The National Center for Health Statistics’ provisional data cites overdose deaths passing 100,000 between April 2020 and April 2021, with the majority caused by synthetic opioids. Although the exact cause is still uncertain, the COVID-19 pandemic has exacerbated overdose-related deaths. Experts theorize that a more dangerous supply of drugs, disrupted treatment and recovery services, social isolation, and increased stress due to social and economic factors all play a role in the increase in overdose-related deaths.

The Biden administration’s American Rescue Plan, signed into effect in 2021, expanded federal behavioral health programs to more effectively address the overdose epidemic facing the US. As a part of this effort, the HHS revamped their Overdose Prevention Strategy (OPS) to focus on four key priorities: primary prevention, harm reduction, evidence-based treatment, and recovery support.

In alignment with this strategy, NACCHO partners with CDC to support local health departments (LHDs) in conducting activities within each of the OPS priorities. Through the Implementing Overdose Prevention Strategies at the Local Level (IOPSLL) project, born out of NACCHO’s cooperative agreement with the CDC, we provide communities with funding and technical assistance to address the unique circumstances of their communities’ overdose epidemic. Over the past three years, 25 LHDs have participated in the program, with four of those sites recently graduating from the eighteen months program, offering a glimpse of some of their successes.

In all four communities in the first cohort, at least 300 people died in 2017 from accidental drug overdoses. Each site implemented initiatives reflective of the diversity in their community context, needs, and priorities. Despite the differences in approach, the IOPSLL program:

• educated health care providers about safe prescribing practices,
• reduced stigma among health care providers and community members more broadly,
• improved access to evidence-based treatment services, and
• linked people experiencing nonfatal overdoses to treatment and recovery resources.

Evidence-Based Approaches for the Overdose Prevention Strategy

A sample of the activities each of the four sites implemented through the IOPSLL program are described below to raise awareness about how evidence-based approaches to addressing overdoses can be applied in communities across the country. Please note, only one example from each site is summarized and presented as the activity aligns with the HHS’s strategies; however, sites conducted additional activities reflecting more than one strategy area.

Primary Prevention

Primary prevention is the initial step that aims to implement strategies for both the general public and the high-risk populations to intervene before the health risk. Marion County Public Health Department (MCPHD) educated providers to improve prescribing practices and reduce the risks associated with prescribing opioids. The LHD worked with the Indiana State Medical Association, ReLink, and HIRONS to educate medical providers with prescription-writing authority on risky opioid prescribing behavior and on non-opioid pain management options. The conference was originally scheduled to take place in-person, however, MCPHD transitioned the training into a virtual event due to COVID-19. One hundred medical providers attended the virtual training session and attendees were offered the opportunity to earn Continuing Medical Education (CME) credits for attending the session. Content from the virtual trainings was edited into individual presentations and is available for viewing on the MCPHD website.

Harm Reduction

Individuals deserve access to services that promote health and decrease the negative impacts of substance misuse. Harm reduction tackles this while also reducing stigma around substance misuse and overdose. In an effort to enhance public health and public safety partnerships for harm reduction, the City of Milwaukee Health Department and the Milwaukee Fire Department collaborated to expand access to harm reduction interventions. Twenty-four members of the Milwaukee Overdose Response Initiative (MORI), which is made up of public safety and peer support, completed training on trauma informed care, SUD and ACEs, as well as motivational interviewing. Between 2019 and 2020, the MORI team identified 2,500 non-fatal overdose survivors and successfully contacted and visited a third of those survivors. About 15% of contacts were linked to treatment and recovery resources. The MORI team worked with social workers to support over 200 family members or loved ones of overdose victims. As part of this public health and public safety collaboration, ten partner agencies implemented a safety net program that took a ‘social autopsy’ approach to create coordinated engagement and break down city-wide silos to collaborate resources and transform to county wide overdose and trauma response. In addition, they distributed over 5,000 treatment and community resources and made 700 referrals for Vivent Health to family, friends, and survivors.

Evidence-Based Treatment

Individuals experiencing substance misuse need access to high-quality, effective treatment, therefore, evidence-based treatment strives to improve access to these services. Working with the Washington State Department of Health and University of Washington, Public Health—Seattle and King County (PHSKC) held four trainings to increase community capacity for evidence-based treatment for Opioid Use Disorder (OUD). There are now 88 new OUD providers who are confirmed as buprenorphine X-Waivered prescribers. Prior to the trainings a pre-survey was conducted to evaluate medical providers’ sentiments around Medications for Opioid Use Disorder (MOUD); 140 people responded to the survey. The survey findings informed an anti-stigma campaign and toolkit for providers. A webinar was held for over 400 registrants, where the resource was presented, and information shared on the stigma around the use of fentanyl and other drugs. These achievements complimented each other by addressing the stigma within the medical provider community and increasing access to MOUD with more prescribers.

Recovery Support

To combat the various challenges preventing availability and use of recovery services, recovery support efforts are implemented to promote recovery services, strengthen the workforce, and increase integration of services. Through the IOPSLL project, the Los Angeles County Department of Public Health enabled access to and encouraged use of integrated recovery support services. They launched the RecoverLA resource guide and mobile web app to increase awareness and referral coordination to overdose prevention and SUD services and resources. LA County’s efforts included hosting community feedback sessions and focus groups with potential web app users, developing and designing the content, holding a community launch event, and conducting targeted trainings for key stakeholders. There were over 1,600 resource guides distributed; 47,000 clicks to the mobile-friendly resource guide; and a 6% increase in clients who were connected to SUD treatment from community organization referrals. More than 100 individuals attended the RecoverLA training and awareness sessions.

What’s Next for IOPSLL and LHDs

Due to the complex structural factors and multiple spheres of influence impacting the overdose crisis, support must align and coordinate to reduce overdose deaths, elevate equity, and build a healthier America. The HHS strategies and the IOSPLL project allow for flexibility in activities to complement a community’s context and needs, striving for the same end goal through a harmonized approach. The four sites presented here illustrate the beneficial role and power that LHDs hold in addressing the overdose crisis.

The need for this work is underscored as national data continues to site staggeringly high overdose deaths. Nationally, increased funds and support are being devoted to the overdose epidemic. CDC and NACCHO continue to support LHDs in addressing the overdose epidemic at the local level to move the needle towards a better future.

If you are interested in learning more, please visit NACCHO’s website or reach out to IVP@naccho.org.