Shelves stacked with small boxes of menstrual products and other items.
The supply shelves at the office of Punks with Lunch, one of the organizations working to reduce the harm caused by the opioid epidemic in Oakland. Credit: Amir Aziz

Alameda County health officials have turned to the public for input on how to use the $40 million they expect to receive through settlements of lawsuits against companies that make, distribute, and prescribe opioids. 

The multi-billion dollar settlement from 2021 to 2023 of lawsuits across the state and country will dole out dollars to cities and counties in the coming years. Local governments must spend the money on “abatement” of opioid use and deaths, but have leeway in deciding how to accomplish that.

Throughout September, Alameda County held listening sessions seeking feedback from community members—many of whom have personal experience with opioid use and addiction, and now work in prevention or treatment.

“I’d like some support reshaping our torn-down community,” said Sonia Reed, a lifelong Oakland resident who works for the treatment program Bonita House, at the final listening session Tuesday morning. “It breaks my heart to see what East Oakland looks like, what the epidemic has done.”

Reed said she grew up using drugs with her parents, who both died of related causes, and now, 16 years sober, is watching her son and grandchildren use substances on the same street corners she did. She said she started a recovery organization to distribute naloxone (Narcan) and drug test strips and hold educational events in East Oakland, but has struggled to navigate grant processes.

“I beg for a liaison,” Reed said. “If somebody could please help us help us.” She suggested turning vacant buildings in East Oakland into “recovery cafés,” supportive, drug-free community spaces.

Opioid overdoses make up the largest number of drug deaths in Alameda County, followed by methamphetamine. While the county’s opioid death rate remains below those of the the rest of California and the U.S., cases have been steadily and dramatically increasing since 2017, according to data from the county. 

The numbers “will continue to go up,” said Dr. Kathleen Clanon, medical director of Alameda County Health Care Services Agency, “unless we’re able to really turn them around” through deliberate interventions. 

Certain populations are harmed at higher rates, with Black Alameda County residents disproportionately dying of opioid overdoses and getting hospitalized for non-fatal cases. 

People experiencing homelessness are also quite overrepresented, accounting for nearly a third of all overdose deaths in Alameda County. Overdoses were the single leading cause of death among unhoused people who’ve died in Alameda County since 2018. In general, more men die from overdoses in the county, while a wide range of ages is represented in the data. 

Both county staff and public speakers said Tuesday that settlement dollars should be distributed based on need, allocating more funds to programs serving neighborhoods and populations hardest hit by the crisis.

“We need to be thinking very particularly about what we can do so people who are homeless can benefit,” Clanon said.

The county already has several plans for how to use the money, which it’ll receive in installments. Officials plan to launch a public education campaign about the opioid crisis and to provide “mini grants” to community organizations. 

They also plan to fund more Medication Assisted Treatment services, like methadone clinics, where people take prescription medications in conjunction with counseling. The county will also use the settlement dollars for detoxification beds in hospitals. 

A speaker during Tuesday’s listening session added that Alameda County needs more hospital beds for people with co-occurring substance use disorders and mental health conditions. Another said supervised withdrawal sites don’t need to be located in overburdened emergency or hospital settings.

Others focused on the people providing the treatment. 

“Set a county wage for frontline workers in treatment programs,” said Gavin O’Neill, who manages the Alameda County’s Office of Collaborative Courts, and has personal experience with substance use treatment. “Those are the soldiers on the ground. Living in the Bay Area, the turnover of frontline staff is very chaotic and not sustainable.”

“Workers who’ve been witnessing all of these deaths…they really need more support, more therapy, more resources in their pockets so they can afford to live here,” said Ryan Wythe, director of homeless services for LifeLong Medical Care.

He also called for better county evaluation of the programs it funds.

Luka Z., who does outreach with Punks with Lunch, called into the meeting from a site on Martin Luther King Jr. Way in Oakland, where they said several overdose deaths have occurred in recent days and months. Organizations like their largely volunteer-group show up consistently to build trust with people, pass out Narcan, train people on safer use, and drive them to treatment appointments. But Punks with Lunch and similar groups don’t have the resources to provide everything that’s needed, said Luka Z. They said drug testing supplies are especially important, since people regularly overdose from using crack that turns out to be laced with fentanyl. 

Presenting possible points of entry for opioid abatement, Clanon said there are opportunities for prevention before people are exposed or ways to reduce opioid supply, methods for treating addiction and reducing harm, and resources for rescuing people experiencing overdoses. 

One harm reduction approach listed in her materials—supervised drug use—won’t be coming to the county anytime soon. Gov. Gavin Newsom last year vetoed a bill that would have allowed Oakland to open supervised injection sites.

Natalie Orenstein covers housing and homelessness for The Oaklandside. She was previously on staff at Berkeleyside, where her extensive reporting on the legacy of school desegregation received recognition from the Society of Professional Journalists NorCal and the Education Writers Association. Natalie’s reporting has also appeared in The J Weekly, The San Francisco Chronicle and elsewhere, and she’s written about public policy for a number of research institutes and think tanks. Natalie lives in Oakland, grew up in Berkeley, and has only left her beloved East Bay once, to attend Pomona College.