A Health and Safety–First Future: How AB 1037 Reframes Substance Use Care in California

California Assembly Bill 1037 (Elhawary), also known as the Substance Use Disorder Care Modernization Act, signed into law in October 2025, modernizes how the state of California funds and regulates substance use disorder (SUD) prevention and treatment. The law lifts outdated restrictions and allows treatment providers to meet people where they are in their recovery journey, rather than reinforcing an abstinence-or-failure binary. The implementation of AB 1037 positions California as a national leader in applying a health and safety-first approach to substance use care.

What AB 1037 Changes

AB 1037 introduces key reforms that reorient the state’s SUD system toward evidence-based, low-barrier, and person-centered care. These changes include the following:

• Permanent syringe access: The law eliminates the sunset on non-prescription syringe sales, which would have taken effect in January 2026, allowing pharmacists and physicians to provide sterile syringes to adults (18+) indefinitely while requiring them to offer safe-disposal options and education on preventing HIV, hepatitis C, and other bloodborne infections.

• Expanded naloxone access: It broadens who can distribute opioid antagonists like naloxone—allowing anyone at risk of overdose, or those likely to assist someone, to carry and administer these life-saving medications with good-faith liability protections even without prior training.

• Legal clarity for safety tools: The bill removes drug-checking equipment, such as fentanyl test strips, from the definition of “drug paraphernalia,” acknowledging their role in overdose prevention and safer use practices.

• Treatment reform: AB 1037 prohibits licensed substance use treatment programs, including outpatient and residential treatment, from requiring abstinence or sobriety as a condition of entry or continued participation, encouraging programs to maintain connection and support  those who return to use and to offer “incidental medical services” such as basic health monitoring or lab testing until that person is read to abstain again. 

Why It Matters

AB 1037 reflects a statewide commitment to compassion-based and safety-focused care—a pragmatic, research-informed approach designed to reduce risk and increase treatment engagement. For decades, California’s prevention and treatment systems were constrained by abstinence-only messaging and fragmented regulations that made it harder for providers to respond to relapse or deliver integrated medical support.

By embedding practices that promote safety, connection, and accountability, AB 1037 affirms that people who use drugs deserve access to care. Decriminalizing drug-checking tools and safer drug use supplies will allow individuals to reduce exposure to fentanyl-contaminated supplies and prevent the spread of infectious disease. Most importantly, removing abstinence requirements allows treatment programs to prioritize ongoing engagement and retention.

Next Steps for Implementation

Aurrera Health Group is available to provide a range of services to support the local implementation of AB 1037, such as:

• Targeted provider training and technical assistance
  Helping pharmacies, syringe service programs, and SUD programs update policies on syringe access, naloxone distribution, relapse-tolerant retention, and integrated medical services.

• Policy and county contract alignment
  Updating county contracts, protocols, and licensing expectations to reflect best clinical practices.

• Monitoring and evaluation frameworks
  Designing practical metrics to track overdose reversals, treatment engagement, and community-level health outcomes.

• Community engagement and stigma-reduction strategies
  Supporting messaging, outreach, and trust-building with populations most affected by overdose and criminalization.

• Cross-system coordination
  Facilitating alignment between public health, behavioral health, providers, and harm-reduction organizations to ensure implementation is consistent and responsive.

If you’d like to learn more about how Aurrera Health Group can support your county or community organization, please reach out to Allison Homewood.

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Authors

Kate Roberts [Deputy Director]

Allison Homewood [Managing Principal]