Responses to the Opioid Crisis

So what can states and local communities do to reduce opioid-use deaths? The CDC has outlined the best evidenced-based practices to prevent opioid overdoses. The following strategies are taken directly from the CDC report Evidence-based strategies for preventing opioid overdoses: What’s working in the United States.

Targeted Naloxone Distribution

Naloxone is an opioid antagonist that can quickly and safely reverse the potentially fatal effects of an opioid overdose. Targeted distribution programs seek to train and equip individuals who are most likely to encounter an overdose with naloxone kits (e.g. police officers or first responders). Effective distribution approaches include community distribution programs, co-prescription of naloxone, and equipping first responders. CDC also recommends naloxone distribution in treatment centers and criminal justice settings, where individuals who are about to be released from supervision and/or cease treatment receive overdose response training and naloxone kits prior to their exit from the program or facility.

Medication-Assisted Treatment

MAT is a proven pharmacological treatment for opioid-use disorders. The backbone of this treatment is FDA approved medications. Agonist drugs, such as methadone and buprenorphine, activate opioid receptors in the brain that prevents painful opioid withdrawal symptoms without causing euphoria. Naltrexone is also used in MAT, but this drug blocks the effects of opioids. MAT is effective at reducing opioid abuse and helping people to lead normal lives. CDC also recommends that MAT should be made available to incarcerated individuals with opioid use disorders; and then be linked with appropriate care providers to continue MAT upon release. CDC further recommends that patients receiving care in emergency departments who have untreated opioid use disorders should also be referred to a MAT provider, allowing treatment to start immediately. This referral should be accompanied by initial doses of methadone or buprenorphine at hospital.

Academic Detailing

“Detailing” is a structured educational strategy developed by commercial manufacturers of medical and pharmaceutical technologies to market these products to prescribers and pharmacists. “Academic detailing” consists of structured visits to healthcare providers by trained professionals who can provide tailored training and technical assistance, helping healthcare providers use best practices. Academic detailing has been used to assist physicians in reducing potentially risky opioid prescribing practices; and to prepare pharmacists to effectively distribute naloxone to the public.

Eliminating Prior-Authorization for Medications for Opioid Use Disorders

In this scenario, health insurance providers cover the cost of MAT as a standard benefit, and all requirements that a physician contact the insurance provider for approval prior to writing the prescription (a process called “prior authorization”) are removed. Without these prior authorization requirements, prescriptions for MAT medications to treat opioid use disorders can be written and filled as soon as a physician deems this treatment necessary.

Screening for Fentanyl in Routine Clinical Toxicology Testing

The standard panel of substances included in routine clinical drug screens (carried out in hospitals, clinics, treatment centers, etc.) should include screening for fentanyl exposure, particularly in jurisdictions where fentanyl is known to be prevalent in the local illicit drug market.

911 Good Samaritan Laws

The term “911 Good Samaritan Law” refers to local or state legislation that may provide overdose victims and/or overdose bystanders with limited immunity from drug-related criminal charges and other criminal or judicial consequences that may otherwise result from calling first responders to the scene. The scope of 911 Good Samaritan Laws varies across U.S. states, but each is written with the goal of reducing barriers to calling 911 in the event of an overdose.

Syringe Services Programs

Sometimes called “needle exchange” or “syringe exchange,” syringe services programs provide access to clean and sterile equipment used for the preparation and consumption of drugs as well as tools for the prevention and reversal of opioid overdose, such as naloxone training and distribution, fentanyl testing strips, and more. Comprehensive syringe services programs also provide additional social and medical services such as: safe disposal of syringes and needles; testing for HIV and hepatitis C infection and linkage to treatment; education about overdose and safer injection practices; referral and access to drug treatment programs, including MAT; tools to prevent HIV and other infectious disease, such as condoms, counseling, or vaccinations; and linkage to medical, mental health, and social services.