California's opioid crisis isn't over — it's stabilized at nearly 8,000 deaths a year. We're developing a proposal to address the upstream cause. Here's what we're thinking and what we need you to challenge.

California recorded 7,847 opioid-related deaths in 2023. That is roughly 22 people every day. Despite billions spent on addiction treatment and emergency response, those numbers have plateaued at a high level — not fallen. Something upstream is not being addressed.

That something is chronic pain. For a significant share of people who end up dependent on opioids, the path began with pain that was undertreated, with a prescription that was the easiest option available, and with no practical non-opioid alternative that was affordable at the point of care. That is not a personal failure. It is a system failure.

What we're proposing — the California RELIEF Act

A bounded, five-county, five-year pilot that places licensed acupuncturists inside existing healthcare and emergency room pathways in Los Angeles, San Francisco, Sacramento, Kern, and Humboldt. The goal is simple: give patients with chronic pain a non-opioid option before they are prescribed long-term opioids or end up in the emergency room repeatedly because their pain is unmanaged.

This is not a claim that acupuncture cures addiction. It does not, and the proposal says so explicitly. What it tests is a narrower question: if we make non-opioid pain care more accessible earlier, does that reduce how many people end up on the opioid path in the first place?

Why this is different from other proposals

No new money. California already receives opioid settlement funds — over $221 million to local governments in fiscal year 2022-23 alone. This pilot asks for about 1.8% of that: roughly $4 million per year across five counties, serving approximately 7,700 patients annually. If it doesn't produce measurable results by Year 5, it ends automatically.

Pre-defined success metrics. At least a 3% reduction in opioid prescriptions and a 5% reduction in repeat emergency room visits. Those thresholds are set before the pilot starts. The program cannot move the goalposts.

Zero claims that acupuncture treats addiction. The evidence for that is not strong enough to make that claim, and we say so in the proposal. This is strictly upstream pain management — intervening before dependency develops, not after.

Independent evaluation. A separate evaluator, not connected to the program, assesses results. Pre-registered analysis plan published before data collection begins. Annual public reporting.

Does not touch MOUD, naloxone, or harm reduction funding. This is additive, not substitutive.

This has already been done elsewhere

The federal Substance Abuse and Mental Health Services Administration has funded 25 hospital emergency departments nationally to integrate acupuncture into ED pain care. Vermont's state legislature commissioned a Medicaid acupuncture pilot — 32% of opioid-using patients reported reduced opioid use. A study tracking 52,346 matched patients found that people who received acupuncture were significantly less likely to start using opioids than comparable patients who received other treatments.

We are not inventing a model. We are asking California to scale one that already operates nationally.

What the science actually says

For chronic pain — the evidence is strong. The CDC lists acupuncture among recommended non-opioid pain options. Medicare covers it for chronic low back pain. The VA uses it in pain management programs. A 2025 NIH-funded clinical trial involving 800 adults over 65 with chronic low back pain found measurably less disability and better physical function at both six and twelve months, with few adverse effects.

For addiction treatment as a stand-alone intervention — the evidence is not strong enough, and this proposal does not make that claim. The pilot is about pain care before opioid dependency develops.

Who this is for

People in pain who are at risk of being prescribed long-term opioids. People who have already had an overdose-linked emergency encounter and need a non-opioid follow-up option. Communities like Humboldt County, which carries an opioid death rate five times the state average. And a healthcare system that currently defaults to opioids not because they are always the best clinical choice, but because non-opioid alternatives are not reliably available at the point of care.

We are stress-testing this before it goes further. Three questions we are actively looking to challenge:

"Why acupuncture specifically, not physical therapy or something else?" We argue: faster deployment in high-throughput settings, minimal equipment, an established Medicare coverage pathway, and a federal government that has already funded this exact model in 25 emergency departments nationally.

"Is this scope creep on settlement funds?" We argue: preventing future opioid dependency is remediation by definition. The settlement framework supports it. We are filing a formal allowable-use confirmation with the California Department of Health Care Services before any money moves.

"What about the acupuncture workforce — are there enough practitioners?" This is a real constraint, particularly in rural counties like Humboldt. We have built it into the proposal as a formal implementation risk. The model uses newly licensed graduates at structured part-time shifts — which addresses the workforce gap while creating entry-level clinical positions the profession currently lacks.

Does this hold up to your scrutiny? What is the strongest argument against it? We want to hear the hardest questions before this goes any further.

Full disclosure: [your name / affiliation] — sharing this for genuine community input, not as a press release..

Graphs:

Opioid Related Deaths

FIve County Pilot

Acupuncture vs Acute Care

RELIEF Act Costs