Overdose Response Strategy
Monthly News and Updates

September 2020
The 2019 ORS Annual Program Report briefly describes the current state of the opioid epidemic and outlines the strategies employed by the ORS in 2019 to combat this epidemic. The report also demonstrates the ORS’ readiness to address other emerging drug threats, such as stimulants. Much of the ORS’ work is conducted at the local level, and that work varies broadly among jurisdictions. This report is not an exhaustive catalog of every ORS effort or success, but instead illustrates, through selected examples, the scope of the work undertaken by the ORS.

November 16th-19th from 1:00 PM to 4:30 PM EST
The ORS will be moving it's annual meeting online!

PHAs and DIOs that are interested in presenting on one or more project they are involved in must fill out this short survey no later than Friday, Sept. 18th.

The ORS is piloting a new train-the-trainer series focused on developing effective overdose fatality review teams (OFRs). This training series has been developed in coordination with the Institute for Intergovernmental Research (IIR) and the Bureau of Justice Assistance (BJA).

Wednesday, Sept. 16th @ 2:00pm – 3:30PM ET
Wednesday, Sept. 300th @ 2:00pm – 3:30PM ET
Wednesday, Oct. 14th @ 2:00pm – 3:30pm ET

This series is already underway. Recordings of Modules 0 through 2 are available. If you have any questions, please reach out to Lindsey Kato (qct5@cdc.gov).
Building New Interventions with Existing Partners
"We had an existing working relationship with North Carolina Harm Reduction Coalition (NC HRC), who have been involved in overdose prevention programs that support law enforcement and the incarcerated population. The pilot project funding allowed NC HRC to pursue a project they had already had considered but were not currently implementing; additionally, my role in supporting the project was essential in providing NC HRC the personnel capacity in implementing and reporting on the project deliverables. My role in supporting the pilot project has been completely different than my PHA role, which is mainly serving as an overdose epidemiologist with the Division of Public Health. This project has given me experience in project management, evaluation design and project implementation. We feel much more connected with NC HRC through this experience, and look forward to finding ways in sustaining our current jail overdose prevention project."

Sherani Jagroep, North Carolina PHA
Benefits of Working with CDC and NACCHO
"We were already beginning implementation on an outreach project when the ORS Pilot Project funding opportunity became available. The leadership team agreed it was a worthy opportunity to pursue, not only have some funds to assist with the project planning, but to also be able to benefit from the technical assistance and expertise that the pilot project provides. The ability to work with CDC and NACCHO to develop tools, implementation plans and evaluation plans have been something that has required more in-depth work than I had previously been involved in for this type of project. It has been incredibly useful to learn and to be able to have a better understand for future projects and partnerships. The experience of working on this pilot has helped to inform similar initiatives across Vermont and we are able to use what we have learned and even adapt developed materials to assist other communities seeking to do something similar."
Stephanie Thompson, Vermont PHA
Helping Prepare Pilot Application
"When the pilot project application opened, I reached out via email to my partners in the state that have already been heavily involved in other overdose prevention initiatives. Specifically, I reached to the network of stakeholders that have been working with us on developing Overdose Fatality Review teams across the state. Because of the short timeline states had for applying for this opportunity, I helped my partners with the application process and secured letters of support for the project. Throughout implementation I’ve provided technical support to the project, reviewing all the documents related to the grant, drafting minutes after meetings, and helping my partners write and analyze data collection tools. I also act as a liaison between agencies involved in the project. The ORS pilot project has strengthened existing partnership within the jurisdiction, which makes it easier for us to work on other overdose prevention initiatives with confidence."

Nava Bastola, New Jersey PHA
Supporting Evaluation Planning
"I have supported Marylands’s ORS pilot project by providing technical assistance in the evaluation process. Specifically, I’ve helped our partners develop the evaluation design, evaluation matrix, methodology and logic model. I have also reviewed the pilot goals and objectives and assisted in making them more specific and appropriate for the evaluation design. The engagement with the evaluation officer is providing me with more insight on specific aspects one should include in developing an effective evaluation plan."

Julia Mandeville, Virginia PHA
(supporting Maryland pilot project)
Expanding the PHA Role
"Working with this project has given me the opportunity to be closer to the program side than I typically am in my data-focused day-to-day work. I have been able to learn more about the practice of service delivery, including the adaptations needed to continue essential service delivery during the COVID-19 pandemic. My involvement has also deepened my relationship with area harm reduction partners, enabling closer communication around overdose spikes and other emerging concerns. This close collaboration has benefited my DIO counterpart and my Department of Health partners as well."

Nicole D'Anna, New York PHA
Upcoming Q&A Panels: ORS Pilot Project Experiences
Would you like an opportunity to hear from other states about their experience participating in ORS pilot projects?

Panel participants will answer questions about the application process, recruiting agencies and organizations, the time commitment that the project required, and tips for how to build effective and sustainable partnerships. We are hosting two Q & A sessions to ensure that everyone who is interested has the chance to participate!

If you would like to submit a question for our pilot project panelists ahead of time, please do so here.

1 - 2pm ET
3 - 4pm ET
4th Annual HIDTA Prevention Summit on Oct. 8th
The Office of National Drug Control Policy’s (ONDCP) National High Intensity Drug Trafficking Area (HIDTA) Program Office and A Division for Advancing Prevention and Treatment (ADAPT) will be hosting the 4th Annual Prevention Summit, titled Advancing Substance Use Prevention in HIDTA Communities: Standards, Strategies, and Support on Thursday, October 8th. Online registration will be available soon.

This September, the National Organization of Black Law Enforcement Executives (NOBLE) and the John Jay College of Criminal Justice are partnering to convene a series of six livestream conversations to reimagine the future of public safety and redefine the role of policing in America today.
These sessions will culminate in the release of a public report that will include substantive and innovative conclusions for communities to consider as they reimagine the future of public safety. The report will serve as a roadmap for local communities to follow as they work toward committing to policing practices that ensure equal justice for everyone. We must collaborate and create a blueprint for the future of public safety—and what that means for policing—together.

A Virtual Conversation with Sam Quinones, Author of "Dreamland: The True Tale of America’s Opiate Epidemic"
On October 8th, Dr. Deb Houry, the director of the CDC's National Center for Injury Prevention and Control, will be moderating a virtual conversation with Sam Quinones, author of Dreamland: The True Tale of America’s Opiate Epidemic.
The conversation will explore the intersection of the pandemic and the opioid epidemic. Isolation, job loss, economic insecurity, and anxiety brought on by COVID-19, combined with diminished access to treatment and personal contact as part of social distancing efforts, could in turn fuel the ongoing opioid epidemic. Yet, there are signs of hope that the pandemic has renewed in all of us an appreciation for community, the desire to make personal connections again, and the strengthening of bonds that may provide resilience in recovery from both COVID-19 and the opioid epidemic.

Upcoming Domestic Highway Enforcement (DHE) Calls
Sept 9: DHE K-9 Working Group
Sept 10: Illicit Currency Packaging and Intelligence
Sept 15: I-40/20/10/85 East and West
Sept 16: DHE Supervisor Working Group
Sept 17: Legal Issues Specialty
Sept 22: I-80/70/15 & I-90/94/84/82
Sept 28*: Scientific Trend Open Network Exchange (STONE)
Oct 6: I-5 Rt. 99 & I-25 and Alaska
Oct 8: DHE Special Topic National Call
Oct 13: I-75/77/81 & I-95, Puerto Rico, & the Virgin Islands
Oct 14: DHE Northwestern Regional Call
Oct 22: DHE Special Topic National Call
Oct 27: I-80/70/15 & I-90/94/84/82
Oct 29: DHE/Overdose Response Strategy Drug Intelligence Officer

*All calls are held at 2pm ET, except the STONE call which will be at 12pm ET
State Policy Center for Opioid Use Disorder Treatment and Access
The opioid use disorder (OUD) epidemic extends beyond the boundaries of traditional state health systems, requiring evidence-based treatment and coordination between state agencies and leaders. To optimize all potential avenues to treatment and reduce overdoses, the National Academy for State Health Policy (NASHP) is working with states to develop a “no-wrong-door” approach to OUD treatment that prioritizes cross-systems policy. NASHP is providing tools and resources, which will be frequently expanded, with support from the Foundation for Opioid Response Efforts (FORE) and its steering committee.

Experts say telehealth still isn't reaching key groups suffering from addiction.

Overdose deaths rise as job losses and stress from COVID-19 destabilize people struggling with addiction.

"In humans, it is probably 60 times stronger than morphine," one expert says.

Opioid overdoses have spiked during the coronavirus pandemic, Linda Porter, director of the Office of Pain Policy at the National Institutes of Health, said during an Axios virtual event.
Knowledge, preparedness, and compassion fatigue among law enforcement officers who respond to opioid overdose
Using data collected during the 2018 ORS Cornerstone Project on 911 Good Samaritan Laws, our ORS colleagues recently published an article describing patrol officers’ knowledge of their state’s Good Samaritan Laws, experience with overdose response, and their perspectives on strategies to prevent and respond to opioid OD.

Illicitly manufactured fentanyls (IMFs), heroin, cocaine, or methamphetamine (alone or in combination) were involved in 83.8% of overdose deaths during January–June 2019; at least one potential opportunity for intervention was identified in 62.7% of overdose deaths.

Rates of ED-treated suspected nonfatal drug overdoses involving opioids, cocaine, and amphetamines, and of polydrug overdoses co-involving opioids and amphetamines increased from 2018 to 2019. Rates of suspected benzodiazepine-involved overdoses declined. Opioids were substantially co-involved with cocaine, amphetamine, and benzodiazepine overdoses in 2019; 23.6%, 17.1%, and 18.7% of cocaine-, amphetamine-, and benzodiazepine-involved overdoses, respectively, involved opioids.

This article seeks to outline an interagency relationship between police and healthcare that illustrates arrest is not the only option that law enforcement may utilize when encountering persons who use illicit substances.

As part of a broader effort to improve community access to naloxone, the authors of this study developed comprehensive training for emergency responders on recognizing and responding to an overdose, basic tenets of addiction, and the roles of treatment and harm reduction strategies. 

This study seeks to describe how the novel coronavirus (COVID-19) pandemic has affected opioid agonist treatment (OAT) programs in jails and prisons. Ten out of 16 systems reported downsizing their OAT programs. Seven of 16 systems made changes to medication dispensation processes. 

This cross-sectional study of urine drug test results from July 15, 2019, through March 12, 2020, included patient specimens analyzed using liquid chromatography-tandem mass spectrometry, submitted by health care professionals as part of routine care to detect fentanyl and fentanyl analogs. The total positivity rate for ten fentanyl analogs was 40.55% in the nonprescribed fentanyl-positive population.

Between 1992 and 2017, treatment admissions involving opioid/cocaine and opioid/alcohol co-use decreased while opioid/methamphetamine and opioid/benzodiazepine co-use increased. In 2016 to 2017, receipt of medications for OUD was significantly higher for those who used opioids only compared with individuals who used opioids with cocaine, methamphetamine, alcohol, or benzodiazepines.

The primary facilitators of naloxone distribution reported by stakeholders included collaborative partnerships, ease of participating in the program, being established in prevention efforts, demand for naloxone and the need for personal protection from overdose. The primary barriers identified by stakeholders included bureaucracy/policy/procedures of their organization or agency, stigma, logistical or planning issues, problems with reporting, lack of communication post distribution and sustainability.

This study assessed the psycho-social correlates associated with OUD over 2015–2018 in the US. In multivariable analysis, age of less than 65 years old, White race, male gender, lower educational attainment, unemployment, large metro area residence, history of alcohol, marijuana, nicotine use disorder, history of criminal justice involvement, and major depressive episodes in previous year were associated with higher odds of OUD.

The objective of this paper is to identify the scope and prevalence of community‐based, post‐opioid overdose EMS programs across the United States. The most comprehensive programs involved combinations of innovative outreach, specialized referrals, integration with police and criminal justice, peer support, and even treatment initiation.

This study seeks to evaluate community attitudes concerning opioid use disorder (OUD) and medication for opioid use disorder (MOUD) in a rural community, and to plan educational initiatives to reduce stigma surrounding OUD and treatment.