California Considers Slew of Bills to Tackle Skyrocketing Fentanyl Overdoses

As the number of people killed by drug overdose continues to skyrocket in California, state legislators are debating numerous fentanyl bills intended to save lives. This includes measures that increase access to treatment, medications that reverse overdoses, and more.

Last year, 6,773 Californians overdosed on fentanyl, according to provisional data released by the Centers for Disease Control and Prevention. That’s up from 2,377 just five years ago.

Fentanyl is a very inexpensive synthetic opioid that is 20 to 40 times stronger than heroin. It can be mixed into any number of street narcotics and prescription drugs without a user knowing what they are consuming. Ingestion of only two milligrams can be fatal.

Although the new federal data revealed some good news for some states on the East Coast, like Massachusetts and Maine, where overdose deaths fell last year, the fentanyl overdose tally in California is nearly 12% higher than it was back in 2022.

“It warms me to see so much action in the state to address the rising overdose crisis,” said Dan Ciccarone, professor in addiction medicine at UCSF.

But he added that “west of the Mississippi River, the fentanyl epidemic is not over. I feel like we’re not even to the halfway point yet. I’m very concerned about California.”

He’s closely following several proposed bills that “are supported by public health evidence and are likely to succeed.”

The first is AB 1842, which prohibits insurers from requiring patients with opioid use disorder to receive prior authorization for medical treatment. It passed the Assembly unanimously and is now before the Senate.

“This is so important as it involves removing barriers to the most effective and cost-effective medications,” Ciccarone said. “Prior authorization is a barrier at the clinical level as it provides just enough frustration to the clinician and the patient to dampen care.”

Two other bills would increase access to medications that can reverse an opioid overdose instantaneously. AB 1976 would require businesses to carry naloxone nasal spray in first aid kits by July 2027. AB 1841 would provide two doses of naloxone to residential advisors at California’s public colleges. Both passed the Assembly unanimously and are now before the Senate.

California lawmakers are considering aligning the state with new federal regulations on methadone under AB 2115. The bill would allow patients to take more doses of methadone home at a time and allow more practitioners to prescribe the medication.

“We have a holdover model, which is a lot tighter than what the federal government requires now,” said Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford University. “That’s a good idea because that’s a treatment that’s in short supply, and it does help a lot of people.”

Other bills targeting fentanyl use are listed below. Many are part of the Safer California Plan, a package of state senate bills designed to address fentanyl use.

These bills would:

• AB 2429: Expand mandatory health education in high school to include information about the dangers associated with fentanyl use.
• AB 2136: Prevent the police from arresting someone who has willingly allowed harm reduction service providers to check their drugs.
• SB 997: Allow middle and high school students to carry naloxone, and it would require middle and high schools to stock and distribute fentanyl test strips.
• SB 908: Require the state’s health department to identify fentanyl-related deaths of children 0-to-5 years of age.
• SB 1319: Expedite the approval process for nursing homes to add behavioral health programs.
• SB 1442: Establish avenues for the state to fund and distribute fentanyl tests to health care providers.
• SB 1468: Educate and encourage providers to dispense a three-day supply of narcotic medication to start detoxification treatment or maintenance treatment for people who use opioids.
• SB 909: Eliminate some loan repayments for physicians who agree to provide direct patient care in an underserved area for three years.
• SB 910: Improve programming, drug testing and medication-assisted treatment for individuals moving through the criminal justice system with new statewide standards.

Ciccarone said that while the suite of legislation is a good step forward, the state is still playing catch up. “We should have been addressing things like prior authorization ten years ago,” he said.

The big ticket item that is absent from the slew of bills, he said, is supervised drug consumption sites, which are fixed or mobile spaces where people can take illicit drugs under the eye of trained staff. Research shows these sites can lower public costs, reduce hospitalizations, and save lives.

Gov. Gavin Newsom vetoed a bill that would have allowed a handful of California cities to pilot supervised consumption projects in 2022.

“The hard stuff that we need is the stuff people are most afraid of,” he said. “We need to develop the courage and political will for big things.” 

The other key policy to reduce overdoses, according to Humphreys, that is missing from the list is a bill that died in committee earlier this year. It would have required communities to test wastewater for illicit drugs.

“Testing sewer water tells us where people are using drugs and what they’re using,” Humphreys said. “And when a new dangerous drug comes into a town, you know it right away. Plus, it lets us know if money spent on treatment, prevention, harm reduction, and law enforcement is working.”