Ventura County-Contracted Narcotic Treatment Programs

The Aegis and Western Pacific clinics are contractually required to provide detailed reports of services provided and outcome data to VCBH. However, VCBH does not make any of this information available to the general public. (Ref-01)

For the past several years VCBH has contracted with Aegis and Western Pacific to provide narcotic treatment and counseling services in the County. The contract requires VCBH to “…conduct at minimum an annual review of the facility, policies, and documentation of compliance, conduct a survey of clients and staff, tour the grounds, and address any concerns or issues found.” (Ref-01)

An internal audit by VCBH conducted of Aegis and Western Pacific records from February 4, 2013, through August 22, 2018, showed consistent problems with documentation. Most notably, at one of the clinics, more than half of 100 reviewed files revealed that methadone dosage was not charted as required.

The Aegis website states that “80% of our patients are drug free within 90 days.” It also states that “88% of our patients stop using illicit opioids within 90 days.” These two statements are conflicting. They are also incompatible with VCBH’s stated aim, which is not to cure, but to “treat” or stabilize NTP patients so they can be healthy and productive members of society. (Ref-02)

A Harvard School of Medicine expert, among other researchers, has drawn parallels between “opioid use disorder” and type 2 diabetes, i.e., both requiring lifelong management. (Ref-03)

The Grand Jury interviewed law-enforcement and city-government officials. It was learned that incidents involving people loitering, trespassing, passing out, and drug dealing occurred in the immediate vicinity of some of the clinics. VCBH acknowledged that illicit drug use might occur outside some clinics but had no knowledge of any of these incidents involving clinic patients. VCBH stated that of the five NTP clinics, only the Aegis clinic in Oxnard maintains security personnel on site. Ventura County-Contracted Narcotic Treatment Programs

VCBH staff said they conducted unannounced site visits in 2018-2019, but did not document them. Conclusions C-01. The Grand Jury concluded that opioid addiction could result in a lifelong MAT regimen. Aegis marketing materials and VCBH’s stated aim are confusing with regard to the effectiveness of MAT and the cure rate for opioid-addicted patients. (FA-04, FA-05) C-02. The Grand Jury concluded that VCBH does not provide any data to the public on measurable outcomes of the NTPs in the County. (FA-01) C-03. The Grand Jury concluded that VCBH does not conduct sufficient unannounced site visits and facility inspections. When conducted, site visits were not documented. (FA-02, FA-07) C-04. The Grand Jury concluded there is lack of oversight by VCBH regarding adequate documentation by NTP clinics in Ventura County. This could put at risk future government funding. (FA-03) C-05. The Grand Jury concluded that some NTP clinics lack sufficient security for the safety of patients and the public. (FA-06) Recommendations R-01. The current VCBH contracts require one site visit per year by VCBH staff. The Grand Jury recommends more unscheduled visits and documentation of those visits upon completion. (C-03) R-02. The Grand Jury recommends that VCBH fulfill its contractual obligation in oversight of each clinic. (C-03, C-04) R-03. The Grand Jury recommends that the Ventura County Auditor-Controller conduct a timely performance and compliance review of Aegis and Western Pacific contracts. (C-03, C-04) R-04. The Grand Jury recommends that VCBH adhere to all federal, State and County contractual policies and procedures in order to ensure continued funding for the administration of narcotic treatment programs. (C-04) R-05. The Grand Jury recommends that VCBH improve its existing educational materials regarding the goals and reasonable expectations of MAT programs. (C-01, C-02) R-06. The Grand Jury recommends that VCBH provide performance outcome data to the public on its contracted MAT programs. (C-01, C-02) R-07. The Grand Jury recommends that VCBH enhance security at contracted NTP clinics. (C-05) Ventura County-Contracted Narcotic Treatment Programs 3 Responses Responses Required From: Ventura County Board of Supervisors (C-01, C-02, C-03, C-04, C-05) (R-01, R-02, R-04, R-05, R-06, R-07) Ventura County Auditor-Controller (R-03) 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-04, R-05, R-06, R-07) References Ref-01. Aegis and Western Pacific contracts http://bosagenda.countyofventura.org/sirepub/cache/2/jvvybvn3w34tfq peyjw0euii/71132504302019043006464.PDF Accessed April 30, 2019 Ref-02. Aegis Treatment Center website https://www.aegistreatmentcenters.com/treatment/ Accessed April 30, 2019 Ref-03. “Can Opioid Addiction Be Cured?” May 19, 2017, Vanessa Shipani https://www.factcheck.org/2017/05/can-opioid-addiction-cured/ Accessed April 30, 2019 4 Ventura County-Contracted Narcotic Treatment Programs Glossary TERM DEFINITION Aegis Aegis Treatment Centers, LLC BOS Ventura County Board of Supervisors County County of Ventura Grand Jury 2018-2019 Ventura County Grand Jury MAT Medication-assisted treatment, which combines behavioral therapy and medications to treat substance use disorders Methadone Schedule II opioid analgesic used to relieve chronic pain and reduce drug cravings in those addicted to substances such as heroin and other prescription drugs NTP Narcotic treatment program State State of California Suboxone A prescription medicine use to treat adults who are dependent on opioids. VCBH Ventura County Behavioral Health Western Pacific Western Pacific Med Corp. Ventura County-Contracted Narcotic Treatment Programs 5