Public health

To better implement a public health approach to reducing opioid deaths, states with the worst outcomes should implement the following strategies:

  • Invest in a no-wrong-door approach to naloxone distribution within communities. This includes provision of naloxone to law enforcement, crisis teams and community service providers, peer support specialists, schools, and other public spaces where people may overdose (see box below).
  • Ensure pharmacists have the knowledge and resources necessary to support in-person education on overdose symptoms and using naloxone.
  • Create public health outreach and education programs on overdose symptoms, risks, and harm reduction techniques in places where people may need or seek support for opioid use within communities (e.g., pharmacies, faith-based institutions), especially in rural communities and health care deserts.
  • Create better data collection systems for where naloxone is distributed beyond pharmacies.
  • Educate community members about their rights around possession and distribution of fentanyl drug-checking equipment, especially in states that do not explicitly permit it in state law.
  • Put naloxone with defibrillators in public spaces.

Health care

To better prevent opioid overdose deaths, states with the worst outcomes should implement the following strategies for the health care sector:

  • Train community health workers and health care providers on educating patients about the risks of fentanyl in the drug supply and availability of naloxone and fentanyl test strips for people who use drugs.
  • Screen all adults for opioid and other substance use in primary care and other non-specialty care settings where providers may be most likely to interact with individuals at high risk for early or unaddressed addiction.
  • Increase training for providers on compassionate engagement with individuals with substance use disorders, with a focus on highly stigmatized conditions like OUD.
  • Educate primary care and other non-mental health providers about state regulations on their ability to prescribe buprenorphine.
  • Develop programs to connect community-based organizations and peer support specialists with clinicians to expand the reach of the buprenorphine workforce.1
  • Reevaluate existing state regulations and expand flexibilities around opioid treatment programs (OTPs) to make MAT as accessible as possible. If it isn’t possible to create new OTPs, states should invest funds into mental health systems to train and implement care teams to expand the reach of physical OTP sites.
  • Use data from state health departments or other publicly available data sources to identify where there is a need for additional transitional and long-term community-based recovery supports (including stable housing and peer support) and focus investments in those areas.

1. Koppelman, J., Doyle, S. & McBournie, A. (2023). State Policies Can Expand Access to Buprenorphine for Opioid Use Disorder. Pew. https://www.pew.org/en/research-and-analysis/issue-briefs/2023/11/state-policies-can-expand-access-to-buprenorphine-for-opioid-use-disorder#:~:text=State%20agency%20actions:%20(1),an%20at%2Dhome%20induction%20model.

Schools

  • At minimum, provide guidance for schools to reevaluate health curriculum to include substance use prevention education.
  • Include specific education on opioids and fentanyl as part of required health curriculum, including how to recognize signs of overdose and how to be an active bystander.
  • Work with state and local health departments to offer professional development training for teachers and faculty on the latest information around opioid use and overdose prevention in schools.
  • Partner with local health departments and Parent Teacher Associations (PTAs) to gather information on what parents want or need to start conversations with their families about preventing opioid use, especially in communities that have experienced an overdose.
  • Make naloxone accessible everywhere that youth are at high risk of overdose, including in schools, youth centers, recreation and sports facilities, and on student transportation.

Jails

  • Pass state legislation or create statewide directives that require all correctional facilities to provide people with known substance use disorders with naloxone upon release.
  • Dedicate funds for bulk ordering of naloxone to ensure that there is enough supply for jails to carry out statewide mandates for naloxone provision.
  • Create a statewide joint strategy between state corrections departments and state health departments to ensure continuity of MAT for people with OUD upon release from incarceration.
  • Contract with community providers, health care systems, or OTPs in communities to provide transition services and ensure continuity of care. These contracts could include hiring case managers or navigators to help reinstate Medicaid coverage upon release.