The Opioid Crisis in Ventura County

One in five County teens has abused prescription drugs. Over 50% of teens get them for free from friends and family. Seventy-three percent of County residents surveyed indicated that prescription drugs, for non-prescribed purposes, are “fairly easy” or “very easy” for teens to obtain. (Ref-01, Ref- 02)

The number of opioid deaths in 2013 was reported as 78 prescription drug deaths and 30 heroin deaths for a total of 108 opioid-related deaths. A report published in August 2017 by the Ventura County Rx Abuse & Heroin Workgroup stated the group’s primary goal was to “decrease fatal opioid overdoses by 50% in the County from the 2013 baseline of reported opioid overdoses.” (Ref-01, Ref-02)

The same report stated that the majority of overdose deaths from all causes [alcohol, marijuana, heroin, and prescription drugs] between 2008 and 2014 involved either heroin or prescription drugs. (Ref-01, Ref-02) 2 Opioid Abuse in Ventura County

The Prevention Services subprogram has the smallest budget, at $2.4 million. The Narcotics Treatment subprogram has the largest budget, at $7.1 million in 2017-2018. (Ref-03)

The Narcotics Treatment Program has no assigned County staff. Services are delivered entirely by contractors who are primarily for-profit entities. (Ref-03)

VCBH collects and submits patient outcome data to two State-level organizations: • The California Department of Health Care Services for billing and audit information pertaining to Medi-Cal reimbursements to County contractors • The California Outcomes Measurement System, a data collection system used in all 58 counties containing patient treatment outcome data

The County has an internal data collection system named AVATAR. This system stores the electronic medical records of all VCBH patients including: • Days in hospital and/or jail • Types and times of service • Levels of impairment at the time of intake compared to levels at the time of release

The Grand Jury discovered most documents describing opioid-related deaths used inconsistent terms. The reports used different definitions of the term “opioids,” some referred to prescription drugs only, some to heroin only, and some to both. (Ref-01, Ref-02) Conclusions C-01. The Grand Jury concluded opioid-related deaths and opioid abuse in general are growing problems in the County. (FA-01, FA-02, FA-03) C-02. The Grand Jury concluded ADP allocates a disproportionate amount of budget resources to treatment programs, as opposed to prevention programs. Prevention program efforts primarily focus on marijuana and alcohol abuse, with minimal attention to opioid abuse. (FA-04) C-03. The Grand Jury concluded the Narcotics Treatment subprogram is overly reliant on contracts with for-profit entities, two of which account for 61% of all ADP contract expenditures. For-profit entities generally have fewer cost-control incentives. (FA-05) C-04. The Grand Jury concluded the use of several different reporting systems results in confusing and inconsistent data that does not present a clear representation of program successes or areas needing improvement. (FA-06, FA-07) Opioid Abuse in Ventura County 3 C-05. The Grand Jury concluded that reports of deaths due to opioid abuse do not consistently use a standard definition of what is considered to be an opioid. (FA-08) Recommendations R-01. The Grand Jury recommends VCBH consider re-allocating existing resources to opioid abuse prevention programs. (C-01, C-02) R-02. The Grand Jury recommends that VCBH include significantly more information about the danger of opioid abuse in its prevention programs. (C-02) R-03. The Grand Jury recommends that VCBH evaluate whether County staff or non-profit entities could provide more cost-effective treatment programs than for-profit entities. (C-03) R-04. The Grand Jury recommends that VCBH standardize the reporting of outcomes of opioid abuse prevention and treatment programs to more accurately measure the success and efficiency of service delivery. (C-04) R-05. The Grand Jury recommends that VCBH and County partners agree upon a standard definition of opioids when reporting the number of deaths resulting from opioid abuse. (C-05) Responses Responses Required From: Ventura County Board of Supervisors, (C-01, C-02, C-03, C-04, C-05, R-01, R-02, R-03, R-04, R-05) Responses Requested From: Ventura County Behavioral Health, Department of Ventura County Health Care Agency, (C-01, C-02, C-03, C-04, C-05, R-01, R-02, R-03, R-04, R-05) References Ref-01. Ventura County Rx Abuse & Heroin Workgroup. Reducing Supply, Saving Lives, Reducing Demand, Issue 2 August 2017. http://venturacountylimits.org/resource_documents/Reducing-Rx- Saving-Lives-FNL.pdf Accessed April 17, 2018 Ref-02. Hunnicutt, K. L. (2017). Overdose deaths in Ventura County: 2008- 2014. Oxnard, CA: Ventura County Behavioral Health, Rx Drug & Heroin Workgroup http://venturacountylimits.org/resource_documents/Drug-Related- Deaths-Issue-Briefing-FNL.pdf Accessed April 17, 2018 4 Opioid Abuse in Ventura County Ref-03. County of Ventura, County Executive Office. Fiscal Year 2017-18 Adopted Budget. https://vcportal.ventura.org/CEO/docs/publications/FY2017- 18_Adopted_Budget.pdf Accessed April 17, 2018 Ref-04. Reynolds, Dean. CBS News. CDC: Opioid Overdoses Kill Almost 5 People Every Hour in the U.S. March 6, 2018. https://www.cbsnews.com/news/report-finds-opioid-overdoses-up-30- percent-in-45-states/ Accessed April 17, 2018 Glossary TERM DEFINITION ADP Alcohol and Drug Prevention Program BOS Ventura County Board of Supervisors CDC Centers for Disease Control and Prevention County County of Ventura Grand Jury The 2017-2018 Ventura County Grand Jury VCBH Ventura County Behavioral Health Opioid Abuse in Ventura County 5