California has allocated more than $1 billion in recent years to combat its opioid crisis. Much of the money has been used to distribute fentanyl test strips and the overdose reversal drug naloxone, as well as deliver medical care to people who are homeless. The state has an opioid awareness campaign tailored to youths and recently called on the National Guard to help detect drug traffickers.

Yet the problem keeps getting worse.

Driven largely by the prevalence of fentanyl, a synthetic opioid up to 100 times stronger than morphine, drug overdoses in California now kill more than twice as many people as car accidents, more than four times as many as homicides, and more than either diabetes or lung cancer, according to California Health Policy Strategies, a Sacramento consulting group. And the state’s overdose surveillance dashboard indicates most opioid overdose deaths involve fentanyl.

Provisional data for last year from the Centers for Disease Control and Prevention shows a small annual increase in overdose deaths in California, to nearly 12,000. Across the U.S., overdose deaths again topped 100,000.

“As a parent, it scares the hell out of me. As a governor, I see it, I recognize the nature of what’s occurred on the streets,” Gov. Gavin Newsom said May 12 in announcing more funding for California to produce its own naloxone.

Despite all the state is doing to reduce drug overdose deaths, public health policy experts say there are no easy or clear answers. Drug policy experts applaud California’s effort to make naloxone as commonly available as fire extinguishers in schools, bars, libraries, and gas stations, but they also recommend diverting more offenders from prisons and jails into treatment and encourage ramping up the use of anti-addiction medication.

“Even if we do a lot of things right in policy, we’re going to have a fair amount of deaths in the coming years,” said Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford University and a drug policy expert.

He said lawmakers should examine the underlying, complex causes of addiction if they want to make lasting change. Lawmakers have created a Select Committee on Fentanyl, Opioid Addiction, and Overdose Prevention and are advancing a bill to create a Fentanyl Addiction and Overdose Prevention Task Force. The bill would require the task force to start meeting next year and submit an interim report by January 2025 and recommendations by July 2025.

“It really is something, like covid, that we have to focus on and make some permanent structural changes, like to health care, mental health care, and funding to deal with addiction,” Humphreys said.

Newsom acknowledged as much, saying, “We have a lot more work to do.”

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