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The findings and conclusions in this presentation are those of the authors and do not necessarily
represent the official position of the Centers for Disease Control and Prevention.
Rapid Increase in Drug Overdose Death - Rates by County
2003 2012
2006 2018
SOURCE: NCHS Data Visualization Gallery
D e a t h s p e r 1 0 0 , 0 0 0 p o p u l a ti o
Waves of the U.S. Opioid Overdose Epidemic
6
TOTAL DEATHS 2013-2019 Cocaine-Involved 72,009
5 Other Psychostimulant-Involved 60,359
0
2000 2002 2004 2006 2008 2010 2012 2014 2016 2018
1 Year Change
Source: Mattson, Tanz, Quinn, Kariisa, Patel, and Davis (2021). MMWR. 70(6), 202
Death Rates
Polysubstance epidemic
driven by fentanyl
1 Year Change
Source: Gladden, O’Donnell, Mattson, Seth (2019)
State Unintentional Drug Overdose Reporting System
Note:: IMF is illicitly manufactured fentanyl. Refer to source for other footnotes
An Everybody Problem
The opioid overdose epidemic is impacting most
populations in America now
In 2019
• Opioid overdoses took the lives of 49,858 Americans in 2019.
This is a double the number in 2013 (25,052) and nearly 6
times the number in 2000 (8,047)
Source: Wilson et al (2020); Seth et al. (2018); and Hedegaard et al. (2020)
The Drug Overdose Epidemic Appears to Have Worsened During
COVID-19 Pandemic – By Drug Class
Percentage change in 12-months ending provisional Percentage change in 12-months ending provisional
count of all fatal overdoses count of fatal overdoses involving synthetic opioids
June 2019 to May 2020
50 STATES June 2019 to May 2020
36 STATES
SOURCE: CDC. Health Alert Network (HAN) No. 438 – Increase in Fatal Drug Overdoses Across the United States Driven by Synthetic Opioids Before and During the COVID-19 Pandemic. 2020.
Lifetime Prevalence of Substance Use and Mean
Number of Other Substances Used - 2018
Source: Compton, Valentin, and Dupont (2021) adapted from Eric Wish. Molecular Psychiatry, 26.1: 41-50.
Drug Use Patterns in the United States - 2019
Past Year Illicit Drug Use Past Year Initiates
(+400K)
(-301K)
(+105K)
(-261K)
(-100K)
1 in 5 People Aged 12
and Older Used Illicit (+154K)
Drugs in 2019 (-203K)
(-12K) Difference from 2018
in Parentheses.
(-21K)
Increase in BLUE
(-67K)
MILLIONS MILLIONS
Almost 20 percent INCREASE in users – over The number of past year initiates of substances declined
9.5 million more people – from 2015 alone in many categories from 2018
Source: Lin, Bohnert, Blow, Gordon, Ignacio, Kim, & Ilgen (2021). Addiction, 116(1), 96-104.
Polysubstance Use in the U.S.
Polysubstance use is not new and is common among persons
struggling with use disorders.
$1.2 TRILLION
6
Potency and Ease of Making, Trafficking, & Profiting
from Illicitly Fentanyl and Fentanyl Analogs
UNITED STATES
OPIOID OVERDOSE EPIDEMIC
7 Mixing or Co-Use of Illicit Fentanyl with Other Drugs –
Especially Cocaine and Methamphetamines
Two groups of people with two different
sets of needs
With Opioid Use Disorder
Need access
to services
Protect from
dangerous drugs
Expand the provision and use of naloxone and overdose
prevention education
we go from
here? Intervene early with individuals at the highest risk
for overdose
STRATEGIES
Guiding Principles
Division of Overdose Prevention
NATURE OF SUBSTANCE USE DISORDER: A substance use disorder is a chronic,
relapsing brain disease not a moral failing. Physiological changes in the body are
driving decision-making and use.
CONTEXT COUNTS: Substance use is influenced and reinforced by past and
present life experiences and circumstances. As a result, prevention, treatment,
& recovery activities need to attend to these life course and contextual factors.
DATA: Data are the bedrock of decision-making and action. Data guide what
we do, where we do it, and allow us to know if our actions are making a
difference.
PREVENTION: Prevention works. Evidence-based programs informed by data
and strengthened by partnerships can be tailored and scaled up.
RECOVERY: Recovery is possible. The public health sector can be a bridge and
linkage safety net to comprehensive treatment and recovery services.
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Guiding Principles
Division of Overdose Prevention
SYSTEM OF SUPPORT: We need a system of care and supports
that protects at every turn. Overdoses should never happen if that
system is optimized.
LIFT EACH OTHER UP: We need to end stigma and lift each other
up – individuals, families, and communities.
VULNERABLE POPULATIONS: It is important to address disparities
and social determinants of health that have impacted historically
underserved and/or vulnerable populations (e.g., minorities, the
homeless, and rural populations).
EQUITY: Achieving the highest level of health for all populations.
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Overdose Data to Action (OD2A)
Empower
Surveillance PDMPs Health System Public Safety Linkage to Care Consumers Local Response
DOSE Drug Overdose Surveillance and
Epidemiology System
OD2A
Morbidity
Getting more timely, comprehensive, localized, and actionable data
SUDORS State Unintentional Drug
Overdose Reporting System
Expanded Drugs: All drug overdose deaths. Not just opioid involved.
7 CDC priorities
OD2A
Innovative
Getting more timely, comprehensive, localized, and actionable data
CDC Guideline Implementation
Focus on four priority areas to maximize the uptake and use of the opioid prescribing
guideline for chronic pain outside of active cancer, palliative, & end-of-life care
Clinical Training
2 Educate providers through medical schools and ongoing continuing medical education
(CME) activities.
Academic Detailing
Fentanyl Toxicology Screening
https://www.cdc.gov/drugoverdose/pdf/pubs/2018-evidence-based-strategies.pdf
Example COOCLIs
Combatting Opioid Overdose through • Warm hand offs and targeted re-entry care coordination prior to
release from incarceration in Philadelphia, PA.
Community Level Intervention • Providing outreach and engagement to individuals and families with
(COOCLI) same-day supportive services in New York NY.
• Addressing the needs of mother and baby through a Plan of Safe
Care in Houston, TX
• Leverage bilingual and bicultural behavioral health support for case
management, recovery support services, and outreach in Boston,
MA.
• Using AmeriCorps Volunteers in Service to America (VISTA) to
implement prevention strategies in Colorado.
Ten Pilots
Planned
Opioid Rapid Response Program
Training Preparedness
Increase Workforce Build State Capabilities
Capacity
COMMUNITY
700+ COALITIONS
Drug Free
Communities
Program
Fentanyl
2016 Presence and status of fentanyl analogs in ORS states
Linkage to Care
2018 Prearrest diversion, drug courts, linkage upon release from
incarceration, post-overdose outreach, and safe stations.