Stanislaus County now has the highest opioid prescribing rate of any county in California, according to newly reviewed state data, a distinction that local health advocates call alarming even as the county's own prescribing numbers have fallen sharply from their peak a decade ago. The finding has pushed a local coalition of government officials, health care workers, educators and grieving families to sharpen its push for answers.
According to a report from The Modesto Bee, Stanislaus County had 253,200 opioid prescriptions written in 2025, per the California Opioid Surveillance Dashboard, translating to a rate of 434 prescriptions per 1,000 residents — roughly double the statewide prescribing rate for that year. Jennifer Marsh, who coordinates the Stanislaus County Opioid Safety Coalition's monthly meetings, said the ranking is “scary” and merits the group's close attention, according to the same report.
The county's 2025 total marks a steep decline from eight years earlier, when 529,832 opioid painkiller prescriptions were written in Stanislaus County in 2017, the Bee's report notes. That falloff tracks with a longer pattern documented by an earlier Modesto Bee investigation, which found that local pharmacies received more than 218 million prescription pain pills over a seven-year stretch — equal to roughly 61 pills per person, per year. Pill distribution in the county rose from 25 million in 2006 to 36 million by 2012, even as the county made up only about 1.37% of California's population yet received 2.71% of the pills shipped statewide during that period, the same investigation found.
A Prescribing Rate About 26% Higher Than the National Average
By 2024, the CDC put Stanislaus County's opioid prescription rate at 44.7 per 100 residents, compared with a national rate of 35.4 per 100 residents that year, per the Bee's reporting. That national figure had itself fallen from 46.8 per 100 residents in 2019. Neighboring counties looked markedly different: San Joaquin County's rate stood at 17.3 per 100 residents and Merced County's at 18.8, while Tuolumne County, at 44.1 per 100 residents, came closest to matching Stanislaus.
Even with prescribing numbers elevated, the county's own figures show a downward arc over the past several years. Opioid prescriptions in Stanislaus County peaked at about 575,691 in 2012, 14 years before 2026, before falling to 529,832 by 2017, an 8% drop, and prescribing fell another 18% between 2019 and 2021, when the county logged 345,215 opioid prescriptions, according to a separate Modesto Bee analysis.
Fentanyl Now Drives the Death Toll
Even as pill prescriptions declined, overdose deaths kept climbing. Stanislaus County recorded 176 total drug-related overdose and poisoning deaths in 2022, including 142 that were opioid-related and 128 tied to fentanyl, according to a county Behavioral Health and Recovery Services report filed with the Stanislaus County Board of Supervisors. That same report shows overdose and poisoning deaths jumped 112% between 2019 and 2020, then rose another 33% in 2021 over 2020, with the county averaging three to four such deaths per week across 2021 and 2022. The Bee's reporting describes illegal fentanyl, a synthetic opioid sold on the street or online, as the driver behind that more recent fatality crisis, with the county now averaging two to three to as many as three to four drug-related deaths per week.
Stanislaus County ranked 15th among California's 58 counties for fatal fentanyl overdoses in 2022, with a rate of 22.37 deaths per 100,000 residents — well above the statewide rate of 15.62 per 100,000, per the Bee's analysis. The county's rate of opioid-overdose emergency room visits, 60.6 per 100,000, landed close to San Francisco's 62.2 per 100,000, the outlet reported. More recent county tracking, covered in a separate Bee report, found 500 suspected drug-overdose incidents between Jan. 1 and June 10 of this year, including 63 unconfirmed fatalities and 225 incidents where first responders administered naloxone; as of the end of June, the county had confirmed 16 fentanyl deaths and 14 methamphetamine-related deaths, with the county noting that fatal fentanyl overdoses were down this year even as methamphetamine deaths had increased.
Coalition Weighs Its Response
The Stanislaus County Opioid Safety Coalition includes representatives from county government, education, health care, criminal justice, nonprofits and families who lost loved ones to overdose or illegal fentanyl poisoning, according to the Bee's reporting. The group has responded to the fentanyl crisis with awareness events, school-based education, a Not My Child 5K run, Narcan distribution and an empty-chair display at Vintage Faire Mall meant to represent lives lost. The coalition requested the prescribing data at the center of this report from a state agency, and on Oct. 8 its members heard a presentation on overdose and substance-use follow-up support, the outlet reported.
That follow-up data paints an uneven picture. Emergency department visits for overdose or substance-use issues totaled 1,916, and 23% of those patients received follow-up care within seven days. For 30-day follow-up, the reported rate was 34.5%, below the national average of 39%; 314 individuals received follow-up within 30 days, according to the Bee's reporting. Patients also showing symptoms of mental illness fared somewhat better, with 44.3% receiving seven-day follow-up and 57.3% receiving follow-up within 30 days. The coalition says it plans to offer specific ideas for addressing the county's high opioid prescribing rate, per the same report.
The Case for and Against Opioids
The tension at the center of the data is one public health officials have wrestled with for years: opioids remain effective for short-term pain and for pain tied to cancer or terminal illness, according to the National Academy of Sciences, Engineering and Medicine, but the academy also warns that long-term use carries greater health risks. The CDC has separately warned that prolonged prescription opioid use can lead to addiction, overdose and death, and high prescribing rates can leave patients addicted to pain narcotics who then turn to dangerous street drugs if they later lose access to prescriptions, per the Bee's reporting.
Part of the difficulty, according to a 2025 American Medical Association report cited in the Bee's coverage, is that many patients face insurance restrictions on non-opioid pain treatments, narrowing the options available to doctors and patients alike. The California Department of Public Health has suggested patients ask their doctors directly about safe pain management options. Taken together, experts see no easy solutions for containing the opioid epidemic and the harms that follow it, the Bee reported.
For now, the numbers leave Stanislaus County in an uncomfortable spot: a county whose prescribing has fallen substantially from its worst years, yet one that still outpaces every other county in California. The Stanislaus County Rx Safety coalition has a stated mission of building community partnerships to prevent and reduce opioid misuse through education, prevention, treatment and recovery support.
