The Opioid Crisis in Ventura County*

Conclusions 2

• CL1
  I (we) agree with the findings numbered: C-01 . I (we) disagree wholly or partially with the findings numbered: C-02, C-03, C-04, C-05 =
• CL2
  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) Response: Agree 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) Response: Partially disagree The conclusion that "a disproportionate amount of budget resources" is allocated to O treatment programs is not substantiated and appears to be inaccurate. VCBH ADP is obligated to meet local needs using categorical funding. Drug Medi-Cal funds cannot be used for Prevention, and they are paid to the County based on claims for treatment services; whereas Substance Abuse Prevention and Treatment Block Grant (SABG) funds can and are used as the "payor of last resort" for treatment services. While DHCS requires that Counties allocate a minimum of 20% of SABG funds to Prevention, VCBH ADP typically allocates double the minimum requirements to adequately meet community needs as indicated on annual cost reports. o VCBH strongly disagrees with the assertion that "Prevention program efforts primarily focus on marijuana and alcohol abuse, with minimal attention to opioid abuse." Among the first documents provided to the Grand Jury was the Strategic Prevention Plan, 2017- 2022 (http://venturacountylimits.org/en/resources/article/A8CB69/strategic-prevention- plan), which outlines the needs and priorities based on local data. Since 2009, addressing Prescription (Rx) Abuse and Heroin problems has been a top priority for the Department. In fact, over the last four years VCBH has been involved in more events, conferences and training sessions related to the opioid crisis than alcohol or marijuana (see list, attachments). Recent events include co-sponsorship of the Gold Coast Opioid Policy Summit with a local Assemblymember in May of 2017 and the VCBH Opioid Solutions Summit with a U.S. Representative in August 2017. These events are just two of the public awareness and professional development opportunities for local medical professionals, law enforcement and others the Department has produced. Moreover, VCBH has organized and hosted dozens of local training and education events over the last several years, such as Conejo Community Forums on the opioid crisis, and parent education events in Simi Valley and Camarillo (in collaboration with the Ventura County Sheriff's Office and the Ventura County Office of Education (see examples of event flyers, events). 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) Response: Partially disagree The Department of Health Care Services is responsible for carrying out applicable 0 statutory and regulatory requirements for licensure and compliance monitoring of all public and private Narcotic Treatment Programs (NTPs) in the State of California. The Department of Health Care Services is also responsible for setting the rates in which NTPs are reimbursed for these services, not the County. As such, the statement that "for-profit entities generally have fewer cost-control incentives" while true, is not applicable in this case because NTP entities are paid the same for contracted Medi-Cal services regardless of their for-profit or non-profit status. A Request for Information (RFI) may be indicated in the new fiscal year as the County aims to expand treatment services, however, the County reserves the right to contract with the most qualified provider(s) - non-profit or other. 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) Response: Partially disagree VCBH collects and submits client-level treatment admission and discharge information 0 through the DHCS CalOMS Tx system and billing information through the DHCS Information Technology Web Services system. While reports generated through these systems are used to facilitate the improvement of service delivery, these systems are administrative databases, which alone, do not adequately capture the information needed to establish benchmarks for clinical or program-level success. In addition to using the reports generated by these systems, VCBH uses information captured through the Avatar system to regularly monitor and evaluate client and program-level activities using clinical service data, quality improvement/quality assurances measures and utilization review/utilization management measures. These activities will continue to be done in consort as new multi-level benchmarks are developed to better ascertain client and program-level success/areas for improvement. 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) Response: Partially disagree Per the National Institute on Drug Abuse, opioids are a class of drugs that include the 0 illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers such as oxycodone, hydrocodone, codeine and morphine. To be consistent with recent federal publications, VCBH has taken steps to more clearly state that use of the term "opioids" generally includes prescription painkillers, fentanyl and heroin. Although medical professionals including the Medical Examiner's office may use more precise pharmacologic or medical terms to refer to drugs implicated in a death, these distinctions do not alter the commonly used term opioid.