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Naloxone is an opioid antagonist approved by the U.S. Food and Drug Administration (FDA) to quickly reverse an opioid overdose by binding to opioid receptors and blocking the effects of common opioids such as heroin, oxycodone, and morphine. When administered properly, this medication can provide life-saving care to individuals experiencing an overdose, allowing them to be transferred to professional medical intervention and treatment.¹ Priority strategies include:

• Expand training for first responders, schools, community support groups and families
• Increase distribution to individuals who are uninsured or whose insurance does not cover the needed service.

Medicated-assisted recovery (MAR), sometimes referred to as medication-assisted treatment (MAT), involves a combination of behavioral therapy and medication to treat individuals with opioid use disorder (OUD) and support them in their recovery process. Continuing MAR has been shown to be effective in treating chronic OUD, using either buprenorphine, methadone, or naltrexone in combination with a means of psychosocial support.² Priority strategies include:

• Increase distribution of MAT to individuals who are uninsured or whose insurance does not cover the needed service
• Provide education to school-based and youth-focused programs that discourage or prevent misuse
• Provide MAT education and awareness training to healthcare providers, EMTs, law enforcement, and other first responders
• Provide treatment and recovery support services such as residential and inpatient treatment, intensive outpatient treatment, outpatient therapy or counseling, and recovery housing that allow or integrate medication with other support services

The number of people who experience OUD while pregnant or following pregnancy quadrupled between 1999 and 2014.³ Pregnant individuals with OUD experience significantly higher rates of morbidity and mortality, and their infants may experience neonatal opioid withdrawal syndrome (NOWS). They also often struggle to gain access to proper healthcare.⁴ Priority strategies include:

• Expand Screening, Brief Intervention, and Referral to Treatment (SBIRT) services to non-Medicaid eligible or uninsured pregnant people
• Expand comprehensive, evidence-based treatment and recovery services, including MAT, for women with co-occurring OUD and other substance use disorder (SUD)/mental health disorders for uninsured individuals for up to 12 months postpartum
• Provide comprehensive wrap-around services to pregnant and postpartum people with OUD, including housing, transportation, job placement/training, and childcare

NOWS is a collection of conditions that can occur when an infant is removed from intrauterine exposure to substances, such as opioids, from maternal opioid use. Symptoms can include poor fetal growth and preterm birth, seizures, irritability, poor feeding, and dehydration.⁴ Priority strategies include:

• Expand comprehensive evidence-based and recovery support for NOWS babies
• Expand services for a better continuum of care with infant-need dyad
• Expand long-term treatment and services for medical monitoring of NOWS babies and their families

Bridge services address a critical gap in the continuity of care for OUD treatment by facilitating an uninterrupted care system for affected individuals.⁵ “Warm hand-offs” involve the members of a patient’s previous healthcare team meeting with their upcoming team to share information, findings, and insights. By reducing barriers to patient-centered care, OUD initiation, OUD treatment, and OUD care innovation, bridge services can provide essential resources and services to people with OUD. Priority strategies include:

• Expand services such as navigators and on-call teams to begin MAR in hospital emergency departments
• Expand warm hand-off services to transition to recovery services
• Broaden scope of recovery services to include co-occurring SUD or mental health conditions
• Provide comprehensive wrap-around services to individuals in recovery, including housing, transportation, job placement/training, and childcare
• Hire additional social workers or other behavioral health workers to facilitate expansions above

In the United States, an estimated 63% of people who are incarcerated experience SUD, compared to 9% in the general population. Moreover, there is a high rate of recidivism, return to use, and overdose for these individuals when they leave the criminal justice system, as they are likely to have a lower tolerance after their period of incarceration.⁶ Priority strategies include:

• Provide evidence-based treatment and recovery support, including MAR for persons with OUD and co-occurring SUD/mental health disorders within and transitioning out of the criminal justice system
• Increase funding for jails to provide treatment to inmates with OUD

One of the most effective means of reducing the risk of overdose death is making sure people are made aware of the risks of opioids. Increasing awareness among adolescents, pregnant people, and physicians is a priority. The earlier on in life individuals begin using a drug, the more likely they are to develop addictive behaviors associated with that substance. Therefore, adolescence is a critical time for prevention interventions.⁷ Priority strategies include:

• Funding for media campaigns to prevent opioid use
• Funding for evidence-based prevention programs in schools
• Funding for medical provider education and outreach regarding best prescribing practices for opioids consistent with the 2016 CDC guidelines, including providers at hospitals
• Funding for community drug disposal programs
• Funding and training for first responders to participate in pre-arrest diversion programs, post-overdose response teams, or similar strategies that connect at-risk individuals to behavioral health services and supports

Harm reduction refers to services and strategies that reduce negative outcomes associated with SUD. Historically, critical wrap-around services such as housing, healthcare, food security, and insurance have only been available to individuals with SUD once they have committed to total abstinence.⁸ However, the harm reduction approach has significantly better overall health outcomes compared to abstinence only.⁹ Syringe exchange services are one form of harm reduction, in which individuals who use intravenous substances can gain access to free, sterile needles and syringes, thus reducing the spread of disease and improving overall health outcomes.⁷ Priority strategies include:

• Provide comprehensive syringe services programs with more wrap-around services, including linkage to OUD treatment, access to sterile syringes, and linkage to care and treatment of infectious diseases

Research and data collection are critical components of program implementation. To ensure overall program fidelity and efficacy, researchers, advocates, and practitioners need to identify aspects of programming that are successful and find any gaps or challenges.