Faced with an ongoing drug overdose epidemic that may have peaked in recent months but is still killing around 100,000 Americans each year, with fentanyl implicated in the great majority of deaths, the nation's governors are moving to get a grip on the problem. On Tuesday, the National Governors Association (NGA) released a roadmap to help support governors and state officials in developing policy solutions to address unprecedented opioid overdose rates. Titled Implementing Best Practices Across the Continuum of Care to Prevent Overdose [22], the roadmap outlines concrete solutions across the full spectrum of health services, from the foundations, to prevention, harm reduction, treatment, and recovery.
Developed in coordination with the O'Neill Institute at Georgetown University Law Center, the roadmap is based on the contributions of more than 30 subject matter experts and 20 states and territories -- providing governors with specific, actionable recommendations to prevent overdose across five pillars of the Substance Use Disorder Continuum of Care.
This is not the first time the governors have addressed the topic. In fact, this report can be seen as an update to the NGA's 2016 Roadmap [23], which covered much of the same territory. The latest iteration, however, reflects the evolving nature of the ongoing drug overdose epidemic and includes strategies specific to the rise of illicitly manufactured fentanyl.
The continued attention is needed. From 2019 to 2021, overdose death rates increased in all 50 states; death rates in 40 states increased by more than 25 percent. The national overdose death rate in 2021 reached 32.4 per 100,000 people, compared to 6.1 in 1999. Overdose deaths among adolescents increased 109 percent from 2019 to 2021, despite low youth substance use rates.
For each of the five pillars -- foundations, prevention, harm reduction, treatment, and recovery -- the NGA roadmap makes specific recommendations:
Foundations
- Establish a state government coordinating body to set a statewide vision for overdose prevention.
- Invest in state infrastructure to maximize resources.
- Seek and include the perspectives and leadership of people with a variety of lived experiences.
- Invest in evaluation and test new ideas. Promote evidence-based requirements for funded prevention initiatives.
- Nurture and grow a mental health and substance use workforce that reflects the populations served.
Prevention
- Champion and invest in initiatives that support family cohesion and well-being.
- Promote evidence-based requirements for funded prevention initiatives.
Harm Reduction
- Maximize federal resources and braid funding to promote health and reduce harm for people who use drugs.
- Implement targeted and low-barrier distribution strategies for overdose reversal agents (ORAs) such as naloxone.
- Champion changes that allow for the distribution of harm reduction tools.
Treatment
- Implement and invest in policies and programs that expand Medication for Opioid Use Disorder (MOUD) access beyond the office setting.
- Implement and invest in evidence-based treatment and access models.
- Maximize federal funding resources for treatment.
- Assess state-level policies that restrict access.
- Make all MOUD treatment forms available to those involved in the criminal legal system.
Recovery
- Foster communities that support recovery.
- Champion changes to policies to establish recovery residence standards.
- Invest in small businesses and community-based organizations led by and employing people with lived experience who represent the communities they serve.
The roadmap goes into gritty, granular detail on each of these recommendations and policy-makers and advocates alike would be well advised to dig deeper. Overall, the NGA provides a progressive, evidence-based approach to dealing with drug overdoses. There is much to apply here.