Jeffrey A. Singer
In last night’s “Red State vs. Blue State” debate between California Governor Gavin Newsom and Florida Governor Ron DeSantis on the Fox News Channel, Governor Newsom claimed that Florida’s drug overdose death rate is 41 percent higher than California’s overdose death rate.
While Governor DeSantis dismissed that and many other of Newsom’s claims as “lies,” Newsom got this one right.
According to the Centers for Disease Control and Prevention, in 2021 (the most recent year the data are available), California ranked sixteenth among the states with 26.6 overdose deaths per 100,000 persons, while Florida ranked thirty‐third with 37.5 deaths per 100,000—41 percent higher.
However, one should not take these numbers at face value. There are multiple factors that might account for these differences. Among them are differences in demographics and availability of harm reduction programs.
For example, access to methadone treatment for opioid use disorder (OUD) can reduce overdose deaths. Methadone treatment eliminates the need to seek drugs on the black market where people cannot be certain of the drugs’ dosage and purity—or even if it is the drug they think it is.
In a recent Cato Institute study on expanding access to methadone treatment, we found that California had a greater number of Opioid Treatment Programs (OTPs) per people with opioid use disorder than Florida. In 2021, California had one OTP for every 3,083 people with OUD, while Florida had one OTP for every 3,216 people with OUD. The states ranked twenty‐fifth and twenty‐sixth respectively, in OTPs per people with OUD. As we argue in the study, Congress can greatly expand access to methadone treatment by enabling primary care providers to prescribe it to treat patients with opioid use disorder.
A Cato study found that both states had legalized syringe services programs (SSPs) by 2021, in which people who use drugs can get clean syringes and, nowadays, are handed the overdose antidote naloxone. However, thirty‐nine sanctioned SSPs were operating in California by 2022, compared to eight in Florida. In 2021, California’s population was 39.4 million, and Florida’s was roughly 44 percent lower at 21.8 million. The population difference does not explain the SSP disparity.
What might help explain the disparity is that, unlike California, Florida requires SSPs to collect one syringe for every syringe it gives out. Harm reduction organizations trying to help people who use drugs have a hard time meeting that requirement. Oftentimes, people who use drugs don’t have their used syringes with them to exchange for clean ones.
State drug paraphernalia laws make it difficult for harm reduction organizations to distribute fentanyl test strips to people who use drugs, allowing them to check the drugs for fentanyl contamination. A Cato study found that, in 2021, both California and Florida explicitly prohibited fentanyl test strips in their paraphernalia laws. Fortunately, California lawmakers legalized distributing fentanyl test strips in 2022, and Florida lawmakers did so last summer.
Most states have enacted “Good Samaritan Laws” to encourage people to call first responders if a person with whom they are using drugs is overdosing. These laws assure people that police will not arrest them for illicit drug use if they call 911. However, in many states, police may arrest the caller for non‐drug‐related offenses. And in Florida, police have charged and arrested people for aggravated manslaughter when the overdose victim died. Such exceptions to these Good Samaritan Laws undermine their intent.
California may provide more access to harm reduction programs than Florida. But earlier this year, Governor Newsom missed a great opportunity to let the country’s most populous state strike a major blow in that direction in 2022 when he vetoed a bill that would have permitted overdose prevention center (OPC) pilot programs in some urban areas with a high density of drug users.
As I reported in a Cato study last February, OPCs have been saving lives since 1986. There are currently 147 government‐sanction OPCs operating in 16 countries, including 14 in Switzerland, 27 in Germany, 38 in Canada, and 2 in New York City. A federal law called the “crack house statute” (21 U.S.C. Section 856) makes OPCs illegal in the US.
While the New York City mayor and the City’s Department of Health approved the two OPCs operating there, they were defying the federal law. In 2022, Rhode Island’s governor signed a bill into law that sanctions privately funded OPCs in the Ocean State, and Minnesota’s governor signed a bill legalizing OPCs earlier this year.
As more states defy federal law by allowing OPCs to reduce overdose deaths, it might push Congress to repeal or amend the 1980s statute. Had Governor Newsom signed the OPC bill lawmakers sent to his desk, it would have given great impetus to the movement to repeal the federal law while saving many California lives.
While Governor DeSantis can boast that Florida does better than California on a number of metrics, he cannot make that claim when it comes to overdose deaths. One way Governor DeSantis can improve Florida’s overdose rate vis‐a‐vis California’s is by working to legalize OPCs in the Sunshine State.
