COMBATTING THE OPIOID CRISIS
Opioid overdose and deaths are one of the most urgent public health threats facing cities and communities throughout the country. Presently, drug overdose is the leading cause of accidental death in the U.S. and drug overdose rates are increasing – among men and women of all ages and races . The opioid epidemic is a cross-cutting national problem, with all 50 states and the District of Columbia experiencing increases in drug misuse and overdose rates. Overdoses, from either prescription or illicit opioids, led to over 33,000 deaths nation-wide in 2015, and over 40,000 deaths in 2016. The preliminary data from 2017 shows that deaths increased to a record 72,000. Thus far, the epidemic has cost the United States over $78.5 billion.
POLICIES & PRACTICES
U.S. opioid-related fatalities have quadrupled in the past 20 years and are still on the rise. It is imperative that cities promote and implement proven strategies to prevent, treat and combat the opioid health crisis. Below is a snapshot of best and promising practices, programs, and/or policies that have shown strong results in combatting the crisis.
SAFE PRESCRIBING GUIDELINES FOR HEALTH CARE PROVIDERS
Safe prescribing guidelines and training improve the way opioids are prescribed through clinical practices that ensure patients have access to safer, more effective chronic pain treatment, while reducing the number of people who misuse, abuse, or overdose from these drugs.
ONLINE TRAINING FOR PROVIDERS
The CDC's Division of Unintentional Injury Prevention (DUIP), launched the first in a series of interactive, online trainings for healthcare providers. These trainings feature the recommendations in the Guideline for Prescribing Opioids for Chronic Pain, providing sample scenarios, feedback, and resources. This series is intended to help healthcare providers communicate effectively with patients about opioid use, decide when to initiate or continue opioid therapy, offer appropriate non-opioid options for pain management, as well as assess and address the harms of opioid use. Addressing the Opioid Epidemic: Recommendations from CDC, the first training in the series, is available for continuing education credit and can be found on the training web page.
PRESCRIPTION DRUG TAKE BACK PROGRAMS
Drug take back programs provide a safe, convenient, and responsible means of prescription drug disposal. Timely disposal of prescription drugs prevents future drug misuse by youth, family pets and adults who inadvertently consume leftover medications.
PUBLIC EDUCATION & AWARENESS CAMPAIGNS
Public education consists of providing community members with knowledge of how to safely store, use and dispose of prescription medications with considerations for long-term health and safety. Public education and awareness campaigns help consumers understand what opioids are, the effects, signs and symptoms of addiction, and where to go to receive help. According to the National Institute of Drug Addiction, each dollar spent on research-based prevention programs can save up to $10 in treatment costs for alcohol and other substance abuse disorders.
PRESCRIPTION DRUG MONITORING PROGRAMS
Prescription Drug Monitoring Programs (PDMPs) are electronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients. They help to support safe opioid prescribing by identifying and protecting patients at risk for addiction. In most cases, PDMPs are operated by states.
NALOXONE DISTRIBUTION & TRAINING
Naloxone is a lifesaving overdose reversal drug that when administered correctly can be used to prevent an opioid overdose.
Prior to the opioid overdose epidemic, community access to naloxone was limited. Recently, a rapidly increasing number of states across the US, and cities where authorized, have issued policies or laws to increase the distribution and availability of naloxone.
Standing orders for naloxone – a physician’s order that is able to be carried out by other health care workers when predetermined conditions have been met – can be issued. Under this model, a doctor with prescriptive authority issues a written order that naloxone can be distributed by designated people (e.g., a pharmacist) to patients whom the physician has not examined. This allows broad community access to naloxone. With training from harm reduction outreach workers, drug users and their loved ones can be equipped with naloxone and prevent an overdose without a doctor being present.
Third-party Prescriptions permit naloxone to be prescribed to people who are not patients of the prescriber, such as friends and family of someone at risk for an opioid overdose. This ensures that community members who are closest to opioid addicted individuals have access to naloxone when they need it prevent an overdose.
Professional immunity and Good Samaritan laws provide immunity to medical professionals who prescribe and dispense naloxone medication or to medical professionals or lay persons who administer naloxone.
SUPERVISED INJECTION SITES
Supervised injection sites are legally sanctioned facilities where drug users can inject pre-obtained drugs under medical supervision. These facilities prevent vulnerable users from experiencing a drug overdose and provide disease testing, rehabilitation services, counseling, and treatment that put vulnerable users on pathways to recovery.
SYRINGE EXCHANGE PROGRAMS
Syringe exchange programs allow for civilians who are likely to inject drugs to access sterile needs and syringes without a prescription. These programs prevent the spread of communicable diseases, serve as outlets to behavioral change services and programs, and offer treatments and vaccinations for vulnerable populations.
GOOD SAMARITAN LAWS
Good Samaritan laws provide immunity from prosecution related to drug possession charges for overdose victims and those who call for help. These laws are designed to encourage users and bystanders to contact the authorities in the event of a potential overdose.
These laws are often enacted at the state level, though some localities have passed their own legislation, when they possess the authority to do so.
OPIOID CRISIS DECLARED STATE/LOCAL PUBLIC HEALTH EMERGENCY
Another way states and localities have addressed the current opioid crisis/epidemic is to formally declare a public health emergency related to the opioid crisis.
As of June 2017, six states have made such declarations that in turn allow them to take special measures to help combat the opioid crisis. For example, Florida’s declaration allows the Governor to spend funds immediately without legislative approval to expedite a public health response. In Virginia, the emergency declaration allowed the public to obtain naloxone prescriptions. The Governor of Massachusetts’s declaration requires physicians and pharmacists to check the Prescription Drug Monitoring Program (PDMP) in certain prescribing situations (previously this was voluntary), allocated $20 million for addiction treatment services, and also expanded naloxone access. A few localities have also made emergency public health crisis declarations around the opioid/heroin use epidemic (eg., Erie County, NY, Anne Arundel County, MD, and Broome County, NY).
Medication-assisted treatment (MAT) is the use of medications in combination with counseling and behavioral therapies for the treatment of substance use disorders. A combination of medication and behavioral therapies is effective in the treatment of substance use disorders, and can help some people to sustain recovery.
Drug courts are specialized court programs targeted to people with drug dependency issues. Those facing drug offense charges in the standard criminal justice system can be sentenced to lengthy prison sentences, leaving their disease untreated. The drug court model takes a different approach by providing specialized treatment services for both juvenile and adult offenders. These programs can keep people out of prison and keep them from re-offending. The Win-Win Project, an initiative of the Center for Health Advancement at the Fielding School of Public Health at UCLA, found that if the drug court system was used to treat the 32,243 drug-addicted juvenile offenders in LA County, the results would include a 28% reduction in recidivism and a 15% reduction in substance abuse over 10 years, among other encouraging results.
Evidence-Based Strategies for Preventing Opioid Overdose: What’s Working in the United States from CDC’s National Center for Injury Prevention and Control
National Alliance of State & Territorial AIDS Directors (NASTAD) Issue Brief: The Intersection of Hepatitis, HIV, and the Opioid Crisis: The Need for a Comprehensive Response
Centers for Disease Control & Prevention: Injury Prevention Center – Opioid Overdose
CDC Vital Signs Opioid Overdoses Factsheet
Winter 2017 issue of NACCHO Exchange, “On the Frontlines: Local Public Health versus America’s Opioid Epidemic”
National Bureau of Economic Research Working Paper: With a Little Help from My Friends: the Effects of Naloxone Access and Good Samaritan Laws on Opioid-Related Deaths
Co-prescribing Naloxone to patients at risk of overdose and other Naloxone resources from the American Medical Association
Centers for Disease Control & Prevention Health Impact in 5 Years (HI-5): Access to Clean Syringes
Legal Interventions to Reduce Overdose Mortality: Naloxone Access and Overdose Good Samaritan Law
An Example of a Standing Order for Dispensing Naloxone Rescue Kits to Individuals at Risk of Experiencing or Witnessing an Opioid Related Overdose
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Note: These are highlights of selected activities going on in cities across the country, and are not meant to be comprehensive.