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San Diego County Supervisors Vote To Expand Addiction Treatment Services

Philadelphia officials cleared the way for a safe injection site for drug users. But there are many details to work out before the idea can become reality.
Matt Rourke AP
Philadelphia officials cleared the way for a safe injection site for drug users. But there are many details to work out before the idea can become reality.
San Diego County Supervisors Vote To Expand Addiction Treatment Services
San Diego County Supervisors Vote To Expand Addiction Treatment Services GUEST:Alfredo Aguirre, director, San Diego County Behavioral Health Services

>>> I am Maureen Cavanaugh . The top story on midday addition, officials have announced a big influx of cash any change in direction for drug addiction treatment program is. The combination of Medi-Cal funds, County dollars in federal grants will triple the amount of money allocated for drug treatment. That is increasing treatment options >> The change comes at a crucial time for San Diego as alcohol-related deaths are on the rise. Joining me is the director of behavioral health services for the San Diego County Health and Human Services agency. Also welcome to the program. >> It is great to be here. >> We have heard it diction and deaths are rising. What is the scope of the problem in San Diego County? >> It is significant. What makes it more challenging is the number of methamphetamine deaths that could exceed the opioids, heroin, when you provide opioids, when you combine those, it is dramatic. It is increasing. The timing is right to initiate this important initiative, to increase our capacity to serve people with addictions and build a system of care for those individuals. >> The amount San Diego will spend on treatment programs jobs from 54 million to 179 million. How did this funding become available and why did San Diego decide to opt in? That we had the option under the Drug Medi-Cal Organized Delivery System waiver which is between California and the federal government, counties. They have the option to join this and 40 counties have some lust increasing funding by providing a continuum of services. They are reimbursed by the federal government. What is interesting is that San Diego goes beyond what is required in terms of terms and conditions. We are ensuring that those individuals that are low income and do not have to have Medi-Cal, they have access to the same continuum. If someone needs residential treatment beyond the federal government is willing to pay, we are invested. When we look at the data on what works, sometimes three or more months of treatment will not do the trick. You need more time for recovery to really sink in the you can get someone moving forward. >> What is this for? Is that primary low income people? What about the jail diversion programs for people who are brought it on charges and who also have addiction problems? >> This will be a specialty drug and alcohol service for people on Medi-Cal. In addition to that, we are serving lower income individuals that do not have health plan. It is to the point of them leaving the justice system and for jail, 60% of the individuals currently that we serve our justice involved. Again, we are working closely with the courts and public safety to ensure there are transitions to care from custody. The other thing is a more elaborative assessment to determine what is the right level of care. Of course, it is required that we provide access to care under the terms and conditions. We are about no wait times. The work is cut out for the county to be ready. >> The county is taking a big leap away from programs that rely on abstinence. What medical help people be able to get now to help with addiction? But we still value the social model which is in place. It has been the hallmark of recovery programs. What we're doing is, we are merging clinical aspects to the program. It is going to be a hybrid of the social model with a clinical/medical model. We will provide the opportunity for individuals if they choose to access medications for treatment. More specifically, opioid treatment programs. The providers understand it is important that they work within this broader system and we have more tools in the toolkit. Again, depending on the needs on the individuals, they may seek those services. >> In addition to twelve-step programs and treatments of those kinds come up person might have the option for prescribed medications? >> Yes. Like with any other illness, we want to make sure we are employing the available medicines that are showing that it works. You know, to reduce the cravings, particular with opioid addiction. By introducing medicine, it is Mac -- an option. We are giving people the opportunity to achieve recovery. >> This begins to go into effect in July. You say it will take years to build out. Why is that? >> We want to stay on track with what is the evidence-based practices. That evolves in terms of what really works in terms of addressing addiction. We realize there are programs designed for individuals in the justice system. We have a commitment with the public safety and behavioral health and human services who work towards developing those programs. They may not be available on July 1st. We are committed to developing that. We have people in the emergency rooms that are revolving door individuals. They are challenged with addiction. We recognized we need to bring services to the emergency room. One thing we are looking at is working with recovery centers. It will not be there in July but we are just making sure the centers are ready to meet the terms and conditions of the programs. We do want to develop the programs that will help give people access from the emergency room and evidence-based models that work for people that perhaps have tendencies that have been in the jail system. We want to address the unique needs of those populations. >> I have been speaking with Alfredo Aguirre, the director of behavioral health services for Sandy to Canty. Thank you very much for your time. >> Thank you for your interest.

The Board of Supervisors voted unanimously Tuesday to ramp up the addiction treatment program for the county's most vulnerable populations by expanding its network of providers, increasing available services and opening those services to more people.

The county will now begin rolling out a Drug Medi-Cal Organized Delivery System, a state program that aims to provide a "continuum of care" for low-income residents facing addiction. The program, modeled after national evidence-based standards, is designed to address the systemic damage addiction inflicts on individuals, their families and their communities.

RELATED: Opioid Crisis Gripping More Addicts Before Adulthood


The plan will increase the county Behavioral Health Services addiction budget from $54.6 million to $179.6 million. The majority of that increase will be funded by Medi-Cal. The low-income health insurance provider currently funds 5.5 percent of the county's addiction treatment budget. Under this new program, which begins July 1, it will fund 42.6 percent — or $76.5 million — of the total amount, according to county health officials.

Other funding comes from county dollars and a federal grant.

The move comes amid a rise in deaths attributed to addiction, which is closely linked to other mental illnesses and homelessness, county officials said.

The additional funding will expand the county's existing provider network of case managers, counselors and residential recovery facilities and will expand capacity by 30 percent.

"With more tools in the toolbox and better connections between providers, this means clients will experience more effective services and a better chance at recovery," said Alfredo Aguirre of the county Health and Human Services Agency.


County officials said the program is a dramatic overhaul of the way addiction is treated in San Diego County. It will be the first time that medication-assisted addiction treatment, such as the use of methadone, will be employed by the county, for example.

That point caused concern from Supervisors Kristin Gaspar and Dianne Jacob, who warned that such programs must be closely monitored and treatments finely tuned for each individual.

RELATED: Understanding The Opioid Epidemic

The program also calls for increased coordination between the justice and mental health systems, where those taken into custody will be evaluated for addiction and the results forwarded to a judge, who can consider whether to send that person to treatment.

San Diego County District Attorney Summer Stephan said her office has assigned someone as a full-time mental health and drug coordinator to assist with ensuring those who should be in treatment can gain access to it.

"San Diego is about to become a leader today in the state, and I would be so bold as to say across the entire country," said Gaspar, the board chairwoman. "It's significant."

Contra Costa, Los Angeles, Riverside and San Francisco counties are among those that have launched similar programs.