Testimony from:

Stacey McKenna, Senior Fellow, Integrated Harm Reduction, R Street Institute

In Support of Mobile Access to Medications for Opioid Use Disorder (CA AB 663)

April 26, 2023

Assembly Appropriations Committee

Chair Holden and honorable members of the committee,

My name is Stacey McKenna, and I am a senior fellow in Integrated Harm Reduction at the R Street Institute (R Street), a public policy research organization focused on advancing limited, effective government in a number of policy areas, including opioid harm reduction.

In 2021, nearly 7,000 Californians died of an opioid-involved overdose.[1] Abstinence-driven policies do not work at the population level, and even the best cessation and prevention programs leave people behind.[2] But medications for opioid use disorder (MOUDs) are a harm reduction-driven, evidence-based approach to recovery that have been proven to reduce risk for overdoses while significantly improving treatment outcomes and retention. As such, we support CA AB 663, which would expand access to one of these medications, buprenorphine.

Buprenorphine is a partial opioid agonist medication that attaches to opioid receptors in the brain to displace and prevent the binding of drugs such as heroin or fentanyl and thus curb withdrawals and cravings.[3] Compared to people engaged in non-MOUD treatment, those taking buprenorphine are significantly less likely to revert to problematic opioid use, experience an overdose, or contract or transmit human immunodeficiency virus (HIV) and hepatitis C.[4]

Unfortunately, despite buprenorphine and other MOUDs’ established efficacy and safety, only 13 to 27 percent of people living with opioid use disorder (OUD) receive medications as part of their recovery.[5] In fact, one study found that in 2019, more than half a million Californians with an OUD lacked access to either of these medications.[6] CA AB 663 would help close that gap by expanding access to buprenorphine via mobile pharmacies.

Policymakers can be confident that in addition to saving lives, expanding access to buprenorphine will save taxpayers money without risk to their broader communities.

In a given year, opioid overdose, misuse and dependence cost Americans roughly $35 billion in health care costs; nearly $14.8 billion in criminal justice expenses; and $92 billion in lost productivity.[7] As such, studies have found that lifetime savings per person treated range between $25,000 and $105,000.[8]

Furthermore, although proponents of strict MOUD regulations cite fears related to diversion and misuse, these are largely unfounded.[9] MOUDs have been repeatedly demonstrated to be safe. Diversion rates are comparable to or lower than those of other prescription drugs (i.e., antibiotics or allergy medications), and tend to decline as access improves.[10] And, when regulations on buprenorphine access were relaxed during COVID-19, buprenorphine-involved overdose rates did not increase.[11]

California’s pharmacy vans were introduced to ensure that the state’s most vulnerable and hard-to-reach populations have access to key medications.[12] CA AB 663 builds on this existing law by allowing these mobile units to carry and dispense buprenorphine, a move that will close gaps in who receives this evidence-based OUD treatment. Given MOUDs’ established history, we can expect that expanding treatment will improve recovery initiation and retention for Californians living with an OUD, and will help reduce risk for overdose, infectious disease and more. As such, R Street urges your favorable report.

Respectfully submitted,

Stacey McKenna
Senior Fellow, Integrated Harm Reduction
R Street Institute
[email protected]

[1] Centers for Disease Control and Prevention, “Opioid Use Disorder,” U.S. Department of Health and Human Services, Aug. 30, 2022. https://www.cdc.gov/dotw/opioid-use-disorder/index.html#:~:text=About%202.7%20million%20people%20in%20the%20United%20States%20report%20suffering%20from%20OUD; National Institute on Drug Abuse, “Drug Overdose Death Rates,” National Institutes of Health, Feb. 9, 2023. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates; Office of Communications, “Fentanyl & Overdose Prevention,” California Department of Public Health, Jan. 23, 2023. https://www.cdph.ca.gov/Programs/OPA/Pages/Communications-Toolkits/Fentanyl-Overdose-Prevention.aspx – :~:text=Fentanyl is a major contributor,19 years old, in California.

[2] Susan E. Collins, “Sobriety is just one pathway to recovery. Harm reduction is another,” STAT News, April 11, 2019. https://www.statnews.com/2019/04/11/harm-reduction-substance-use-disorder

[3] “Medication for Opioid Use Disorder (MOUD) Overview,” National Harm Reduction Coalition, Sept. 8, 2020. https://harmreduction.org/issues/facts

[4] Sarah E. Wakeman et al., “Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder,” JAMA Network Open 3:2 (Feb. 5, 2020). https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2760032#:~:text=Our%20findings%20are%20also%20consistent,treatment%20or%20non%2DMOUD%20treatment; National Institute on Drug Abuse, “Medications to Treat Opioid Use Disorder Research Report: What is the impact of medication for opioid use disorder treatment on HIV/HCV outcomes?,”National Institutes of Health, December 2021.  https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/what-impact-medication-opioid-use-disorder-treatment-hivhcv-outcomes.

[5] Centers for Disease Control and Prevention. https://www.cdc.gov/dotw/opioid-use-disorder/index.html#:~:text=About%202.7%20million%20people%20in%20the%20United%20States%20report%20suffering%20from%20OUD.

[6] Lisa Clemans-Cope et al., “California Opioid Use Disorder and Treatment Needs,” Urban Institute, October 2019. https://www.urban.org/sites/default/files/2020/01/31/california_totals.pdf

[7] “The High Price of the Opioid Crisis, 2021,” The Pew Charitable Trusts, Aug. 27, 2021. https://www.pewtrusts.org/en/research-and-analysis/data-visualizations/2021/the-high-price-of-the-opioid-crisis-2021.

[8] Michael Fairley et al., “Cost-effectiveness of Treatments for Opioid Use Disorder,” JAMA Psychiatry 78:7 (March 31, 2021), pp. 1-11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014209

[9] Brandon del Pozo and Josiah D. Rich, “Revising our attitudes towards agonist medications and their diversion in a time of pandemic,” Journal of Substance Abuse Treatment 119 (December 2020). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505066; K. Michelle Peavy et al., “Rapid Implementation of Service Delivery Changes to Mitigate COVID-19 and Maintain Access to Methadone Among Persons with and at High-Risk for HIV in an Opioid Treatment Program,” AIDS and Behavior 24 (April 28, 2020), pp. 2469-2472. https://link.springer.com/article/10.1007/s10461-020-02887-1.

[10] National Academies of Sciences, Engineering, and Medicine et al., Medications for Opioid Use Disorder Save Lives (National Academies Press, 2019). https://www.ncbi.nlm.nih.gov/books/NBK541389.

[11] Office of Science and Data Policy, “Flexibilities in Controlled Substances Prescribing and Dispensing During the COVID-19 Pandemic,” Assistant Secretary for Planning and Evaluation, August 2022. https://aspe.hhs.gov/sites/default/files/documents/8d26dfc6c859795bf2307ae6a845b7f5/ASPE-brief-covid-flexibilities-aug-2022.pdf.

[12] CBS San Francisco, “New California law allows mobile pharmacies to serve vulnerable populations,” CBS News Bay Area, Aug. 30, 2022. https://www.cbsnews.com/sanfrancisco/news/sb872-mobile-pharamcies-new-california-law-sen-bill-dodd.