Plugging deadly holes in California’s addiction treatment system – East Bay Times


They tried a wilderness program in Idaho. Boarding faculty. Costly personal remedy packages and sober residing properties in Orange County, the San Fernando Valley, Beverlywood.

After spending almost $200,000 attempting to free him from the tyrannous grip of dependancy, Juli Shamash’s son, Tyler, died in 2018 of an overdose within the toilet of a sober residing house proper across the nook from her home. He was 19.

“They don’t’ educate you this in ‘Mommy and Me,’ ” Shamash stated. “You haven’t any clue the place to start out, what to do, when your little one is an addict. Which packages are good? That are dangerous? I’m a researcher, it’s what I do. I appeared up all the pieces I might, however you’re blind. You simply don’t know.”

After years of research, a first-of-its-kind coalition of greater than 50 teams — together with the California Hospital Affiliation, California Medical Affiliation, county well being administrators, public security officers and family-based organizations — intends to vary that. The Behavioral Health Action’s new Blueprint for Behavioral Health presents a brand new path ahead for dependancy remedy and rather more. The necessity for a brand new method may be seen in public parks, beneath freeway overpasses and even in sober residing properties.

How did Tyler get the cash to purchase the medicine that killed him? A “pal” brokered him to a program in Laguna Hills that accepted Tyler’s insurance coverage — and acquired $2,000 for his troubles, Shamash stated. Being a “pal,” he break up the cash with Tyler.

Juli Shamash and her son Tyler, who was 19 when he died in 2018. (Courtesy Juli Shamash) 

Tragedy has offered a most unwelcome readability. “What I’ve realized is that the higher locations aren’t these personal packages,” she stated. “It’s the general public packages that take MediCal for low-income folks the place you get higher care.

“I want I had recognized that.”

Coalition members need everybody to know that, and so they waste no phrases in saying so.

“They’re in a special world,” stated Steve Fields, the Progress Basis’s govt director, referring to California’s huge community of personal remedy packages that run on personal medical insurance funds.

“In the event you’re within the public behavioral well being system since you don’t have insurance coverage, otherwise you’re in Medicaid, you may have a greater likelihood of getting recovery-based remedy than you do in a non-public program.”

Flip the triangle

The Blueprint goals to “flip the triangle” on how California invests in psychological well being, which incorporates dependancy remedy.

Proper now, the majority of psychological well being spending is funneled to acute care — serving to sufferers after a disaster has already occurred. As a substitute, the coalition desires spending focused on prevention and training, to cease circumstances from changing into acute to start with.

It additionally requires measurable outcomes for psychological well being packages so it’s clear what works, what doesn’t and whether or not we’re making progress towards targets — an concept that has traditionally met fierce resistance from psychological well being care suppliers — in addition to better transparency for shoppers searching for assist, like Shamash.

“We now have to do higher within the state of California,” stated Carmela Coyle, BHA co-chair and president & CEO of the California Hospital Affiliation. “We’re providing a brand new and higher path ahead.”

An enormous a part of that’s filling the fracture between the psychological well being and bodily well being care methods, that are largely divorced from each other.

In simply the most recent instance of one thing gone terribly awry, former Mater Dei Excessive and Saddleback Faculty quarterback Colt Brennan died early Tuesday morning, May 11, at age 37, of what appears to be an overdose.

Brennan, who starred on the College of Hawaii and had a quick NFL profession, struggled with substance use. Previous to his demise he spent months at a non-public remedy heart in Costa Mesa. Final week, he wound up at his mother and father’ house in Orange County, showing intoxicated. His father took him to a hospital emergency room, the place Brennan was apparently stabilized and, as a result of he was an grownup, was launched with out the household being notified. He then apparently went to a lodge, ingested one thing with fentanyl, and by no means regained consciousness, his father stated.

“We don’t have a course of for involuntary remedy for substance use problems regardless of how extreme,” stated Aimee Moulin, behavioral well being director for the UC Davis Medical Middle’s emergency division and a director at CA Bridge. “For psychological sickness, we will deal with somebody towards their will in the event that they meet sure standards. There’s plenty of overlap between overdose and suicidality that’s under-appreciated.

“Nevertheless, if the affected person has capability to make their very own selections, and doesn’t meet standards for a psychological well being maintain, they get to make their very own selections,” Moulin stated.

What occurred within the ER, and what ought to have occurred, aren’t clear, however specialists counsel totally different guidelines within the psychological well being care system might need modified Brennan’s tragic final result.

“We have to actually begin treating folks with behavioral well being wants the way in which we deal with folks with bodily well being wants, from begin to end,” stated Jessica Cruz,  Behavioral Well being Alliance co-chair and CEO of the Nationwide Alliance on Psychological Sickness California.

Hawaii quarterback Colt Brennan (15) celebrates after defeating Boise State 39-27 of their school soccer recreation in Honolulu, on this Nov. 23, 2007 file photograph. (AP Picture/Ronen Zilberman) 

“You’d by no means flip somebody away who’s having a coronary heart assault and desires providers. That by no means would occur if somebody confirmed up with a damaged arm. You’d get it fastened.”

Numerous the issues stem from how psychological well being providers are funded, she stated. “We now have to verify private and non-private methods work collectively in the identical method as they might when somebody has a bodily ailment.”

Motion, the coalition stated, can’t be delayed.

Indicators of hope

State Sen. Pat Bates, R-Laguna Niguel, was as soon as a social employee. She noticed the devastation wrought by psychological sickness and dependancy up shut, lengthy earlier than she began pushing for reforms to California’s dependancy remedy system within the Legislature. This blueprint, she stated, takes steps in the suitable path.

“Inverting the triangle — that’s crucial,” Bates stated. “We’ve been investing in training and prevention for years — however we have to do one thing in another way.

“With fentanyl in all the pieces, it must be seen as a poison, a step into the abyss of despair and early lives misplaced,” she added.

A key shall be educating mother and father to acknowledge the indicators of potential psychological sicknesses whereas their kids are nonetheless younger, and mobilizing whole neighborhood networks — faculties, legislators, neighborhood leaders — into the trouble. “We are able to make a distinction,” Bates stated. “I’m satisfied of that.”

Half of all circumstances of psychological sickness start by age 14, and 75% by age 24, the Blueprint says. It calls for a lot extra early, particular person screenings for danger indicators and trauma — which frequently precede psychological sickness and substance abuse — in addition to energetic engagement of their mother and father and caregivers and cautious case administration to get folks the assistance they want and keep away from disaster.

These are all good concepts, stated Laurie Girand of Advocates for Responsible Treatment in San Juan Capistrano. Prevention is clearly higher than remedy, and involving households within the course of — privateness legal guidelines usually make that very tough — is vitally vital.

However Girand has been pushing for higher high quality management, oversight and enforcement for personal remedy packages in California for years, and doesn’t see these points tackled right here.

There’s a lot discuss not having sufficient beds to deal with dependancy, however the elephant within the room is, how most of the folks coming to California for remedy are literally from right here? Personal packages have been paying folks from different states to come back for remedy in California — so the packages can invoice their insurance coverage firms — and nobody has tried to quantify that.

Josh Web page holds an image of his pal Timmy Solomon who died of an obvious drug overdose Sept. 2 at age 31. Solomon’s wrestle was depicted in SCNG’s Rehab Riviera protection. (Picture by Mindy Schauer, Orange County Register/SCNG) 

“Addicts are weak to predation,” Girand stated. “There’s actually nothing in right here about that.”

The Blueprint’s backers say the main points are for policymakers to work out — they’re simply attempting to assemble the guardrails “at a time when California faces a behavioral well being ‘tsunami’ because of the impacts of the COVID-19 world pandemic.”

Early knowledge suggests the nation’s drug disaster spiraled through the pandemic. Practically 90,000 Americans died of drug overdoses over the 12-month interval ending in October, based on knowledge from the Facilities for Illness Management — a rise of 30% from the earlier yr.

And in California, the response to that disaster — earlier than and as we exit the pandemic — has been chaotic. Psychological well being (together with dependancy remedy) challenges are normally dealt with one county at a time, usually leading to 58 totally different approaches, various high quality and inconsistent choices from one county to a different. This, the coalition stated, requires a complete statewide repair.

Shamash’s son Tyler was a super-bright child who was fascinated with electronics, all the time inventing issues, fixing no matter was damaged. Now, Shamash is attempting to spin one thing good out of her household’s tragedy. She based WE ARE M.A.D. (MomsAgainstDrugs) to serve grieving mother and father and households by means of advocacy, honor misplaced family members, unfold consciousness, cease the stigma and propel a paradigm shift in society’s view of dependancy. A narrative informed, she stated, is a life saved.

Along with setting high quality requirements, growing transparency and understanding the variations between private and non-private remedy packages, Shamash’s reform want record would ensure that all hospitals take a look at any potential overdose sufferer for fentanyl. Such a take a look at may not have saved her son, however maybe it might save others.

“There’s no constant normal of care,” Shamash stated. “One thing isn’t working. The system wants to vary.”


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