Is California’s $40 million opioid awareness campaign making an impact?

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With fentanyl killing nearly 20 Californians every day, state health care officials have staked millions of dollars on a boutique Sacramento-based advertising firm to “raise awareness, break the stigma, promote recovery, build hope and save lives” in the battle against the powerful opioid.

But was there a better way to spend $40 million?

That’s one of the questions rankling state lawmakers this month who say their bipartisan bills aimed at the state’s fentanyl crisis collapsed partly over funding concerns. The tension comes as California struggles to shape its strategy to address a drug that has destroyed tens of thousands of families and last year killed a record 6,095 Californians.

Since 2019, the state says its Choose Change California campaign has generated 4.2 billion “impressions” on billboards, radio spots, television ads, concerts and sporting events, targeting vulnerable communities in English, Spanish, Mandarin and Cantonese. That’s the equivalent of reaching every Californian more than 100 times.

“Change can happen when you choose it,” says one of the ads as a stylish young woman walking along a pristine city sidewalk texts a friend: “I think I might be addicted to opioids.”

VIDEO: Choose Change California advertisement.

But on the front lines of the epidemic, Twan Lewis says he doesn’t remember ever encountering the ads around the Oakland encampments where he’s seen many people die of fentanyl poisoning over the eight years he’s lived on the streets. “I wouldn’t pay no attention,” he said.

And in the halls of Sacramento, frustrated state lawmakers entrenched in legislative battles said they also were oblivious that the ad campaign existed — much less had been underway for years — until they were informed this month by the Bay Area News Group.

They were even more shocked by the price tag.

The state Department of Health Care Services extended the original $10 million campaign by pumping an additional $30 million into the program with M&M Media Solutions, according to records obtained by the Bay Area News Group. The state says it initially contracted the company in 2018 through a competitive process, although all three of the contracts reviewed by the news organization are marked as “non-competitively bid.” The same firm has also received $73 million in no-bid deals to spread the word about COVID-19.

“That is a ton of money,” said Assemblymember Joe Patterson, a Republican from Rocklin, whose bill to require public schools maintain at least two doses of the overdose-reversing drug Narcan sailed through the Assembly with no opposition but then stalled unexpectedly in the Senate appropriations committee. “I mean, having Narcan in schools, having it at other places, restaurants, concert halls — the amount of money that costs compared to funding a media program that nobody knows about is — it’s cheaper to just do the life-saving treatment.”

Democratic lawmakers also balked at the price tag, and questioned the impact of some of the campaign’s media efforts, like displaying the “Choose Change California” logo during broadcasts of Warriors and Sacramento Kings basketball games.

“Those are media buys that aren’t really targeted at the demographic,” said State Sen. Dave Cortese, a San Jose Democrat, whose bill to require schools to come up with safety plans to respond to an opioid overdose is awaiting Gov. Gavin Newsom’s approval. “Why would you go to a Kings game, and try to be Johnny Appleseed there, you know, with your messaging, when you could go right into the schools and have the conversation with each and every family right now?”

Responding to a series of questions from the Bay Area News Group, the state Department of Health Care Services defended the Choose Change California campaign, saying it was an effective part of a much broader strategy to get opioid-addicted Californians into treatment and is funded largely through federal opioid-relief grants – not state taxpayers. Since 2017, it’s spent more than $690 million on those projects.

DHCS says the agency awarded some contracts directly to M&M Media without a formal bidding process because addressing the fentanyl and COVID-19 crises required quick action and urgency. When the Bay Area News Group reached out to M&M Media, the firm referred all questions back to DHCS. While the vast majority of the campaign’s funding goes toward creating and broadcasting ads, contracts reviewed by the news organization show members of M&M Media are paid rates of $150 to $180 an hour among other benefits.

Founded in 1991, the company bills itself as California’s premier independent media buying agency. Its offices are a 15-minute walk from the Department of Health Care Services and the state Capitol. The firm’s accounts with California agencies include the State Treasury, California Highway Patrol and Office of Problem Gambling. But neither the company nor its CEO, Cynthia Metler, appears to have a reputation as politically influential.

DHCS says it chose M&M Media based on its “exceptional capability to connect with California’s diverse populations.”

But critics say one thing is clear: Choose Change California’s outreach isn’t aimed at the thousands of unhoused Californians lost to addiction who don’t need a media campaign to understand the horrors of fentanyl. Many say they’ve gotten used to finding their friends dead in their tents — their lips a distinctive blue hue caused by the suffocating effects of fentanyl poisoning.

Twan Lewis, a resident of a homeless camp on West Grand Avenue in Oakland, Calif., reflects on the state's new campaign to prioritize media campaigns against fentanyl use rather than passing bills to mandate Narcan availabiity. (Karl Mondon/Bay Area News Group)
Twan Lewis, a resident of a homeless camp on West Grand Avenue in Oakland, Calif., reflects on the state’s new campaign to prioritize media campaigns against fentanyl use rather than passing bills to mandate Narcan availability. (Karl Mondon/Bay Area News Group) 

When the Bay Area News Group showed unhoused people the television ads developed by M&M Media, some pointed out access to a television is rare. One man said that the ads, which feature people with laptops, iPads, tablets and fancy apartments, were not relatable for those living on the frontline of the crisis. “Even with opioid use disorder, you still have a choice,” one of the ads says. “By choosing treatment, you choose family, your career and your life. On your terms.”

“F*** the ads. They need Narcan in the residential motels, hotels, gas stations, bars, even the liquor stores,” said Lewis, who said he ended up on the streets after losing his job at the Tesla factory. The struggle for so many, he says, is to stay alive. “I’m tired of being a pallbearer at funerals.”

California officials insist distributing life-saving treatments is a major part of the state’s strategy. In the last five years, DHCS said the state has spent $324 million and provided more than 2.85 million kits of Naloxone, the generic name for Narcan, to groups throughout the state, including jails, emergency responders, schools, public health departments and local organizations. Those doses have been used to reverse more than 198,000 opioid-related overdoses, the agency said. is another important tool, they say, with the website attracting an average of 50,000 visitors each month. The most-watched ad on the campaign’s YouTube site had just over 120 views last week, but state officials say the ads reach a wide audience on cable and streaming services and social media. The campaign also relies heavily on radio ads and sponsored iHeartRadio’s 2022 Jingle Ball Concert in Los Angeles.

The agency said M&M Media monitors the campaign “to ensure optimal delivery” and provides regular reports on the project’s progress. But studies have shown in general the impact of drug awareness campaigns — such as the infamous 1980s Reagan-era Just Say No — is nebulous.

While state lawmakers voiced frustration after learning about how much money the state was pouring into the Choose Change California campaign, they couldn’t imagine why the money isn’t available to require lifesaving Narcan medication at schools and other public venues across the state.

Narcan nasal spray
Narcan nasal spray is a lifesaving treatment for people who overdose on opioids, including fentanyl and heroin. (Dreamstime/TNS) 

Brandon Richards, a Newsom spokesperson, said the concerns raised by the lawmakers are “inaccurate and … not reflective of the Governor’s vast efforts to address the ongoing opioid crisis.” Richards pointed out that the governor’s proposed budget included several million dollars in funding to get Narcan into every middle school, high school and adult school in California.

But San Francisco Assemblymember Matt Haney, whose bill to require bars, single-room occupancy (SRO) hotels, gas stations and libraries to have Narcan onsite, said more needs to be done. He suspects the $400,000-a-year price tag may have stalled his bill, even though it is only 4% of Choose Change California’s budget this year.

“People need to know that if their friend or family member is overdosing … that there will be Narcan there,” Haney said.

“We shouldn’t just put things out there just to put it out there and put money into the pockets of media companies with no results. Narcan gets results.”

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