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Opioid-Abatement Toolkit

Opioid-Abatement Toolkit

Communiversity Developed and Tested

CDC Healthcare Advisory

Recommendations for Each Segment Concerned with Healthcare and OUD 

The following guidelines are sensible approaches to a difficult problem. If followed, many more people will be alive. Issued on Dec. 17, 2020.

  • Public health departmentsand community-based organizations:
    • Raise awareness about 
      • The critical need for bystanders to have naloxone on hand and use it during an overdose (PDF)
      • The changing illicit drug marketplace and the wider availability and geographic dispersion of illicitly manufactured fentanyl and novel psychoactive substances (e.g., fentanyl analogs);
      • Common co-use of illicitly manufactured fentanyl with other drugs such as cocaine and methamphetamine; and
      • Infrequent mixing of illicitly manufactured fentanyl into the illicit drug supplies of methamphetamine and cocaine.
    • Increase awareness about the risk of using drugs when alone and emphasize the need for risk-reduction strategies among people who use drugs. Strategies can include
      • Not using drugs alone and knowing what drugs are being used;
      • Ensuring naloxone is available and that people who use drugs and their loved ones know how to administer it and
      • Having a friend or loved one check in on people who use drugs regularly, especially during use.
    • Provide messaging to community groups (particularly those providing services to high-risk populations), community leaders, school officials, faith-based leaders, parents, students and others about the changing illicit drug supply and risks for overdose and exposure to highly potent opioids such as illicitly manufactured fentanyl or counterfeit drugs appearing to be legal prescription medications.
  • Healthcare providers:
    • Talk to patients about the changing illicit drug supply and risks for overdose and exposure to highly potent opioids such as illicitly manufactured fentanyl.
    • Prescribe naloxone (PDF) to individuals at risk for opioid overdose, such as those with a prior history of overdose, those with opioid use disorder, and individuals using illicit opioids and other drugs that might be mixed with illicitly manufactured fentanyl.
    • Co-prescribe naloxone to patients with high morphine milligram equivalents and those receiving opioids and benzodiazepines.
    • Expand locations in which overdose prevention education and take-home naloxone are provided. These locations can include inpatient and outpatient treatment programs, primary care settings, retail pharmacies, counseling and support groups, and other community-based settings. Expanding locations may be especially important in rural areas.
    • Counsel patients that multiple doses of naloxone may be needed for a single overdose event because of the potency of illicitly manufactured fentanyl and fentanyl analogs and that multiple doses of naloxone may be needed over time due to the prolonged effects of opioids in some cases.
  • Harm-reduction organizations:
    • Increase the provision of overdose prevention education and take-home naloxone to people who use drugs, their friends, and others likely to witness or experience an overdose.
    • Ensure that individuals have sufficient doses of take-home naloxone to account for the potency of illicitly manufactured fentanyl and fentanyl analogs.
    • Call 911 immediately after recognizing an overdose or resuscitating a patient. Naloxone available in the field may not be sufficient to reverse the overdose. Those who receive naloxone may experience a recurrence of overdose symptoms or experience other acute medical, traumatic, toxicologic, or psychiatric conditions.
    • Prioritize naloxone distribution to people who use drugs following periods of abstinence and during transitions where opioid tolerance may have waned. There is a higher risk of overdose during these periods, including post-incarceration and after treatment for an opioid use disorder, if a relapse occurs.
  • First responders to overdoses:
  • Healthcare providers:
    • Provide Medications for Opioid Use Disorder (MOUD)
      • Treatment with the FDA-approved medications methadone, buprenorphine, or naltrexone are lifesaving and the most effective forms of treatment for opioid use disorder.
      • Ensure treatment access, especially for people who are transitioning from institutional settings such as the criminal justice system, residential treatment, or a recent hospitalization.
      • During the COVID-19 public health emergency, the Federal Government has made it easier to obtain MOUD through telehealth. 
      • Provide Stimulant (Cocaine, Methamphetamine) Use Disorder Treatment
        • Unlike opioid use disorder treatment, there are no FDA-approved medications to treat stimulant use disorders.
        • The most effective treatments for stimulant use disorders are psychosocial therapies such as motivational interviewing, contingency management, contingency management combined with community reinforcement approach, and contingency management combined with cognitive-behavioral therapy. These therapies have demonstrated effectiveness for stimulant use disorders. For additional information about each of these treatment strategies, see SAMHSA’s Treatment for Stimulant Use Disorder.
        • Harm reduction organizations:
          • Offer buprenorphine on-site, in a mobile van, or through telemedicine for clients with opioid use disorder.
  • Public health departments and harm reduction organizations:
    • Link people who are at risk for overdose with care and track their retention in care programs. People who are at risk include those who have recently been treated for a non-fatal overdose.
    • Consider expanding peer navigator programs or using recovery coaches to intervene with individuals at the highest risk of overdose.
  • Healthcare providers:
    • Initiate or continue medications for opioid use disorder among people leaving correctional and detention facilities. See Recommendation #2 on treatment.
    • Provide active referral-to-treatment options and recovery support services.
    • Implement post-overdose response protocols, including in emergency departments, that incorporate links between public health, treatment providers, community-based service organizations, and healthcare providers. These protocols promote overdose education, treatment, linkage to care and MOUD, and naloxone distribution.
  • Public safety:
  • Public health departments:
    • Identify drug overdose outbreaks and spikes rapidly using existing surveillance systems such as syndromic surveillance emergency department data, emergency medical services data, commercial laboratory data, poison center data, medical examiner or coroner data, and tools like Overdose Detection – Mapping Application Program (Existing syndromic surveillance- emergency department data sources include the CDC’s Drug Overdose Surveillance and Epidemiology (DOSE) system and the National Syndromic Surveillance Program (NSSP).
    • Track and monitor trends in the illicit opioid drug supply and overdoses using local, state, and federal data systems and toxicological testing, including: 
      • The geographic distribution of illicit drugs and overdoses;
      • Shifts in demographic characteristics of individuals at risk for overdose (e.g., by sex, race/ethnicity) and
      • The identification of the drugs with which opioids are mixed and drug products containing multiple opioids (e.g., heroin and illicitly manufactured fentanyl).
    • Medical examiners and coroners:
      • Screen specimens (PDF), including in suspected overdose deaths involving heroin, using an enzyme-linked immunosorbent assay (ELISA) test that can detect substances, including fentanyl and fentanyl analogs.47See the laboratory section below.
      • Screen for novel psychoactive substances prevalent in your region or when an unexplained increase in drug overdoses occurs. 
        • Consider specialized testing for fentanyl analogs or other novel synthetic opioids when fentanyl screening is negative or confirmatory testing is inconclusive, yet opioid or fentanyl overdose is highly suspected. This is particularly important if an increase in overdoses is occurring or fentanyl analogs have been detected in local drug products.
      • Laboratories:
        • Implement an opioid bio-surveillance program in line with the Association of Public Health Laboratories (APHL) guidance (PDF) on developing model surveillance systems for use in tracking non-fatal opioid overdoses at the state level.
        • Use CDC’s Traceable Opioid Material® Kits (TOM Kits®). This product line provides reference materials enabling labs to screen for more than 210 synthetic opioid compounds – including more than 190 fentanyl analogs.Available kits include the Opioid Certified Reference Material kit (Opioid CRM kit) and the Fentanyl Analog Screening (FAS) Kit.
      • Harm reduction organizations:
        • Implement drug-checking services and drug supply surveillance in line with applicable state and local laws.
        • Partner with public safety and public health to obtain and disseminate the latest information on local drug supply and overdose trends.
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Introduction
Learning Modules
Terminology
Terminology, cont.
History
2. Building Community Coalitions
Risk & Protective Factors
Adverse Childhood Experiences (ACEs)
Peer Pressure
Boundaries
4. Preventing Opioid Deaths
Treatment & Support
Special Populations
Evaluation and Impact
Community Change Agent Quiz
Call to Action
Contact
Print the Toolkit
Print the Workbook
Credits
Appendix A: References
Appendix B: Definitions
CDC Healthcare Advisory
Resource Guide
Opioid Awareness Materials