County says overdose deaths have fallen since 2023 but warns funding changes could reverse gains

Alameda County health officials told the Health Committee on Feb. 23 that overdose deaths in the county peaked in 2023 and have since shown a sustained decline, but they cautioned that upcoming funding changes and policy shifts could reverse progress.

"Overdose deaths have actually peaked in 2023," said Joel Rabier (introduced by county staff as a colleague), summarizing trend charts and racial and housing‑status disparities. He said the county has seen a “significant and sustained decrease” in overdose deaths over the last two years, while also highlighting that Black residents and people who are currently or recently homeless remain disproportionately affected.

County interventions and evidence of impact: speakers credited investments in treatment, harm reduction and rescue capacity. Presenters said the county distributes more than 50,000 doses of naloxone annually and has deployed over 50 public access naloxone boxes. Officials also described expanded medication for addiction treatment (MAT) in Santa Rita Jail, increased use of long‑acting injectable buprenorphine and pilot programs such as drug checking.

Amy Lang, medical director at Santa Rita Jail, said the jail’s MAT census has grown from 100–200 patients to the 300s and sometimes as high as 500, and that reported Narcan uses have fallen in recent months (Lang cited January counts of 18 uses in 2024, 5 in January 2025 and 0 in January 2026 for the jail context).

Opioid settlement funding and mini‑grants: county staff described an updated local allocation estimate that rose from an initial $46,000,000 projection to about $80,000,000 in settlements, with roughly $31,700,000 received to date and a projected county spend of about $18,700,000 this fiscal year. Staff said they had deployed $5,500,000 in so‑called mini‑grants through a competitive process (administered by a partner organization) to fund innovative community projects and that 22 awards were made across the county.

Budget and sustainability concerns: presenters warned that changes tied to Prop 1 and Medi‑Cal eligibility (and federal policy pressures described during the presentation) could reduce access to care and make it harder to sustain programs after one‑time settlement dollars are spent. Staff emphasized planning for sustainability and noted that some uses of settlement funds are time‑limited and must be encumbered within statutory windows or returned to the state.

Operational priorities and next steps: county speakers highlighted EMS and Santa Rita Jail as high‑touch points where follow‑up and warm handoffs into community treatment are priorities. They said a mobile pharmacy pilot and investments in substance‑use navigators aim to bridge gaps in pharmacy availability and transportation. Staff said they are collecting interim results from mini‑grant recipients and expect a formal outcomes presentation later in the year.

The board and committee members asked detailed questions about funding timing, which programs could be supported with opioid‑abatement dollars, and how the county will measure outcomes. Officials pledged continued tracking, audits of allocations and a November checkpoint for mini‑grant outcomes.