Understanding needs in Santa Clara County

In early 2024, the Public Health Department completed a community needs assessment (CNA) about substance use treatment and services in Santa Clara County. A CNA is a way to collect data about what’s going well and what still needs work. This CNA gathered direct feedback from community members and other experts throughout the county. It provides several recommendations on how to improve local services for people who use substances.

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Overdose trends in Santa Clara County

This is a graph of county overdose deaths among county residents by drug type used by the deceased between the years of 2001 to 2023. From 2016 to 2021, Santa Clara County experienced an increase in overdose death rates, which data shows is driven mainly by an increase in methamphetamine-alone, fentanyl-alone, and polysubstance deaths (i.e., deaths resulting from the combined use of opioids and stimulants, such as methamphetamine). Polysubstance use deaths are occurring at a very high rate. — Count of drug overdose deaths among county residents by drug type used by the deceased, identified by medical certifier, 2021 to 2023. Overdose types include polysubstance, fentanyl-alone, methamphetamine-alone, other opioid-alone, or other drug overdose.

Since the late 1990s, drug overdose has become a leading cause of death in the United States. More than 100,000 people have died of overdose each year since 2021.

From 2016 to 2021, Santa Clara County experienced an increase in overdose death rates, driven mainly by an increase in methamphetamine-alone, fentanyl-alone, and polysubstance deaths. Polysubstance deaths result from the combined use of opioids and stimulants, such as methamphetamine.

Communities most impacted

The rise of deadly overdoses in the county most significantly impacts certain groups.

This infographic identifies the communities most burdened by overdose. Males; people experiencing homelessness; Latino, African/African Ancestry, and American Indian/Alaskan Native populations; the 55+ age group (relating specifically to methamphetamine overdose deaths), and residents of the county zip codes 95002, 95110, and 95116 are the groups most impacted by overdose in Santa Clara County. — Overdoses significantly impact the following groups: Males, people experiencing homelessness, Latino, African/African Ancestry, American Indian/Alaskan Native population, 55 and older age group, and zip codes 95002, 95110, 95116.

What causes overdose?

According to interviews, there are four main reasons for overdose:

Taking too much of a substance
Not knowing drug contents
Not caring about living or dying or a desire to stop living
Long-term methamphetamine use and pre-existing health conditions

The current landscape

To gain a better understanding of overdose trends and possible solutions in Santa Clara County, the Public Health Department interviewed professional experts in substance use and treatment and people who use drugs in the community to pinpoint strengths and gaps in substance use treatment and support services in the county.

Interviewers asked respondents about multiple overdose prevention strategies to identify areas of opportunity to effectively prevent overdose in the county. Actionable, key recommendations are included in this report.

Access to substance use treatment is essential for reducing overdose, yet barriers remain:

There are not enough treatment facilities in the county.
Insurance and payment difficulties.
Absence of real-time connections to care.
Insufficient resources and personnel providing medication-assisted treatment (MAT).

Key recommendations

Hire more substance use treatment navigators, especially peer navigators.
Develop options for care that are “truly drop-in" so that people seeking care can access it in the moment and are not discouraged by delays.
Foster cooperation among County agencies by creating new treatment connection hubs and centralized clinics.
Add more beds for residential treatment.

“If you want to stop using substances, you want to stop right now. You have to strike while the iron is hot.”

The Santa Clara County Harm Reduction Program provides services and supplies to people who use drugs in a manner free of stigma and judgement. Services are centered on their needs with the goal of reducing overdose and disease transmission in the county. Barriers to Harm Reduction Program successes:

Insufficient Harm Reduction Program staffing to meet needs of community and avoid staff burnout.
Little program name recognition among people who use drugs.
Lack of awareness of the program’s existence, services, and supplies offered by the program, and locations.

Key recommendations

Hire more staff to meet program demand and reduce burden on existing staff.
Expand program availability through the addition of another site, supply vending machines, and longer hours.
Set up a permanent location with 9 a.m. - 5 p.m. drop-in business hours.

“I think it needs to magnify at a substantial rate to put a dent in the actual problem… More staff, more locations, more…delivery.”

Stigma is a set of negative beliefs society holds about a group of people. Stigma can lead to prejudice and discrimination against people who use drugs and can limit treatment options and decrease quality of care. Interviews suggested the following about stigma in the substance use landscape and society, in general:

Emergency Departments and drop-in clinics are not always stigma-free settings.
People who use drugs fear seeking care due to judgment from providers and poor quality of care.
People who use drugs feel that family members, friends, and society, in general, treat them differently due to their substance use.
Recent improvements in healthcare and law enforcement policies have made people who use drugs feel more able to seek care.

Key recommendations

Provide anti-stigma training for providers in emergency department and drop-in care settings.
Identify ways to reduce stigma towards people who use drugs in healthcare settings.
Combat societal stigma through the County using public information campaigns.

“I've had people in the hospital who were nice to me until they did a drug test and found out I was on meth, then they treated me like a criminal.”

Physician and health system practices play a central role in shaping the options available to people who use drugs when they seek both general care and drug treatment. Interview findings show the following:

Provision of medication-assisted treatment in the county is not standardized or consistently low-barrier.
Too few providers, especially primary care providers, are providing medication-assisted treatment to their patients.
Great need for the delivery of holistic, integrated care centered around the unique and diverse needs of the individual in treatment settings.

Key recommendations

Expand physician training on and prescription of medication-assisted treatment.
Standardize medication-assisted treatment practices among county providers that are centered around increasing treatment accessibility.
Expand medication-assisted treatment accessibility through telemedicine and mobile pharmacy options.
Move toward a system of care in which individuals are treated holistically.

“I know so many people who don't wanna...be using but just are afraid to stop and don't know how and are waiting to get into treatment.”

Combating the overdose epidemic requires a full picture of the crisis. Here’s a look at what’s happening now:

Public Health recently reached agreements with two County agencies to receive overdose data, allowing us to begin identifying potential overdose “hot spots”.
Public Health launched a public-facing resource hub and overdose data dashboard in September 2024.
Public Health lacks access to data on what County services overdose victims might have interacted with prior to overdosing, which could be identified as missed opportunities for overdose prevention efforts.

Key recommendations

Use available data sources to identify potential overdose hot spots within the county, monitor emerging trends in substances leading to overdoses and groups most impacted by overdoses, and target harm reduction services.
Develop and enact overdose data-sharing agreements between County agencies.
Create a centralized data hub to identify and design interventions to address missed opportunities and residents at risk of overdose.

“Just...better understanding of what's going on behind overdose deaths to better see where there were missed opportunities. ”

Next steps: taking action

Request technical assistance

Our staff are here to assist and support community efforts to end overdose and stigma. If you are with a community-based organization (CBO) interested in taking action and would like technical assistance to adopt key recommendations, guidance on implementing harm reduction strategies, or developing overdose prevention programs, fill out the following form.

Submit the form

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Dedicated to those affected by overdose

This assessment is dedicated to members of the Santa Clara County community lost to overdose, the friends and family who loved them, and the many advocates, healthcare professionals, and other partners dedicated to creating safe and supportive resources for them.

While this assessment provides data about overdose, Public Health recognizes that every number represented is a person whose life was cut short. Overdose is a heartbreaking, complex, and preventable issue that requires thoughtful, humanizing solutions.

Public Health hopes that the contributions provided in this report will help the community heal and will guide county-wide efforts in advancing overdose prevention work.

View executive summary