The next settlement dollar should chase the drug that's actually leading

Free naloxone is available countywide. In crisis, call or text 988, or (888) 724-7240.

San Diego County has earned the right to be trusted with settlement money. It spent 11% of its first-year receipts while it built programs, then 99% of year two's — three times the statewide pace — and every dollar is traceable through public filings data page 7. The programs it bought (ED peer response, field buprenorphine, naloxone saturation, drug checking) are precisely the ones the 2024-25 overdose decline is credited to.

But the settlement framework was written for the epidemic of 2022, and the county's own task force data describes a different epidemic in 2024: methamphetamine was present in 63% of overdose deaths — eleven points ahead of fentanyl — and among San Diegans experiencing homelessness, meth has outkilled fentanyl every single year since 2020 data page 8. Treatment paired with sober living and recuperative housing is the response that matches this data.

Almost the entire settlement-funded toolkit is opioid-shaped. Naloxone does not reverse a meth overdose. Buprenorphine does not treat stimulant use disorder. There is no medication to field-initiate. For stimulants, the evidence-based interventions are treatment — contingency management above all, the single best-supported therapy for stimulant use disorder, now Medi-Cal-reimbursable under California's recovery incentives expansion — plus sustained engagement and step-down structure after stabilization data page 1, data page 8.

Settlement allowable-use guidelines permit funding treatment for co-occurring and stimulant-involved substance use where opioids are part of the picture — and in San Diego they are: a third of 2024's overdose deaths involved fentanyl and meth together [data page 8].

What we're asking for

1. Name stimulants in the next annual budget memo. The CAO reports to the Board annually on the settlement plan. The next memo should state, in its framing, what the task force data shows — that the county's leading overdose drug is now methamphetamine — and allocate against it explicitly rather than incidentally.
2. Fund contingency management to scale. Stand up or expand CM programs within DMC-ODS, prioritized for the populations the data flags: people experiencing homelessness and the Central, Mountain Empire, and East County high-burden areas data page 9.
3. Connect the new withdrawal-management beds to step-down. The 44 new live-in WM beds (2026) will discharge roughly 2,700 people a year, most with stimulant involvement. Dedicate a settlement-funded linkage protocol — and slots — so those discharges land in structured day treatment rather than back on the street with a resource list.
4. Keep the receipts public. The county's expenditure filings are its best accountability asset. Publish the stimulant-specific allocations as their own line so next year's report card can grade the pivot.

The county built an opioid response worthy of the data it had. The data has moved. The money should follow it.