NEXT SLIDE
PLEASE. WHAT ARE THE POLICY
RECOMMENDATIONS FOR HOW WE CAN
ADDRESS THIS CRISIS. WHAT WE CAN
DO IS WE CAN AMEND STATE AND
HEALTH REGULATIONS TO ALLOW
CALIFORNIA HEALTH SYSTEMS TO
ADOPT THE 72 HOUR RULE, WHICH
WOULD INCREASE ACCESS TO
METHADONE. WE CAN ALLOW ALIGN
OUR STATE POLICIES TO ALIGN WITH
THE FEDERAL RECOMMENDATIONS FROM
THE SUBSTANCE ABUSE AND MENTAL
HEALTH SERVICES ADMINISTRATION,
ADMINISTRATION, AND THAT
INCLUDES INCREASING AVAILABLE
METHADONE TAKE HOME DOSES DURING
EARLIER PERIODS OF TREATMENT,
REMOVING THE REQUIREMENTS FOR
COUNSELING, AND THEN ALLOWING
FOLLOWING FEDERAL GUIDELINES ON
URINE DRUG TESTING AND METHADONE
TREATMENT, AMONG MANY OTHER
RECOMMENDATIONS AND IT'S
IMPORTANT TO NOTE TO THANK
ASSEMBLY MEMBER HANEY FOR
INTRODUCING AB 2115, WHICH WOULD
IMPLEMENT ALL OF THESE UPDATES.
FINALLY, EXPANDING MOBILE
METHADONE MEDICATION UNITS CAN
DELIVER METHADONE TO MORE AREAS
WITH LOWER ACCESS, ESPECIALLY IN
PLACES THAT DO NOT HAVE ACCESS
TO COUNTIES. SO NEXT SLIDE. I
THANK YOU FOR YOUR TIME AND I
WELCOME ANY QUESTIONS. THANK YOU
SO MUCH, NEXT WE HAVE DOCTOR
MULLIN. VERY GOOD. THANK YOU
VERY MUCH. IT'S EASIER THAN
BUPRENORPHINE. SO I FIGURED
YOU'RE THAT ONE. TOOK ME A
WHILE. I KNEW YOU WERE GOING TO
DO WELL. THANK YOU, I DON'T KNOW
IF THE SLIDES ARE UP, BUT I'M
DOCTOR AMY MULLIN. I'M AN
EMERGENCY PHYSICIAN AND
ADDICTION MEDICINE PHYSICIAN. I
ALSO WORK FOR CALIFORNIA BRIDGE,
WHICH IS AN EFFORT TO EXPAND
ACCESS TO ADDICTION TREATMENT.
AND NEXT SLIDE, ONE OF OUR KEY
TENANTS. AND I THINK THIS SHOULD
BE THE PIECE THAT DRIVES US. IS
THAT ALL PEOPLE DESERVE RAPID
ACTION, RAPID ACCESS TO
ADDICTION TREATMENT. WE ARE VERY
FAR FROM HITTING THAT GOAL. AND
SO THAT SHOULD BE THE MAIN
DRIVER OF ALL OF OUR POLICIES IS
HOW WELL ARE WE DELIVERING RAPID
ACCESS TO ALL CALIFORNIANS? NEXT
SLIDE. THIS IS WHERE WE ARE
NATIONALLY. THIS IS FROM THE
NATIONAL SURVEY ON DRUG USE AND
HEALTH. AND WHAT YOU SEE IS THAT
95% OF PEOPLE WHO HAVE SUBSTANCE
USE DISORDERS WITHIN THE PAST
YEAR DID NOT RECEIVE SUBSTANCE
USE DISORDER TREATMENT. AND WHAT
PEOPLE WILL TELL YOU IS THAT
THAT 95% DOES NOT WANT TREATMENT
. AND I CAN TELL YOU FROM MY
EXPERIENCE, THAT IS SIMPLY NOT
TRUE. WE ARE NOT OFFERING
TREATMENT. WE HAVE PUT DRUG
TREATMENT BEHIND LOCK AND KEY
AND MADE IT REALLY DIFFICULT TO
ACCESS. SO THE VERY PEOPLE WHO
ARE EXPERIENCING THE SOCIAL
CHAOS IN THEIR LIVES, WE HAVE
MADE IT EXCESSIVELY HARD TO
ACCESS EVIDENCE BASED TREATMENT.
NEXT SLIDE. THE RADICAL AND
OBVIOUS SOLUTION THAT WE HAVE
APPROACHED, THAT WE HAVE TAKEN
IN OUR EMERGENCY DEPARTMENTS IS
TO UNIVERSALLY OFFER TREATMENT
ON DEMAND. SO CURRENTLY, SOMEONE
WALKS INTO THE EMERGENCY
DEPARTMENT, HAS A SUBSTANCE USE
DISORDER, AND WE START TREATMENT
ON DEMAND. THIS IS BOTH RADICAL
BUT EXTREMELY OBVIOUS THAT ALL
PEOPLE SHOULD HAVE ACCESS TO
ADDICTION TREATMENT. SO THIS HAS
BEEN OUR PROGRAM. WE ARE
PRIMARILY USING BUPRENORPHINE
THROUGH THE EMERGENCY
DEPARTMENTS. FUNCTIONALLY
BECAUSE IT IS EASIER. NEXT SLIDE
. AS MY COLLEAGUE MENTIONED,
BUPRENORPHINE IS A PARTIAL
AGONIST. IT BECAUSE IT IS A
PARTIAL AGONIST IT CAN BE
PRESCRIBED. SO I CAN WRITE A
PRESCRIPTION FOR BUPRENORPHINE.
AND THAT INDIVIDUAL CAN GO TO A
PHARMACY AND PICK IT UP AND THEN
ATTEND A CLINIC APPOINTMENT IN
TWO WEEKS. TIME CAN BE
PRESCRIBED CURRENTLY BY ANY
PHYSICIAN WITH A DEA LICENSE.
PREVIOUSLY, IT WAS SO DIFFICULT
TO ACCESS ONLY SPECIAL
PHYSICIANS COULD PRESCRIBE IT IN
A LIMITED NUMBER. WE HAVE A LONG
HISTORY OF PROVIDING VERY
DIFFICULT TO ACCESS, HIGHLY
STIGMATIZED CARE, AND WE ARE
JUST STARTING TO DIG OUT OF IT,
AND WE NEED TO RAPIDLY RAMP UP
OUR ABILITY TO PROVIDE TREATMENT
TO PEOPLE WHO NEED IT. SO
BUPRENORPHINE TREATS CRAVINGS
AND WITHDRAWAL. IT IS A PARTIAL
AGONIST. IT IS NOT A FULL OPIOID
, WHICH ALLOWS US THOSE
FLEXIBILITIES TO PRESCRIBE IT
AND THEN REFER SOMEONE TO ANY
OUTPATIENT CLINIC. WE DO NOT
NEED TO BE CONNECTED TO A
SPECIFIC OPIOID TREATMENT
PROGRAM, WHICH IS A LOT MORE
GEOGRAPHIC FLEXIBILITY ACROSS
THE STATE. NEXT SLIDE. I WANT TO
REITERATE THESE MEDICATIONS ARE
HIGHLY EFFECTIVE. THEY ARE NOT
NEW Tð. THESE ARE MEDICATIONS
THAT WE'VE HAD FOR A LONG TIME.
WE HAVE DECADES OF STUDYING
THESE MEDICATIONS.
BUPRENORPHINE. THIS IS SOMETHING
WE TALK ABOUT IN MEDICINE IS HOW
MANY PATIENTS DO I NEED TO TREAT
TO HAVE AN IMPACT, TO GIVE
SOMEONE TO HAVE AN IMPACT JUST
BY GIVING ASPIRIN. YOU ALL HAVE
HEARD OF THIS FOR A HEART
ATTACK. I NEED TO TREAT 42
PEOPLE TO HAVE AN IMPACT. THE
ENTIRE EMS SYSTEM THAT WE HAVE
DEVELOPED, WHICH IS DESIGNED TO
ADDRESS CARDIAC ARREST AND
PROVIDE DEFIBRILLATION, THEY
NEED TO TREAT TWO AND A HALF
PEOPLE TO HAVE AN EFFECT. I ONLY
NEED TO TREAT TWO PEOPLE WITH
BUPRENORPHINE TO GET SOMEONE
INTO TREATMENT. THESE ARE HIGHLY
EFFECTIVE MEDICATIONS THAT WE
HAVE STUDIED FOR A LONG TIME.
NEXT SLIDE. THIS IS OUR
CALIFORNIA BRIDGE PROGRAM. WHAT
I WANT TO HIGHLIGHT FOR YOU FROM
THIS DATA THAT IS STATEWIDE,
LOOKING AT THE NUMBER OF PEOPLE
THAT WE HAVE ENGAGED IN
TREATMENT IS OF THE FOLKS THAT
WE HAVE IDENTIFIED. AND JUST
KEEP IN MIND, THIS IS A TINY
FRACTION OF THE PEOPLE WE COULD
BE REACHING 176,000 PEOPLE. WE
IDENTIFIED WITH OPIOID USE
DISORDER, 76,000 WERE STARTED ON
TREATMENT IN THAT VISIT. SO
REMEMBER THE MYTH OF 95% OF THE
PEOPLE WHO DON'T WANT TREATMENT
HERE? I CAN TELL YOU ABOUT 40%
OF THE PEOPLE THAT WE
ENCOUNTERED IN THE EMERGENCY
DEPARTMENT ACCEPTED TREATMENT ON
THAT VISIT. THESE ARE THE
TRADITIONAL HARDEST TO REACH
INDIVIDUALS. PEOPLE WITH
CO-OCCURRING MENTAL ILLNESS,
PEOPLE WITH UNSTABLE HOUSING,
PEOPLE WHO ARE CURRENTLY
DISCONNECTED FROM TRADITIONAL
SOURCES OF CARE. THIS IS THE
POPULATION THAT HAS THAT MOST
PEOPLE WILL HAVE YOU BELIEVE IS
TREATMENT RESISTANT. AND WE CAN
SEE THAT IT IS NOT TRUE. NEXT
SLIDE. WHAT WE HAVE LEARNED IS
THAT LOW BARRIER, EASY TO ACCESS
TREATMENT DRIVES INCREASED
DEMAND FOR TREATMENT. THE REASON
WE DO NOT HAVE MORE PEOPLE IN
TREATMENT IS BECAUSE WE HAVE NOT
ASKED IF THEY WANT IT. NEXT
SLIDE. CURRENTLY, OUR OUTPATIENT
TREATMENT, WE HAVE FOCUSED ON
THE SPECIALTY DRUG MEDI-CAL
SYSTEM, WHICH IS PRIMARILY OUR
METHADONE CLINICS. BUT WE NEED
TO INCORPORATE ALL AREAS OF
CARE. WE NEED TO INCORPORATE
PRIMARY CARE EMERGENCY
DEPARTMENTS, FEDERALLY QUALIFIED
HEALTH CARE CENTERS. WE NEED AN
ALL HANDS ON DECK APPROACH SO
THAT ALL PLACES WHERE AN
INDIVIDUAL CAN ACCESS CARE IS
ABLE TO PROVIDE THEM THAT RAPID
ACCESS TO TREATMENT. SO I'M
GOING TO LEAVE YOU WITH THE
FINAL PIECE WHERE WE SHOULD ALL
BE, WHICH IS ALL PEOPLE DESERVE
RAPID ACCESS TO TREATMENT. WE
ARE VERY FAR FROM HITTING THAT
GOAL. BUT OVERDOSE, PARTICULARLY
OPIOID USE DISORDER, IS A HIGHLY
TREATABLE DISEASE PROCESS. THIS
IS A SOLVABLE PROBLEM, AND WE
ACTUALLY KNOW HOW TO SOLVE IT.
WE JUST NEED TO DO IT. HAPPY TO
ANSWER ANY QUESTIONS. THANK YOU.
I APPRECIATE THAT, DOCTOR TROPE.
DOCTOR LEE TROPE. I'M A
PEDIATRICIAN, CAN YOU HEAR ME?
I'M A PEDIATRIC HOSPITALIST, SO,
I WORK IN THE HOSPITAL, TAKING
CARE OF KIDS WITH ALL SORTS OF
DISEASES. BUT SINCE 2020, I'VE
STARTED TO FOCUS ON ADMITTING
PATIENTS WHO ARE, UNDER 21 TO
THE HOSPITAL TO TREAT THEM FOR
OPIOID USE DISORDER. AND I'M
GOING TO TALK A LITTLE BIT ABOUT
THE OPIOID EPIDEMIC. MY SLIDES
ARE UP IN YOUNG CALIFORNIANS. SO
I REALLY APPRECIATE, AXEL, YOUR
COMMENTS. HE KIND OF BROUGHT TO
LIFE SOMETHING THAT WE SEE,
WHICH IS THAT MOST PEOPLE START
USING WHEN THEY'RE MINORS OR
ADOLESCENTS OR YOUNG ADULTS, BUT
THEY DON'T ACTUALLY HAVE ACCESS
TO CARE FOR DECADE. AND SO THIS
IS A PEDIATRIC DISEASE THAT THE
PEDIATRIC COMMUNITY AND OUR
SYSTEMS ARE NOT TREATING IN A
TIMELY FASHION. SO NEXT SLIDE
PLEASE I'LL TALK A LITTLE BIT
MORE ABOUT THAT. SO IF YOU LOOK
AT KIDS NOW THIS IS LOOKING AT
TEENS. THE GRAPH TO THE LEFT IS
NATIONAL DATA. AND THE GRAPH TO
THE RIGHT IS CALIFORNIA DATA. TO
THE LEFT YOU CAN SEE JUST A HUGE
INCREASE AROUND 2019 2020 IN
DEATHS. AND THAT GRAY LINE IT'S
PROBABLY TOO SMALL TO SEE IS
BECAUSE OF FENTANYL. SO THAT'S
OVERDOSE DEATHS IN TEENS. AND
CALIFORNIA IS NO DIFFERENT. I
MEAN IT'S JUST STAGGERING. WHEN
YOU LOOK AT THE GRAPH, THIS IS
ACTUALLY IN THE CONTEXT OF
RECORD DOWN TRENDING SUBSTANCE
USE IN TEENS. SO ACTUALLY WHEN
WE LOOK AT THE DATA, LESS AND
LESS YOUNG PEOPLE ARE USING
DRUGS THAN IT USED TO BE. BUT
THESE DRUGS ARE SO DEADLY THAT
THEY'RE KILLING A LOT MORE
PEOPLE. NEXT SLIDE PLEASE, THIS
IS JUST TALKING ABOUT NATIONAL
DATA ON YOUNG PEOPLE AND
OPIOIDS. FENTANYL IS NOW BEHIND
90% OF ALL OVERDOSE DEATHS IN
TEENS. AND WHEN WE DO AUTOPSIES,
WE FIND THAT MOST OF THEM HAVE
ANOTHER SUBSTANCE IN THEIR
SYSTEM AT THE TIME OF DEATH,
THIS, THIS NEXT SECTION TALKS
ABOUT OVERDOSE DEATHS. SO I'M
GOING TO TALK ABOUT OPIOID USE
DISORDER AND TREATMENT. BUT I'M
ALSO GOING TO TALK ABOUT
OVERDOSE TODAY. AND WHEN YOU
LOOK AT OVERDOSE DEATHS IN IN
TEENAGERS, YOU FIND THAT 60%
OCCURRED AT HOME, 67% OF THE
TIME. SOMEBODY ELSE WAS ALSO
HOME 60% OF THE TIME A TEEN WAS
PULSELESS. BY THE TIME THE EMS
ARRIVED, AND NARCAN WAS GIVEN IN
LESS THAN ONE THIRD OF
OVERDOSES. SO HUGE OPPORTUNITY
TO IMPROVE OUR OVERDOSE CARE. IF
YOU GO TO THE NEXT SLIDE, WHEN
YOU TALK TO OUR PATIENTS, YOU
ASK, WHERE DO YOU GET WHERE DO
THEY GET OPIOIDS FROM? AND YOU
MAY BE SHOCKED TO FIND OUT. OR
YOU MAY ALREADY KNOW THIS, BUT A
LOT OF PEOPLE ARE SHOCKED TO
FIND OUT THAT A LOT OF IT IS ON
SOCIAL MEDIA. SO A LOT OF OUR
KIDS WILL SAY THEY WENT OUT
LOOKING FOR SPECIFIC SUBSTANCES,
AND WE'VE ACTUALLY FOUND SOME
KIDS AFTER OVERDOSE. WHEN WE
LOOK AT THEIR SEARCH HISTORY
THAT THEY WERE LIKE, WHAT DOSE
OF PERCOCET DO I NEED TO HELP
WITH MY BACK PAIN? WHAT WOULD BE
SAFE FOR ME? AND WHAT THEY DON'T
REALIZE IS THAT THAT PERCOCET IS
ACTUALLY LACED WITH A LETHAL
DOSE OF FENTANYL. SO WE'VE WE'VE
RECENTLY DISCOVERED THAT 60% OF
THE COUNTERFEIT PILLS THAT ARE
OUT, IN THE COMMUNITY AROUND
HERE ARE, CONTAIN A POTENTIALLY
LETHAL DOSE OF FENTANYL IF
YOU'RE OPIOID NAIVE. AND TO THE
RIGHT, YOU CAN LOOK AT THE DEA.
I'M SURE THIS IS ANY TIME WE AS
ADULTS FIND OUT ABOUT EMOJIS OR
ANYTHING ONLINE. IT'S ALREADY
OUTDATED. BUT THE DEA PUT OUT A
KIND OF A SET OF EMOJI CODES
THAT TEENS ARE USING ON SOCIAL
MEDIA TO ASK FOR DIFFERENT
SUBSTANCES. SO THIS IS AT LEAST
THE LATEST EVIDENCE THAT WE
HAVE, THOUGH OF COURSE, THIS IS
A FAST CHANGING PHENOMENON. IF
YOU GO TO THE NEXT SLIDE,
BECAUSE THE CURRENT DRUG SUPPLY
IS SO DIFFERENT, WE NEED A
DIFFERENT APPROACH TO EDUCATING
YOUTH ABOUT THE DRUG LANDSCAPE.
SO WHEN I WAS IN HIGH SCHOOL OR
MIDDLE SCHOOL, WE HAD THIS IDEA
OF JUST SAY NO WITH THE DARE
PROGRAM THAT YOU GUYS PROBABLY
KNOW A LOT ABOUT, AND THERE'S
THIS MOVEMENT FOR A NEW DRUG
TALK WITH YOUNG PEOPLE. JUST SAY
NO, K-N-O-W WHEN WE WERE YOUNG,
IT WAS IT WAS KIND OF TOLD TO US
THAT IF WE USE SUBSTANCES, WE
MAY END UP ON THE WRONG PATH AND
THAT WRONG PATH MAY LEAD US TO
ALL SORTS OF THINGS. THE TRUTH
IS, IS THAT IT'S MORE LIKE A
MINEFIELD NOW OUT THERE FOR
YOUNG PEOPLE. THEIR FIRST OR
SECOND STEP OUT CAN BE DEADLY
AND SO, YOU KNOW, YOUNG, YOUNG
ADULTHOOD OR ADOLESCENCE IS A
NORMAL TIME FOR RISK TAKING.
THERE'S ALWAYS BEEN A SUBSET OF
PEOPLE WHO ARE GOING TO
EXPERIMENT WITH SUBSTANCES, BUT
THEY REALLY DO NEED TO
UNDERSTAND THE RISKS THAT THEY
AND THEIR FRIENDS ARE TAKING
THESE DAYS, WHICH IS VERY
DIFFERENT THAN IT USED TO BE.
AND SO OUR EDUCATION SYSTEM
NEEDS TO KIND OF UNDERSTAND THAT
THE CURRENT LANDSCAPE AND NOT TO
SCARE KIDS, BUT TO KIND OF, ARM
THEM WITH INFORMATION SO THAT
THEY CAN MAKE THE BEST DECISIONS
FOR THEMSELVES AND THEIR
FRIENDS. NEXT SLIDE. SO JUST
BRIEFLY, THE YOUNG PEOPLE IN
OPIOID USE DISORDER. SO THESE
OVERDOSE DEATHS THAT WE SEE, WE
DON'T KNOW, THERE'S NO DATA THAT
I'M AWARE OF WHERE WE CAN SPLIT,
HOW MANY OF THESE KIDS ARE
THINKING, OH, I'M JUST TAKING
SOME OTHER SUBSTANCE FOR FUN.
AND IT ACTUALLY HAS A LETHAL
DOSE OF FENTANYL AND THEY DIE.
VERSUS HOW MANY KIDS HAVE OPIOID
USE DISORDER AND THEY DIE.
THERE'S SOME SUBSET OF THE KIDS
THAT ARE DYING BECAUSE THEY
ALREADY HAVE ADDICTION, AND SOME
SUBSET THAT ARE DYING BECAUSE
THEY MEAN TO USE SOMETHING ELSE,
BUT WHEN WE ASK ADULTS AND I
KIND OF EMPHASIZE THIS AT THE
BEGINNING, WHEN DID YOU START
USING WE FIND THAT TWO THIRDS OF
THEM SAY, BEFORE 21 AND ONE
THIRD BEFORE 18. SO THIS IS A
PEDIATRIC DISEASE IN A LOT OF
WAYS THAT WE'RE FAILING TO
TREAT. AND YOUNG PEOPLE BECAUSE
THEY'RE YOUNG PEOPLE, HAVE A
TENDENCY TO RAPIDLY ESCALATE
THEIR OPIOID USE. THEY
UNDERESTIMATE THE RISKS, AND
THEY HAVE A HIGH RISK OF
OVERDOSE AS A CONSEQUENCE. AND
ON THE RIGHT, I HAVE THE THERE'S
THIS DSM MANUAL THAT WE USE IN
MEDICINE TO KIND OF, DIAGNOSE
CERTAIN CONDITIONS I HAVE ON THE
RIGHT HERE, JUST, YOU KNOW, JUST
USING OPIOIDS DOESN'T MAKE YOU
ADDICTED TO OPIOIDS OR HAVE
OPIOID USE DISORDER. YOU HAVE TO
USE IT HAS TO HAVE NEGATIVE
CONSEQUENCES ON YOUR LIFE. YOU
HAVE TO HAVE A, YOU KNOW, GET
TOLERANCE WHERE YOU NEED MORE
AND MORE IN ORDER TO HAVE THE
SAME EFFECTS. AND THEN, YOU
KNOW, YOU HAVE THIS WITHDRAWAL
PHENOMENON. SO I'M NOT GOING TO
BELABOR THIS POINT, BUT I JUST
WANT TO EMPHASIZE THAT JUST
BECAUSE SOMEBODY YOUNG IS USING
SUBSTANCES DOESN'T NECESSARILY
MEAN THEY HAVE AN OPIOID USE
DISORDER, THE NEXT SLIDE IS JUST
WE KIND OF ALREADY TALKED ABOUT
THIS, BUT I LOVE THIS GRAPH.
IT'S ACTUALLY FROM CALIFORNIA
BRIDGE, DOCTOR MULLINS PROGRAM.
AND WHAT IT JUST SHOWS YOU IS
WHY DO WE NEED MEDICATION TO
TREAT OPIOID USE DISORDER. YOU
CAN SEE THAT, YOU KNOW, WHEN
PEOPLE START USING, THEY FEEL
NORMAL AND THEN THEY USE AND
THEY FEEL HIGH OR SOME SENSE OF
EUPHORIA. AND OVER TIME THAT
EUPHORIA KIND OF GOES DOWN AS
YOU LOOK AT THIS SLIDE. THEY'LL
NEED MORE AND MORE SUBSTANCES TO
HAVE THE SAME EFFECT. BUT ONCE
THEY DEVELOP TOLERANCE AND
DEPENDANCE, MANY, MANY PEOPLE
WILL DESCRIBE TO US THAT THEY'RE
NOT USING TO GET HIGH OR FOR
EUPHORIA. THEY'RE USING TO FEEL
NORMAL. THEY DON'T WANT TO BE IN
THIS TERRIBLE STATE OF
WITHDRAWAL. AND SO YOU FIND THAT
YOU FIND THAT THEY'RE JUST USING
TO STAY IN THAT MIDDLE RANGE.
AND WHAT METHADONE AND
BUPRENORPHINE ALLOW THEM TO DO
IS STAY IN THAT NORMAL RANGE.
THEY'RE GOING TO SCHOOL, THEY'RE
HAVING THEY'RE AT THEIR JOB.
THEY'RE WITH THEIR FAMILY AND
FRIENDS, WITHOUT THIS CYCLE OF
WITHDRAWAL USE, WITHDRAWAL USE
AND THE NEXT SLIDE IS JUST AGAIN
EMPHASIZING WHAT THE OTHER
DOCTORS ALREADY SAID, THAT WHEN
WE ACTUALLY STUDY THIS, WE FIND
THAT THESE MEDICATIONS SAVE
LIVES. AND WE'VE TALKED ABOUT
THIS ALREADY, BUT WE WE'RE
UNDERUTILIZING A TOOL THAT'S
LIFE SAVING. NEXT SLIDE PLEASE.
SO WE HAVE A TREATMENT ACCESS
CRISIS. IT'S HARD OUT THERE FOR
ADULTS TO ACCESS TREATMENT. IT
IS NEARLY IMPOSSIBLE FOR
SOMEBODY UNDER 18 TO ACCESS
TREATMENT. WE MET BUPRENORPHINE
IS THE ONLY TREATMENT THAT'S
APPROVED FOR ADOLESCENTS. SO IF
YOU'RE UNDER 18 WE DON'T HAVE
METHADONE APPROVED FOR THAT AGE
GROUP FOR A VARIETY OF REASONS.
BUT A RECENT STUDY SHOWED THAT
LESS THAN 5% OF YOUNG PEOPLE WHO
HAVE OPIOID USE DISORDER HAVE
ANY TIMELY ACCESS TO ANY
TREATMENT, AND THIS HAS TO DO
WITH SO MANY DIFFERENT THINGS
THAT WE'VE ALREADY DISCUSSED
TODAY. AND PART OF THAT IS MY
PROFESSION, PEDIATRICS, OUR
FIELD HAS NOT TOTALLY REALIZED
THIS AND TAKEN THIS ON AS A
PRIORITY, WHICH IS SOMETHING
THAT I THINK NEEDS TO CHANGE
DRAMATICALLY. PART OF THE
CHALLENGE THOUGH, NEXT SLIDE
THAT WE HAVEN'T TALKED TOO MUCH
ABOUT TODAY IS JUST THE
LOGISTICS OF STARTING
BUPRENORPHINE SPECIFICALLY. WE
LIKE EVERYONE'S BEEN SAYING WE
NEED TIMELY ACCESS, BUT IT IS A
LITTLE BIT OF A TRICKY
MEDICATION TO START. IT'S NOT
THE SAME AS STARTING YOUR BLOOD
PRESSURE MEDICINE AND YOU JUST
GET A PRESCRIPTION. ACTUALLY, I
DON'T KNOW MUCH ABOUT BLOOD
PRESSURE. I SHOULDN'T SAY THAT,
BUT I'M A PEDIATRICIAN. BUT IT'S
NOT LIKE STARTING OTHER
MEDICATIONS WHERE YOU JUST KIND
OF GO IN AND THEN YOU START
TAKING IT. YOU HAVE TO THERE'S
MULTIPLE DIFFERENT WAYS TO START
BUPRENORPHINE THAT WE CAN ALL
TALK ABOUT AT LENGTH IF THERE'S
QUESTIONS. BUT, THE MOST COMMON
WAY IS THAT YOU WANT TO START
WHEN SOMEONE'S IN A LITTLE BIT
OF A MILD WITHDRAWAL BEFORE THEY
START. AND WHY THAT, THAT MAKES
IT A CHALLENGE IS THAT YOU
REALLY NEED TO BE ABLE TO CATCH
PEOPLE WHEN THEY'RE, SAFE TO
START TREATMENT BECAUSE IF YOU
START TOO EARLY, YOU CAN
PRECIPITATE A SEVERE AND VERY
UNCOMFORTABLE WITHDRAWAL. BUT IF
YOU START TOO LATE, THEY'RE JUST
GOING TO GO OUT AND USE BECAUSE
IT'S SO UNCOMFORTABLE TO BE IN
WITHDRAWAL. AND SO THAT TIMING,
ESPECIALLY FOR YOUNG PEOPLE, HAS
MADE IT A CHALLENGE TO START IN
THE CLINIC WHERE THEY HAVE A
VERY HARD TIME TIMING THEIR
WITHDRAWAL SYMPTOMS WITH A 10
A.M. APPOINTMENT TIME, AT HOME,
WHERE THEY HAVE ALL THEIR
TRIGGERS AND ALL THEIR ACCESS TO
SUBSTANCES IN THE EMERGENCY
DEPARTMENT HAS BEEN AMAZING. BUT
A LOT OF OUR YOUTH FIND THAT
THEY HAVE TROUBLE, YOU KNOW,
GETTING THERE AT THE RIGHT
MOMENT WHEN THEY'RE READY TO
START TREATMENT. THE EMERGENCY
DEPARTMENTS CAN'T WAIT FOR, YOU
KNOW, 24 HOURS FOR THEM TO
TYPICALLY NOT THEIR THEIR BUSY
PLACES. AND SO WHAT WE FOUND IS
ACTUALLY ADMITTING SOME OF THE
YOUNG FOLKS TO THE HOSPITAL,
WAITING FOR THEM TO BE READY TO
START AND THEN STARTING THEM
THERE IN A CONTROLLED
ENVIRONMENT, HAS FOUND SOME
SUCCESS. AND WE'VE TREATED NOW
ALMOST 100, TEENAGERS AND YOUNG
ADULTS IN MY HOSPITAL AND HAVE
HAD A LOT OF SUCCESS DOING THAT.
I THINK THAT THE YOUNG
POPULATION, I THINK PROBABLY THE
ENTIRE POPULATION, BUT I CAN
ONLY SPEAK TO THE YOUNG
POPULATION SOME SUBSET OF THAT
IS GOING TO NEED SOME TLC THAT A
HOSPITAL AND A PEDIATRIC
ENVIRONMENT CAN GIVE WHEN
THEY'RE INITIATING THIS
TREATMENT. AND THEN WE OF
COURSE, LINK THEM TO OUTPATIENT
CARE, BUT AT THE END OF THE DAY,
WHAT EVERYBODY'S EMPHASIZING
HERE, I CAN'T EMPHASIZE STRONGLY
ENOUGH DIFFERENT PEOPLE ARE
GOING TO NEED TO START IN
DIFFERENT PLACES, AND THERE
SHOULD BE NO WRONG DOOR TO
STARTING TREATMENT IN OUR STATE,
THE NEXT SLIDE. I'M GETTING TO
THE END HERE, BUT I JUST WANTED
TO GRAPHICALLY SHOW YOU GUYS
WHAT THE PROBLEM IS IN YOUTH. I
THINK THIS SLIDE REALLY SHOWS US
THAT IF THE OVERALL PREVALENCE
IN IN YOUNG ADULTS IN OUR IN IN
ADOLESCENTS AND YOUNG ADULTS IN
OUR COUNTRY WHO HAVE OPIOID USE
DISORDER IS ABOUT 1, A VERY
SMALL PORTION OF THOSE ARE BEING
DIAGNOSED. THE BLUE, THE BLUE
PART OF THE GRAPH IS SHOWING THE
PROPORTION OF THIS BEING
DIAGNOSED, EVEN LESS, RECEIVE
ANY TREATMENT, WAY LESS START
MEDICATION, EVEN LESS THAN THAT.
STAY IN TREATMENT AT ONE MONTH
AND THEN EVEN LESS THAN THAT.
STAY IN TREATMENT BY SIX MONTHS.
SO THIS IS THERE'S OPPORTUNITIES
FOR LEGISLATION AT EACH PART OF
THIS GRAPH. AND THEN I WANTED TO
JUST TALK IN THE NEXT SLIDE
BRIEFLY ABOUT HARM REDUCTION. SO
OVERDOSE PREVENTION THIS IS
REALLY BIG. SO WE HAVE, WE, WE
TRY TO, EQUIP ALL OF OUR YOUNG
PEOPLE. AND THIS IS SOMETHING
THAT I THINK HAS A ROLE IN THE
EDUCATION SYSTEM IN, IN HOW TO
PREVENT OVERDOSE. AND SO WE
REMIND THEM NEVER TO USE ALONE.
AND THERE'S ACTUALLY A NATIONAL
HOTLINE NOW THAT YOU CAN CALL,
CALL, USE YOUR SUBSTANCES. AND
IF YOU DON'T RESPOND IN A
CERTAIN AMOUNT OF TIME, THEY'LL
CALL EMS IN. BUT NEVER USING
ALONE, FENTANYL TEST STRIPS,
WHICH ARE USEFUL IN CERTAIN
SITUATIONS AND A LITTLE BIT MORE
COMPLICATED THAN OTHERS. I'M
HAPPY TO TALK MORE ABOUT THAT,
BUT WE'RE TRYING TO GIVE OUR OUR
YOUNG PEOPLE FENTANYL TEST
STRIPS, REMINDING THEM TO START
WITH A SMALL AMOUNT TO WATCH AND
WAIT BEFORE THE NEXT PERSON
USES. NARCAN IS HUGE. HAVE
NALOXONE OR NARCAN READY,
THERE'S BEEN A HUGE EFFORT TO
GET NARCAN INTO ALL, DIFFERENT
PLACES IN OUR COMMUNITY, AND I
THINK THAT'S REALLY USEFUL. AND
THEN, YOU KNOW, REMINDING PEOPLE
TO CALL RIGHT AWAY. NEXT SLIDE.
WE HAD A BIG LEGISLATIVE WIN,
THANK YOU, ASSEMBLY MEMBER
HAYNIE, FOR ALLOWING US. NOW,
ASSEMBLY BILL 816 PASSED LAST
YEAR, ALLOWING US NOW TO TREAT
TEENS THAT ARE 16 AND OLDER WITH
BUPRENORPHINE. AND THEY CAN
CONSENT TO THEIR OWN TREATMENT.
THAT IS, WE ALWAYS, ALWAYS WANT
TO HAVE PARENTS AND FAMILIES
INVOLVED WHEN APPROPRIATE. BUT
IN RARE SITUATIONS, FAMILY
MEMBERS ARE UNABLE TO CONSENT
FOR TREATMENT, AND THAT SHOULD
ABSOLUTELY NOT BE A BARRIER TO
CARE. AND WE'VE ALREADY HAD ON
THE GROUND A LOT OF TEENS THAT
HAVE BEEN ABLE TO ACCESS
TREATMENT BECAUSE OF THIS LAW.
SO THANK YOU FOR THAT. MY LAST
SLIDE JUST HAS SOME POTENTIAL
LEGISLATIVE OPPORTUNITIES, THAT
I THINK COULD BE REALLY USEFUL,
I THINK WE NEED TO DO BETTER
WITH PREVENTION AND EDUCATION,
WE NEED UNIVERSAL SCHOOL BASED
EDUCATION AND RESOURCES TO
PREVENT SUBSTANCE USE AND
OVERDOSE USING SEX EDUCATION AS
A MODEL. EVERY CALIFORNIA MIDDLE
SCHOOLER HAS TO TAKE SEX
EDUCATION IN HIGH SCHOOLER. I
THINK THERE NEEDS TO BE A
SIMILAR APPROACH TO SUBSTANCE
USE AND THE CURRENT DRUG
LANDSCAPE. WE ALSO NEED FUNDS TO
EVALUATE THESE PREVENTION
STRATEGIES AND TO REFORM, TO
INFORM IMPLEMENTATION, AND ALSO
DE IMPLEMENTATION, BECAUSE AS WE
LEARNED THROUGH DARE, SOME OF
THESE PROGRAMS ACTUALLY DO NOT
WORK, SO IT'S IMPORTANT THAT WE
ARE CONSTANTLY ASSESSING IF
WE'RE HAVING AN IMPACT, THE NEXT
SECTION IS JUST ON LOW BARRIER
CARE FOR YOUTH WITH SUBSTANCE
USE AND SUBSTANCE USE DISORDERS.
SO JUST OVERARCHING DOORS AND
YOU KNOW, I, I'M, I'M EXCITED TO
WORK WITH THIS GROUP AND THE AND
THE STATE TO DEVELOP MORE
SPECIFICS AROUND THIS. BUT
OVERARCHING GOALS ARE THERE
SHOULD BE NO WRONG DOOR TO ENTER
CARE. THAT TREATMENT SHOULD BE
AVAILABLE 24 SEVEN. BECAUSE IF
YOU MISS THE WINDOW WHERE
SOMEBODY IS READY TO START, YOU
REALLY. BECAUSE OF THE
WITHDRAWAL PHENOMENON, MANY
PEOPLE WILL THEN USE AND THEN
YOU LOST YOUR OPPORTUNITY. SO
THIS, THIS, THIS TREATMENT
AVAILABLE AT ALL TIMES IS HUGE
FOR SUBSTANCE USE, ESPECIALLY
WITH BUPRENORPHINE TREATMENT AND
THEN INTEGRATION INTO GENERAL
HEALTH SERVICES. SO SOMETHING I
SEE A LOT OF, LEGISLATIVE
EFFORTS GOING TO IS KIND OF MORE
BEDS FOR OPIOID USE DISORDER,
MORE, SPECIFIC PROVIDERS. AND
IT'S VERY NARROWLY FOCUSED ON
OPIOID USE DISORDER. BUT THIS
THIS DISEASE IS PART OF A
HOLISTIC CARE. AND FOLKS NEED IT
NEEDS TO BE INTEGRATED INTO OUR
GENERAL MEDICAL HEALTH SYSTEM
AND NOT JUST SILOED INTO
SPECIALTY CLINICS AND, AND
PROVIDERS, WE NEED AVAILABILITY
OF RESIDENTIAL FACILITIES THAT
OFFER MEDICATION TREATMENT TO
MINORS. VERY FEW OF OUR
RESIDENTIAL BEDS ARE OPEN TO
ANYBODY UNDER 18. AND IT'S A
HUGE BARRIER, I, YOU KNOW, MY
PROGRAM IS TREATING OPIOID
WITHDRAWAL AND TREATMENT
INITIATION IN THE HOSPITAL. AND
I THINK IN THE SPIRIT OF NO
WRONG DOOR, THAT THERE SHOULD BE
HOSPITAL REIMBURSEMENT FOR THAT
ACROSS THE BOARD. AND THEN WE
NEED TO INCENTIVIZE SCREENING,
PREVENTION, HARM REDUCTION AND
EVIDENCE BASED TREATMENT IN THE
OUTPATIENT SETTING, USING ACES
AS A MODEL. YOU GUYS CAME UP
WITH LEGISLATION RECENTLY TO
INCREASE REIMBURSEMENT OF ACES.
AND I'VE JUST WATCHED THE ENTIRE
PEDIATRIC OUTPATIENT COMMUNITY
CHANGE THEIR CLINIC STRUCTURE TO
NOW SCREEN. FOR THAT. WE CAN DO
THE SAME THING FOR OPIOID USE
DISORDER, AND THE VERY LAST
THING I KNOW, I'M TALKING A LOT,
BUT, IS JUST THAT, THIS THIS IS
A LOT OF PEOPLE. A LOT OF TEENS
WILL TELL ME THAT THEY WENT TO
USING SUBSTANCES BECAUSE OF
UNTREATED MENTAL HEALTH
CONDITIONS. AND THERE'S BEEN A
LOT OF WORK INTO IMPROVING OUR
MENTAL HEALTH SYSTEM IN YOUTH.
BUT THAT IS, YOU KNOW,
COMPLETELY RELATED TO OUR
OVERDOSE CRISIS. AND SO
INNOVATIVE SOLUTIONS FOR MENTAL
HEALTH TREATMENT ACCESS IS ALSO,
IN MY OPINION, OPIOID, OPIOID
OVERDOSE AND OPIOID ADDICTION
PREVENTION ACCESS. THANK YOU
GUYS FOR YOUR TIME. THANK YOU,
MISTER CHAIR. AND THANK YOU TO
DOCTORS. VERY INFORMATIVE, AND
VERY HELPFUL IN GIVING US
GREATER CONTEXT AS WELL AS
UNDERSTANDING THAT SOME OF THE
THINGS THAT WE'RE DOING, LIKE AS
REFERRED TO SUMMERHAYS BILL
REDUCING THE AGE OF CONSENT TO
FOR TREATMENT, YOU KNOW, IT'S
CRITICALLY IMPORTANT. OF COURSE.
SUMMER HANEY HAS FURTHER
LEGISLATION THIS YEAR, WHICH I
THINK WILL BE NOT JUST FOR ALL
OF US THAT WILL BE SUPPORTING
HIS EFFORTS, BUT ALSO INFORMING
THE AUTHOR AND OUR STAFFS ON
WHAT IT SHOULD LOOK LIKE. AND
HOW THE LEGISLATION SHOULD MOVE
FORWARD IN A WAY THAT'S
EFFECTIVE, DOCTOR TROPE, THANK
YOU FOR YOUR SERVICE TO VALLEY
MEDICAL CENTER AND VALLEY
MEDICAL CENTER, ONE OF THE, YOU
HAD MENTIONED THAT METHADONE IS
DISALLOWED FOR USE ON MINORS,
THAT A FEDERAL REGULATION. YES.
OKAY GOOD TO KNOW, BECAUSE WE
CAN ALSO WORK WITH OUR FEDERAL
PARTNERS ON, ON, ON EVEN THOUGH,
AS, DOCTOR SUEN INDICATED THAT
THE FEDERAL RULES HAVE BECOME A
MUCH MORE FLEXIBLE THAN THE
CALIFORNIA RULES, IT DOESN'T
MEAN THERE AREN'T SOME THINGS
THAT WE CAN STILL ADVOCATE FOR
AT THE FEDERAL LEVEL WITH OUR
FEDERAL PARTNERS. DOCTOR MULLAN,
YOU HAD MENTIONED, BUPRENORPHINE
IS EASIER, IN THE HOSPITAL
SETTING TO USE. BUT IS THAT
SIMPLY BECAUSE METHADONE IS MUCH
MORE REGULATED? IT IS EASIER TO
CONNECT THAT PERSON TO
OUTPATIENT TREATMENT WITH
BUPRENORPHINE. OKAY. SO WE DO
START METHADONE, BUT THERE ARE,
SWATHS OF THE STATE WHERE
GETTING TO METHADONE IS ALMOST
IMPOSSIBLE. ALSO, IF YOU HAVE
CHALLENGES WITH TRANSPORTATION,
GETTING TO A METHADONE CLINIC
CAN BE IMPOSSIBLE IF YOU HAVE
CHILD CARE. GETTING TO A
METHADONE CLINIC ALMOST EVERY
DAY CAN BE IMPOSSIBLE. SO IT'S
REALLY THAT WE FOCUS ON THAT
LINKAGE TO CARE AND WHAT WILL
WORK FOR PEOPLE. AND MOST OF THE
TIME THAT IS BUPRENORPHINE. AND
SO BUT BUT A LOT OF THAT
DECISION MAKING IS BASED UPON
THE REGULATORY HURDLES THAT
EXIST. YES. ON THE LOGISTICS FOR
THAT INDIVIDUAL. OKAY THANK YOU.
AND THEN, DOCTOR SUEN, I THINK
THIS ACTUALLY GOES TO THAT, IN
TERMS OF, THE FEDERAL
REGULATIONS, YOU KNOW, ALLOWING
FOR GREATER FLEXIBILITY, THE 72
HOUR RULE IN PARTICULAR, BUT
JUST THE ABILITY TO MORE EASILY
HAVE KIND OF TAKE HOME DOSAGE. I
THINK THAT SPEAKS TO THE
PHYSICAL PRESENCE OF METHADONE
CLINICS, HOW CHALLENGING THEY
CAN BE. I REMEMBER, AND THIS WAS
SOME TIME AGO, BUT EVEN BACK
WHEN I WAS A PUBLIC DEFENDER AND
HAVE CLIENTS THAT THE COURT
WOULD TRY TO GET INTO METHADONE
CLINICS, AND HOW CHALLENGING
THAT WOULD BE, BUT DO YOU, WELL,
A COUPLE QUESTIONS. ONE IS,
WOULD YOU SUGGEST JUST THAT
CALIFORNIA MOVED IN A SIMILAR
DIRECTION IN TERMS OF AT HOME
DOSAGE AS WELL AS THE 72 HOUR
RULE, I WOULD, BASED ON THE
EVIDENCE, JUST BECAUSE OF THE
MANY STUDIES THAT HAVE COME OUT
SINCE COVID OF THE PAST FOUR
YEARS. WITH THE ADOPTION OF THE
TAKE HOME FLEXIBILITIES, WE
FOUND REALLY GREAT OUTCOMES OF
TREATMENT RETENTION AND IMPROVED
QUALITY OF CARE WITHOUT THE
FEARED CONSEQUENCES OF OVERDOSE.
AND SO THAT REALLY POINTS US TO
REALLY RETHINK OUR REGULATIONS
AND REALLY THINK ABOUT HOW WE'RE
DELIVERING THIS TREATMENT. AND
THEN ALSO THE 72 HOUR METHADONE
HAS ALREADY BEEN DELIVERED IN
MANY OTHER STATES IN THE UNITED
STATES, INCLUDING MASSACHUSETTS,
COLORADO, CONNECTICUT. AND WE IN
CALIFORNIA ARE INCREDIBLY
JEALOUS THAT WE CAN'T DO THIS.
AND SO WE WOULD REALLY, REALLY
APPRECIATE, YOU KNOW, BEING ABLE
TO PROVIDE CARE THAT ALIGNS WITH
FEDERAL GUIDANCE. I MEAN, THE
COVID, THE PANDEMIC TAUGHT US A
LOT OF THINGS. WE YOU KNOW, THE
SILVER LINING IS I THINK WE
LEARNED A LOT ABOUT HOW WE CAN
DO A LOT OF THINGS BETTER. BUT I
THINK IN THIS CASE, THIS IS THIS
IS REALLY, TRULY ABOUT SAVING
LIVES. AND THE LAST QUESTION TO
YOU OR TO ANY OF THE DOCTORS,
BUT, WHEN IT COMES TO THE USE OF
METHADONE AND I AND I KNOW THIS
AND YOU KNOW, AXEL SPOKE TO IT,
I'VE HAD CLIENTS THAT HAVE BEEN
ON METHADONE TREATMENT FOR MANY,
MANY, MANY, MANY YEARS, IS THERE
A METHOD OR PROCEDURE TO WEAN
FOLKS OFF OF IT, HOW SUCCESSFUL
IS THAT? AND I'M ASSUMING IT'S
PATIENT SPECIFIC. SO YOU CAN,
YOU KNOW, RATHER THAN TALKING
ABOUT INDIVIDUAL KIND OF ON THE
MACRO SCALE, IS THAT SOMETHING
THAT IS KIND OF THAT WE SHOULD
BE CONSIDERING AS PART OF AN
OVERALL PLAN OF ALLOWING ACCESS
TO METHADONE? YEAH. NO, THAT'S A
WONDERFUL QUESTION. I THINK THAT
RIGHT NOW OUR SYSTEM IS JUST SO
LIMITED WITH ACCESS THAT I
APPRECIATE THAT YOU'RE THINKING
ABOUT THE FUTURE OF LIKE, WELL,
WHAT HAPPENS AFTERWARD, AND I
ALSO, YOU KNOW, WHAT THE
EVIDENCE SHOWS IS THAT WHEN
PEOPLE ARE ON THESE MEDICATIONS
FOR ANYWHERE FROM A YEAR TO SIX
MONTHS TO A YEAR, I OFTEN TELL
PATIENTS, GIVE ME A YEAR AND I
WILL. I WILL GIVE YOU YOUR LIFE
BACK. AND SO I OFTEN THINK OF
THAT IN THE SHORT TERME. AND
THEN WHAT HAPPENS ONCE THEIR
LIVES ARE STABILIZED, ONCE THEY
ARE ABLE TO, YOU KNOW, FIND
EMPLOYMENT OR, RECONNECT WITH
FAMILY, THEN WE CAN HAVE THAT
CONVERSATION OF WHAT HAPPENS.
MANY PEOPLE STAY ON IT FOR MANY,
MANY YEARS. SOME PEOPLE TAPER
OFF AND THEY'RE FINE. AND SO
IT'S VERY MUCH INDIVIDUALIZED,
BUT WE YOU KNOW, WHAT THE
EVIDENCE REALLY EMPHASIZES IS
GIVE US A YEAR. GREAT. WELL, I'M
VERY GRATEFUL TO ALL OF YOU. I'M
GOING TO SHORTLY, HEAD BACK TO
MY DISTRICT. SO I APOLOGIZE TO
THE STATE FOLKS IF I DON'T. BUT
YOU KNOW, IT IS STREAMED. I'M
WATCHING. MY STAFF IS WATCHING.
BUT, ALL IN ALL, I'M VERY
GRATEFUL TO ALL OF YOU. FOR
HELPING TO BETTER EDUCATE ALL OF
US AS TO HOW WE CREATE POLICIES,
LIKE IN THE CASE OF SUMMARY BILL
, THAT ACTUALLY HELPS YOU, HELP
YOUR PATIENTS, BECAUSE THAT'S
REALLY WHAT THIS IS ABOUT, IN
TERMS OF THE REGULATORY HURDLES
AND THE RESOURCES THAT ARE
NECESSARY, WHETHER IT'S
RESOURCES THAT GO TO THE
HOSPITALS THAT ARE PROVIDING,
TREATMENT IN THE HOSPITALS, OR
TO MAKE SURE THAT EITHER THERE'S
AT HOME ACCESSIBILITY OR THAT
THE IN CLINIC IN METHADONE
CLINIC EXPERIENCE IS MADE BETTER
AND MORE EFFICIENT AND MORE
RESOURCED SO THAT WE DON'T HAVE
AS MUCH OF THE NEGATIVITY OF
THAT EXPERIENCE SO THAT MORE
PEOPLE STAY ON THEIR TREATMENT.
SO THANK YOU ALL SO MUCH. THANK
YOU, MR. KALRA, MISS ORTEGA,
THANK YOU. CHAIR, THANK YOU.
DOCTORS LAST YEAR, YOU KNOW, I
WAS NEW TO THE LEGISLATURE, AND,
VERY QUICKLY STARTED TO LEARN
MORE AND MORE ABOUT THE FENTANYL
CRISIS. AND THERE WAS A SLIDE
YOU SHOWED EARLIER. I DON'T KNOW
IF IT CAN GO BACK UP, BUT WHERE
WE TALKED ABOUT THE SMALL
AMOUNTS OF DOSAGE THAT CAN KILL,
YOU KNOW, AN INDIVIDUAL. AND
THAT'S WHERE MY INTEREST KIND OF
PEAKED IN TERMS OF NOT JUST AS A
POLICY MAKER, BUT ALSO AS A
PARENT AND SEEING THE RISE OF
OVERDOSE IN YOUNG CHILDREN AND,
MIDDLE SCHOOL, HIGH SCHOOL AND
MANY OF THEM, YOU KNOW, THE
STORIES I WAS HEARING, THEY HAD
NEVER EXPERIMENTED WITH ANY
OTHER DRUG. IT WAS A, YOU KNOW,
IT WAS WHETHER THEY PURCHASED IT
ONLINE OR THEY THOUGHT THEY WERE
GETTING SOMETHING ELSE AND THEN
DIED. THE PARENTS WOULD FIND
THEM DECEASED THE NEXT MORNING.
IT WAS HORRIFYING. I INTRODUCED
A BILL. IT WAS VETOED, BUT IN
THAT PROCESS, I, SPENT A LOT OF
TIME GOING INTO THE HIGH SCHOOLS
AND TALKING TO PARENTS AND
EDUCATING STUDENTS, AND PARENTS
UNDERSTAND ENDING THE FAILURE OF
OTHER, YOU KNOW, YOU KNOW, I
THINK YOU MENTIONED EARLIER, SAY
NO TO, YOU KNOW, DON'T USE DRUGS
TO SAY NO TO DRUGS, SO TRYING TO
FIGURE OUT WAYS TO TALK TO
PARENTS AND TALK TO YOUTH ABOUT
THESE DANGEROUS THINGS THAT WERE
OUT THERE AND UNDERSTANDING THAT
AT SOME POINT OR ANOTHER,
WHETHER THEY KNEW IT OR NOT,
THEY WERE GOING TO BE
INTERACTING WITH SOME OF THESE
AND HOW TO SAVE THEIR LIVES. SO,
MY ENTIRE FOCUS LAST YEAR WAS
ABOUT SAVING LIVES. SO I GUESS
MY QUESTION TO YOU IS HOW DO WE
CONTINUE THAT WORK FROM A POLICY
PERSPECTIVE? YOU HAD ONE BULLET
POINT ABOUT WORKING WITH THE
SCHOOL SYSTEM, YOU KNOW, SO JUST
WANTED TO GET YOUR THOUGHTS
ABOUT HOW DO WE CONTINUE, YOU
KNOW, EDUCATING FOLKS ABOUT
WHAT'S HAPPENING, AND IN A WAY
THAT, AGAIN, GETS TO OUR
ULTIMATE GOAL OF SAVING LIVES,
PARTICULARLY YOUNG LIVES. YEAH.
I THINK I THINK THAT, YOU KNOW,
PART OF THERE'S SO MANY
DIFFERENT INNOVATIVE PROGRAMS
OUT THERE THAT ARE TRYING TO
EDUCATE YOUNG PEOPLE, BUT
THEY'RE PRETTY FRAGMENTED AND
THERE'S NOT LIKE A UNIVERSAL
STATE PROGRAM THAT'S THEN BEING
EVALUATED TO SEE IF IT'S
EFFECTIVE. AND SO I DO THINK
THERE'S AN OPPORTUNITY THERE. I
MEAN, WE HAVE THAT'S WHY I GAVE
THE EXAMPLE OF SEX EDUCATION. I
MEAN, WE HAVE EXAMPLES OF OTHER
PROGRAMS THAT ARE UNIVERSAL,
STATE BASED, EVERY MIDDLE SCHOOL
OR EVERY HIGH SCHOOL STUDENT HAS
TO TAKE THIS CURRICULUM. AND
THEN THAT CURRICULUM IS SORT OF
EVALUATED BY THE STATE AND
UPDATED, AND SO I DO THINK THAT
THERE NEEDS TO BE A UNIVERSAL,
STATE BASED APPROACH TO
EDUCATION. AND I THINK IT SHOULD
BE SCHOOL BASED AND CRITICALLY,
BECAUSE WE DID DO SOMETHING FOR
YEARS AND YEARS THAT WAS FOUND
TO BE INEFFECTIVE IN SOME WAYS
HARMFUL. IT SHOULD BE
CONSISTENTLY EVALUATED FOR
EFFECTIVENESS AND EDITED AS
NEEDED. THE OTHER QUESTION I
HAVE IS, AROUND SOCIAL MEDIA, A
LOT OF THESE, DRUGS ARE BEING,
BOUGHT OR SOUGHT AFTER AND ALL
THESE DIFFERENT SITES. AND SO
I'M WONDERING IF YOU HAVE ANY
DATA OR ANY INFORMATION THAT YOU
COULD SHARE WITH US AROUND SOME
OF THIS INCREASE ACCESS THROUGH
SOCIAL MEDIA TO YOUTH? I DON'T
HAVE ANY DATA, BUT I KNOW THAT
SOME OF OUR LAW ENFORCEMENT
PARTNERS DO. I CAN TELL YOU
EVERY TEENAGER THAT WE SEE AFTER
AN OVERDOSE, THEY GET IT OFF OF
INSTAGRAM, INSTAGRAM OR
SNAPCHAT. I MEAN, IT'S PERVASIVE
, I THINK WE USED TO THINK ABOUT
DRUG DEALERS IN THE PARK, BUT
REALLY THEY ARE ON INSTAGRAM AND
SNAPCHAT. AND SO THAT IS ONE OF
THE CHALLENGES IS THAT BECAUSE
ACCESS HAS BECOME SO PERVASIVE,
BUT ALSO SO ANONYMOUS, SO WE
DON'T SEE IT. SOME OF THE OTHER
STUDIES THAT LOOK AT DANGEROUS
USE IN CHILDREN, AND PART OF THE
NATIONAL SURVEY ON DRUG USE AND
HEALTH FOR PEDIATRIC PATIENTS
SHOWED THAT OVER 30% OF TEENS
WHO ARE USING OPIOIDS ARE USING
THEM ALONE, WHICH IS VERY RISKY.
SO PART OF THAT EDUCATION THAT
YOU TALKED ABOUT COULD BE AROUND
WHEN THESE ARE DANGEROUS. BUT
THE CONCEPT OF HARM REDUCTION
DON'T USE ALONE HAVE ACCESS TO
NARCAN, HOW YOU USE BECAUSE
SMOKING FENTANYL HAS A MUCH
HIGHER RISK BECAUSE A HIGHER
CONCENTRATION. SO WE ALSO WILL
SEE OVERDOSE REYES IN THE ED,
SOMEONE WHO WOULD PREVIOUSLY
INGEST IT NOW SMOKED, AND SO I
THINK THERE'S A LOT THAT WE CAN
DO AROUND EDUCATION ON HARM
REDUCTION. GREAT. THANK YOU VERY
MUCH, YOU KNOW, I'VE, WHY IS
THIS MICROPHONE SO CLOSE? JUST
THIS ONE. I'VE DONE A LOT OF
LEGISLATION ON FENTANYL, AND I
APPRECIATE THE OPPORTUNITY TO BE
ON THIS COMMITTEE, WE'VE WORKED,
I THINK, PRETTY BIPARTISAN
MANNER ON, ON SOME OF THESE
ISSUES. AND I'VE BEEN WILLING TO
, GO OUTSIDE OF MY COMFORT ZONE
ON ON MANY ISSUES TO TRY TO
ADDRESS THIS PARTICULAR CRISIS.
I'VE ALWAYS SAID FOR A LONG TIME
THAT I THOUGHT THAT THIS WAS A
THREE PRONGED APPROACH, I HAD A,
A NEIGHBOR WHO WHO DIED FROM
FENTANYL POISONING. HE WAS A 19
YEAR OLD, YOU KNOW, EAGLE SCOUT
AND, TOOK ONE PILL AND
UNFORTUNATELY PASSED AWAY. AND
THAT WAS MY FIRST EXPOSURE WHEN
I WAS ON THE ROCKLAND CITY
COUNCIL. AND THEN, LATER ON, MY
FAMILY INDICATED TO ME THAT MY
COUSIN, WHO HAD DIED JUST A FEW
MONTHS BEFORE THAT, WHO MAY HAVE
BEEN A DRUG USER, MORE ACTIVE
DRUG USER HAD PASSED AWAY FROM
FENTANYL AS WELL. AND THERE WERE
A LOT OF PROBLEMS, BY THE WAY,
IN TERMS OF, WHEN THIS WAS NOT
IN CALIFORNIA, BUT WHEN
EMERGENCY PERSONNEL ARRIVED TO
THE SCENE AND WHAT LACK OF
ASSISTANCE IN THAT STATE THEY
WERE ABLE TO GIVE THEM. BUT I
GOT ALL SORTS OF THOUGHTS ON MY
THREE PRONGED APPROACH, ONE OF
THEM THAT WE DON'T GET A LOT AS
MUCH LOVE IN THIS BUILDING AS I
THINK WE NEED, AND THAT'S
ACCOUNTABILITY. AND I'M NOT
NECESSARILY TALKING ABOUT FOR
THE USERS PER SE, ALTHOUGH I
THINK THERE'S SOME OF THAT THAT
CAN BE ADDED TO, BUT REALLY TO
THE TRAFFICKING THAT'S COMING
INTO THIS COUNTRY. I MEAN, THE
DEA SAYS IT, PRESIDENT BIDEN
SAYS IT. EVERYBODY SAYS IT. WE
KNOW EXACTLY WHERE THIS IS
COMING FROM, AND WE DON'T DO
ENOUGH TO PREVENT IT FROM COMING
INTO OUR COUNTRY, THE OTHER
THING IS, IN TERMS OF THE
EDUCATION COMPONENT, WHICH IS
VERY IMPORTANT TO ME, I PASSED A
BILL LAST YEAR AND WAS SIGNED BY
THE GOVERNOR THAT WOULD REQUIRE,
WOULD REQUIRE SCHOOLS TO NOTIFY
PARENTS OF THE OF THE DANGERS OF
FENTANYL AND OTHER OPIOIDS. SO
PARENTS NOW ANNUALLY, STARTING
THIS YEAR, WILL RECEIVE A
NOTIFICATION FROM THEIR SCHOOLS
BECAUSE I THINK PARENTS KNOWING
ABOUT THIS HAS BEEN A HUGE
HURDLE TO OVERCOME. EVERY
INDIVIDUAL THAT I'VE KNOWN WHO,
IT'S GETTING A LOT BETTER. BUT
EVERY TIME I'VE MET A PARENT, A
FAMILY OF ONE OF THESE YOUNG
CHILDREN OR YOUNG ADULTS WHO'VE
DIED, THEIR PARENTS HAD NO IDEA
WHAT THIS WAS, WHAT FENTANYL
WAS. NOW, I THINK THINGS ARE
CHANGING RAPIDLY ON THAT, AND I
THINK THAT'S REALLY GOOD. BUT I
WANTED TO COMMENT, BRIEFLY. AND
IF YOU HAVE COMMENTS, I'D LOVE
TO HEAR IT. BUT, I REMEMBER THE
DARE PROGRAM AS WELL, YOU KNOW,
AND I THINK FOR A WHILE IT
BECAME KIND OF LIKE THIS MOCKING
YOU KNOW, IT WAS MOCKED A LOT
FOR, YOU KNOW, JUST SAY NO OR
WHATEVER, AND I LIKE YOUR
REFRAMING. K-N-O-W. BY THE WAY,
OF THAT, OF THAT. BUT, I MEAN, I
THOUGHT IT I DON'T KNOW HOW
EFFECTIVE IT WAS. I MEAN,
THERE'S DATA THAT SORT OF SAYS
LIKE DIFFERENT THINGS ON THAT.
BUT, YOU KNOW, FOR ME, IT IT
CONTINUES, I THINK ABOUT SOME OF
THOSE, ITEMS THAT WE LEARNED,
BUT I STILL BELIEVE THAT THAT
THE, THE MOCKING OF THE DARE
PROGRAM, WHICH, BY THE WAY, I
THINK IS KIND OF COMING BACK,
BUT IT CONTINUES IN THIS
BUILDING TO THIS DAY THAT FOR
SOME REASON, EDUCATING CHILDREN.
THÀNH. AND AGAIN, I'M NOT
TALKING ABOUT ANY OF MY
PARTICULAR COLLEAGUES UP HERE
WHO HAVE BEEN ADVOCATES FOR
ADDRESSING THIS ISSUE. BUT
CONTINUE TO DISMISS EDUCATIONAL
EFFORTS BECAUSE OF THE DARE
PROGRAM. AND HEY, IF WE CREATE
THIS NEW PROGRAM, THEN IS IT
GOING TO BE LIKE, DARE OR
WHATEVER? YOU KNOW, AND THAT'S
REALLY FRUSTRATING TO ME BECAUSE
WE KNOW THAT. I MEAN, YOU'RE
SEEING IT ALL THE TIME WITH THE
YOUTH ARE GETTING ACCESS TO
THIS, AND SOMETIMES IT'S
ACCIDENTAL. THEY DON'T EVEN
KNOW, YOU KNOW, AND THIS WHOLE
EMOJI STUFF AND WHATEVER, YOU'RE
RIGHT. THESE GUYS SORT OF
DEVELOP NEW EMOJIS TO
COMMUNICATE WITH EACH OTHER. SO
ANYWAYS, I DON'T I WOULD LOVE TO
SEE SOLUTIONS OR, RECOMMEND
OPTIONS THAT THE LEGISLATURE
COULD BRING IN ON CREATING SORT
OF A PROGRAM WITHIN SCHOOLS,
EVEN IF IT WAS PRIVATELY FUNDED,
BECAUSE I KNOW MY COUNTY WOULD
PROBABLY WORK ON FUNDING
SOMETHING IN THE SCHOOLS TO
EDUCATE CHILDREN ABOUT THE
DANGERS OF NOT ONLY ACCIDENTAL
FENTANYL USE, BUT IF YOU START
USING DRUGS IN GENERAL. SO IF
YOU HAVE ANY THOUGHTS NOW OR IN
THE FUTURE, I'D LOVE TO KNOW
ABOUT THEM. AND IF YOU EVER
CONTACT MY OFFICE, THERE ARE TWO
PATTERSON'S IN LEGISLATORS. JUST
REMEMBER JOE PATTERSON, THE NEW
AND IMPROVED VERSION. YOU KNOW,
IT'S SUCH AN IMPORTANT POINT.
AND I EVEN IF WE WERE TO YOU
KNOW, I DON'T I'M NOT AN EXPERT
ON THE DARE AND ALL THE
LITERATURE ON DARE, AND I DON'T
EVEN WANT TO GO THERE BECAUSE
EVEN IF WE, YOU KNOW, RIGHT NOW,
WE'RE NOT IN THE DARE ERA. WE'RE
IN A TOTALLY DIFFERENT ERA.
WE'RE IN THE FENTANYL ERA. AND
SO EVEN IF WE WERE, EVEN IF
THERE WAS A HUGE SUCCESS, IT
WOULDN'T APPLY. IT WOULDN'T
APPLY TO OUR CURRENT LANDSCAPE
BECAUSE THE DRUG LANDSCAPE HAS
CHANGED. AND I DO THINK THAT
IT'S CRITICAL THAT THAT YOUNG
PEOPLE AND THEIR PARENTS ARE
JUST ARE AWARE AND ARE, YOU
KNOW, HAVE THE KNOWLEDGE. AND,
WE HAVE WE DO HAVE DATA AND
YOUNG PEOPLE THAT WHEN THEY
REALLY UNDERSTAND, WHEN
ADOLESCENTS REALLY UNDERSTAND
THE RISKS AND WE TREAT THEM LIKE
PEOPLE WHO CAN MAKE DECISIONS
FOR THEMSELVES, AND WE EXPLAIN
TO THEM WHAT, WHAT IS REALLY
GOING ON. AND WHAT THE RISKS ARE
OF THEIR BEHAVIORS IN OTHER IN
OTHER AREAS, LIKE, FOR EXAMPLE,
SEX EDUCATION, WE HAVE DATA THAT
THAT WORKS. AND SO I, YOU KNOW,
I WOULD ADVOCATE FOR ROBUST
PROGRAMING THAT REFLECTS THE
CURRENT DRUG LANDSCAPE THAT IS
CONSTANTLY AND CONTINUOUSLY
EVALUATED FOR EFFICACY AND
CHANGED, AS NEEDED. SO I'M GLAD
YOU SAID THAT BECAUSE, IN I WAS
ACTUALLY THINKING ABOUT,
SOMEBODY GOING TO STEAL MY IDEA,
PROBABLY A DEMOCRAT WILL STEAL
MY IDEA AND RUN IT AS A BILL
NEXT YEAR, BUT, YEAH. YEAH. MR.
HANEY IS TAKING NOTES. MR.
ORTEGA TOO. BUT IN IN MY
NOTIFICATION LEGISLATION, I
MEAN, LOOK, I HAVE FOUR KIDS. I
MEAN, I, I CAN'T EVEN READ
EMAILS FROM THE SCHOOL, YOU
KNOW, I MEAN, BUT I ALWAYS SAID,
HEY, LOOK, IT COSTS $150,000 A
YEAR FOR THE STATE TO IMPLEMENT
THIS PROGRAM STATEWIDE. AND IF
1% OF THE 6 MILLION PEOPLE READ
THAT THING, THAT'S 60,000 PEOPLE
IN CALIFORNIA, RIGHT? SO, SO I
FIGURED, OKAY, YOU KNOW, THIS IS
A VERY LOW COST TO HELP, BUT I
INSTEAD OF SAYING, HEY, LOOK, WE
NEED TO DO, FENTANYL OR OTHER
OPIOIDS NOTIFICATION. I THOUGHT
ABOUT CREATING SOME KIND OF TASK
FORCE OR SOMETHING AT THE
DEPARTMENT OF EDUCATION THAT CAN
SORT OF UPDATE THE KIND OF
NOTIFICATION THAT GOES TO
PARENTS, BECAUSE WHAT WAS
FENTANYL IN 2023 IS QUICKLY
BECOMING TRAGIC. IN 2024. RIGHT?
SO THE RISKS ARE CHANGING. AS
YOU SAY THEY EVOLVE. RIGHT. AND
I THINK OUR STATUTES NEED TO
REFLECT THE EVOLUTION OF DRUG
ABUSE, BECAUSE WHETHER IT'S, 20,
WHETHER IT'S FENTANYL NOW, IT
COULD BE SOMETHING ELSE. AND
NEXT YEAR OR THE YEAR AFTER, I
DO ALSO JUST WANT TO EMPHASIZE
THAT SOMETHING THAT I MENTIONED
AT THE END, WHICH I DO THINK
THAT PART OF PREVENTION FOR
YOUNG PEOPLE IS MENTAL HEALTH
TREATMENT AND ACCESS THAT IS
SEPARATE FROM DRUG USE. WE STILL
HAVE, YOU KNOW, THIS HAS BEEN A
HUGE PROBLEM NATIONWIDE, OVER
THE LAST SEVERAL YEARS. AND WE
STILL HAVE, BARRIERS TO
ACCESSING JUST GENERAL MENTAL
HEALTH SUPPORT, WHETHER THAT BE
PSYCHIATRY OR THERAPY IN YOUNG
PEOPLE, WHETHER THEY'RE PRIVATE
PAYER OR MEDICARE, MEDICAID,
THAT'S STILL A BIG BARRIER. AND
I SEE THEM AS VERY MUCH
INTERRELATED TO PREVENTION OF
SUBSTANCE USE DISORDER, OPIOID
USE DISORDER. MANY OF OUR
PATIENTS SAY THAT THEY HAD
SEVERE ANXIETY OR SEVERE TRAUMA,
AND THEY USE FENTANYL BECAUSE
IT'S EASIER TO GET THAN ACTUALLY
MEDICAL TREATMENT OR COUNSELING.
AND THAT IS PART OF THE
PREVENTION THAT IS PART OF THE
PREVENTION TOOLKIT THAT I THINK
IS CRITICAL. I DO THINK THAT'S A
GOOD IDEA. SO I WON'T STEAL IT.
BUT I WANT TO IF YOU WANT TO
COAUTHOR, WE CAN DO THAT, YOU'VE
GOT PROBABLY TWO UP HERE, WELL,
I APPRECIATE ALL OF YOUR INSIGHT
AND EXPERTISE AND, I HOPE THAT
WE CAN CONTINUE TO WORK
TOGETHER. WE'VE BEEN ABLE TO
COLLABORATE. I KNOW WITH MY
OFFICE ON A NUMBER OF BILLS, AND
I'M SURE THE OTHER FOLKS ON THE
COMMITTEE WOULD WOULD LOVE TO
CONTINUE TO WORK ON A LOT OF
THESE ISSUES. THERE'S FOR A GOOD
REASON, A LOT OF INTEREST IN HOW
WE ADDRESS, YOUTH OVERDOSE AND
YOUTH ADDICTION AND, AND TO BE
ABLE TO SUPPORT YOUNG PEOPLE SO
THAT THEY DON'T GET ON THIS
LONGER AND DEEPER PATH OF, OF
ADDICTION. AND SO I KNOW THAT
THERE'S A LOT OF INTEREST IN HOW
WE ADDRESS THAT, I THINK THAT
THE POINT THAT WAS MADE OR THE
STATEMENT ABOUT HOW WE ARE IN
THE, THE, THE FENTANYL ERA NOW
AND HOW THAT HAS CHANGED
EVERYTHING, I THINK COULD APPLY
TO EVERYTHING THAT WE'RE DOING
AND THAT WE'RE TALKING ABOUT
HERE, WHEN YOU HAVE A DRUG LIKE
THIS THAT IN SUCH A TINY AMOUNT
CAN KILL SOMEBODY, IT IS SO
ADDICTIVE AND ADDICTIVE IN WAYS
THAT CAUSE WITHDRAWALS THAT LEAD
TO CERTAIN BEHAVIORS AND A NEED
TO CONSTANTLY ACCESS THAT DRUG,
AND I THINK IT DOES CHANGE
THINGS ON ON ALL OF THESE
FRONTS. IT CERTAINLY CHANGES
THINGS ON HOW WE THINK ABOUT
ENFORCING IT AND ACCOUNTABILITY
AND THE LAW ENFORCEMENT SIDE OF
THINGS, I THINK IT CHANGES
THINGS. ON PREVENTION AND, AND
HOW WE TALK ABOUT EDUCATION, IT
CHANGES THINGS ON ON HARM
REDUCTION AND WHAT OUR
RESPONSIBILITY IS THERE AND WHAT
NEEDS TO BE ACCESSIBLE. AND IT
ALSO ABSOLUTELY CHANGES THINGS.
ON WHAT THE MAIN FOCUS OF OUR
HEARING IS TODAY, WHICH IS ON
TREATMENT. EVERYBODY WHO COMES
INTO THE EMERGENCY ROOM, WHO IS
DIAGNOSED IN ANY WAY WITH A
SUBSTANCE USE DISORDER, HAS TO
BE ENROLLED IN TREATMENT, HAS TO
IMMEDIATELY HAVE ACCESS TO
MEDICATION ASSISTED TREATMENT,
NOT YOU HAVE TO GO TO THIS
CLINIC THAT IS, YOU KNOW, 100
MILES AWAY AND YOU CAN ONLY GET
THERE AT A CERTAIN TIME WHEN WE
KNOW THAT THAT'S NOT EVEN THE
RIGHT TIME TO BE ENROLLED IN A
TREATMENT, THERE ARE SO MANY
THINGS ABOUT THE WAY WE APPROACH
TREATMENT. WE MAKE IT. WE PUT UP
ALL OF THESE BARRIERS. IT'S
ALMOST. I MEAN, IF YOU COULD
DESIGN. I'M NOT. I'M I'M NOT
SURE YOU COULD DESIGN A WORSE
SYSTEM. IF THE GOAL IS TO GET
PEOPLE ONTO TREATMENT AND KEEP
THEM ON TREATMENT, ALL OF THE
BARRIERS AND ROADBLOCKS AND
HURDLES THAT THEY HAVE TO GO
THROUGH WHEN THEY CAN JUST WALK
OUT ONTO THE STREET OR GO ONLINE
AND FOR A TINY AMOUNT OF MONEY,
GET ACCESS TO THIS DRUG THAT
THEIR BODY IS TELLING THEM THEY
NEED. AND SO WHAT WE EXPECT OF
PEOPLE TO BE ABLE TO OVERCOME
THAT IS ENTIRELY UNREALISTIC.
AND AS A RESULT, WE HAVE WHAT WE
HAVE. WE HAVE AN OPIOID
EPIDEMIC. WE HAVE A SUBSTANCE
USE DISORDER CHALLENGE, OVERDOSE
, EPIDEMIC THAT IS GETTING WORSE
AND WORSE AND WORSE AND WORSE
AND SO WE HAVE TO CHANGE THESE
LAWS RIGHT NOW IMMEDIATELY. AND
SO I I'M, I KNOW WE HAVE THIS
BILL THIS YEAR, BUT THERE ARE
CLEARLY A LOT OF OTHER EFFORTS
THAT WE NEED TO TAKE. I'M TAKING
NOTE OF THE MOBILE METHADONE.
MOBILE METHADONE IS HOW, AS I
NOTED, MANY OTHER COUNTRIES.
THAT'S HOW THEY DELIVER ACCESS
TO METHADONE. YOU DON'T HAVE TO
GO 100 MILES AWAY OR LONGER AND
WAIT EVERY DAY. THEY ACTUALLY
BRING IT TO WHERE YOU ARE,
THAT'S ULTIMATELY WHERE WE'RE
GOING TO NEED TO GET AS WELL. IF
WE'RE GOING TO GET PEOPLE OFF OF
THIS DRUG THAT IS KILLING SO
MANY OF OUR CONSTITUENTS AND
RESIDENTS, AND, AND, AND ALSO
REALLY IMPACTING COMMUNITIES
BROADLY. I MEAN, YOU CAN GO
THERE'S DOWN TO DOWNTOWN
SACRAMENTO AND WALK ON THE WAY
AFTER THIS. WHEN I WALKED TO MY
HOTEL TO GET MY BAG, I'M GOING
TO SEE ALL OF THE VISIBLE
IMPACTS OF THE OF THE FAILURES
OF THESE POLICIES THAT WE HAVE
HERE. AND SO I WANT TO
APPRECIATE ALL OF YOU FOR YOUR
EXPERTISE, FOR YOUR COMMITMENT,
FOR YOUR SERVICE, AND FOR YOUR
PARTNERSHIP WITH US, BECAUSE YOU
TRULY ARE ADVOCATING FOR YOUR
PATIENTS AND SEEING FIRSTHAND
HOW LAWS THAT HAVE BEEN MADE IN
THIS BUILDING AND IN DC HAVE
TRAGICALLY CONTRIBUTED TO THE
CRISIS WE'RE FACING. THANK YOU
FOR YOUR TIME. I APPRECIATE IT.
THANK YOU SO MUCH FOR JOINING
US. AND, I'M SURE WE'LL WE'LL
CONTINUE TO BE IN TOUCH AND IN
PARTNERSHIP WITH YOU ALL. THANK
YOU. ALL RIGHT. WE WERE GOING TO
BRING UP OUR LAST PANEL HERE AND
THANK THEM FOR THEIR THEIR
PATIENCE. IT'S, OUR THIRD PANEL
IS ON THE STATE EFFORTS BY THE
DEPARTMENT OF HEALTH CARE
SERVICES, AND WE HAVE, TYLER
SADWITH FROM WHO IS THE STATE
MEDICAID DIRECTOR, AND, PAULA
WILHELM, WHO IS THE ASSISTANT
DEPUTY DIRECTOR OF BEHAVIORAL
HEALTH AT DCS. WELCOME. AND
THANK YOU SO MUCH. THANK YOU.
AND GOOD AFTERNOON. MY NAME IS
TYLER SADWITH, AND I SERVE AS
THE STATE MEDICAID DIRECTOR FOR
THE DEPARTMENT OF HEALTH CARE
SERVICES. THANK YOU TO ASSEMBLY
MEMBER HAYNIE AND THE SELECT
COMMITTEE FOR THE OPPORTUNITY TO
PARTICIPATE IN THIS HEARING,
BEFORE I BEGIN, I JUST WANT TO
SAY THANK YOU TO BIXEL FOR
SHARING YOUR EXPERIENCE AND TO
THE OTHER PANELISTS. MY FAMILY
HAS BEEN IMPACTED BY, OPIOID
ADDICTION AND, LONG TERME
RECOVERY FROM OPIOID USE
DISORDER. SO THIS ISSUE HAS
PERSONAL SIGNIFICANCE TO ME,
REDUCING OVERDOSE DEATHS AND
EXPANDING ACCESS TO EVIDENCE
BASED INTERVENTIONS IS A TOP
PRIORITY FOR THE DEPARTMENT OF
HEALTH CARE SERVICES, AS THE
DEPARTMENT IS TAKING SIGNIFICANT
STEPS TO EXPAND PREVENTION,
TREATMENT, RECOVERY AND OVERDOSE
REVERSAL RESOURCES IN A VARIETY
OF HEALTH CARE AND COMMUNITY
BASED SETTINGS. OUR EMPHASIS HAS
BEEN ON DEPLOYING RESOURCES TO
THE COMMUNITIES THAT HAVE BEEN
HIT HARDEST BY THE OPIOID
EPIDEMIC AND DEVELOPING
INITIATIVES THAT MEET PEOPLE
WHERE THEY ARE. ON PARTNERING
WITH TRUSTED MESSENGERS AND ON
STRATEGICALLY INVESTING. GRANT
FUNDING IN CAPACITY DEVELOPMENT,
CLINICAL PRACTICE, TRANSFER
ACTION AND EVIDENCE BASED
PROGRAMS THAT CAN BE SUSTAINED
AND SUPPORTED THROUGH MEDI-CAL.
THE DEPARTMENT IS FUNDING
INVESTMENTS, STRENGTHENING AND
REFORMING POLICIES, AND
PROVIDING TECHNICAL ASSISTANCE
TO EXPAND ACCESS TO MEDICATIONS
FOR ADDICTION TREATMENT, TO
DISTRIBUTE NALOXONE ACROSS THE
STATE AND AT SCALE. TO CULTIVATE
A WELL-TRAINED AND DIVERSE
WORKFORCE. TO EXPAND
INFRASTRUCTURE TO CLOSE GAPS
ACROSS THE ENTIRE CONTINUUM OF
CARE. TO SUPPORT HARM REDUCTION,
PEER SERVICES AND HOUSING, AND
TO TACKLE STIGMA WHICH WE KNOW
CAN PREVENT PEOPLE FROM REACHING
OUT FOR HELP. SOME CALIFORNIANS
EXPERIENCE CHALLENGES WHEN THEY
SEEK TREATMENT. MAJOR BARRIERS
INCLUDE GAPS IN ACCESS TO KEY
LEVELS OF CARE, INCLUDING
CLINICALLY INTENSIVE OUTPATIENT
TREATMENT AND RESIDENTIAL
TREATMENT FOR POPULATIONS SUCH
AS ADOLESCENTS AND CLOSING THESE
GAPS IS MADE EVEN MORE
CHALLENGING BY THE ACUTE
BEHAVIORAL HEALTH WORKFORCE
SHORTAGE THAT WE'RE EXPERIENCING
IN CALIFORNIA. OTHER GAPS
INCLUDE A LONG STANDING BARRIER
IS A SPECIALTY ADDICTION
TREATMENT SYSTEM THAT HAS
HISTORICALLY NOT EMBRACED
MEDICATIONS AND HISTORICALLY HAS
EXPECTED PATIENTS TO BE READY
FOR FULL ABSTINENCE ON DAY ONE.
WHEN WE KNOW ADDICTION IS
RECURRENT AND CHRONIC, AND NOT
ALL INDIVIDUALS ARE AT THE SAME
STAGE OF READINESS TO CHANGE.
AND A FINAL BARRIER IS A LACK OF
HEALTH CARE SETTINGS THAT ARE
WILLING TO ENGAGE THIS
VULNERABLE POPULATION. THE
DEPARTMENT WORKS IN CLOSE
PARTNERSHIP WITH STATE AND
COUNTY AGENCIES. THE SUBSTANCE
USE DISORDER TREATMENT PROVIDER,
COMMUNITY HOSPITALS, JAILS,
TRIBAL PARTNERS, PRIMARY CARE
AND HARM REDUCTION
ORGANIZATIONS. TO TACKLE THESE
BARRIERS AND TO EXPAND ACCESS TO
EVIDENCE BASED INTERVENTIONS IN
EVERY SETTING AND IN EVERY
SERVICE SYSTEM. JUST AS A BRIEF
SNAPSHOT THAT PAULA WILHELM WILL
WILL WALK THROUGH AND FURTHER
DETAIL THE CALIFORNIA OPIOID
RESPONSE PROJECT HAS ACCELERATED
THE IMPLEMENTATION OF
MEDICATIONS FOR ADDICTION
TREATMENT IN FEDERALLY QUALIFIED
HEALTH CARE SETTINGS, JAILS,
EMERGENCY DEPARTMENTS, TRIBAL
AND URBAN INDIAN HEALTH CARE
SETTINGS, AND COMMUNITIES
THROUGH CULTURALLY CENTERED
EDUCATION AND COMMUNITY
AWARENESS APPROACHES. IT HAS
LAUNCHED CAMPAIGNS TO ENGAGE
YOUTH AND TO EDUCATE THEM ABOUT
THE DANGERS OF THE PRESENCE OF
FENTANYL AND FAKE PILLS, AND IT
HAS DISTRIBUTED NEARLY 4 MILLION
KITS OF NALOXONE, RESULTING IN
OVER 247,000 REPORTED OVERDOSE
REVERSALS. THIS PROJECT HAS
SUPPORTED SOME OF THE
INITIATIVES AND EFFORTS THAT
WERE SHARED TODAY, INCLUDING THE
CALIFORNIA BRIDGE PROGRAM AND
SONG FOR CHARLIE, WHICH WAS THE
YOUTH EDUCATION APPROACH. OUR
CROSS-SECTOR PARTNERSHIP IS
GUIDED BY THREE KEY PRINCIPLES
OPIOID USE DISORDER IS A
PREVENTABLE AND TREATABLE
MEDICAL CONDITION. MEDICATIONS
FOR OPIOID TREATMENT ARE
EVIDENCE BASED AND EFFECTIVE,
AND LONG TERME RECOVERY IS
POSSIBLE. AND WITH THAT, I WILL
TURN IT OVER TO PAULA WILHELM,
INTERIM DEPUTY DIRECTOR FOR
BEHAVIORAL HEALTH, TO PROVIDE
ADDITIONAL DETAIL. THANK YOU,
TYLER, AND I THINK I CAN SAY
GOOD AFTERNOON. AT THIS POINT,
THANK YOU ALL AGAIN FOR
CONVENING THE HEARING AND
INVITING DCS TO TALK ABOUT SOME
OF OUR WORK, I WANTED TO SHARE
JUST A FEW HIGHLIGHTS FROM DCS
EFFORTS TO ADVANCE HARM
REDUCTION AND PREVENT OVERDOSE
DEATHS TO MAXIMIZE THE
EFFECTIVENESS OF OUR DRUG
MEDI-CAL ORGANIZED DELIVERY
SYSTEM TO IMPROVE ACCESS TO
MEDICATIONS FOR ADDICTION
TREATMENT OR MAT, AND TO INVEST
IN NEW WORKFORCE DEVELOPMENT,
TREATMENT, AND RECOVERY PROGRAMS
, WE'VE TALKED A LOT TODAY ABOUT
THE IMPORTANCE OF HAVING
NALOXONE AVAILABLE TO REVERSE
OVERDOSES. AND THE COMMITTEE
MEMBERS MAY BE AWARE THAT
THROUGH OUR NALOXONE
DISTRIBUTION PROJECT, DCS
PROVIDES FREE NALOXONE TO
COMMUNITY ORGANIZATIONS AND
ENTITIES. TO DATE, THE PROJECT
HAS DISTRIBUTED MORE THAN 3.9
MILLION UNITS OF NALOXONE TO
MORE THAN 3900 UNIQUE
ORGANIZATIONS, AND THOSE
ORGANIZATIONS HAVE REPORTED
USING THIS TO REVERSE MORE THAN
247,000 OVERDOSES AND TO FURTHER
PROMOTE PATIENT CENTERED CARE
AND REDUCE BARRIERS TO
TREATMENT, DCS IS PROVIDING
TECHNICAL ASSISTANCE TO
TREATMENT PROVIDERS TO HELP THEM
INCORPORATE HARM REDUCTION
PHILOSOPHIES INTO THEIR PROGRAMS
. THE DEPARTMENT IS COMMISSIONED
THE AMERICAN SOCIETY FOR
ADDICTION MEDICINE TO DEVELOP
FORMAL CLINICAL GUIDANCE ON THIS
TOPIC, AND WE'VE BEEN CONVENING
HARM REDUCTION SUMMITS TO
FACILITATE DIALOG AND CATALYZE
CHANGE ACROSS THE STATE. IN
COMBINATION WITH THESE HARM
REDUCTION AND OVERDOSE
PREVENTION STRATEGIES, WE HAVE
AN ONGOING FOCUS ON EXPANDING
TREATMENT OPTIONS AND RESOURCES.
SO SINCE 2017, DCS AND
CALIFORNIA COUNTIES HAVE BEEN
IMPLEMENTING EXPANDED SUBSTANCE
USE DISORDER TREATMENT SERVICES
IN MEDI-CAL VIA THE DRUG
MEDI-CAL ORGANIZED DELIVERY
SYSTEM, OR DMC ÓRDENES. TODAY,
97% OF OUR MEDI-CAL MEMBERS
RESIDE IN PARTICIPATING COUNTIES
AND ARE ABLE TO ACCESS EXPANDED
SERVICES UNDER THE DMC ÓRDENES
CALIFORNIA HAS ALSO BECOME THE
FIRST STATE IN THE NATION TO
RECEIVE FEDERAL APPROVAL FOR
COVERAGE OF CONTINGENCY
MANAGEMENT IN MEDICAID. AS PART
OF OUR CHALUM WAIVER,
CONTINGENCY MANAGEMENT IS THE
ONLY EVIDENCE BASED TREATMENT
FOR INDIVIDUALS WITH STIMULANT
USE DISORDER. THIS INTERVENTION
IS A CRITICAL STRATEGY TO
ADDRESS INCREASING RATES OF
OVERDOSES THAT INVOLVE
STIMULANTS AND TO DATE, 74% OF
OUR MEDI-CAL POPULATION LIVES IN
A COUNTY THAT HAS AT LEAST ONE
MEDI-CAL CONTINGENCY MANAGEMENT
PROVIDER. CHALUM ALSO INCLUDES A
FIRST IN THE NATION APPROVAL TO
COVER A TARGETED SET OF
PRERELEASE SERVICES, INCLUDING
MAT UNDER MEDI-CAL FOR
INDIVIDUALS WHO ARE PREPARING TO
REENTER THE COMMUNITY FROM
PRISON, JAIL, OR A YOUTH
CORRECTIONAL FACILITY. BECAUSE
AS THESE INDIVIDUALS REENTERING
FROM CORRECTIONAL SETTINGS
SETTINGS ARE OVER 100 TIMES MORE
LIKELY TO DIE FROM AN OVERDOSE
COMPARED TO THE GENERAL
POPULATION, WE KNOW THAT
OFFERING MEDI-CAL COVERED
SERVICES DURING THIS TIME AND
MAKING THOSE WARM LINKAGES AND
CONNECTIONS TO COMMUNITY BASED
TREATMENT IS AN INCREDIBLY
POWERFUL OPPORTUNITY. DCS IS
ALSO FOCUSED ON STRENGTHENING
ACCESS TO MAT MORE BROADLY, AND
AS OUR PHYSICIAN PANEL
EXPLAINED, MAT IS THE STANDARD
OF CARE FOR TREATING OPIOID USE
DISORDER AND HAS BEEN SHOWN TO
IMPROVE QUALITY OF LIFE, REDUCE
SUBSTANCE MISUSE, LOWER
EMERGENCY DEPARTMENT AND
HOSPITALIZATION COSTS, AND
REDUCE OVERDOSE DEATHS. SO ALL
OF OUR PROVIDERS IN THE DMC
ÓRDENES ARE REQUIRED TO OFFER
MAT DIRECTLY OR HAVE AN
EFFECTIVE REFERRAL MECHANISM FOR
MEDI-CAL MEMBERS WHO NEED MAT.
WE ARE ALSO IMPLEMENTING SENATE
BILL 184, CHAPTER 47, STATUTES
OF 2022, AND THIS LEGISLATION
REQUIRES ALL LICENSED AND
CERTIFIED SUBSTANCE USE DISORDER
PROVIDERS TO ALSO MEET THAT
STANDARD FOR OFFERING MAT
DIRECTLY OR HAVING A REFERRAL
MECHANISM, AND TO HAVE A
COMPREHENSIVE MAT POLICY THAT
ENSURES EVERY SINGLE PATIENT WHO
NEEDS IT RECEIVES AN EVIDENCE
BASED ASSESSMENT FOR MAT IS
EDUCATED AND INFORMED ABOUT THE
BENEFITS AND RISKS OF MAT AND IS
ABLE TO RECEIVE ALL FORMS OF MAT
. DCS ALSO CONTINUES TO PROMOTE
AND EXPAND ACCESS TO NARCOTIC
TREATMENT PROGRAM SERVICES. WE
RECENTLY RELEASED GUIDANCE THAT
WILL ENABLE THE OPERATION OF
MOBILE NARCOTIC TREATMENT
PROGRAMS AND WILL HELP FUND
START UP COSTS FOR MOBILE
PROGRAMS. FINALLY, WE CONTINUE
TO ADMINISTER UNPRECEDENTED
STATE AND FEDERAL INVESTMENTS IN
OPIOID RESPONSE. SINCE 2017, DCS
HAS ALLOCATED APPROXIMATELY $1.5
BILLION IN FEDERAL, STATE AND
OPIOID SETTLEMENT FUNDS TO
IMPLEMENT PREVENTION, HARM
REDUCTION, TREATMENT, AND
RECOVERY SERVICES THROUGH GRANT
PROGRAMS. THE BULK OF THIS
FUNDING IS ADMINISTERED THROUGH
OUR CALIFORNIA OPIOID RESPONSE
PROJECT, FORMERLY KNOWN AS THE
MAT EXPANSION PROJECT, AND I'LL
SHARE JUST A COUPLE OF SUCCESSES
FROM THE OPIOID RESPONSE
PROJECT. BUT THERE IS A GREAT
WEBSITE WITH A LOT OF RESOURCES
TO SHOW WHERE THESE DOLLARS ARE
GOING. SO AS OF MARCH 2024,
43,124 INDIVIDUALS HAVE RECEIVED
MAT WHILE INCARCERATED IN COUNTY
JAILS IN 41 COUNTIES THAT
PARTICIPATED IN A LEARNING
COLLABORATIVE FOCUSED ON JAIL
MAT ACCESS AND FUNDED THROUGH
OUR OPIOID RESPONSE PROJECT. WE
TALKED ABOUT THE CALIFORNIA
BRIDGE PROGRAM ON THE PREVIOUS
PANEL THAT IS ALSO PART OF THE
CALIFORNIA OPIOID RESPONSE
PROJECT, LOCATES NAVIGATORS AND
HOSPITAL EMERGENCY DEPARTMENTS
TO FACILITATE MAT ACCESS AND
COORDINATE, FOLLOW UP COMMUNITY
BASED CARE. CALIFORNIA BRIDGE
ENGAGED 276 EMERGENCY
DEPARTMENTS, OR OVER 80% OF THE
EMERGENCY DEPARTMENTS IN THE
STATE, AND BECAME THE SINGLE
GREATEST SOURCE OF NEW MAT
INITIATIONS BETWEEN 2020 AND
2022. JUST A NOTE ON EXPANDING
TREATMENT PROGRAMS MORE BROADLY,
WE HAVE ALSO AWARDED 225 GRANTS
THROUGH THE BEHAVIORAL HEALTH
CONTINUUM INFRASTRUCTURE
PROGRAM. THIS IS TO EXPAND
BEHAVIORAL HEALTH TREATMENT
INFRASTRUCTURE IN SETTINGS THAT
SERVE MEDI-CAL BENEFICIARIES. SO
THIS IS 1.7 BILLION IN FUNDING
THAT WILL UNDERWRITE 129
OUTPATIENT AND 94 NEW
RESIDENTIAL BEHAVIORAL HEALTH
FACILITIES FOR MENTAL HEALTH
SUBSTANCE USE TREATMENT, OR
BOTH. FINALLY, DCS IS TAKING
STEPS TO ADDRESS THE STATEWIDE
SHORTAGE OF QUALIFIED BEHAVIORAL
HEALTH PROVIDERS, ONE WORKFORCE
INITIATIVE WE'D LIKE TO
HIGHLIGHT IS PART OF OUR
CALIFORNIA BEHAVIORAL HEALTH
COMMUNITY BASED ORGANIZED
NETWORKS OF EQUITABLE CARE AND
TREATMENT DEMONSTRATION, WHICH
WE REFERRED TO AS CONNECT. AND
WE ARE REQUESTING EXPENDITURE
AUTHORITY FOR 2.4 BILLION FROM
OUR COLLEAGUES AT THE CENTERS
FOR MEDICARE AND MEDICAID
SERVICES OVER THE COURSE OF THE
FIVE YEAR DEMONSTRATION TO
INVEST IN THE BEHAVIORAL HEALTH
WORKFORCE. THIS REQUEST WAS
SUBMITTED LAST OCTOBER AND
PENDING FEDERAL APPROVAL, AND
SHOULD ENABLE CALIFORNIA TO
LEVERAGE FEDERAL FUNDING TO
EXPAND THE NUMBER AND EXPERTISE
DIVERSITY AND CULTURAL
COMPETENCY OF OUR BEHAVIORAL
HEALTH WORKFORCE. SERVING
MEDI-CAL MEMBERS. SO I WILL
CLOSE HERE AND NOTE THAT DHS
REMAINS DEEPLY COMMITTED TO
CONTINUING TO PARTNER WITH ALL
OF OUR STAKEHOLDERS AND THE
LEGISLATURE TO IMPROVE OUR
POLICIES, PROVIDE TECHNICAL
ASSISTANCE, AND MAKE FUNDS
AVAILABLE TO CLOSE GAPS IN
ACCESS. AND WE WANT TO ENSURE
ALL CALIFORNIANS CAN GET THE
HELP THEY NEED WITH SUBSTANCE
USE. WE REALLY APPRECIATE THE
OPPORTUNITY TO PARTICIPATE IN
THE DISCUSSION TODAY, AND WE'RE
HAPPY TO SHARE MORE INFORMATION
OR ANSWER QUESTIONS. THANK YOU.
THANK YOU. I APPRECIATE, BOTH
YOUR WORK AND YOUR PRESENTATION
AND YOUR PATIENCE, FOR BEING
HERE WITH US, ONE OF THE I
WANTED TO ASK A QUESTION ABOUT
ACCESS. I KNOW YOU MENTIONED
THAT, SOME OF THE WORK IS
LOOKING AT, HOW TO EXPAND ACCESS
IN CERTAIN PARTS OF THE STATE.
IT'S ACTUALLY NOT SOMETHING THAT
REALLY IS A SAN FRANCISCO,
QUESTION IN TERMS OF THE MY
FOCUS HERE, BUT I KNOW THAT
THERE ARE PARTS OF THE STATE
WHERE THERE REALLY IS NOT A
WHOLE LOT OF ACCESS TO CLINICS,
PARTICULARLY A METHADONE CLINIC
THAT MAY BE VERY FAR FROM WHERE
PEOPLE ARE AND LIVE. AND
CONSIDERING THE REGULATIONS, IT
JUST IS NOT FEASIBLE AT ALL FOR
THEM TO BE ABLE TO TRAVEL THOSE
DISTANCES, IS THAT SO? BOTH ON
THE QUESTION OF HOW YOU ALL
THINK ABOUT THAT IN TERMS OF
PARTS OF OUR STATE WHERE THERE
REALLY ISN'T ANY ACCESS AND HOW
WE'RE TRYING TO ADDRESS THAT,
AND THEN I KNOW THERE WAS A
POINT, MADE ABOUT HOW SOME OF
THE FEDERAL REGULATIONS MAY BE
MAY ALLOW FOR SOME MOBILE
METHADONE. PROGRAMING. IS THAT
SOMETHING THAT WE ARE LOOKING
AT? DO YOU THINK THAT'S
SOMETHING THAT WE SHOULD
CONSIDER OR HOW OR DO YOU AND DO
YOU THINK THAT THE REGULATIONS
ALLOW FOR THAT? IS THAT YOUR
UNDERSTANDING? YEAH. THANK YOU
FOR THE QUESTION, THERE ARE,
POCKETS AND ENTIRE REGIONS OF
CALIFORNIA THAT DO NOT HAVE
ACCESS TO ALL THREE FORMS OF
MEDICATION THAT ARE APPROVED FOR
OPIOID USE DISORDER TREATMENT,
IN PARTICULAR METHADONE. GIVEN
SOME OF THE FEDERALLY MANDATED
AND STATE MANDATED REGULATIONS
REGARDING THE PROVISION OF
METHADONE, THE, SORT OF PHYSICAL
LOGISTICAL REQUIREMENTS, IN THE
REGULATORY FRAMEWORK, TO DATE,
THERE ARE A FEW, SORT OF
FLEXIBLE CITIES THAT ARE
AVAILABLE TODAY. ONE IS
MEDICATION UNITS. THIS IS
PERMISSIBLE IN FEDERAL
REGULATION AND IN STATE
REGULATION. THIS ALLOWS FOR,
SORT OF LOCAL HEALTH CARE
FACILITIES TO SERVE AS A
DISPENSING LOCATION FOR NPS, SO
THIS WOULD ALLOW, SAY, YOU KNOW,
FEDERALLY QUALIFIED HEALTH
CENTER, PRIMARY CARE CLINIC, OR
A SUBSTANCE USE DISORDER
PROVIDER LOCATED IN A REGION TO
BE DISPENSING, METHADONE AS PART
OF THE FORMAL NPS ORGANIZED
VERSION, EVEN IF THAT PNP IS
LOCATED ELSEWHERE. WE HAVE
ISSUED GUIDANCE ON THIS AND HAVE
PROVIDED GRANT FUNDING AND
TECHNICAL ASSISTANCE TO NPS AND
TO THE PROVIDER COMMUNITY IN THE
STATE TO SUPPORT THE UPTAKE OF
THIS. I THINK WE JUST ISSUED AN
OPPORTUNITY FOR FUNDING FOR
$400,000 START UP COSTS TO
SUPPORT THE UPTAKE OF MEDICATION
UNITS, SEPARATE AND DISTINCT
FROM MEDICATION UNITS ARE MOBILE
N N TREATMENT PROGRAMS. THIS, WE
ARE HAPPY THAT OUR FEDERAL
PARTNERS RECENTLY ISSUED
GUIDANCE TO PERMIT THIS. THIS
HAD BEEN, SORT OF FROZEN IN TIME
FOR FAR TOO LONG, THE FEDERAL
GOVERNMENT WAS NOT APPROVING NEW
APPLICATIONS FOR MOBILE NP
UNITS, THOSE FEDERAL REGULATIONS
WERE RECENTLY UPDATED. AND
EARLIER THIS YEAR, WE ISSUED
GUIDANCE THAT WOULD SUPPORT NPS
TO IMPLEMENT MOBILE NP UNITS.
WE'VE BEEN PROVIDING TECHNICAL
ASSISTANCE AND GRANT FUNDING TO
SUPPORT NPS TO DO THIS,
INCLUDING A GRANT OPPORTUNITY
PROGRAM THAT WOULD PROVIDE, I
BELIEVE, $1 MILLION PER
APPLICATION TO SUPPORT THIS. AND
WHEN YOU SAY, NPS, THAT WOULD BE
WOULD INCLUDE METHADONE. OH, I
APOLOGIZE FOR NOT BEING CLEAR.
YES. SO IN CALIFORNIA, METHOD
METHADONE CLINICS ARE, REFERRED
TO IN STATUTE AND REGULATIONS AS
NARCOTIC TREATMENT PROGRAMS OR
NP. SO I APOLOGIZE FOR THE
MISCUE MEDICATION. YOU'RE YOU'RE
A YOU'RE AN EXPERT ON THIS. SO
I, I'M I APPRECIATE THAT. AND I
JUST WANT TO MAKE SURE I
UNDERSTAND THE TERMINOLOGY. AND
THAT'S THAT'S GREAT TO HEAR. AND
THANK THANK YOU FOR THAT UPDATE
AND THAT WORK AND I'D IMAGINE
WE'RE ALSO LOOKING AT, BEYOND
THE MOBILE UNITS WHERE IN THE
STATE WE CAN EXPAND ACCESS AND
BE MORE INTENTIONAL AND
DELIBERATE ABOUT THAT.
ABSOLUTELY. SO, PAULA REFERRED
TO THE BEHAVIORAL HEALTH
CONTINUUM INFRASTRUCTURE PROGRAM
, WHICH PROVIDES AN OPPORTUNITY
FOR BRICK AND MORTAR PHYSICAL
INFRASTRUCTURE TO BE DEVELOPED
ACROSS THE BEHAVIORAL HEALTH
CONTINUUM. AND SO NARCOTIC
TREATMENT PROGRAMS HAVE BEEN A
KEY PART OF THAT. AND, LOOKING
REALLY AT ACROSS, GEOGRAPHY AND
DEMOGRAPHY, WHAT ARE SORT OF THE
EQUITY GAPS IN THE Kò ACCESS
ISSUES THAT CAN BE SUPPORTED
THROUGH THAT PROGRAM? THANK YOU
FOR BEING HERE. AND ALL THAT YOU
ARE DOING IN THIS AREA, YOU
KNOW, I HAD A QUESTION, SO, SO
MY BILL LAST YEAR AROUND,
ACCESSING OR HAVING ACCESS TO
NALOXONE, WAS VETOED IN PART
BECAUSE I KNOW THAT YOUR
DEPARTMENT AND THE GOVERNOR'S
OFFICE HAS BEEN REALLY WORKING
REALLY HARD TO MAKE SURE THAT
MORE AND MORE PEOPLE HAVE ACCESS
TO THIS LIFE SAVING, MEDICATION.
AND LAST, I THINK IT WAS EARLIER
THIS YEAR, THERE WAS A STATEMENT
PUT OUT THAT MORE, WE WERE ON
TRACK TO HAVE OUR OWN, NALOXONE
PRODUCED BY THE STATE. SO WHERE
ARE WE ON THAT TIMELINE? AND
WHAT IS THE DISTRIBUTION PLAN
FOR THAT? THAT'S A GREAT
QUESTION. I WOULD, POLITELY
DEFER TO MY COLLEAGUES AT THE
CALIFORNIA HEALTH AND HUMAN
SERVICES AGENCY TO PROVIDE, THE
MOST RECENT AND UPDATED
INFORMATION ON THAT EFFORT.
THAT'S NOT SOMETHING THE
DEPARTMENT IS, SORT OF TASKED
WITH LEADING OUT AT THIS POINT,
BUT ARE YOU IN COMMUNICATIONS
WITH THEM? BUT YOU GUYS, YOU
DON'T KNOW, PARTICULARLY WHEN
THAT WE ARE WE ARE SUPPORTING
THAT EFFORT WITH THE GOAL OF
EXPANDING, NALOXONE AND
ACHIEVING SORT OF THE BEST,
EFFICIENCY FOR OUR PURCHASING
DOLLARS, SO WE ARE WE ARE
SUPPORTING THAT EFFORT. OKAY,
THE OTHER QUESTION I HAD WAS
AROUND YOU MENTIONED THE
EDUCATION EFFORTS THROUGHOUT THE
STATE WHEN IT COMES TO YOUTH.
CAN YOU TALK A LITTLE BIT MORE
ABOUT WHAT IT IS THAT YOU GUYS
ARE DOING AND IS IT WORKING AND
WHAT ADDITIONAL SUPPORT CAN WE
AS A LEGISLATURE GIVE YOU, TO,
TO REACH AS MANY YOUTH AS WE
POSSIBLY CAN AROUND THIS ISSUE?
YEAH. THAT'S A IT'S A GREAT
QUESTION. I THINK IN PARTICULAR,
GIVEN THE, THE REALITY THAT
WE'RE LIVING IN, THAT THE LAST
PANEL PROVIDED WHERE YOUTH ARE
PURCHASING COUNTERFEIT AND
ILLICITLY MANUFACTURED XANAX OR
PERCOCET OFF INSTAGRAM OR
SNAPCHAT, AND IT'S LACED WITH
FENTANYL AND THEY'RE THEY'RE
DYING AND THEY DON'T EVEN KNOW
IT. SO WE HAVE BEEN, INVESTING
IN A FEW, TARGETED OPPORTUNITIES
TO EXPAND PREVENTION, EDUCATION
AWARENESS, PEER MENTORSHIP, AND
SERVICES TO YOUTH, ONE EXAMPLE
IS SONG FOR CHARLIE, WHICH WAS
HIGHLIGHTED IN THE PREVIOUS
PANEL. AND THAT IS THAT IS
REALLY DEDICATED TO, TO,
PROMOTING AND RAISING AWARENESS
ABOUT THE PRESENCE OF FENTANYL
IN, YOU KNOW, THEY CAN BE CALLED
FENTANYL PILLS OR ILLICITLY
MANUFACTURED PILLS. THAT IS A
COMMON ROUTE FOR, ADOLESCENT AND
YOUTH TO BE EXPOSED TO FENTANYL,
SO THAT THAT IS SOMETHING THAT
THAT WE ARE ACTIVELY SUPPORTING,
I'D BE HAPPY TO PROVIDE MORE
INFORMATION ABOUT THE OTHER SORT
OF YOUTH SPECIFIC PROGRAMING
THAT WE ARE PROVIDING, THROUGH
OUR CALIFORNIA OPIOID RESPONSE
PROJECT. WELL, AGAIN, MAYBE I
REPHRASE THIS. YOU KNOW, WE
TALKED ABOUT A LOT MORE NEEDS TO
BE DONE. SO I'M ACTUALLY
WONDERING, DO WE HAVE ANY DATA,
ANY ANECDOTES, ANYTHING THAT
LEADS US TO GIVES ME SOMETHING
OR WHAT ARE THE RESULTS? IS THIS
EDUCATION WORKING? IF NOT, WHAT
DO WE NEED TO DO MORE OF? AND
AGAIN, HOW CAN THE LEGISLATURE
HELP? THAT'S A HELPFUL QUESTION,
I'D BE HAPPY TO FOLLOW UP AND
PROVIDE THE DATA ON THE
EFFECTIVENESS OF THESE PROGRAMS.
I APOLOGIZE, I DON'T HAVE THEM
WITH ME OFFHAND, I WOULD I WOULD
WANT TO HIGHLIGHT ONE SORT OF
EVIDENCE BASED INTERVENTION THAT
WE ARE IMPLEMENTING FOR YOUTH IN
PARTICULAR IN SCHOOL BASED
SETTINGS, WHICH THE LAST PANEL
RAISED THROUGH THE CHILDREN AND
YOUTH BEHAVIORAL HEALTH
INITIATIVE. WE ARE PARTNERING
WITH KEY STAKEHOLDERS, INCLUDING
SCHOOL DISTRICTS, MEDI-CAL
MANAGED CARE PLANS, AND
COMMERCIAL PAYERS TO IMPLEMENT A
STATEWIDE SCHOOL LINKED FEE
SCHEDULE SO THAT ALL CHILDREN
ARE ABLE TO RECEIVE A UNIVERSAL
SET OF MENTAL HEALTH SERVICES IN
SCHOOLS AND THAT ALL PAYERS,
REGARDLESS OF PAYER SOURCE,
WHETHER THAT CHILD HAS HEALTH
CARE COVERAGE THROUGH MEDI-CAL
OR COVERED UNDER A COMMERCIAL
PLAN. THE PLAN WOULD PAY FOR
THOSE SERVICES THAT ARE
DELIVERED IN A SCHOOL SETTING
ACCORDING TO A SET REIMBURSEMENT
RATE AND THAT, SCHOOL LINKED FEE
SCHEDULE DOES INCLUDE SCREENING,
ASSESSMENT, AND BRIEF
INTERVENTION FOR SUBSTANCE USE
DISORDERS SO THAT IS REALLY A
KEY EVIDENCE BASED INTERVENTION
THAT IS BEING IMPLEMENTED
STATEWIDE IN THE SCHOOL SETTING.
THANK YOU. AND, AGAIN, WE
APPRECIATE YOUR TIME AND YOUR
WORK. AND I ALSO FROM SOME OF
THE THINGS THAT HAVE COME UP
HERE, I THINK I HAVE SOME IDEAS
FOR TOPICS ON ON FUTURE HEARINGS
AS WELL. I THINK WE DO HAVE A
LOT OF INTEREST IN SOME OF THE
WORK AROUND EDUCATION AND
PREVENTION AND YOUTH AS AS WAS
BROUGHT UP. AND I KNOW THAT WE
ARE ALL COMMITTED TO CONTINUING
TO SUPPORT THE WORK OF EXPANDING
ACCESS TO MEDICATION ASSISTED
TREATMENT, AS WE'VE HEARD, THERE
ARE STILL FAR TOO MANY BARRIERS
AND ROADBLOCKS FOR PEOPLE TO GET
INTO THIS TYPE OF TREATMENT,
WHETHER THAT'S BECAUSE OF WHERE
THE CLINICS ARE, THE
REQUIREMENTS AND REGULATIONS OF
THE STEPS THAT THEY HAVE TO TAKE
TO STAY ENROLLED OR GET ENROLLED
. AND, I THINK WE'RE GOING TO
TRY TO DO WHATEVER WE CAN ON THE
POLICY SIDE TO SUPPORT YOUR WORK
AND FUND YOUR WORK SO THAT WE
CAN, GET MORE PEOPLE INTO
TREATMENT THAT CAN SAVE THEIR
LIVES, THAT CAN GET THEM MORE
PERMANENTLY AWAY FROM THESE
DEADLY DRUGS THAT WE KNOW THAT
ARE TAKING TOO MANY LIVES IN OUR
IN OUR STATE. I WANT TO THANK
YOU FOR BEING HERE AND THANK YOU
FOR YOUR TIME. THANK YOU. THANK
YOU. ALL RIGHT, LAST BUT NOT
LEAST, I DON'T KNOW IF THERE ARE
MEMBERS OF THE PUBLIC WHO ARE
HERE, WHO WOULD LIKE TO PROVIDE
ANY PUBLIC COMMENT, BUT, IF SO,
PLEASE COME UP TO THE MIC AND,
EACH WITNESS, IF YOU CAN STATE
YOUR NAME, ORGANIZATION AND A
BRIEF STATEMENT ON THE ISSUE.
THANK YOU. YES. THANK YOU. CHAIR
GOOD AFTERNOON. MY NAME IS TRENT
MURPHY. I'M HERE REPRESENTING
THE CALIFORNIA ASSOCIATION OF
ALCOHOL AND DRUG PROGRAM
EXECUTIVES, OUR MEMBERS MAKE UP
THE BULK OF THE PUBLICLY FUNDED
SUBSTANCE USE DISORDER TREATMENT
NETWORK FOR THE STATE OF
CALIFORNIA, OPIOID TREATMENT
PROGRAMS HAVE LONG BEEN
HISTORICALLY STIGMATIZED AND
SILOED FROM THE REST OF THE
HEALTH CARE SYSTEM. DESPITE
PROVIDING EFFECTIVE TREATMENT
AND SAVING COUNTLESS LIVES, WE
INVITE EACH OF THE MEMBERS OF
THE COMMITTEE AND ALSO LOOK
FORWARD TO CONTINUING TO WORK
WITH STAKEHOLDERS IN THIS SPACE
TO HELP DESTIGMATIZE, MATT, AND
WE ALSO THANK THIS COMMITTEE FOR
TAKING AN IMPORTANT FIRST STEP
WITH THIS HEARING AND HELPING
DESTIGMATIZE. MATT, THANK YOU,
THANK YOU, THANK YOU FOR BEING
HERE. GOOD AFTERNOON. LISA
GARDNER WITH THE COUNTY
BEHAVIORAL HEALTH DIRECTORS
ASSOCIATION. WE REPRESENT THE
LEADERS OF THE PUBLIC BEHAVIORAL
HEALTH SAFETY NET IN 58 COUNTIES
AND TWO CITIES. WE REALLY
APPRECIATE THE FOCUS OF THIS
HEARING, WE'RE PROUD SUPPORTERS
OF AB 2150 TÍNH TO EXPAND ACCESS
TO METHADONE AND WANTED TO
REITERATE OUR COMMITMENT TO
INCREASING ACCESS TO LOW BARRIER
MAT AT ALL, AT ALL LEVELS OF
CARE, AND WE BELIEVE THAT ANY
EFFORTS THAT, THAT PURSUE
CONTINUING ACCESS TO THESE TO
LOW BARRIER MAT SHOULD INCLUDE
ALL LEVELS OF CARE, INCLUDING
OUR DRUG MEDI-CAL SYSTEM. THANK
YOU VERY MUCH. THANK YOU.
APPRECIATE IT. GOOD AFTERNOON.
I'M JENNIFER ALI. I'M WITH THE
CALIFORNIA OPIOID MAINTENANCE
PROVIDER, GROUP. ENCOMPASS
ADVOCATED FOR ACCESS TO HIGH
QUALITY EVIDENCE BASED MAT FOR
MORE THAN 30 YEARS, AND WE'RE
GLAD TO SEE OTHERS EMBRACING MAT
SO WIDELY, CALIFORNIA ACTUALLY
HAS ONE OF THE MOST ROBUST
NETWORKS, BUT UNFORTUNATELY,
THERE ARE SOME AREAS IN THE
STATE WHERE THEY DO LACK ACCESS,
AND, AND WE REALLY WANT TO
CONTINUE, YOU KNOW, THE LONG
PARTNERSHIP BETWEEN THE
REGULATORY BODIES, AND, AND,
EXPANSION WITH VARIOUS GRANT
OPPORTUNITIES THAT OUR MEMBERS
HAVE BEEN ENGAGED WITH, STILL,
YOU KNOW, WE FULLY ACKNOWLEDGE
WE NEED TO DO BETTER IN SOME
RURAL AREAS, AND THAT WILL BE
POSSIBLE, WE THINK, WITH THE NEW
FEDERAL REGULATIONS THAT HAVE
ALREADY BEEN DISCUSSED TODAY,
AND WE'RE ALWAYS EAGER TO BE A
RESOURCE TO THE LEGISLATURE
SHOWING OUT OUTCOME DATA OF THE
EFFICIENCY OF OUR SERVICES AND
HAPPY TO HOST TOURS AND SHOW
POLICY MAKERS, INCLUDING
YOURSELF, ANYONE ELSE? THE GREAT
WORK THAT, CONNECT US WITH OUR
MEMBERSHIP AND OUR PATIENTS. SO
THANK YOU VERY MUCH. THANK YOU.
AND THANK YOU TO ALL OF THE
PROVIDERS AND STAKEHOLDERS WHO
ARE HERE. I KNOW THAT THERE IS A
WIDE AND SHARED COMMITMENT TO
EXPAND ACCESS TO MAT, IT'S SORT
OF AWKWARD FOR ME TO CALL IT MAT
AS A MAT MYSELF, BUT I KNOW
THAT'S THAT'S THE TERME, AND,
JUST JUST GRATEFUL FOR EVERYBODY
COMING TOGETHER TODAY. YOU HAVE
MY FULL COMMITMENT TO CONTINUE
TO WORK ON THIS, TO SUPPORT ALL
OF THE EFFORTS AND, AND
OPPORTUNITIES THAT COME FOR US
TO MAKE SURE THAT WE CAN GET
MORE PEOPLE INTO THIS TYPE OF
CARE, WHICH IS EVIDENCE BASED,
WHICH IS PROVEN AND WHICH IS
SCIENTIFIC. AND NOW WE NEED OUR
POLICY AND OUR POLICY MAKERS TO
CATCH UP TO MAKE SURE THAT IT'S
ACTUALLY AVAILABLE TO PEOPLE
WHERE IT'S NEEDED AND EVERYWHERE
THAT'S NEEDED. SO WITH THAT,
THANK YOU FOR YOUR TIME TODAY ON
BEHALF OF MY COLLEAGUES WHO I
KNOW ARE FOLLOWING THIS AND THE
FOLKS WHO ARE GOING TO CONTINUE
TO WORK ON THIS IN THIS
BUILDING, WE APPRECIATE YOUR
PARTNERSHIP. THANK YOU.
MEETING'S ADJOURNED.