To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services, County Administrator Office
Staff Name and Phone Number: Nolan Sullivan, 707-565-4774; Jan Cobaleda-Kegler, 707-565-5157
Vote Requirement: 4/5th
Supervisorial District(s): Countywide
Title:
Title
Opioid Settlement Funds Notice of Funding Availability Recommendations
End
Recommended Action:
Recommended action
A) Authorize the Director of Health Services, or designee, to execute three (3) Opioid Settlement Fund agreements, subject to review and approval by County Counsel;
i. Buckelew Recovery Residences for a term of Effective Date through 6/30/26 and a not-to-exceed amount of $3,873,235
ii. West County Health Centers for a term of Effective Date through 6/30/28 and a not-to-exceed amount of $637,365
iii. Drug Abuse Alternatives Center for a term of Effective Date through 6/30/28 and a not-to-exceed amount of $489,400
B) Adopt a Resolution authorizing budgetary adjustments to the Department of Health Services fiscal year 2025-2026 adopted budget, increasing appropriations in the amount of $4,139,308 to reflect revenues and expenditures associated with Opioid Settlement Fund funding agreements for providers of Substance Use Disorder services. (4/5th Vote Required)
end
Executive Summary:
In the last decade, state and local governments have pursued pharmaceutical companies and distributors with legal claims stemming from actions that fueled the opioid addiction epidemic. National settlements have been secured to create the Opioid Settlement Fund (OSF). Of this, the State of California is expected to receive approximately $2.05 billion to be paid through calendar year 2038. To date, Sonoma County has received over $14 million which must be used on activities tied to ending, reducing or lessening the effects of the opioid crisis in our jurisdiction.
The Department of Health Services (hereinafter, “DHS” or “the Department”) is requesting the Board delegate authority to the Director of DHS, or designee, to execute three agreements resulting from the Opioid Settlement Funds Notice of Funding Availability (NOFA).
Additionally, staff will provide an update on planning for the overall initiative.
Discussion:
Background
In July 2021, settlement agreements were announced with the first prescription manufacturers in the Multi-District Litigation case that would provide substantial funds for the abatement of the opioid epidemic in California. This was the first of several settlements with various opioid defendants in the national opioid lawsuit. Additional pharmaceutical distributors and manufacturers reached settlements in 2022, 2023, and 2024. All settlements have identified unique distribution amounts to the County. Numerous litigations are still pending and funding allocations are expected to grow following conclusion of the remaining active litigations.
Sonoma County has an age-adjusted drug overdose death rate of 22.4 per 100,000 and similar to the state average of 22 per 100,000. The lasting effects of the COVID-19 pandemic, restricted access to healthcare and harm reduction services, and the changing drug supply are factors in these trends.
The growing presence of fentanyl in opioids and other drugs have led to an overall increase in unintentional drug overdose deaths, with Black, Latino/a/x, and multiracial residents among those having experienced the greater increases in opioid overdose deaths. Opioid overdose death rates for Sonoma County men more than tripled from 2016-2018 to 2021-2023 and are more than three times higher than the rates for women. Death rates for both Sonoma County men and women fell in 2022-2024 but remain higher than pre-pandemic rates. Geographically, the Russian River area continues to experience the highest opioid overdose death rates in the region, with zip code 95446 consistently the highest in the county. People experiencing homelessness make up about 1% of the population of Sonoma County but 10% of the drug overdose deaths.
This crisis is complex, and the settlement funds are intended to give outreach, care, and community services a much-needed opportunity for expansion. Sonoma County had 113 drug overdose (OD) fatalities in 2024 and of these 67% were opioid involved. The highest age adjusted death rates per 100,000 were in the Russian River area (37.3) and Santa Rosa (30.6). Sonoma County opioid overdoses resulting in emergency department (ED) visits for 2023 stand at 254 with 46% of these involving fentanyl. Men substantially outnumber women for both opioid overdose deaths and ED visits with age adjusted rates of 23.1 vs 8.9 (OD deaths) and 97.4 vs 39.9 (opioid OD ED visits) respectively. Black residents have ED visit rates due to opioid OD more than twice that of Whites (196.3/100,000 vs. 91.0/100,000) and 7 times higher than that of Latino residents of the county (28.2/100,000).
Data Source: <https://gis-community-health.sonomacounty.ca.gov/pages/mental-health-related-deaths%20>
Board Direction
On February 11, 2025 <https://sonoma-county.legistar.com/LegislationDetail.aspx?ID=7129389&GUID=21A8E19C-A57C-4250-9F1B-A06438570A61&Options=ID|Text|&Search=opioid>, DHS staff provided the Board with an overview of the Opioid Settlement Fund, allowable uses, shared programmatic recommendations, and received Board direction. This direction included releasing a $5 million dollar NOFA for the development and multi-year operation of new or expanded Substance Use Disorder (SUD) prevention, education, and harm reduction programs within Sonoma County. Through this NOFA the Board prioritized projects serving populations disproportionally impacted by opioid use, including Black, Indigenous, and People of Color, male populations, and in regional areas lacking current SUD treatment and recovery residences.
On March 27, 2025, DHS released an Opioid Settlement Funds NOFA. The goal of this NOFA is to provide funding to promote the following initiatives:
• Reduce overdose related deaths and emergency department utilization
• Increase youth prevention and education programming for Opioid Use Disorders/ Substance Use Disorders
• Increase community awareness and reduce negative stigma for treatment, recovery, and Medication-Assisted Treatment services
• Add and expand Opioid Use Disorder/SUD prevention and harm reduction programs for adults
• Expand community access to recovery residences
• Increase community-wide utilization of Naloxone and drug testing strips
• Focus on providing services that improve geographic, racial, and ethnic equity in Sonoma County
• Focus on serving the most vulnerable community members
This NOFA prioritized the following project areas (additional information available in Attachment 2):
• Recovery Residences
• Syringe Exchange Programs
• Prevention, Education, and Harm Reduction
Funding
Approximately $14.1 million in Opioid Settlement Funds has been allocated to Sonoma County so far. $5 million was allocated competitively via a NOFA as referenced above. DHS has created a preliminary plan for the remainder and are looking for Board direction and feedback. A chart illustrating the $14.1 million allocation overview with proposed project descriptions is provided in Attachment 2. The Department will return to the Board requesting appropriations as projects progress.
2025 NOFA Funding Recommendations:
The Opioid Settlement Fund NOFA was released in March 2025 and made $5 million available. In May 2025, DHS received seventeen (17) proposals requesting $16,066,839 million. Submissions were received from community providers, a police department, and health providers. Each proposal was reviewed and scored by a panel of Substance Use Disorder (SUD) leadership from Glenn, Marin, and Napa counties in alignment with the NOFA and the project priority areas (Recovery Residences, Syringe Exchange Programs, and Prevention, Education, and Harm Reduction). The panel used the following scoring criteria:
• Organization Information - 10 Points
• Qualifications and Experience - 90 Points
• Project Approach and Work Schedule - 165 Points
• Privacy and Security - 20 Points
• Fiscal - 20 Points
• Cost Of Service / Budget - 30 Points
• Leveraged Funds - 30 Points
• Sustainability - 30 Points
• Monitoring and Evaluation - 30 Points
The highest ranked proposal in each priority area is recommended for funding. An illustration of the NOFA funding recommendations and accompanying project descriptions is provided below:
• Buckelew - Sonoma County Housing for Hope - $3,873,235 for the term: Effective Date through 6/30/2028
• West County Health Centers - Lower Russian River Opioid Prevention and Harm Reduction Initiative - $637,365 for the term 7/1/2025 through 6/30/2028
• Drug Abuse Alternatives Center - Wellness on Wheels Program Expansion - $489,400 for the term of 7/1/2025 through 6/30/2028
Over the course of the current fiscal year, the Department intends to come back to the Board for delegated authority for the remaining $9.1 million, as needed, which is planned as outlined below (additional details available in Attachment 2):
• Bond Behavioral Health Continuum Infrastructure Program (Bond BHCIP) Round 1 - Match - $3,800,000
• Psychiatrists / Medication Assisted Treatment Expansion - $2,000,000
• BHCIP Youth Residential Treatment - $1,500,000
• Muir Wood Residential Substance Use Disorder Treatment - $977,000
• Sonoma County Sheriff's Office Medication Assisted Treatment Discharge Planner - $450,000
• Preliminary Set-Aside for future - To Be Determined - Opioid Settlement Fund Prevention Activities - $273,000
• Prevention - New Hope for Youth - $100,000
Strategic Plan:
This item directly supports the County’s Five-year Strategic Plan and is aligned with the following pillar, goal, and objective.
Pillar: Healthy and Safe Communities
Goal: Goal 1: Expand integrated system of care to address gaps in services to the County’s most vulnerable.
Objective: Objective 3: Create a “no wrong door” approach where clients who need services across multiple departments and programs are able to access the array of services needed regardless of where they enter the system.
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
On February 11, 2025, the Board approved staff recommendation regarding the implementation plan for use of the Prescription Opioid Settlement Funds awarded to Sonoma County, for expansion of substance use services and other allowable prevention, education, and abatement activities.
On September 24, 2024, the Board received a report on the status of Opioid Settlement Funds and receive Board input on potential uses.
Fiscal Summary
|
Expenditures |
FY 25-26 Adopted |
FY 26-27 Projected |
FY 27-28 Projected |
|
Budgeted Expenses |
|
|
|
|
Additional Appropriation Requested |
$4,139,308 |
$344,501 |
$516,191 |
|
Total Expenditures |
$4,139,308 |
$344,501 |
$516,191 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
|
|
|
|
Fees/Other |
$4,139,308 |
$344,501 |
$516,191 |
|
Use of Fund Balance |
|
|
|
|
General Fund Contingencies |
|
|
|
|
Total Sources |
$4,139,308 |
$344,501 |
$516,191 |
Narrative Explanation of Fiscal Impacts:
The recommended action seeks approval for a total appropriation of $5,000,000 to fund three community-based behavioral health and harm reduction programs over the next three fiscal years, using opioid settlement funds. For Fiscal Year (FY) 2025-2026 $4,139,308 is requested, with the remaining $344,501 for FY 2026-2027 and $516,191 for FY 2027-2028 to be included in the regular budget process for those years.
Of the total, $3,873,235 is allocated in FY 2025-2026 to Buckelew Programs to support Recovery Residences, providing transitional housing and recovery services for individuals with substance use disorders. West County Health Centers will receive $637,365 over three years (FY 2025-2028) for the Lower Russian River Opioid Prevention and Harm Reduction Initiative, with anticipated spending of $102,939 in Year 1, $181,368 in Year 2, and $353,058 in Year 3. The Drug Abuse Alternatives Center (DAAC) is allocated $489,400 over the same period to support syringe exchange and outreach services, with estimated annual funding of $163,133. These investments support the county’s priorities around opioid response and prevention and are fully funded by restricted opioid settlement revenues, requiring no General Fund dollars.
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Narrative Explanation of Staffing Impacts (If Required):
None
Attachments:
Attachment 1 - Budget Resolution
Attachment 2 - Additional Information
Attachment 3 - Sample Agreement
Attachment 4 - Presentation
Related Items “On File” with the Clerk of the Board:
None