Stanislaus County faces a $5 million cost increase for drug treatment services. Why?

Aegis Treatment Centers is asking for a $5 million increase in its contract with Stanislaus County for drug treatment services.

Aegis, which provides narcotic replacement therapy using methadone or suboxone, is assisting more than 500 additional clients, which is a 70% increase in the past 15 months.

Since January 2023, the contractor’s caseload has risen from 803 adults to 1,364. During that time period, the county’s Genesis drug treatment program on Scenic Drive was closed and the county’s 224 clients were referred to the Aegis clinic on McHenry Avenue for continued treatment.

Aegis also opened a medication unit in Turlock four months ago for dispensing methadone and suboxone to clients there. The Turlock unit is an extension of the Aegis clinic in Ceres, serving to increase access to counseling and other services in Ceres.

County staff cited the bigger caseload and higher costs of medication and counseling services in a report that recommended the Board of Supervisors approve the $5 million contract amendment Tuesday evening.

It would boost the maximum amount of the Aegis contract from $7 million to $12 million in the current fiscal year. The drug treatment services are funded through the state’s 2011 public safety realignment and the Drug Medi-Cal program. There’s no impact to the county General Fund, the staff report said.

An Aegis representative did not respond to a phone message and email from The Modesto Bee.

Stanislaus County is reeling from high rates of opioid use. More than 70% of the 213 drug overdose deaths last year were caused by illegal fentanyl and other opioid drugs.

Opioids accounted for 63% of substance use disorder diagnoses made by county Behavioral Health and Recovery Services and treatment contractors in 2022. That was four times more than diagnoses of methamphetamine and alcohol addiction.

Four to five overdose deaths are occurring every week in the county of more than 552,000 residents. County agencies issued a public alert that four overdose deaths occurred in a 12-hour period on Friday.

Dr. Lyn Raible, a former medical director for Aegis clinics, said in a text message the increase in the treatment caseload “speaks to how dramatically underserved those with opioid use disorder were.” Raible said more county residents are getting help today because of the access to drug treatment in Ceres and Turlock. She suspected a smaller part of the upward trend was increased use of opioids.

Reducing the stigma around substance use disorder also serves to encourage people to seek treatment, she said.

“Until the Ceres clinic opened in 2019, the only clinics in the county were Genesis and Aegis in Modesto,” Raible said. She also said the state’s Drug Medi-Cal program was slow in approving payments for administering buprenorphine (or suboxone) at Modesto-area clinics, which is considered a safer alternative to methadone.

In addition to the growth in caseload, part of the reason for increasing the contract amount with the county is the increased costs of Medi-Cal payment reform. Drug Medi-Cal is paying more for assessments, examinations, drug therapy and mandatory counseling than what was paid in previous years, and that increases the burden for taxpayers.

Narcotics treatment programs formerly could charge a bundled rate of $16.20 per day, but now can charge $18.76.

According to the county staff report, Aegis’ costs for medication services increased from $4.3 million in 2022-23 to $5.2 million this year. The cost of methadone services rose the most — by 71%.