Opioid Epidemic Toolkit 2021

Monitoring and surveillance are important components to improve a local health department’s understanding of the impacts of the opioid epidemic at the community level for public health investigation and response.

LOCAL RESOURCES

• 2017 Drug-Related Data Report (Jackson County Health Department, MI & Jackson County Substance Abuse Prevention Coalition)
  • This 2017 Jackson County Health Department, MI Drug Related Data Report outlines opioid use impacts in Jackson County.
• County Healthy Rankings & Roadmaps (University of Wisconsin Population Health Institute)
  • Webpage for health ratings by county on indicators, including drug overdose deaths and other substance use indicators.
• Data Sharing Agreement (Lawrence-Douglas County Health Department, KS)
  • This 4-page document serves as a template for values, principles, benefits, and factors for success to develop a data sharing agreement.
• Franklin County Health Department Program Evaluation Strategy (Franklin County Health Department, OH)
  • This evaluation report from the health department's MSFP2 Project includes the evaluation and data collection plan, logic models, evaluation report, and the stakeholder engagement plan.
• Kentucky Harm Reduction Survey (Multiple Kentucky Counties)
  • This 5-page document includes survey results from multiple Kentucky counties on their syringe exchange policies, policy involvement, supplies, collection, recovery, and operating hours.
• Marketing Metrics Report (Frederick County Health Department, MD)
  • This resource is a good example of digital/social media collection/evaluation.
• Medicare Part D Opioid Prescriber Summary File (Centers for Medicare & Medicaid Services)
  • Prescriber-level data set demonstrating number and percentage of prescription claims for opioid prescriptions.
• Non-fatal Overdose Surveillance Code (Baltimore City Health Department, MD)
  • Code for performing space-time cluster analysis of non-fatal overdoses, including a mechanism to share results.
• Ocean County Overdose Fatality Review Program (Ocean County Health Department, NJ)
  • Report on the countywide Fatality Review Program and pilot program to address opioid overdoses.
• Ocean County Overdose Fatality Review Program Annual Report (Ocean County Health Department, NJ)
  • Year 2 report on the countywide Fatality Review Program
• Opiate Crisis Quarterly Report (Franklin County Public Health, OH)
  • This 10-page quarterly report from Franklin County Public Health, Ohio includes opioid statistics captured in 2018.
• Opioid Overdose Outbreak - West Virginia, August 2016 (Morbidity and Mortality Weekly Report)
  • Article describing how a spike in opioid overdoses was tracked to provide evidence of a new synthetic opioid, including process explanations and a demonstration of local surveillance techniques.
• Public Health Reports Article: Linking Opioid-Overdose Data to Human Services and Criminal Justice Data: Opportunities for Intervention (Allegheny County Health Department, PA)
  • Published article about connections and intervention opportunities between opioid-overdose, human services, and criminal justice data.
• RxStat: Technical Assistance Manual (New York City Department of Health and Mental Hygiene, NY)
  • Manual to support local jurisdictions in establishing an RxStat initiative, which is a public health and public safety collaboration for advancing a shared understanding of patterns and characteristics of problem drug use.
• Report: Syndromic Surveillance Case Definition for Monitoring Opioid Related ED Visits (Tri-County Health Department, State of Nebraska Dept. of Human Services, Marion County Public Health, Denver Public Health)
  • This 2-page progress report is the result of collaboration across three different health departments to determining a syndromic surveillance case definition for monitoring opioid related ED visits.
• Stark County Prescription Drug Overdose Prevention Report and Logic Model (Stark County Health Department, OH)
  • This 15-page report from the Stark County Health Department covers background and evaluation information from their prescription drug overdose project. The report includes their project flow chart, implementation, evaluation logic model, results, and lessons learned.
• Use This Research in Your Communication and Social Media Campaigns (ICF)
  • This presentation includes research used to drive social media campaigns.

STATE RESOURCES

• Appalachian Overdose Mapping Tool (Appalachian Regional Commission)
  • Interactive mapping tool to better understand drug overdose deaths in Appalachia, and other related factors to opioid misuse and overdose in the region.
• California Opioid Overdose Surveillance Dashboard (California Department of Public Health)
  • Data dashboard with surveillance data on opioid-related indicators, including county-level data.
• New York State Opioid Data Dashboard (New York State Department of Health)
  • Data dashboard with 78 opioid-related indicators, including county-level data and assessments of progress over time.
• Rapid Increase in Drug Overdoses: Community Response Plan Template (Ohio Department of Health)
  • Outline providing guidance on how to mobilize immediate local efforts to respond to spikes in overdoses within a community.

NATIONAL RESOURCES

• 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes (CDC)
  • Report summarizes national prescribing patterns, drug use, and nonfatal and fatal overdoses related to the domestic opioid epidemic.
• Facing Addiction in America: The Surgeon General's Spotlight on Opioids (Office of the Surgeon General)
  • Documentation of latest data on substance use prevalence with a focus on opioid misuse and overdose, including background on the science of addiction and treatment.
• Healthcare Cost and Utilization Project (HCUP) (Agency for Healthcare Research and Quality)
  • Data source to compare emergency department and inpatient trends for opioid-related visits at the state and national level.
• Mapping the Opioid Epidemic (Esri)
  • Collection of maps including opioid prescription claims and providers, drug overdose deaths, as well as additional national-level statistics, information, and resources.
• Opioid Misuse Community Assessment Tool (NORC)
  • Interactive map that illustrates data on drug overdose deaths, and other factors that impact opioid overdose at the national and local level.
• Opioid Overdoses Treated in Emergency Departments (CDC Vital Signs)
  • Report on emergency department visits, including resource database with information on substance use disorder and LHD response.
• Provisional Drug Overdose Death Counts (CDC Health Center for National Statistics)
  • Data visualization for provisional counts for drug overdose deaths based, including comparisons, based on current flow of mortality data.
• Risk Index for Overdose or Serious Opioid-Induced Respiratory Distress (American Academy of Pain Medicine)
  • Score sheet to calculate an individual's risk of overdose or opioid-induced respiratory distress, including indicators on health status, health behaviors, and current opioid prescriptions.
• State Prescription Drug Monitoring Program Information (Brandeis University)
  • Comprehensive directory including a PDMP locator, information on PDMP policy and technology, and other PDMP-related resources.

Local health departments can expand and promote education for providers, partners, and the public about opioid use and misuse to reduce stigma and improve access to services for prevention, treatment, and recovery.

LOCAL RESOURCES

• Billboard Examples (Erie County, NY; Montgomery County, OH; State of Ohio; Summit County, OH)
  • This resources include combined examples of billboard ads from multiple counties.
• City Health Dashboard (NYU Langone Health & National Resource Network)
• Dashboard containing 36 measures of health and health equity, meant to guide local solutions in 500 domestic cities.
• Expanding Contraceptive Access for Women with Substance Use Disorders: Partnerships Between Public Health Departments and County Jails (East Region of the Tennessee Department of Health)
• This 9-page published article from the East Region of the Tennessee Department of Health describes their partnership with county correctional facilities to provide comprehensive family planning education and voluntary long-acting reversible contraception (LARC) to women in 15 jails.
• Facts About Opioids (Frederick County Health Department, MD)
  • This is an example of a two-page informational flyer.
• "I Wish I Knew" Campaign (Mid-Shore Opioid Misuse Prevention)
  • This digital ad campaign shows a variety of sizes and styles.
• Lessons Learned From Implementing Project Lazarus in North Carolina (UNC-Chapel Hill)
• Extensive report on a community-based initiative's implementation, successes, and failures.
• Movement on Medication Safety (MOMS) and Combatting NAS Toolkit (Lincoln County Health Department & MRC)
  • Online toolkit containing resources for addressing NAS, aimed at community members, providers, prescribers, and MRC volunteers.
• Opioid Efforts in Los Angeles County Slideshow (Los Angeles County Department of Public Health, CA)
  • This 30-slide presentation from the Los Angeles County Department of Public Health provides information on opioid use and community impacts as well as local prevention and response activities.
• Opioid Safety Toolkit (National Resource Center for Academic Detailing)
  • Toolkit for developing an academic detailing initiative to improve opioid prescribing practices.
• OUD: City Actions and Opportunities to Address the Epidemic (National League of Cities)
  • Report detailing stories about opioid response in cities and counties, including successes and challenges from the local perspective.
• Prescription for Action: Local Leadership in Ending the Opioid Crisis (National Association of Counties & National League of Cities)
  • Joint report examining how cities and counties can strengthen collaboration among local, state, federal, private-sector, and non-profit partners, including recommendations and case examples of local practices.
• Rx Awareness Campaign Toolkit for Agencies & Organizations in Indiana (Indiana State Department of Health)
• Toolkit containing templates and social media messages for communities adapting the CDC Rx Awareness Campaign.
• The Opiate Epidemic in Summit County, Ohio (Summit County Public Health, OH)
  • This 5-minute video from Summit County Public Health provides a brief overview of opioid use and overdose impacts in Summit County as well as some of their programs and treatment options.

STATE RESOURCES

• Opioid Misuse Resource Map (USDA)
  • Map and list of resources and initiatives underway in all 50 states to combat the opioid epidemic.
• Public Health Approaches to Preventing Substance Misuse and Addictions (Association of State & Territorial Health Officials)
  • Interactive framework tool for state health agencies as they plan and implement strategies for responding to the epidemic

• Master Evidence-Based Table (The Rhode Island Department of Health Drug Overdose Prevention Program)
  • "Collection of evidence-based and innovative drug overdose prevention interventions to guide the development and enhancement of opioid-related work"

NATIONAL RESOURCES

• Evidence-Based Strategies for Preventing Opioid Overdose: What's Working in the United States (CDC)
  • Guidebook that includes 11 evidence-based strategies for public health, law enforcement, and community organizers for preventing opioid overdoses.
• Guideline for Prescribing Opioids for Chronic Pain (CDC)
  • Guideline for primacy care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.
• Help, Resources, and Information: National Opioid Crisis (Department of Health and Human Services)
  • Public-facing website including general information, national resources and hotlines, first-person stories of opioid misuse, and an explanation of the HHS 5-Point Strategy.
• HIV and the Opioid Epidemic: 5 Key Points (Kaiser Family Foundation)
  • Information and infographics highlighting key points about the intersection of the nation's HIV and opioid epidemics.
• Opioid Use Disorder Prevention Playbook (National Interoperability Collaborative)
  • Resource detailing 11 "plays" that communities can take to respond to opioids.
• Opportunities for Prevention & Intervention of Opioid Overdose in the Emergency Department (Annals of Emergency Medicine)
  • Resource for prevention and intervention measures for managing opioid overdoses at emergency departments.
    
• Rural Opioid Educational Resources (National Organization of State Offices of Rural Health)
  • Comprehensive repository of resources for opioid response in rural communities, including customizable resources, training resources and presentations, and reports.
• Rural Response to the Opioid Crisis (Rural Health Information Hub)
  • Repository of resources on prevention, harm reduction, and treatment relevant to rural communities, including funding initiatives, data sets, and stories from the field.
• Rx Awareness Campaign (CDC)
  • Public-facing website for CDC's education and anti-stigma campaign, including first-person stories of opioid misuse and addiction, downloadable resources and videos, and social media tools.
• Safe Opioid Disposal - Remove the Risk Outreach Toolkit (FDA)
  • This digital toolkit has a wide range of English and Spanish materials to support safe disposal of medications.
• Stem the Tide: Addressing the Opioid Epidemic (American Hospital Association)
  • Instructional primer for hospitals and health systems to work with patients, clinicians, and communities in relation to opioid use, misuse, and overdose.
    
• The Truth About Opioids (Truth Initiative)
  • Public-facing website with general facts, tips, and resources about the opioid epidemic.

Local health departments can act as the frontline response and improve outcomes for people who use opioids or have OUD by providing services and resources to reduce the harms associated with opioid misuse and addiction.

LOCAL RESOURCES

• Communication and Information Toolkit for Needle Exchange Programs (Ontario Harm Reduction Distribution Program)
  • Communication toolkit for how to speak about and message a needle exchange program to both media and stakeholders, including tools for media relations and example answers for common questions.
• Community Response Planning for Outbreaks of Hepatitis and HIV Among People Who Inject Drugs (NACCHO)
  • Report on a local community's process to develop a community response plan for future outbreaks of infectious disease among people who inject drugs, including examples of tabletop exercises and community feedback.
• Guide to Establishing Syringe Services Programs in Rural, At-Risk Areas (Comer Family Foundation)
  • Comprehensive guide with harm reduction resources and specific examples from communities in Kentucky, West Virginia, Indiana, and North Carolina.
• Healthy Pima Action Plan, Project Description, and Alliance Roster (Pima County Health Department, AZ)
  • This action plan from Pima County, AZ Health Department's "Healthy Pima" Project includes project goals, objectives, and strategies, program slides, and alliance roster.
• Narcan Distribution Collaborative: Expanding Access in Hamilton County, OH and the Impacts (Hamilton County Public Health, OH)
  • Hamilton County Public Health, OH developed the Narcan Distribution Collaborative. These materials include project overview slides, a project report, and outcomes data.
• Owen County Harm Reduction Program Flyer (Three Rivers Health District, KY)
  • This resource is an example of a flyer promoting Owen County's harm reduction program.
• Treatment Referral Flyer - Trades Workers (Mystic Valley Public Health Coalition, MA)
  • This flyer shows impact statistics for trade workers and identifies local options for treatment, referrals, recovery groups, naloxone trainings, housing, etc.
• Understanding Behavioral Health in Douglas County, Kansas (Lawrence-Douglas County Health Department, KS)
  
  • This resource is a deep dive on the state of behavioral health in Douglas County, KS.
• Vulnerable Counties and Jurisdictions Experiencing or At-Risk of Outbreaks (CDC)
  • Map showing states and counties at-risk for increases in hepatitis infection or HIV outbreaks due to injection drug use.
• Washtenaw County Opioid Summit Press Release (Washtenaw County Health Department, MI)
  • This resource provides an example of a press release.

STATE RESOURCES

• Before It's Too Late (Maryland Department of Health)
  • Public-facing website with general information, resources for prevention and treatment, and links to state-level services.
• Naloxone Overdose Prevention Laws (Prescription Drug Abuse Policy System)
  • Database and map providing state-level information on legislation related to naloxone distribution, training, and utilization.
• Prevention Overdose RI (Rhode Island Governor's Overdose Prevention & Intervention Task Force)
  • Webpage explaining Rhode Island's comprehensive naloxone program, including resources on prevention, naloxone use, treatment and recovery, and community response.
    
• State Approaches to Addressing the Infectious Disease Consequences of the Opioid Epidemic (National Governors Association)
  • White papers about the intersection of the opioid epidemic and infectious diseases that highlight key considerations for governors working to address the consequences.

NATIONAL RESOURCES

• Directory of Syringe Exchange Programs (North American Syringe Exchange Network)
  • National directory of syringe exchange programs.
• Fentanyl Overdose Reduction Checking Analysis Study (Bloomberg American Health Initiative)
  • Report and recommendations from a three-phase study of fentanyl test strips that evaluated strip utilization, perceptions around fentanyl, and how fentanyl test strips impact behavior and drug use.
    
• Fentanyl Test Strip Survey (Harm Reduction Coalition)
  • Example survey for individuals who use fentanyl test strips, including questions about strip utilization, test result, and potential behavior change.
    
• #GetWaivered (Massachusetts General Hospital)
  • Campaign (available on Twitter and webpage) to promote waiver training and medication-assisted treatment (MAT), including resources to sign up for a waiver training.
• Have the Conversation: Caring for People Who Inject Drugs (NH Harm Reduction Coalition)
  • Primer with suggestions for engaging with people who inject drugs to encourage harm reduction behaviors.
    
• HI-5 Access to Clean Syringes (CDC)
  • Webpage with background information on syringe exchange services, including research and evidence-base for health benefits and cost-effectiveness.
• Intersection of Hepatitis, HIV, and the Opioid Crisis: The Need for a Comprehensive Response (NASTAD)
  • Issue brief that outlines the core elements of creating a response to address the intersection of Hepatitis, HIV, and opioids, including information on the evidence base for various programs.
• Legal Interventions to Reduce Overdose Mortality: Naloxone Access & Overdose Good Samaritan Laws (Network for Public Health Law)
  • Report on state-by-state legislation around naloxone access and Good Samaritan protections for bystanders of an overdose.
    
• Managing HIV and Hepatitis C Among People Who Inject Drugs (CDC)
  • Report including information on preparing for, detecting, investigating, and responding to an outbreak of HIV or hepatitis C, as well as suggestions for engaging community partners and law enforcement.
    
• Reducing Harm From Injection Drug Use & Opioid Use Disorder with Syringe Services Programs (CDC)
  • Fact sheet with basic information and statistics on the comprehensive services and benefits provided by a syringe service program.
    
• Skin Care Guide for People Who Inject Drugs (University of New Hampshire & NH Harm Reduction Coalition)
  • Fact sheet on how to reduce physical harms from injection drug use, including basic wound care principles.
    
• Supervised Injection Sites Are Coming to the United States - Here's What You Should Know ([email protected])
  • Webpage with background and basic facts about supervised injection sites, including an exploration of the evidence base.
• The Opioid Crisis and the Black/African American Population: An Urgent Issue (SAMHSA)
  • Report curated by the Substance Abuse and Mental Health Services Administration that "presents recent data on prevalence of opioid misuse and death rates in the Black population; contextual factors & challenges to prevention & treatment; innovative outreach & engagement strategies to connect people to evidence-based treatment; and the importance of community voice."

Local health departments are well positioned to facilitate linkages to care for people who experience an overdose or choose to seek treatment for OUD.

LOCAL RESOURCES

• Community Convening Guide (Facing Addiction)
• How-to guide for convening local prevention programs, including organizing tools and information on improving local awareness and amplifying community support.
• Criminal Justice System as a Point of Intervention to Prevent Opioid-related Deaths (Hennepin County Health Department, MN)
  • This 8-page report from the Hennepin County Health Department (MN) outlines the data collection and advocacy steps taken to provide MAT services in local Jails.
• Greater Manchester's Community Compass: Navigating Local Resources for Substance Use Disorder (Makin' It Happen)
  • Compendium of local resources for people with SUD, and their friends and family, including sections targeted to urgent help, behavioral health, prevention, intervention, treatment, and recovery.
• Mobile Addiction Treatment Unit (Caroline County Health Department, MD)
  • Press release for the launch of a county-level mobile addiction treatment unit, including rationale and a description of services.

STATE RESOURCES

• Key Components for Delivering Community-Based MAT Services for OUD in New Hampshire (NH Dept. of Health & Human Services)
  • Report on MAT capacity and infrastructure, including lessons learned and recommendations for increasing buprenorphine waivers, naltrexone awareness, and opportunities for office-based MAT.
• Overview of State Pain Management & Prescribing Policies (National Alliance for Model State Drug Laws)
  • Report on state-level statutes, regulations, and guidelines related to treatment of chronic pain and prescribing practices, as well as information on the regulation of pain clinics and facilities.

NATIONAL RESOURCES

• Addiction Resource Center (Addiction Policy Forum)
  • Resource portal for addiction services and assistance for individuals seeking treatment for a substance use disorder.
• Addiction Resource Hub (Facing Addiction)
  • Public-facing resource webpage with information on addiction support, housing, and insurance, targeted for users living or residing in a major city.
• Characteristics of Medications for Opioid Addiction Treatment (New England Journal of Medicine)
  • Chart comparing the treatment class, effects, advantages, and disadvantages of three medications for MAT (methadone, buprenorphine, naltrexone).
• Medications for Opioid Use Disorder Save Lives (National Academies of Sciences, Engineering, and Medicine)
  • Report examining the evidence for medications for opioid use disorder, including an analysis of the barriers to access.

• Playbook on MAT for OUD in Primary Care Settings (The AHRQ Academy)

  • Playbook providing a practical guide for primary care providers in MAT implementation, specifically in rural settings.

• Implementing Medication-Assisted Treatment for Opioid Use Disorder: A Planning and Implementation Toolkit (National Council)

  • Tool Kit developed in partnership with Vital Strategies and Bloomberg Philanthropies, with support from the CDC, containing information to advance the implementation of evidence-based medications for OUD within jail and prison settings.

Local health departments are neutral conveners of cross-cutting community partners, and they can highlight the benefit of collaboration at the local level to address this multifaceted epidemic.

LOCAL RESOURCES

• Abstract: COOP Planning in SUD Facilities (Nashua Division of Public Health and Community Services, NH)
• This is a sample APHA abstract.
• Drug Coalition Addressing Challenges Through Communication and Collaboration (Noble County Health Department, OH)
  • This media article describes Noble County LHD and their partners activities to address opioid use in their community.
• Essential Measures: A Local Public Health Toolkit for Addressing the Opioid Epidemic (Massachusetts Health Officers Association)
  • Toolkit with explanations, case examples, and resources for responding to the opioid epidemic through local public health organized by the ten essential services.
• Fairfax County Opioid Task Force Plan (Fairfax County Opioid Task Force & Steering Group)
  • Report outlining one community's task force plan for responding to their local opioid epidemic.
• Medical Reserve Corps Response to the Opioid Epidemic (Medical Reserve Corps)
  • Fact sheet highlighting the MRC's response to the opioid epidemic.
• Mobilizing Community Partnerships in Rural Communities: Strategies and Techniques (NACCHO)
  • Guide providing strategies for rural communities to mobilize community partnerships for public health programming, including local examples and lessons learned.
• Opioid Crisis (National League of Cities)
• Website with background information on the epidemic, including targeted resources for cities working to respond to local issues.
• Opioid Deaths Drop in Manchester, Nashua (Nashua Health Department, NH)
  • Sample media article.
• Spokane Regional Opioid Taskforce: Strategic Plan (Spokane Regional Health District, WA)
  • This task force strategic plan provides a template to outline goals, tactics, outcomes, performance measures, and leads.

NATIONAL RESOURCES

• A Rise in Opioid Overdoses is Detected - What Now? (CDC Vital Signs)
  • Infographic displaying potential efforts to address overdoses by partnering with stakeholders such as first responders, providers, community members and organizations, and health departments.
    
• Aligning City, County and State Resources to Address the Opioid Epidemic (National League of Cities)
  • Report that shares the key findings, emerging priorities, lessons learned, and future strategies for six cities involved in responses to the opioid epidemic.
• Changing the Narrative (Health In Justice Action Lab at Northeastern University School of Law)
  • This communications network provides sources to help media better represent drug use and addiction, including assistance with common stigmatizing language.
• Mobilizing for Action through Planning and Partnerships (NACCHO)
  • Webpage demonstrating the MAPP framework for a community-driven strategic planning process for improving community health.
• Multi-Sector Partnerships (Practical Playbook)
  • Directory of public health and health care projects involving multiple stakeholders that aim to improve the health of a community, city, or state.
• Strategic Messaging Guide 2018 (NACCHO)
  • Communications guide for local health departments, including messaging examples for opioid use and overdose.
    
• Opioid Overdose Prevention Toolkit (Substance Abuse and Mental Health Services Administration)
  • General toolkit for local health departments and their stakeholders about prevention programs, resources, and advice.
    
• Ten Standards of Care: Policing and the Opioid Crisis (Bloomberg American Health Initiative)
  • Guide with recommendations and standards of care for police departments involved in responses to the opioid epidemic.
• Tracking Federal Funding to Combat the Opioid Crisis (Bipartisan Policy Center)
  • Report examining how federal funding is invested in opioid prevention and response efforts, with case studies and data for selected states.