Turning the Tide on Overdose
Can Prop 1 Deliver on Its Promise?
For over a decade, my work at the intersection of disability rights, substance use disorder (SUD) best practices, and behavioral health system transformation has taught me that recovery is neither linear nor universal. Shaped by social determinants like economic instability, trauma, and lack of access to care, my journey echoes those of so many Californians, each with their own unique story.
As highlighted in my last Substack, The Ballooning Crisis, Los Angeles County Substance Abuse Prevention and Control (SAPC) launched the Reaching the 95 (R95) Initiative to address the reality that 95% of people never access traditional SUD treatment. R95 removes abstinence barriers, incentivizes programs to support clients through lapses, and encourages providers to become R95 Champions, all while fostering a more realistic, person-centered, and welcoming care environment—regardless of someone’s readiness for abstinence or experience with a recurrence of use.
This shift has real-world results. While California faced more than 10,900 drug overdose deaths in 2024—an 80% increase over three years—L.A. County Public Health SPAC’s comprehensive efforts led to the sharpest decline in county history: a 22% drop in overdose deaths, a 37% reduction in fentanyl fatalities, and 20% fewer methamphetamine-involved deaths last year.
Such progress can reach even more people when we pair SAPC’s bold actions with the embedding of Certified Peer Support Specialists, Community Health Workers, and authentic recovery advocates in Dual Diagnosis Teams within SUD and co-occurring care. This approach makes recovery feel possible, hopeful, and grounded in connection and unconditional respect. These efforts can be further amplified with targeted funding from Prop 1, such as through the Behavioral Health Continuum Infrastructure Program, giving SUD communities the tools they need to scale what works.
However, there are deep concerns about the implementation of Prop 1 at the intersection of California’s Behavioral Health Services Act and SUD. Many observers have noted that without an explicit focus on best practices in SUD care—such as harm reduction, culturally responsive interventions, and the intentional inclusion of those with lived experience—even dedicated funding or integrated planning may overlook those most at risk. Stakeholder engagement efforts required under BHSA—like public listening sessions, advisory committees, and direct community consultation—must move beyond box-checking. Insights about what truly saves lives need to become policy and fiscal priorities, not just discussion points. The risk remains that integration will default to the status quo and fail to produce meaningful results for high-risk and underserved groups, especially when strong, diverse community expertise is not fully included at the planning table or given the room needed to define which SUD services should be prioritized under the BHSA.
If Prop 1 is to realize its promise, California must bridge the gap between engagement and implementation. This means transparent oversight, meaningful accountability, and an unwavering commitment to advancing the practices that have already proven successful in the lives and recoveries of so many. Only then can we build systems that meet people where they are and finally move the needle on our most urgent behavioral health crises.
Vanessa Ramos is a Senior Advisor at Disability Rights California and a member of the All People’s Health Collective, advancing disability justice and equitable drug policy through community advocacy and peer leadership. Outside of work she’s mom to Angel, Esther, Little Kitty, and Sol.