California dhcs opioid response (SOR 4) - in SOR IV, california will continue efforts to implement and expand evidence-based treatment for opioid use disorders (OUD) and stimulant use disorders (STUD)

Priority populations include black, tribal/urban indian, hispanic/latinx, and LGBTQIA2S+ communities, and youth. Overdose death rates in the state of california have increased rapidly in the wake of the covid-19 pandemic (kiang ET AL. 2022). By the end of 2022, the statewide all drug-related overdose death rate rose to 27.11 deaths per 100,000 residents. While opioids were involved in the greatest proportion of overdoses (67%), psychostimulants were involved in over half of all overdoses (53%) (cdph 2024). This may be driven, in part, by the increasing presence of synthetic opioids, like fentanyl, in stimulants and other drugs (shover ET AL. 2020). There is an urgent and growing need to address the health and safety of california residents who use all drug types, especially fentanyl. SOR IV projects and activities will be implemented across california, with an emphasis on areas with the highest rates and volume of overdose deaths. Activities will focus on settings where individuals with substance use disorders (SUD) are routinely present, such as primary care, hospitals, SUD treatment providers, and community settings. A continued focus on increasing access to and utilization of services across the continuum of care - from prevention through treatment and recovery - will be a priority. However, several barriers remain to realizing this vision, including access to moud, which is a concern in rural areas, but many urban areas still lack capacity to treat all individuals with an OUD. Stigma also continues to pose barriers to referrals and engagement in treatment for individuals with OUD. Effective education for the justice-involved system, courts, child welfare, health system, behavioral health workforce, and SUD providers continues to be a proven method to combat stigma and engage clients into services. In SOR IV, california will expand its approach to prevention, harm reduction, treatment, and recovery services through the following objectives: 1) expand access to moud through strategic access points; 2) address health inequities and disparities for vulnerable populations across the continuum of SUD care; 3) expand prevention activities to prevent opioid and stimulant misuse and overdose deaths, and; 4) expand access to evidence-based harm reduction approaches, including education, access to naloxone, counseling, and referral to low-barrier treatment for OUD and SUD. California's SOR IV projects will use evidence-based practices, including FDA-approved medications, counseling, and peer support recovery supports. California's department of health care services (CDHCS), the administrator for the SOR program, will work with county governments, health providers, community organizations, foundations, and other key partners as part of a collaborative effort. As in years past, the grant will continue to support efforts to reduce stigma, coordinate of funding streams, create project sustainability, and increase awareness of the effectiveness and availability of treatment for OUD and SUD. Note: all references can be found in attachment 9 - needs assessment.