Why Trump's latest order could devastate substance abuse treatment in Orange County

Orange County’s top healthcare official warns President Donald Trump’s latest executive order that seeks to overhaul the way the U.S. manages homelessness could “cripple” the county’s substance abuse treatment programs and worsen homelessness.

The county could lose out on federal grants for substance abuse prevention and treatment that total around $42.6 million.

“If we were to lose that funding, that is more than half of our substance use disorder funding for the county of Orange,” Dr. Veronica Kelley, the director of the OC Healthcare Agency, told LAist. “It will cripple our system and it will create far more despair and untreated addiction, which will then contribute to increased numbers of people who are unhoused.”

What the order does

In Trump’s latest order, Attorney General Pam Bondi and other federal officials were directed to withhold funding to states that do not enforce bans on street camping. The order also directs officials to use federal funds to force the unhoused to seek substance use treatment and mental health rehabilitation.

This is in direct contrast to California’s housing policies, which take a “housing first” approach, where people living on streets are first housed even if they use drugs. Also, California policies focus on harm reduction, which studies have shown help prevent overdoses and makes drug use safer.

Orange County officials say the county also receives federal housing and homelessness assistance funding through Continuum of Care grants, HUD Entitlement programs such as Emergency Solution Act funding, HOME Investment Partnerships Program and Community Development Block Grant. The county said all of those grants could be on the chopping block in addition to substance use disorder grants.

Kelley told LAist  California gets about $187 million in federal grants for substance abuse treatment and prevention that is then distributed to counties. Losing that funding would weaken healthcare systems throughout the state, Kelley said.

The order, she added, could  increase stigma and operates on “myths about what homelessness is and what causes homelessness. And much of it is not based in scientific fact regarding how behavioral health issues are addressed and addressing the root causes of homelessness.”

In Orange County, the high cost of living and lack of well paying jobs contribute to homelessness, she said.

Cesar Covarrubias, executive director at the nonprofit Kennedy Commission, which works to increase affordable housing options in the county, said the executive order will make affordable housing in Orange County — where the median rent for a studio is $2,300 — even more scarce.

“You have a continuous flow of individuals who are at risk of being homeless or are homeless because of just purely the cost of housing in Orange County,” Covarrubias said.

Not every person who is unhoused uses drugs or falls into homelessness because of a substance abuse problem, he said. Instead, people begin using drugs as a way to cope with homelessness and the lack of support from living in the streets.

 ”Homelessness is is something that creates a ripple effect to substance abuse,” he said.

The last point in time count in Orange County showed a dramatic increase in the number of people experiencing homelessness.

Because of Trump's new order, he said, the county could see an increase in people living in the cars, in river beds or living in a way they will not be detected.

Increasing stigma around seeking mental health treatment

The executive order requires a compulsory sharing of health data with law enforcement, a step Kelley said could discourage people from seeking care.

“That is a violation of our civil liberties,” Kelley said. “Sharing that I might have an issue with alcohol with law enforcement is not going to encourage me to get treatment. It's going to do the opposite. It's going to discourage me from seeking care for a disease that is absolutely treatable.”

Kelley said the county is already seeing a 20% reduction in people seeking treatment for substance abuse after immigration enforcement began ramping up in Southern California in the last few weeks.

“ People just do not feel safe and again, adding something like what we're seeing in this executive order is simply going to exacerbate that,” Kelley said.