HomeMy WebLinkAbout2021-12-14; City Council; ; Authorize Participation in National Opioids SettlementsCA Review CKM
Meeting Date: Dec. 14, 2021
To: Mayor and City Council
From: Scott Chadwick, City Manager
Staff Contact: Cindie K. McMahon, Assistant City Attorney
cindie.mcmahon@carlsbadca.gov, 760-434-2891
Subject: Authorize Participation in National Opioids Settlements
District: All
Recommended Action
Adopt a resolution authorizing the City Attorney to sign the necessary documents for the City of
Carlsbad to participate in the National Opioids Settlements.
Executive Summary
To participate in and receive funds from the national settlement reached over the opioid
epidemic, the City of Carlsbad must authorize a representative to sign settlement-related
documents. The deadline to sign these documents is Jan. 2, 2022. The proposed resolution
authorizes the City Attorney to sign the necessary documents. The funds from the settlements
must be spent for opioid epidemic remediation and abatement activities.
Discussion
Background
On July 21, 2021, the National Prescription Opiate Litigation Multidistrict Litigation Plaintiffs’
Executive Committee, several state attorneys general, including the California Attorney
General, and four major defendants announced an agreement on the terms of proposed
nationwide settlements to resolve all opioid-related litigation brought by states and local
governments against the three largest pharmaceutical distributors: McKesson, Cardinal Health
and AmerisourceBergen and manufacturer Janssen Pharmaceuticals Inc. and its parent
company Johnson & Johnson
Settlement terms
Under the terms of the settlements:
•The distributors will collectively pay up to $21 billion over 18 years
•Janssen and Johnson & Johnson will pay up to $5 billion over nine years, with up to $3.7
billion to be paid during the first three years
•Approximately $22.7 billion is earmarked for use by participating states and local
governments to remediate and abate the impacts of the opioid crisis
Dec. 14, 2021 Item #10 Page 1 of 21
• The total funding distributed will be determined by the overall degree of participation
by both litigating and non-litigating state and local governments1
• The substantial majority of the money is to be spent on opioid treatment and
prevention
• Each state’s share of the funding has been determined by agreement among the states
using a formula that considers the impact of the opioid crisis on the state – the number
of overdose deaths, the number of residents with substance use disorder, and the
number of opioids prescribed – and the population of the state
The settlements also include requirements on the distributors intended to help prevent this
type of crisis from reoccurring. The settlements will result in court orders requiring the
distributors, for a period of 10 years, to:
• Establish a centralized independent clearinghouse to provide the distributors and state
regulators with aggregated data and analytics about where drugs are going and how
often, eliminating blind spots in the current systems used by distributors
• Use data-driven systems to detect suspicious opioid orders from customer pharmacies
• Terminate customer pharmacies’ ability to receive shipments, and report those
companies to state regulators when they show certain signs of drug diversion
• Report and prohibit shipping of suspicious opioid orders
• Prohibit sales staff from influencing decisions related to identifying suspicious opioid
orders
• Require senior corporate officials to engage in regular oversight of anti-diversion efforts
The settlements will also result in court orders requiring Janssen and Johnson & Johnson to:
• Stop selling opioids for 10 years
• Not fund or provide grants to third parties for promoting opioids
• Not lobby on activities related to opioids
• Share clinical trial data under the Yale University Open Data Access Project
Approval of the settlements is contingent on a critical mass of states and local governments
participating in the settlements. To bring the maximum amount of money – approximately
$2.36 billion – into California, the settlements require local governments, whether they have
filed a lawsuit or not, to join the settlements.
More information on the litigation and settlements, including full copies of the settlement
agreements, can be found on the National Opioids Settlement website.
1 The litigating state and local governments, that is, those that were parties to the litigation, include the State of
California and 79 of its cities and counties. Carlsbad is a non-litigating local government.
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Allocation of settlement funds in California
California may receive up to $1.8 billion from the distributors settlement and up to $423 million
from the Janssen and Johnson & Johnson settlement. The exact dollar amounts the state will
receive will depend on the number of local jurisdictions that join the settlement agreements.
A statewide working group of more than 20 city and county litigants coordinated with the
California Attorney General’s Office to create an equitable intrastate allocation of the funds
that will flow to California. The working group developed two agreements, one for each
settlement. They are the Proposed California State-Subdivision Agreements Regarding
Distribution and Use of Settlements Funds – Distributor Settlement and the Proposed California
State-Subdivision Agreements Regarding Distribution and Use of Settlements Funds – Janssen
Settlement. Copies of these agreements are also available on the National Opioids Settlement
website.
According to the intrastate allocation agreements, 70% of the funds received by the state will
be distributed among eligible local jurisdictions. The City of Carlsbad will receive approximately
0.1050485% of the funds distributed to eligible local jurisdictions from the distributors
settlement and approximately 0.1961456% of the funds distributed to eligible local jurisdictions
from the Janssen and Johnson & Johnson settlement. The distributors will make payments over
an 18-year period, while Janssen and Johnson & Johnson will make payments over a nine-year
period. The exact dollar amounts that the city will receive will depend on the amount that the
state receives, which will be determined by the number of cities and counties that join the
settlement agreements.
The working group based the intrastate allocation of funds on nationally available federal data
on opioid use disorder, overdose deaths and opioid shipments into California. Acceptance of
the intrastate allocation agreements is a condition of the city joining either or both settlements.
The intrastate allocation agreements will not be finalized unless enough local jurisdictions sign
on to the agreements.
Use of the settlement proceeds
The city has the choice of receiving direct payment of the settlement proceeds or allowing all or
part of its share of the settlement proceeds to be distributed to San Diego County. If the city
receives direct payment of the proceeds, at least 50% of the proceeds received in each calendar
year must be spent on one or more of the following “high impact abatement activities”:
• The provision of matching funds or operating costs for substance use disorder facilities
within the Behavioral Health Continuum Infrastructure Program
• Creating new or expanded substance use disorder treatment infrastructure
• Addressing the needs of communities of color and vulnerable populations (including
sheltered and unsheltered homeless populations) that are disproportionately impacted
by substance use disorder
• Diversion of people with substance use disorder from the justice system into treatment,
including by providing training and resources to first and early responders (sworn and
non-sworn) and implementing best practices for outreach, diversion and deflection,
employability, restorative justice and harm reduction
• Interventions to prevent drug addiction in vulnerable youth.
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The remaining 50% may be spent on these activities or the list of approved opioid remediation
uses in Exhibit 2.
If the city allows all or part of its share of the settlement proceeds to be distributed to the
county, the county must use the proceeds for similar activities. However, the county would not
be obliged to use the proceeds for activities exclusively within Carlsbad.
Unless the City Council directs otherwise, the City Attorney will inform the Settlement Fund
Administrator that the city requests direct payment of the settlement proceeds. The city may
change this election at any time.
Participation
If the city wishes to participate the settlements, the city must adopt a resolution (Exhibit 1)
authorizing a representative, which is proposed to be the City Attorney, to sign the required
participation documents. The documents must be signed by Jan. 2, 2022.
Options
If the city does not participate in the settlements, its share of the settlement proceeds will go to
the State of California. However, since the settlement amount California receives is dependent
upon the participation rate of cities and counties, the total amount that California receives may
be reduced if the city declines to participate.
Fiscal Analysis
The city will not be able to determine the exact dollar amount of the settlement funds that will
be paid to the city until the settlement agreements become final, which will not occur until
after the Jan. 2, 2022 participation deadline. Based on the estimated amount that the State of
California may receive and the approximate percentages designated for the City of Carlsbad
contained in the intrastate allocation agreements, the city could receive up to about $1,323,600
over 18 years from the distributors settlement and up to approximately $580,800 over 9 years
from the Janssen and Johnson & Johnson settlement.
Next Steps
If the City Council adopts the resolution, the City Attorney will sign the necessary documents for
the City of Carlsbad to participate in the national opioids settlements. The City Manager will
provide the City Council with more information about potential uses of the city’s share of the
settlement proceeds at a later date.
Environmental Evaluation
The recommended action does not constitute a “project” within the meaning of the California
Environmental Quality Act under California Public Resources Code Section 21065 in that it has
no potential to cause either a direct physical change in the environment or a reasonably
foreseeable indirect physical change in the environment.
Public Notification and Outreach
This item was noticed in keeping with the state's Ralph M. Brown Act and it was available for
public viewing and review at least 72 hours before the scheduled meeting date.
Exhibits
1. City Council resolution
2. List of opioid remediation uses
Dec. 14, 2021 Item #10 Page 4 of 21
RESOLUTION NO. 2021-285
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CARLSBAD,
CALIFORNIA, AUTHORIZING THE CITY ATTORNEY TO SIGN THE NECESSARY
DOCUMENTS FOR THE CITY OF CARLSBAD TO PARTICIPATE IN THE
NATIONAL OPIOID SETTLEMENTS
WHEREAS, the National Prescription Opiate Litigation Multidistrict Litigation Plaintiffs
Executive Committee, several state attorneys general, including the California Attorney General, and
four major defendants have agreed on the terms of proposed nationwide settlements to resolve al·
opioid litigation brought by states and local governments against the three largest pharmaceutica
distributors: McKesson, Cardinal Health and AmerisourceBergen, and manufacturer Jansser
Pharmaceuticals, Inc. and its parent company Johnson & Johnson; and
WHEREAS, the deadline for eligible cities and counties to join these settlements is Jan. 2, 2022.
and
WHEREAS, the settlements will provide substantial funds for the abatement of the opioid
epidemic in California and throughout the United States, and they will require changes in the way that
the settling defendants conduct their business; and
WHEREAS, the amount of funds received by the State of California is dependent on the number
of local jurisdictions participating in the settlements; and
WHEREAS, the State of California, and counsel representing a group of California cities and
counties, have reached agreement on a proposed intrastate allocation of funds California may receive
from the settlements; arid
WHEREAS, the City of Carlsbad will not receive a portion of the settlement funds and the State
of California may receive less settlement funds unless the City of Carlsbad elects to participate in the
settlements; and
WHEREAS, the City Council of the City of Carlsbad has determined that it is in the best interest
of the City of Carlsbad to participate in the settlements.
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Carlsbad, California, as
follows:
1. That the above recitations are true and correct.
2. That the City Attorney is authorized to sign the necessary documents for the City of
Carlsbad to participate in the National Opioids Settlements.
EXHIBIT 2
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EXHIBIT E
List of Opioid Remediation Uses
Schedule A
Core Strategies
States and Qualifying Block Grantees shall choose from among the abatement strategies listed in
Schedule B. However, priority shall be given to the following core abatement strategies (“Core
Strategies”).14
A.NALOXONE OR OTHER FDA-APPROVED DRUG TO
REVERSE OPIOID OVERDOSES
1.Expand training for first responders, schools, community
support groups and families; and
2.Increase distribution to individuals who are uninsured or
whose insurance does not cover the needed service.
B.MEDICATION-ASSISTED TREATMENT (“MAT”)
DISTRIBUTION AND OTHER OPIOID-RELATED
TREATMENT
1.Increase distribution of MAT to individuals who are
uninsured or whose insurance does not cover the needed
service;
2.Provide education to school-based and youth-focused
programs that discourage or prevent misuse;
3.Provide MAT education and awareness training to
healthcare providers, EMTs, law enforcement, and other
first responders; and
4.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 and with other
support services.
14 As used in this Schedule A, words like “expand,” “fund,” “provide” or the like shall not indicate a preference for
new or existing programs.
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C.PREGNANT & POSTPARTUM WOMEN
1.Expand Screening, Brief Intervention, and Referral to
Treatment (“SBIRT”) services to non-Medicaid eligible or
uninsured pregnant women;
2.Expand comprehensive evidence-based treatment and
recovery services, including MAT, for women with co-
occurring Opioid Use Disorder (“OUD”) and other
Substance Use Disorder (“SUD”)/Mental Health disorders
for uninsured individuals for up to 12 months postpartum;
and
3.Provide comprehensive wrap-around services to individuals
with OUD, including housing, transportation, job
placement/training, and childcare.
D.EXPANDING TREATMENT FOR NEONATAL
ABSTINENCE SYNDROME (“NAS”)
1.Expand comprehensive evidence-based and recovery
support for NAS babies;
2.Expand services for better continuum of care with infant-
need dyad; and
3.Expand long-term treatment and services for medical
monitoring of NAS babies and their families.
E.EXPANSION OF WARM HAND-OFF PROGRAMS AND
RECOVERY SERVICES
1.Expand services such as navigators and on-call teams to
begin MAT in hospital emergency departments;
2.Expand warm hand-off services to transition to recovery
services;
3.Broaden scope of recovery services to include co-occurring
SUD or mental health conditions;
4.Provide comprehensive wrap-around services to individuals
in recovery, including housing, transportation, job
placement/training, and childcare; and
5.Hire additional social workers or other behavioral health
workers to facilitate expansions above.
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F.TREATMENT FOR INCARCERATED POPULATION
1.Provide evidence-based treatment and recovery support,
including MAT for persons with OUD and co-occurring
SUD/MH disorders within and transitioning out of the
criminal justice system; and
2.Increase funding for jails to provide treatment to inmates
with OUD.
G.PREVENTION PROGRAMS
1.Funding for media campaigns to prevent opioid use (similar
to the FDA’s “Real Cost” campaign to prevent youth from
misusing tobacco);
2.Funding for evidence-based prevention programs in
schools;
3.Funding for medical provider education and outreach
regarding best prescribing practices for opioids consistent
with the 2016 CDC guidelines, including providers at
hospitals (academic detailing);
4.Funding for community drug disposal programs; and
5.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.
H.EXPANDING SYRINGE SERVICE PROGRAMS
1.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.
I.EVIDENCE-BASED DATA COLLECTION AND
RESEARCH ANALYZING THE EFFECTIVENESS OF THE
ABATEMENT STRATEGIES WITHIN THE STATE
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Schedule B
Approved Uses
Support treatment of Opioid Use Disorder (OUD) and any co-occurring Substance Use Disorder
or Mental Health (SUD/MH) conditions through evidence-based or evidence-informed programs
or strategies that may include, but are not limited to, the following:
PART ONE: TREATMENT
A.TREAT OPIOID USE DISORDER (OUD)
Support treatment of Opioid Use Disorder (“OUD”) and any co-occurring Substance Use
Disorder or Mental Health (“SUD/MH”) conditions through evidence-based or evidence-
informed programs or strategies that may include, but are not limited to, those that:15
1.Expand availability of treatment for OUD and any co-occurring SUD/MH
conditions, including all forms of Medication-Assisted Treatment (“MAT”)
approved by the U.S. Food and Drug Administration.
2.Support and reimburse evidence-based services that adhere to the American
Society of Addiction Medicine (“ASAM”) continuum of care for OUD and any co-
occurring SUD/MH conditions.
3.Expand telehealth to increase access to treatment for OUD and any co-occurring
SUD/MH conditions, including MAT, as well as counseling, psychiatric support,
and other treatment and recovery support services.
4.Improve oversight of Opioid Treatment Programs (“OTPs”) to assure evidence-
based or evidence-informed practices such as adequate methadone dosing and low
threshold approaches to treatment.
5.Support mobile intervention, treatment, and recovery services, offered by
qualified professionals and service providers, such as peer recovery coaches, for
persons with OUD and any co-occurring SUD/MH conditions and for persons
who have experienced an opioid overdose.
6.Provide treatment of trauma for individuals with OUD (e.g., violence, sexual
assault, human trafficking, or adverse childhood experiences) and family
members (e.g., surviving family members after an overdose or overdose fatality),
and training of health care personnel to identify and address such trauma.
7.Support evidence-based withdrawal management services for people with OUD
and any co-occurring mental health conditions.
15 As used in this Schedule B, words like “expand,” “fund,” “provide” or the like shall not indicate a preference for
new or existing programs.
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8.Provide training on MAT for health care providers, first responders, students, or
other supporting professionals, such as peer recovery coaches or recovery
outreach specialists, including telementoring to assist community-based providers
in rural or underserved areas.
9.Support workforce development for addiction professionals who work with
persons with OUD and any co-occurring SUD/MH conditions.
10.Offer fellowships for addiction medicine specialists for direct patient care,
instructors, and clinical research for treatments.
11.Offer scholarships and supports for behavioral health practitioners or workers
involved in addressing OUD and any co-occurring SUD/MH or mental health
conditions, including, but not limited to, training, scholarships, fellowships, loan
repayment programs, or other incentives for providers to work in rural or
underserved areas.
12.Provide funding and training for clinicians to obtain a waiver under the federal
Drug Addiction Treatment Act of 2000 (“DATA 2000”) to prescribe MAT for
OUD, and provide technical assistance and professional support to clinicians who
have obtained a DATA 2000 waiver.
13.Disseminate of web-based training curricula, such as the American Academy of
Addiction Psychiatry’s Provider Clinical Support Service–Opioids web-based
training curriculum and motivational interviewing.
14.Develop and disseminate new curricula, such as the American Academy of
Addiction Psychiatry’s Provider Clinical Support Service for Medication–
Assisted Treatment.
B.SUPPORT PEOPLE IN TREATMENT AND RECOVERY
Support people in recovery from OUD and any co-occurring SUD/MH conditions
through evidence-based or evidence-informed programs or strategies that may include,
but are not limited to, the programs or strategies that:
1.Provide comprehensive wrap-around services to individuals with OUD and any
co-occurring SUD/MH conditions, including housing, transportation, education,
job placement, job training, or childcare.
2.Provide the full continuum of care of treatment and recovery services for OUD
and any co-occurring SUD/MH conditions, including supportive housing, peer
support services and counseling, community navigators, case management, and
connections to community-based services.
3.Provide counseling, peer-support, recovery case management and residential
treatment with access to medications for those who need it to persons with OUD
and any co-occurring SUD/MH conditions.
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4.Provide access to housing for people with OUD and any co-occurring SUD/MH
conditions, including supportive housing, recovery housing, housing assistance
programs, training for housing providers, or recovery housing programs that allow
or integrate FDA-approved mediation with other support services.
5.Provide community support services, including social and legal services, to assist
in deinstitutionalizing persons with OUD and any co-occurring SUD/MH
conditions.
6.Support or expand peer-recovery centers, which may include support groups,
social events, computer access, or other services for persons with OUD and any
co-occurring SUD/MH conditions.
7.Provide or support transportation to treatment or recovery programs or services
for persons with OUD and any co-occurring SUD/MH conditions.
8.Provide employment training or educational services for persons in treatment for
or recovery from OUD and any co-occurring SUD/MH conditions.
9.Identify successful recovery programs such as physician, pilot, and college
recovery programs, and provide support and technical assistance to increase the
number and capacity of high-quality programs to help those in recovery.
10.Engage non-profits, faith-based communities, and community coalitions to
support people in treatment and recovery and to support family members in their
efforts to support the person with OUD in the family.
11.Provide training and development of procedures for government staff to
appropriately interact and provide social and other services to individuals with or
in recovery from OUD, including reducing stigma.
12.Support stigma reduction efforts regarding treatment and support for persons with
OUD, including reducing the stigma on effective treatment.
13.Create or support culturally appropriate services and programs for persons with
OUD and any co-occurring SUD/MH conditions, including new Americans.
14.Create and/or support recovery high schools.
15.Hire or train behavioral health workers to provide or expand any of the services or
supports listed above.
C.CONNECT PEOPLE WHO NEED HELP TO THE HELP THEY NEED
(CONNECTIONS TO CARE)
Provide connections to care for people who have—or are at risk of developing—OUD
and any co-occurring SUD/MH conditions through evidence-based or evidence-informed
programs or strategies that may include, but are not limited to, those that:
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1.Ensure that health care providers are screening for OUD and other risk factors and
know how to appropriately counsel and treat (or refer if necessary) a patient for
OUD treatment.
2.Fund SBIRT programs to reduce the transition from use to disorders, including
SBIRT services to pregnant women who are uninsured or not eligible for
Medicaid.
3.Provide training and long-term implementation of SBIRT in key systems (health,
schools, colleges, criminal justice, and probation), with a focus on youth and
young adults when transition from misuse to opioid disorder is common.
4.Purchase automated versions of SBIRT and support ongoing costs of the
technology.
5.Expand services such as navigators and on-call teams to begin MAT in hospital
emergency departments.
6.Provide training for emergency room personnel treating opioid overdose patients
on post-discharge planning, including community referrals for MAT, recovery
case management or support services.
7.Support hospital programs that transition persons with OUD and any co-occurring
SUD/MH conditions, or persons who have experienced an opioid overdose, into
clinically appropriate follow-up care through a bridge clinic or similar approach.
8.Support crisis stabilization centers that serve as an alternative to hospital
emergency departments for persons with OUD and any co-occurring SUD/MH
conditions or persons that have experienced an opioid overdose.
9.Support the work of Emergency Medical Systems, including peer support
specialists, to connect individuals to treatment or other appropriate services
following an opioid overdose or other opioid-related adverse event.
10.Provide funding for peer support specialists or recovery coaches in emergency
departments, detox facilities, recovery centers, recovery housing, or similar
settings; offer services, supports, or connections to care to persons with OUD and
any co-occurring SUD/MH conditions or to persons who have experienced an
opioid overdose.
11.Expand warm hand-off services to transition to recovery services.
12.Create or support school-based contacts that parents can engage with to seek
immediate treatment services for their child; and support prevention, intervention,
treatment, and recovery programs focused on young people.
13.Develop and support best practices on addressing OUD in the workplace.
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14.Support assistance programs for health care providers with OUD.
15.Engage non-profits and the faith community as a system to support outreach for
treatment.
16.Support centralized call centers that provide information and connections to
appropriate services and supports for persons with OUD and any co-occurring
SUD/MH conditions.
D.ADDRESS THE NEEDS OF CRIMINAL JUSTICE-INVOLVED PERSONS
Address the needs of persons with OUD and any co-occurring SUD/MH conditions who
are involved in, are at risk of becoming involved in, or are transitioning out of the
criminal justice system through evidence-based or evidence-informed programs or
strategies that may include, but are not limited to, those that:
1.Support pre-arrest or pre-arraignment diversion and deflection strategies for
persons with OUD and any co-occurring SUD/MH conditions, including
established strategies such as:
1.Self-referral strategies such as the Angel Programs or the Police Assisted
Addiction Recovery Initiative (“PAARI”);
2.Active outreach strategies such as the Drug Abuse Response Team
(“DART”) model;
3.“Naloxone Plus” strategies, which work to ensure that individuals who
have received naloxone to reverse the effects of an overdose are then
linked to treatment programs or other appropriate services;
4.Officer prevention strategies, such as the Law Enforcement Assisted
Diversion (“LEAD”) model;
5.Officer intervention strategies such as the Leon County, Florida Adult
Civil Citation Network or the Chicago Westside Narcotics Diversion to
Treatment Initiative; or
6.Co-responder and/or alternative responder models to address OUD-related
911 calls with greater SUD expertise.
2.Support pre-trial services that connect individuals with OUD and any co-
occurring SUD/MH conditions to evidence-informed treatment, including MAT,
and related services.
3.Support treatment and recovery courts that provide evidence-based options for
persons with OUD and any co-occurring SUD/MH conditions.
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4.Provide evidence-informed treatment, including MAT, recovery support, harm
reduction, or other appropriate services to individuals with OUD and any co-
occurring SUD/MH conditions who are incarcerated in jail or prison.
5.Provide evidence-informed treatment, including MAT, recovery support, harm
reduction, or other appropriate services to individuals with OUD and any co-
occurring SUD/MH conditions who are leaving jail or prison or have recently left
jail or prison, are on probation or parole, are under community corrections
supervision, or are in re-entry programs or facilities.
6.Support critical time interventions (“CTI”), particularly for individuals living with
dual-diagnosis OUD/serious mental illness, and services for individuals who face
immediate risks and service needs and risks upon release from correctional
settings.
7.Provide training on best practices for addressing the needs of criminal justice-
involved persons with OUD and any co-occurring SUD/MH conditions to law
enforcement, correctional, or judicial personnel or to providers of treatment,
recovery, harm reduction, case management, or other services offered in
connection with any of the strategies described in this section.
E.ADDRESS THE NEEDS OF PREGNANT OR PARENTING WOMEN AND
THEIR FAMILIES, INCLUDING BABIES WITH NEONATAL ABSTINENCE
SYNDROME
Address the needs of pregnant or parenting women with OUD and any co-occurring
SUD/MH conditions, and the needs of their families, including babies with neonatal
abstinence syndrome (“NAS”), through evidence-based or evidence-informed programs
or strategies that may include, but are not limited to, those that:
1.Support evidence-based or evidence-informed treatment, including MAT,
recovery services and supports, and prevention services for pregnant women—or
women who could become pregnant—who have OUD and any co-occurring
SUD/MH conditions, and other measures to educate and provide support to
families affected by Neonatal Abstinence Syndrome.
2.Expand comprehensive evidence-based treatment and recovery services, including
MAT, for uninsured women with OUD and any co-occurring SUD/MH
conditions for up to 12 months postpartum.
3.Provide training for obstetricians or other healthcare personnel who work with
pregnant women and their families regarding treatment of OUD and any co-
occurring SUD/MH conditions.
4.Expand comprehensive evidence-based treatment and recovery support for NAS
babies; expand services for better continuum of care with infant-need dyad; and
expand long-term treatment and services for medical monitoring of NAS babies
and their families.
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5.Provide training to health care providers who work with pregnant or parenting
women on best practices for compliance with federal requirements that children
born with NAS get referred to appropriate services and receive a plan of safe care.
6.Provide child and family supports for parenting women with OUD and any co-
occurring SUD/MH conditions.
7.Provide enhanced family support and child care services for parents with OUD
and any co-occurring SUD/MH conditions.
8.Provide enhanced support for children and family members suffering trauma as a
result of addiction in the family; and offer trauma-informed behavioral health
treatment for adverse childhood events.
9.Offer home-based wrap-around services to persons with OUD and any co-
occurring SUD/MH conditions, including, but not limited to, parent skills
training.
10.Provide support for Children’s Services—Fund additional positions and services,
including supportive housing and other residential services, relating to children
being removed from the home and/or placed in foster care due to custodial opioid
use.
PART TWO: PREVENTION
F.PREVENT OVER-PRESCRIBING AND ENSURE APPROPRIATE
PRESCRIBING AND DISPENSING OF OPIOIDS
Support efforts to prevent over-prescribing and ensure appropriate prescribing and
dispensing of opioids through evidence-based or evidence-informed programs or
strategies that may include, but are not limited to, the following:
1.Funding medical provider education and outreach regarding best prescribing
practices for opioids consistent with the Guidelines for Prescribing Opioids for
Chronic Pain from the U.S. Centers for Disease Control and Prevention, including
providers at hospitals (academic detailing).
2.Training for health care providers regarding safe and responsible opioid
prescribing, dosing, and tapering patients off opioids.
3.Continuing Medical Education (CME) on appropriate prescribing of opioids.
4.Providing Support for non-opioid pain treatment alternatives, including training
providers to offer or refer to multi-modal, evidence-informed treatment of pain.
5.Supporting enhancements or improvements to Prescription Drug Monitoring
Programs (“PDMPs”), including, but not limited to, improvements that:
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1.Increase the number of prescribers using PDMPs;
2.Improve point-of-care decision-making by increasing the quantity, quality,
or format of data available to prescribers using PDMPs, by improving the
interface that prescribers use to access PDMP data, or both; or
3.Enable states to use PDMP data in support of surveillance or intervention
strategies, including MAT referrals and follow-up for individuals
identified within PDMP data as likely to experience OUD in a manner that
complies with all relevant privacy and security laws and rules.
6.Ensuring PDMPs incorporate available overdose/naloxone deployment data,
including the United States Department of Transportation’s Emergency Medical
Technician overdose database in a manner that complies with all relevant privacy
and security laws and rules.
7.Increasing electronic prescribing to prevent diversion or forgery.
8.Educating dispensers on appropriate opioid dispensing.
G.PREVENT MISUSE OF OPIOIDS
Support efforts to discourage or prevent misuse of opioids through evidence-based or
evidence-informed programs or strategies that may include, but are not limited to, the
following:
1.Funding media campaigns to prevent opioid misuse.
2.Corrective advertising or affirmative public education campaigns based on
evidence.
3.Public education relating to drug disposal.
4.Drug take-back disposal or destruction programs.
5.Funding community anti-drug coalitions that engage in drug prevention efforts.
6.Supporting community coalitions in implementing evidence-informed prevention,
such as reduced social access and physical access, stigma reduction—including
staffing, educational campaigns, support for people in treatment or recovery, or
training of coalitions in evidence-informed implementation, including the
Strategic Prevention Framework developed by the U.S. Substance Abuse and
Mental Health Services Administration (“SAMHSA”).
7.Engaging non-profits and faith-based communities as systems to support
prevention.
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8.Funding evidence-based prevention programs in schools or evidence-informed
school and community education programs and campaigns for students, families,
school employees, school athletic programs, parent-teacher and student
associations, and others.
9.School-based or youth-focused programs or strategies that have demonstrated
effectiveness in preventing drug misuse and seem likely to be effective in
preventing the uptake and use of opioids.
10.Create or support community-based education or intervention services for
families, youth, and adolescents at risk for OUD and any co-occurring SUD/MH
conditions.
11.Support evidence-informed programs or curricula to address mental health needs
of young people who may be at risk of misusing opioids or other drugs, including
emotional modulation and resilience skills.
12.Support greater access to mental health services and supports for young people,
including services and supports provided by school nurses, behavioral health
workers or other school staff, to address mental health needs in young people that
(when not properly addressed) increase the risk of opioid or another drug misuse.
H.PREVENT OVERDOSE DEATHS AND OTHER HARMS (HARM REDUCTION)
Support efforts to prevent or reduce overdose deaths or other opioid-related harms
through evidence-based or evidence-informed programs or strategies that may include,
but are not limited to, the following:
1.Increased availability and distribution of naloxone and other drugs that treat
overdoses for first responders, overdose patients, individuals with OUD and their
friends and family members, schools, community navigators and outreach
workers, persons being released from jail or prison, or other members of the
general public.
2.Public health entities providing free naloxone to anyone in the community.
3.Training and education regarding naloxone and other drugs that treat overdoses
for first responders, overdose patients, patients taking opioids, families, schools,
community support groups, and other members of the general public.
4.Enabling school nurses and other school staff to respond to opioid overdoses, and
provide them with naloxone, training, and support.
5.Expanding, improving, or developing data tracking software and applications for
overdoses/naloxone revivals.
6.Public education relating to emergency responses to overdoses.
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7.Public education relating to immunity and Good Samaritan laws.
8.Educating first responders regarding the existence and operation of immunity and
Good Samaritan laws.
9.Syringe service programs and other evidence-informed programs to reduce harms
associated with intravenous drug use, including supplies, staffing, space, peer
support services, referrals to treatment, fentanyl checking, connections to care,
and the full range of harm reduction and treatment services provided by these
programs.
10.Expanding access to testing and treatment for infectious diseases such as HIV and
Hepatitis C resulting from intravenous opioid use.
11.Supporting mobile units that offer or provide referrals to harm reduction services,
treatment, recovery supports, health care, or other appropriate services to persons
that use opioids or persons with OUD and any co-occurring SUD/MH conditions.
12.Providing training in harm reduction strategies to health care providers, students,
peer recovery coaches, recovery outreach specialists, or other professionals that
provide care to persons who use opioids or persons with OUD and any co-
occurring SUD/MH conditions.
13.Supporting screening for fentanyl in routine clinical toxicology testing.
PART THREE: OTHER STRATEGIES
I.FIRST RESPONDERS
In addition to items in section C, D and H relating to first responders, support the
following:
1.Education of law enforcement or other first responders regarding appropriate
practices and precautions when dealing with fentanyl or other drugs.
2.Provision of wellness and support services for first responders and others who
experience secondary trauma associated with opioid-related emergency events.
J.LEADERSHIP, PLANNING AND COORDINATION
Support efforts to provide leadership, planning, coordination, facilitations, training and
technical assistance to abate the opioid epidemic through activities, programs, or
strategies that may include, but are not limited to, the following:
1.Statewide, regional, local or community regional planning to identify root causes
of addiction and overdose, goals for reducing harms related to the opioid
epidemic, and areas and populations with the greatest needs for treatment
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intervention services, and to support training and technical assistance and other
strategies to abate the opioid epidemic described in this opioid abatement strategy
list.
2.A dashboard to (a) share reports, recommendations, or plans to spend opioid
settlement funds; (b) to show how opioid settlement funds have been spent; (c) to
report program or strategy outcomes; or (d) to track, share or visualize key opioid-
or health-related indicators and supports as identified through collaborative
statewide, regional, local or community processes.
3.Invest in infrastructure or staffing at government or not-for-profit agencies to
support collaborative, cross-system coordination with the purpose of preventing
overprescribing, opioid misuse, or opioid overdoses, treating those with OUD and
any co-occurring SUD/MH conditions, supporting them in treatment or recovery,
connecting them to care, or implementing other strategies to abate the opioid
epidemic described in this opioid abatement strategy list.
4.Provide resources to staff government oversight and management of opioid
abatement programs.
K.TRAINING
In addition to the training referred to throughout this document, support training to abate
the opioid epidemic through activities, programs, or strategies that may include, but are
not limited to, those that:
1.Provide funding for staff training or networking programs and services to improve
the capability of government, community, and not-for-profit entities to abate the
opioid crisis.
2.Support infrastructure and staffing for collaborative cross-system coordination to
prevent opioid misuse, prevent overdoses, and treat those with OUD and any co-
occurring SUD/MH conditions, or implement other strategies to abate the opioid
epidemic described in this opioid abatement strategy list (e.g., health care,
primary care, pharmacies, PDMPs, etc.).
L.RESEARCH
Support opioid abatement research that may include, but is not limited to, the following:
1.Monitoring, surveillance, data collection and evaluation of programs and
strategies described in this opioid abatement strategy list.
2.Research non-opioid treatment of chronic pain.
3.Research on improved service delivery for modalities such as SBIRT that
demonstrate promising but mixed results in populations vulnerable to
opioid use disorders.
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4.Research on novel harm reduction and prevention efforts such as the
provision of fentanyl test strips.
5.Research on innovative supply-side enforcement efforts such as improved
detection of mail-based delivery of synthetic opioids.
6.Expanded research on swift/certain/fair models to reduce and deter opioid
misuse within criminal justice populations that build upon promising
approaches used to address other substances (e.g., Hawaii HOPE and
Dakota 24/7).
7.Epidemiological surveillance of OUD-related behaviors in critical
populations, including individuals entering the criminal justice system,
including, but not limited to approaches modeled on the Arrestee Drug
Abuse Monitoring (“ADAM”) system.
8.Qualitative and quantitative research regarding public health risks and
harm reduction opportunities within illicit drug markets, including surveys
of market participants who sell or distribute illicit opioids.
9.Geospatial analysis of access barriers to MAT and their association with
treatment engagement and treatment outcomes.
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