Media Wiki - User contributions [en]

Expand School-Based Prevention Programs

2021-11-12T02:21:13Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

'''Stigma in School-Based Programs'''

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believed it would help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they used these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. Half of the students reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

 

'''Effectiveness of Different Kinds of School-Based Prevention Programs'''

Not all school-based programs are created equally. Researchers typically find that more traditional and common approaches, like Drug Abuse Resistance Education (D.A.R.E.), are ineffective.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448384/</ref> One study found that there should be a greater focus on risk factors specific to the students; and that programs targeting teens need to keep them as an individual in mind, as well as the teen developmental stage and their social context.<ref>https://www.sciencedirect.com/science/article/pii/S0091743596900614</ref>

Multiple studies have come to the same conclusion that the most effective programs in schools are interactive.<ref>https://lx.iriss.org.uk/sites/default/files/resources/0023318.pdf</ref> As opposed to non-interactive programs, those deemed interactive encourage active participation from every student. Active participation may look like classroom discussions or a lesson plan surrounding skills practice. Importantly, interactions should primarily occur between peers, not between students and the teacher. Non-interactive programs typically involve the teacher leading the class and often using most of the class period to teach via a presentation. When participatory activities are included, they typically involve interactions between the teacher and student, like answering questions, rather than between students.

Along with building self-esteem and improving decision-making skills, school-based programs must also acknowledge the social environment that kids and adolescents live in when surrounded by their peers. Focusing on peer pressure and real-life encounters students may have with friends better prepares them to deal with uncomfortable situations. Studies have found that programs that focus solely on increasing self-esteem and encouraging good decision-making lack a focus on substances,<ref>https://lx.iriss.org.uk/sites/default/files/resources/0023318.pdf</ref> highlighting the importance of encouraging teachers to discuss topics they may view as taboo. Unless teachers discuss realistic scenarios, students will be ill-equipped to use the skills they learned inside the classroom when faced with peer pressure.

 

'''Effectiveness of School-Based Programs in Rural Communities'''

A meta-analysis regarding the general effectiveness of school-based programs in rural areas.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768124/</ref> Researchers concluded that students that benefited from the program the most did not use substances to begin with and were part of an interactive school-based program. It was also discovered that the lessons learned from the program had the greatest impact six months after its completion, and after that, positive effects began to decrease. The results exemplify the importance of starting preventive programs at a young age since those already using substances did not have a reduction in the use of new substances like those who were substance-free.

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

'''California''': Public schools are required to provide drug use education. Specifically, California law requires an anti-drug stance, which has been criticized by many. Due to lack of enforcement, it has not been followed by teachers around the state. So, while schools do ensure that substance use is being discussed in schools, strategies vary from abstinence-based to evidence-based curriculums.<ref>https://www.kqed.org/stateofhealth/363545/in-the-land-of-legal-weed-drug-education-moves-from-dont-to-delay</ref>

'''Connecticut''': In public schools, students at every grade level must learn about substances and how to avoid their harmful effects (CGS § 10-19(a)). Programs in elementary and secondary schools are required to be looked at by “public health and mental health and addiction services commissioners” to ensure it is a quality curriculum. <ref>https://www.cga.ct.gov/2002/rpt/2002-R-0140.htm</ref>

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

 

'''A Toolkit to Start Substance Use Prevention in Elementary Schools '''

Provides information and resources for elementary school teachers to begin teaching their students about substance use in an age-appropriate and evidence-based way. Examples of what this toolkit includes are ways to talk about the program with school administrators, parents, and students, as well as grants to apply for and examples of curriculums to teach.<ref>https://www.dellchildrens.net/wp-content/uploads/sites/60/2019/08/Substance-Use-Prevention-Toolkit-for-Elementary-Schools.pdf</ref>

 

'''Lesson Plan and Activity Finder'''

The National Institutes of Health created a database that allows teachers to look through lesson plans regarding substance use. The lowest grade level that the resources are aimed at is the fifth grade, and they go up until twelfth grade. There are options to choose either English or Spanish lesson plans.<ref>https://teens.drugabuse.gov/teachers/lessonplans?sort=revised_date:desc&language=en</ref>

 

'''Safety First: Real Drug Education for Teens- Sample Lesson Plan <ref>https://drugpolicy.org/sites/default/files/safety-first-sample-lesson_0.pdf </ref>'''

The Drug Policy Alliance created the first harm reduction-based substance education program in the United States aimed at high schoolers. It is intended for high school freshman and sophomore students and has fifteen lesson plans lasting around 45 minutes. They offer the entire curriculum after registering at this link:  [https://engage.drugpolicy.org/secure/download-safety-first-curriculum?_ga=2.96173340.1473889140.1636474296-215870604.1636330811 https://engage.drugpolicy.org/secure/download-safety-first-curriculum?_ga=2.96173340.1473889140.1636474296-215870604.1636330811]

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-12T02:20:56Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

'''Stigma in School-Based Programs'''

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believed it would help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they used these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. Half of the students reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

 

'''Effectiveness of Different Kinds of School-Based Prevention Programs'''

Not all school-based programs are created equally. Researchers typically find that more traditional and common approaches, like Drug Abuse Resistance Education (D.A.R.E.), are ineffective.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448384/</ref> One study found that there should be a greater focus on risk factors specific to the students; and that programs targeting teens need to keep them as an individual in mind, as well as the teen developmental stage and their social context.<ref>https://www.sciencedirect.com/science/article/pii/S0091743596900614</ref>

Multiple studies have come to the same conclusion that the most effective programs in schools are interactive.<ref>https://lx.iriss.org.uk/sites/default/files/resources/0023318.pdf</ref> As opposed to non-interactive programs, those deemed interactive encourage active participation from every student. Active participation may look like classroom discussions or a lesson plan surrounding skills practice. Importantly, interactions should primarily occur between peers, not between students and the teacher. Non-interactive programs typically involve the teacher leading the class and often using most of the class period to teach via a presentation. When participatory activities are included, they typically involve interactions between the teacher and student, like answering questions, rather than between students.

Along with building self-esteem and improving decision-making skills, school-based programs must also acknowledge the social environment that kids and adolescents live in when surrounded by their peers. Focusing on peer pressure and real-life encounters students may have with friends better prepares them to deal with uncomfortable situations. Studies have found that programs that focus solely on increasing self-esteem and encouraging good decision-making lack a focus on substances,<ref>https://lx.iriss.org.uk/sites/default/files/resources/0023318.pdf</ref> highlighting the importance of encouraging teachers to discuss topics they may view as taboo. Unless teachers discuss realistic scenarios, students will be ill-equipped to use the skills they learned inside the classroom when faced with peer pressure.

 

'''Effectiveness of School-Based Programs in Rural Communities'''

A meta-analysis regarding the general effectiveness of school-based programs in rural areas.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768124/</ref> Researchers concluded that students that benefited from the program the most did not use substances to begin with and were part of an interactive school-based program. It was also discovered that the lessons learned from the program had the greatest impact six months after its completion, and after that, positive effects began to decrease. The results exemplify the importance of starting preventive programs at a young age since those already using substances did not have a reduction in the use of new substances like those who were substance-free.

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

'''California''': Public schools are required to provide drug use education. Specifically, California law requires an anti-drug stance, which has been criticized by many. Due to lack of enforcement, it has not been followed by teachers around the state. So, while schools do ensure that substance use is being discussed in schools, strategies vary from abstinence-based to evidence-based curriculums.<ref>https://www.kqed.org/stateofhealth/363545/in-the-land-of-legal-weed-drug-education-moves-from-dont-to-delay</ref>

'''Connecticut''': In public schools, students at every grade level must learn about substances and how to avoid their harmful effects (CGS § 10-19(a)). Programs in elementary and secondary schools are required to be looked at by “public health and mental health and addiction services commissioners” to ensure it is a quality curriculum. <ref>https://www.cga.ct.gov/2002/rpt/2002-R-0140.htm</ref>

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

 

'''A Toolkit to Start Substance Use Prevention in Elementary Schools '''

Provides information and resources for elementary school teachers to begin teaching their students about substance use in an age-appropriate and evidence-based way. Examples of what this toolkit includes are ways to talk about the program with school administrators, parents, and students, as well as grants to apply for and examples of curriculums to teach.<ref>https://www.dellchildrens.net/wp-content/uploads/sites/60/2019/08/Substance-Use-Prevention-Toolkit-for-Elementary-Schools.pdf</ref>

'''Lesson Plan and Activity Finder'''

The National Institutes of Health created a database that allows teachers to look through lesson plans regarding substance use. The lowest grade level that the resources are aimed at is the fifth grade, and they go up until twelfth grade. There are options to choose either English or Spanish lesson plans.<ref>https://teens.drugabuse.gov/teachers/lessonplans?sort=revised_date:desc&language=en</ref>

'''Safety First: Real Drug Education for Teens- Sample Lesson Plan <ref>https://drugpolicy.org/sites/default/files/safety-first-sample-lesson_0.pdf </ref>'''

The Drug Policy Alliance created the first harm reduction-based substance education program in the United States aimed at high schoolers. It is intended for high school freshman and sophomore students and has fifteen lesson plans lasting around 45 minutes. They offer the entire curriculum after registering at this link:  [https://engage.drugpolicy.org/secure/download-safety-first-curriculum?_ga=2.96173340.1473889140.1636474296-215870604.1636330811 https://engage.drugpolicy.org/secure/download-safety-first-curriculum?_ga=2.96173340.1473889140.1636474296-215870604.1636330811]

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-12T02:18:28Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

'''Stigma in School-Based Programs'''

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believed it would help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they used these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. Half of the students reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

'''Effectiveness of Different Kinds of School-Based Prevention Programs'''

Not all school-based programs are created equally. Researchers typically find that more traditional and common approaches, like Drug Abuse Resistance Education (D.A.R.E.), are ineffective.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448384/</ref> One study found that there should be a greater focus on risk factors specific to the students; and that programs targeting teens need to keep them as an individual in mind, as well as the teen developmental stage and their social context.<ref>https://www.sciencedirect.com/science/article/pii/S0091743596900614</ref>

Multiple studies have come to the same conclusion that the most effective programs in schools are interactive.<ref>https://lx.iriss.org.uk/sites/default/files/resources/0023318.pdf</ref> As opposed to non-interactive programs, those deemed interactive encourage active participation from every student. Active participation may look like classroom discussions or a lesson plan surrounding skills practice. Importantly, interactions should primarily occur between peers, not between students and the teacher. Non-interactive programs typically involve the teacher leading the class and often using most of the class period to teach via a presentation. When participatory activities are included, they typically involve interactions between the teacher and student, like answering questions, rather than between students.

Along with building self-esteem and improving decision-making skills, school-based programs must also acknowledge the social environment that kids and adolescents live in when surrounded by their peers. Focusing on peer pressure and real-life encounters students may have with friends better prepares them to deal with uncomfortable situations. Studies have found that programs that focus solely on increasing self-esteem and encouraging good decision-making lack a focus on substances,<ref>https://lx.iriss.org.uk/sites/default/files/resources/0023318.pdf</ref> highlighting the importance of encouraging teachers to discuss topics they may view as taboo. Unless teachers discuss realistic scenarios, students will be ill-equipped to use the skills they learned inside the classroom when faced with peer pressure.

'''Effectiveness of School-Based Programs in Rural Communities'''

A meta-analysis regarding the general effectiveness of school-based programs in rural areas.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768124/</ref> Researchers concluded that students that benefited from the program the most did not use substances to begin with and were part of an interactive school-based program. It was also discovered that the lessons learned from the program had the greatest impact six months after its completion, and after that, positive effects began to decrease. The results exemplify the importance of starting preventive programs at a young age since those already using substances did not have a reduction in the use of new substances like those who were substance-free.

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

'''California''': Public schools are required to provide drug use education. Specifically, California law requires an anti-drug stance, which has been criticized by many. Due to lack of enforcement, it has not been followed by teachers around the state. So, while schools do ensure that substance use is being discussed in schools, strategies vary from abstinence-based to evidence-based curriculums.<ref>https://www.kqed.org/stateofhealth/363545/in-the-land-of-legal-weed-drug-education-moves-from-dont-to-delay</ref>

'''Connecticut''': In public schools, students at every grade level must learn about substances and how to avoid their harmful effects (CGS § 10-19(a)). Programs in elementary and secondary schools are required to be looked at by “public health and mental health and addiction services commissioners” to ensure it is a quality curriculum. <ref>https://www.cga.ct.gov/2002/rpt/2002-R-0140.htm</ref>

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

 

'''A Toolkit to Start Substance Use Prevention in Elementary Schools '''

Provides information and resources for elementary school teachers to begin teaching their students about substance use in an age-appropriate and evidence-based way. Examples of what this toolkit includes are ways to talk about the program with school administrators, parents, and students, as well as grants to apply for and examples of curriculums to teach.<ref>https://www.dellchildrens.net/wp-content/uploads/sites/60/2019/08/Substance-Use-Prevention-Toolkit-for-Elementary-Schools.pdf</ref>

'''Lesson Plan and Activity Finder'''

The National Institutes of Health created a database that allows teachers to look through lesson plans regarding substance use. The lowest grade level that the resources are aimed at is the fifth grade, and they go up until twelfth grade. There are options to choose either English or Spanish lesson plans.<ref>https://teens.drugabuse.gov/teachers/lessonplans?sort=revised_date:desc&language=en</ref>

'''Safety First: Real Drug Education for Teens- Sample Lesson Plan <ref>https://drugpolicy.org/sites/default/files/safety-first-sample-lesson_0.pdf </ref>'''

The Drug Policy Alliance created the first harm reduction-based substance education program in the United States aimed at high schoolers. It is intended for high school freshman and sophomore students and has fifteen lesson plans lasting around 45 minutes. They offer the entire curriculum after registering at this link:  [https://engage.drugpolicy.org/secure/download-safety-first-curriculum?_ga=2.96173340.1473889140.1636474296-215870604.1636330811 https://engage.drugpolicy.org/secure/download-safety-first-curriculum?_ga=2.96173340.1473889140.1636474296-215870604.1636330811]

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-10T21:36:47Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

'''Stigma in School-Based Programs'''

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believe it will help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they use these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. Half of the students reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

'''Effectiveness of Different Kinds of School-Based Prevention Programs'''

Not all school-based programs are created equally. Researchers typically find that more traditional and common approaches, like Drug Abuse Resistance Education (D.A.R.E.), are ineffective.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448384/</ref> One study found that there should be a greater focus on risk factors specific to the students; and that programs targeting teens need to keep them as an individual in mind, as well as the teen developmental stage and their social context.<ref>https://www.sciencedirect.com/science/article/pii/S0091743596900614</ref>

Multiple studies have come to the same conclusion that the most effective programs in schools are interactive.<ref>https://lx.iriss.org.uk/sites/default/files/resources/0023318.pdf</ref> As opposed to non-interactive programs, those deemed interactive encourage active participation from every student. Active participation may look like classroom discussions or a lesson plan surrounding skills practice. Importantly, interactions should primarily occur between peers, not between students and the teacher. Non-interactive programs typically involve the teacher leading the class and often using most of the class period to teach via a presentation. When participatory activities are included, they typically involve interactions between the teacher and student, like answering questions, rather than between students.

Along with building self-esteem and improving decision-making skills, school-based programs must also acknowledge the social environment that kids and adolescents live in when surrounded by their peers. Focusing on peer pressure and real-life encounters students may have with friends better prepares them to deal with uncomfortable situations. Studies have found that programs that focus solely on increasing self-esteem and encouraging good decision-making lack a focus on substances,<ref>https://lx.iriss.org.uk/sites/default/files/resources/0023318.pdf</ref> highlighting the importance of encouraging teachers to discuss topics they may view as taboo. Unless teachers discuss realistic scenarios, students will be ill-equipped to use the skills they learned inside the classroom when faced with peer pressure.

'''Effectiveness of School-Based Programs in Rural Communities'''

A meta-analysis regarding the general effectiveness of school-based programs in rural areas.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768124/</ref> Researchers concluded that students that benefited from the program the most did not use substances to begin with and were part of an interactive school-based program. It was also discovered that the lessons learned from the program had the greatest impact six months after its completion, and after that, positive effects began to decrease. The results exemplify the importance of starting preventive programs at a young age since those already using substances did not have a reduction in the use of new substances like those who were substance-free.

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

'''California''': Public schools are required to provide drug use education. Specifically, California law requires an anti-drug stance, which has been criticized by many. Due to lack of enforcement, it has not been followed by teachers around the state. So, while schools do ensure that substance use is being discussed in schools, strategies vary from abstinence-based to evidence-based curriculums.<ref>https://www.kqed.org/stateofhealth/363545/in-the-land-of-legal-weed-drug-education-moves-from-dont-to-delay</ref>

'''Connecticut''': In public schools, students at every grade level must learn about substances and how to avoid their harmful effects (CGS § 10-19(a)). Programs in elementary and secondary schools are required to be looked at by “public health and mental health and addiction services commissioners” to ensure it is a quality curriculum. <ref>https://www.cga.ct.gov/2002/rpt/2002-R-0140.htm</ref>

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

 

'''A Toolkit to Start Substance Use Prevention in Elementary Schools '''

Provides information and resources for elementary school teachers to begin teaching their students about substance use in an age-appropriate and evidence-based way. Examples of what this toolkit includes are ways to talk about the program with school administrators, parents, and students, as well as grants to apply for and examples of curriculums to teach.<ref>https://www.dellchildrens.net/wp-content/uploads/sites/60/2019/08/Substance-Use-Prevention-Toolkit-for-Elementary-Schools.pdf</ref>

'''Lesson Plan and Activity Finder'''

The National Institutes of Health created a database that allows teachers to look through lesson plans regarding substance use. The lowest grade level that the resources are aimed at is the fifth grade, and they go up until twelfth grade. There are options to choose either English or Spanish lesson plans.<ref>https://teens.drugabuse.gov/teachers/lessonplans?sort=revised_date:desc&language=en</ref>

'''Safety First: Real Drug Education for Teens- Sample Lesson Plan <ref>https://drugpolicy.org/sites/default/files/safety-first-sample-lesson_0.pdf </ref>'''

The Drug Policy Alliance created the first harm reduction-based substance education program in the United States aimed at high schoolers. It is intended for high school freshman and sophomore students and has fifteen lesson plans lasting around 45 minutes. They offer the entire curriculum after registering at this link:  [https://engage.drugpolicy.org/secure/download-safety-first-curriculum?_ga=2.96173340.1473889140.1636474296-215870604.1636330811 https://engage.drugpolicy.org/secure/download-safety-first-curriculum?_ga=2.96173340.1473889140.1636474296-215870604.1636330811]

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-10T00:23:05Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

'''Stigma in School-Based Programs'''

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believe it will help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they use these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. Half of the students reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

'''Effectiveness of Different Kinds of School-Based Prevention Programs'''

Not all school-based programs are created equally. Researchers typically find that more traditional and common approaches, like Drug Abuse Resistance Education (D.A.R.E.), are ineffective.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448384/</ref> One study found that there should be a greater focus on risk factors specific to the students; and that programs targeting teens need to keep them as an individual in mind, as well as the teen developmental stage and their social context.<ref>https://www.sciencedirect.com/science/article/pii/S0091743596900614</ref>

Multiple studies have come to the same conclusion that the most effective programs in schools are interactive.<ref>https://lx.iriss.org.uk/sites/default/files/resources/0023318.pdf</ref> As opposed to non-interactive programs, those deemed interactive encourage active participation from every student. This may look like classroom discussions or a lesson plan surrounding skills practice. Importantly, interactions should primarily occur between peers, not between students and the teacher. Non-interactive programs typically involve the teacher leading the class and often using most of the class period to teach via a presentation. When participatory activities are included, they typically involve interactions between the teacher and student, like answering questions, rather than between students.

Along with building self-esteem and improving decision-making skills, school-based programs must also acknowledge the social environment that kids and adolescents live in when surrounded by their peers. Focusing on peer pressure and real-life encounters students may have with friends better prepares them to deal with uncomfortable situations. Studies have found that programs that focus solely on increasing self-esteem and encouraging good decision-making lack a focus on substances,<ref>https://lx.iriss.org.uk/sites/default/files/resources/0023318.pdf</ref> highlighting the importance of encouraging teachers to discuss topics they may view as taboo. Unless teachers discuss realistic scenarios, students will be ill-equipped to use the skills they learned inside the classroom when faced with peer pressure.

'''Effectiveness of School-Based Programs in Rural Communities'''

A meta-analysis regarding the general effectiveness of school-based programs in rural areas.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768124/</ref> Researchers concluded that students that benefited from the program the most did not use substances to begin with and were part of an interactive school-based program. It was also discovered that the lessons learned from the program had the greatest impact six months after its completion, and after that, positive effects began to decrease. The results exemplify the importance of starting preventive programs at a young age since those already using substances did not have a reduction in the use of new substances like those who were substance-free.

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

'''California''': Public schools are required to provide drug use education. Specifically, California law requires an anti-drug stance, which has been criticized by many. Due to lack of enforcement, it has not been followed by teachers around the state. So, while schools do ensure that substance use is being discussed in schools, strategies vary from abstinence-based to evidence-based curriculums.<ref>https://www.kqed.org/stateofhealth/363545/in-the-land-of-legal-weed-drug-education-moves-from-dont-to-delay</ref>

'''Connecticut''': In public schools, students at every grade level must learn about substances and how to avoid their harmful effects (CGS § 10-19(a)). Programs in elementary and secondary schools are required to be looked at by “public health and mental health and addiction services commissioners” to ensure it is a quality curriculum. <ref>https://www.cga.ct.gov/2002/rpt/2002-R-0140.htm</ref>

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

 

'''A Toolkit to Start Substance Use Prevention in Elementary Schools '''

Provides information and resources for elementary school teachers to begin teaching their students about substance use in an age-appropriate and evidence-based way. Examples of what this toolkit includes are ways to talk about the program with school administrators, parents, and students, as well as grants to apply for and examples of curriculums to teach.<ref>https://www.dellchildrens.net/wp-content/uploads/sites/60/2019/08/Substance-Use-Prevention-Toolkit-for-Elementary-Schools.pdf</ref>

'''Lesson Plan and Activity Finder'''

The National Institutes of Health created a database that allows teachers to look through lesson plans regarding substance use. The lowest grade level that the resources are aimed at is the fifth grade, and they go up until twelfth grade. There are options to choose either English or Spanish lesson plans.<ref>https://teens.drugabuse.gov/teachers/lessonplans?sort=revised_date:desc&language=en</ref>

'''Safety First: Real Drug Education for Teens- Sample Lesson Plan <ref>https://drugpolicy.org/sites/default/files/safety-first-sample-lesson_0.pdf </ref>'''

The Drug Policy Alliance created the first harm reduction-based substance education program in the United States aimed at high schoolers. It is intended for high school freshman and sophomore students and has fifteen lesson plans lasting around 45 minutes. They offer the entire curriculum after registering at this link:  [https://engage.drugpolicy.org/secure/download-safety-first-curriculum?_ga=2.96173340.1473889140.1636474296-215870604.1636330811 https://engage.drugpolicy.org/secure/download-safety-first-curriculum?_ga=2.96173340.1473889140.1636474296-215870604.1636330811]

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-09T16:36:53Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

'''Stigma in School-Based Programs'''

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believe it will help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they use these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. Half of the students reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

'''Effectiveness of School-Based Prevention Programs'''

Not all school-based programs are created equally. Researchers typically find that more traditional and common approaches, like Drug Abuse Resistance Education (D.A.R.E.), are ineffective.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448384/</ref> One study found that there should be a greater focus on risk factors specific to the students; and that programs targeting teens need to keep them as an individual in mind, as well as the teen developmental stage and their social context.<ref>https://www.sciencedirect.com/science/article/pii/S0091743596900614</ref>

Multiple studies have come to the same conclusion that the most effective programs in schools are interactive.<ref>https://lx.iriss.org.uk/sites/default/files/resources/0023318.pdf</ref> As opposed to non-interactive programs, those deemed interactive encourage active participation from every student. This may look like classroom discussions or a lesson plan surrounding skills practice. Importantly, interactions should primarily occur between peers, not between students and the teacher. Non-interactive programs typically involve the teacher leading the class and often using most of the class period to teach via a presentation. When participatory activities are included, they typically involve interactions between the teacher and student, like answering questions, rather than between students.

Along with building self-esteem and improving decision-making skills, school-based programs must also acknowledge the social environment that kids and adolescents live in when surrounded by their peers. Focusing on peer pressure and real-life encounters students may have with friends better prepares them to deal with uncomfortable situations. Studies have found that programs that focus solely on increasing self-esteem and encouraging good decision-making lack a focus on substances,<ref>https://lx.iriss.org.uk/sites/default/files/resources/0023318.pdf</ref> highlighting the importance of encouraging teachers to discuss topics they may view as taboo. Unless teachers discuss realistic scenarios, students will be ill-equipped to use the skills they learned inside the classroom when faced with peer pressure.

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

'''California''': Public schools are required to provide drug use education. Specifically, California law requires an anti-drug stance, which has been criticized by many. Due to lack of enforcement, it has not been followed by teachers around the state. So, while schools do ensure that substance use is being discussed in schools, strategies vary from abstinence-based to evidence-based curriculums.<ref>https://www.kqed.org/stateofhealth/363545/in-the-land-of-legal-weed-drug-education-moves-from-dont-to-delay</ref>

'''Connecticut''': In public schools, students at every grade level must learn about substances and how to avoid their harmful effects (CGS § 10-19(a)). Programs in elementary and secondary schools are required to be looked at by “public health and mental health and addiction services commissioners” to ensure it is a quality curriculum. <ref>https://www.cga.ct.gov/2002/rpt/2002-R-0140.htm</ref>

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

 

'''A Toolkit to Start Substance Use Prevention in Elementary Schools '''

Provides information and resources for elementary school teachers to begin teaching their students about substance use in an age-appropriate and evidence-based way. Examples of what this toolkit includes are ways to talk about the program with school administrators, parents, and students, as well as grants to apply for and examples of curriculums to teach.<ref>https://www.dellchildrens.net/wp-content/uploads/sites/60/2019/08/Substance-Use-Prevention-Toolkit-for-Elementary-Schools.pdf</ref>

'''Lesson Plan and Activity Finder'''

The National Institutes of Health created a database that allows teachers to look through lesson plans regarding substance use. The lowest grade level that the resources are aimed at is the fifth grade, and they go up until twelfth grade. There are options to choose either English or Spanish lesson plans.<ref>https://teens.drugabuse.gov/teachers/lessonplans?sort=revised_date:desc&language=en</ref>

'''Safety First: Real Drug Education for Teens- Sample Lesson Plan <ref>https://drugpolicy.org/sites/default/files/safety-first-sample-lesson_0.pdf </ref>'''

The Drug Policy Alliance created the first harm reduction-based substance education program in the United States aimed at high schoolers. It is intended for high school freshman and sophomore students and has fifteen lesson plans lasting around 45 minutes. They offer the entire curriculum after registering at this link:  [https://engage.drugpolicy.org/secure/download-safety-first-curriculum?_ga=2.96173340.1473889140.1636474296-215870604.1636330811 https://engage.drugpolicy.org/secure/download-safety-first-curriculum?_ga=2.96173340.1473889140.1636474296-215870604.1636330811]

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-09T16:09:30Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

'''Stigma in School-Based Programs'''

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believe it will help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they use these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. Half of the students reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

'''Effectiveness of School-Based Prevention Programs'''

Not all school-based programs are created equally. Researchers typically find that more traditional and common approaches, like Drug Abuse Resistance Education (D.A.R.E.), are ineffective.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448384/</ref> One study found that there should be a greater focus on risk factors specific to the students; and that programs targeting teens need to keep them as an individual in mind, as well as the teen developmental stage and their social context.<ref>https://www.sciencedirect.com/science/article/pii/S0091743596900614</ref>

Multiple studies have come to the same conclusion that the most effective programs in schools are interactive.<ref>https://lx.iriss.org.uk/sites/default/files/resources/0023318.pdf</ref> As opposed to non-interactive programs, those deemed interactive encourage active participation from every student. This may look like classroom discussions or a lesson plan surrounding skills practice. Importantly, interactions should primarily occur between peers, not between students and the teacher. Non-interactive programs typically involve the teacher leading the class and often using most of the class period to teach via a presentation. When participatory activities are included, they typically involve interactions between the teacher and student, like answering questions, rather than between students.

Along with building self-esteem and improving decision-making skills, school-based programs must also acknowledge the social environment that kids and adolescents live in when surrounded by their peers. Focusing on peer pressure and real-life encounters students may have with friends better prepares them to deal with uncomfortable situations. Studies have found that programs that focus solely on increasing self-esteem and encouraging good decision-making lack a focus on substances,<ref>https://lx.iriss.org.uk/sites/default/files/resources/0023318.pdf</ref> highlighting the importance of encouraging teachers to discuss topics they may view as taboo. Unless teachers discuss realistic scenarios, students will be ill-equipped to use the skills they learned inside the classroom when faced with peer pressure.

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

'''California''': Public schools are required to provide drug use education. Specifically, California law requires an anti-drug stance, which has been criticized by many. Due to lack of enforcement, it has not been followed by teachers around the state. So, while schools do ensure that substance use is being discussed in schools, strategies vary from abstinence-based to evidence-based curriculums.<ref>https://www.kqed.org/stateofhealth/363545/in-the-land-of-legal-weed-drug-education-moves-from-dont-to-delay</ref>

'''Connecticut''': In public schools, students at every grade level must learn about substances and how to avoid their harmful effects (CGS § 10-19(a)). Programs in elementary and secondary schools are required to be looked at by “public health and mental health and addiction services commissioners” to ensure it is a quality curriculum. <ref>https://www.cga.ct.gov/2002/rpt/2002-R-0140.htm</ref>

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

 

'''A Toolkit to Start Substance Use Prevention in Elementary Schools '''

Provides information and resources for elementary school teachers to begin teaching their students about substance use in an age-appropriate and evidence-based way. Examples of what this toolkit includes are ways to talk about the program with school administrators, parents, and students, as well as grants to apply for and examples of curriculums to teach.<ref>https://www.dellchildrens.net/wp-content/uploads/sites/60/2019/08/Substance-Use-Prevention-Toolkit-for-Elementary-Schools.pdf</ref>

'''Lesson Plan and Activity Finder'''

The National Institutes of Health created a database that allows teachers to look through lesson plans regarding substance use. The lowest grade level that the resources are aimed at is the fifth grade, and they go up until twelfth grade. There are options to choose either English or Spanish lesson plans.<ref>https://teens.drugabuse.gov/teachers/lessonplans?sort=revised_date:desc&language=en</ref>

 

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-09T16:07:53Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

'''Stigma in School-Based Programs'''

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believe it will help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they use these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. Half of the students reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

'''Effectiveness of School-Based Prevention Programs'''

Not all school-based programs are created equally. Researchers typically find that more traditional and common approaches, like Drug Abuse Resistance Education (D.A.R.E.), are ineffective.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448384/</ref> One study found that there should be a greater focus on risk factors specific to the students; and that programs targeting teens need to keep them as an individual in mind, as well as the teen developmental stage and their social context.

Multiple studies have come to the same conclusion that the most effective programs in schools are interactive.<ref>https://lx.iriss.org.uk/sites/default/files/resources/0023318.pdf</ref> As opposed to non-interactive programs, those deemed interactive encourage active participation from every student. This may look like classroom discussions or a lesson plan surrounding skills practice. Importantly, interactions should primarily occur between peers, not between students and the teacher. Non-interactive programs typically involve the teacher leading the class and often using most of the class period to teach via a presentation. When participatory activities are included, they typically involve interactions between the teacher and student, like answering questions, rather than between students.

Along with building self-esteem and improving decision-making skills, school-based programs must also acknowledge the social environment that kids and adolescents live in when surrounded by their peers. Focusing on peer pressure and real-life encounters students may have with friends better prepares them to deal with uncomfortable situations. Studies have found that programs that focus solely on increasing self-esteem and encouraging good decision-making lack a focus on substances,<ref>https://lx.iriss.org.uk/sites/default/files/resources/0023318.pdf</ref> highlighting the importance of encouraging teachers to discuss topics they may view as taboo. Unless teachers discuss realistic scenarios, students will be ill-equipped to use the skills they learned inside the classroom when faced with peer pressure.

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

'''California''': Public schools are required to provide drug use education. Specifically, California law requires an anti-drug stance, which has been criticized by many. Due to lack of enforcement, it has not been followed by teachers around the state. So, while schools do ensure that substance use is being discussed in schools, strategies vary from abstinence-based to evidence-based curriculums.<ref>https://www.kqed.org/stateofhealth/363545/in-the-land-of-legal-weed-drug-education-moves-from-dont-to-delay</ref>

'''Connecticut''': In public schools, students at every grade level must learn about substances and how to avoid their harmful effects (CGS § 10-19(a)). Programs in elementary and secondary schools are required to be looked at by “public health and mental health and addiction services commissioners” to ensure it is a quality curriculum. <ref>https://www.cga.ct.gov/2002/rpt/2002-R-0140.htm</ref>

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

 

'''A Toolkit to Start Substance Use Prevention in Elementary Schools '''

Provides information and resources for elementary school teachers to begin teaching their students about substance use in an age-appropriate and evidence-based way. Examples of what this toolkit includes are ways to talk about the program with school administrators, parents, and students, as well as grants to apply for and examples of curriculums to teach.<ref>https://www.dellchildrens.net/wp-content/uploads/sites/60/2019/08/Substance-Use-Prevention-Toolkit-for-Elementary-Schools.pdf</ref>

'''Lesson Plan and Activity Finder'''

The National Institutes of Health created a database that allows teachers to look through lesson plans regarding substance use. The lowest grade level that the resources are aimed at is the fifth grade, and they go up until twelfth grade. There are options to choose either English or Spanish lesson plans.<ref>https://teens.drugabuse.gov/teachers/lessonplans?sort=revised_date:desc&language=en</ref>

 

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-09T16:02:18Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

'''Stigma in School-Based Programs'''

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believe it will help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they use these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. Half of the students reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

'''Effectiveness of School-Based Prevention Programs'''

Not all school-based programs are created equally. Researchers typically find that more traditional and common approaches, like Drug Abuse Resistance Education (D.A.R.E.), are ineffective. One study found that there should be a greater focus on risk factors specific to the students; and that programs targeting teens need to keep them as an individual in mind, as well as the teen developmental stage and their social context.

Multiple studies have come to the same conclusion that the most effective programs in schools are interactive.<ref>https://lx.iriss.org.uk/sites/default/files/resources/0023318.pdf</ref> As opposed to non-interactive programs, those deemed interactive encourage active participation from every student. This may look like classroom discussions or a lesson plan surrounding skills practice. Importantly, interactions should primarily occur between peers, not between students and the teacher. Non-interactive programs typically involve the teacher leading the class and often using most of the class period to teach via a presentation. When participatory activities are included, they typically involve interactions between the teacher and student, like answering questions, rather than between students.

Along with building self-esteem and improving decision-making skills, school-based programs must also acknowledge the social environment that kids and adolescents live in when surrounded by their peers. Focusing on peer pressure and real-life encounters students may have with friends better prepares them to deal with uncomfortable situations. Studies have found that programs that focus solely on increasing self-esteem and encouraging good decision-making lack a focus on substances,<ref>https://lx.iriss.org.uk/sites/default/files/resources/0023318.pdf</ref> highlighting the importance of encouraging teachers to discuss topics they may view as taboo. Unless teachers discuss realistic scenarios, students will be ill-equipped to use the skills they learned inside the classroom when faced with peer pressure.

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

'''California''': Public schools are required to provide drug use education. Specifically, California law requires an anti-drug stance, which has been criticized by many. Due to lack of enforcement, it has not been followed by teachers around the state. So, while schools do ensure that substance use is being discussed in schools, strategies vary from abstinence-based to evidence-based curriculums.<ref>https://www.kqed.org/stateofhealth/363545/in-the-land-of-legal-weed-drug-education-moves-from-dont-to-delay</ref>

'''Connecticut''': In public schools, students at every grade level must learn about substances and how to avoid their harmful effects (CGS § 10-19(a)). Programs in elementary and secondary schools are required to be looked at by “public health and mental health and addiction services commissioners” to ensure it is a quality curriculum. <ref>https://www.cga.ct.gov/2002/rpt/2002-R-0140.htm</ref>

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

 

'''A Toolkit to Start Substance Use Prevention in Elementary Schools '''

Provides information and resources for elementary school teachers to begin teaching their students about substance use in an age-appropriate and evidence-based way. Examples of what this toolkit includes are ways to talk about the program with school administrators, parents, and students, as well as grants to apply for and examples of curriculums to teach.<ref>https://www.dellchildrens.net/wp-content/uploads/sites/60/2019/08/Substance-Use-Prevention-Toolkit-for-Elementary-Schools.pdf</ref>

'''Lesson Plan and Activity Finder'''

The National Institutes of Health created a database that allows teachers to look through lesson plans regarding substance use. The lowest grade level that the resources are aimed at is the fifth grade, and they go up until twelfth grade. There are options to choose either English or Spanish lesson plans.<ref>https://teens.drugabuse.gov/teachers/lessonplans?sort=revised_date:desc&language=en</ref>

 

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-09T15:44:01Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

'''Stigma in School-Based Programs'''

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believe it will help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they use these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. Half of the students reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

'''Effectiveness of School-Based Prevention Programs'''

Not all school-based programs are created equally. Researchers typically find that more traditional and common approaches, like Drug Abuse Resistance Education (D.A.R.E.), are ineffective. One study found that there should be a greater focus on risk factors specific to the students; and that programs targeting teens need to keep them as an individual in mind, as well as the teen developmental stage and their social context.

Multiple studies have come to the same conclusion that the most effective programs in schools are interactive. As opposed to non-interactive programs, those deemed interactive encourage active participation from every student. This may look like classroom discussions or a lesson plan surrounding skills practice. Importantly, interactions should primarily occur between peers, not between students and the teacher. Non-interactive programs typically involve the teacher leading the class and often using most of the class period to teach via a presentation. When participatory activities are included, they typically involve interactions between the teacher and student, like answering questions, rather than between students.

Along with building self-esteem and improving decision-making skills, school-based programs must also acknowledge the social environment that kids and adolescents live in when surrounded by their peers. Focusing on peer pressure and real-life encounters students may have with friends better prepares them to deal with uncomfortable situations. Studies have found that programs that focus solely on increasing self-esteem and encouraging good decision-making lack a focus on substances, highlighting the importance of encouraging teachers to discuss topics they may view as taboo. Unless teachers discuss realistic scenarios, students will be ill-equipped to use the skills they learned inside the classroom when faced with peer pressure.

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

'''California''': Public schools are required to provide drug use education. Specifically, California law requires an anti-drug stance, which has been criticized by many. Due to lack of enforcement, it has not been followed by teachers around the state. So, while schools do ensure that substance use is being discussed in schools, strategies vary from abstinence-based to evidence-based curriculums.<ref>https://www.kqed.org/stateofhealth/363545/in-the-land-of-legal-weed-drug-education-moves-from-dont-to-delay</ref>

'''Connecticut''': In public schools, students at every grade level must learn about substances and how to avoid their harmful effects (CGS § 10-19(a)). Programs in elementary and secondary schools are required to be looked at by “public health and mental health and addiction services commissioners” to ensure it is a quality curriculum. <ref>https://www.cga.ct.gov/2002/rpt/2002-R-0140.htm</ref>

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

 

'''A Toolkit to Start Substance Use Prevention in Elementary Schools '''

Provides information and resources for elementary school teachers to begin teaching their students about substance use in an age-appropriate and evidence-based way. Examples of what this toolkit includes are ways to talk about the program with school administrators, parents, and students, as well as grants to apply for and examples of curriculums to teach.<ref>https://www.dellchildrens.net/wp-content/uploads/sites/60/2019/08/Substance-Use-Prevention-Toolkit-for-Elementary-Schools.pdf</ref>

'''Lesson Plan and Activity Finder'''

The National Institutes of Health created a database that allows teachers to look through lesson plans regarding substance use. The lowest grade level that the resources are aimed at is the fifth grade, and they go up until twelfth grade. There are options to choose either English or Spanish lesson plans.<ref>https://teens.drugabuse.gov/teachers/lessonplans?sort=revised_date:desc&language=en</ref>

 

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-09T15:00:00Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

'''Stigma in School-Based Programs'''

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believe it will help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they use these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. Half of the students reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

'''Effectiveness of School-Based Prevention Programs'''

Not all school-based programs are created equally. Researchers typically find that more traditional and common approaches, like Drug Abuse Resistance Education (D.A.R.E.), are ineffective. One study found that there should be a greater focus on risk factors specific to the students; and that programs targeting teens need to keep them as an individual in mind, as well as the teen developmental stage and their social context.

Multiple studies have come to the same conclusion that the most effective programs in schools are interactive. As opposed to non-interactive programs, those deemed interactive encourage active participation from every student. This may look like classroom discussions or a lesson plan surrounding skills practice. Importantly, interactions should primarily occur between peers, not between students and the teacher. Non-interactive programs typically involve the teacher leading the class and often using most of the class period to teach via a presentation. When participatory activities are included, they typically involve interactions between the teacher and student, like answering questions, rather than between students.

 

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

'''California''': Public schools are required to provide drug use education. Specifically, California law requires an anti-drug stance, which has been criticized by many. Due to lack of enforcement, it has not been followed by teachers around the state. So, while schools do ensure that substance use is being discussed in schools, strategies vary from abstinence-based to evidence-based curriculums.<ref>https://www.kqed.org/stateofhealth/363545/in-the-land-of-legal-weed-drug-education-moves-from-dont-to-delay</ref>

'''Connecticut''': In public schools, students at every grade level must learn about substances and how to avoid their harmful effects (CGS § 10-19(a)). Programs in elementary and secondary schools are required to be looked at by “public health and mental health and addiction services commissioners” to ensure it is a quality curriculum. <ref>https://www.cga.ct.gov/2002/rpt/2002-R-0140.htm</ref>

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

 

'''A Toolkit to Start Substance Use Prevention in Elementary Schools '''

Provides information and resources for elementary school teachers to begin teaching their students about substance use in an age-appropriate and evidence-based way. Examples of what this toolkit includes are ways to talk about the program with school administrators, parents, and students, as well as grants to apply for and examples of curriculums to teach.<ref>https://www.dellchildrens.net/wp-content/uploads/sites/60/2019/08/Substance-Use-Prevention-Toolkit-for-Elementary-Schools.pdf</ref>

'''Lesson Plan and Activity Finder'''

The National Institutes of Health created a database that allows teachers to look through lesson plans regarding substance use. The lowest grade level that the resources are aimed at is the fifth grade, and they go up until twelfth grade. There are options to choose either English or Spanish lesson plans.<ref>https://teens.drugabuse.gov/teachers/lessonplans?sort=revised_date:desc&language=en</ref>

 

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-09T14:50:52Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

'''Stigma in School-Based Programs'''

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believe it will help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they use these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. Half of the students reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

'''Effectiveness of School-Based Prevention Programs'''

Not all school-based programs are created equally. Researchers typically find that more traditional and common approaches, like Drug Abuse Resistance Education (D.A.R.E.), are ineffective. One study found that there should be a greater focus on risk factors specific to the students; and that programs targeting teens need to keep them as an individual in mind, as well as the teen developmental stage and their social context.

Multiple studies have come to the same conclusion that the most effective programs in schools are interactive.

 

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

'''California''': Public schools are required to provide drug use education. Specifically, California law requires an anti-drug stance, which has been criticized by many. Due to lack of enforcement, it has not been followed by teachers around the state. So, while schools do ensure that substance use is being discussed in schools, strategies vary from abstinence-based to evidence-based curriculums.<ref>https://www.kqed.org/stateofhealth/363545/in-the-land-of-legal-weed-drug-education-moves-from-dont-to-delay</ref>

'''Connecticut''': In public schools, students at every grade level must learn about substances and how to avoid their harmful effects (CGS § 10-19(a)). Programs in elementary and secondary schools are required to be looked at by “public health and mental health and addiction services commissioners” to ensure it is a quality curriculum. <ref>https://www.cga.ct.gov/2002/rpt/2002-R-0140.htm</ref>

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

 

'''A Toolkit to Start Substance Use Prevention in Elementary Schools '''

Provides information and resources for elementary school teachers to begin teaching their students about substance use in an age-appropriate and evidence-based way. Examples of what this toolkit includes are ways to talk about the program with school administrators, parents, and students, as well as grants to apply for and examples of curriculums to teach.<ref>https://www.dellchildrens.net/wp-content/uploads/sites/60/2019/08/Substance-Use-Prevention-Toolkit-for-Elementary-Schools.pdf</ref>

'''Lesson Plan and Activity Finder'''

The National Institutes of Health created a database that allows teachers to look through lesson plans regarding substance use. The lowest grade level that the resources are aimed at is the fifth grade, and they go up until twelfth grade. There are options to choose either English or Spanish lesson plans.<ref>https://teens.drugabuse.gov/teachers/lessonplans?sort=revised_date:desc&language=en</ref>

 

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-09T14:47:31Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

'''Stigma in School-Based Programs'''

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believe it will help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they use these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. One half reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

'''Effectiveness of School-Based Prevention Programs'''

Not all school-based programs are created equally. Researchers typically find that more traditional and common approaches, like Drug Abuse Resistance Education (D.A.R.E.), are ineffective. One study found that there should be a greater focus on risk factors specific to the students; and that programs targeting teens need to keep them as an individual in mind, as well as the teen developmental stage and their social context.

Multiple studies have come to the same conclusion that the most effective programs in schools are interactive.

 

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

'''California''': Public schools are required to provide drug use education. Specifically, California law requires an anti-drug stance, which has been criticized by many. Due to lack of enforcement, it has not been followed by teachers around the state. So, while schools do ensure that substance use is being discussed in schools, strategies vary from abstinence-based to evidence-based curriculums.<ref>https://www.kqed.org/stateofhealth/363545/in-the-land-of-legal-weed-drug-education-moves-from-dont-to-delay</ref>

'''Connecticut''': In public schools, students at every grade level must learn about substances and how to avoid their harmful effects (CGS § 10-19(a)). Programs in elementary and secondary schools are required to be looked at by “public health and mental health and addiction services commissioners” to ensure it is a quality curriculum. <ref>https://www.cga.ct.gov/2002/rpt/2002-R-0140.htm</ref>

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

 

'''A Toolkit to Start Substance Use Prevention in Elementary Schools '''

Provides information and resources for elementary school teachers to begin teaching their students about substance use in an age-appropriate and evidence-based way. Examples of what this toolkit includes are ways to talk about the program with school administrators, parents, and students, as well as grants to apply for and examples of curriculums to teach.<ref>https://www.dellchildrens.net/wp-content/uploads/sites/60/2019/08/Substance-Use-Prevention-Toolkit-for-Elementary-Schools.pdf</ref>

'''Lesson Plan and Activity Finder'''

The National Institutes of Health created a database that allows teachers to look through lesson plans regarding substance use. The lowest grade level that the resources are aimed at is the fifth grade, and they go up until twelfth grade. There are options to choose either English or Spanish lesson plans.<ref>https://teens.drugabuse.gov/teachers/lessonplans?sort=revised_date:desc&language=en</ref>

 

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-08T01:54:49Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believe it will help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they use these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. One half reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

 

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

'''California''': Public schools are required to provide drug use education. Specifically, California law requires an anti-drug stance, which has been criticized by many. Due to lack of enforcement, it has not been followed by teachers around the state. So, while schools do ensure that substance use is being discussed in schools, strategies vary from abstinence-based to evidence-based curriculums.<ref>https://www.kqed.org/stateofhealth/363545/in-the-land-of-legal-weed-drug-education-moves-from-dont-to-delay</ref>

'''Connecticut''': In public schools, students at every grade level must learn about substances and how to avoid their harmful effects (CGS § 10-19(a)). Programs in elementary and secondary schools are required to be looked at by “public health and mental health and addiction services commissioners” to ensure it is a quality curriculum. <ref>https://www.cga.ct.gov/2002/rpt/2002-R-0140.htm</ref>

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

 

'''A Toolkit to Start Substance Use Prevention in Elementary Schools '''

Provides information and resources for elementary school teachers to begin teaching their students about substance use in an age-appropriate and evidence-based way. Examples of what this toolkit includes are ways to talk about the program with school administrators, parents, and students, as well as grants to apply for and examples of curriculums to teach.<ref>https://www.dellchildrens.net/wp-content/uploads/sites/60/2019/08/Substance-Use-Prevention-Toolkit-for-Elementary-Schools.pdf</ref>

'''Lesson Plan and Activity Finder'''

The National Institutes of Health created a database that allows teachers to look through lesson plans regarding substance use. The lowest grade level that the resources are aimed at is the fifth grade, and they go up until twelfth grade. There are options to choose either English or Spanish lesson plans.<ref>https://teens.drugabuse.gov/teachers/lessonplans?sort=revised_date:desc&language=en</ref>

 

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-08T01:41:32Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believe it will help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they use these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. One half reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

 

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

'''Connecticut''': In public schools, students at every grade level must learn about substances and how to avoid their harmful effects (CGS § 10-19(a)). Programs in elementary and secondary schools are required to be looked at by “public health and mental health and addiction services commissioners” to ensure it is a quality curriculum. <ref>https://www.cga.ct.gov/2002/rpt/2002-R-0140.htm</ref>

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

 

'''A Toolkit to Start Substance Use Prevention in Elementary Schools '''

Provides information and resources for elementary school teachers to begin teaching their students about substance use in an age-appropriate and evidence-based way. Examples of what this toolkit includes are ways to talk about the program with school administrators, parents, and students, as well as grants to apply for and examples of curriculums to teach.<ref>https://www.dellchildrens.net/wp-content/uploads/sites/60/2019/08/Substance-Use-Prevention-Toolkit-for-Elementary-Schools.pdf</ref>

'''Lesson Plan and Activity Finder'''

The National Institutes of Health created a database that allows teachers to look through lesson plans regarding substance use. The lowest grade level that the resources are aimed at is the fifth grade, and they go up until twelfth grade. There are options to choose either English or Spanish lesson plans.<ref>https://teens.drugabuse.gov/teachers/lessonplans?sort=revised_date:desc&language=en</ref>

 

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-08T01:39:58Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believe it will help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they use these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. One half reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

 

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

 

Connecticut: In public schools, at every grade level students must be taught information regarding substances and how to avoid the harmful effects of them (CGS § 10-19(a)). Programs in elementary and secondary schools are required to be looked at by “public health and mental health and addiction services commissioners” to ensure it is a quality curriculum. <ref>https://www.cga.ct.gov/2002/rpt/2002-R-0140.htm</ref>

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

 

'''A Toolkit to Start Substance Use Prevention in Elementary Schools '''

Provides information and resources for elementary school teachers to begin teaching their students about substance use in an age-appropriate and evidence-based way. Examples of what this toolkit includes are ways to talk about the program with school administrators, parents, and students, as well as grants to apply for and examples of curriculums to teach.<ref>https://www.dellchildrens.net/wp-content/uploads/sites/60/2019/08/Substance-Use-Prevention-Toolkit-for-Elementary-Schools.pdf</ref>

'''Lesson Plan and Activity Finder'''

The National Institutes of Health created a database that allows teachers to look through lesson plans regarding substance use. The lowest grade level that the resources are aimed at is the fifth grade, and they go up until twelfth grade. There are options to choose either English or Spanish lesson plans.<ref>https://teens.drugabuse.gov/teachers/lessonplans?sort=revised_date:desc&language=en</ref>

 

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-08T00:45:30Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believe it will help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they use these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. One half reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

 

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

 

'''A Toolkit to Start Substance Use Prevention in Elementary Schools '''

Provides information and resources for elementary school teachers to begin teaching their students about substance use in an age-appropriate and evidence-based way. Examples of what this toolkit includes are ways to talk about the program with school administrators, parents, and students, as well as grants to apply for and examples of curriculums to teach.<ref>https://www.dellchildrens.net/wp-content/uploads/sites/60/2019/08/Substance-Use-Prevention-Toolkit-for-Elementary-Schools.pdf</ref>

'''Lesson Plan and Activity Finder'''

The National Institutes of Health created a database that allows teachers to look through lesson plans regarding substance use. The lowest grade level that the resources are aimed at is the fifth grade, and they go up until twelfth grade. There are options to choose either English or Spanish lesson plans.<ref>https://teens.drugabuse.gov/teachers/lessonplans?sort=revised_date:desc&language=en</ref>

 

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-08T00:33:00Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believe it will help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they use these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. One half reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

 

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

 

'''A Toolkit to Start Substance Use Prevention in Elementary Schools '''

Provides information and resources for elementary school teachers to begin teaching their students about substance use in an age-appropriate and evidence-based way. Examples of what this toolkit includes are ways to talk about the program with school administrators, parents, and students, as well as grants to apply for and examples of curriculums to teach.<ref>https://www.dellchildrens.net/wp-content/uploads/sites/60/2019/08/Substance-Use-Prevention-Toolkit-for-Elementary-Schools.pdf</ref>

 

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-08T00:11:42Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believe it will help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. Numerous teachers told the researchers that they use these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. One half reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

 

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-08T00:09:15Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believe it will help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. The teachers told researchers that they use these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. One half reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the dangers of school-based programs that use a “shock-horror approach” to prevent kids from using substances because they promote stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

 

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-08T00:07:54Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.

= Key Information =

The National Survey on Drug Use and Health (NSDUH)<ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>, conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016).<ref>https://eric.ed.gov/?id=ED578539</ref>

 

'''Opioid Education Programs''' Recommendations for selecting a school program<ref>https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations</ref>

Start by looking at programs that have evidence that they work. The list on Blueprints for Healthy Youth Development is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. Look for programs that have a good Return on Investment (effective, but not too expensive). Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis.

'''School Prevention Programs have a Positive Impact''' In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.  

'''Classroom Resources'''

'''''            Operation Prevention'''''

*Operation Prevention, a joint partnership between Discovery Education and the DEA, developed free resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See Empower & Strengthen Parents for more strategies to include parents. See Tools & Resources for copies of toolkits. '''''Not Prescribed'''''
*Not Prescribed is a classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.    '''''Everfi's Prescription Drug Safety Course'''''
*EVERFI provides schools with a free, state-of-the-art on-line learning course on prescription drug safety  <ref>https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/</ref>
*Due to support from a wide range of public and private supporters in the Presecription Drug Safety Network, EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.  EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.   This report shares some of the impact that this course is having.  '''''Analysis of Research-Based Programs and Return on Investment'''''
*This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs. '''''Wsipp_Preventing Youth Substance Use''':'' A Review of Thirteen Programs Benefit-Cost-Results   Preventing Youth Substance Use<ref>https://www.wsipp.wa.gov/ReportFile/1562/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Report.pdf</ref> '''''Positive Prevention Plus''':'' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/</ref> 

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

Researchers in Northern Ireland found that teachers often used scare-based strategies because they believe it will help deter students aged 14 to 16 from using substances.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> Of the fourteen teachers interviewed, only two had histories of substance use. The twelve other teachers based their perceptions of illicit drug use on the news or the experiences of their friends or students from previous years. The title of the paper is “Junkies, Wasters and Thieves”.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> These are all words that teachers in the study used to describe individuals who use illicit substances. The teachers told researchers that they use these words to prevent students from being interested in drug use, even if it meant stigmatizing those affected. The researchers questioned students about how their teachers' language use affected their perceptions of individuals who use drugs. Many students described people who use drugs as criminals, people who “have diseases”, and a disgrace.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref> 

Some students in the school-based program used illicit substances. They reported feeling like an outcast and stated that they could not ask for support or help from their teacher. At many of these schools, using a scare-based approach split the school in half. One half reported believing that individuals who use drugs should be shamed or imprisoned. The other half sympathized with individuals who face difficulties with substance use or had a personal connection with substance use. The drastic difference of opinion led to an us vs. them mindset, creating distinct groups within schools. 

Ultimately, this study displayed the harmful effects of school-based programs that use a “shock-horror approach” to prevent kids from using substances because it promotes stigmatizing individuals and seeing them as unworthy of support.<ref>http://www.jceps.com/wp-content/uploads/2017/03/15-1-5.pdf</ref>

 

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

= Promising Practices =

 '''SPORT Prevention Plus Wellness: '''A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<ref>https://www.blueprintsprograms.org/programs/477999999/sport-prevention-plus-wellness/#:~:text=SPORT%20Prevention%20Plus%20Wellness%20is%20a%20health%20promotion,counterproductive%20to%20achieving%20positive%20image%20and%20behavior%20goals.</ref>

 '''Positive Prevention Plus:''' A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<ref>https://positivepreventionplus.com/curriculum-downloads/</ref>

''' Olweus Bullying Prevention Program:''' Includes schoolwide, classroom, individual, and community strategies.<ref>https://olweus.sites.clemson.edu/</ref>

'''Media Literacy''' Media literacy is a promising approach to school-based substance abuse intervention.<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Beneficial outcomes include:

Increased media skepticism<ref name="Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from">http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased perceived efficiency in resisting pro-drug media messages<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Greater ability to make counter-arguments to beer advertisements<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Increased belief that smoking and drinking are "wrong"<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref> Reduced middle school boys' intentions to use alcohol or tobacco in the future<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>

'''Healthy Youth Development Programs in Schools reduce Opioid Misuse<ref>http://mediadetectiveprograms.com/media-literacys-role-in-prevention/</ref>'''  

'''Putnam Middle School Social Norms Campaign<ref>https://preventionsolutions.edc.org/book/export/html/242</ref>''' In partnership with Putnam Pride, this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."

  Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.

 

'''SAFIR -- Substance Abuse Free Indian River<ref>https://safirc.org/</ref>''' This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.   “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”[9]At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.

  SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.

  A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on  

'''Boy Scouts & Girl Scouts<ref>https://www.getsmartaboutdrugs.gov/get-involved/red-ribbon-week-patch-program</ref>''' Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See Tools & Resources details on participation.

= Sources =

Expand School-Based Prevention Programs

2021-11-08T00:03:52Z

G.Lehrman:

Expand School-Based Prevention Programs

2021-11-07T20:48:41Z

G.Lehrman:

Expand Access to Medication-Assisted Treatment (MAT)

2021-11-07T20:14:08Z

G.Lehrman:

__NOTOC__ Return to [[ZOOM_MAP_-_Expand_Access_to_Optimized_MAT|Zoom Map - Expand Access to Optimized MAT]] or  [[ZOOM_MAP_-_Improve_Treatment_&_Enable_Recovery_for_People_with_SUDs|Zoom Map (Improve Treatment & Enable Recovery for People with SUDs)]] or the [[ZOOM_MAP_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]] <div class="wiki" id="content_view" style="display: block">
 __TOC__

= Overview =
<div class="_">Medication-assisted treatment (MAT), including opioid treatment programs (OTPs), combines behavioral therapy and medications to treat substance use disorders.<ref>[1]chanell.baylor. (2015, July 21). Medication-Assisted Treatment (MAT) [Text]. Retrieved December 5, 2019, from https://www.samhsa.gov/medication-assisted-treatment
</ref> Information on medications used in MAT can be found further down on this page. The President's [https://trumpwhitehouse.archives.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-15-2017.pdf Commission on Combating Drug Addiction and the Opioid Crisis] has recommended that the federal government "immediately establish and fund a federal incentive to enhance access to Medication-Assisted Treatment (MAT)."<ref>[2]Commission to the President (2016), Retrieved from: https://trumpwhitehouse.archives.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-15-2017.pdf</ref></div> <div class="_">The above report documents that MAT has been proven to:</div>
*Reduce overdose deaths
*Retain persons in treatment
*Decrease use of heroin
*Prevent spread of infectious disease

= Key Information =

=== The Value of MAT (or Opioid-Agonist Treatment) ===

*International addiction experts consider initial opioid-agonist treatment, or OAT, ''with no duration restrictions'', the evidence-based standard of care for opioid-use disorder, the authors write online November 20, 2018, in Annals of Internal Medicine.<ref>Association, A. P. (n.d.). APA Learning Center The Role of Behavioral Interventions in Buprenorphine Maintenance Treatment (Webinar). Retrieved December 5, 2019, from APA Learning Center website: https://education.psychiatry.org/diweb/catalog/item?id=5913605&_ga=2.63318255.1744877395.1635561868-1008822590.1635561868</ref>
*In California, where more people have been diagnosed with opioid disorder than in any other U.S. state, ''publicly funded treatment programs require patients to “fail” - twice - at a three-week course of medically supervised withdrawal before they become eligible for OAT''. Policymakers likely maintained this medically managed withdrawal requirement under the belief it was saving money. The study demonstrates, however, that the policy creates significantly greater long-term costs for criminal justice and healthcare systems.
**The study concludes OAT would have saved as much as $850 million over five years, not including savings to the criminal justice system, and more than $2 billion, including the cost of arrests and prosecutions. Over 10 years, the total savings would rise to $2.87 billion.<ref>Krebs, E., Enns, B., Evans, E., Urada, D., Anglin, M. D., Rawson, R. A., … Nosyk, B. (2018). Cost-Effectiveness of Publicly Funded Treatment of Opioid Use Disorder in California. Annals of Internal Medicine, 168(1), 10. https://doi.org/10.7326/M17-0611
</ref>
**“In order to see overdose deaths come down, we need to make sure people who have opioid addiction are able to access effective treatment more easily than they can access heroin, fentanyl or pain pills."
**"We need a model whereby patients can get immediate access to opioid-agonist treatment, a lifesaving intervention, without obstacles."
**“Among experts in the field of addiction, we already know that detox doesn’t work, that they’re going to relapse and when they relapse, they’re going to be at great risk for an overdose, that they’ll be at great risk for hepatitis,” Kolodny said. “Opioid addiction is a life-threatening illness."

Access the study here:<ref>What’s this agonist / antagonist stuff? (n.d.). Retrieved December 5, 2019, from https://www.naabt.org/faq_answers.cfm?ID=5
</ref>

This article talks of how the use of Buprenorphine reduces the cost of opioid addiction<ref>[1]Behavioral Healthcare Executive | Psychiatry & Behavioral Health Learning Network. (n.d.). Retrieved December 5, 2019, from https://www.psychcongress.com/node/721
</ref>

 

= Relevant Research =
<div class="_">An article in the August 2017 issue of the American Journal of Psychiatry, by Roger D. Weiss, MD, the Chief of the Division of Alcohol and Drug Abuse at McLean Hospital (Belmont, MA) and Professor of Psychiatry at Harvard Medical School and Kathleen Carroll, Ph.D. concluded: "Finally, with 6-month retention rates seldom exceeding 50% and poor outcomes following dropout, we must explore innovative strategies for enhancing retention in buprenorphine treatment."<ref>https://pubmed.ncbi.nlm.nih.gov/27978771/</ref></div> <div class="_"> </div> <div class="_">This report reveals the need for significantly more studies that can yield additional insights to inform MAT practices. Current literature focuses mainly on the outcome of treatment retention and negative urine drug screens. Enhanced research would look at broader outcomes of social functioning and well-being including employment, stable housing and other measures of well-being. Also, research would ideally have information on many other factors such as information on co-occurring disorders and different types of behavioral treatments that would be appropriate for different individuals. While not mentioned specifically in that article, a person's history of trauma or adverse childhood experiences (ACEs), length of time with an SUD, their current level of supports, and genetic factors such as the rates at which they metabolize different drugs would all impact what type of treatment would be most appropriate. All of these unique factors and the wide range of potential interventions are reasons that more research is needed, and conclusions from studies that look at a limited number of inputs and outcomes and lack visibility into all the unique factors that influence what might impact successful outcomes should be seen as early insights in a journey of finding the optimal forms of treatment for each person's situation.</div> <div class="_"> </div> <div class="_">Weiss and Carroll highlight some key findings from their report in a webinar done through the American Journal of Psychiatry learning center.[3] Key points include:</div>
*Buprenorphine is an excellent medication, but there is still much room for improvement in how MAT is done.
*Research designs, such as the intensity of Medication Management, the dose of buprenorphine, and the characteristics of the group participants, influence outcomes.
*Different sub-groups respond differently to different elements of treatment plans.
*Early treatment response has a major impact on long-term success, and a better understanding of that insight may help decision-making.
**Patients who abstain from opioids in the first two weeks of treatment have a good chance of a good 12-week outcome.
**Patients who use opioids during the first two weeks of treatment have very little chance of abstaining by week 12.
*There is evidence that the use of [https://drugabuse.com/treatment/contingency-management/ Contingency Management ](CM), including the use of computer-based therapies, seems to increase success rates.
*Patients dependent on prescription opioids seemed to respond more positively to Cognitive Behavioral Therapy (CBT) than those who were primarily heroin users.
*Different treatment approaches appeal to different patients, and using approaches that appeal to the patients helps to increase their retention rates.
*More data is needed to better understand what treatment options are best for different individuals.

== Ways to Improve and Optimize MAT ==

The effectiveness of MAT is enhanced when there is an emphasis on a broad range of treatment and recovery supports, not just providing the medication part of the MAT.  MAT is optimized when those providing and funding the treatment keep striving to improve all aspects of the treatment plan, optimized for each individual as much as practical. 

Some of the ways that MAT can be optimized are listed below::

*Precision medication ([[Expand_DNA_Testing_to_Improve_Precision_MAT_Therapies|Expand DNA Testing to Improve Precision MAT]])
*A coordinated, proactive, whole-person care plan ([[Integrate_MAT_into_a_Whole_Person_Care_Model|Integrate MAT into whole-person care model]])
*Community engagement ([[Expand_community_engagement_to_improve_MAT|Expand community engagement to improve MAT]])
*Use of innovative technologies ([[Use_innovative_technologies_to_enhance_MAT|Use innovative technologies to enhance MAT]])

== Current Status of MAT Practices ==

*Only 10% of conventional drug treatment facilities in the United States provide MAT for opioid use disorders (need source and date)
*According to SAMHSA data collected in early 2017, 40 percent of the physicians who have a waiver do not prescribe buprenorphine at all. This may be due to physicians' reluctance to have patients with addictive disorders frequenting their offices or due to concerns about DEA audits, among other reasons.[4]
*Avalere’s analysis finds that 11 states (IA, IL, MD, MI, MO, NC, NH, OH, VA, WI, WV) located in the Midwest and Mid-Atlantic and DC have significantly lower-than-average rates of providers who prescribe buprenorphine compared to opioid overdose deaths.<ref>https://avalere.com/press-releases/midwest-and-mid-atlantic-states-face-provider-shortage-to-address-opioid-epidemic</ref>

</div>

== Co-occurring Disorders ==

Co-occurring disorders, or dual diagnosis, refers to having a simultaneous mental health disorder and substance use disorder. It is common for people with addictions to also suffer from depression, anxiety, or more severe mental illnesses such as schizophrenia or bipolar disorder. Research shows that people who use alcohol or other drugs early in life are more likely to have mental or emotional problems. It’s also true that many people with mental illnesses “self-medicate” with alcohol or other drugs to numb emotional pain, relieve anxiety, or quiet their thoughts. In the past, the medical profession treated one disorder first, typically the substance use disorder, before addressing the other. It is now understood that treating both simultaneously leads to better outcomes. Any successful addiction treatment program will include a mental health assessment and treat co-occurring disorders at the same time.<ref> [6]Weiss, R. D., Potter, J. S., Fiellin, D. A., Byrne, M., Connery, H. S., Dickinson, W., … Ling, W. (2011). Adjunctive counseling during brief and extended buprenorphine-naloxone treatment for prescription opioid dependence: A 2-phase randomized controlled trial. Archives of General Psychiatry, 68(12), 1238–1246. https://doi.org/10.1001/archgenpsychiatry.2011.121
</ref>

 

== Different Medications Used in MAT: ==

=== Agonists & Antagonists ===
<div class="_">An opioid agonist activates opioid receptors in the brain. An antagonist blocks opioids by attaching to the opioid receptors without activating them.<ref>[7]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>[Detoxification vs. Stabilization]</div> <div class="_"> </div> <div class="_">Buprenorphine</div>
*Buprenorphine is used in MAT to help people reduce or quit their use of heroin or other opiates, such as pain relievers like morphine. One study showed that 50% of the people in treatment who were also on Buprenorphine stayed on treatment compared with 7% who only had treatment.<ref>[8]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Buprenorphine is a partial agonist that suppresses opioid withdrawal symptoms. It can produce opioid agonist effects, such as euphoria, it is milder than full agonists such as methadone.<ref>https://www.drugabuse.gov/download/21349/medications-to-treat-opioid-use-disorder-research-report.pdf?v=99088f7584dac93ddcfa98648065bfbe</ref>
*Buprenorphine can be prescribed by physicians in an outpatient setting who have completed a training course and received a DEA DATA 2000 waiver. It is taken as a pill or sublingual film. Buprenorphine was also approved in a 6-month implant form in May 2016<ref>https://archives.drugabuse.gov/news-events/news-releases/2016/05/fda-approves-six-month-implant-treatment-opioid-dependence</ref>
*Training for Buprenorphine providers is an 8-hour course (24 for Nurse Practitioners and Physician Assistants) and allow for the following patient loads and responsibilities:<ref>[11]Medication-Assisted Treatment: Buprenorphine in the HCH Community (2016), National Health Care for the Homeless Council, Retrieved From: https://nhchc.org/wp-content/uploads/2019/08/policy-brief-buprenorphine-in-the-hch-community-final.pdf</ref>

#30 Addiction Treatmtent Patients per provider for the first year
#100 patients each year thereafter
#An additional 175 (totaling 275) patients can be allotted if the Physician is board certified in addiction or if a facility:

*Has 24 Call Coverage for patients
*Uses an EMR/EHS to monitor and update patient records (for those looking for an entry-level EHS, PracticeFusion is a free system)
*Provision of Care Management Services
*Subscribing to a State-led Drug Management System
*Acceptance of Third Party Insurance

It should be noted that only around 10% of those who wish to seek treatment can find qualified providers to allow for it. <ref>[12]https://www.fiercehealthcare.com/practices/only-10-eligible-primary-care-providers-can-prescribe-buprenorphine-to-treat-patients-for</ref> As a result, there are cases where medication diversion does occur, and there is a black market for the drug for self-treatment purposes.<ref>[13]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref> Treatment with buprenorphine has been proven effective in opioid addiction, decreasing mortality by approximately 50%. Patients treated with buprenorphine show improved social functioning with increased retention in treatment (67% at one year) compared to drug-free treatment (7% to 25% at one year), reduced criminal activity, lower rates of illicit substance abuse, and reduced risk of HIV and hepatitis infection.<ref>[14]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>

*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine SAMSHA page on Buprenorphine]
*[[More_info_on_Buprenorphine|More info on Buprenorphine]]

For more information, one can visit the information page on [[File/view/BupForOUD.pdf/614583113/BupForOUD.pdf|Buprenorphine for Patients and Families]], which includes information on side effects, information to share with providers, and other useful information. This document was compiled by Intermountain Health Care.

=== Suboxone ===

*Suboxone is a brand name for a hybrid that is three parts Buprenorphine and one part Naloxone.
*Suboxone is more difficult to misuse because it will cause the patient to enter opioid withdrawal if it is misused in any way, such as injection.<ref>[15]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*[[More_info_on_Suboxone|More info on Suboxone]] (including generic options)

 

=== Probuphine ===

*Probuphine is an implant that contains the medicine buprenorphine. Probuphine is used to treat certain adults who are addicted to (dependent on) opioid drugs (either prescription or illegal). Probuphine is part of a complete treatment program that also includes counseling and behavioral therapy.
*Because Probuphine contains buprenorphine, it may cause physical dependence.
*Four implants are inserted under the skin of your upper arm during a procedure done in your physician's office or Opioid Treatment Program (OTP).
*The implants remain in your arm for six months.
*After the six-month period, your doctor must remove the implants.
*If you wish to continue Probuphine, your doctor may insert new implants to continue treatment.
*The implants can be removed sooner if you want to stop treatment.
*Patients must continue to see their doctor at least every month while on Probuphine therapy.
*[https://probuphinerems.com For more information visit their website.]

=== Methadone ===

*Methadone, sold under the brand name [https://www.drugs.com/cdi/dolophine.html Dolophine] among others, is used in MAT to help with detoxification or as part of [https://en.wikipedia.org/wiki/Maintenance_therapy maintenance therapy] or [https://en.wikipedia.org/wiki/Opioid_replacement_therapy Opioid Replacement Therapy].
*Methadone is an opioid replacement. It works by changing how the brain and nervous system respond to pain. It lessens the painful symptoms of opiate withdrawal and blocks the euphoric effects of opiate drugs such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone.<ref>[16]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Methadone is to be prescribed as part of a comprehensive treatment plan that includes counseling and participation in social support programs.
*Methadone can only be dispensed at SAMHSA-certified outpatient treatment programs or in hospitals in an emergency. <ref>17]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Methadone has been used to treat chronic pain, however, this use is limited because of the serious risk of dependence and overdose.<ref>[18]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/methadone SAMSHA page on Methadone]
*[[More_Information_on_Methadone|More info on Methadone]]

=== Naltrexone ===

*Naltrexone is a nonaddictive medicine that serves as an opioid receptor antagonist and not an opioid replacement, unlike methadone and buprenorphine. It is a primary ingredient in the treatment of alcohol and opioid dependence. Naltrexone blocks certain receptors in the part of the brain that triggers dopamine release so they cannot be activated. Dopamine release reinforces the vicious and compulsive addiction feedback loop. When we block these areas of the brain, the craving for alcohol and opiates is eliminated or significantly reduced. The pleasure is very limited and the uncontrollable cascade of relapse is much less likely, if alcohol is consumed after the implant procedure, in addition, if opiates are consumed after the procedure, there are no effects.<ref>[19]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Naltrexone is administered in a long-active, injectable formulation administered once a month.<ref>[20]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Naltrexone does not prevent withdrawal symptoms so it is recommended for patients who do not have opioids in their system.<ref>[21]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone SAMSHA page on Naltrexone] (The 30-day injectable version is commercially known as Vivitrol)
*[[More_info_on_Naltrexone_and_Vivitrol|More info on Naltrexone and Vivitrol]]

 

=== Naloxone ===

*Naloxone is an opioid antagonist used to reverse opioid overdose
*Naloxone (commercially known as Narcan) is available in intravenous or intramuscular injection and nasal delivery options. Intramuscular injection or intranasal delivery is safe for administration by any person.<ref>[22]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Naloxone works within minutes and effects last for up to an hour. Multiple doses may be required depending on the severity of respiratory depression.<ref>[23]Garcia-Portilla, M. P., Bobes-Bascaran, M. T., Bascaran, M. T., Saiz, P. A., & Bobes, J. (2014). Long term outcomes of pharmacological treatments for opioid dependence: Does methadone still lead the pack? British Journal of Clinical Pharmacology, 77(2), 272–284. https://doi.org/10.1111/bcp.12031
</ref>
*Naloxone does not produce tolerance or dependence. <ref>[24]Moving from Stigma to Science in Treating Addiction. (2016, December 17). Retrieved December 5, 2019, from California Health Care Foundation website: https://www.chcf.org/blog/moving-from-stigma-to-science-in-treating-addiction/
</ref>
*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/naloxone SAMSHA page on Naloxone]
*[[More_info_on_Naloxone|More info on Naloxone]] (including discounted public pricing and free Narcan for schools)
*(for [http://www.samhsa.gov/medication-assisted-treatment/treatment/opioid-overdose opioid overdose])

 Find information on physical ailments often diagnosed in MAT patients. Also known as [http://www.samhsa.gov/medication-assisted-treatment/treatment/common-comorbidities common comorbidities], these include viral hepatitis, HIV, and AIDS. Medications Used in Addiction Treatment**<ref>[25]The Case for Medication-Assisted Treatment. (n.d.). Retrieved December 5, 2019, from http://pew.org/2kdLIf2
</ref>

{| border="1" class="wiki_table"
|-
| Sept 2017
| Where it can be provided
| FDA indications
| Effectiveness
| Administration
|-
| Methadone
| OUD. Licensed opioid treatment programs Pain. Any Drug Enforcement Agency (DEA)-licensed prescriber
| OUD and pain management
| 74% to 80%<ref>[26]Summary: Major components of the HHS final rule. Effective August 8, 2016. (n.d.). Retrieved December 5, 2019, from https://www.asam.org/resources/publications/magazine/read/article/2016/07/06/summary-of-the-major-components-of-the-hhs-final-rule-which-will-be-effective-on-august-5-2016
</ref>
| OUD. Daily pill, liquid, and wafer forms; injectable form in hospitalized patients unable to take oral medications Pain. Injectable, transdermal, and buccal film
|-
| Buprenorphine and buprenorphine/naloxone
|
*Prescribed by community physicians and dispensed by pharmacies; available in some opioid treatment programs.
*Physicians receive federal waivers after eight hours of training; nurse practitioners and physician assistants require 24 hours. Patient panels are capped at 30, 100, and 275 per provider (depending on experience and setting).<ref>[27]Why Health Plan Should Go to the “MAT” in the Fight against Opioid Addiction(2017), California Health Care Foundation, Retrieved form: https://www.chcf.org/wp-content/uploads/2017/12/PDF-Why-Health-Plans-Should-Go-to-the-MAT.pdf</ref><ref>[28]Garcia-Portilla, M. P., Bobes-Bascaran, M. T., Bascaran, M. T., Saiz, P. A., & Bobes, J. (2014). Long term outcomes of pharmacological treatments for opioid dependence: Does methadone still lead the pack? British Journal of Clinical Pharmacology, 77(2), 272–284. https://doi.org/10.1111/bcp.12031
</ref><ref>[29]Kakko, J., Svanborg, K. D., Kreek, M. J., & Heilig, M. (2003). 1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: A randomised, placebo-controlled trial. The Lancet, 361(9358), 662–668. https://doi.org/10.1016/S0140-6736(03)12600-1
</ref>
*Any DEA-licensed provider can prescribe buprenorphine for pain.

| OUD and pain management (depending on formulation and dose)
| 60% to 90%<ref>[30]McNicholas, L.(n.d).Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction, U.S Department of Health and Human Rights, Retrieved from : https://www.naabt.org/documents/TIP40.pdf</ref>
| OUD. Daily sublingual, buccal, film, and tablet, or six-month intradermal device Pain. Injectable, transdermal, and buccal film
|-
| Naltrexone
| No restrictions
| Opioid and alcohol use disorders
| OUD. 10% to 21%<ref>[31]Miranda, A., & Taca, A. (2018). Neuromodulation with percutaneous electrical nerve field stimulation is associated with reduction in signs and symptoms of opioid withdrawal: A multisite, retrospective assessment. The American Journal of Drug and Alcohol Abuse, 44(1), 56–63. https://doi.org/10.1080/00952990.2017.1295459
</ref>
| Daily pill or monthly injectable
|-
| Naloxone (used only for overdose reversal, not addiction treatment)
| Any setting: prescribed or dispensed by a clinician, furnished by a pharmacy without a prescription (legal in several states), dispensed by lay staff in community settings (by standing order), or carried by law enforcement or other first responders.
| To reverse respiratory suppression in suspected opioid overdose
| May require high doses for extremely high-potency illicit drug use (fentanyl and carfentanyl)
| Intranasal spray, or intravenous, intramuscular, or subcutaneous injectable
|}
<div class="_">Extensive research has demonstrated the effectiveness of opioid agonist treatment (methadone and buprenorphine) in opioid use disorder. A meta-analysis of 50 studies showed methadone's retention rate ranging from 70% to 84% at one year, buprenorphine ranging from 60% to 90% at one year, with both treatments resulting in significant reductions in overdose death, illicit drug use, criminal activity, arrests, risk behaviors, HIV and hepatitis C incidence, as well as improvements in health status, functioning, and quality of life.<ref>https://www.chcf.org/wp-content/uploads/2017/12/PDF-Why-Health-Plans-Should-Go-to-the-MAT.pdf</ref>  </div>
== Stages of MAT with Buprenorphine ==

=== Induction ===
<div class="_">"Induction is the first stage of buprenorphine treatment and involves helping patients begin the process of switching from the opioid of abuse to buprenorphine. The goal of the induction phase is to find the minimum dose of buprenorphine at which the patient discontinues or markedly diminishes use of other opioids and experiences no withdrawal symptoms, minimal or no side effects, and no craving for the drug of abuse."<ref>[33]Addiction experts look to new and expanded opioid treatment options in 2017. (2017, January 13). Retrieved December 5, 2019, from FOX 61 website: https://fox61.com/2017/01/13/addiction-experts-look-to-new-and-expanded-opioid-treatment-options-in-2017/
</ref></div> <div class="_">New non-pharmacological approaches to treat opioid withdrawal could provide alternative pathways to help a patient manage withdrawal symptoms as they transition into MAT. The [https://i-h-s.com/ BRIDGE]® is a noninvasive, percutaneous electrical nerve field stimulator developed to target pain. An article published in 2018 in The American Journal of Drug and Alcohol Abuse shared significant promising results in using the BRIDGE to help people transition to MAT. The neurostimulation rapidly and dramatically reduced the [https://www.drugabuse.gov/sites/default/files/files/ClinicalOpiateWithdrawalScale.pdf COWS scores] of the participants, and 64 of the 73 people successfully transitioned to MAT. Some training programs suggest that [https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=99a59495-2a48-4276-bbe3-cdd55a45aba4 Clonidine] or [https://www.webmd.com/drugs/2/drug-16910-8296/ondansetron-oral/ondansetron-disintegrating-tablet-oral/details Ondansetron] may be used to ease the withdrawal symptoms during induction.<ref> [35]Vermont Global Commitment to Health Section 1115 Demonstration Fact Sheet (2018). Retrieved from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/vt/vt-global-commitment-to-health-fs.pdf</ref></div> <div class="_">[[More_information_on_buprenorphine_induction|More information on buprenorphine induction]].</div> <div class="_"> </div>
=== Stabilization ===
<div class="_">"The stabilization phase has begun when a patient is experiencing no withdrawal symptoms, is experiencing minimal or no side effects, and no longer has uncontrollable cravings for opioid agonists. Dosage adjustments may be necessary during early stabilization, and frequent contact with the patient increases the likelihood of compliance."</div> <div class="_"> [[More_information_on_buprenorphine_stabilization|More information on buprenorphine stabilization]].</div>
=== Maintenance ===
<div class="_">"The longest period that a patient is on buprenorphine is the maintenance phase. This period may be indefinite. During the maintenance phase, attention must be focused on the psychosocial and family issues that have been identified during the course of treatment as contributing to a patient’s addiction."</div> <div class="_">[[More_information_on_buprenorphine_maintenance|More information on buprenorphine maintenance]]</div>
== Medically Supervised Withdrawal (Detoxification) ==
<div class="_">As an alternative to the three stages above, the goal of using buprenorphine for medically supervised withdrawal from opioids is to provide a transition from the state of physical dependence on opioids to an opioid-free state, while minimizing withdrawal symptoms (and avoiding side effects of buprenorphine). Medically supervised withdrawal with buprenorphine consists of an induction phase and a dose-reduction phase. The consensus panel recommends that patients dependent on short-acting opioids (e.g., hydromorphone, oxycodone, heroin) who will be receiving medically supervised withdrawal be inducted directly onto buprenorphine/naloxone tablets. The use of buprenorphine (either as buprenorphine monotherapy or buprenorphine/naloxone combination treatment) to taper off long-acting opioids should be considered only for those patients who have evidence of sustained medical and psychosocial stability.</div>

= Impactful Federal, State, and Local Policies =

== New 2018 SAMHSA Guide for Medications for Opioid Use Disorder ==

This latest, detailed [https://store.samhsa.gov/product/TIP-63-Medications-for-Opioid-Use-Disorder-Executive-Summary/SMA18-5063EXSUMM 330-page report] can be downloaded for free. 

= Promising Practices =

== New & Expanded Treatment Options ==

=== Connecticut ===
<div class="_">Connecticut's Department of Mental Health and Addiction Services (DMHAS) recently received two federal grants, one of which is meant to go to medication-assisted treatment, the other toward prevention efforts. DMHAS is also collaborating with the Connecticut Community for Addiction Recovery on a new program that will enable people who were saved from overdose through the use of naloxone to work with a recovery coach who can connect them to services and a support network.<ref> [36]Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence: A Randomized Clinical Trial | Emergency Medicine | JAMA | JAMA Network. (n.d.). Retrieved December 5, 2019, from https://jamanetwork.com/journals/jama/fullarticle/2279713
</ref></div>

=== Vermont ===
<div class="_">Vermont's Health Home for Opioid Addiction has employed a "Hub & Spoke" system in handling the Opioid Crisis, called the "Care Alliance for Opioid Addiction," which has seen some success in treating addicted individuals while helping lift the burden of care from singular doctors and clinics. The system is composed of the following parts<ref> [37] Kashef, Z. (2015, April 28). Emergency department treatment for opioid addiction better than referrals. Retrieved December 5, 2019, from YaleNews website: https://news.yale.edu/2015/04/28/emergency-department-treatment-opioid-addiction-better-referrals
</ref>:</div>
*The Hub, a designated provider of specialty addiction treatment, is designed as an Opioid Treatment Program which is operated by Community Behavioral Health Agencies.
*The Spokes are health care teams led by physicians who can prescribe Buprenorphine and are regulated as Office Based Opioid Treatment providers.

Payment infrastructure for providers are structured after already existing Medicare and Medicaid Structures, which are documented in the Vermont Global Commitment To Health Section 1115 Demonstration Fact Sheet<ref>[38]Kashef, Z. (2015, April 28). Emergency department treatment for opioid addiction better than referrals. Retrieved December 5, 2019, from YaleNews website: https://news.yale.edu/2015/04/28/emergency-department-treatment-opioid-addiction-better-referrals
</ref>

*
**An evaluation of the Care Alliance for Opioid Addiction has shown that people in treatment for opioid addiction reported a 96 percent decrease in opioid use, and a 100 percent drop in overdose incidences, according to a [http://www.healthvermont.gov/media/newsroom/hub-and-spoke-evaluation-shows-significant-impact-january-22-2018 new report] from the Vermont Department of Health released 1/22/18.
**Additional findings include:
***92% drop in injection drug use.
***89% decrease in emergency department visits.
***90% reduction in both illegal activities and police stops/arrests.
***Zero participants in treatment had overdosed in the 90 days leading up to the study interview, compared to 25% who had overdosed in the 90 days before entering treatment.
***Family conflict, feelings of depression, anxiety and anger decreased, and participants reported being much more satisfied with their lives.

More information can be found at: <ref>[3]Hub and Spoke Evaluation Shows Significant Impact (January 22, 2018). (2018, January 22). Retrieved December 5, 2019, from Vermont Department of Health website: https://www.healthvermont.gov/media/newsroom/hub-and-spoke-evaluation-shows-significant-impact-january-22-2018

</ref>

== Emergency Department Treatment Protocols ==
<div class="_">In a Yale Randomized trial, it was found that individuals who receive Buprenorphine while getting medical care within an emergency room are more likely to adhere to treatment protocols and have a better chance at ceasing opioid use when compared to those who have received referrals to receive the treatment, or those who received motivational support.<ref>[39] Weiss, R. D., Potter, J. S., Griffin, M. L., Provost, S. E., Fitzmaurice, G. M., McDermott, K. A., … Carroll, K. M. (2015). Long-term outcomes from the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study. Drug and Alcohol Dependence, 150, 112–119. https://doi.org/10.1016/j.drugalcdep.2015.02.030
</ref>This can be an initiation point for treatment of opioid dependence and can be followed up by primary care facilities. This has shown to decrease the need for in-patient facilities. This can be attributed to engaging patients at the optimal point of access. <ref>[40]Health plan offers financial incentives for MAT training | Psychiatry & Behavioral Health Learning Network. (n.d.). Retrieved December 5, 2019, from https://www.psychcongress.com/article/policy/health-plan-offers-financial-incentives-mat-training
</ref></div>

== National Healthcare For Homeless Council ==
<div class="_">As one may assume, there is cross-over between the homeless and addicted communities. The National Healthcare for the Homeless Council has as a result, released a policy brief that may be of some use for both policy makers and health care providers alike. Within the brief, a basic strategy is considered as follows when treating addicted and homeless/addicted patients:</div> <div class="_">  • '''Establish stability'''. Stable housing is central to attaining treatment goals as it provides patients with stability, a sense of safety, an increased ability to meet basic needs, and an opportunity to have increased control over their lives and environment. Securing stable housing as early as possible is key to the treatment and recovery process.   • '''Address comorbidities using integrated care'''. Untreated medical and/or other behavioral health conditions may complicate MAT. The most successful interventions are provided through integrated care models of interdisciplinary teams made up of medical, mental health, substance use, and social service providers. Each discipline should not only be co-located, but should work collaboratively as a team with multiple services offered in the same visit.   • '''Treat the whole person'''. Substance use disorders cannot be treated apart from addressing the needs of the whole person in the context of his or her environment. In addition to addressing comorbidities, assistance in accessing food, clothing, shelter/housing, financial assistance, counseling, job training, employment services, and other needs as identified must be included alongside MAT.   • '''Take a harm reduction approach'''. Harm reduction therapy is an evidence-based practice that supports and respects a person’s experience and treats them with dignity, which is especially important for persons experiencing homelessness who regularly interact with systems and situations that limit self-determination and lack respect. Harm reduction therapy relies on collaboration, respect, and stage-based interventions that acknowledge self-defined positive change. Harm reduction therapy focuses on client-defined priorities and acknowledges that any improvement that reduces harm is beneficial. The key to harm reduction therapy is low barrier, integrated care that is trauma informed and respectful of the collaborative therapeutic relationship.   • '''Utilize evidence-based best practices'''. In addition to harm reduction, using other evidence-based best practices such as the use of peer specialists, motivational interviewing, and individual and group therapy can help patients maintain recovery and have successful treatment outcomes.   •'''Be patient centered'''. Building trust and developing relationships is essential to providing high-quality care and achieving good health outcomes. Engaging in patient centered care based on a patient’s individual needs, strengths, goals, and timeframe rather than on a pre-determined benchmark for outcomes is one way to build relationships and empower patients in the process. Patients should be actively involved in setting goals and planning their treatment.   •'''Be flexible'''. There is no one-size-fits-all treatment that will work for all patients. While MAT recommends a combination of medication and behavioral health therapy, treatment should be flexible and individualized to the patient’s needs, especially the frequency/schedule for therapy. For some, medication alone and regular consultation with a primary care provider is enough to maintain and recover from addiction, while others may need the additional supports provided by behavioral health therapy.</div> <div class="_"> </div> <div class="_">More information can be found on the [[File/view/HCHBrief.pdf/614804863/HCHBrief.pdf|Policy Document]] itself.</div>

== Opioid Treatment Program Directory ==
<div class="_">Select [http://dpt2.samhsa.gov/treatment/directory.aspx this directory] to view the opioid treatment programs in each state</div>

== Moving from Stigma to Science ==

=== Pennsylvania and New Jersey ===
<div class="_">The Department of Behavioral Health and Intellectual Disability Services of Pennsylvania has taken actions to ensure that halfway houses and other rehabilitation facilities cannot turn away individuals using MAT as a means of treating Opioid Abuse. <ref>[41] https://dbhids.org/MAT/</ref> Underlying problems still exist in restrictive medication regimen practices, insurance coverage, and Public-Private partnerships, which require support to overturn previous hard-lined policies. An evidence-based approach has shown that introduction of MAT, especially with Buprenorphine, has had an increased mitigation effect on relapse and a higher chance of long-term recovery.<ref> [42]https://dbhids.org/MAT/</ref></div>

=== National Healthcare For Homeless Council ===

The National Healthcare for the Homeless Council also has recommendations of policy that not only controls the prescription of opiates, but also the treatment of opioid addiction. They are as follows:
<div class="_">Remove the cap on the number of patients a physician can treat with buprenorphine. Existing limits are arbitrary and create barriers to accessing treatment. While put in place to mitigate diversion, cap limits may inadvertently aid diversion by limiting the supply of MAT, leading to individuals pursuing self-treatment by purchasing diverted drugs. Ironically, there are no limits to the number of patients a physician can prescribe other opioid drugs that present a much greater risk of causing addiction, overdose, and death (e.g., Methadone, Oxycodone, Hydrocodone, and Fentanyl). Removing the caps will allow providers to determine the number of patients they are able to treat based on the capacity of their practice and other factors, thereby increasing access to treatment.</div>
*Expand prescribing rights to all clinicians who are eligible to prescribe Class III, IV, and V CDS drugs. Limiting prescribing rights to physicians creates an additional barrier to accessing treatment and is incongruent with the existing scope of many clinical practices. Expanding prescribing rights to Nurse Practitioners, Physicians Assistants, and other clinicians who are authorized to prescribe Class III, IV, and V CDS drugs will expand treatment opportunities and decrease barriers to care. Clinicians who can prescribe opioids for pain should also be able to prescribe buprenorphine to treat the addictions that sometimes result.
*Require training to prescribe all opioids, not just buprenorphine. Specialized training is required to prescribe buprenorphine, but no other drug (opioid or otherwise) requires this as a condition of practice. Given the lower risks associated with diversion of buprenorphine, and the elevated risk associated with many opiates that can be prescribed with few restrictions, training should be extended to the prescribing of any opioid and focus on administering and monitoring prescriptions and understanding the nature of addiction. In addition, prescribers should have greater access to technical assistance and resources to develop plans to identify and avoid diversion.
*Enforce parity laws. Substance abuse treatment and other behavioral health services should be just as easy to access as primary care services. Parity laws are in place to ensure insurance plans treat these services equally, and should be enforced. Health insurance practices that require prior authorizations for opioid treatment should be scrutinized, especially when they create barriers to behavioral health care that do not exist for primary care. Just as there are no prior authorizations required for opioid drugs prescribed for pain management, there should be no prior authorizations required for MAT. Addiction is a time-sensitive condition to treat, and presenting for treatment is a big step for patients; even a delay of one day can be the difference in someone getting treatment or not.
*Reduce stigma and treat addiction as a disease. The main barrier to any type of treatment for persons experiencing homelessness is a lack of stable housing. In addition, drug screens are often required when accessing housing, and employers often require drug screens for employment. Landlords and employers need to accept buprenorphine prescribed as part of a MAT plan as a medical treatment process, and not have it count negatively against a person by including it as a prohibited substance. Addiction needs to be seen as a disease and not a moral failing, and engagement in MATs as a health care intervention should not be a liability to accessing housing or employment.
*Train all health care disciplines on addiction. Expanding awareness of addiction and providing substance abuse education for medical students, residents, practicing physicians, and all other health care providers is essential. Curricula which treat substance use conditions similarly to other chronic disorders and provide more adequate basic preparation need to be implemented. In addition, continuing education opportunities to learn about evidence-based practices for the treatment of SUDs need to be provided, and programs to support the adoption of MAT, screening, brief intervention, and referral to treatment need to be identified and implemented.

More information can be seen in this [[File/view/HCHBrief.pdf/614804863/HCHBrief.pdf|Policy Brief Document]].

== Financial Incentives for MAT training ==

'''Neighborhood Health Plan''' (NHP) of Massachusetts has announced a series of initiatives to increase access to Substance Use Disorder treatments. This non-profit health plan is providing financial incentives to encourage more prescribers to train and be certified to prescribe buprenorphine products. NHP will reimburse prescribers $500, which is roughly the cost of required training, for earning their certification in buprenorphine product dispensing. Prescribers can receive an additional $2,000 if they provide documentation showing that at least 10 patients have been treated after becoming certified. This financial incentive has become increasingly popular, as NHP has received several inquiries about the program from prospective prescribers within days of its announcement. Other initiatives include hiring recovery coaches to work with patients as part of their follow-up care as well as waiving member copays for naloxone. "Pharmacists will be reminded to notify plan members that they are eligible for free naloxone supplies when they pick up high-dose narcotic painkilling prescription medications."<ref>https://www.hmpgloballearningnetwork.com/site/behavioral/article/policy/health-plan-offers-financial-incentives-mat-training</ref> Another initiative is to offer a benefit design that encourages plan members to seek alternatives to opioid medications. NHP waives copays for alternative treatments to prescription painkillers including chiropractic care, acupuncture, and physical therapy.

== Canadian Guidelines ==
<div class="_">This [https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Prescribing-Drugs/Advice-to-the-Profession-Prescribing-Drugs document ]has details on the MAT Methadone guidelines from Canada</div>

= Available Tools and Resources =

[[TR_-_Expand_Access_to_Medication-Assisted_Treatment|TR - Expand Access to Medication-Assisted Treatment]] PCSS The Provider's Clinical Support System offers a [[File/view/StigmaandMethadone.pdf/614518761/StigmaandMethadone.pdf|module]] for CME credit on the Stigma on Maintenance Treatment. This can address the primary perceived and actual stigmas from patients as well as follow professionals. <ref>https://pcssnow.org</ref> [http://www.buppractice.com/ BupPractice] This is a DATA 2000 accredited resource for providing either an 8-hour training for Physicians or a 24-hour training session for Physician Assistants and Nurse Practitioners, both for $199 per full series. It also offers up to 9 AMA PRA Category 1 Credits, and is further supported by the ASAM (American Society of Addiction Medicine). [[File/view/ADAPTINGPRACTICE.pdf/614804967/ADAPTINGPRACTICE.pdf|HCH Clinician's Network]] This resource provides recommendations for one's practice when dealing with opioid addicted patients, particularly those who also happen to be homeless. [[File/view/BHSHomeless.pdf/614805019/BHSHomeless.pdf|SAMSHA's Treatment Improvement Protocol for Homeless Persons]] This document shows current resources for those attempting to handle behavioral health topics, particularly in homeless populations, as well as strategies to develop one's own programs. Where Can Clinicians Get Training and Support? Buprenorphine training sessions are offered at several locations and websites. The training takes about eight hours and can be attended in person, online, or a combination of both. Buprenorphine waiver training can be valuable to any clinician (medical or behavioral) as it covers the basics of opioid addiction and how buprenorphine works. Clinicians can only prescribe buprenorphine for addiction after receiving certified training and a Drug Enforcement Administration (DEA) waiver. However, any DEA-licensed clinician can prescribe buprenorphine for pain. Training opportunities are posted on the following websites: Substance Abuse and Medical Health Services Administration (SAMHSA), American Academy of Addiction Psychiatry (AAAP), American Osteopathic Academy of Addiction Medicine (AOAAM), and Providers’ Clinical Support System (PCSS).24-27 Some sites also offer other tools and resources. PCSS offers online mentorship, and Project ECHO28 offers video telementoring and monthly case review. The Clinicians Consultation Center at UCSF offers expert clinical advice, Monday through Friday, 7 a.m. to 3 p.m. PST.29 Substance Use Warmline: (855) 300-3595. <ref>https://nccc.ucsf.edu/about-the-center/</ref>  

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[[Category:SAFE-Treatment and Recovery]]

Expand Access to Medication-Assisted Treatment (MAT)

2021-11-07T20:12:08Z

G.Lehrman:

__NOTOC__ Return to [[ZOOM_MAP_-_Expand_Access_to_Optimized_MAT|Zoom Map - Expand Access to Optimized MAT]] or  [[ZOOM_MAP_-_Improve_Treatment_&_Enable_Recovery_for_People_with_SUDs|Zoom Map (Improve Treatment & Enable Recovery for People with SUDs)]] or the [[ZOOM_MAP_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]] <div class="wiki" id="content_view" style="display: block">
 __TOC__

= Overview =
<div class="_">Medication-assisted treatment (MAT), including opioid treatment programs (OTPs), combines behavioral therapy and medications to treat substance use disorders.<ref>[1]chanell.baylor. (2015, July 21). Medication-Assisted Treatment (MAT) [Text]. Retrieved December 5, 2019, from https://www.samhsa.gov/medication-assisted-treatment
</ref> Information on medications used in MAT can be found further down on this page. The President's [https://trumpwhitehouse.archives.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-15-2017.pdf Commission on Combating Drug Addiction and the Opioid Crisis] has recommended that the federal government "immediately establish and fund a federal incentive to enhance access to Medication-Assisted Treatment (MAT)."<ref>[2]Commission to the President (2016), Retrieved from: https://trumpwhitehouse.archives.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-15-2017.pdf</ref></div> <div class="_">The above report documents that MAT has been proven to:</div>
*Reduce overdose deaths
*Retain persons in treatment
*Decrease use of heroin
*Prevent spread of infectious disease

= Key Information =

=== The Value of MAT (or Opioid-Agonist Treatment) ===

*International addiction experts consider initial opioid-agonist treatment, or OAT, ''with no duration restrictions'', the evidence-based standard of care for opioid-use disorder, the authors write online November 20, 2018, in Annals of Internal Medicine.<ref>Association, A. P. (n.d.). APA Learning Center The Role of Behavioral Interventions in Buprenorphine Maintenance Treatment (Webinar). Retrieved December 5, 2019, from APA Learning Center website: https://education.psychiatry.org/diweb/catalog/item?id=5913605&_ga=2.63318255.1744877395.1635561868-1008822590.1635561868</ref>
*In California, where more people have been diagnosed with opioid disorder than in any other U.S. state, ''publicly funded treatment programs require patients to “fail” - twice - at a three-week course of medically supervised withdrawal before they become eligible for OAT''. Policymakers likely maintained this medically managed withdrawal requirement under the belief it was saving money. The study demonstrates, however, that the policy creates significantly greater long-term costs for criminal justice and healthcare systems.
**The study concludes OAT would have saved as much as $850 million over five years, not including savings to the criminal justice system, and more than $2 billion, including the cost of arrests and prosecutions. Over 10 years, the total savings would rise to $2.87 billion.<ref>Krebs, E., Enns, B., Evans, E., Urada, D., Anglin, M. D., Rawson, R. A., … Nosyk, B. (2018). Cost-Effectiveness of Publicly Funded Treatment of Opioid Use Disorder in California. Annals of Internal Medicine, 168(1), 10. https://doi.org/10.7326/M17-0611
</ref>
**“In order to see overdose deaths come down, we need to make sure people who have opioid addiction are able to access effective treatment more easily than they can access heroin, fentanyl or pain pills."
**"We need a model whereby patients can get immediate access to opioid-agonist treatment, a lifesaving intervention, without obstacles."
**“Among experts in the field of addiction, we already know that detox doesn’t work, that they’re going to relapse and when they relapse, they’re going to be at great risk for an overdose, that they’ll be at great risk for hepatitis,” Kolodny said. “Opioid addiction is a life-threatening illness."

Access the study here:<ref>What’s this agonist / antagonist stuff? (n.d.). Retrieved December 5, 2019, from https://www.naabt.org/faq_answers.cfm?ID=5
</ref>

This article talks of how the use of Buprenorphine reduces the cost of opioid addiction<ref>[1]Behavioral Healthcare Executive | Psychiatry & Behavioral Health Learning Network. (n.d.). Retrieved December 5, 2019, from https://www.psychcongress.com/node/721
</ref>

 

= Relevant Research =
<div class="_">An article in the August 2017 issue of the American Journal of Psychiatry, by Roger D. Weiss, MD, the Chief of the Division of Alcohol and Drug Abuse at McLean Hospital (Belmont, MA) and Professor of Psychiatry at Harvard Medical School and Kathleen Carroll, Ph.D. concluded: "Finally, with 6-month retention rates seldom exceeding 50% and poor outcomes following dropout, we must explore innovative strategies for enhancing retention in buprenorphine treatment."<ref>https://pubmed.ncbi.nlm.nih.gov/27978771/</ref></div> <div class="_"> </div> <div class="_">This report reveals the need for significantly more studies that can yield additional insights to inform MAT practices. Current literature focuses mainly on the outcome of treatment retention and negative urine drug screens. Enhanced research would look at broader outcomes of social functioning and well-being including employment, stable housing and other measures of well-being. Also, research would ideally have information on many other factors such as information on co-occurring disorders and different types of behavioral treatments that would be appropriate for different individuals. While not mentioned specifically in that article, a person's history of trauma or adverse childhood experiences (ACEs), length of time with an SUD, their current level of supports, and genetic factors such as the rates at which they metabolize different drugs would all impact what type of treatment would be most appropriate. All of these unique factors and the wide range of potential interventions are reasons that more research is needed, and conclusions from studies that look at a limited number of inputs and outcomes and lack visibility into all the unique factors that influence what might impact successful outcomes should be seen as early insights in a journey of finding the optimal forms of treatment for each person's situation.</div> <div class="_"> </div> <div class="_">Weiss and Carroll highlight some key findings from their report in a webinar done through the American Journal of Psychiatry learning center.[3] Key points include:</div>
*Buprenorphine is an excellent medication, but there is still much room for improvement in how MAT is done.
*Research designs, such as the intensity of Medication Management, the dose of buprenorphine, and the characteristics of the group participants, influence outcomes.
*Different sub-groups respond differently to different elements of treatment plans.
*Early treatment response has a major impact on long-term success, and a better understanding of that insight may help decision-making.
**Patients who abstain from opioids in the first two weeks of treatment have a good chance of a good 12-week outcome.
**Patients who use opioids during the first two weeks of treatment have very little chance of abstaining by week 12.
*There is evidence that the use of [https://drugabuse.com/treatment/contingency-management/ Contingency Management ](CM), including the use of computer-based therapies, seems to increase success rates.
*Patients dependent on prescription opioids seemed to respond more positively to Cognitive Behavioral Therapy (CBT) than those who were primarily heroin users.
*Different treatment approaches appeal to different patients, and using approaches that appeal to the patients helps to increase their retention rates.
*More data is needed to better understand what treatment options are best for different individuals.

== Ways to Improve and Optimize MAT ==

The effectiveness of MAT is enhanced when there is an emphasis on a broad range of treatment and recovery supports, not just providing the medication part of the MAT.  MAT is optimized when those providing and funding the treatment keep striving to improve all aspects of the treatment plan, optimized for each individual as much as practical. 

Some of the ways that MAT can be optimized are listed below::

*Precision medication ([[Expand_DNA_Testing_to_Improve_Precision_MAT_Therapies|Expand DNA Testing to Improve Precision MAT]])
*A coordinated, proactive, whole-person care plan ([[Integrate_MAT_into_a_Whole_Person_Care_Model|Integrate MAT into whole-person care model]])
*Community engagement ([[Expand_community_engagement_to_improve_MAT|Expand community engagement to improve MAT]])
*Use of innovative technologies ([[Use_innovative_technologies_to_enhance_MAT|Use innovative technologies to enhance MAT]])

== Current Status of MAT Practices ==

*Only 10% of conventional drug treatment facilities in the United States provide MAT for opioid use disorders (need source and date)
*According to SAMHSA data collected in early 2017, 40 percent of the physicians who have a waiver do not prescribe buprenorphine at all. This may be due to physicians' reluctance to have patients with addictive disorders frequenting their offices or due to concerns about DEA audits, among other reasons.[4]
*Avalere’s analysis finds that 11 states (IA, IL, MD, MI, MO, NC, NH, OH, VA, WI, WV) located in the Midwest and Mid-Atlantic and DC have significantly lower-than-average rates of providers who prescribe buprenorphine compared to opioid overdose deaths.<ref>https://avalere.com/press-releases/midwest-and-mid-atlantic-states-face-provider-shortage-to-address-opioid-epidemic</ref>

</div>

== Co-occurring Disorders ==

Co-occurring disorders, or dual diagnosis, refers to having a simultaneous mental health disorder and substance use disorder. It is common for people with addictions to also suffer from depression, anxiety, or more severe mental illnesses such as schizophrenia or bipolar disorder. Research shows that people who use alcohol or other drugs early in life are more likely to have mental or emotional problems. It’s also true that many people with mental illnesses “self-medicate” with alcohol or other drugs to numb emotional pain, relieve anxiety, or quiet their thoughts. In the past, the medical profession treated one disorder first, typically the substance use disorder, before addressing the other. It is now understood that treating both simultaneously leads to better outcomes. Any successful addiction treatment program will include a mental health assessment and treat co-occurring disorders at the same time.<ref> [6]Weiss, R. D., Potter, J. S., Fiellin, D. A., Byrne, M., Connery, H. S., Dickinson, W., … Ling, W. (2011). Adjunctive counseling during brief and extended buprenorphine-naloxone treatment for prescription opioid dependence: A 2-phase randomized controlled trial. Archives of General Psychiatry, 68(12), 1238–1246. https://doi.org/10.1001/archgenpsychiatry.2011.121
</ref>

 

== Different Medications Used in MAT: ==

=== Agonists & Antagonists ===
<div class="_">An opioid agonist activates opioid receptors in the brain. An antagonist blocks opioids by attaching to the opioid receptors without activating them.<ref>[7]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>[Detoxification vs. Stabilization]</div> <div class="_"> </div> <div class="_">Buprenorphine</div>
*Buprenorphine is used in MAT to help people reduce or quit their use of heroin or other opiates, such as pain relievers like morphine. One study showed that 50% of the people in treatment who were also on Buprenorphine stayed on treatment compared with 7% who only had treatment.<ref>[8]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Buprenorphine is a partial agonist that suppresses opioid withdrawal symptoms. It can produce opioid agonist effects, such as euphoria, it is milder than full agonists such as methadone.<ref>https://www.drugabuse.gov/download/21349/medications-to-treat-opioid-use-disorder-research-report.pdf?v=99088f7584dac93ddcfa98648065bfbe</ref>
*Buprenorphine can be prescribed by physicians in an outpatient setting who have completed a training course and received a DEA DATA 2000 waiver. It is taken as a pill or sublingual film. Buprenorphine was also approved in a 6-month implant form in May 2016<ref>https://archives.drugabuse.gov/news-events/news-releases/2016/05/fda-approves-six-month-implant-treatment-opioid-dependence</ref>
*Training for Buprenorphine providers is an 8-hour course (24 for Nurse Practitioners and Physician Assistants) and allow for the following patient loads and responsibilities:<ref>[11]Medication-Assisted Treatment: Buprenorphine in the HCH Community (2016), National Health Care for the Homeless Council, Retrieved From: https://nhchc.org/wp-content/uploads/2019/08/policy-brief-buprenorphine-in-the-hch-community-final.pdf</ref>

#30 Addiction Treatmtent Patients per provider for the first year
#100 patients each year thereafter
#An additional 175 (totaling 275) patients can be allotted if the Physician is board certified in addiction or if a facility:

*Has 24 Call Coverage for patients
*Uses an EMR/EHS to monitor and update patient records (for those looking for an entry-level EHS, PracticeFusion is a free system)
*Provision of Care Management Services
*Subscribing to a State-led Drug Management System
*Acceptance of Third Party Insurance

It should be noted that only around 10% of those who wish to seek treatment can find qualified providers to allow for it. <ref>[12]https://www.fiercehealthcare.com/practices/only-10-eligible-primary-care-providers-can-prescribe-buprenorphine-to-treat-patients-for</ref> As a result, there are cases where medication diversion does occur, and there is a black market for the drug for self-treatment purposes.<ref>[13]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref> Treatment with buprenorphine has been proven effective in opioid addiction, decreasing mortality by approximately 50%. Patients treated with buprenorphine show improved social functioning with increased retention in treatment (67% at one year) compared to drug-free treatment (7% to 25% at one year), reduced criminal activity, lower rates of illicit substance abuse, and reduced risk of HIV and hepatitis infection.<ref>[14]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>

*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine SAMSHA page on Buprenorphine]
*[[More_info_on_Buprenorphine|More info on Buprenorphine]]

For more information, one can visit the information page on [[File/view/BupForOUD.pdf/614583113/BupForOUD.pdf|Buprenorphine for Patients and Families]], which includes information on side effects, information to share with providers, and other useful information. This document was compiled by Intermountain Health Care.

=== Suboxone ===

*Suboxone is a brand name for a hybrid that is three parts Buprenorphine and one part Naloxone.
*Suboxone is more difficult to misuse because it will cause the patient to enter opioid withdrawal if it is misused in any way, such as injection.<ref>[15]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*[[More_info_on_Suboxone|More info on Suboxone]] (including generic options)

 

=== Probuphine ===

*Probuphine is an implant that contains the medicine buprenorphine. Probuphine is used to treat certain adults who are addicted to (dependent on) opioid drugs (either prescription or illegal). Probuphine is part of a complete treatment program that also includes counseling and behavioral therapy.
*Because Probuphine contains buprenorphine, it may cause physical dependence.
*Four implants are inserted under the skin of your upper arm during a procedure done in your physician's office or Opioid Treatment Program (OTP).
*The implants remain in your arm for six months.
*After the six-month period, your doctor must remove the implants.
*If you wish to continue Probuphine, your doctor may insert new implants to continue treatment.
*The implants can be removed sooner if you want to stop treatment.
*Patients must continue to see their doctor at least every month while on Probuphine therapy.
*[https://probuphinerems.com For more information visit their website.]

=== Methadone ===

*Methadone, sold under the brand name [https://www.drugs.com/cdi/dolophine.html Dolophine] among others, is used in MAT to help with detoxification or as part of [https://en.wikipedia.org/wiki/Maintenance_therapy maintenance therapy] or [https://en.wikipedia.org/wiki/Opioid_replacement_therapy Opioid Replacement Therapy].
*Methadone is an opioid replacement. It works by changing how the brain and nervous system respond to pain. It lessens the painful symptoms of opiate withdrawal and blocks the euphoric effects of opiate drugs such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone.<ref>[16]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Methadone is to be prescribed as part of a comprehensive treatment plan that includes counseling and participation in social support programs.
*Methadone can only be dispensed at SAMHSA-certified outpatient treatment programs or in hospitals in an emergency. <ref>17]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Methadone has been used to treat chronic pain, however, this use is limited because of the serious risk of dependence and overdose.<ref>[18]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/methadone SAMSHA page on Methadone]
*[[More_Information_on_Methadone|More info on Methadone]]

=== Naltrexone ===

*Naltrexone is a nonaddictive medicine that serves as an opioid receptor antagonist and not an opioid replacement, unlike methadone and buprenorphine. It is a primary ingredient in the treatment of alcohol and opioid dependence. Naltrexone blocks certain receptors in the part of the brain that triggers dopamine release so they cannot be activated. Dopamine release reinforces the vicious and compulsive addiction feedback loop. When we block these areas of the brain, the craving for alcohol and opiates is eliminated or significantly reduced. The pleasure is very limited and the uncontrollable cascade of relapse is much less likely, if alcohol is consumed after the implant procedure, in addition, if opiates are consumed after the procedure, there are no effects.<ref>[19]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Naltrexone is administered in a long-active, injectable formulation administered once a month.<ref>[20]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Naltrexone does not prevent withdrawal symptoms so it is recommended for patients who do not have opioids in their system.<ref>[21]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone SAMSHA page on Naltrexone] (The 30-day injectable version is commercially known as Vivitrol)
*[[More_info_on_Naltrexone_and_Vivitrol|More info on Naltrexone and Vivitrol]]

 

=== Naloxone ===

*Naloxone is an opioid antagonist used to reverse opioid overdose
*Naloxone (commercially known as Narcan) is available in intravenous or intramuscular injection and nasal delivery options. Intramuscular injection or intranasal delivery is safe for administration by any person.<ref>[22]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Naloxone works within minutes and effects last for up to an hour. Multiple doses may be required depending on the severity of respiratory depression.<ref>[23]Garcia-Portilla, M. P., Bobes-Bascaran, M. T., Bascaran, M. T., Saiz, P. A., & Bobes, J. (2014). Long term outcomes of pharmacological treatments for opioid dependence: Does methadone still lead the pack? British Journal of Clinical Pharmacology, 77(2), 272–284. https://doi.org/10.1111/bcp.12031
</ref>
*Naloxone does not produce tolerance or dependence. <ref>[24]Moving from Stigma to Science in Treating Addiction. (2016, December 17). Retrieved December 5, 2019, from California Health Care Foundation website: https://www.chcf.org/blog/moving-from-stigma-to-science-in-treating-addiction/
</ref>
*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/naloxone SAMSHA page on Naloxone]
*[[More_info_on_Naloxone|More info on Naloxone]] (including discounted public pricing and free Narcan for schools)
*(for [http://www.samhsa.gov/medication-assisted-treatment/treatment/opioid-overdose opioid overdose])

 Find information on physical ailments often diagnosed in MAT patients. Also known as [http://www.samhsa.gov/medication-assisted-treatment/treatment/common-comorbidities common comorbidities], these include viral hepatitis, HIV, and AIDS. Medications Used in Addiction Treatment**<ref>[25]The Case for Medication-Assisted Treatment. (n.d.). Retrieved December 5, 2019, from http://pew.org/2kdLIf2
</ref>

{| border="1" class="wiki_table"
|-
| Sept 2017
| Where it can be provided
| FDA indications
| Effectiveness
| Administration
|-
| Methadone
| OUD. Licensed opioid treatment programs Pain. Any Drug Enforcement Agency (DEA)-licensed prescriber
| OUD and pain management
| 74% to 80%<ref>[26]Summary: Major components of the HHS final rule. Effective August 8, 2016. (n.d.). Retrieved December 5, 2019, from https://www.asam.org/resources/publications/magazine/read/article/2016/07/06/summary-of-the-major-components-of-the-hhs-final-rule-which-will-be-effective-on-august-5-2016
</ref>
| OUD. Daily pill, liquid, and wafer forms; injectable form in hospitalized patients unable to take oral medications Pain. Injectable, transdermal, and buccal film
|-
| Buprenorphine and buprenorphine/naloxone
|
*Prescribed by community physicians and dispensed by pharmacies; available in some opioid treatment programs.
*Physicians receive federal waivers after eight hours of training; nurse practitioners and physician assistants require 24 hours. Patient panels are capped at 30, 100, and 275 per provider (depending on experience and setting).<ref>[27]Why Health Plan Should Go to the “MAT” in the Fight against Opioid Addiction(2017), California Health Care Foundation, Retrieved form: https://www.chcf.org/wp-content/uploads/2017/12/PDF-Why-Health-Plans-Should-Go-to-the-MAT.pdf</ref><ref>[28]Garcia-Portilla, M. P., Bobes-Bascaran, M. T., Bascaran, M. T., Saiz, P. A., & Bobes, J. (2014). Long term outcomes of pharmacological treatments for opioid dependence: Does methadone still lead the pack? British Journal of Clinical Pharmacology, 77(2), 272–284. https://doi.org/10.1111/bcp.12031
</ref><ref>[29]Kakko, J., Svanborg, K. D., Kreek, M. J., & Heilig, M. (2003). 1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: A randomised, placebo-controlled trial. The Lancet, 361(9358), 662–668. https://doi.org/10.1016/S0140-6736(03)12600-1
</ref>
*Any DEA-licensed provider can prescribe buprenorphine for pain.

| OUD and pain management (depending on formulation and dose)
| 60% to 90%<ref>[30]McNicholas, L.(n.d).Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction, U.S Department of Health and Human Rights, Retrieved from : https://www.naabt.org/documents/TIP40.pdf</ref>
| OUD. Daily sublingual, buccal, film, and tablet, or six-month intradermal device Pain. Injectable, transdermal, and buccal film
|-
| Naltrexone
| No restrictions
| Opioid and alcohol use disorders
| OUD. 10% to 21%<ref>[31]Miranda, A., & Taca, A. (2018). Neuromodulation with percutaneous electrical nerve field stimulation is associated with reduction in signs and symptoms of opioid withdrawal: A multisite, retrospective assessment. The American Journal of Drug and Alcohol Abuse, 44(1), 56–63. https://doi.org/10.1080/00952990.2017.1295459
</ref>
| Daily pill or monthly injectable
|-
| Naloxone (used only for overdose reversal, not addiction treatment)
| Any setting: prescribed or dispensed by a clinician, furnished by a pharmacy without a prescription (legal in several states), dispensed by lay staff in community settings (by standing order), or carried by law enforcement or other first responders.
| To reverse respiratory suppression in suspected opioid overdose
| May require high doses for extremely high-potency illicit drug use (fentanyl and carfentanyl)
| Intranasal spray, or intravenous, intramuscular, or subcutaneous injectable
|}
<div class="_">Extensive research has demonstrated the effectiveness of opioid agonist treatment (methadone and buprenorphine) in opioid use disorder. A meta-analysis of 50 studies showed methadone's retention rate ranging from 70% to 84% at one year, buprenorphine ranging from 60% to 90% at one year, with both treatments resulting in significant reductions in overdose death, illicit drug use, criminal activity, arrests, risk behaviors, HIV and hepatitis C incidence, as well as improvements in health status, functioning, and quality of life.<ref>https://www.chcf.org/wp-content/uploads/2017/12/PDF-Why-Health-Plans-Should-Go-to-the-MAT.pdf</ref>  </div>
== Stages of MAT with Buprenorphine ==

=== Induction ===
<div class="_">"Induction is the first stage of buprenorphine treatment and involves helping patients begin the process of switching from the opioid of abuse to buprenorphine. The goal of the induction phase is to find the minimum dose of buprenorphine at which the patient discontinues or markedly diminishes use of other opioids and experiences no withdrawal symptoms, minimal or no side effects, and no craving for the drug of abuse."<ref>[33]Addiction experts look to new and expanded opioid treatment options in 2017. (2017, January 13). Retrieved December 5, 2019, from FOX 61 website: https://fox61.com/2017/01/13/addiction-experts-look-to-new-and-expanded-opioid-treatment-options-in-2017/
</ref></div> <div class="_">New non-pharmacological approaches to treat opioid withdrawal could provide alternative pathways to help a patient manage withdrawal symptoms as they transition into MAT. The [https://i-h-s.com/ BRIDGE]® is a noninvasive, percutaneous electrical nerve field stimulator developed to target pain. An article published in 2018 in The American Journal of Drug and Alcohol Abuse shared significant promising results in using the BRIDGE to help people transition to MAT. The neurostimulation rapidly and dramatically reduced the [https://www.drugabuse.gov/sites/default/files/files/ClinicalOpiateWithdrawalScale.pdf COWS scores] of the participants, and 64 of the 73 people successfully transitioned to MAT. Some training programs suggest that [https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=99a59495-2a48-4276-bbe3-cdd55a45aba4 Clonidine] or [https://www.webmd.com/drugs/2/drug-16910-8296/ondansetron-oral/ondansetron-disintegrating-tablet-oral/details Ondansetron] may be used to ease the withdrawal symptoms during induction.<ref> [35]Vermont Global Commitment to Health Section 1115 Demonstration Fact Sheet (2018). Retrieved from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/vt/vt-global-commitment-to-health-fs.pdf</ref></div> <div class="_">[[More_information_on_buprenorphine_induction|More information on buprenorphine induction]].</div> <div class="_"> </div>
=== Stabilization ===
<div class="_">"The stabilization phase has begun when a patient is experiencing no withdrawal symptoms, is experiencing minimal or no side effects, and no longer has uncontrollable cravings for opioid agonists. Dosage adjustments may be necessary during early stabilization, and frequent contact with the patient increases the likelihood of compliance."</div> <div class="_"> [[More_information_on_buprenorphine_stabilization|More information on buprenorphine stabilization]].</div>
=== Maintenance ===
<div class="_">"The longest period that a patient is on buprenorphine is the maintenance phase. This period may be indefinite. During the maintenance phase, attention must be focused on the psychosocial and family issues that have been identified during the course of treatment as contributing to a patient’s addiction."</div> <div class="_">[[More_information_on_buprenorphine_maintenance|More information on buprenorphine maintenance]]</div>
== Medically Supervised Withdrawal (Detoxification) ==
<div class="_">As an alternative to the three stages above, the goal of using buprenorphine for medically supervised withdrawal from opioids is to provide a transition from the state of physical dependence on opioids to an opioid-free state, while minimizing withdrawal symptoms (and avoiding side effects of buprenorphine). Medically supervised withdrawal with buprenorphine consists of an induction phase and a dose-reduction phase. The consensus panel recommends that patients dependent on short-acting opioids (e.g., hydromorphone, oxycodone, heroin) who will be receiving medically supervised withdrawal be inducted directly onto buprenorphine/naloxone tablets. The use of buprenorphine (either as buprenorphine monotherapy or buprenorphine/naloxone combination treatment) to taper off long-acting opioids should be considered only for those patients who have evidence of sustained medical and psychosocial stability.</div>

= Impactful Federal, State, and Local Policies =

== New 2018 SAMHSA Guide for Medications for Opioid Use Disorder ==

This latest, detailed [https://store.samhsa.gov/product/TIP-63-Medications-for-Opioid-Use-Disorder-Executive-Summary/SMA18-5063EXSUMM 330-page report] can be downloaded for free. 

= Promising Practices =

== New & Expanded Treatment Options ==

=== Connecticut ===
<div class="_">Connecticut's Department of Mental Health and Addiction Services (DMHAS) recently received two federal grants, one of which is meant to go to medication-assisted treatment, the other toward prevention efforts. DMHAS is also collaborating with the Connecticut Community for Addiction Recovery on a new program that will enable people who were saved from overdose through the use of naloxone to work with a recovery coach who can connect them to services and a support network.<ref> [36]Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence: A Randomized Clinical Trial | Emergency Medicine | JAMA | JAMA Network. (n.d.). Retrieved December 5, 2019, from https://jamanetwork.com/journals/jama/fullarticle/2279713
</ref></div>

=== Vermont ===
<div class="_">Vermont's Health Home for Opioid Addiction has employed a "Hub & Spoke" system in handling the Opioid Crisis, called the "Care Alliance for Opioid Addiction," which has seen some success in treating addicted individuals while helping lift the burden of care from singular doctors and clinics. The system is composed of the following parts<ref> [37] Kashef, Z. (2015, April 28). Emergency department treatment for opioid addiction better than referrals. Retrieved December 5, 2019, from YaleNews website: https://news.yale.edu/2015/04/28/emergency-department-treatment-opioid-addiction-better-referrals
</ref>:</div>
*The Hub, a designated provider of specialty addiction treatment, is designed as an Opioid Treatment Program which is operated by Community Behavioral Health Agencies.
*The Spokes are health care teams led by physicians who can prescribe Buprenorphine and are regulated as Office Based Opioid Treatment providers.

Payment infrastructure for providers are structured after already existing Medicare and Medicaid Structures, which are documented in the Vermont Global Commitment To Health Section 1115 Demonstration Fact Sheet<ref>[38]Kashef, Z. (2015, April 28). Emergency department treatment for opioid addiction better than referrals. Retrieved December 5, 2019, from YaleNews website: https://news.yale.edu/2015/04/28/emergency-department-treatment-opioid-addiction-better-referrals
</ref>

*
**An evaluation of the Care Alliance for Opioid Addiction has shown that people in treatment for opioid addiction reported a 96 percent decrease in opioid use, and a 100 percent drop in overdose incidences, according to a [http://www.healthvermont.gov/media/newsroom/hub-and-spoke-evaluation-shows-significant-impact-january-22-2018 new report] from the Vermont Department of Health released 1/22/18.
**Additional findings include:
***92% drop in injection drug use.
***89% decrease in emergency department visits.
***90% reduction in both illegal activities and police stops/arrests.
***Zero participants in treatment had overdosed in the 90 days leading up to the study interview, compared to 25% who had overdosed in the 90 days before entering treatment.
***Family conflict, feelings of depression, anxiety and anger decreased, and participants reported being much more satisfied with their lives.

More information can be found at: <ref>[3]Hub and Spoke Evaluation Shows Significant Impact (January 22, 2018). (2018, January 22). Retrieved December 5, 2019, from Vermont Department of Health website: https://www.healthvermont.gov/media/newsroom/hub-and-spoke-evaluation-shows-significant-impact-january-22-2018

</ref>

== Emergency Department Treatment Protocols ==
<div class="_">In a Yale Randomized trial, it was found that individuals who receive Buprenorphine while getting medical care within an emergency room are more likely to adhere to treatment protocols and have a better chance at ceasing opioid use when compared to those who have received referrals to receive the treatment, or those who received motivational support.<ref>[39] Weiss, R. D., Potter, J. S., Griffin, M. L., Provost, S. E., Fitzmaurice, G. M., McDermott, K. A., … Carroll, K. M. (2015). Long-term outcomes from the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study. Drug and Alcohol Dependence, 150, 112–119. https://doi.org/10.1016/j.drugalcdep.2015.02.030
</ref>This can be an initiation point for treatment of opioid dependence and can be followed up by primary care facilities. This has shown to decrease the need for in-patient facilities. This can be attributed to engaging patients at the optimal point of access. <ref>[40]Health plan offers financial incentives for MAT training | Psychiatry & Behavioral Health Learning Network. (n.d.). Retrieved December 5, 2019, from https://www.psychcongress.com/article/policy/health-plan-offers-financial-incentives-mat-training
</ref></div>

== National Healthcare For Homeless Council ==
<div class="_">As one may assume, there is cross-over between the homeless and addicted communities. The National Healthcare for the Homeless Council has as a result, released a policy brief that may be of some use for both policy makers and health care providers alike. Within the brief, a basic strategy is considered as follows when treating addicted and homeless/addicted patients:</div> <div class="_">  • '''Establish stability'''. Stable housing is central to attaining treatment goals as it provides patients with stability, a sense of safety, an increased ability to meet basic needs, and an opportunity to have increased control over their lives and environment. Securing stable housing as early as possible is key to the treatment and recovery process.   • '''Address comorbidities using integrated care'''. Untreated medical and/or other behavioral health conditions may complicate MAT. The most successful interventions are provided through integrated care models of interdisciplinary teams made up of medical, mental health, substance use, and social service providers. Each discipline should not only be co-located, but should work collaboratively as a team with multiple services offered in the same visit.   • '''Treat the whole person'''. Substance use disorders cannot be treated apart from addressing the needs of the whole person in the context of his or her environment. In addition to addressing comorbidities, assistance in accessing food, clothing, shelter/housing, financial assistance, counseling, job training, employment services, and other needs as identified must be included alongside MAT.   • '''Take a harm reduction approach'''. Harm reduction therapy is an evidence-based practice that supports and respects a person’s experience and treats them with dignity, which is especially important for persons experiencing homelessness who regularly interact with systems and situations that limit self-determination and lack respect. Harm reduction therapy relies on collaboration, respect, and stage-based interventions that acknowledge self-defined positive change. Harm reduction therapy focuses on client-defined priorities and acknowledges that any improvement that reduces harm is beneficial. The key to harm reduction therapy is low barrier, integrated care that is trauma informed and respectful of the collaborative therapeutic relationship.   • '''Utilize evidence-based best practices'''. In addition to harm reduction, using other evidence-based best practices such as the use of peer specialists, motivational interviewing, and individual and group therapy can help patients maintain recovery and have successful treatment outcomes.   •'''Be patient centered'''. Building trust and developing relationships is essential to providing high-quality care and achieving good health outcomes. Engaging in patient centered care based on a patient’s individual needs, strengths, goals, and timeframe rather than on a pre-determined benchmark for outcomes is one way to build relationships and empower patients in the process. Patients should be actively involved in setting goals and planning their treatment.   •'''Be flexible'''. There is no one-size-fits-all treatment that will work for all patients. While MAT recommends a combination of medication and behavioral health therapy, treatment should be flexible and individualized to the patient’s needs, especially the frequency/schedule for therapy. For some, medication alone and regular consultation with a primary care provider is enough to maintain and recover from addiction, while others may need the additional supports provided by behavioral health therapy.</div> <div class="_"> </div> <div class="_">More information can be found on the [[File/view/HCHBrief.pdf/614804863/HCHBrief.pdf|Policy Document]] itself.</div>

== Opioid Treatment Program Directory ==
<div class="_">Select [http://dpt2.samhsa.gov/treatment/directory.aspx this directory] to view the opioid treatment programs in each state</div>

== Moving from Stigma to Science ==

=== Pennsylvania and New Jersey ===
<div class="_">The Department of Behavioral Health and Intellectual Disability Services of Pennsylvania has taken actions to ensure that halfway houses and other rehabilitation facilities cannot turn away individuals using MAT as a means of treating Opioid Abuse. <ref>[41] https://dbhids.org/MAT/</ref> Underlying problems still exist in restrictive medication regimen practices, insurance coverage, and Public-Private partnerships, which require support to overturn previous hard-lined policies. An evidence-based approach has shown that introduction of MAT, especially with Buprenorphine, has had an increased mitigation effect on relapse and a higher chance of long-term recovery.<ref> [42]Page Not Found</ref></div>

=== National Healthcare For Homeless Council ===

The National Healthcare for the Homeless Council also has recommendations of policy that not only controls the prescription of opiates, but also the treatment of opioid addiction. They are as follows:
<div class="_">Remove the cap on the number of patients a physician can treat with buprenorphine. Existing limits are arbitrary and create barriers to accessing treatment. While put in place to mitigate diversion, cap limits may inadvertently aid diversion by limiting the supply of MAT, leading to individuals pursuing self-treatment by purchasing diverted drugs. Ironically, there are no limits to the number of patients a physician can prescribe other opioid drugs that present a much greater risk of causing addiction, overdose, and death (e.g., Methadone, Oxycodone, Hydrocodone, and Fentanyl). Removing the caps will allow providers to determine the number of patients they are able to treat based on the capacity of their practice and other factors, thereby increasing access to treatment.</div>
*Expand prescribing rights to all clinicians who are eligible to prescribe Class III, IV, and V CDS drugs. Limiting prescribing rights to physicians creates an additional barrier to accessing treatment and is incongruent with the existing scope of many clinical practices. Expanding prescribing rights to Nurse Practitioners, Physicians Assistants, and other clinicians who are authorized to prescribe Class III, IV, and V CDS drugs will expand treatment opportunities and decrease barriers to care. Clinicians who can prescribe opioids for pain should also be able to prescribe buprenorphine to treat the addictions that sometimes result.
*Require training to prescribe all opioids, not just buprenorphine. Specialized training is required to prescribe buprenorphine, but no other drug (opioid or otherwise) requires this as a condition of practice. Given the lower risks associated with diversion of buprenorphine, and the elevated risk associated with many opiates that can be prescribed with few restrictions, training should be extended to the prescribing of any opioid and focus on administering and monitoring prescriptions and understanding the nature of addiction. In addition, prescribers should have greater access to technical assistance and resources to develop plans to identify and avoid diversion.
*Enforce parity laws. Substance abuse treatment and other behavioral health services should be just as easy to access as primary care services. Parity laws are in place to ensure insurance plans treat these services equally, and should be enforced. Health insurance practices that require prior authorizations for opioid treatment should be scrutinized, especially when they create barriers to behavioral health care that do not exist for primary care. Just as there are no prior authorizations required for opioid drugs prescribed for pain management, there should be no prior authorizations required for MAT. Addiction is a time-sensitive condition to treat, and presenting for treatment is a big step for patients; even a delay of one day can be the difference in someone getting treatment or not.
*Reduce stigma and treat addiction as a disease. The main barrier to any type of treatment for persons experiencing homelessness is a lack of stable housing. In addition, drug screens are often required when accessing housing, and employers often require drug screens for employment. Landlords and employers need to accept buprenorphine prescribed as part of a MAT plan as a medical treatment process, and not have it count negatively against a person by including it as a prohibited substance. Addiction needs to be seen as a disease and not a moral failing, and engagement in MATs as a health care intervention should not be a liability to accessing housing or employment.
*Train all health care disciplines on addiction. Expanding awareness of addiction and providing substance abuse education for medical students, residents, practicing physicians, and all other health care providers is essential. Curricula which treat substance use conditions similarly to other chronic disorders and provide more adequate basic preparation need to be implemented. In addition, continuing education opportunities to learn about evidence-based practices for the treatment of SUDs need to be provided, and programs to support the adoption of MAT, screening, brief intervention, and referral to treatment need to be identified and implemented.

More information can be seen in this [[File/view/HCHBrief.pdf/614804863/HCHBrief.pdf|Policy Brief Document]].

== Financial Incentives for MAT training ==

'''Neighborhood Health Plan''' (NHP) of Massachusetts has announced a series of initiatives to increase access to Substance Use Disorder treatments. This non-profit health plan is providing financial incentives to encourage more prescribers to train and be certified to prescribe buprenorphine products. NHP will reimburse prescribers $500, which is roughly the cost of required training, for earning their certification in buprenorphine product dispensing. Prescribers can receive an additional $2,000 if they provide documentation showing that at least 10 patients have been treated after becoming certified. This financial incentive has become increasingly popular, as NHP has received several inquiries about the program from prospective prescribers within days of its announcement. Other initiatives include hiring recovery coaches to work with patients as part of their follow-up care as well as waiving member copays for naloxone. "Pharmacists will be reminded to notify plan members that they are eligible for free naloxone supplies when they pick up high-dose narcotic painkilling prescription medications."<ref>https://www.hmpgloballearningnetwork.com/site/behavioral/article/policy/health-plan-offers-financial-incentives-mat-training</ref> Another initiative is to offer a benefit design that encourages plan members to seek alternatives to opioid medications. NHP waives copays for alternative treatments to prescription painkillers including chiropractic care, acupuncture, and physical therapy.

== Canadian Guidelines ==
<div class="_">This [https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Prescribing-Drugs/Advice-to-the-Profession-Prescribing-Drugs document ]has details on the MAT Methadone guidelines from Canada</div>

= Available Tools and Resources =

[[TR_-_Expand_Access_to_Medication-Assisted_Treatment|TR - Expand Access to Medication-Assisted Treatment]] PCSS The Provider's Clinical Support System offers a [[File/view/StigmaandMethadone.pdf/614518761/StigmaandMethadone.pdf|module]] for CME credit on the Stigma on Maintenance Treatment. This can address the primary perceived and actual stigmas from patients as well as follow professionals. <ref>https://pcssnow.org</ref> [http://www.buppractice.com/ BupPractice] This is a DATA 2000 accredited resource for providing either an 8-hour training for Physicians or a 24-hour training session for Physician Assistants and Nurse Practitioners, both for $199 per full series. It also offers up to 9 AMA PRA Category 1 Credits, and is further supported by the ASAM (American Society of Addiction Medicine). [[File/view/ADAPTINGPRACTICE.pdf/614804967/ADAPTINGPRACTICE.pdf|HCH Clinician's Network]] This resource provides recommendations for one's practice when dealing with opioid addicted patients, particularly those who also happen to be homeless. [[File/view/BHSHomeless.pdf/614805019/BHSHomeless.pdf|SAMSHA's Treatment Improvement Protocol for Homeless Persons]] This document shows current resources for those attempting to handle behavioral health topics, particularly in homeless populations, as well as strategies to develop one's own programs. Where Can Clinicians Get Training and Support? Buprenorphine training sessions are offered at several locations and websites. The training takes about eight hours and can be attended in person, online, or a combination of both. Buprenorphine waiver training can be valuable to any clinician (medical or behavioral) as it covers the basics of opioid addiction and how buprenorphine works. Clinicians can only prescribe buprenorphine for addiction after receiving certified training and a Drug Enforcement Administration (DEA) waiver. However, any DEA-licensed clinician can prescribe buprenorphine for pain. Training opportunities are posted on the following websites: Substance Abuse and Medical Health Services Administration (SAMHSA), American Academy of Addiction Psychiatry (AAAP), American Osteopathic Academy of Addiction Medicine (AOAAM), and Providers’ Clinical Support System (PCSS).24-27 Some sites also offer other tools and resources. PCSS offers online mentorship, and Project ECHO28 offers video telementoring and monthly case review. The Clinicians Consultation Center at UCSF offers expert clinical advice, Monday through Friday, 7 a.m. to 3 p.m. PST.29 Substance Use Warmline: (855) 300-3595. <ref>https://nccc.ucsf.edu/about-the-center/</ref>  

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[[Category:SAFE-Treatment and Recovery]]

Expand & Enhance Prescription Drug Monitoring Program (PDMP)

2021-11-07T20:05:06Z

G.Lehrman:

'''''Return to '''[[ZOOM_MAP_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Program|Zoom Map (Expand & Enhance PDMP) ]] or [[ZOOM_MAP_-_Reduce_Access_to_Opioids|Zoom Map (Reduce Access to Opioids)]] or [[ZOOM_MAP_-_Minimize_Diversion_of_Prescription_Drugs|Zoom Map (Minimize Diversion of Prescription Drugs)]] or [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom map - Reduce Prescription of Opioids]]''

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= Introductory Paragraph =

Prescription Drug Monitoring Programs (PDMP) allow pre-registered users including licensed healthcare prescribers to prescribe controlled substances, pharmacists authorized to dispense controlled substances, and law enforcement and regulatory boards to access timely patient-controlled substance history information.<ref>[1]PDMP/CURES. (n.d.). Retrieved November 24, 2019, from https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/PDMP-CURES.html</ref> PDMPs are designed to collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners. This information is used to assist prescribers, dispensers, and other health care professionals in making clinical decisions for their patients. PDMPs also have been shown to reduce adverse drug interactions, and help health care professionals identify patients who may be in need of substance use treatment. Law enforcement and regulatory/licensing board officials utilize PDMP information, under appropriate circumstances, to further their investigations of suspected violations of controlled substance laws and compliance with regulatory/licensing board practice standards. Many states have also begun to use PDMPs as a public health surveillance tool. PDMPs continue to be among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.<ref>[2]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from https://bja.ojp.gov/library/publications/comprehensive-opioid-abuse-site-based-program-fy-2017-competitive-grant</ref>

 

= Key Information =

The main objectives of PDMP programs are to:

*Improve patient safety.
*Build a data collection and analysis system at the state level.
*Enhance existing programs' ability to analyze and use collected data.
*Facilitate the exchange of collected prescription data among states.
*Assess the efficiency and effectiveness of the programs funded under this initiative.<ref>[3]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1</ref>

 PDMPs can alert healthcare providers to provide potentially lifesaving information and interventions.

*They DO for those using prescription opioids
**Help collaborate with the patient to taper to a safer dosage
**Consider offering naloxone
**Communicate with other providers managing the patient
**Weigh patient goals, needs, risks
*They DO for those who they consider to have opioid use disorder, discuss safety concerns and treatment options<ref>[4]What Healthcare Providers Need to Know about PDMPs | Drug Overdose | CDC Injury Center. (2019, July 12). Retrieved November 24, 2019, from https://www.cdc.gov/drugoverdose/pdmp/providers.html</ref>
*They DO NOT dismiss patients from care

 With this in mind, states are trying to find ways to increase the use of PDMPs by prescribers so they avoid having a mandate. In some states, you are automatically registered when practitioners apply for a license. There are also efforts to integrate PDMP data into electronic medical record systems so the information is available at the point of care.<ref>[5]How to monitor prescription drugs | Psychiatry & Behavioral Health Learning Network. (n.d.). Retrieved November 24, 2019, from https://www.psychcongress.com/article/how-monitor-prescription-drugs</ref>   [https://www.cdc.gov/drugoverdose/pdmp/ Prescription Drug Monitoring Programs]

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== Examples of Positive Impact ==

*Between the years 2010-2012, Florida implemented a PDMP and other "pill mill" policies that had a positive impact on the opioid epidemic. According to the CDC, Florida recorded a 26.1% decrease in opioid analgesic overdose deaths, after these policies were implemented.<ref>[6]Decline in Drug Overdose Deaths After State Policy Changes—Florida, 2010–2012. (n.d.). Retrieved November 24, 2019, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6326a3.htm</ref> The Florida Department of Health said that from 2010 to 2013, oxycodone overdose deaths fell from 1,516 to 534—a 65% decrease.<ref>[7]Rutkow, L., Chang, H.-Y., Daubresse, M., Webster, D. W., Stuart, E. A., & Alexander, G. C. (2015). Effect of Florida’s Prescription Drug Monitoring Program and Pill Mill Laws on Opioid Prescribing and Use. JAMA Internal Medicine, 175(10), 1642–1649. https://doi.org/10.1001/jamainternmed.2015.3931</ref>
*New York experienced a 75% decrease in prescriptions issued through "doctor shopping" as a result of a 2012 requirement that prescribers check the PDMP before writing a prescription.<ref>[8]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref>
*74% of California physicians reportedly changed their prescribing practice as a result of patient activity reports created using the state's PDMP<ref>[9]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref>
*After establishing a PDMP, Tennessee saw a reduction in the morphine milligram equivalents dispensed, a reduction in the number of doctor and pharmacy shoppers going to multiple outlets to obtain drugs, an increase in queries to the State's Controlled Substance Monitoring Database Program by prescribers and extenders, and a change in practices, with some 41.4% less likely to prescribe certain controlled substances.<ref>[10]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref>

 

== Examples of Negative Impact ==
<div class="_">The existence of a Prescription Drug Monitoring Program within a state, however, '''appears to increase drug diversion activities in contiguous non-PDMP states'''. When states begin to monitor drugs, drug diversion activities tend to spill across boundaries to non-PDMP states. One example is provided by Kentucky, which shares a boundary with seven states, only two of which have PDMPs -- Indiana and Illinois. As drug diverters became aware of Kentucky PDMP's ability to trace their drug histories, they tended to move their diversion activities to nearby nonmonitored states. OxyContin diversion problems have worsened in Tennessee, West Virginia, and Virginia -- all contiguous non-PDMP states -- because of the presence of Kentucky's PDMP, according to a joint federal, state, and local drug diversion report.<ref>[11]Diversion of Prescription Drugs. (n.d.). Retrieved November 24, 2019, from Drug War Facts website: https://www.drugwarfacts.org/chapter/diversion</ref></div> <div class="_"> </div>

== Provider Challenges to Effective Use of PDMPs ==

*Insufficient Resources: Providers lack the time within their practice to perform all activities (not staffed sufficiently, not reimbursed, not value-added). Virtually every knowledge and use survey for PDMPs, for example, shows only half of physicians use the PDMP and the reasons cited for not using it are "its too time consuming" and "its too difficult to use." ("I need to see a patient every 12 minutes to make ends meet, I do not have the time or capacity to do all of this work.")
*Patient-Provider Relationship: The design of many programs tends to compromise the trust between patients and physicians because the providers are required to police their patients, and this is not something physicians see as part of their role as care providers. ("I did not go to medical school for this. I need a trusting relationship with the patient, which is not possible when I ask to count their pills.")
*Data Management: There is no automation support for any of this activity today, no field within the EMR to enter the risk-adjusted monitoring protocols or schedule patient activities according to risk levels, there is no place to store the results of a pill count or PDMP check or alert the physician when a treatment agreement needs to be updated.
*Consistency: Whether it is patients within a practice, practices within a network, or health systems within the state -- getting everyone to establish and adhere to protocols consistently is a challenge, yet inconsistent application of protocols is one of the greatest liabilities for any provider.<ref>[19]Preventing Chronic Opioid Therapy Addiction: PDMP’s alone are not the answer! | LinkedIn. (n.d.). Retrieved November 24, 2019, from https://www.linkedin.com/pulse/preventing-chronic-opioid-therapy-addiction-pdmps-alone-ron-frost/</ref>

 '''Prescription Drug Monitoring Information Exchange (PMIX)''' Architecture enables nationwide information sharing by the use of free, open, and consensus-based solutions; common formatting of shared data; security and privacy protocols to protect sensitive information; and preserving the state choice of interstate sharing solutions.<ref>[20]Prescription Drug Monitoring Programs: Critical Information Sharing Enabled by National Standards, Retrieved from https://bja.ojp.gov/sites/g/files/xyckuh186/files/media/document/PMIXArchitecture.pdf</ref>

== Use PDMPs to Improve Patient Safety ==

== National Alliance for Model State Drug Laws ==
<div class="_">View [https://namsdl.org/model-laws/ model PDMP laws ] and documents from states with prescription drug monitoring programs</div> <div class="_"> </div>
*Annual Summaries or Highlights
*Administration of PDMPs
*Data Reporting and Retention
*Types of Authorized Recipients
*Access and Registration
*PDMPs and Privacy
*Miscellaneous Documents
<div class="_"> </div>

= Funding Opportunities =

=== Current Funding Methods ===

*Federal grants
*Private/Non-federal grants
*General revenue funds
*Controlled substance registration fees
*Professional licensing fees
*Regulatory board funds

 

 

=== Potential Funding Methods ===

*PDMP licensing fees
*Health insurance licensing fees
*Private donations
*Medicaid fraud settlements
*Assessed fines
*Asset Forfeiture
*Drug manufacturers' assessment
*Prescription fees
*Private third-party payers or health insurers
*PDMP authorized users<ref> [13]Technical Assistance Guide, No.04-13, Prescription Drug Monitoring Program Training and Technical Assistance Center, Brandeis University, July 3, 2013. Retrieved from https://www.pdmpassist.org</ref>
*See the PDMP TTAC Funding Options for Prescription Drug Monitoring Programs in [[TR_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Programs|Tools and Resources for]] full descriptions. The Comprehensive Opioid Abuse Program Training and Technical Assistance (TTA) Program is a grant from the U.S. Bureau of Justice given to state, local, and tribal governments to provide resources to intervene with persons with substance use disorders.<ref>[14]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1</ref> The goals of the Comprehensive Opioid Abuse TTA Program are twofold. First, the program aims to support site-based and state initiatives designed to reduce opioid misuse and the number of overdose fatalities. Second, the program supports PDMPs and their stakeholders in expanding the implementation, enhancement, and proactive use of prescription drug monitoring programs to support clinical decision-making and prevent the misuse and diversion of controlled substances. Proposals were due April 25, 2017.<ref>[15]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from https://bja.ojp.gov/sites/g/files/xyckuh186/files/media/document/CARA17.pdf</ref> The Comprehensive Opioid Abuse Site-based Program - Harold Rogers Prescription Drug Monitoring Program Implementation and Enhancement Projects Funding opportunity which provides state, local, and tribal governments resources to intervene with persons with substance use disorders. The Harold Rogers Prescription Drug Monitoring Program (PDMP) is being incorporated into the FY 2017 Comprehensive Opioid Abuse Site-based Program. The purpose of this program is to improve collaboration and strategic decision-making of regulatory and law enforcement agencies and public health officials to address prescription drug and opioid misuse, save lives, and reduce crime. This is made possible through the collection and analysis of controlled substance prescription data and other scheduled chemical products through a centralized database administered by an authorized state agency. This program was applied in 2017.<ref>[16]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from https://bja.ojp.gov/sites/g/files/xyckuh186/files/media/document/CARA17.pdf</ref>
<div class="_"> </div>

= Relevant Research =

SAFE Solutions is an ever-growing platform. Currently limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

= Impactful Federal, State, and Local Policies =
<div class="_">The Prescription Drug Monitoring Program was created by the FY 2002 U.S. Department of Justice Appropriations Act (Public Law 107-77). <ref>[12]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1
</ref> Opportunities to Enhance PDMPs</div>
= Available Tools & Resources =

[[TR_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Programs|TR - Expand & Enhance Prescription Drug Monitoring Programs]] The Pew Charitable Trust created a report on [http://www.pewtrusts.org/en/research-and-analysis/reports/2016/12/prescription-drug-monitoring-programs Evidence-Based Practices to Optimize Use of PDMPs]

 

= Promising Practices =

#[https://oag.ca.gov/cures CURES]: California's state PDMP. Learn more at [https://oag.ca.gov/cures/faqs CURES FAQs]
#[https://www.hcinnovationgroup.com/policy-value-based-care/medicare-medicaid/blog/13022596/improving-emergency-department-information-flow-in-the-pacific-northwest EDIE]: Oregon and Washington use the Emergency Department Information Exchange (EDIE) system. This technology allows ED practicioners to identify patients with more than 5 ER visits in a one-year period or those with complex care needs who can be directed to appropriate care. This system allows for alerts to hospitals as soon as a patient visits the ER.
#[http://www.floridahealth.gov/statistics-and-data/e-forcse/ EFORSCE]: Florida's PDMP. This database has been in effect since 2010 and there are [http://www.floridahealth.gov/statistics-and-data/e-forcse/news-reports/index.html annual reports ] for each year. The website also includes a list of its [http://www.floridahealth.gov/statistics-and-data/e-forcse/funding/index.html funding sources].
#[https://pharmacypmp.az.gov/ Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program (CSPMP) ]- Allows practitioners and pharmacists to look up, view, and print controlled substance dispensing information on their specific patients directly via username and password.
#[http://www.worxpdmp.com/ WORx]Wyoming's active PDMP system.

 

== Find Your State's PDMP ==
<div class="_">Use this [https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-at-a-glance-prescription-drug-monitoring-programs-pdmp link] to find your state's Prescription Drug Monitoring Program.</div>
== TTAC ==

[http://www.pdmpassist.org/ Training Technical Assistance Center]: Brandeis University, in partnership with the Bureau of Justice Assistance, has developed the PDMP TTAC to provide services, support, resources, and strategies to improve the effectiveness of state PDMPs. Call 781-609-7741 for more information.

== Third-Party Patient Monitoring ==

'''GuideMed Monitoring''' is a management program for prescription narcotics monitoring. It helps provider networks prevent prescription drug misuse and it helps to protect the network and its practitioners from liabilities associated with prescription narcotics.<ref>[17] https://www.guidemed.com/solutions/guidemed-opioid-monitoring-solution</ref> Patient service stations are established on-site or freestanding in locations determined by the physician, where GuideMed nurses will staff and manage the monitoring activities chosen by the physician (Risk Assessments, PDMP Checks, CSA Reviews, Pill Counts, Toxicology Testing). After the nurse gathers all the necessary information, a report is prepared and sent to the patient's physician via a PDF file attached to that patient's record. GuideMed also provides any data needed for a compliance officer.

 '''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

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[[Category:SAFE-Prescriptions and Medical Response]]

Expand & Enhance Prescription Drug Monitoring Program (PDMP)

2021-11-07T20:04:25Z

G.Lehrman:

'''''Return to '''[[ZOOM_MAP_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Program|Zoom Map (Expand & Enhance PDMP) ]] or [[ZOOM_MAP_-_Reduce_Access_to_Opioids|Zoom Map (Reduce Access to Opioids)]] or [[ZOOM_MAP_-_Minimize_Diversion_of_Prescription_Drugs|Zoom Map (Minimize Diversion of Prescription Drugs)]] or [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom map - Reduce Prescription of Opioids]]''

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= Introductory Paragraph =

Prescription Drug Monitoring Programs (PDMP) allow pre-registered users including licensed healthcare prescribers to prescribe controlled substances, pharmacists authorized to dispense controlled substances, and law enforcement and regulatory boards to access timely patient-controlled substance history information.<ref>[1]PDMP/CURES. (n.d.). Retrieved November 24, 2019, from https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/PDMP-CURES.html</ref> PDMPs are designed to collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners. This information is used to assist prescribers, dispensers, and other health care professionals in making clinical decisions for their patients. PDMPs also have been shown to reduce adverse drug interactions, and help health care professionals identify patients who may be in need of substance use treatment. Law enforcement and regulatory/licensing board officials utilize PDMP information, under appropriate circumstances, to further their investigations of suspected violations of controlled substance laws and compliance with regulatory/licensing board practice standards. Many states have also begun to use PDMPs as a public health surveillance tool. PDMPs continue to be among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.<ref>[2]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from https://bja.ojp.gov/library/publications/comprehensive-opioid-abuse-site-based-program-fy-2017-competitive-grant</ref>

 

= Key Information =

The main objectives of PDMP programs are to:

*Improve patient safety.
*Build a data collection and analysis system at the state level.
*Enhance existing programs' ability to analyze and use collected data.
*Facilitate the exchange of collected prescription data among states.
*Assess the efficiency and effectiveness of the programs funded under this initiative.<ref>[3]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1</ref>

 PDMPs can alert healthcare providers to provide potentially lifesaving information and interventions.

*They DO for those using prescription opioids
**Help collaborate with the patient to taper to a safer dosage
**Consider offering naloxone
**Communicate with other providers managing the patient
**Weigh patient goals, needs, risks
*They DO for those who they consider to have opioid use disorder, discuss safety concerns and treatment options<ref>[4]What Healthcare Providers Need to Know about PDMPs | Drug Overdose | CDC Injury Center. (2019, July 12). Retrieved November 24, 2019, from https://www.cdc.gov/drugoverdose/pdmp/providers.html</ref>
*They DO NOT dismiss patients from care

 With this in mind, states are trying to find ways to increase the use of PDMPs by prescribers so they avoid having a mandate. In some states, you are automatically registered when practitioners apply for a license. There are also efforts to integrate PDMP data into electronic medical record systems so the information is available at the point of care.<ref>[5]How to monitor prescription drugs | Psychiatry & Behavioral Health Learning Network. (n.d.). Retrieved November 24, 2019, from https://www.psychcongress.com/article/how-monitor-prescription-drugs</ref>   [https://www.cdc.gov/drugoverdose/pdmp/ Prescription Drug Monitoring Programs]

__TOC__

== Examples of Positive Impact ==

*Between the years 2010-2012, Florida implemented a PDMP and other "pill mill" policies that had a positive impact on the opioid epidemic. According to the CDC, Florida recorded a 26.1% decrease in opioid analgesic overdose deaths, after these policies were implemented.<ref>[6]Decline in Drug Overdose Deaths After State Policy Changes—Florida, 2010–2012. (n.d.). Retrieved November 24, 2019, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6326a3.htm</ref> The Florida Department of Health said that from 2010 to 2013, oxycodone overdose deaths fell from 1,516 to 534—a 65% decrease.<ref>[7]Rutkow, L., Chang, H.-Y., Daubresse, M., Webster, D. W., Stuart, E. A., & Alexander, G. C. (2015). Effect of Florida’s Prescription Drug Monitoring Program and Pill Mill Laws on Opioid Prescribing and Use. JAMA Internal Medicine, 175(10), 1642–1649. https://doi.org/10.1001/jamainternmed.2015.3931</ref>
*New York experienced a 75% decrease in prescriptions issued through "doctor shopping" as a result of a 2012 requirement that prescribers check the PDMP before writing a prescription.<ref>[8]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref>
*74% of California physicians reportedly changed their prescribing practice as a result of patient activity reports created using the state's PDMP<ref>[9]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref>
*After establishing a PDMP, Tennessee saw a reduction in the morphine milligram equivalents dispensed, a reduction in the number of doctor and pharmacy shoppers going to multiple outlets to obtain drugs, an increase in queries to the State's Controlled Substance Monitoring Database Program by prescribers and extenders, and a change in practices, with some 41.4% less likely to prescribe certain controlled substances.<ref>[10]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref>

 

== Examples of Negative Impact ==
<div class="_">The existence of a Prescription Drug Monitoring Program within a state, however, '''appears to increase drug diversion activities in contiguous non-PDMP states'''. When states begin to monitor drugs, drug diversion activities tend to spill across boundaries to non-PDMP states. One example is provided by Kentucky, which shares a boundary with seven states, only two of which have PDMPs -- Indiana and Illinois. As drug diverters became aware of Kentucky PDMP's ability to trace their drug histories, they tended to move their diversion activities to nearby nonmonitored states. OxyContin diversion problems have worsened in Tennessee, West Virginia, and Virginia -- all contiguous non-PDMP states -- because of the presence of Kentucky's PDMP, according to a joint federal, state, and local drug diversion report.<ref>[11]Diversion of Prescription Drugs. (n.d.). Retrieved November 24, 2019, from Drug War Facts website: https://www.drugwarfacts.org/chapter/diversion</ref></div> <div class="_"> </div>

== Provider Challenges to Effective Use of PDMPs ==

*Insufficient Resources: Providers lack the time within their practice to perform all activities (not staffed sufficiently, not reimbursed, not value-added). Virtually every knowledge and use survey for PDMPs, for example, shows only half of physicians use the PDMP and the reasons cited for not using it are "its too time consuming" and "its too difficult to use." ("I need to see a patient every 12 minutes to make ends meet, I do not have the time or capacity to do all of this work.")
*Patient-Provider Relationship: The design of many programs tends to compromise the trust between patients and physicians because the providers are required to police their patients, and this is not something physicians see as part of their role as care providers. ("I did not go to medical school for this. I need a trusting relationship with the patient, which is not possible when I ask to count their pills.")
*Data Management: There is no automation support for any of this activity today, no field within the EMR to enter the risk-adjusted monitoring protocols or schedule patient activities according to risk levels, there is no place to store the results of a pill count or PDMP check or alert the physician when a treatment agreement needs to be updated.
*Consistency: Whether it is patients within a practice, practices within a network, or health systems within the state -- getting everyone to establish and adhere to protocols consistently is a challenge, yet inconsistent application of protocols is one of the greatest liabilities for any provider.<ref>[19]Preventing Chronic Opioid Therapy Addiction: PDMP’s alone are not the answer! | LinkedIn. (n.d.). Retrieved November 24, 2019, from https://www.linkedin.com/pulse/preventing-chronic-opioid-therapy-addiction-pdmps-alone-ron-frost/</ref>

 '''Prescription Drug Monitoring Information Exchange (PMIX)''' Architecture enables nationwide information sharing by the use of free, open, and consensus-based solutions; common formatting of shared data; security and privacy protocols to protect sensitive information; and preserving the state choice of interstate sharing solutions.<ref>[20]Prescription Drug Monitoring Programs: Critical Information Sharing Enabled by National Standards, Retrieved from https://bja.ojp.gov/sites/g/files/xyckuh186/files/media/document/PMIXArchitecture.pdf</ref>

== Use PDMPs to Improve Patient Safety ==

== National Alliance for Model State Drug Laws ==
<div class="_">View [https://namsdl.org/model-laws/ model PDMP laws ] and documents from states with prescription drug monitoring programs</div> <div class="_"> </div>
*Annual Summaries or Highlights
*Administration of PDMPs
*Data Reporting and Retention
*Types of Authorized Recipients
*Access and Registration
*PDMPs and Privacy
*Miscellaneous Documents
<div class="_"> </div>
= Funding Opportunities =

=== Current Funding Methods ===

*Federal grants
*Private/Non-federal grants
*General revenue funds
*Controlled substance registration fees
*Professional licensing fees
*Regulatory board funds

 

=== Potential Funding Methods ===

*PDMP licensing fees
*Health insurance licensing fees
*Private donations
*Medicaid fraud settlements
*Assessed fines
*Asset Forfeiture
*Drug manufacturers' assessment
*Prescription fees
*Private third-party payers or health insurers
*PDMP authorized users<ref> [13]Technical Assistance Guide, No.04-13, Prescription Drug Monitoring Program Training and Technical Assistance Center, Brandeis University, July 3, 2013. Retrieved from https://www.pdmpassist.org</ref>
*See the PDMP TTAC Funding Options for Prescription Drug Monitoring Programs in [[TR_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Programs|Tools and Resources for]] full descriptions. The Comprehensive Opioid Abuse Program Training and Technical Assistance (TTA) Program is a grant from the U.S. Bureau of Justice given to state, local, and tribal governments to provide resources to intervene with persons with substance use disorders.<ref>[14]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1</ref> The goals of the Comprehensive Opioid Abuse TTA Program are twofold. First, the program aims to support site-based and state initiatives designed to reduce opioid misuse and the number of overdose fatalities. Second, the program supports PDMPs and their stakeholders in expanding the implementation, enhancement, and proactive use of prescription drug monitoring programs to support clinical decision-making and prevent the misuse and diversion of controlled substances. Proposals were due April 25, 2017.<ref>[15]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from https://bja.ojp.gov/sites/g/files/xyckuh186/files/media/document/CARA17.pdf</ref> The Comprehensive Opioid Abuse Site-based Program - Harold Rogers Prescription Drug Monitoring Program Implementation and Enhancement Projects Funding opportunity which provides state, local, and tribal governments resources to intervene with persons with substance use disorders. The Harold Rogers Prescription Drug Monitoring Program (PDMP) is being incorporated into the FY 2017 Comprehensive Opioid Abuse Site-based Program. The purpose of this program is to improve collaboration and strategic decision-making of regulatory and law enforcement agencies and public health officials to address prescription drug and opioid misuse, save lives, and reduce crime. This is made possible through the collection and analysis of controlled substance prescription data and other scheduled chemical products through a centralized database administered by an authorized state agency. This program was applied in 2017.<ref>[16]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2FFunding%2FCARA17.pdf</ref>
<div class="_"> </div>

= Relevant Research =

SAFE Solutions is an ever-growing platform. Currently limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

= Impactful Federal, State, and Local Policies =
<div class="_">The Prescription Drug Monitoring Program was created by the FY 2002 U.S. Department of Justice Appropriations Act (Public Law 107-77). <ref>[12]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1
</ref> Opportunities to Enhance PDMPs</div>
= Available Tools & Resources =

[[TR_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Programs|TR - Expand & Enhance Prescription Drug Monitoring Programs]] The Pew Charitable Trust created a report on [http://www.pewtrusts.org/en/research-and-analysis/reports/2016/12/prescription-drug-monitoring-programs Evidence-Based Practices to Optimize Use of PDMPs]

 

= Promising Practices =

#[https://oag.ca.gov/cures CURES]: California's state PDMP. Learn more at [https://oag.ca.gov/cures/faqs CURES FAQs]
#[https://www.hcinnovationgroup.com/policy-value-based-care/medicare-medicaid/blog/13022596/improving-emergency-department-information-flow-in-the-pacific-northwest EDIE]: Oregon and Washington use the Emergency Department Information Exchange (EDIE) system. This technology allows ED practicioners to identify patients with more than 5 ER visits in a one-year period or those with complex care needs who can be directed to appropriate care. This system allows for alerts to hospitals as soon as a patient visits the ER.
#[http://www.floridahealth.gov/statistics-and-data/e-forcse/ EFORSCE]: Florida's PDMP. This database has been in effect since 2010 and there are [http://www.floridahealth.gov/statistics-and-data/e-forcse/news-reports/index.html annual reports ] for each year. The website also includes a list of its [http://www.floridahealth.gov/statistics-and-data/e-forcse/funding/index.html funding sources].
#[https://pharmacypmp.az.gov/ Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program (CSPMP) ]- Allows practitioners and pharmacists to look up, view, and print controlled substance dispensing information on their specific patients directly via username and password.
#[http://www.worxpdmp.com/ WORx]Wyoming's active PDMP system.

 

== Find Your State's PDMP ==
<div class="_">Use this [https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-at-a-glance-prescription-drug-monitoring-programs-pdmp link] to find your state's Prescription Drug Monitoring Program.</div>
== TTAC ==

[http://www.pdmpassist.org/ Training Technical Assistance Center]: Brandeis University, in partnership with the Bureau of Justice Assistance, has developed the PDMP TTAC to provide services, support, resources, and strategies to improve the effectiveness of state PDMPs. Call 781-609-7741 for more information.

== Third-Party Patient Monitoring ==

'''GuideMed Monitoring''' is a management program for prescription narcotics monitoring. It helps provider networks prevent prescription drug misuse and it helps to protect the network and its practitioners from liabilities associated with prescription narcotics.<ref>[17] https://www.guidemed.com/solutions/guidemed-opioid-monitoring-solution</ref> Patient service stations are established on-site or freestanding in locations determined by the physician, where GuideMed nurses will staff and manage the monitoring activities chosen by the physician (Risk Assessments, PDMP Checks, CSA Reviews, Pill Counts, Toxicology Testing). After the nurse gathers all the necessary information, a report is prepared and sent to the patient's physician via a PDF file attached to that patient's record. GuideMed also provides any data needed for a compliance officer.

 '''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =

 

[[Category:SAFE-Prescriptions and Medical Response]]

Expand & Enhance Prescription Drug Monitoring Program (PDMP)

2021-11-07T19:58:35Z

G.Lehrman:

'''''Return to '''[[ZOOM_MAP_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Program|Zoom Map (Expand & Enhance PDMP) ]] or [[ZOOM_MAP_-_Reduce_Access_to_Opioids|Zoom Map (Reduce Access to Opioids)]] or [[ZOOM_MAP_-_Minimize_Diversion_of_Prescription_Drugs|Zoom Map (Minimize Diversion of Prescription Drugs)]] or [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom map - Reduce Prescription of Opioids]]''

----

 

__TOC__

 

 

= Introductory Paragraph =

Prescription Drug Monitoring Programs (PDMP) allow pre-registered users including licensed healthcare prescribers to prescribe controlled substances, pharmacists authorized to dispense controlled substances, and law enforcement and regulatory boards to access timely patient-controlled substance history information.<ref>[1]PDMP/CURES. (n.d.). Retrieved November 24, 2019, from https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/PDMP-CURES.html</ref> PDMPs are designed to collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners. This information is used to assist prescribers, dispensers, and other health care professionals in making clinical decisions for their patients. PDMPs also have been shown to reduce adverse drug interactions, and help health care professionals identify patients who may be in need of substance use treatment. Law enforcement and regulatory/licensing board officials utilize PDMP information, under appropriate circumstances, to further their investigations of suspected violations of controlled substance laws and compliance with regulatory/licensing board practice standards. Many states have also begun to use PDMPs as a public health surveillance tool. PDMPs continue to be among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.<ref>[2]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from https://bja.ojp.gov/library/publications/comprehensive-opioid-abuse-site-based-program-fy-2017-competitive-grant</ref>

 

= Key Information =

The main objectives of PDMP programs are to:

*Improve patient safety.
*Build a data collection and analysis system at the state level.
*Enhance existing programs' ability to analyze and use collected data.
*Facilitate the exchange of collected prescription data among states.
*Assess the efficiency and effectiveness of the programs funded under this initiative.<ref>[3]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1</ref>

 PDMPs can alert healthcare providers to provide potentially lifesaving information and interventions.

*They DO for those using prescription opioids
**Help collaborate with the patient to taper to a safer dosage
**Consider offering naloxone
**Communicate with other providers managing the patient
**Weigh patient goals, needs, risks
*They DO for those who they consider to have opioid use disorder, discuss safety concerns and treatment options<ref>[4]What Healthcare Providers Need to Know about PDMPs | Drug Overdose | CDC Injury Center. (2019, July 12). Retrieved November 24, 2019, from https://www.cdc.gov/drugoverdose/pdmp/providers.html</ref>
*They DO NOT dismiss patients from care

 With this in mind, states are trying to find ways to increase the use of PDMPs by prescribers so they avoid having a mandate. In some states, you are automatically registered when practitioners apply for a license. There are also efforts to integrate PDMP data into electronic medical record systems so the information is available at the point of care.<ref>[5]How to monitor prescription drugs | Psychiatry & Behavioral Health Learning Network. (n.d.). Retrieved November 24, 2019, from https://www.psychcongress.com/article/how-monitor-prescription-drugs</ref>   [https://www.cdc.gov/drugoverdose/pdmp/ Prescription Drug Monitoring Programs]

__TOC__

== Examples of Positive Impact ==

*Between the years 2010-2012, Florida implemented a PDMP and other "pill mill" policies that had a positive impact on the opioid epidemic. According to the CDC, Florida recorded a 26.1% decrease in opioid analgesic overdose deaths, after these policies were implemented.<ref>[6]Decline in Drug Overdose Deaths After State Policy Changes—Florida, 2010–2012. (n.d.). Retrieved November 24, 2019, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6326a3.htm</ref> The Florida Department of Health said that from 2010 to 2013, oxycodone overdose deaths fell from 1,516 to 534—a 65% decrease.<ref>[7]Rutkow, L., Chang, H.-Y., Daubresse, M., Webster, D. W., Stuart, E. A., & Alexander, G. C. (2015). Effect of Florida’s Prescription Drug Monitoring Program and Pill Mill Laws on Opioid Prescribing and Use. JAMA Internal Medicine, 175(10), 1642–1649. https://doi.org/10.1001/jamainternmed.2015.3931</ref>
*New York experienced a 75% decrease in prescriptions issued through "doctor shopping" as a result of a 2012 requirement that prescribers check the PDMP before writing a prescription.<ref>[8]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref>
*74% of California physicians reportedly changed their prescribing practice as a result of patient activity reports created using the state's PDMP<ref>[9]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref>
*After establishing a PDMP, Tennessee saw a reduction in the morphine milligram equivalents dispensed, a reduction in the number of doctor and pharmacy shoppers going to multiple outlets to obtain drugs, an increase in queries to the State's Controlled Substance Monitoring Database Program by prescribers and extenders, and a change in practices, with some 41.4% less likely to prescribe certain controlled substances.<ref>[10]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref>

 

== Examples of Negative Impact ==
<div class="_">The existence of a Prescription Drug Monitoring Program within a state, however, '''appears to increase drug diversion activities in contiguous non-PDMP states'''. When states begin to monitor drugs, drug diversion activities tend to spill across boundaries to non-PDMP states. One example is provided by Kentucky, which shares a boundary with seven states, only two of which have PDMPs -- Indiana and Illinois. As drug diverters became aware of Kentucky PDMP's ability to trace their drug histories, they tended to move their diversion activities to nearby nonmonitored states. OxyContin diversion problems have worsened in Tennessee, West Virginia, and Virginia -- all contiguous non-PDMP states -- because of the presence of Kentucky's PDMP, according to a joint federal, state, and local drug diversion report.<ref>[11]Diversion of Prescription Drugs. (n.d.). Retrieved November 24, 2019, from Drug War Facts website: https://www.drugwarfacts.org/chapter/diversion</ref></div> <div class="_"> </div>

== Provider Challenges to Effective Use of PDMPs ==

*Insufficient Resources: Providers lack the time within their practice to perform all activities (not staffed sufficiently, not reimbursed, not value-added). Virtually every knowledge and use survey for PDMPs, for example, shows only half of physicians use the PDMP and the reasons cited for not using it are "its too time consuming" and "its too difficult to use." ("I need to see a patient every 12 minutes to make ends meet, I do not have the time or capacity to do all of this work.")
*Patient-Provider Relationship: The design of many programs tends to compromise the trust between patients and physicians because the providers are required to police their patients, and this is not something physicians see as part of their role as care providers. ("I did not go to medical school for this. I need a trusting relationship with the patient, which is not possible when I ask to count their pills.")
*Data Management: There is no automation support for any of this activity today, no field within the EMR to enter the risk-adjusted monitoring protocols or schedule patient activities according to risk levels, there is no place to store the results of a pill count or PDMP check or alert the physician when a treatment agreement needs to be updated.
*Consistency: Whether it is patients within a practice, practices within a network, or health systems within the state -- getting everyone to establish and adhere to protocols consistently is a challenge, yet inconsistent application of protocols is one of the greatest liabilities for any provider.<ref>[19]Preventing Chronic Opioid Therapy Addiction: PDMP’s alone are not the answer! | LinkedIn. (n.d.). Retrieved November 24, 2019, from https://www.linkedin.com/pulse/preventing-chronic-opioid-therapy-addiction-pdmps-alone-ron-frost/</ref>

 '''Prescription Drug Monitoring Information Exchange (PMIX)''' Architecture enables nationwide information sharing by the use of free, open, and consensus-based solutions; common formatting of shared data; security and privacy protocols to protect sensitive information; and preserving the state choice of interstate sharing solutions.<ref>[20]Prescription Drug Monitoring Programs: Critical Information Sharing Enabled by National Standards, Retrieved from https://bja.ojp.gov/sites/g/files/xyckuh186/files/media/document/PMIXArchitecture.pdf</ref>

== Use PDMPs to Improve Patient Safety ==

== National Alliance for Model State Drug Laws ==
<div class="_">View [https://namsdl.org/model-laws/ model PDMP laws ] and documents from states with prescription drug monitoring programs</div> <div class="_"> </div>
*Annual Summaries or Highlights
*Administration of PDMPs
*Data Reporting and Retention
*Types of Authorized Recipients
*Access and Registration
*PDMPs and Privacy
*Miscellaneous Documents
<div class="_"> </div>
= Funding Opportunities =

=== Current Funding Methods ===

*Federal grants
*Private/Non-federal grants
*General revenue funds
*Controlled substance registration fees
*Professional licensing fees
*Regulatory board funds

 

=== Potential Funding Methods ===

*PDMP licensing fees
*Health insurance licensing fees
*Private donations
*Medicaid fraud settlements
*Assessed fines
*Asset Forfeiture
*Drug manufacturers' assessment
*Prescription fees
*Private third-party payers or health insurers
*PDMP authorized users<ref> [13]Technical Assistance Guide, No.04-13, Prescription Drug Monitoring Program Training and Technical Assistance Center, Brandeis University, July 3, 2013. Retrieved from https://www.pdmpassist.org</ref>
*See the PDMP TTAC Funding Options for Prescription Drug Monitoring Programs in [[TR_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Programs|Tools and Resources for]] full descriptions. The Comprehensive Opioid Abuse Program Training and Technical Assistance (TTA) Program is a grant from the U.S. Bureau of Justice given to state, local, and tribal governments to provide resources to intervene with persons with substance use disorders.<ref>[14]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1</ref> The goals of the Comprehensive Opioid Abuse TTA Program are twofold. First, the program aims to support site-based and state initiatives designed to reduce opioid misuse and the number of overdose fatalities. Second, the program supports PDMPs and their stakeholders in expanding the implementation, enhancement, and proactive use of prescription drug monitoring programs to support clinical decision-making and prevent the misuse and diversion of controlled substances. Proposals were due April 25, 2017.<ref>[15]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2FFunding%2FCARA17.pdf</ref> The Comprehensive Opioid Abuse Site-based Program - Harold Rogers Prescription Drug Monitoring Program Implementation and Enhancement Projects Funding opportunity which provides state, local, and tribal governments resources to intervene with persons with substance use disorders. The Harold Rogers Prescription Drug Monitoring Program (PDMP) is being incorporated into the FY 2017 Comprehensive Opioid Abuse Site-based Program. The purpose of this program is to improve collaboration and strategic decision-making of regulatory and law enforcement agencies and public health officials to address prescription drug and opioid misuse, save lives, and reduce crime. This is made possible through the collection and analysis of controlled substance prescription data and other scheduled chemical products through a centralized database administered by an authorized state agency. This program was applied in 2017.<ref>[16]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2FFunding%2FCARA17.pdf</ref>
<div class="_"> </div>

= Relevant Research =

SAFE Solutions is an ever-growing platform. Currently limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

= Impactful Federal, State, and Local Policies =
<div class="_">The Prescription Drug Monitoring Program was created by the FY 2002 U.S. Department of Justice Appropriations Act (Public Law 107-77). <ref>[12]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1
</ref> Opportunities to Enhance PDMPs</div>
= Available Tools & Resources =

[[TR_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Programs|TR - Expand & Enhance Prescription Drug Monitoring Programs]] The Pew Charitable Trust created a report on [http://www.pewtrusts.org/en/research-and-analysis/reports/2016/12/prescription-drug-monitoring-programs Evidence-Based Practices to Optimize Use of PDMPs]

 

= Promising Practices =

#[https://oag.ca.gov/cures CURES]: California's state PDMP. Learn more at [https://oag.ca.gov/cures/faqs CURES FAQs]
#[https://www.hcinnovationgroup.com/policy-value-based-care/medicare-medicaid/blog/13022596/improving-emergency-department-information-flow-in-the-pacific-northwest EDIE]: Oregon and Washington use the Emergency Department Information Exchange (EDIE) system. This technology allows ED practicioners to identify patients with more than 5 ER visits in a one-year period or those with complex care needs who can be directed to appropriate care. This system allows for alerts to hospitals as soon as a patient visits the ER.
#[http://www.floridahealth.gov/statistics-and-data/e-forcse/ EFORSCE]: Florida's PDMP. This database has been in effect since 2010 and there are [http://www.floridahealth.gov/statistics-and-data/e-forcse/news-reports/index.html annual reports ] for each year. The website also includes a list of its [http://www.floridahealth.gov/statistics-and-data/e-forcse/funding/index.html funding sources].
#[https://pharmacypmp.az.gov/ Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program (CSPMP) ]- Allows practitioners and pharmacists to look up, view, and print controlled substance dispensing information on their specific patients directly via username and password.
#[http://www.worxpdmp.com/ WORx]Wyoming's active PDMP system.

 

== Find Your State's PDMP ==
<div class="_">Use this [https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-at-a-glance-prescription-drug-monitoring-programs-pdmp link] to find your state's Prescription Drug Monitoring Program.</div>
== TTAC ==

[http://www.pdmpassist.org/ Training Technical Assistance Center]: Brandeis University, in partnership with the Bureau of Justice Assistance, has developed the PDMP TTAC to provide services, support, resources, and strategies to improve the effectiveness of state PDMPs. Call 781-609-7741 for more information.

== Third-Party Patient Monitoring ==

'''GuideMed Monitoring''' is a management program for prescription narcotics monitoring. It helps provider networks prevent prescription drug misuse and it helps to protect the network and its practitioners from liabilities associated with prescription narcotics.<ref>[17] https://www.guidemed.com/solutions/guidemed-opioid-monitoring-solution</ref> Patient service stations are established on-site or freestanding in locations determined by the physician, where GuideMed nurses will staff and manage the monitoring activities chosen by the physician (Risk Assessments, PDMP Checks, CSA Reviews, Pill Counts, Toxicology Testing). After the nurse gathers all the necessary information, a report is prepared and sent to the patient's physician via a PDF file attached to that patient's record. GuideMed also provides any data needed for a compliance officer.

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[[Category:SAFE-Prescriptions and Medical Response]]

Expand & Enhance Prescription Drug Monitoring Program (PDMP)

2021-11-07T19:56:57Z

G.Lehrman:

'''''Return to '''[[ZOOM_MAP_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Program|Zoom Map (Expand & Enhance PDMP) ]] or [[ZOOM_MAP_-_Reduce_Access_to_Opioids|Zoom Map (Reduce Access to Opioids)]] or [[ZOOM_MAP_-_Minimize_Diversion_of_Prescription_Drugs|Zoom Map (Minimize Diversion of Prescription Drugs)]] or [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom map - Reduce Prescription of Opioids]]''

----

 

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= Introductory Paragraph =

Prescription Drug Monitoring Programs (PDMP) allow pre-registered users including licensed healthcare prescribers to prescribe controlled substances, pharmacists authorized to dispense controlled substances, and law enforcement and regulatory boards to access timely patient-controlled substance history information.<ref>[1]PDMP/CURES. (n.d.). Retrieved November 24, 2019, from https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/PDMP-CURES.html</ref> PDMPs are designed to collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners. This information is used to assist prescribers, dispensers, and other health care professionals in making clinical decisions for their patients. PDMPs also have been shown to reduce adverse drug interactions, and help health care professionals identify patients who may be in need of substance use treatment. Law enforcement and regulatory/licensing board officials utilize PDMP information, under appropriate circumstances, to further their investigations of suspected violations of controlled substance laws and compliance with regulatory/licensing board practice standards. Many states have also begun to use PDMPs as a public health surveillance tool. PDMPs continue to be among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.<ref>[2]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from https://bja.ojp.gov/library/publications/comprehensive-opioid-abuse-site-based-program-fy-2017-competitive-grant</ref>

 

= Key Information =

The main objectives of PDMP programs are to:

*Improve patient safety.
*Build a data collection and analysis system at the state level.
*Enhance existing programs' ability to analyze and use collected data.
*Facilitate the exchange of collected prescription data among states.
*Assess the efficiency and effectiveness of the programs funded under this initiative.<ref>[3]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1</ref>

 PDMPs can alert healthcare providers to provide potentially lifesaving information and interventions.

*They DO for those using prescription opioids
**Help collaborate with the patient to taper to a safer dosage
**Consider offering naloxone
**Communicate with other providers managing the patient
**Weigh patient goals, needs, risks
*They DO for those who they consider to have opioid use disorder, discuss safety concerns and treatment options<ref>[4]What Healthcare Providers Need to Know about PDMPs | Drug Overdose | CDC Injury Center. (2019, July 12). Retrieved November 24, 2019, from https://www.cdc.gov/drugoverdose/pdmp/providers.html</ref>
*They DO NOT dismiss patients from care

 With this in mind, states are trying to find ways to increase the use of PDMPs by prescribers so they avoid having a mandate. In some states, you are automatically registered when practitioners apply for a license. There are also efforts to integrate PDMP data into electronic medical record systems so the information is available at the point of care.<ref>[5]How to monitor prescription drugs | Psychiatry & Behavioral Health Learning Network. (n.d.). Retrieved November 24, 2019, from https://www.psychcongress.com/article/how-monitor-prescription-drugs</ref>   [https://www.cdc.gov/drugoverdose/pdmp/ Prescription Drug Monitoring Programs]

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== Examples of Positive Impact ==

*Between the years 2010-2012, Florida implemented a PDMP and other "pill mill" policies that had a positive impact on the opioid epidemic. According to the CDC, Florida recorded a 26.1% decrease in opioid analgesic overdose deaths, after these policies were implemented.<ref>[6]Decline in Drug Overdose Deaths After State Policy Changes—Florida, 2010–2012. (n.d.). Retrieved November 24, 2019, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6326a3.htm</ref> The Florida Department of Health said that from 2010 to 2013, oxycodone overdose deaths fell from 1,516 to 534—a 65% decrease.<ref>[7]Rutkow, L., Chang, H.-Y., Daubresse, M., Webster, D. W., Stuart, E. A., & Alexander, G. C. (2015). Effect of Florida’s Prescription Drug Monitoring Program and Pill Mill Laws on Opioid Prescribing and Use. JAMA Internal Medicine, 175(10), 1642–1649. https://doi.org/10.1001/jamainternmed.2015.3931</ref>
*New York experienced a 75% decrease in prescriptions issued through "doctor shopping" as a result of a 2012 requirement that prescribers check the PDMP before writing a prescription.<ref>[8]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref>
*74% of California physicians reportedly changed their prescribing practice as a result of patient activity reports created using the state's PDMP<ref>[9]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref>
*After establishing a PDMP, Tennessee saw a reduction in the morphine milligram equivalents dispensed, a reduction in the number of doctor and pharmacy shoppers going to multiple outlets to obtain drugs, an increase in queries to the State's Controlled Substance Monitoring Database Program by prescribers and extenders, and a change in practices, with some 41.4% less likely to prescribe certain controlled substances.<ref>[10]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref>

 

== Examples of Negative Impact ==
<div class="_">The existence of a Prescription Drug Monitoring Program within a state, however, '''appears to increase drug diversion activities in contiguous non-PDMP states'''. When states begin to monitor drugs, drug diversion activities tend to spill across boundaries to non-PDMP states. One example is provided by Kentucky, which shares a boundary with seven states, only two of which have PDMPs -- Indiana and Illinois. As drug diverters became aware of Kentucky PDMP's ability to trace their drug histories, they tended to move their diversion activities to nearby nonmonitored states. OxyContin diversion problems have worsened in Tennessee, West Virginia, and Virginia -- all contiguous non-PDMP states -- because of the presence of Kentucky's PDMP, according to a joint federal, state, and local drug diversion report.<ref>[11]Diversion of Prescription Drugs. (n.d.). Retrieved November 24, 2019, from Drug War Facts website: https://www.drugwarfacts.org/chapter/diversion</ref></div> <div class="_"> </div>

== Provider Challenges to Effective Use of PDMPs ==

*Insufficient Resources: Providers lack the time within their practice to perform all activities (not staffed sufficiently, not reimbursed, not value-added). Virtually every knowledge and use survey for PDMPs, for example, shows only half of physicians use the PDMP and the reasons cited for not using it are "its too time consuming" and "its too difficult to use." ("I need to see a patient every 12 minutes to make ends meet, I do not have the time or capacity to do all of this work.")
*Patient-Provider Relationship: The design of many programs tends to compromise the trust between patients and physicians because the providers are required to police their patients, and this is not something physicians see as part of their role as care providers. ("I did not go to medical school for this. I need a trusting relationship with the patient, which is not possible when I ask to count their pills.")
*Data Management: There is no automation support for any of this activity today, no field within the EMR to enter the risk-adjusted monitoring protocols or schedule patient activities according to risk levels, there is no place to store the results of a pill count or PDMP check or alert the physician when a treatment agreement needs to be updated.
*Consistency: Whether it is patients within a practice, practices within a network, or health systems within the state -- getting everyone to establish and adhere to protocols consistently is a challenge, yet inconsistent application of protocols is one of the greatest liabilities for any provider.<ref>[19]Preventing Chronic Opioid Therapy Addiction: PDMP’s alone are not the answer! | LinkedIn. (n.d.). Retrieved November 24, 2019, from https://www.linkedin.com/pulse/preventing-chronic-opioid-therapy-addiction-pdmps-alone-ron-frost/</ref>

 '''Prescription Drug Monitoring Information Exchange (PMIX)''' Architecture enables nationwide information sharing by the use of free, open, and consensus-based solutions; common formatting of shared data; security and privacy protocols to protect sensitive information; and preserving the state choice of interstate sharing solutions.<ref>[20]Prescription Drug Monitoring Programs: Critical Information Sharing Enabled by National Standards, Retrieved from https://bja.ojp.gov/sites/g/files/xyckuh186/files/media/document/PMIXArchitecture.pdf</ref>

== Use PDMPs to Improve Patient Safety ==

== National Alliance for Model State Drug Laws ==
<div class="_">View [https://namsdl.org/model-laws/ model PDMP laws ] and documents from states with prescription drug monitoring programs</div> <div class="_"> </div>
*Annual Summaries or Highlights
*Administration of PDMPs
*Data Reporting and Retention
*Types of Authorized Recipients
*Access and Registration
*PDMPs and Privacy
*Miscellaneous Documents
<div class="_"> </div>
= Funding Opportunities =

=== Current Funding Methods ===

*Federal grants
*Private/Non-federal grants
*General revenue funds
*Controlled substance registration fees
*Professional licensing fees
*Regulatory board funds

 

=== Potential Funding Methods ===

*PDMP licensing fees
*Health insurance licensing fees
*Private donations
*Medicaid fraud settlements
*Assessed fines
*Asset Forfeiture
*Drug manufacturers' assessment
*Prescription fees
*Private third-party payers or health insurers
*PDMP authorized users<ref> [13]Technical Assistance Guide, No.04-13, Prescription Drug Monitoring Program Training and Technical Assistance Center, Brandeis University, July 3, 2013. Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=http%3A%2F%2Fwww.pdmpassist.org%2Fpdf%2FPDMP_Funding_Options_TAG.pdf</ref>
*See the PDMP TTAC Funding Options for Prescription Drug Monitoring Programs in [[TR_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Programs|Tools and Resources for]] full descriptions. The Comprehensive Opioid Abuse Program Training and Technical Assistance (TTA) Program is a grant from the U.S. Bureau of Justice given to state, local, and tribal governments to provide resources to intervene with persons with substance use disorders.<ref>[14]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1</ref> The goals of the Comprehensive Opioid Abuse TTA Program are twofold. First, the program aims to support site-based and state initiatives designed to reduce opioid misuse and the number of overdose fatalities. Second, the program supports PDMPs and their stakeholders in expanding the implementation, enhancement, and proactive use of prescription drug monitoring programs to support clinical decision-making and prevent the misuse and diversion of controlled substances. Proposals were due April 25, 2017.<ref>[15]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2FFunding%2FCARA17.pdf</ref> The Comprehensive Opioid Abuse Site-based Program - Harold Rogers Prescription Drug Monitoring Program Implementation and Enhancement Projects Funding opportunity which provides state, local, and tribal governments resources to intervene with persons with substance use disorders. The Harold Rogers Prescription Drug Monitoring Program (PDMP) is being incorporated into the FY 2017 Comprehensive Opioid Abuse Site-based Program. The purpose of this program is to improve collaboration and strategic decision-making of regulatory and law enforcement agencies and public health officials to address prescription drug and opioid misuse, save lives, and reduce crime. This is made possible through the collection and analysis of controlled substance prescription data and other scheduled chemical products through a centralized database administered by an authorized state agency. This program was applied in 2017.<ref>[16]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2FFunding%2FCARA17.pdf</ref>
<div class="_"> </div>

= Relevant Research =

SAFE Solutions is an ever-growing platform. Currently limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

= Impactful Federal, State, and Local Policies =
<div class="_">The Prescription Drug Monitoring Program was created by the FY 2002 U.S. Department of Justice Appropriations Act (Public Law 107-77). <ref>[12]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1
</ref> Opportunities to Enhance PDMPs</div>
= Available Tools & Resources =

[[TR_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Programs|TR - Expand & Enhance Prescription Drug Monitoring Programs]] The Pew Charitable Trust created a report on [http://www.pewtrusts.org/en/research-and-analysis/reports/2016/12/prescription-drug-monitoring-programs Evidence-Based Practices to Optimize Use of PDMPs]

 

= Promising Practices =

#[https://oag.ca.gov/cures CURES]: California's state PDMP. Learn more at [https://oag.ca.gov/cures/faqs CURES FAQs]
#[https://www.hcinnovationgroup.com/policy-value-based-care/medicare-medicaid/blog/13022596/improving-emergency-department-information-flow-in-the-pacific-northwest EDIE]: Oregon and Washington use the Emergency Department Information Exchange (EDIE) system. This technology allows ED practicioners to identify patients with more than 5 ER visits in a one-year period or those with complex care needs who can be directed to appropriate care. This system allows for alerts to hospitals as soon as a patient visits the ER.
#[http://www.floridahealth.gov/statistics-and-data/e-forcse/ EFORSCE]: Florida's PDMP. This database has been in effect since 2010 and there are [http://www.floridahealth.gov/statistics-and-data/e-forcse/news-reports/index.html annual reports ] for each year. The website also includes a list of its [http://www.floridahealth.gov/statistics-and-data/e-forcse/funding/index.html funding sources].
#[https://pharmacypmp.az.gov/ Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program (CSPMP) ]- Allows practitioners and pharmacists to look up, view, and print controlled substance dispensing information on their specific patients directly via username and password.
#[http://www.worxpdmp.com/ WORx]Wyoming's active PDMP system.

 

== Find Your State's PDMP ==
<div class="_">Use this [https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-at-a-glance-prescription-drug-monitoring-programs-pdmp link] to find your state's Prescription Drug Monitoring Program.</div>
== TTAC ==

[http://www.pdmpassist.org/ Training Technical Assistance Center]: Brandeis University, in partnership with the Bureau of Justice Assistance, has developed the PDMP TTAC to provide services, support, resources, and strategies to improve the effectiveness of state PDMPs. Call 781-609-7741 for more information.

== Third-Party Patient Monitoring ==

'''GuideMed Monitoring''' is a management program for prescription narcotics monitoring. It helps provider networks prevent prescription drug misuse and it helps to protect the network and its practitioners from liabilities associated with prescription narcotics.<ref>[17] https://www.guidemed.com/solutions/guidemed-opioid-monitoring-solution</ref> Patient service stations are established on-site or freestanding in locations determined by the physician, where GuideMed nurses will staff and manage the monitoring activities chosen by the physician (Risk Assessments, PDMP Checks, CSA Reviews, Pill Counts, Toxicology Testing). After the nurse gathers all the necessary information, a report is prepared and sent to the patient's physician via a PDF file attached to that patient's record. GuideMed also provides any data needed for a compliance officer.

 '''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

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[[Category:SAFE-Prescriptions and Medical Response]]

Expand Access to Medication-Assisted Treatment (MAT)

2021-11-07T19:48:28Z

G.Lehrman:

__NOTOC__ Return to [[ZOOM_MAP_-_Expand_Access_to_Optimized_MAT|Zoom Map - Expand Access to Optimized MAT]] or  [[ZOOM_MAP_-_Improve_Treatment_&_Enable_Recovery_for_People_with_SUDs|Zoom Map (Improve Treatment & Enable Recovery for People with SUDs)]] or the [[ZOOM_MAP_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]] <div class="wiki" id="content_view" style="display: block">
 __TOC__

= Overview =
<div class="_">Medication-assisted treatment (MAT), including opioid treatment programs (OTPs), combines behavioral therapy and medications to treat substance use disorders.<ref>[1]chanell.baylor. (2015, July 21). Medication-Assisted Treatment (MAT) [Text]. Retrieved December 5, 2019, from https://www.samhsa.gov/medication-assisted-treatment
</ref> Information on medications used in MAT can be found further down on this page. The President's [https://trumpwhitehouse.archives.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-15-2017.pdf Commission on Combating Drug Addiction and the Opioid Crisis] has recommended that the federal government "immediately establish and fund a federal incentive to enhance access to Medication-Assisted Treatment (MAT)."<ref>[2]Commission to the President (2016), Retrieved from: https://trumpwhitehouse.archives.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-15-2017.pdf</ref></div> <div class="_">The above report documents that MAT has been proven to:</div>
*Reduce overdose deaths
*Retain persons in treatment
*Decrease use of heroin
*Prevent spread of infectious disease

= Key Information =

=== The Value of MAT (or Opioid-Agonist Treatment) ===

*International addiction experts consider initial opioid-agonist treatment, or OAT, ''with no duration restrictions'', the evidence-based standard of care for opioid-use disorder, the authors write online November 20, 2018, in Annals of Internal Medicine.<ref>Association, A. P. (n.d.). APA Learning Center The Role of Behavioral Interventions in Buprenorphine Maintenance Treatment (Webinar). Retrieved December 5, 2019, from APA Learning Center website: https://education.psychiatry.org/diweb/catalog/item?id=5913605&_ga=2.63318255.1744877395.1635561868-1008822590.1635561868</ref>
*In California, where more people have been diagnosed with opioid disorder than in any other U.S. state, ''publicly funded treatment programs require patients to “fail” - twice - at a three-week course of medically supervised withdrawal before they become eligible for OAT''. Policymakers likely maintained this medically managed withdrawal requirement under the belief it was saving money. The study demonstrates, however, that the policy creates significantly greater long-term costs for criminal justice and healthcare systems.
**The study concludes OAT would have saved as much as $850 million over five years, not including savings to the criminal justice system, and more than $2 billion, including the cost of arrests and prosecutions. Over 10 years, the total savings would rise to $2.87 billion.<ref>Krebs, E., Enns, B., Evans, E., Urada, D., Anglin, M. D., Rawson, R. A., … Nosyk, B. (2018). Cost-Effectiveness of Publicly Funded Treatment of Opioid Use Disorder in California. Annals of Internal Medicine, 168(1), 10. https://doi.org/10.7326/M17-0611
</ref>
**“In order to see overdose deaths come down, we need to make sure people who have opioid addiction are able to access effective treatment more easily than they can access heroin, fentanyl or pain pills."
**"We need a model whereby patients can get immediate access to opioid-agonist treatment, a lifesaving intervention, without obstacles."
**“Among experts in the field of addiction, we already know that detox doesn’t work, that they’re going to relapse and when they relapse, they’re going to be at great risk for an overdose, that they’ll be at great risk for hepatitis,” Kolodny said. “Opioid addiction is a life-threatening illness."

Access the study here:<ref>What’s this agonist / antagonist stuff? (n.d.). Retrieved December 5, 2019, from https://www.naabt.org/faq_answers.cfm?ID=5
</ref>

This article talks of how the use of Buprenorphine reduces the cost of opioid addiction<ref>[1]Behavioral Healthcare Executive | Psychiatry & Behavioral Health Learning Network. (n.d.). Retrieved December 5, 2019, from https://www.psychcongress.com/node/721
</ref>

 

= Relevant Research =
<div class="_">An article in the August 2017 issue of the American Journal of Psychiatry, by Roger D. Weiss, MD, the Chief of the Division of Alcohol and Drug Abuse at McLean Hospital (Belmont, MA) and Professor of Psychiatry at Harvard Medical School and Kathleen Carroll, Ph.D. concluded: "Finally, with 6-month retention rates seldom exceeding 50% and poor outcomes following dropout, we must explore innovative strategies for enhancing retention in buprenorphine treatment."<ref>https://pubmed.ncbi.nlm.nih.gov/27978771/</ref></div> <div class="_"> </div> <div class="_">This report reveals the need for significantly more studies that can yield additional insights to inform MAT practices. Current literature focuses mainly on the outcome of treatment retention and negative urine drug screens. Enhanced research would look at broader outcomes of social functioning and well-being including employment, stable housing and other measures of well-being. Also, research would ideally have information on many other factors such as information on co-occurring disorders and different types of behavioral treatments that would be appropriate for different individuals. While not mentioned specifically in that article, a person's history of trauma or adverse childhood experiences (ACEs), length of time with an SUD, their current level of supports, and genetic factors such as the rates at which they metabolize different drugs would all impact what type of treatment would be most appropriate. All of these unique factors and the wide range of potential interventions are reasons that more research is needed, and conclusions from studies that look at a limited number of inputs and outcomes and lack visibility into all the unique factors that influence what might impact successful outcomes should be seen as early insights in a journey of finding the optimal forms of treatment for each person's situation.</div> <div class="_"> </div> <div class="_">Weiss and Carroll highlight some key findings from their report in a webinar done through the American Journal of Psychiatry learning center.[3] Key points include:</div>
*Buprenorphine is an excellent medication, but there is still much room for improvement in how MAT is done.
*Research designs, such as the intensity of Medication Management, the dose of buprenorphine, and the characteristics of the group participants, influence outcomes.
*Different sub-groups respond differently to different elements of treatment plans.
*Early treatment response has a major impact on long-term success, and a better understanding of that insight may help decision-making.
**Patients who abstain from opioids in the first two weeks of treatment have a good chance of a good 12-week outcome.
**Patients who use opioids during the first two weeks of treatment have very little chance of abstaining by week 12.
*There is evidence that the use of [https://drugabuse.com/treatment/contingency-management/ Contingency Management ](CM), including the use of computer-based therapies, seems to increase success rates.
*Patients dependent on prescription opioids seemed to respond more positively to Cognitive Behavioral Therapy (CBT) than those who were primarily heroin users.
*Different treatment approaches appeal to different patients, and using approaches that appeal to the patients helps to increase their retention rates.
*More data is needed to better understand what treatment options are best for different individuals.

== Ways to Improve and Optimize MAT ==

The effectiveness of MAT is enhanced when there is an emphasis on a broad range of treatment and recovery supports, not just providing the medication part of the MAT.  MAT is optimized when those providing and funding the treatment keep striving to improve all aspects of the treatment plan, optimized for each individual as much as practical. 

Some of the ways that MAT can be optimized are listed below::

*Precision medication ([[Expand_DNA_Testing_to_Improve_Precision_MAT_Therapies|Expand DNA Testing to Improve Precision MAT]])
*A coordinated, proactive, whole-person care plan ([[Integrate_MAT_into_a_Whole_Person_Care_Model|Integrate MAT into whole-person care model]])
*Community engagement ([[Expand_community_engagement_to_improve_MAT|Expand community engagement to improve MAT]])
*Use of innovative technologies ([[Use_innovative_technologies_to_enhance_MAT|Use innovative technologies to enhance MAT]])

== Current Status of MAT Practices ==

*Only 10% of conventional drug treatment facilities in the United States provide MAT for opioid use disorders (need source and date)
*According to SAMHSA data collected in early 2017, 40 percent of the physicians who have a waiver do not prescribe buprenorphine at all. This may be due to physicians' reluctance to have patients with addictive disorders frequenting their offices or due to concerns about DEA audits, among other reasons.[4]
*Avalere’s analysis finds that 11 states (IA, IL, MD, MI, MO, NC, NH, OH, VA, WI, WV) located in the Midwest and Mid-Atlantic and DC have significantly lower-than-average rates of providers who prescribe buprenorphine compared to opioid overdose deaths.<ref>https://avalere.com/press-releases/midwest-and-mid-atlantic-states-face-provider-shortage-to-address-opioid-epidemic</ref>

</div>

== Co-occurring Disorders ==

Co-occurring disorders, or dual diagnosis, refers to having a simultaneous mental health disorder and substance use disorder. It is common for people with addictions to also suffer from depression, anxiety, or more severe mental illnesses such as schizophrenia or bipolar disorder. Research shows that people who use alcohol or other drugs early in life are more likely to have mental or emotional problems. It’s also true that many people with mental illnesses “self-medicate” with alcohol or other drugs to numb emotional pain, relieve anxiety, or quiet their thoughts. In the past, the medical profession treated one disorder first, typically the substance use disorder, before addressing the other. It is now understood that treating both simultaneously leads to better outcomes. Any successful addiction treatment program will include a mental health assessment and treat co-occurring disorders at the same time.<ref> [6]Weiss, R. D., Potter, J. S., Fiellin, D. A., Byrne, M., Connery, H. S., Dickinson, W., … Ling, W. (2011). Adjunctive counseling during brief and extended buprenorphine-naloxone treatment for prescription opioid dependence: A 2-phase randomized controlled trial. Archives of General Psychiatry, 68(12), 1238–1246. https://doi.org/10.1001/archgenpsychiatry.2011.121
</ref>

 

== Different Medications Used in MAT: ==

=== Agonists & Antagonists ===
<div class="_">An opioid agonist activates opioid receptors in the brain. An antagonist blocks opioids by attaching to the opioid receptors without activating them.<ref>[7]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>[Detoxification vs. Stabilization]</div> <div class="_"> </div> <div class="_">Buprenorphine</div>
*Buprenorphine is used in MAT to help people reduce or quit their use of heroin or other opiates, such as pain relievers like morphine. One study showed that 50% of the people in treatment who were also on Buprenorphine stayed on treatment compared with 7% who only had treatment.<ref>[8]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Buprenorphine is a partial agonist that suppresses opioid withdrawal symptoms. It can produce opioid agonist effects, such as euphoria, it is milder than full agonists such as methadone.<ref>https://www.drugabuse.gov/download/21349/medications-to-treat-opioid-use-disorder-research-report.pdf?v=99088f7584dac93ddcfa98648065bfbe</ref>
*Buprenorphine can be prescribed by physicians in an outpatient setting who have completed a training course and received a DEA DATA 2000 waiver. It is taken as a pill or sublingual film. Buprenorphine was also approved in a 6-month implant form in May 2016<ref>https://archives.drugabuse.gov/news-events/news-releases/2016/05/fda-approves-six-month-implant-treatment-opioid-dependence</ref>
*Training for Buprenorphine providers is an 8-hour course (24 for Nurse Practitioners and Physician Assistants) and allow for the following patient loads and responsibilities:<ref>[11]Medication-Assisted Treatment: Buprenorphine in the HCH Community (2016), National Health Care for the Homeless Council, Retrieved From: https://nhchc.org/wp-content/uploads/2019/08/policy-brief-buprenorphine-in-the-hch-community-final.pdf</ref>

#30 Addiction Treatmtent Patients per provider for the first year
#100 patients each year thereafter
#An additional 175 (totaling 275) patients can be allotted if the Physician is board certified in addiction or if a facility:

*Has 24 Call Coverage for patients
*Uses an EMR/EHS to monitor and update patient records (for those looking for an entry-level EHS, PracticeFusion is a free system)
*Provision of Care Management Services
*Subscribing to a State-led Drug Management System
*Acceptance of Third Party Insurance

It should be noted that only around 10% of those who wish to seek treatment can find qualified providers to allow for it. <ref>[12]https://www.fiercehealthcare.com/practices/only-10-eligible-primary-care-providers-can-prescribe-buprenorphine-to-treat-patients-for</ref> As a result, there are cases where medication diversion does occur, and there is a black market for the drug for self-treatment purposes.<ref>[13]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref> Treatment with buprenorphine has been proven effective in opioid addiction, decreasing mortality by approximately 50%. Patients treated with buprenorphine show improved social functioning with increased retention in treatment (67% at one year) compared to drug-free treatment (7% to 25% at one year), reduced criminal activity, lower rates of illicit substance abuse, and reduced risk of HIV and hepatitis infection.<ref>[14]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>

*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine SAMSHA page on Buprenorphine]
*[[More_info_on_Buprenorphine|More info on Buprenorphine]]

For more information, one can visit the information page on [[File/view/BupForOUD.pdf/614583113/BupForOUD.pdf|Buprenorphine for Patients and Families]], which includes information on side effects, information to share with providers, and other useful information. This document was compiled by Intermountain Health Care.

=== Suboxone ===

*Suboxone is a brand name for a hybrid that is three parts Buprenorphine and one part Naloxone.
*Suboxone is more difficult to misuse because it will cause the patient to enter opioid withdrawal if it is misused in any way, such as injection.<ref>[15]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*[[More_info_on_Suboxone|More info on Suboxone]] (including generic options)

 

=== Probuphine ===

*Probuphine is an implant that contains the medicine buprenorphine. Probuphine is used to treat certain adults who are addicted to (dependent on) opioid drugs (either prescription or illegal). Probuphine is part of a complete treatment program that also includes counseling and behavioral therapy.
*Because Probuphine contains buprenorphine, it may cause physical dependence.
*Four implants are inserted under the skin of your upper arm during a procedure done in your physician's office or Opioid Treatment Program (OTP).
*The implants remain in your arm for six months.
*After the six-month period, your doctor must remove the implants.
*If you wish to continue Probuphine, your doctor may insert new implants to continue treatment.
*The implants can be removed sooner if you want to stop treatment.
*Patients must continue to see their doctor at least every month while on Probuphine therapy.
*[https://probuphinerems.com For more information visit their website.]

=== Methadone ===

*Methadone, sold under the brand name [https://www.drugs.com/cdi/dolophine.html Dolophine] among others, is used in MAT to help with detoxification or as part of [https://en.wikipedia.org/wiki/Maintenance_therapy maintenance therapy] or [https://en.wikipedia.org/wiki/Opioid_replacement_therapy Opioid Replacement Therapy].
*Methadone is an opioid replacement. It works by changing how the brain and nervous system respond to pain. It lessens the painful symptoms of opiate withdrawal and blocks the euphoric effects of opiate drugs such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone.<ref>[16]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Methadone is to be prescribed as part of a comprehensive treatment plan that includes counseling and participation in social support programs.
*Methadone can only be dispensed at SAMHSA-certified outpatient treatment programs or in hospitals in an emergency. <ref>17]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Methadone has been used to treat chronic pain, however, this use is limited because of the serious risk of dependence and overdose.<ref>[18]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/methadone SAMSHA page on Methadone]
*[[More_Information_on_Methadone|More info on Methadone]]

=== Naltrexone ===

*Naltrexone is a nonaddictive medicine that serves as an opioid receptor antagonist and not an opioid replacement, unlike methadone and buprenorphine. It is a primary ingredient in the treatment of alcohol and opioid dependence. Naltrexone blocks certain receptors in the part of the brain that triggers dopamine release so they cannot be activated. Dopamine release reinforces the vicious and compulsive addiction feedback loop. When we block these areas of the brain, the craving for alcohol and opiates is eliminated or significantly reduced. The pleasure is very limited and the uncontrollable cascade of relapse is much less likely, if alcohol is consumed after the implant procedure, in addition, if opiates are consumed after the procedure, there are no effects.<ref>[19]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Naltrexone is administered in a long-active, injectable formulation administered once a month.<ref>[20]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Naltrexone does not prevent withdrawal symptoms so it is recommended for patients who do not have opioids in their system.<ref>[21]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone SAMSHA page on Naltrexone] (The 30-day injectable version is commercially known as Vivitrol)
*[[More_info_on_Naltrexone_and_Vivitrol|More info on Naltrexone and Vivitrol]]

 

=== Naloxone ===

*Naloxone is an opioid antagonist used to reverse opioid overdose
*Naloxone (commercially known as Narcan) is available in intravenous or intramuscular injection and nasal delivery options. Intramuscular injection or intranasal delivery is safe for administration by any person.<ref>[22]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
*Naloxone works within minutes and effects last for up to an hour. Multiple doses may be required depending on the severity of respiratory depression.<ref>[23]Garcia-Portilla, M. P., Bobes-Bascaran, M. T., Bascaran, M. T., Saiz, P. A., & Bobes, J. (2014). Long term outcomes of pharmacological treatments for opioid dependence: Does methadone still lead the pack? British Journal of Clinical Pharmacology, 77(2), 272–284. https://doi.org/10.1111/bcp.12031
</ref>
*Naloxone does not produce tolerance or dependence. <ref>[24]Moving from Stigma to Science in Treating Addiction. (2016, December 17). Retrieved December 5, 2019, from California Health Care Foundation website: https://www.chcf.org/blog/moving-from-stigma-to-science-in-treating-addiction/
</ref>
*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/naloxone SAMSHA page on Naloxone]
*[[More_info_on_Naloxone|More info on Naloxone]] (including discounted public pricing and free Narcan for schools)
*(for [http://www.samhsa.gov/medication-assisted-treatment/treatment/opioid-overdose opioid overdose])

 Find information on physical ailments often diagnosed in MAT patients. Also known as [http://www.samhsa.gov/medication-assisted-treatment/treatment/common-comorbidities common comorbidities], these include viral hepatitis, HIV, and AIDS. Medications Used in Addiction Treatment**<ref>[25]The Case for Medication-Assisted Treatment. (n.d.). Retrieved December 5, 2019, from http://pew.org/2kdLIf2
</ref>

{| border="1" class="wiki_table"
|-
| Sept 2017
| Where it can be provided
| FDA indications
| Effectiveness
| Administration
|-
| Methadone
| OUD. Licensed opioid treatment programs Pain. Any Drug Enforcement Agency (DEA)-licensed prescriber
| OUD and pain management
| 74% to 80%<ref>[26]Summary: Major components of the HHS final rule. Effective August 8, 2016. (n.d.). Retrieved December 5, 2019, from https://www.asam.org/resources/publications/magazine/read/article/2016/07/06/summary-of-the-major-components-of-the-hhs-final-rule-which-will-be-effective-on-august-5-2016
</ref>
| OUD. Daily pill, liquid, and wafer forms; injectable form in hospitalized patients unable to take oral medications Pain. Injectable, transdermal, and buccal film
|-
| Buprenorphine and buprenorphine/naloxone
|
*Prescribed by community physicians and dispensed by pharmacies; available in some opioid treatment programs.
*Physicians receive federal waivers after eight hours of training; nurse practitioners and physician assistants require 24 hours. Patient panels are capped at 30, 100, and 275 per provider (depending on experience and setting).<ref>[27]Why Health Plan Should Go to the “MAT” in the Fight against Opioid Addiction(2017), California Health Care Foundation, Retrieved form: https://www.chcf.org/wp-content/uploads/2017/12/PDF-Why-Health-Plans-Should-Go-to-the-MAT.pdf</ref><ref>[28]Garcia-Portilla, M. P., Bobes-Bascaran, M. T., Bascaran, M. T., Saiz, P. A., & Bobes, J. (2014). Long term outcomes of pharmacological treatments for opioid dependence: Does methadone still lead the pack? British Journal of Clinical Pharmacology, 77(2), 272–284. https://doi.org/10.1111/bcp.12031
</ref><ref>[29]Kakko, J., Svanborg, K. D., Kreek, M. J., & Heilig, M. (2003). 1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: A randomised, placebo-controlled trial. The Lancet, 361(9358), 662–668. https://doi.org/10.1016/S0140-6736(03)12600-1
</ref>
*Any DEA-licensed provider can prescribe buprenorphine for pain.

| OUD and pain management (depending on formulation and dose)
| 60% to 90%<ref>[30]McNicholas, L.(n.d).Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction, U.S Department of Health and Human Rights, Retrieved from : https://www.naabt.org/documents/TIP40.pdf</ref>
| OUD. Daily sublingual, buccal, film, and tablet, or six-month intradermal device Pain. Injectable, transdermal, and buccal film
|-
| Naltrexone
| No restrictions
| Opioid and alcohol use disorders
| OUD. 10% to 21%<ref>[31]Miranda, A., & Taca, A. (2018). Neuromodulation with percutaneous electrical nerve field stimulation is associated with reduction in signs and symptoms of opioid withdrawal: A multisite, retrospective assessment. The American Journal of Drug and Alcohol Abuse, 44(1), 56–63. https://doi.org/10.1080/00952990.2017.1295459
</ref>
| Daily pill or monthly injectable
|-
| Naloxone (used only for overdose reversal, not addiction treatment)
| Any setting: prescribed or dispensed by a clinician, furnished by a pharmacy without a prescription (legal in several states), dispensed by lay staff in community settings (by standing order), or carried by law enforcement or other first responders.
| To reverse respiratory suppression in suspected opioid overdose
| May require high doses for extremely high-potency illicit drug use (fentanyl and carfentanyl)
| Intranasal spray, or intravenous, intramuscular, or subcutaneous injectable
|}
<div class="_">Extensive research has demonstrated the effectiveness of opioid agonist treatment (methadone and buprenorphine) in opioid use disorder. A meta-analysis of 50 studies showed methadone's retention rate ranging from 70% to 84% at one year, buprenorphine ranging from 60% to 90% at one year, with both treatments resulting in significant reductions in overdose death, illicit drug use, criminal activity, arrests, risk behaviors, HIV and hepatitis C incidence, as well as improvements in health status, functioning, and quality of life.<ref>https://www.chcf.org/wp-content/uploads/2017/12/PDF-Why-Health-Plans-Should-Go-to-the-MAT.pdf</ref>  </div>
== Stages of MAT with Buprenorphine ==

=== Induction ===
<div class="_">"Induction is the first stage of buprenorphine treatment and involves helping patients begin the process of switching from the opioid of abuse to buprenorphine. The goal of the induction phase is to find the minimum dose of buprenorphine at which the patient discontinues or markedly diminishes use of other opioids and experiences no withdrawal symptoms, minimal or no side effects, and no craving for the drug of abuse."<ref>[33]Addiction experts look to new and expanded opioid treatment options in 2017. (2017, January 13). Retrieved December 5, 2019, from FOX 61 website: https://fox61.com/2017/01/13/addiction-experts-look-to-new-and-expanded-opioid-treatment-options-in-2017/
</ref></div> <div class="_">New non-pharmacological approaches to treat opioid withdrawal could provide alternative pathways to help a patient manage withdrawal symptoms as they transition into MAT. The [https://i-h-s.com/ BRIDGE]® is a noninvasive, percutaneous electrical nerve field stimulator developed to target pain. An article published in 2018 in The American Journal of Drug and Alcohol Abuse shared significant promising results in using the BRIDGE to help people transition to MAT. The neurostimulation rapidly and dramatically reduced the [https://www.drugabuse.gov/sites/default/files/files/ClinicalOpiateWithdrawalScale.pdf COWS scores] of the participants, and 64 of the 73 people successfully transitioned to MAT. Some training programs suggest that [https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=99a59495-2a48-4276-bbe3-cdd55a45aba4 Clonidine] or [https://www.webmd.com/drugs/2/drug-16910-8296/ondansetron-oral/ondansetron-disintegrating-tablet-oral/details Ondansetron] may be used to ease the withdrawal symptoms during induction.<ref> [35]Vermont Global Commitment to Health Section 1115 Demonstration Fact Sheet (2018). Retrieved from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/vt/vt-global-commitment-to-health-fs.pdf</ref></div> <div class="_">[[More_information_on_buprenorphine_induction|More information on buprenorphine induction]].</div> <div class="_"> </div>
=== Stabilization ===
<div class="_">"The stabilization phase has begun when a patient is experiencing no withdrawal symptoms, is experiencing minimal or no side effects, and no longer has uncontrollable cravings for opioid agonists. Dosage adjustments may be necessary during early stabilization, and frequent contact with the patient increases the likelihood of compliance."</div> <div class="_"> [[More_information_on_buprenorphine_stabilization|More information on buprenorphine stabilization]].</div>
=== Maintenance ===
<div class="_">"The longest period that a patient is on buprenorphine is the maintenance phase. This period may be indefinite. During the maintenance phase, attention must be focused on the psychosocial and family issues that have been identified during the course of treatment as contributing to a patient’s addiction."</div> <div class="_">[[More_information_on_buprenorphine_maintenance|More information on buprenorphine maintenance]]</div>
== Medically Supervised Withdrawal (Detoxification) ==
<div class="_">As an alternative to the three stages above, the goal of using buprenorphine for medically supervised withdrawal from opioids is to provide a transition from the state of physical dependence on opioids to an opioid-free state, while minimizing withdrawal symptoms (and avoiding side effects of buprenorphine). Medically supervised withdrawal with buprenorphine consists of an induction phase and a dose-reduction phase. The consensus panel recommends that patients dependent on short-acting opioids (e.g., hydromorphone, oxycodone, heroin) who will be receiving medically supervised withdrawal be inducted directly onto buprenorphine/naloxone tablets. The use of buprenorphine (either as buprenorphine monotherapy or buprenorphine/naloxone combination treatment) to taper off long-acting opioids should be considered only for those patients who have evidence of sustained medical and psychosocial stability.</div>

= Impactful Federal, State, and Local Policies =

== New 2018 SAMHSA Guide for Medications for Opioid Use Disorder ==

This latest, detailed [https://store.samhsa.gov/product/TIP-63-Medications-for-Opioid-Use-Disorder-Executive-Summary/SMA18-5063EXSUMM 330-page report] can be downloaded for free. 

= Promising Practices =

== New & Expanded Treatment Options ==

=== Connecticut ===
<div class="_">Connecticut's Department of Mental Health and Addiction Services (DMHAS) recently received two federal grants, one of which is meant to go to medication-assisted treatment, the other toward prevention efforts. DMHAS is also collaborating with the Connecticut Community for Addiction Recovery on a new program that will enable people who were saved from overdose through the use of naloxone to work with a recovery coach who can connect them to services and a support network.<ref> [36]Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence: A Randomized Clinical Trial | Emergency Medicine | JAMA | JAMA Network. (n.d.). Retrieved December 5, 2019, from https://jamanetwork.com/journals/jama/fullarticle/2279713
</ref></div>

=== Vermont ===
<div class="_">Vermont's Health Home for Opioid Addiction has employed a "Hub & Spoke" system in handling the Opioid Crisis, called the "Care Alliance for Opioid Addiction," which has seen some success in treating addicted individuals while helping lift the burden of care from singular doctors and clinics. The system is composed of the following parts<ref> [37] Kashef, Z. (2015, April 28). Emergency department treatment for opioid addiction better than referrals. Retrieved December 5, 2019, from YaleNews website: https://news.yale.edu/2015/04/28/emergency-department-treatment-opioid-addiction-better-referrals
</ref>:</div>
*The Hub, a designated provider of specialty addiction treatment, is designed as an Opioid Treatment Program which is operated by Community Behavioral Health Agencies.
*The Spokes are health care teams led by physicians who can prescribe Buprenorphine and are regulated as Office Based Opioid Treatment providers.

Payment infrastructure for providers are structured after already existing Medicare and Medicaid Structures, which are documented in the Vermont Global Commitment To Health Section 1115 Demonstration Fact Sheet<ref>[38]Kashef, Z. (2015, April 28). Emergency department treatment for opioid addiction better than referrals. Retrieved December 5, 2019, from YaleNews website: https://news.yale.edu/2015/04/28/emergency-department-treatment-opioid-addiction-better-referrals
</ref>

*
**An evaluation of the Care Alliance for Opioid Addiction has shown that people in treatment for opioid addiction reported a 96 percent decrease in opioid use, and a 100 percent drop in overdose incidences, according to a [http://www.healthvermont.gov/media/newsroom/hub-and-spoke-evaluation-shows-significant-impact-january-22-2018 new report] from the Vermont Department of Health released 1/22/18.
**Additional findings include:
***92% drop in injection drug use.
***89% decrease in emergency department visits.
***90% reduction in both illegal activities and police stops/arrests.
***Zero participants in treatment had overdosed in the 90 days leading up to the study interview, compared to 25% who had overdosed in the 90 days before entering treatment.
***Family conflict, feelings of depression, anxiety and anger decreased, and participants reported being much more satisfied with their lives.

More information can be found at: <ref>[3]Hub and Spoke Evaluation Shows Significant Impact (January 22, 2018). (2018, January 22). Retrieved December 5, 2019, from Vermont Department of Health website: https://www.healthvermont.gov/media/newsroom/hub-and-spoke-evaluation-shows-significant-impact-january-22-2018

</ref>

== Emergency Department Treatment Protocols ==
<div class="_">In a Yale Randomized trial, it was found that individuals who receive Buprenorphine while getting medical care within an emergency room are more likely to adhere to treatment protocols and have a better chance at ceasing opioid use when compared to those who have received referrals to receive the treatment, or those who received motivational support.<ref>[39] Weiss, R. D., Potter, J. S., Griffin, M. L., Provost, S. E., Fitzmaurice, G. M., McDermott, K. A., … Carroll, K. M. (2015). Long-term outcomes from the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study. Drug and Alcohol Dependence, 150, 112–119. https://doi.org/10.1016/j.drugalcdep.2015.02.030
</ref>This can be an initiation point for treatment of opioid dependence and can be followed up by primary care facilities. This has shown to decrease the need for in-patient facilities. This can be attributed to engaging patients at the optimal point of access. <ref>[40]Health plan offers financial incentives for MAT training | Psychiatry & Behavioral Health Learning Network. (n.d.). Retrieved December 5, 2019, from https://www.psychcongress.com/article/policy/health-plan-offers-financial-incentives-mat-training
</ref></div>

== National Healthcare For Homeless Council ==
<div class="_">As one may assume, there is cross-over between the homeless and addicted communities. The National Healthcare for the Homeless Council has as a result, released a policy brief that may be of some use for both policy makers and health care providers alike. Within the brief, a basic strategy is considered as follows when treating addicted and homeless/addicted patients:</div> <div class="_">  • '''Establish stability'''. Stable housing is central to attaining treatment goals as it provides patients with stability, a sense of safety, an increased ability to meet basic needs, and an opportunity to have increased control over their lives and environment. Securing stable housing as early as possible is key to the treatment and recovery process.   • '''Address comorbidities using integrated care'''. Untreated medical and/or other behavioral health conditions may complicate MAT. The most successful interventions are provided through integrated care models of interdisciplinary teams made up of medical, mental health, substance use, and social service providers. Each discipline should not only be co-located, but should work collaboratively as a team with multiple services offered in the same visit.   • '''Treat the whole person'''. Substance use disorders cannot be treated apart from addressing the needs of the whole person in the context of his or her environment. In addition to addressing comorbidities, assistance in accessing food, clothing, shelter/housing, financial assistance, counseling, job training, employment services, and other needs as identified must be included alongside MAT.   • '''Take a harm reduction approach'''. Harm reduction therapy is an evidence-based practice that supports and respects a person’s experience and treats them with dignity, which is especially important for persons experiencing homelessness who regularly interact with systems and situations that limit self-determination and lack respect. Harm reduction therapy relies on collaboration, respect, and stage-based interventions that acknowledge self-defined positive change. Harm reduction therapy focuses on client-defined priorities and acknowledges that any improvement that reduces harm is beneficial. The key to harm reduction therapy is low barrier, integrated care that is trauma informed and respectful of the collaborative therapeutic relationship.   • '''Utilize evidence-based best practices'''. In addition to harm reduction, using other evidence-based best practices such as the use of peer specialists, motivational interviewing, and individual and group therapy can help patients maintain recovery and have successful treatment outcomes.   •'''Be patient centered'''. Building trust and developing relationships is essential to providing high-quality care and achieving good health outcomes. Engaging in patient centered care based on a patient’s individual needs, strengths, goals, and timeframe rather than on a pre-determined benchmark for outcomes is one way to build relationships and empower patients in the process. Patients should be actively involved in setting goals and planning their treatment.   •'''Be flexible'''. There is no one-size-fits-all treatment that will work for all patients. While MAT recommends a combination of medication and behavioral health therapy, treatment should be flexible and individualized to the patient’s needs, especially the frequency/schedule for therapy. For some, medication alone and regular consultation with a primary care provider is enough to maintain and recover from addiction, while others may need the additional supports provided by behavioral health therapy.</div> <div class="_"> </div> <div class="_">More information can be found on the [[File/view/HCHBrief.pdf/614804863/HCHBrief.pdf|Policy Document]] itself.</div>

== Opioid Treatment Program Directory ==
<div class="_">Select [http://dpt2.samhsa.gov/treatment/directory.aspx this directory] to view the opioid treatment programs in each state</div>

== Moving from Stigma to Science ==

=== Pennsylvania and New Jersey ===
<div class="_">The Department of Behavioral Health and Intellectual Disability Services of Pennsylvania has taken actions to ensure that halfway houses and other rehabilitation facilities cannot turn away individuals using MAT as a means of treating Opioid Abuse. <ref>[41] Page Not Found</ref> Underlying problems still exist in restrictive medication regimen practices, insurance coverage, and Public-Private partnerships, which require support to overturn previous hard-lined policies. An evidence-based approach has shown that introduction of MAT, especially with Buprenorphine, has had an increased mitigation effect on relapse and a higher chance of long-term recovery.<ref> [42]Page Not Found</ref></div>

=== National Healthcare For Homeless Council ===

The National Healthcare for the Homeless Council also has recommendations of policy that not only controls the prescription of opiates, but also the treatment of opioid addiction. They are as follows:
<div class="_">Remove the cap on the number of patients a physician can treat with buprenorphine. Existing limits are arbitrary and create barriers to accessing treatment. While put in place to mitigate diversion, cap limits may inadvertently aid diversion by limiting the supply of MAT, leading to individuals pursuing self-treatment by purchasing diverted drugs. Ironically, there are no limits to the number of patients a physician can prescribe other opioid drugs that present a much greater risk of causing addiction, overdose, and death (e.g., Methadone, Oxycodone, Hydrocodone, and Fentanyl). Removing the caps will allow providers to determine the number of patients they are able to treat based on the capacity of their practice and other factors, thereby increasing access to treatment.</div>
*Expand prescribing rights to all clinicians who are eligible to prescribe Class III, IV, and V CDS drugs. Limiting prescribing rights to physicians creates an additional barrier to accessing treatment and is incongruent with the existing scope of many clinical practices. Expanding prescribing rights to Nurse Practitioners, Physicians Assistants, and other clinicians who are authorized to prescribe Class III, IV, and V CDS drugs will expand treatment opportunities and decrease barriers to care. Clinicians who can prescribe opioids for pain should also be able to prescribe buprenorphine to treat the addictions that sometimes result.
*Require training to prescribe all opioids, not just buprenorphine. Specialized training is required to prescribe buprenorphine, but no other drug (opioid or otherwise) requires this as a condition of practice. Given the lower risks associated with diversion of buprenorphine, and the elevated risk associated with many opiates that can be prescribed with few restrictions, training should be extended to the prescribing of any opioid and focus on administering and monitoring prescriptions and understanding the nature of addiction. In addition, prescribers should have greater access to technical assistance and resources to develop plans to identify and avoid diversion.
*Enforce parity laws. Substance abuse treatment and other behavioral health services should be just as easy to access as primary care services. Parity laws are in place to ensure insurance plans treat these services equally, and should be enforced. Health insurance practices that require prior authorizations for opioid treatment should be scrutinized, especially when they create barriers to behavioral health care that do not exist for primary care. Just as there are no prior authorizations required for opioid drugs prescribed for pain management, there should be no prior authorizations required for MAT. Addiction is a time-sensitive condition to treat, and presenting for treatment is a big step for patients; even a delay of one day can be the difference in someone getting treatment or not.
*Reduce stigma and treat addiction as a disease. The main barrier to any type of treatment for persons experiencing homelessness is a lack of stable housing. In addition, drug screens are often required when accessing housing, and employers often require drug screens for employment. Landlords and employers need to accept buprenorphine prescribed as part of a MAT plan as a medical treatment process, and not have it count negatively against a person by including it as a prohibited substance. Addiction needs to be seen as a disease and not a moral failing, and engagement in MATs as a health care intervention should not be a liability to accessing housing or employment.
*Train all health care disciplines on addiction. Expanding awareness of addiction and providing substance abuse education for medical students, residents, practicing physicians, and all other health care providers is essential. Curricula which treat substance use conditions similarly to other chronic disorders and provide more adequate basic preparation need to be implemented. In addition, continuing education opportunities to learn about evidence-based practices for the treatment of SUDs need to be provided, and programs to support the adoption of MAT, screening, brief intervention, and referral to treatment need to be identified and implemented.

More information can be seen in this [[File/view/HCHBrief.pdf/614804863/HCHBrief.pdf|Policy Brief Document]].

== Financial Incentives for MAT training ==

'''Neighborhood Health Plan''' (NHP) of Massachusetts has announced a series of initiatives to increase access to Substance Use Disorder treatments. This non-profit health plan is providing financial incentives to encourage more prescribers to train and be certified to prescribe buprenorphine products. NHP will reimburse prescribers $500, which is roughly the cost of required training, for earning their certification in buprenorphine product dispensing. Prescribers can receive an additional $2,000 if they provide documentation showing that at least 10 patients have been treated after becoming certified. This financial incentive has become increasingly popular, as NHP has received several inquiries about the program from prospective prescribers within days of its announcement. Other initiatives include hiring recovery coaches to work with patients as part of their follow-up care as well as waiving member copays for naloxone. "Pharmacists will be reminded to notify plan members that they are eligible for free naloxone supplies when they pick up high-dose narcotic painkilling prescription medications."<ref>https://www.hmpgloballearningnetwork.com/site/behavioral/article/policy/health-plan-offers-financial-incentives-mat-training</ref> Another initiative is to offer a benefit design that encourages plan members to seek alternatives to opioid medications. NHP waives copays for alternative treatments to prescription painkillers including chiropractic care, acupuncture, and physical therapy.

== Canadian Guidelines ==
<div class="_">This [https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Prescribing-Drugs/Advice-to-the-Profession-Prescribing-Drugs document ]has details on the MAT Methadone guidelines from Canada</div>

= Available Tools and Resources =

[[TR_-_Expand_Access_to_Medication-Assisted_Treatment|TR - Expand Access to Medication-Assisted Treatment]] PCSS The Provider's Clinical Support System offers a [[File/view/StigmaandMethadone.pdf/614518761/StigmaandMethadone.pdf|module]] for CME credit on the Stigma on Maintenance Treatment. This can address the primary perceived and actual stigmas from patients as well as follow professionals. <ref>https://pcssnow.org</ref> [http://www.buppractice.com/ BupPractice] This is a DATA 2000 accredited resource for providing either an 8-hour training for Physicians or a 24-hour training session for Physician Assistants and Nurse Practitioners, both for $199 per full series. It also offers up to 9 AMA PRA Category 1 Credits, and is further supported by the ASAM (American Society of Addiction Medicine). [[File/view/ADAPTINGPRACTICE.pdf/614804967/ADAPTINGPRACTICE.pdf|HCH Clinician's Network]] This resource provides recommendations for one's practice when dealing with opioid addicted patients, particularly those who also happen to be homeless. [[File/view/BHSHomeless.pdf/614805019/BHSHomeless.pdf|SAMSHA's Treatment Improvement Protocol for Homeless Persons]] This document shows current resources for those attempting to handle behavioral health topics, particularly in homeless populations, as well as strategies to develop one's own programs. Where Can Clinicians Get Training and Support? Buprenorphine training sessions are offered at several locations and websites. The training takes about eight hours and can be attended in person, online, or a combination of both. Buprenorphine waiver training can be valuable to any clinician (medical or behavioral) as it covers the basics of opioid addiction and how buprenorphine works. Clinicians can only prescribe buprenorphine for addiction after receiving certified training and a Drug Enforcement Administration (DEA) waiver. However, any DEA-licensed clinician can prescribe buprenorphine for pain. Training opportunities are posted on the following websites: Substance Abuse and Medical Health Services Administration (SAMHSA), American Academy of Addiction Psychiatry (AAAP), American Osteopathic Academy of Addiction Medicine (AOAAM), and Providers’ Clinical Support System (PCSS).24-27 Some sites also offer other tools and resources. PCSS offers online mentorship, and Project ECHO28 offers video telementoring and monthly case review. The Clinicians Consultation Center at UCSF offers expert clinical advice, Monday through Friday, 7 a.m. to 3 p.m. PST.29 Substance Use Warmline: (855) 300-3595. <ref>https://nccc.ucsf.edu/about-the-center/</ref>  

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[[Category:SAFE-Treatment and Recovery]]

Expand & Enhance Prescription Drug Monitoring Program (PDMP)

2021-11-07T19:29:39Z

G.Lehrman:

'''''Return to '''[[ZOOM_MAP_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Program|Zoom Map (Expand & Enhance PDMP) ]] or [[ZOOM_MAP_-_Reduce_Access_to_Opioids|Zoom Map (Reduce Access to Opioids)]] or [[ZOOM_MAP_-_Minimize_Diversion_of_Prescription_Drugs|Zoom Map (Minimize Diversion of Prescription Drugs)]] or [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom map - Reduce Prescription of Opioids]]''

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= Introductory Paragraph =

Prescription Drug Monitoring Programs (PDMP) allow pre-registered users including licensed healthcare prescribers to prescribe controlled substances, pharmacists authorized to dispense controlled substances, and law enforcement and regulatory boards to access timely patient-controlled substance history information.<ref>[1]PDMP/CURES. (n.d.). Retrieved November 24, 2019, from https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/PDMP-CURES.html</ref> PDMPs are designed to collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners. This information is used to assist prescribers, dispensers, and other health care professionals in making clinical decisions for their patients. PDMPs also have been shown to reduce adverse drug interactions, and help health care professionals identify patients who may be in need of substance use treatment. Law enforcement and regulatory/licensing board officials utilize PDMP information, under appropriate circumstances, to further their investigations of suspected violations of controlled substance laws and compliance with regulatory/licensing board practice standards. Many states have also begun to use PDMPs as a public health surveillance tool. PDMPs continue to be among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.<ref>[2]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from https://bja.ojp.gov/library/publications/comprehensive-opioid-abuse-site-based-program-fy-2017-competitive-grant</ref>

 

= Key Information =

The main objectives of PDMP programs are to:

*Improve patient safety.
*Build a data collection and analysis system at the state level.
*Enhance existing programs' ability to analyze and use collected data.
*Facilitate the exchange of collected prescription data among states.
*Assess the efficiency and effectiveness of the programs funded under this initiative.<ref>[3]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1</ref>

 PDMPs can alert healthcare providers to provide potentially lifesaving information and interventions.

*They DO for those using prescription opioids
**Help collaborate with the patient to taper to a safer dosage
**Consider offering naloxone
**Communicate with other providers managing the patient
**Weigh patient goals, needs, risks
*They DO for those who they consider to have opioid use disorder, discuss safety concerns and treatment options<ref>[4]What Healthcare Providers Need to Know about PDMPs | Drug Overdose | CDC Injury Center. (2019, July 12). Retrieved November 24, 2019, from https://www.cdc.gov/drugoverdose/pdmp/providers.html</ref>
*They DO NOT dismiss patients from care

 With this in mind, states are trying to find ways to increase the use of PDMPs by prescribers so they avoid having a mandate. In some states, you are automatically registered when practitioners apply for a license. There are also efforts to integrate PDMP data into electronic medical record systems so the information is available at the point of care.<ref>[5]How to monitor prescription drugs | Psychiatry & Behavioral Health Learning Network. (n.d.). Retrieved November 24, 2019, from https://www.psychcongress.com/article/how-monitor-prescription-drugs</ref>   [https://www.cdc.gov/drugoverdose/pdmp/ Prescription Drug Monitoring Programs]

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== Examples of Positive Impact ==

*Between the years 2010-2012, Florida implemented a PDMP and other "pill mill" policies that had a positive impact on the opioid epidemic. According to the CDC, Florida recorded a 26.1% decrease in opioid analgesic overdose deaths, after these policies were implemented.<ref>[6]Decline in Drug Overdose Deaths After State Policy Changes—Florida, 2010–2012. (n.d.). Retrieved November 24, 2019, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6326a3.htm</ref> The Florida Department of Health said that from 2010 to 2013, oxycodone overdose deaths fell from 1,516 to 534—a 65% decrease.<ref>[7]Rutkow, L., Chang, H.-Y., Daubresse, M., Webster, D. W., Stuart, E. A., & Alexander, G. C. (2015). Effect of Florida’s Prescription Drug Monitoring Program and Pill Mill Laws on Opioid Prescribing and Use. JAMA Internal Medicine, 175(10), 1642–1649. https://doi.org/10.1001/jamainternmed.2015.3931</ref>
*New York experienced a 75% decrease in prescriptions issued through "doctor shopping" as a result of a 2012 requirement that prescribers check the PDMP before writing a prescription.<ref>[8]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref>
*74% of California physicians reportedly changed their prescribing practice as a result of patient activity reports created using the state's PDMP<ref>[9]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref>
*After establishing a PDMP, Tennessee saw a reduction in the morphine milligram equivalents dispensed, a reduction in the number of doctor and pharmacy shoppers going to multiple outlets to obtain drugs, an increase in queries to the State's Controlled Substance Monitoring Database Program by prescribers and extenders, and a change in practices, with some 41.4% less likely to prescribe certain controlled substances.<ref>[10]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref>

 

== Examples of Negative Impact ==
<div class="_">The existence of a Prescription Drug Monitoring Program within a state, however, '''appears to increase drug diversion activities in contiguous non-PDMP states'''. When states begin to monitor drugs, drug diversion activities tend to spill across boundaries to non-PDMP states. One example is provided by Kentucky, which shares a boundary with seven states, only two of which have PDMPs -- Indiana and Illinois. As drug diverters became aware of Kentucky PDMP's ability to trace their drug histories, they tended to move their diversion activities to nearby nonmonitored states. OxyContin diversion problems have worsened in Tennessee, West Virginia, and Virginia -- all contiguous non-PDMP states -- because of the presence of Kentucky's PDMP, according to a joint federal, state, and local drug diversion report.<ref>[11]Diversion of Prescription Drugs. (n.d.). Retrieved November 24, 2019, from Drug War Facts website: https://www.drugwarfacts.org/chapter/diversion</ref></div> <div class="_"> </div>
== Provider Challenges to Effective Use of PDMPs ==

*Insufficient Resources: Providers lack the time within their practice to perform all activities (not staffed sufficiently, not reimbursed, not value-added). Virtually every knowledge and use survey for PDMPs, for example, shows only half of physicians use the PDMP and the reasons cited for not using it are "its too time consuming" and "its too difficult to use." ("I need to see a patient every 12 minutes to make ends meet, I do not have the time or capacity to do all of this work.")
*Patient-Provider Relationship: The design of many programs tends to compromise the trust between patients and physicians because the providers are required to police their patients, and this is not something physicians see as part of their role as care providers. ("I did not go to medical school for this. I need a trusting relationship with the patient, which is not possible when I ask to count their pills.")
*Data Management: There is no automation support for any of this activity today, no field within the EMR to enter the risk-adjusted monitoring protocols or schedule patient activities according to risk levels, there is no place to store the results of a pill count or PDMP check or alert the physician when a treatment agreement needs to be updated.
*Consistency: Whether it is patients within a practice, practices within a network, or health systems within the state -- getting everyone to establish and adhere to protocols consistently is a challenge, yet inconsistent application of protocols is one of the greatest liabilities for any provider.<ref>[19]Preventing Chronic Opioid Therapy Addiction: PDMP’s alone are not the answer! | LinkedIn. (n.d.). Retrieved November 24, 2019, from https://www.linkedin.com/pulse/preventing-chronic-opioid-therapy-addiction-pdmps-alone-ron-frost/</ref>

 '''Prescription Drug Monitoring Information Exchange (PMIX)''' Architecture enables nationwide information sharing by the use of free, open, and consensus-based solutions; common formatting of shared data; security and privacy protocols to protect sensitive information; and preserving the state choice of interstate sharing solutions.<ref>[20]Prescription Drug Monitoring Programs: Critical Information Sharing Enabled by National Standards, Retrieved from : chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2Fprograms%2Fpmixarchitecture.pdf</ref>

== Use PDMPs to Improve Patient Safety ==

== National Alliance for Model State Drug Laws ==
<div class="_">View [https://namsdl.org/model-laws/ model PDMP laws ] and documents from states with prescription drug monitoring programs</div> <div class="_"> </div>
*Annual Summaries or Highlights
*Administration of PDMPs
*Data Reporting and Retention
*Types of Authorized Recipients
*Access and Registration
*PDMPs and Privacy
*Miscellaneous Documents
<div class="_"> </div>
= Funding Opportunities =

=== Current Funding Methods ===

*Federal grants
*Private/Non-federal grants
*General revenue funds
*Controlled substance registration fees
*Professional licensing fees
*Regulatory board funds

 

=== Potential Funding Methods ===

*PDMP licensing fees
*Health insurance licensing fees
*Private donations
*Medicaid fraud settlements
*Assessed fines
*Asset Forfeiture
*Drug manufacturers' assessment
*Prescription fees
*Private third-party payers or health insurers
*PDMP authorized users<ref> [13]Technical Assistance Guide, No.04-13, Prescription Drug Monitoring Program Training and Technical Assistance Center, Brandeis University, July 3, 2013. Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=http%3A%2F%2Fwww.pdmpassist.org%2Fpdf%2FPDMP_Funding_Options_TAG.pdf</ref>
*See the PDMP TTAC Funding Options for Prescription Drug Monitoring Programs in [[TR_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Programs|Tools and Resources for]] full descriptions. The Comprehensive Opioid Abuse Program Training and Technical Assistance (TTA) Program is a grant from the U.S. Bureau of Justice given to state, local, and tribal governments to provide resources to intervene with persons with substance use disorders.<ref>[14]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1</ref> The goals of the Comprehensive Opioid Abuse TTA Program are twofold. First, the program aims to support site-based and state initiatives designed to reduce opioid misuse and the number of overdose fatalities. Second, the program supports PDMPs and their stakeholders in expanding the implementation, enhancement, and proactive use of prescription drug monitoring programs to support clinical decision-making and prevent the misuse and diversion of controlled substances. Proposals were due April 25, 2017.<ref>[15]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2FFunding%2FCARA17.pdf</ref> The Comprehensive Opioid Abuse Site-based Program - Harold Rogers Prescription Drug Monitoring Program Implementation and Enhancement Projects Funding opportunity which provides state, local, and tribal governments resources to intervene with persons with substance use disorders. The Harold Rogers Prescription Drug Monitoring Program (PDMP) is being incorporated into the FY 2017 Comprehensive Opioid Abuse Site-based Program. The purpose of this program is to improve collaboration and strategic decision-making of regulatory and law enforcement agencies and public health officials to address prescription drug and opioid misuse, save lives, and reduce crime. This is made possible through the collection and analysis of controlled substance prescription data and other scheduled chemical products through a centralized database administered by an authorized state agency. This program was applied in 2017.<ref>[16]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2FFunding%2FCARA17.pdf</ref>
<div class="_"> </div>

= Relevant Research =

SAFE Solutions is an ever-growing platform. Currently limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

= Impactful Federal, State, and Local Policies =
<div class="_">The Prescription Drug Monitoring Program was created by the FY 2002 U.S. Department of Justice Appropriations Act (Public Law 107-77). <ref>[12]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1
</ref> Opportunities to Enhance PDMPs</div>
= Available Tools & Resources =

[[TR_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Programs|TR - Expand & Enhance Prescription Drug Monitoring Programs]] The Pew Charitable Trust created a report on [http://www.pewtrusts.org/en/research-and-analysis/reports/2016/12/prescription-drug-monitoring-programs Evidence-Based Practices to Optimize Use of PDMPs]

 

= Promising Practices =

#[https://oag.ca.gov/cures CURES]: California's state PDMP. Learn more at [https://oag.ca.gov/cures/faqs CURES FAQs]
#[https://www.hcinnovationgroup.com/policy-value-based-care/medicare-medicaid/blog/13022596/improving-emergency-department-information-flow-in-the-pacific-northwest EDIE]: Oregon and Washington use the Emergency Department Information Exchange (EDIE) system. This technology allows ED practicioners to identify patients with more than 5 ER visits in a one-year period or those with complex care needs who can be directed to appropriate care. This system allows for alerts to hospitals as soon as a patient visits the ER.
#[http://www.floridahealth.gov/statistics-and-data/e-forcse/ EFORSCE]: Florida's PDMP. This database has been in effect since 2010 and there are [http://www.floridahealth.gov/statistics-and-data/e-forcse/news-reports/index.html annual reports ] for each year. The website also includes a list of its [http://www.floridahealth.gov/statistics-and-data/e-forcse/funding/index.html funding sources].
#[https://pharmacypmp.az.gov/ Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program (CSPMP) ]- Allows practitioners and pharmacists to look up, view, and print controlled substance dispensing information on their specific patients directly via username and password.
#[http://www.worxpdmp.com/ WORx]Wyoming's active PDMP system.

 

== Find Your State's PDMP ==
<div class="_">Use this [https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-at-a-glance-prescription-drug-monitoring-programs-pdmp link] to find your state's Prescription Drug Monitoring Program.</div>
== TTAC ==

[http://www.pdmpassist.org/ Training Technical Assistance Center]: Brandeis University, in partnership with the Bureau of Justice Assistance, has developed the PDMP TTAC to provide services, support, resources, and strategies to improve the effectiveness of state PDMPs. Call 781-609-7741 for more information.

== Third-Party Patient Monitoring ==

'''GuideMed Monitoring''' is a management program for prescription narcotics monitoring. It helps provider networks prevent prescription drug misuse and it helps to protect the network and its practitioners from liabilities associated with prescription narcotics.<ref>[17] https://www.guidemed.com/solutions/guidemed-opioid-monitoring-solution</ref> Patient service stations are established on-site or freestanding in locations determined by the physician, where GuideMed nurses will staff and manage the monitoring activities chosen by the physician (Risk Assessments, PDMP Checks, CSA Reviews, Pill Counts, Toxicology Testing). After the nurse gathers all the necessary information, a report is prepared and sent to the patient's physician via a PDF file attached to that patient's record. GuideMed also provides any data needed for a compliance officer.

 '''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

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[[Category:SAFE-Prescriptions and Medical Response]]

Increase Access to Overdose Reversal Medications

2021-11-07T19:21:45Z

G.Lehrman:

<div class="wiki" id="content_view" style="display: block">
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map or]] [[ZOOM_MAP_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]] or [[ZOOM_Map-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|ZOOM MAP - Improve Access to Treatment that ]][[ZOOM_Map-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|Prevent]][[ZOOM_Map-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths| Overdose Deaths]]

= Overview =

[[Additional_Info_on_Naloxone|Naloxone]] (Narcan) is a prescription medicine that can reverse an opioid overdose or prevent it long enough for the person to receive adequate medical care. It blocks the opioid receptors in the brain to prevent an opioid user’s breathing and heart rates from slowing to fatal levels. Beginning in 2016, thirty-five states have made Narcan available to the general public as an over-the-counter drug to use as a nasal spray. Many other states are now working to pass laws that give police, first responders, and concerned family members the ability to carry and administer Narcan when called to a possible overdose situation. It is either injected or administered in a nasal spray. While [[Additional_Info_on_Naloxone|Naloxone]] is not readily available for ordinary citizens, it can be easily administered with little or no formal training. State laws have made it difficult for citizens to obtain the life-saving medication, due to third-party prescription and prescription via standing order policies. The third party-prescription law prohibits the prescription of drugs to someone other than the person who will receive them, while the standing order law prohibits the prescription of drugs to a person not personally examined by the prescribing physician. Although the drug could potentially save more lives if more widely distributed, there is fear of bystanders not summoning medical assistance due to possible prosecution against them. According to a report by Community Anti-Drug Coalitions of America (CADCA), a small community in Connecticut has made training for first responders to an overdose mandatory. Officers found a man in an unconscious state and realized he was overdosing. With the administration of Narcan, the man was able to recover from the overdose and regain consciousness. Narcan has the potential to be very beneficial in communities with a high opioid problem. Making a community aware of its existence, and its power to reverse overdose is a benefit unlike any other. Narcan will allow victims of substance abuse to be more likely to survive an overdose when first responders are rightly prepared. This medicine is one of need if a community is struggling with an opioid problem. It has been effective in saving lives, giving people with addiction a chance to realize the depth of their problem and a chance to ask for help.<ref>Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016.</ref>

= Key Information =

Opioid overdose education and naloxone distribution programs aimed at opioid users and individuals likely to be near people who overdose increase knowledge on how to effectively respond when someone is experiencing an overdose. Participation in the naloxone distribution programs is linked to a reduction in overdose deaths and an increase in confidence when responding to overdose. More research is still needed to confirm these benefits. <ref>https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/naloxone-education-distribution-programs</ref>

Researchers believe that communities that have programs aimed at training bystanders to respond to opioid overdoses have experienced a reduction in opioid overdose death rates quicker than communities without these programs. <ref>https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/naloxone-education-distribution-programs</ref>

Those close to opioid users have greater knowledge about overdose and how to respond appropriately after they have completed training in naloxone administration compared to peers who learn via an information booklet. Current and former opioid users who complete overdose response training identify an overdose and can tell when naloxone is appropriate as accurately as medical experts. Some studies have found that opioid users who participate in only a brief 5-minute training or learned about naloxone administration through social networks can respond appropriately to an overdose.

Training first responders to administer naloxone may reduce time to overdose rescue, possibly decreasing overdose-related injury and death. Law enforcement officers who participate in naloxone administration and overdose training report having increased knowledge and confidence in dealing with opioid overdose emergencies after the program is finished.<ref>https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/naloxone-education-distribution-programs</ref>

= Relevant Research =

A recent study in Massachusetts found that cities that have naloxone distribution programs have [http://www.bmj.com/content/346/bmj.f174 lower overdose death] rates than those without a program. Similarly, the [https://www.nchrc.org North Carolina Harm Reduction Coalition] has given out 52,000 naloxone kits since 2013 through their statewide grassroots network that includes syringe exchange and naloxone distribution, with more than 8,700 overdose reversals reported.<ref>https://www.usatoday.com/story/opinion/2017/12/01/opioid-commission-almost-got-right-their-naloxone-recommendation-megan-mclemore-corey-davis-column/899812001/</ref> [http://www.cadca.org/resources/coalition-action-meriden-healthy-youth-coalition-mhyc-provides-life-saving-overdose CADCA: Narcan Awareness ]<ref>CACDA Administration of Narcan. 2017 - http://www.cadca.org/resources/coalition-action-meriden-healthy-youth-coalition-mhyc-provides-life-saving-overdose
</ref>

== Educate About the Dangers of Dual use ==

In 2013 there were 23,153 opioid overdose deaths -- 16,235 involving opioid painkillers, 8,260 involving heroin/opium, and at least 1,342 involving a combination of the two. However, opioid overdoses are seldom due to opioid use alone.  The majority of overdoses are a result of mixing an opioid with some other drug. The best way to avoid an opioid overdose is not taking opioids and avoid knowingly mixing opioids with other drugs.  It is imperative to understand the risk when opioids are mixed with other drugs and to take extra safety precautions when mixing drugs. These include:

*Don't use alone
*Limit the amount of drugs you have available
*Stick to less lethal combinations of drugs
*Use smaller amounts of each drug
*Use the least impairing drug first
*Have Narcan on hand
*When injecting drugs of unknown strength and purity (street heroin), start with a small "tester" shot to gauge the strength of the drug before injecting a full dose
*When using a drug or drug combination for the first time, start with a small dose to gauge your innate tolerance
*Make sure your friends (or at least someone) knows what drug combinations you have taken
*Have a plan in place in case something goes wrong

Narcan only works on opioids, but doesn't harm an individual in the case of a non-opioid overdose. So if there's any question as to what a person took, use Narcan; it can only help.<ref>http://www.rehabs.com/pro-talk-articles/the-ultimate-harm-reduction-guide-to-drug-mixing/</ref>

= Impactful Federal, State, and Local Policies =

== Good Samaritan Laws ==

People often hesitate to seek treatment or call medical assistance in fear of incarceration or other forms of punishment. In August of 2015, the White House announced a treatment-based initiative. The $2.5 million budget would go towards a pilot program that engaged law enforcement officers and public health professionals to collect data on the movement of heroin along the East coast and train first responders on when it is adequate to administer Naloxone.<ref>http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html</ref>

In 2006, New Mexico passed a [http://www.nytimes.com/2007/04/05/us/05drugs.html "Good Samaritan Law"] that "granted limited immunity from prosecution on simple possession charges for people who dialed 911 to report a drug overdose". By 2015, 28 states in addition to the District of Columbia had passed similar laws.

In Minnesota, a "Good Samaritan" law was passed to assure that people who call the police or emergency responders to help with an overdose situation will not face legal consequences for their involvement, use of, or possession of legal or illegal opioids. This removes a potential barrier--fear of arrest--that sometimes leads to help not being called and lives being lost to overdose.<ref>https://www.revisor.mn.gov/statutes/cite/604A.01</ref>

 [http://www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx Drug Overdose Immunity and Good Samaritan Laws] for minimizing the fears of calling for help in the case of an overdose.

== Increasing Awareness of Law ==

*A University of Washington study evaluating the initial results of Washington state’s Good Samaritan policy found in a survey that drug users who were aware of the law were 88 percent more likely to call 911 in the event of an overdose than before.<ref>http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html</ref> [http://adai.uw.edu/pubs/infobriefs/ADAI-IB-2011-05.pdf University of Washington study]
*After New York state passed its Good Samaritan law in 2011, the Drug Policy Alliance printed 1 million cards and posters that explained the law and offered basic instructions on how to initially respond to an overdose and worked with various agencies to help distribute these materials to vulnerable populations.  

== Federal Changes to Address Problem ==

Various federal organizations came together to encourage good faith prescription of naloxone to ordinary citizens. They also encourage bystanders to become "Good Samaritans" by summoning emergency responders without fear of negative legal consequences.

== State Law Passage ==

By the end of 2016, all but 3 states, Kansas, Montana, and Wyoming have passed laws to improve ordinary person naloxone access.

== Pharmacists ==

In California, The California State Board of Pharmacy passed a policy that allows pharmacists to give out Naloxone (Narcan) without a prescription in case of emergencies.<ref>https://nabp.pharmacy/news/news-releases/california-pharmacists-may-now-dispense-naloxone-without-prescription/</ref>

== New in 2016: Improved Access to Nasal Narcan ==
New Public Interest Pricing $37.50 per dose <div class="objectEmbed">[[Media:Press_Release_for_Adapt_Pharma_and_Public_Interest_Pricing.pdf|Press Release for Adapt Pharma and Public Interest Pricing.pdf]]  (230 KB)</div> Free case of Narcan Nasal for any school. (Only 9 states allow as of Jan 2016). <div class="objectEmbed"><div>[[Media:Free_Narcan_Nasal_Spray_and_Education_for_High_Schools.pdf|Free Narcan Nasal Spray and Education for High Schools.pdf]]  (164 KB)</div> </div>

== Law Enforcement Use of Naloxone ==

*A 2016 report by the Police Executive Research Forum provides case examples of law enforcement naloxone programs instituted in Fayetteville (NC), Lummi Nation (WA), Virginia Beach (VA), Staten Island (NY), Camden County (CJ), Mongomery County (MD), and Hagerstown (MD) including descriptions of training, funding, administration, and support.<ref>https://cops.usdoj.gov/RIC/Publications/cops-p356-pub.pdf</ref>
*The Bureau of Justice Assistance (BJA) maintains an online toolkit featuring resources and information on naloxone, including a section on liability and risk for law enforcement officers and their employers associated with naloxone administration.<ref>https://bjatta.bja.ojp.gov/tools/naloxone/Liability-and-Risk</ref>

== Database of State Legislative Efforts ==

The National Conference of State Legislatures [http://www.ncsl.org/research/health/prevention-of-prescription-drug-overdose-and-abuse.aspx site] has many examples of policy efforts that have been attempted or passed.

=== Prevent Overdose strategies ===

The National Association of Drug Diversion Investigators, Inc. (NADDI) overdose and prevention strategies is a resource that has put every state's strategy into an online resource hub. This gives users a free resource to see what is being enacted in other states and lets people compare and contrast. This will allow for communities to enter and see what works and what does not.

 [https://www.overdosepreventionstrategies.org/ Overdose Prevention Strategies]

= Promising Practices =

[[CP_-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|CP - Improve Access to Treatments that Prevent Overdose Deaths]]

== Waive Copays ==

Many people who are prescribed Narcan (nearly 35%) don’t pick it up—presumably because they can’t afford the co-pay.<ref>https://www.healthcaredive.com/news/aetna-launches-new-policies-to-combat-opioid-crisis/512866/</ref> Having insurers eliminate the co-pay is one strategy to help address that. [https://www.aetna.com/index.html?cid=ppc-700000001035216-National_Always%20On_Branded_Aetna_Exact-Aetna-aetna&s_dfa=1&gclid=Cj0KCQiA38jRBRCQARIsACEqIeuilyQ_mSIjuCUt394XAuPY7X7VLnJ16hmHFgFYPcLvvOwo4NUwmxkaAsEhEALw_wcB&gclsrc=aw.ds Aetna] is currently the first national payer to waive copays for Narcan for its fully-insured commercial members. This will improve access by eliminating potential financial barriers to the lifesaving drug.<ref>https://www.healthcaredive.com/news/aetna-launches-new-policies-to-combat-opioid-crisis/512866/</ref>

= Tools & Resources =

[[TR_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|TR - Improve Access to Treatment that Prevent Overdose Deaths]] [https://store.samhsa.gov/sites/default/files/d7/priv/sma18-4742.pdf SAMHSA- Opioid Overdose Prevention Toolkit] - In particular, sections Facts for Community Members and Information for Prescribers may be of special interest.

 

== Actions to Take ==

[[PA_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|Actions for Coalitions]]

[[PAI_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|Actions for Individuals]]

= Sources =
</div>
[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Treatment and Recovery]]

Increase Access to Contraception

2021-11-07T19:21:04Z

G.Lehrman:

Return to  [[ZOOM_MAP_-_Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_during_Opioid_Use|ZOOM MAP - Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy during Opioid Use]]
Intro paragraph

 

 

= Introductory Paragraph =

Family planning and preconception care for women who use opioids are considered an important strategy to reduce the incidence of neonatal abstinence syndrome (NAS). <ref>https://www.cdc.gov/mmwr/volumes/66/wr/mm6609a2.htm</ref>  "CDC and the Office of Population Affairs of the U.S. Department of Health and Human Services recommend that health care providers support family planning services, which include preconception services, pregnancy intention screening, and contraceptive counseling to prevent unintended pregnancy by increasing access to the full range of contraceptive methods, including long-acting reversible contraception (e.g., intrauterine devices and implants)."<ref>Gavin L, Moskosky S, Carter M, et al. Providing quality family planning services: recommendations of CDC and the U.S. Office of Population Affairs. MMWR Recomm Rep 2014;63(No. RR-4).</ref>

Current Status:

*31% to 47% of US pregnancies are unintended. Research suggests that, for women with opioid use disorder, the proportion of unintended pregnancies was higher than 85%.<ref>https://www.cdc.gov/mmwr/volumes/66/wr/mm6609a2.htm</ref>

*The statistics of a study in Eastern Tennessee were alarming:
**Half of the 320,000 women in Medicaid in Tennessee received an opioid prescription in 2016<ref>https://www.venturenashville.com/empower-health-sets-12m-raise-for-push-into-self-pay-nad-infusion-space-cms-1917</ref>
**Only 3% of them use a reliable birth control method<ref>https://www.venturenashville.com/empower-health-sets-12m-raise-for-push-into-self-pay-nad-infusion-space-cms-1917</ref>
**Their general knowledge of birth control is very low<ref>https://www.venturenashville.com/empower-health-sets-12m-raise-for-push-into-self-pay-nad-infusion-space-cms-1917</ref>

= Key Information =

While there is often disagreement on what type of sex education is appropriate, communities should make it a priority to improve understanding of birth control as a way to avoid unintended pregnancies.

== Prevention through Contraception ==

=== Long-Acting Reversible Contraception (LARC) ===

One-in-two pregnancies in the US are unintended, and approximately half of these end in termination of pregnancy.<ref>Finer L, Henshaw S. Disparities in rates of unintended pregnancy in the United States 1994–2001. Perspect Sex Reprod Health. 2006;38:90.</ref> Unintended pregnancies result from contraceptive failure, incorrect or inconsistent use of a method, or lack of use of any form of contraception.<ref>Jones RK, Darroch JE, Henshaw SK. Contraceptive use among U.S. women having abortions in 2000–2001. Perspect Sex Reprod Health. 2002;34:294–303.</ref><ref>Moreau C, Trussell J, Rodrigues G, Bajoo N, Bouyer J. Contraceptive failure rate in France: results from a population based survey. Hum Reprod Update. 2007;22:2422–7.</ref>Interventions to increase adherence to pills and condoms, such as enhanced counseling, have not consistently improved contraceptive use patterns, continuation rates (ongoing use of the method after 12 months), or unintended pregnancies.<ref>Cleland J, Bernstein S, Ezeh A, Faundes A, Glasier A, Innis J. Family planning: the unfinished agenda. Lancet. 2006;368:1810–27.</ref> A US prospective study found that women using user-depended methods (pills, patches, and rings) were 20 times more likely to have an unplanned pregnancy than women using an intrauterine device (IUD) or implant.<ref>Winner B, Peipert JF, Zhao Q, et al. Effectiveness of long-acting reversible contraception. N Engl J Med. 2012;366(21):1998–2007.</ref> The IUDs and the implants are collectively known as LARC methods, and these are the most effective and cost-effective reversible methods available. They have an inherent ability to prevent pregnancy, but their effectiveness also arises from the fact that they are set and forget methods that do not require daily compliance, unlike condoms or the oral contraceptive pill. These are attributes that women themselves rate highly when considering their contraceptive options.<ref>Madden T, Secura GM, Nease RF, Politi MC, Peipert JF. The role of contraceptive attributes in women’s contraceptive decision making. Am J Obstet Gynecol. 2015;213(1):e41–6.</ref> Therefore, using LARCs should be promoted. One way may be via the integration of contraceptive services into drug health clinics. In this way, women may be enabled to more easily address their various needs in an environment that is both more familiar and less threatening. Similarly, integrated services may be more successful if they can provide low-threshold service access, ie, services with few or no barriers to access.<ref>Islam MM, Topp L, Conigrave KM, Day CA. Defining a service for people who use drugs as ‘low-threshold’: what should be the criteria? Int J Drug Policy. 2013;24(3):220–2.</ref><ref>Islam MM, Topp L, Conigrave KM, Day CA. Opioid substitution therapy clients’ preferences for targeted versus general primary health-care outlets. Drug Alcohol Rev. 2013;32:211–3.</ref> An analysis of a publicly funded family planning program calculated that LARC methods save US$7 in costs from unintended pregnancy for every US$1 spent. Thus, improving access to LARC methods is likely to be cost-effective.<ref>Foster D, Rostovtseva D, Brindis C, Biggs MA, Hulett D, Darney PD. Cost savings from the provision of specific methods of contraception in a publicly funded program. Am J Public Health. 2009;99:446–51.</ref>

=== Incentives for LARC use ===

Project Prevention relies on donations and pays women $300 to get on long term birth control<ref>https://www.heraldcourier.com/news/addicted_at_birth/project-prevention-program-aims-to-stop-nas-by-birth-control/article_3ebf4d37-5c7f-57b5-b297-47b1958127a5.html</ref>

=== Organizations Offering Free or Reduced LARC ===

The number of babies born with NAS has dropped nearly 90 percent in one year in counties that have the program. Tennessee Department of Health officials are sharing the project’s success. Some 41 local jails and methadone clinics now work with county health officials to make available free IUDs. The project is paid for by federal funds for incarcerated women who don't have private insurance or have lost TennCare, which automatically ends during incarceration. Officials stress that the choice to obtain long-acting and reversible contraceptives is up to each incarcerated woman.<ref>https://www.tennessean.com/story/news/2017/02/04/iuds-inmates-seen-tool-combat-opioid-crisis/97056396/</ref> The Access and Resources in Contraceptive Health (ARCH) Patient Assistance Program provides Bayer IUDs (Kyleena, Mirena, and Skyla) at no cost to women in the United States who do not have either private health insurance or Medicaid coverage for Bayer IUDs and who meet all other program eligibility requirements. Please note that while Bayer provides Bayer IUDs at no cost to patients, patients may incur other costs such as insertion and removal costs. Please speak with your insurance company or your healthcare provider for more information.<ref>http://www.archpatientassistance.com/</ref> "A Step Ahead" In East Tennessee - With an appointment for free birth control (LARC), will provide a free "Well Woman's" visit, including a pregnancy test and STI test. If you are over 21 and your medical provider deems it medically necessary, you may also receive a free PAP test. They also provide transportation.<ref>http://www.astepaheadeasttn.org/faq.html</ref>

 

== Offer Contraception at Pain Management/Addiction/Methadone/Suboxone clinics ==

The feasibility of delivery of family planning services at addiction treatment clinics is being actively explored, as seen from a study completed in West North Carolina.<ref>https://sys.mahec.net/media/onlinejournal/Contraceptive%20Choices.pdf</ref>

Offer contraception planning in non-traditional venues, such as a pediatric clinic within a drug treatment facility. <ref>https://doi.org/10.1080/15332985.2011.575723</ref> A barrier is staff education and comfort discussing the issue. Education and availability of appropriate staff would be paramount.

Contraceptive counseling and access to contraceptive services should be a routine part of substance use disorder treatment among women of reproductive age to mitigate the risk of unplanned pregnancy.<ref>https://www.regulations.gov/document?D=SAMHSA-2016-0002-0001</ref>

 

= Relevant Research =

== Research on Birth Control Options ==

See this article on [https://www.bedsider.org/features/224-gold-standard-birth-control-the-iud-and-the-implant preferences and effectiveness of different birth control options]. 

 

== LARCs ==

Increasing access to Long Acting Reversible Contraceptives (LARCs) could be a key part of a strategy. Since 2007, researchers have seen a sharp rise in LARCs, such as intrauterine devices and implants. These forms of birth control last for years once inserted and prevent pregnancy for more than 99 percent of users. That helps explain why they're a big part of the story behind America's plummeting unintended pregnancy rate. <ref>https://www.vox.com/2016/3/2/11148108/unplanned-pregnancy-larc-iud</ref> One of the biggest obstacles to LARC use, historically, has been price. Planned Parenthood has estimated that IUDs can cost between $500 and $900 out of pocket. Insurance plans tended to charge patients more for IUDs than for birth control pills, just because the devices have such high upfront costs.<ref>https://www.vox.com/2016/3/2/11148108/unplanned-pregnancy-larc-iud</ref>  [http://www.latimes.com/health/la-he-0528-birth-control-20160515-snap-story.html This article] makes some interesting points and has information on the relative effectiveness of different types of contraceptives.

== Hormone-releasing Implants ==

[https://www.nexplanon.com NEXPLANON] is a hormone-releasing birth control implant for use by women to prevent pregnancy for up to 3 years.  

== Non-Hormone IUDs ==

[http://www.paragard.com Paragard] is an IUD that can prevent pregnancy for up to 10 years. Paragard is a hormone-free IUD. It may be 100% covered by insurance. See [http://Paragardbvsp.com Paragardbvsp.com] to learn if benefits cover Paraguard. 

== Overcoming Cost Barriers to Access ==

Healthcare providers or clinics can join a Group Purchasing Organization (GPO) to get lower costs on birth control Afaxys is a pharma company that produces birth control pills, but they also have a Group Purchasing Organization that provides discount pricing on Bayer IUDs.

== Other Barriers to Access ==

Approximately 1 in 7 ob/gyns believe pelvic inflammatory disease is a significant risk of IUD use, despite substantial research to the contrary.<ref>Luchowski, A.T., et al. (2014). Obstetrician-Gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations. Contraception 89.</ref>

 

== Contraceptive Counseling ==

EmpowerHealth USA provides a telehealth option for contraception counseling.<ref>https://www.venturenashville.com/empower-health-sets-12m-raise-for-push-into-self-pay-nad-infusion-space-cms-1917</ref>

== Statistics ==

*A study of 946 women who were using opioids who gave birth revealed that 86% reported that the pregnancy was unintended.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052960/</ref>

== Potential Barriers ==

"For example, the ACOG supports placement of LARC devices during the immediate postpartum period to improve the use of LARC among postpartum women;  however, bundled payments for delivery create a relative financial disincentive to place LARC devices at the time of delivery.<ref>https://pediatrics.aappublications.org/content/139/3/e20164070</ref> State Medicaid programs play a critical role in ensuring access to highly effective contraception at the time when it is desired, including the time of delivery. However, recent research suggests that states are variable in aligning financial incentives to ensure access to LARC methods if elected at the time of delivery." <ref>Pace, L.E., Dusetzina, S.B., Fendrick, A.M., Keating, N.L., and Dalton, V.K. The impact of out-of-pocket costs on the use of intrauterine contraception among women with employer-sponsored insurance. Medical Care. 2013; 51: 959–963</ref> Patient contraceptive selection is sensitive to copayment. A 2010 analysis confirmed that employer-based plans display significant variation in copayments by contraceptive method, with LARC methods being the most expensive in terms of upfront costs to patients.<ref>Dusetzina, S.B., Dalton, V.K., Chernew, M.E., Pace, L.E., Bowden, G., and Fendrick, A.M. Cost of contraceptive methods to privately insured women in the United States. Women's Health Issues. 2013; 23: e69–71</ref> The Medicaid program has always required that family planning services be fully covered for patients without cost sharing.<ref>National Women's Law Center. (2015). Fact sheet: Contraceptive coverage in the health care law: Frequently asked questions. Accessed August 24, 2015.</ref> The Patient Protection and Affordable Care Act (ACA) similarly required new private health plans to provide no-cost coverage for all FDA-approved contraceptives.<ref>https://www.patientassistance.bayer.us/</ref>

= Impactful Federal, State, and Local Policies =

Virginia law allows women a full year of birth control covered by insurance vs. the previous 3 month supply

= Available Tools and Resources =

SAFE Solutions is an ever-growing platform. Currently limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

= Promising Practices =

== NAS Primary Prevention Initiative ==

[https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjCts7gtNDzAhWsl3IEHY0_Bx8QFnoECAkQAQ&url=https://www.tn.gov/content/dam/tn/health/documents/Bright_Spot_East_Region_NAS_Reduction_Effort_10-6-14_mbb_10-10-14.docx&usg=AOvVaw38qzEf-QI-U4gTE-ix_-Wj East Tennessee Primary Prevention Initiative] - Tennessee Department of Health Contact: Erica Wilson, MPH, Community Services Director,  [mailto:erica.wilson@tn.gov erica.wilson@tn.gov]

'''Overview of program''' 

*Partnership with local jails
*Health education sessions
**focus on NAS prevention
**information on effective contraceptives and LARCs
*Partnerships with jails to refer inmates to local health department for family planning
*Among 442 referrals (2014-15), 94% received a contraceptive method, 84% chose a voluntary LARC

''Resources'':

*PowerPoint presentation - to educate community partners [contacted for resource]
*Pamphlet - to educate community partners [contacted for resource]
*Presentation - conducted to inmates on NAS and how it can be prevented [contacted for resource]

 

== emPOWERhealthUSA ==

emPOWERhealthUSA has a program that provides telehealth coaching on birth control (among other things) to help more women get LARCs or make other informed decisions on birth control, with a focus on women who are using opioids.<ref>https://www.venturenashville.com/empower-health-sets-12m-raise-for-push-into-self-pay-nad-infusion-space-cms-1917</ref>

== Access and Resources in Contraceptive Health (ARCH) Patient Assistance Program ==

This patient assistance program provides Bayer IUDs (intrauterine devices), Kyleena, Mirena, and Skyla, at no cost to eligible women.<ref>https://www.patientassistance.bayer.us/</ref> Eligible women include those who do not have either private health insurance or Medicaid coverage for Bayer IUDs and who meet all other program eligibility requirements. Kyleena and Mirena can help prevent pregnancy for up to 5 years and Skyla up to 3 years.<ref>https://www.patientassistance.bayer.us/</ref>

 

= Sources =

----

 

[[Category:SAFE-Prescriptions and Medical Response]]

Increase Access to Contraception

2021-11-07T19:20:48Z

G.Lehrman:

Return to  [[ZOOM_MAP_-_Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_during_Opioid_Use|ZOOM MAP - Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy during Opioid Use]]
Intro paragraph

 

 

= Introductory Paragraph =

Family planning and preconception care for women who use opioids are considered an important strategy to reduce the incidence of neonatal abstinence syndrome (NAS). <ref>https://www.cdc.gov/mmwr/volumes/66/wr/mm6609a2.htm</ref>  "CDC and the Office of Population Affairs of the U.S. Department of Health and Human Services recommend that health care providers support family planning services, which include preconception services, pregnancy intention screening, and contraceptive counseling to prevent unintended pregnancy by increasing access to the full range of contraceptive methods, including long-acting reversible contraception (e.g., intrauterine devices and implants)."<ref>Gavin L, Moskosky S, Carter M, et al. Providing quality family planning services: recommendations of CDC and the U.S. Office of Population Affairs. MMWR Recomm Rep 2014;63(No. RR-4).</ref>

Current Status:

*31% to 47% of US pregnancies are unintended. Research suggests that, for women with opioid use disorder, the proportion of unintended pregnancies was higher than 85%.<ref>https://www.cdc.gov/mmwr/volumes/66/wr/mm6609a2.htm</ref>

*The statistics of a study in Eastern Tennessee were alarming:
**Half of the 320,000 women in Medicaid in Tennessee received an opioid prescription in 2016<ref>https://www.venturenashville.com/empower-health-sets-12m-raise-for-push-into-self-pay-nad-infusion-space-cms-1917</ref>
**Only 3% of them use a reliable birth control method<ref>https://www.venturenashville.com/empower-health-sets-12m-raise-for-push-into-self-pay-nad-infusion-space-cms-1917</ref>
**Their general knowledge of birth control is very low<ref>https://www.venturenashville.com/empower-health-sets-12m-raise-for-push-into-self-pay-nad-infusion-space-cms-1917</ref>

= Key Information =

While there is often disagreement on what type of sex education is appropriate, communities should make it a priority to improve understanding of birth control as a way to avoid unintended pregnancies.

== Prevention through Contraception ==

=== Long-Acting Reversible Contraception (LARC) ===

One-in-two pregnancies in the US are unintended, and approximately half of these end in termination of pregnancy.<ref>Finer L, Henshaw S. Disparities in rates of unintended pregnancy in the United States 1994–2001. Perspect Sex Reprod Health. 2006;38:90.</ref> Unintended pregnancies result from contraceptive failure, incorrect or inconsistent use of a method, or lack of use of any form of contraception.<ref>Jones RK, Darroch JE, Henshaw SK. Contraceptive use among U.S. women having abortions in 2000–2001. Perspect Sex Reprod Health. 2002;34:294–303.</ref><ref>Moreau C, Trussell J, Rodrigues G, Bajoo N, Bouyer J. Contraceptive failure rate in France: results from a population based survey. Hum Reprod Update. 2007;22:2422–7.</ref>Interventions to increase adherence to pills and condoms, such as enhanced counseling, have not consistently improved contraceptive use patterns, continuation rates (ongoing use of the method after 12 months), or unintended pregnancies.<ref>Cleland J, Bernstein S, Ezeh A, Faundes A, Glasier A, Innis J. Family planning: the unfinished agenda. Lancet. 2006;368:1810–27.</ref> A US prospective study found that women using user-depended methods (pills, patches, and rings) were 20 times more likely to have an unplanned pregnancy than women using an intrauterine device (IUD) or implant.<ref>Winner B, Peipert JF, Zhao Q, et al. Effectiveness of long-acting reversible contraception. N Engl J Med. 2012;366(21):1998–2007.</ref> The IUDs and the implants are collectively known as LARC methods, and these are the most effective and cost-effective reversible methods available. They have an inherent ability to prevent pregnancy, but their effectiveness also arises from the fact that they are set and forget methods that do not require daily compliance, unlike condoms or the oral contraceptive pill. These are attributes that women themselves rate highly when considering their contraceptive options.<ref>Madden T, Secura GM, Nease RF, Politi MC, Peipert JF. The role of contraceptive attributes in women’s contraceptive decision making. Am J Obstet Gynecol. 2015;213(1):e41–6.</ref> Therefore, using LARCs should be promoted. One way may be via the integration of contraceptive services into drug health clinics. In this way, women may be enabled to more easily address their various needs in an environment that is both more familiar and less threatening. Similarly, integrated services may be more successful if they can provide low-threshold service access, ie, services with few or no barriers to access.<ref>Islam MM, Topp L, Conigrave KM, Day CA. Defining a service for people who use drugs as ‘low-threshold’: what should be the criteria? Int J Drug Policy. 2013;24(3):220–2.</ref><ref>Islam MM, Topp L, Conigrave KM, Day CA. Opioid substitution therapy clients’ preferences for targeted versus general primary health-care outlets. Drug Alcohol Rev. 2013;32:211–3.</ref> An analysis of a publicly funded family planning program calculated that LARC methods save US$7 in costs from unintended pregnancy for every US$1 spent. Thus, improving access to LARC methods is likely to be cost-effective.<ref>Foster D, Rostovtseva D, Brindis C, Biggs MA, Hulett D, Darney PD. Cost savings from the provision of specific methods of contraception in a publicly funded program. Am J Public Health. 2009;99:446–51.</ref>

=== Incentives for LARC use ===

Project Prevention relies on donations and pays women $300 to get on long term birth control<ref>https://www.heraldcourier.com/news/addicted_at_birth/project-prevention-program-aims-to-stop-nas-by-birth-control/article_3ebf4d37-5c7f-57b5-b297-47b1958127a5.html</ref>

=== Organizations Offering Free or Reduced LARC ===

The number of babies born with NAS has dropped nearly 90 percent in one year in counties that have the program. Tennessee Department of Health officials are sharing the project’s success. Some 41 local jails and methadone clinics now work with county health officials to make available free IUDs. The project is paid for by federal funds for incarcerated women who don't have private insurance or have lost TennCare, which automatically ends during incarceration. Officials stress that the choice to obtain long-acting and reversible contraceptives is up to each incarcerated woman.<ref>https://www.tennessean.com/story/news/2017/02/04/iuds-inmates-seen-tool-combat-opioid-crisis/97056396/</ref> The Access and Resources in Contraceptive Health (ARCH) Patient Assistance Program provides Bayer IUDs (Kyleena, Mirena, and Skyla) at no cost to women in the United States who do not have either private health insurance or Medicaid coverage for Bayer IUDs and who meet all other program eligibility requirements. Please note that while Bayer provides Bayer IUDs at no cost to patients, patients may incur other costs such as insertion and removal costs. Please speak with your insurance company or your healthcare provider for more information.<ref>http://www.archpatientassistance.com/</ref> "A Step Ahead" In East Tennessee - With an appointment for free birth control (LARC), will provide a free "Well Woman's" visit, including a pregnancy test and STI test. If you are over 21 and your medical provider deems it medically necessary, you may also receive a free PAP test. They also provide transportation.<ref>http://www.astepaheadeasttn.org/faq.html</ref>

 

== Offer Contraception at Pain Management/Addiction/Methadone/Suboxone clinics ==

The feasibility of delivery of family planning services at addiction treatment clinics is being actively explored, as seen from a study completed in West North Carolina.<ref>https://sys.mahec.net/media/onlinejournal/Contraceptive%20Choices.pdf</ref>

Offer contraception planning in non-traditional venues, such as a pediatric clinic within a drug treatment facility. <ref>https://doi.org/10.1080/15332985.2011.575723</ref> A barrier is staff education and comfort discussing the issue. Education and availability of appropriate staff would be paramount.

Contraceptive counseling and access to contraceptive services should be a routine part of substance use disorder treatment among women of reproductive age to mitigate the risk of unplanned pregnancy.<ref>https://www.regulations.gov/document?D=SAMHSA-2016-0002-0001</ref>

 

= Relevant Research =

== Research on Birth Control Options ==

See this article on [https://www.bedsider.org/features/224-gold-standard-birth-control-the-iud-and-the-implant preferences and effectiveness of different birth control options]. 

 

== LARCs ==

Increasing access to Long Acting Reversible Contraceptives (LARCs) could be a key part of a strategy. Since 2007, researchers have seen a sharp rise in LARCs, such as intrauterine devices and implants. These forms of birth control last for years once inserted and prevent pregnancy for more than 99 percent of users. That helps explain why they're a big part of the story behind America's plummeting unintended pregnancy rate. <ref>https://www.vox.com/2016/3/2/11148108/unplanned-pregnancy-larc-iud</ref> One of the biggest obstacles to LARC use, historically, has been price. Planned Parenthood has estimated that IUDs can cost between $500 and $900 out of pocket. Insurance plans tended to charge patients more for IUDs than for birth control pills, just because the devices have such high upfront costs.<ref>https://www.vox.com/2016/3/2/11148108/unplanned-pregnancy-larc-iud</ref>  [http://www.latimes.com/health/la-he-0528-birth-control-20160515-snap-story.html This article] makes some interesting points and has information on the relative effectiveness of different types of contraceptives.  

 

== Hormone-releasing Implants ==

[https://www.nexplanon.com NEXPLANON] is a hormone-releasing birth control implant for use by women to prevent pregnancy for up to 3 years.  

== Non-Hormone IUDs ==

[http://www.paragard.com Paragard] is an IUD that can prevent pregnancy for up to 10 years. Paragard is a hormone-free IUD. It may be 100% covered by insurance. See [http://Paragardbvsp.com Paragardbvsp.com] to learn if benefits cover Paraguard. 

== Overcoming Cost Barriers to Access ==

Healthcare providers or clinics can join a Group Purchasing Organization (GPO) to get lower costs on birth control Afaxys is a pharma company that produces birth control pills, but they also have a Group Purchasing Organization that provides discount pricing on Bayer IUDs.

== Other Barriers to Access ==

Approximately 1 in 7 ob/gyns believe pelvic inflammatory disease is a significant risk of IUD use, despite substantial research to the contrary.<ref>Luchowski, A.T., et al. (2014). Obstetrician-Gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations. Contraception 89.</ref>

 

== Contraceptive Counseling ==

EmpowerHealth USA provides a telehealth option for contraception counseling.<ref>https://www.venturenashville.com/empower-health-sets-12m-raise-for-push-into-self-pay-nad-infusion-space-cms-1917</ref>

== Statistics ==

*A study of 946 women who were using opioids who gave birth revealed that 86% reported that the pregnancy was unintended.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052960/</ref>

== Potential Barriers ==

"For example, the ACOG supports placement of LARC devices during the immediate postpartum period to improve the use of LARC among postpartum women;  however, bundled payments for delivery create a relative financial disincentive to place LARC devices at the time of delivery.<ref>https://pediatrics.aappublications.org/content/139/3/e20164070</ref> State Medicaid programs play a critical role in ensuring access to highly effective contraception at the time when it is desired, including the time of delivery. However, recent research suggests that states are variable in aligning financial incentives to ensure access to LARC methods if elected at the time of delivery." <ref>Pace, L.E., Dusetzina, S.B., Fendrick, A.M., Keating, N.L., and Dalton, V.K. The impact of out-of-pocket costs on the use of intrauterine contraception among women with employer-sponsored insurance. Medical Care. 2013; 51: 959–963</ref> Patient contraceptive selection is sensitive to copayment. A 2010 analysis confirmed that employer-based plans display significant variation in copayments by contraceptive method, with LARC methods being the most expensive in terms of upfront costs to patients.<ref>Dusetzina, S.B., Dalton, V.K., Chernew, M.E., Pace, L.E., Bowden, G., and Fendrick, A.M. Cost of contraceptive methods to privately insured women in the United States. Women's Health Issues. 2013; 23: e69–71</ref> The Medicaid program has always required that family planning services be fully covered for patients without cost sharing.<ref>National Women's Law Center. (2015). Fact sheet: Contraceptive coverage in the health care law: Frequently asked questions. Accessed August 24, 2015.</ref> The Patient Protection and Affordable Care Act (ACA) similarly required new private health plans to provide no-cost coverage for all FDA-approved contraceptives.<ref>https://www.patientassistance.bayer.us/</ref>

= Impactful Federal, State, and Local Policies =

Virginia law allows women a full year of birth control covered by insurance vs. the previous 3 month supply

= Available Tools and Resources =

SAFE Solutions is an ever-growing platform. Currently limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

= Promising Practices =

== NAS Primary Prevention Initiative ==

[https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjCts7gtNDzAhWsl3IEHY0_Bx8QFnoECAkQAQ&url=https://www.tn.gov/content/dam/tn/health/documents/Bright_Spot_East_Region_NAS_Reduction_Effort_10-6-14_mbb_10-10-14.docx&usg=AOvVaw38qzEf-QI-U4gTE-ix_-Wj East Tennessee Primary Prevention Initiative] - Tennessee Department of Health Contact: Erica Wilson, MPH, Community Services Director,  [mailto:erica.wilson@tn.gov erica.wilson@tn.gov]

'''Overview of program''' 

*Partnership with local jails
*Health education sessions
**focus on NAS prevention
**information on effective contraceptives and LARCs
*Partnerships with jails to refer inmates to local health department for family planning
*Among 442 referrals (2014-15), 94% received a contraceptive method, 84% chose a voluntary LARC

''Resources'':

*PowerPoint presentation - to educate community partners [contacted for resource]
*Pamphlet - to educate community partners [contacted for resource]
*Presentation - conducted to inmates on NAS and how it can be prevented [contacted for resource]

 

== emPOWERhealthUSA ==

emPOWERhealthUSA has a program that provides telehealth coaching on birth control (among other things) to help more women get LARCs or make other informed decisions on birth control, with a focus on women who are using opioids.<ref>https://www.venturenashville.com/empower-health-sets-12m-raise-for-push-into-self-pay-nad-infusion-space-cms-1917</ref>

== Access and Resources in Contraceptive Health (ARCH) Patient Assistance Program ==

This patient assistance program provides Bayer IUDs (intrauterine devices), Kyleena, Mirena, and Skyla, at no cost to eligible women.<ref>https://www.patientassistance.bayer.us/</ref> Eligible women include those who do not have either private health insurance or Medicaid coverage for Bayer IUDs and who meet all other program eligibility requirements. Kyleena and Mirena can help prevent pregnancy for up to 5 years and Skyla up to 3 years.<ref>https://www.patientassistance.bayer.us/</ref>

 

= Sources =

----

 

[[Category:SAFE-Prescriptions and Medical Response]]

Create Recovery-Ready Communities

2021-10-31T04:15:01Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Substance Use Disorders (SUDs) continue to be a leading cause of death, a leading correlate in violent crime, and a leading cause of lost productivity in the workplace. 

Recovery happens in communities, and community-based resources have been shown to positively affect SUD impact and SUD recovery. By educating communities and creating continuity among support services, community-based services, and new innovations, such as recovery community organizations and other recovery support services, recovery efforts and improved sustained recovery has improved for individuals that live within the community.<ref>https://www.tandfonline.com/doi/abs/10.1080/16066359.2019.1571191?journalCode=iart20</ref>

Recovery is not just a matter of individual treatment or individual approaches combined with peer group support. The whole community plays a role in supporting successful recovery. A community response to SUDs can provide social and economic support and have a health impact at a community level.  

Recovery-Oriented Systems of Care (ROSC) provide coordinated community-based services that are person-centered and build strength and resilience of individuals, families, and communities. 

Community Recovery is a voluntary process through which a community uses the assertive resolution of alcohol and other drug-related problems as a vehicle for collective healing, community renewal, and enhanced intergenerational resilience. <ref>https://peerrecoverynow.org/pdf/ppt_slides/CreatingRecovery-ReadyCommunityFINAL.pdf</ref>

 

= Key Information =

Recovery-ready communities include internal and external resources that support and sustain recovery from SUD.  Recovery capital is becoming a term identified and linked to recovery-ready communities. Faces & Voices of Recovery <ref>https://facesandvoicesofrecovery.org/blog/2019/10/08/recovery-capital-its-role-in-sustaining-recovery/</ref> provides a breakdown of recovery capital and the roles of sustaining recovery.  

1. '''Personal recovery capital. '''This includes an individual’s physical and human capital. Physical capital is the available resources to fulfill a person’s basic needs, like their health, healthcare, financial resources, clothing, food, safe and habitable shelter, and transportation. Human capital relates to a person’s abilities, skills, and knowledge, like problem-solving, education and credentials, self-esteem, the ability to navigate challenging situations and achieve goals, interpersonal skills, and a sense of meaning and purpose in life. 

2. '''Family/social recovery capital. '''These resources relate to intimate relationships with friends and family, relationships with people in recovery, and supportive partners. It also includes the availability of recovery-related social events

3'''. Community recovery capital. '''This includes attitudes, policies, and resources specifically related to helping individuals resolve substance use disorders. Community resources are vast.

They can include:

*Recovery activism and advocacy aimed at reducing stigma
*A full range of addiction treatment resources
*Peer-led support, such as mutual-aid meetings, that seek to meet the diverse needs of the community
*Recovery Community Organizations
*Recovery support institutions, educational-based recovery support such as recovery high schools, colleges, recovery housing, and recovery ministries and churches
*Visible and diverse local recovery role models
*Resources to sustain recovery and early intervention programs, like employee assistance programs, and drug courts
*Cultural capital. These resources resonate with individuals cultural and faith-based beliefs

Recovery-ready communities also encompass individual, community, institutional and policy level Involvement and collaboration.  A community that is recovery ready provides a continuum of care and support to those in recovery or seeking recovery support. 

Key components of a recovery-ready community are adequate detox and treatment facilities, the ability to address all pathways to recovery, harm reduction, youth recovery, recovery housing, prevention, recovery community organizations, and family support. Criminal justice involvement (police, court systems) and special interest populations (faith-based, LGBTQ). 

''' Examples of Recovery Support Services:'''

'''Alternative Peer Groups''': is a comprehensive adolescent recovery support model that integrates recovering peers and prosocial activities into evidence-based clinical practice.  These are community-based peer support programs that act as a liaison between residential treatment programs and mental health professionals. The purpose is positive peer support to maintain sobriety. <ref>http://www.aapg-recovery.com/</ref>

'''Collegiate Recovery Support:'''  Provides a supportive environment on campus to reduce the addiction cycle. Includes educational resources and recovery support. <ref>https://collegiaterecovery.org/</ref>

'''Jail & Prison-based Recovery Support: '''Support programs and resources to assist incarcerated individuals or those involved in the criminal justice system. 

'''Peer Recovery Coaching: '''Non-clinical peer recovery coaches who appropriately bring their own experience to the table while helping others on their recovery journey.

'''Medication-Assisted Recovery:''' Recovery Support Programs that include medication-assisted treatment (MAT). 

'''Recovery Community Centers: '''A recovery-oriented hub in the community. Offers recovery and family support services. Peer operated and may include coaching, education, peer-support, medication-assisted treatment, employment resources, etc. 

'''Recovery High Schools: '''Focus on academics and recovery. Positive peer pressure. <ref>https://recoveryschools.org/</ref>

'''Recovery Housing: '''Substance-free living environments that support individuals in recovery from addiction. 

'''Community Task Force'''

Addiction is an ongoing epidemic, and recovery-ready communities and community collaboration are key to providing community-based solutions. 

CORE Task Force missions: prevention, early intervention, harm reduction, treatment, and recovery support services.<ref>https://cabhp.asu.edu/sites/default/files/session_14-_community_advocacy-_using_coordinated_response_to_create_recovery_ready_communities_-_angie_green_mariah_hile.pdf</ref>   

'''Advocacy'''

SAMHSA provides 10 concrete steps leaders can take for recovery-ready communities. <ref>https://peerrecoverynow.org/pdf/ppt_slides/CreatingRecovery-ReadyCommunityFINAL.pdf#:~:text=Recovery%20Ready%20Communities%20Community%20Recovery%20is%20a%20voluntary,collective%20healing%2C%20community%20renewal%2C%20and%20enhanced%20intergenerational%20resilience.</ref>

#Bring people in recovery to the table early and often to create a shared vision of recovery.
#Identify leaders in the recovery community
#Identify recovery champions to support the effort and to be ambassadors for the cause.
#Launch community visioning. 
#Assess community strengths. Where is recovery thriving?
#Conduct a community recovery capital assessment to identify areas where recovery support and recovery-friendly policies are most prevalent. 
#Get creative and innovative.
#Encourage friends, family, and colleagues to share their personal stories. 
#Create recovery community centers that make recovery visible on Main Street. 
#Celebrate recovery from addiction!

= Relevant Research =

SAFE Solutions is an ever-growing platform.  Currently no information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.

= Impactful Federal, State, and Local Policies =

A 2010 report prepared for the Partners for Recovery initiative provides information regarding the funding sources that support Recovery Support Services throughout the continuum of care. The report includes Federal, state, and private funding overview and highlights practices for obtaining funding.  Funding sources continue to be limited.<ref>https://facesandvoicesofrecovery.org/wp-content/uploads/2019/06/Financing-Recovery-Support-Services.pdf</ref>

 

= Available Tools and Resources =

'''Recovery Oriented Systems of Care (ROSC)'''

One approach advocated by SAMHSA and others is the Recovery Oriented Systems of Care.

  According to Ijeoma Achara, CEO of Achara Consulting, a ROSC is NOT:

⦁ A Model

⦁ Primarily focused on the integration of recovery support services

⦁ Dependent on new dollars for development

⦁ A new initiative

⦁ A group of providers that increase their collaboration to improve coordination

⦁ An infusion of evidence-based practices

⦁ An organizational entity, group of people, or committee

⦁ A closed network of services and supports

 

Dr. Achara continues to explain that a ROSC is:

⦁ Value-driven APPRROACH to structuring behavioral health systems and a network of clinical and non-clinical services and supports

⦁ Framework to guide systems transformation

 

SAMHSA produced a guidebook on Recovery Oriented Systems of Care <ref>1. https://www.samhsa.gov/sites/default/files/rosc_resource_guide_book.pdf</ref> in 2010, but there have been improvements to that general approach in recent years.

A ROSC is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resiliencies of individuals, families, and communities to achieve abstinence and improved health, wellness, and quality of life for those with or at risk of alcohol and drug problems. Visit Recovery-Oriented Systems of Care (ROSC) to learn more.

'''Café Model'''

The Recovery Cafe Model allows those in recovery to have a safe place that "meets people where they are on the recovery continuum, engages them for a lifetime of managing their disease, focuses holistically on a person’s needs, and empowers them to build a life that realizes their full potential." <ref>1. https://recoverycafenetwork.org/</ref>  The organization is committed to successfully replicating the model in additional communities. Click here to bring a Recovery Cafe to your community.

'''SAFE Project Community Playbook'''-The Community Playbook serves as a blueprint framework for rural, suburban, and urban communities navigating an effective, collaborative response using a six-step approach.

'''Community Listening Forum Toolkit'''- Provides guidance to taking action with building a recovery-ready community.  <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/FaceVoicRec_communityToolkit.pdf</ref>

'''Recovery-Ready communities'''- A guide to recovery support services. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/FaceVoicRec_creatingrecoveryreadycommunities.pdf</ref>

= Promising Practices =

No single program or innovation makes a community the ideal place to support recovery, but communities can add things and then integrate them with treatment and recovery services to create a community that provides more support and better options for people in recovery.  

  '''Men's Sheds''' This concept originated in Australia in the late 1990s, and there are now more than 1,000 Men's Sheds in Australia with thriving movements in a growing number of other countries. Available buildings (such as vacant warehouses, foreclosed houses that have been possessed by the city or county, or vacant space in a retail center) can be donated, rented, or purchased to create a space for men to gather ( it would not need to be limited to men, but that has been the roots). The space is then filled with tools, workbenches, and materials that can be used for the men to tinker, build, fix, and putter--all while building new social relationships. More information on Men's Sheds   '''Community Gardening''' Integrating participation with a community gardening program can bring many benefits to people in recovery. It provides positive social interaction, skill building, improved access to healthy foods, and more. Ideally, involvement with community gardening could be integrated with peer-to-peer recovery groups, recovery coaches, tools like rTribe or Triggr, or a comprehensive success plan managed in a community care coordination platform like XCare Community.  See more information on how gardening helps with recovery   '''Fitness & Recreation-based Recovery Programs''' Programs like Phoenix Multisport in Colorado (and other places) have demonstrated the power of having a recovery community that emphasizes active living and recreation.

'''Eugene Oregon'''- a case study on Recovery-ready ecosystems. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/08/Building-a-Recovery-Ready-Ecosystem-in-Oregon-Robert-Ashford1000.pdf</ref>

'''Operation New Hope-''' Operation New Hope is a model program that provides support, and life and job skills training for citizens returning to the community after incarceration in the state of Florida.<ref>https://operationnewhope.org/</ref>

= Sources =

Create Recovery-Ready Communities

2021-10-31T04:13:15Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Substance Use Disorders (SUDs) continue to be a leading cause of death, a leading correlate in violent crime, and a leading cause of lost productivity in the workplace. 

Recovery happens in communities, and community-based resources have been shown to positively affect SUD impact and SUD recovery. By educating communities and creating continuity among support services, community-based services, and new innovations, such as recovery community organizations and other recovery support services, recovery efforts and improved sustained recovery has improved for individuals that live within the community.<ref>https://www.tandfonline.com/doi/abs/10.1080/16066359.2019.1571191?journalCode=iart20</ref>

Recovery is not just a matter of individual treatment or individual approaches combined with peer group support. The whole community plays a role in supporting successful recovery. A community response to SUDs can provide social and economic support and have a health impact at a community level.  

Recovery-Oriented Systems of Care (ROSC) provide coordinated community-based services that are person-centered and build strength and resilience of individuals, families, and communities. 

Community Recovery is a voluntary process through which a community uses the assertive resolution of alcohol and other drug-related problems as a vehicle for collective healing, community renewal, and enhanced intergenerational resilience. <ref>https://peerrecoverynow.org/pdf/ppt_slides/CreatingRecovery-ReadyCommunityFINAL.pdf</ref>

 

= Key Information =

Recovery-ready communities include internal and external resources that support and sustain recovery from SUD.  Recovery capital is becoming a term identified and linked to recovery-ready communities. Faces & Voices of Recovery <ref>https://facesandvoicesofrecovery.org/blog/2019/10/08/recovery-capital-its-role-in-sustaining-recovery/</ref> provides a breakdown of recovery capital and the roles of sustaining recovery.  

1. '''Personal recovery capital. '''This includes an individual’s physical and human capital. Physical capital is the available resources to fulfill a person’s basic needs, like their health, healthcare, financial resources, clothing, food, safe and habitable shelter, and transportation. Human capital relates to a person’s abilities, skills, and knowledge, like problem-solving, education and credentials, self-esteem, the ability to navigate challenging situations and achieve goals, interpersonal skills, and a sense of meaning and purpose in life. 

2. '''Family/social recovery capital. '''These resources relate to intimate relationships with friends and family, relationships with people in recovery, and supportive partners. It also includes the availability of recovery-related social events

3'''. Community recovery capital. '''This includes attitudes, policies, and resources specifically related to helping individuals resolve substance use disorders. Community resources are vast.

They can include:

*Recovery activism and advocacy aimed at reducing stigma
*A full range of addiction treatment resources
*Peer-led support, such as mutual-aid meetings, that seek to meet the diverse needs of the community
*Recovery Community Organizations
*Recovery support institutions, educational-based recovery support such as recovery high schools, colleges, recovery housing, and recovery ministries and churches
*Visible and diverse local recovery role models
*Resources to sustain recovery and early intervention programs, like employee assistance programs, and drug courts
*Cultural capital. These resources resonate with individuals cultural and faith-based beliefs

Recovery-ready communities also encompass individual, community, institutional and policy level Involvement and collaboration.  A community that is recovery ready provides a continuum of care and support to those in recovery or seeking recovery support. 

Key components of a recovery-ready community are adequate detox and treatment facilities, the ability to address all pathways to recovery, harm reduction, youth recovery, recovery housing, prevention, recovery community organizations, and family support. Criminal justice involvement (police, court systems) and special interest populations (faith-based, LGBTQ). 

''' Examples of Recovery Support Services:'''

'''Alternative Peer Groups''': is a comprehensive adolescent recovery support model that integrates recovering peers and prosocial activities into evidence-based clinical practice.  These are community-based peer support programs that act as a liaison between residential treatment programs and mental health professionals. The purpose is positive peer support to maintain sobriety. <ref>http://www.aapg-recovery.com/</ref>

'''Collegiate Recovery Support:'''  Provides a supportive environment on campus to reduce the addiction cycle. Includes educational resources and recovery support. <ref>https://collegiaterecovery.org/</ref>

'''Jail & Prison-based Recovery Support: '''Support programs and resources to assist incarcerated individuals or those involved in the criminal justice system. 

'''Peer Recovery Coaching: '''Non-clinical peer recovery coaches who appropriately bring their own experience to the table while helping others on their recovery journey.

'''Medication-Assisted Recovery:''' Recovery Support Programs that include medication-assisted treatment (MAT). 

'''Recovery Community Centers: '''A recovery-oriented hub in the community. Offers recovery and family support services. Peer operated and may include coaching, education, peer-support, medication-assisted treatment, employment resources, etc. 

'''Recovery High Schools: '''Focus on academics and recovery. Positive peer pressure. <ref>https://recoveryschools.org/</ref>

'''Recovery Housing: '''Substance-free living environments that support individuals in recovery from addiction. 

'''Community Task Force'''

Addiction is an ongoing epidemic, and recovery-ready communities and community collaboration are key to providing community-based solutions. 

CORE Task Force missions: prevention, early intervention, harm reduction, treatment, and recovery support services.<ref>https://cabhp.asu.edu/sites/default/files/session_14-_community_advocacy-_using_coordinated_response_to_create_recovery_ready_communities_-_angie_green_mariah_hile.pdf</ref>   

'''Advocacy'''

SAMHSA provides 10 concrete steps leaders can take for recovery-ready communities. <ref>https://peerrecoverynow.org/pdf/ppt_slides/CreatingRecovery-ReadyCommunityFINAL.pdf#:~:text=Recovery%20Ready%20Communities%20Community%20Recovery%20is%20a%20voluntary,collective%20healing%2C%20community%20renewal%2C%20and%20enhanced%20intergenerational%20resilience.</ref>

#Bring people in recovery to the table early and often to create a shared vision of recovery.
#Identify leaders in the recovery community
#Identify recovery champions to support the effort and to be ambassadors for the cause.
#Launch community visioning. 
#Assess community strengths. Where is recovery thriving?
#Conduct a community recovery capital assessment to identify areas where recovery support and recovery-friendly policies are most prevalent. 
#Get creative and innovative.
#Encourage friends, family, and colleagues to share their personal stories. 
#Create recovery community centers that make recovery visible on Main Street. 
#Celebrate recovery from addiction!

= Relevant Research =

SAFE Solutions is an ever-growing platform.  Currently no information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.

= Impactful Federal, State, and Local Policies =

A 2010 report prepared for the Partners for Recovery initiative provides information regarding the funding sources that support Recovery Support Services throughout the continuum of care. The report includes Federal, state, and private funding overview and highlights practices for obtaining funding.  Funding sources continue to be limited.<ref>https://facesandvoicesofrecovery.org/wp-content/uploads/2019/06/Financing-Recovery-Support-Services.pdf</ref>

 

= Available Tools and Resources =

'''Recovery Oriented Systems of Care (ROSC)'''

One approach advocated by SAMHSA and others is the Recovery Oriented Systems of Care.

  According to Ijeoma Achara, CEO of Achara Consulting, a ROSC is NOT:

⦁ A Model

⦁ Primarily focused on the integration of recovery support services

⦁ Dependent on new dollars for development

⦁ A new initiative

⦁ A group of providers that increase their collaboration to improve coordination

⦁ An infusion of evidence-based practices

⦁ An organizational entity, group of people, or committee

⦁ A closed network of services and supports

 

Dr. Achara continues to explain that a ROSC is:

⦁ Value-driven APPRROACH to structuring behavioral health systems and a network of clinical and non-clinical services and supports

⦁ Framework to guide systems transformation

 

SAMHSA produced a guidebook on Recovery Oriented Systems of Care <ref>1. https://www.samhsa.gov/sites/default/files/rosc_resource_guide_book.pdf</ref> in 2010, but there have been improvements to that general approach in recent years.

A ROSC is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resiliencies of individuals, families, and communities to achieve abstinence and improved health, wellness, and quality of life for those with or at risk of alcohol and drug problems. Visit Recovery-Oriented Systems of Care (ROSC) to learn more.

'''Café Model'''

The Recovery Cafe Model allows those in recovery to have a safe place that "meets people where they are on the recovery continuum, engages them for a lifetime of managing their disease, focuses holistically on a person’s needs, and empowers them to build a life that realizes their full potential." <ref>1. https://recoverycafenetwork.org/</ref>  The organization is committed to successfully replicating the model in additional communities. Click here to bring a Recovery Cafe to your community.

'''SAFE Project Community Playbook'''-The Community Playbook serves as a blueprint framework for rural, suburban, and urban communities navigating an effective, collaborative response using a six-step approach.

'''Community Listening Forum Toolkit'''- Provides guidance to taking action with building a recovery-ready community.  <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/FaceVoicRec_communityToolkit.pdf</ref>

'''Recovery-Ready communities'''- A guide to recovery support services. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/FaceVoicRec_creatingrecoveryreadycommunities.pdf</ref>

= Promising Practices =

No single program or innovation makes a community the ideal place to support recovery, but communities can add things and then integrate them with treatment and recovery services to create a community that provides more support and better options for people in recovery.  

  '''Men's Sheds''' This concept originated in Australia in the late 1990s, and there are now more than 1,000 Men's Sheds in Australia with thriving movements in a growing number of other countries. Available buildings (such as vacant warehouses, foreclosed houses that have been possessed by the city or county, or vacant space in a retail center) can be donated, rented or purchased to create a space for men to gather (and it would not need to be limited to men, but that has been the roots). The space is then filled with tools, workbenches, and materials that can be used for the men to tinker, build, fix, and putter--all while building new social relationship. More information on Men's Sheds   '''Community Gardening''' Integrating participation in with a community gardening program can bring many benefits to people in recovery. It provides positive social interaction, skill building, improve access to healthy foods and more. Ideally, involvement with community gardening could be integrated with peer-to-peer recovery groups, recovery coaches, tools like rTribe or Triggr, or a comprehensive success plan managed in a community care coordination platform like XCare Community.  See more information on how gardening helps with recovery   '''Fitness & Recreation-based Recovery Programs''' Programs like Phoenix Multisport in Colorado (and other places) have demonstrated the power of having a recovery community that emphasizes active living and recreation.

'''Eugene Oregon'''- a case study on Recovery-ready ecosystems. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/08/Building-a-Recovery-Ready-Ecosystem-in-Oregon-Robert-Ashford1000.pdf</ref>

'''Operation New Hope-''' Operation New Hope is a model program that provides support, life and job skills training for citizens returning to the community after incarceration in the state of Florida.<ref>https://operationnewhope.org/</ref>

= Sources =

Create Recovery-Ready Communities

2021-10-31T04:12:20Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Substance Use Disorders (SUDs) continue to be a leading cause of death, a leading correlate in violent crime, and a leading cause of lost productivity in the workplace. 

Recovery happens in communities, and community-based resources have been shown to positively affect SUD impact and SUD recovery. By educating communities and creating continuity among support services, community-based services, and new innovations, such as recovery community organizations and other recovery support services, recovery efforts and improved sustained recovery has improved for individuals that live within the community.<ref>https://www.tandfonline.com/doi/abs/10.1080/16066359.2019.1571191?journalCode=iart20</ref>

Recovery is not just a matter of individual treatment or individual approaches combined with peer group support. The whole community plays a role in supporting successful recovery. A community response to SUDs can provide social and economic support and have a health impact at a community level.  

Recovery-Oriented Systems of Care (ROSC) provide coordinated community-based services that are person-centered and build strength and resilience of individuals, families, and communities. 

Community Recovery is a voluntary process through which a community uses the assertive resolution of alcohol and other drug-related problems as a vehicle for collective healing, community renewal, and enhanced intergenerational resilience. <ref>https://peerrecoverynow.org/pdf/ppt_slides/CreatingRecovery-ReadyCommunityFINAL.pdf</ref>

 

= Key Information =

Recovery-ready communities include internal and external resources that support and sustain recovery from SUD.  Recovery capital is becoming a term identified and linked to recovery-ready communities. Faces & Voices of Recovery <ref>https://facesandvoicesofrecovery.org/blog/2019/10/08/recovery-capital-its-role-in-sustaining-recovery/</ref> provides a breakdown of recovery capital and the roles of sustaining recovery.  

1. '''Personal recovery capital. '''This includes an individual’s physical and human capital. Physical capital is the available resources to fulfill a person’s basic needs, like their health, healthcare, financial resources, clothing, food, safe and habitable shelter, and transportation. Human capital relates to a person’s abilities, skills, and knowledge, like problem-solving, education and credentials, self-esteem, the ability to navigate challenging situations and achieve goals, interpersonal skills, and a sense of meaning and purpose in life. 

2. '''Family/social recovery capital. '''These resources relate to intimate relationships with friends and family, relationships with people in recovery, and supportive partners. It also includes the availability of recovery-related social events

3'''. Community recovery capital. '''This includes attitudes, policies, and resources specifically related to helping individuals resolve substance use disorders. Community resources are vast.

They can include:

*Recovery activism and advocacy aimed at reducing stigma
*A full range of addiction treatment resources
*Peer-led support, such as mutual-aid meetings, that seek to meet the diverse needs of the community
*Recovery Community Organizations
*Recovery support institutions, educational-based recovery support such as recovery high schools, colleges, recovery housing, and recovery ministries and churches
*Visible and diverse local recovery role models
*Resources to sustain recovery and early intervention programs, like employee assistance programs, and drug courts
*Cultural capital. These resources resonate with individuals cultural and faith-based beliefs

Recovery-ready communities also encompass individual, community, institutional and policy level Involvement and collaboration.  A community that is recovery ready provides a continuum of care and support to those in recovery or seeking recovery support. 

Key components of a recovery-ready community are adequate detox and treatment facilities, the ability to address all pathways to recovery, harm reduction, youth recovery, recovery housing, prevention, recovery community organizations, and family support. Criminal justice involvement (police, court systems) and special interest populations (faith-based, LGBTQ). 

''' Examples of Recovery Support Services:'''

'''Alternative Peer Groups''': is a comprehensive adolescent recovery support model that integrates recovering peers and prosocial activities into evidence-based clinical practice.  These are community-based peer support programs that act as a liaison between residential treatment programs and mental health professionals. The purpose is positive peer support to maintain sobriety. <ref>http://www.aapg-recovery.com/</ref>

'''Collegiate Recovery Support:'''  Provides a supportive environment on campus to reduce the addiction cycle. Includes educational resources and recovery support. <ref>https://collegiaterecovery.org/</ref>

'''Jail & Prison-based Recovery Support: '''Support programs and resources to assist incarcerated individuals or those involved in the criminal justice system. 

'''Peer Recovery Coaching: '''Non-clinical peer recovery coaches who appropriately bring their own experience to the table while helping others on their recovery journey.

'''Medication-Assisted Recovery:''' Recovery Support Programs that include medication-assisted treatment (MAT). 

'''Recovery Community Centers: '''A recovery-oriented hub in the community. Offers recovery and family support services. Peer operated and may include coaching, education, peer-support, medication-assisted treatment, employment resources, etc. 

'''Recovery High Schools: '''Focus on academics and recovery. Positive peer pressure. <ref>https://recoveryschools.org/</ref>

'''Recovery Housing: '''Substance-free living environments that support individuals in recovery from addiction. 

'''Community Task Force'''

Addiction is an ongoing epidemic, and recovery-ready communities and community collaboration are key to providing community-based solutions. 

CORE Task Force missions: prevention, early intervention, harm reduction, treatment, and recovery support services.<ref>https://cabhp.asu.edu/sites/default/files/session_14-_community_advocacy-_using_coordinated_response_to_create_recovery_ready_communities_-_angie_green_mariah_hile.pdf</ref>   

'''Advocacy'''

SAMHSA provides 10 concrete steps leaders can take for recovery-ready communities. <ref>https://peerrecoverynow.org/pdf/ppt_slides/CreatingRecovery-ReadyCommunityFINAL.pdf#:~:text=Recovery%20Ready%20Communities%20Community%20Recovery%20is%20a%20voluntary,collective%20healing%2C%20community%20renewal%2C%20and%20enhanced%20intergenerational%20resilience.</ref>

#Bring people in recovery to the table early and often to create a shared vision of recovery.
#Identify leaders in the recovery community
#Identify recovery champions to support the effort and to be ambassadors for the cause.
#Launch community visioning. 
#Assess community strengths. Where is recovery thriving?
#Conduct a community recovery capital assessment to identify areas where recovery support and recovery-friendly policies are most prevalent. 
#Get creative and innovative.
#Encourage friends, family, and colleagues to share their personal stories. 
#Create recovery community centers that make recovery visible on Main Street. 
#Celebrate recovery from addiction!

= Relevant Research =

SAFE Solutions is an ever-growing platform.  Currently no information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.

= Impactful Federal, State, and Local Policies =

A 2010 report prepared for the Partners for Recovery initiative provides information regarding the funding sources that support Recovery Support Services throughout the continuum of care. The report includes Federal, state, and private funding overview and highlights practices for obtaining funding.  Funding sources continue to be limited.<ref>https://facesandvoicesofrecovery.org/wp-content/uploads/2019/06/Financing-Recovery-Support-Services.pdf</ref>

 

= Available Tools and Resources =

'''Recovery Oriented Systems of Care (ROSC)'''

One approach advocated by SAMHSA and others is the Recovery Oriented Systems of Care.

  According to Ijeoma Achara, CEO of Achara Consulting, an ROSC is NOT:

⦁ A Model

⦁ Primarily focused on the integration of recovery support services

⦁ Dependent on new dollars for development

⦁ A new initiative

⦁ A group of providers that increase their collaboration to improve coordination

⦁ An infusion of evidence-based practices

⦁ An organizational entity, group of people or committee

⦁ A closed network of services and supports

 

Dr. Achara continues to explain that a ROSC is:

⦁ Value-driven APRROACH to structuring behavioral health systems and a network of clinical and non-clinical services and supports

⦁ Framework to guide systems transformation

 

SAMHSA produced a guide book on Recovery Oriented Systems of Care <ref>1. https://www.samhsa.gov/sites/default/files/rosc_resource_guide_book.pdf</ref> in 2010, but there have been improvements to that general approach in recent years.

A ROSC is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resiliencies of individuals, families, and communities to achieve abstinence and improved health, wellness, and quality of life for those with or at risk of alcohol and drug problems. Visit Recovery-Oriented Systems of Care (ROSC) to learn more.

'''Café Model'''

The Recovery Cafe Model allows those in recovery to have a safe place that "meets people where they are on the recovery continuum, engages them for a lifetime of managing their disease, focuses holistically on a person’s needs, and empowers them to build a life that realizes their full potential." <ref>1. https://recoverycafenetwork.org/</ref>  The organization is committed to successfully replicating the model in additional communities. Click here to bring a Recovery Cafe to your community.

'''SAFE Project Community Playbook'''-The Community Playbook serves as a blueprint framework for rural, suburban, and urban communities navigating an effective, collaborative response using a six-step approach.

'''Community Listening Forum Toolkit'''- Provides guidance to taking action with building a recovery-ready community.  <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/FaceVoicRec_communityToolkit.pdf</ref>

'''Recovery-Ready communities'''- A guide to recovery support services. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/FaceVoicRec_creatingrecoveryreadycommunities.pdf</ref>

= Promising Practices =

No single program or innovation makes a community the ideal place to support recovery, but communities can add things and then integrate them with treatment and recovery services to create a community that provides more support and better options for people in recovery.  

  '''Men's Sheds''' This concept originated in Australia in the late 1990s, and there are now more than 1,000 Men's Sheds in Australia with thriving movements in a growing number of other countries. Available buildings (such as vacant warehouses, foreclosed houses that have been possessed by the city or county, or vacant space in a retail center) can be donated, rented or purchased to create a space for men to gather (and it would not need to be limited to men, but that has been the roots). The space is then filled with tools, workbenches, and materials that can be used for the men to tinker, build, fix, and putter--all while building new social relationship. More information on Men's Sheds   '''Community Gardening''' Integrating participation in with a community gardening program can bring many benefits to people in recovery. It provides positive social interaction, skill building, improve access to healthy foods and more. Ideally, involvement with community gardening could be integrated with peer-to-peer recovery groups, recovery coaches, tools like rTribe or Triggr, or a comprehensive success plan managed in a community care coordination platform like XCare Community.  See more information on how gardening helps with recovery   '''Fitness & Recreation-based Recovery Programs''' Programs like Phoenix Multisport in Colorado (and other places) have demonstrated the power of having a recovery community that emphasizes active living and recreation.

'''Eugene Oregon'''- a case study on Recovery-ready ecosystems. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/08/Building-a-Recovery-Ready-Ecosystem-in-Oregon-Robert-Ashford1000.pdf</ref>

'''Operation New Hope-''' Operation New Hope is a model program that provides support, life and job skills training for citizens returning to the community after incarceration in the state of Florida.<ref>https://operationnewhope.org/</ref>

= Sources =

Create Recovery-Ready Communities

2021-10-31T04:11:58Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Substance Use Disorders (SUDs) continue to be a leading cause of death, a leading correlate in violent crime, and a leading cause of lost productivity in the workplace. 

Recovery happens in communities, and community-based resources have been shown to positively affect SUD impact and SUD recovery. By educating communities and creating continuity among support services, community-based services, and new innovations, such as recovery community organizations and other recovery support services, recovery efforts and improved sustained recovery has improved for individuals that live within the community.<ref>https://www.tandfonline.com/doi/abs/10.1080/16066359.2019.1571191?journalCode=iart20</ref>

Recovery is not just a matter of individual treatment or individual approaches combined with peer group support. The whole community plays a role in supporting successful recovery. A community response to SUDs can provide social and economic support and have a health impact at a community level.  

Recovery-Oriented Systems of Care (ROSC) provide coordinated community-based services that are person-centered and build strength and resilience of individuals, families, and communities. 

Community Recovery is a voluntary process through which a community uses the assertive resolution of alcohol and other drug-related problems as a vehicle for collective healing, community renewal, and enhanced intergenerational resilience. <ref>https://peerrecoverynow.org/pdf/ppt_slides/CreatingRecovery-ReadyCommunityFINAL.pdf</ref>

 

= Key Information =

Recovery-ready communities include internal and external resources that support and sustain recovery from SUD.  Recovery capital is becoming a term identified and linked to recovery-ready communities. Faces & Voices of Recovery <ref>https://facesandvoicesofrecovery.org/blog/2019/10/08/recovery-capital-its-role-in-sustaining-recovery/</ref> provides a breakdown of recovery capital and the roles of sustaining recovery.  

1. '''Personal recovery capital. '''This includes an individual’s physical and human capital. Physical capital is the available resources to fulfill a person’s basic needs, like their health, healthcare, financial resources, clothing, food, safe and habitable shelter, and transportation. Human capital relates to a person’s abilities, skills, and knowledge, like problem-solving, education and credentials, self-esteem, the ability to navigate challenging situations and achieve goals, interpersonal skills, and a sense of meaning and purpose in life. 

2. '''Family/social recovery capital. '''These resources relate to intimate relationships with friends and family, relationships with people in recovery, and supportive partners. It also includes the availability of recovery-related social events

3'''. Community recovery capital. '''This includes attitudes, policies, and resources specifically related to helping individuals resolve substance use disorders. Community resources are vast.

They can include:

*Recovery activism and advocacy aimed at reducing stigma
*A full range of addiction treatment resources
*Peer-led support, such as mutual-aid meetings, that seek to meet the diverse needs of the community
*Recovery Community Organizations
*Recovery support institutions, educational-based recovery support such as recovery high schools, colleges, recovery housing, and recovery ministries and churches
*Visible and diverse local recovery role models
*Resources to sustain recovery and early intervention programs, like employee assistance programs, and drug courts
*Cultural capital. These resources resonate with individuals cultural and faith-based beliefs

Recovery-ready communities also encompass individual, community, institutional and policy level Involvement and collaboration.  A community that is recovery ready provides a continuum of care and support to those in recovery or seeking recovery support. 

Key components of a recovery-ready community are adequate detox and treatment facilities, the ability to address all pathways to recovery, harm reduction, youth recovery, recovery housing, prevention, recovery community organizations, and family support. Criminal justice involvement (police, court systems) and special interest populations (faith-based, LGBTQ). 

''' Examples of Recovery Support Services:'''

'''Alternative Peer Groups''': is a comprehensive adolescent recovery support model that integrates recovering peers and prosocial activities into evidence-based clinical practice.  These are community-based peer support programs that act as a liaison between residential treatment programs and mental health professionals. The purpose is positive peer support to maintain sobriety. <ref>http://www.aapg-recovery.com/</ref>

'''Collegiate Recovery Support:'''  Provides a supportive environment on campus to reduce the addiction cycle. Includes educational resources and recovery support. <ref>https://collegiaterecovery.org/</ref>

'''Jail & Prison-based Recovery Support: '''Support programs and resources to assist incarcerated individuals or those involved in the criminal justice system. 

'''Peer Recovery Coaching: '''Non-clinical peer recovery coaches who appropriately bring their own experience to the table while helping others on their recovery journey.

'''Medication-Assisted Recovery:''' Recovery Support Programs that include medication-assisted treatment (MAT). 

'''Recovery Community Centers: '''A recovery-oriented hub in the community. Offers recovery and family support services. Peer operated and may include coaching, education, peer-support, medication-assisted treatment, employment resources, etc. 

'''Recovery High Schools: '''Focus on academics and recovery. Positive peer pressure. <ref>https://recoveryschools.org/</ref>

'''Recovery Housing: '''Substance-free living environments that support individuals in recovery from addiction. 

'''Community Task Force'''

Addiction is an ongoing epidemic, and recovery-ready communities and community collaboration are key to providing community-based solutions. 

CORE Task Force missions: prevention, early intervention, harm reduction, treatment, and recovery support services.<ref>https://cabhp.asu.edu/sites/default/files/session_14-_community_advocacy-_using_coordinated_response_to_create_recovery_ready_communities_-_angie_green_mariah_hile.pdf</ref>   

'''Advocacy'''

SAMHSA provides 10 concrete steps leaders can take for recovery-ready communities. <ref>https://peerrecoverynow.org/pdf/ppt_slides/CreatingRecovery-ReadyCommunityFINAL.pdf#:~:text=Recovery%20Ready%20Communities%20Community%20Recovery%20is%20a%20voluntary,collective%20healing%2C%20community%20renewal%2C%20and%20enhanced%20intergenerational%20resilience.</ref>

#Bring people in recovery to the table early and often to create a shared vision of recovery.
#Identify leaders in the recovery community
#Identify recovery champions to support the effort and to be ambassadors for the cause.
#Launch community visioning. 
#Assess community strengths. Where is recovery thriving?
#Conduct a community recovery capital assessment to identify areas where recovery support and recovery-friendly policies are most prevalent. 
#Get creative and innovative.
#Encourage friends, family, and colleagues to share their personal stories. 
#Create recovery community centers that make recovery visible on Main Street. 
#Celebrate recovery from addiction!

= Relevant Research =

SAFE Solutions is an ever-growing platform.  Currently no information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.

= Impactful Federal, State, and Local Policies =

A 2010 report prepared for the Partners for Recovery initiative provides information regarding the funding sources that support Recovery Support Services throughout the continuum of care. The report includes Federal, state and private funding overview and highlights practices for obtaining funding.  Funding sources continue to be limited.<ref>https://facesandvoicesofrecovery.org/wp-content/uploads/2019/06/Financing-Recovery-Support-Services.pdf</ref>

 

= Available Tools and Resources =

'''Recovery Oriented Systems of Care (ROSC)'''

One approach advocated by SAMHSA and others is the Recovery Oriented Systems of Care.

  According to Ijeoma Achara, CEO of Achara Consulting, an ROSC is NOT:

⦁ A Model

⦁ Primarily focused on the integration of recovery support services

⦁ Dependent on new dollars for development

⦁ A new initiative

⦁ A group of providers that increase their collaboration to improve coordination

⦁ An infusion of evidence-based practices

⦁ An organizational entity, group of people or committee

⦁ A closed network of services and supports

 

Dr. Achara continues to explain that a ROSC is:

⦁ Value-driven APRROACH to structuring behavioral health systems and a network of clinical and non-clinical services and supports

⦁ Framework to guide systems transformation

 

SAMHSA produced a guide book on Recovery Oriented Systems of Care <ref>1. https://www.samhsa.gov/sites/default/files/rosc_resource_guide_book.pdf</ref> in 2010, but there have been improvements to that general approach in recent years.

A ROSC is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resiliencies of individuals, families, and communities to achieve abstinence and improved health, wellness, and quality of life for those with or at risk of alcohol and drug problems. Visit Recovery-Oriented Systems of Care (ROSC) to learn more.

'''Café Model'''

The Recovery Cafe Model allows those in recovery to have a safe place that "meets people where they are on the recovery continuum, engages them for a lifetime of managing their disease, focuses holistically on a person’s needs, and empowers them to build a life that realizes their full potential." <ref>1. https://recoverycafenetwork.org/</ref>  The organization is committed to successfully replicating the model in additional communities. Click here to bring a Recovery Cafe to your community.

'''SAFE Project Community Playbook'''-The Community Playbook serves as a blueprint framework for rural, suburban, and urban communities navigating an effective, collaborative response using a six-step approach.

'''Community Listening Forum Toolkit'''- Provides guidance to taking action with building a recovery-ready community.  <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/FaceVoicRec_communityToolkit.pdf</ref>

'''Recovery-Ready communities'''- A guide to recovery support services. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/FaceVoicRec_creatingrecoveryreadycommunities.pdf</ref>

= Promising Practices =

No single program or innovation makes a community the ideal place to support recovery, but communities can add things and then integrate them with treatment and recovery services to create a community that provides more support and better options for people in recovery.  

  '''Men's Sheds''' This concept originated in Australia in the late 1990s, and there are now more than 1,000 Men's Sheds in Australia with thriving movements in a growing number of other countries. Available buildings (such as vacant warehouses, foreclosed houses that have been possessed by the city or county, or vacant space in a retail center) can be donated, rented or purchased to create a space for men to gather (and it would not need to be limited to men, but that has been the roots). The space is then filled with tools, workbenches, and materials that can be used for the men to tinker, build, fix, and putter--all while building new social relationship. More information on Men's Sheds   '''Community Gardening''' Integrating participation in with a community gardening program can bring many benefits to people in recovery. It provides positive social interaction, skill building, improve access to healthy foods and more. Ideally, involvement with community gardening could be integrated with peer-to-peer recovery groups, recovery coaches, tools like rTribe or Triggr, or a comprehensive success plan managed in a community care coordination platform like XCare Community.  See more information on how gardening helps with recovery   '''Fitness & Recreation-based Recovery Programs''' Programs like Phoenix Multisport in Colorado (and other places) have demonstrated the power of having a recovery community that emphasizes active living and recreation.

'''Eugene Oregon'''- a case study on Recovery-ready ecosystems. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/08/Building-a-Recovery-Ready-Ecosystem-in-Oregon-Robert-Ashford1000.pdf</ref>

'''Operation New Hope-''' Operation New Hope is a model program that provides support, life and job skills training for citizens returning to the community after incarceration in the state of Florida.<ref>https://operationnewhope.org/</ref>

= Sources =

Create Recovery-Ready Communities

2021-10-31T04:10:38Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Substance Use Disorders (SUDs) continue to be a leading cause of death, a leading correlate in violent crime, and a leading cause of lost productivity in the workplace. 

Recovery happens in communities, and community-based resources have been shown to positively affect SUD impact and SUD recovery. By educating communities and creating continuity among support services, community-based services, and new innovations, such as recovery community organizations and other recovery support services, recovery efforts and improved sustained recovery has improved for individuals that live within the community.<ref>https://www.tandfonline.com/doi/abs/10.1080/16066359.2019.1571191?journalCode=iart20</ref>

Recovery is not just a matter of individual treatment or individual approaches combined with peer group support. The whole community plays a role in supporting successful recovery. A community response to SUDs can provide social and economic support and have a health impact at a community level.  

Recovery-Oriented Systems of Care (ROSC) provide coordinated community-based services that are person-centered and build strength and resilience of individuals, families, and communities. 

Community Recovery is a voluntary process through which a community uses the assertive resolution of alcohol and other drug-related problems as a vehicle for collective healing, community renewal, and enhanced intergenerational resilience. <ref>https://peerrecoverynow.org/pdf/ppt_slides/CreatingRecovery-ReadyCommunityFINAL.pdf</ref>

 

= Key Information =

Recovery-ready communities include internal and external resources that support and sustain recovery from SUD.  Recovery capital is becoming a term identified and linked to recovery-ready communities. Faces & Voices of Recovery <ref>https://facesandvoicesofrecovery.org/blog/2019/10/08/recovery-capital-its-role-in-sustaining-recovery/</ref> provides a breakdown of recovery capital and the roles of sustaining recovery.  

1. '''Personal recovery capital. '''This includes an individual’s physical and human capital. Physical capital is the available resources to fulfill a person’s basic needs, like their health, healthcare, financial resources, clothing, food, safe and habitable shelter, and transportation. Human capital relates to a person’s abilities, skills, and knowledge, like problem-solving, education and credentials, self-esteem, the ability to navigate challenging situations and achieve goals, interpersonal skills, and a sense of meaning and purpose in life. 

2. '''Family/social recovery capital. '''These resources relate to intimate relationships with friends and family, relationships with people in recovery, and supportive partners. It also includes the availability of recovery-related social events

3'''. Community recovery capital. '''This includes attitudes, policies, and resources specifically related to helping individuals resolve substance use disorders. Community resources are vast.

They can include:

*Recovery activism and advocacy aimed at reducing stigma
*A full range of addiction treatment resources
*Peer-led support, such as mutual-aid meetings, that seek to meet the diverse needs of the community
*Recovery Community Organizations
*Recovery support institutions, educational-based recovery support such as recovery high schools, colleges, recovery housing, and recovery ministries and churches
*Visible and diverse local recovery role models
*Resources to sustain recovery and early intervention programs, like employee assistance programs, and drug courts
*Cultural capital. These resources resonate with individuals cultural and faith-based beliefs

Recovery-ready communities also encompass individual, community, institutional and policy level Involvement and collaboration.  A community that is recovery ready provides a continuum of care and support to those in recovery or seeking recovery support. 

Key components of a recovery-ready community are adequate detox and treatment facilities, the ability to address all pathways to recovery, harm reduction, youth recovery, recovery housing, prevention, recovery community organizations, and family support. Criminal justice involvement (police, court systems) and special interest populations (faith-based, LGBTQ). 

''' Examples of Recovery Support Services:'''

'''Alternative Peer Groups''': is a comprehensive adolescent recovery support model that integrates recovering peers and prosocial activities into evidence-based clinical practice.  These are community-based peer support programs that act as a liaison between residential treatment programs and mental health professionals. The purpose is positive peer support to maintain sobriety. <ref>http://www.aapg-recovery.com/</ref>

'''Collegiate Recovery Support:'''  Provides a supportive environment on campus to reduce the addiction cycle. Includes educational resources and recovery support. <ref>https://collegiaterecovery.org/</ref>

'''Jail & Prison-based Recovery Support: '''Support programs and resources to assist incarcerated individuals or those involved in the criminal justice system. 

'''Peer Recovery Coaching: '''Non-clinical peer recovery coaches who appropriately bring their own experience to the table while helping others on their recovery journey.

'''Medication-Assisted Recovery:''' Recovery Support Programs that include medication-assisted treatment (MAT). 

'''Recovery Community Centers: '''A recovery-oriented hub in the community. Offers recovery and family support services. Peer operated and may include coaching, education, peer-support, medication-assisted treatment, employment resources, etc. 

'''Recovery High Schools: '''Focus on academics and recovery. Positive peer pressure. <ref>https://recoveryschools.org/</ref>

'''Recovery Housing: '''Substance-free living environments that support individuals in recovery from addiction. 

'''Community Task Force'''

Addiction is an ongoing epidemic, and recovery-ready communities and community collaboration are key to providing community-based solutions. 

CORE Task Force missions: prevention, early intervention, harm reduction, treatment, and recovery support services.<ref>https://cabhp.asu.edu/sites/default/files/session_14-_community_advocacy-_using_coordinated_response_to_create_recovery_ready_communities_-_angie_green_mariah_hile.pdf</ref>   

'''Advocacy'''

SAMHSA provides 10 concrete steps leaders can take for recovery-ready communities. <ref>https://peerrecoverynow.org/pdf/ppt_slides/CreatingRecovery-ReadyCommunityFINAL.pdf#:~:text=Recovery%20Ready%20Communities%20Community%20Recovery%20is%20a%20voluntary,collective%20healing%2C%20community%20renewal%2C%20and%20enhanced%20intergenerational%20resilience.</ref>

#Bring people in recovery to the table early and often to create a shared vision of recovery.
#Identify leaders in the recovery community
#Identify recovery champions to support the effort and to be ambassadors for the cause.
#Launch community visioning. 
#Assess community strengths. Where is recovery thriving?
#Conduct a community recovery capital assessment to identify areas where recovery support and recovery-friendly policies are most prevalent. 
#Get creative and innovative.
#Encourage friends, family, and colleagues to share their personal stories. 
#Create recovery community centers that make recovery visible on Main Street. 
#Celebrate recovery from addiction!

= Relevant Research =

SAFE Solutions is an ever-growing platform.  Currently no information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.

= Impactful Federal, State, and Local Policies =

A 2010 report prepared for the Partners for Recovery initiative provides information regarding the funding sources that support Recovery Support Services throughout the continuum of care. The report includes Federal, State and private funding overview and highlights practices for obtaining funding.  Funding sources continue to be limited.<ref>https://facesandvoicesofrecovery.org/wp-content/uploads/2019/06/Financing-Recovery-Support-Services.pdf</ref>

 

= Available Tools and Resources =

'''Recovery Oriented Systems of Care (ROSC)'''

One approach advocated by SAMHSA and others is the Recovery Oriented Systems of Care.

  According to Ijeoma Achara, CEO of Achara Consulting, an ROSC is NOT:

⦁ A Model

⦁ Primarily focused on the integration of recovery support services

⦁ Dependent on new dollars for development

⦁ A new initiative

⦁ A group of providers that increase their collaboration to improve coordination

⦁ An infusion of evidence-based practices

⦁ An organizational entity, group of people or committee

⦁ A closed network of services and supports

 

Dr. Achara continues to explain that a ROSC is:

⦁ Value-driven APRROACH to structuring behavioral health systems and a network of clinical and non-clinical services and supports

⦁ Framework to guide systems transformation

 

SAMHSA produced a guide book on Recovery Oriented Systems of Care <ref>1. https://www.samhsa.gov/sites/default/files/rosc_resource_guide_book.pdf</ref> in 2010, but there have been improvements to that general approach in recent years.

A ROSC is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resiliencies of individuals, families, and communities to achieve abstinence and improved health, wellness, and quality of life for those with or at risk of alcohol and drug problems. Visit Recovery-Oriented Systems of Care (ROSC) to learn more.

'''Café Model'''

The Recovery Cafe Model allows those in recovery to have a safe place that "meets people where they are on the recovery continuum, engages them for a lifetime of managing their disease, focuses holistically on a person’s needs, and empowers them to build a life that realizes their full potential." <ref>1. https://recoverycafenetwork.org/</ref>  The organization is committed to successfully replicating the model in additional communities. Click here to bring a Recovery Cafe to your community.

'''SAFE Project Community Playbook'''-The Community Playbook serves as a blueprint framework for rural, suburban, and urban communities navigating an effective, collaborative response using a six-step approach.

'''Community Listening Forum Toolkit'''- Provides guidance to taking action with building a recovery-ready community.  <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/FaceVoicRec_communityToolkit.pdf</ref>

'''Recovery-Ready communities'''- A guide to recovery support services. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/FaceVoicRec_creatingrecoveryreadycommunities.pdf</ref>

= Promising Practices =

No single program or innovation makes a community the ideal place to support recovery, but communities can add things and then integrate them with treatment and recovery services to create a community that provides more support and better options for people in recovery.  

  '''Men's Sheds''' This concept originated in Australia in the late 1990s, and there are now more than 1,000 Men's Sheds in Australia with thriving movements in a growing number of other countries. Available buildings (such as vacant warehouses, foreclosed houses that have been possessed by the city or county, or vacant space in a retail center) can be donated, rented or purchased to create a space for men to gather (and it would not need to be limited to men, but that has been the roots). The space is then filled with tools, workbenches, and materials that can be used for the men to tinker, build, fix, and putter--all while building new social relationship. More information on Men's Sheds   '''Community Gardening''' Integrating participation in with a community gardening program can bring many benefits to people in recovery. It provides positive social interaction, skill building, improve access to healthy foods and more. Ideally, involvement with community gardening could be integrated with peer-to-peer recovery groups, recovery coaches, tools like rTribe or Triggr, or a comprehensive success plan managed in a community care coordination platform like XCare Community.  See more information on how gardening helps with recovery   '''Fitness & Recreation-based Recovery Programs''' Programs like Phoenix Multisport in Colorado (and other places) have demonstrated the power of having a recovery community that emphasizes active living and recreation.

'''Eugene Oregon'''- a case study on Recovery-ready ecosystems. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/08/Building-a-Recovery-Ready-Ecosystem-in-Oregon-Robert-Ashford1000.pdf</ref>

'''Operation New Hope-''' Operation New Hope is a model program that provides support, life and job skills training for citizens returning to the community after incarceration in the state of Florida.<ref>https://operationnewhope.org/</ref>

= Sources =

Create Recovery-Ready Communities

2021-10-31T04:07:20Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Substance Use Disorders (SUDs) continue to be a leading cause of death, a leading correlate in violent crime, and a leading cause of lost productivity in the workplace. 

Recovery happens in communities, and community-based resources have been shown to positively affect SUD impact and SUD recovery. By educating communities and creating continuity among support services, community-based services, and new innovations, such as recovery community organizations and other recovery support services, recovery efforts and improved sustained recovery has improved for individuals that live within the community.<ref>https://www.tandfonline.com/doi/abs/10.1080/16066359.2019.1571191?journalCode=iart20</ref>

Recovery is not just a matter of individual treatment or individual approaches combined with peer group support. The whole community plays a role in supporting successful recovery. A community response to SUDs can provide social and economic support and have a health impact at a community level.  

Recovery-Oriented Systems of Care (ROSC) provide coordinated community-based services that are person-centered and build strength and resilience of individuals, families, and communities. 

Community Recovery is a voluntary process through which a community uses the assertive resolution of alcohol and other drug-related problems as a vehicle for collective healing, community renewal, and enhanced intergenerational resilience. <ref>https://peerrecoverynow.org/pdf/ppt_slides/CreatingRecovery-ReadyCommunityFINAL.pdf</ref>

 

= Key Information =

Recovery-ready communities include internal and external resources that support and sustain recovery from SUD.  Recovery capital is becoming a term identified and linked to recovery-ready communities. Faces & Voices of Recovery <ref>https://facesandvoicesofrecovery.org/blog/2019/10/08/recovery-capital-its-role-in-sustaining-recovery/</ref> provides a breakdown of recovery capital and the roles of sustaining recovery.  

1. '''Personal recovery capital. '''This includes an individual’s physical and human capital. Physical capital is the available resources to fulfill a person’s basic needs, like their health, healthcare, financial resources, clothing, food, safe and habitable shelter, and transportation. Human capital relates to a person’s abilities, skills, and knowledge, like problem-solving, education and credentials, self-esteem, the ability to navigate challenging situations and achieve goals, interpersonal skills, and a sense of meaning and purpose in life. 

2. '''Family/social recovery capital. '''These resources relate to intimate relationships with friends and family, relationships with people in recovery, and supportive partners. It also includes the availability of recovery-related social events

3'''. Community recovery capital. '''This includes attitudes, policies, and resources specifically related to helping individuals resolve substance use disorders. Community resources are vast.

They can include:

*Recovery activism and advocacy aimed at reducing stigma
*A full range of addiction treatment resources
*Peer-led support, such as mutual-aid meetings, that seek to meet the diverse needs of the community
*Recovery Community Organizations
*Recovery support institutions, educational-based recovery support such as recovery high schools, colleges, recovery housing, and recovery ministries and churches
*Visible and diverse local recovery role models
*Resources to sustain recovery and early intervention programs, like employee assistance programs, and drug courts
*Cultural capital. These resources resonate with individuals cultural and faith-based beliefs

Recovery-ready communities also encompass individual, community, institutional and policy level Involvement and collaboration.  A community that is recovery ready provides a continuum of care and support to those in recovery or seeking recovery support. 

Key components of a recovery-ready community are adequate detox and treatment facilities, the ability to address all pathways to recovery, harm reduction, youth recovery, recovery housing, prevention, recovery community organizations, and family support. Criminal justice involvement (police, court systems) and special interest populations (faith-based, LGBTQ). 

''' Examples of Recovery Support Services:'''

'''Alternative Peer Groups''': is a comprehensive adolescent recovery support model that integrates recovering peers and prosocial activities into evidence-based clinical practice.  These are community-based peer support programs that act as a liaison between residential treatment programs and mental health professionals. The purpose is positive peer support to maintain sobriety. <ref>http://www.aapg-recovery.com/</ref>

'''Collegiate Recovery Support:'''  Provides a supportive environment on campus to reduce the addiction cycle. Includes educational resources and recovery support. <ref>https://collegiaterecovery.org/</ref>

'''Jail & Prison-based Recovery Support: '''Support programs and resources to assist incarcerated individuals or those involved in the criminal justice system. 

'''Peer Recovery Coaching: '''Non-clinical peer recovery coaches who appropriately bring their own experience to the table while helping others on their recovery journey.

'''Medication-Assisted Recovery:''' Recovery Support Programs that include medication-assisted treatment (MAT). 

'''Recovery Community Centers: '''A recovery-oriented hub in the community. Offers recovery and family support services. Peer operated and may include coaching, education, peer-support, medication assisted treatment, employment resources, etc. 

'''Recovery High Schools: '''Focus on academics and recovery. Positive peer pressure. <ref>https://recoveryschools.org/</ref>

'''Recovery Housing: '''Substance-free living environments that support individuals in recovery from addiction. 

'''Community Task Force'''

Addiction is an ongoing epidemic, and recovery-ready communities and community collaboration are key to providing community-based solutions. 

CORE Task Force missions: prevention, early intervention, harm reduction, treatment, and recovery support services.<ref>https://cabhp.asu.edu/sites/default/files/session_14-_community_advocacy-_using_coordinated_response_to_create_recovery_ready_communities_-_angie_green_mariah_hile.pdf</ref>   

'''Advocacy'''

SAMHSA provides 10 concrete steps leaders can take for recovery-ready communities. <ref>https://peerrecoverynow.org/pdf/ppt_slides/CreatingRecovery-ReadyCommunityFINAL.pdf#:~:text=Recovery%20Ready%20Communities%20Community%20Recovery%20is%20a%20voluntary,collective%20healing%2C%20community%20renewal%2C%20and%20enhanced%20intergenerational%20resilience.</ref>

#Bring people in recovery to the table early and often to create a shared vision of recovery.
#Identify leaders in the recovery community
#Identify recovery champions to support the effort and to be ambassadors for the cause.
#Launch community visioning. 
#Assess community strengths. Where is recovery thriving?
#Conduct a community recovery capital assessment to identify areas where recovery support and recovery-friendly policies are most prevalent. 
#Get creative and innovative.
#Encourage friends, family, and colleagues to share their personal stories. 
#Create recovery community centers that make recovery visible on Main Street. 
#Celebrate recovery from addiction!

= Relevant Research =

SAFE Solutions is an ever-growing platform.  Currently no information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.

= Impactful Federal, State, and Local Policies =

A 2010 report prepared for the Partners for Recovery initiative provides information regarding the funding sources that support Recovery Support Services throughout the continuum of care. The report includes Federal, State and private funding overview and highlights practices for obtaining funding.  Funding sources continue to be limited.<ref>https://facesandvoicesofrecovery.org/wp-content/uploads/2019/06/Financing-Recovery-Support-Services.pdf</ref>

 

= Available Tools and Resources =

'''Recovery Oriented Systems of Care (ROSC)'''

One approach advocated by SAMHSA and others is the Recovery Oriented Systems of Care.

  According to Ijeoma Achara, CEO of Achara Consulting, an ROSC is NOT:

⦁ A Model

⦁ Primarily focused on the integration of recovery support services

⦁ Dependent on new dollars for development

⦁ A new initiative

⦁ A group of providers that increase their collaboration to improve coordination

⦁ An infusion of evidence-based practices

⦁ An organizational entity, group of people or committee

⦁ A closed network of services and supports

 

Dr. Achara continues to explain that a ROSC is:

⦁ Value-driven APRROACH to structuring behavioral health systems and a network of clinical and non-clinical services and supports

⦁ Framework to guide systems transformation

 

SAMHSA produced a guide book on Recovery Oriented Systems of Care <ref>1. https://www.samhsa.gov/sites/default/files/rosc_resource_guide_book.pdf</ref> in 2010, but there have been improvements to that general approach in recent years.

A ROSC is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resiliencies of individuals, families, and communities to achieve abstinence and improved health, wellness, and quality of life for those with or at risk of alcohol and drug problems. Visit Recovery-Oriented Systems of Care (ROSC) to learn more.

'''Café Model'''

The Recovery Cafe Model allows those in recovery to have a safe place that "meets people where they are on the recovery continuum, engages them for a lifetime of managing their disease, focuses holistically on a person’s needs, and empowers them to build a life that realizes their full potential." <ref>1. https://recoverycafenetwork.org/</ref>  The organization is committed to successfully replicating the model in additional communities. Click here to bring a Recovery Cafe to your community.

'''SAFE Project Community Playbook'''-The Community Playbook serves as a blueprint framework for rural, suburban, and urban communities navigating an effective, collaborative response using a six-step approach.

'''Community Listening Forum Toolkit'''- Provides guidance to taking action with building a recovery-ready community.  <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/FaceVoicRec_communityToolkit.pdf</ref>

'''Recovery-Ready communities'''- A guide to recovery support services. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/FaceVoicRec_creatingrecoveryreadycommunities.pdf</ref>

= Promising Practices =

No single program or innovation makes a community the ideal place to support recovery, but communities can add things and then integrate them with treatment and recovery services to create a community that provides more support and better options for people in recovery.  

  '''Men's Sheds''' This concept originated in Australia in the late 1990s, and there are now more than 1,000 Men's Sheds in Australia with thriving movements in a growing number of other countries. Available buildings (such as vacant warehouses, foreclosed houses that have been possessed by the city or county, or vacant space in a retail center) can be donated, rented or purchased to create a space for men to gather (and it would not need to be limited to men, but that has been the roots). The space is then filled with tools, workbenches, and materials that can be used for the men to tinker, build, fix, and putter--all while building new social relationship. More information on Men's Sheds   '''Community Gardening''' Integrating participation in with a community gardening program can bring many benefits to people in recovery. It provides positive social interaction, skill building, improve access to healthy foods and more. Ideally, involvement with community gardening could be integrated with peer-to-peer recovery groups, recovery coaches, tools like rTribe or Triggr, or a comprehensive success plan managed in a community care coordination platform like XCare Community.  See more information on how gardening helps with recovery   '''Fitness & Recreation-based Recovery Programs''' Programs like Phoenix Multisport in Colorado (and other places) have demonstrated the power of having a recovery community that emphasizes active living and recreation.

'''Eugene Oregon'''- a case study on Recovery-ready ecosystems. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/08/Building-a-Recovery-Ready-Ecosystem-in-Oregon-Robert-Ashford1000.pdf</ref>

'''Operation New Hope-''' Operation New Hope is a model program that provides support, life and job skills training for citizens returning to the community after incarceration in the state of Florida.<ref>https://operationnewhope.org/</ref>

= Sources =

Create Recovery-Ready Communities

2021-10-31T03:58:48Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Substance Use Disorders (SUDs) continue to be a leading cause of death, a leading correlate in violent crime, and a leading cause of lost productivity in the workplace. 

Recovery happens in communities, and community-based resources have been shown to positively affect SUD impact and SUD recovery. By educating communities and creating continuity among support services, community-based services, and new innovations, such as recovery community organizations and other recovery support services, recovery efforts and improved sustained recovery has improved for individuals that live within the community.<ref>https://www.tandfonline.com/doi/abs/10.1080/16066359.2019.1571191?journalCode=iart20</ref>

Recovery is not just a matter of individual treatment or individual approaches combined with peer group support. The whole community plays a role in supporting successful recovery. A community response to SUDs can provide social and economic support and have a health impact at a community level.  

Recovery-Oriented Systems of Care (ROSC) provide coordinated community-based services that are person-centered and build strength and resilience of individuals, families, and communities. 

Community Recovery is a voluntary process through which a community uses the assertive resolution of alcohol and other drug-related problems as a vehicle for collective healing, community renewal, and enhanced intergenerational resilience. <ref>https://peerrecoverynow.org/pdf/ppt_slides/CreatingRecovery-ReadyCommunityFINAL.pdf</ref>

 

= Key Information =

Recovery-ready communities include internal and external resources that support and sustain recovery from SUD.  Recovery Capital Is becoming a term Identified and linked to recovery-ready communities. Faces & Voices of Recovery <ref>https://facesandvoicesofrecovery.org/blog/2019/10/08/recovery-capital-its-role-in-sustaining-recovery/</ref>provides a breakdown of recovery capital and the roles of sustaining recovery.  

1.'''Personal recovery capital. '''This includes an individual’s physical and human capital. Physical capital is the available resources to fulfil a person’s basic needs, like their health, healthcare, financial resources, clothing, food, safe and habitable shelter, and transportation. Human capital relates to a person’s abilities, skills, and knowledge, like problem-solving, education and credentials, self-esteem, the ability to navigate challenging situations and achieve goals, interpersonal skills, and a sense of meaning and purpose in life. 

2. '''Family/social recovery capital. '''These resources relate to intimate relationships with friends and family, relationships with people in recovery, and supportive partners. It also includes the availability of recovery-related social events

3'''. Community recovery capital. '''This includes attitudes, policies, and resources specifically related to helping individuals resolve substance use disorders. Community resources are vast.

They can include:

*Recovery activism and advocacy aimed at reducing stigma
*A full range of addiction treatment resources
*Peer-led support, such as mutual-aid meetings, that seek to meet the diverse needs of the community
*Recovery Community Organizations
*Recovery support institutions, educational-based recovery support such as recovery high schools, colleges, recovery housing, and recovery ministries and churches
*Visible and diverse local recovery role models
*Resources to sustain recovery and early intervention programs, like employee assistance programs, and drug courts
*Cultural capital. These resources resonate with individuals cultural and faith-based beliefs

Recovery-ready communities also encompass Individual, community, Institutional and policy level Involvement and collaboration.  A community that Is recovery ready provides a continuum of care and support to those In recovery or seeking recovery support. 

Key components of a recovery-ready community are adequate detox and treatment facilities, the ability to address all pathways to recovery, harm reduction, youth recovery, recovery housing, prevention, recovery community organizations, family support. criminal justice Involvement (police, court systems) special Interest populations (faith-based, LGBTQ). 

''' Examples of Recovery Support Services:'''

'''Alternative Peer Groups''': is a comprehensive adolescent recovery support model that integrates recovering peers and prosocial activities into evidence-based clinical practice.  These are community-based peer support programs that act as a liaison between residential treatment programs, mental health professionals. Purpose Is positive peer support to maintain sobriety. <ref>http://www.aapg-recovery.com/</ref>

'''Collegiate Recovery Support:'''  Provides a supportive environment on campus to reduce the addiction cycle. Incudes educational resources and recovery support. <ref>https://collegiaterecovery.org/</ref>

'''Jail & Prison based recovery Support: '''Support programs and resources to assist Incarcerated Individuals or those Involved In the criminal justice system. 

'''Peer Recovery Coaching: '''Non-clinical peer recovery coaches who appropriately bring their own experience to the table while helping others on their recovery journey.

'''Medication Assisted Recovery:''' Recovery Support Programs that Include medication assisted treatment. 

'''Recovery Community Centers: '''A recovery-oriented hub In the community. Offers recovery and family support services. Peer operated and may Include coaching, education, peer-support, medication assisted treatment (MAT), employment resources, etc. 

'''Recovery High Schools: '''Focus on academics and recovery. Positive peer pressure. <ref>https://recoveryschools.org/</ref>

'''Recovery Housing: '''Substance-free living environments that support Individuals In recovery from addiction. 

 

'''Community Task Force'''

Addiction Is an ongoing epidemic and recovery-ready communities and community collaboration are key to providing community-based solutions. 

CORE Task Force missions: prevention, early Intervention, harm reduction, treatment, recovery support services.<ref>https://cabhp.asu.edu/sites/default/files/session_14-_community_advocacy-_using_coordinated_response_to_create_recovery_ready_communities_-_angie_green_mariah_hile.pdf</ref>   

'''Advocacy'''

SAMHSA provides 10 concrete steps leaders can take for recovery-ready communities. <ref>https://peerrecoverynow.org/pdf/ppt_slides/CreatingRecovery-ReadyCommunityFINAL.pdf#:~:text=Recovery%20Ready%20Communities%20Community%20Recovery%20is%20a%20voluntary,collective%20healing%2C%20community%20renewal%2C%20and%20enhanced%20intergenerational%20resilience.</ref>

#Bring people in recovery to the table early and often to create a shared vision of recovery.
#Identify leaders in the recovery community
#Identify recovery champions to support the effort and to be ambassadors for the cause.
# Launch community visioning. 
#Assess community strengths. Where is recovery thriving?
#Conduct a community recovery capital assessment to identify areas where recovery support and recovery-friendly policies are most prevalent. 
#Get creative and innovative.
#Encourage friends, family and colleagues to share their personal stories. 
#Create recovery community centers that make recovery visible on Main Street. 
#Celebrate recovery from addiction!

= Relevant Research =

SAFE Solutions is an ever-growing platform.  Currently no information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.

= Impactful Federal, State, and Local Policies =

A 2010 report prepared for the Partners for Recovery initiative provides information regarding the funding sources that support Recovery Support Services throughout the continuum of care. The report includes Federal, State and private funding overview and highlights practices for obtaining funding.  Funding sources continue to be limited.<ref>https://facesandvoicesofrecovery.org/wp-content/uploads/2019/06/Financing-Recovery-Support-Services.pdf</ref>

 

= Available Tools and Resources =

'''Recovery Oriented Systems of Care (ROSC)'''

One approach advocated by SAMHSA and others is the Recovery Oriented Systems of Care.

  According to Ijeoma Achara, CEO of Achara Consulting, an ROSC is NOT:

⦁ A Model

⦁ Primarily focused on the integration of recovery support services

⦁ Dependent on new dollars for development

⦁ A new initiative

⦁ A group of providers that increase their collaboration to improve coordination

⦁ An infusion of evidence-based practices

⦁ An organizational entity, group of people or committee

⦁ A closed network of services and supports

 

Dr. Achara continues to explain that a ROSC is:

⦁ Value-driven APRROACH to structuring behavioral health systems and a network of clinical and non-clinical services and supports

⦁ Framework to guide systems transformation

 

SAMHSA produced a guide book on Recovery Oriented Systems of Care <ref>1. https://www.samhsa.gov/sites/default/files/rosc_resource_guide_book.pdf</ref> in 2010, but there have been improvements to that general approach in recent years.

A ROSC is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resiliencies of individuals, families, and communities to achieve abstinence and improved health, wellness, and quality of life for those with or at risk of alcohol and drug problems. Visit Recovery-Oriented Systems of Care (ROSC) to learn more.

'''Café Model'''

The Recovery Cafe Model allows those in recovery to have a safe place that "meets people where they are on the recovery continuum, engages them for a lifetime of managing their disease, focuses holistically on a person’s needs, and empowers them to build a life that realizes their full potential." <ref>1. https://recoverycafenetwork.org/</ref>  The organization is committed to successfully replicating the model in additional communities. Click here to bring a Recovery Cafe to your community.

'''SAFE Project Community Playbook'''-The Community Playbook serves as a blueprint framework for rural, suburban, and urban communities navigating an effective, collaborative response using a six-step approach.

'''Community Listening Forum Toolkit'''- Provides guidance to taking action with building a recovery-ready community.  <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/FaceVoicRec_communityToolkit.pdf</ref>

'''Recovery-Ready communities'''- A guide to recovery support services. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/FaceVoicRec_creatingrecoveryreadycommunities.pdf</ref>

= Promising Practices =

No single program or innovation makes a community the ideal place to support recovery, but communities can add things and then integrate them with treatment and recovery services to create a community that provides more support and better options for people in recovery.  

  '''Men's Sheds''' This concept originated in Australia in the late 1990s, and there are now more than 1,000 Men's Sheds in Australia with thriving movements in a growing number of other countries. Available buildings (such as vacant warehouses, foreclosed houses that have been possessed by the city or county, or vacant space in a retail center) can be donated, rented or purchased to create a space for men to gather (and it would not need to be limited to men, but that has been the roots). The space is then filled with tools, workbenches, and materials that can be used for the men to tinker, build, fix, and putter--all while building new social relationship. More information on Men's Sheds   '''Community Gardening''' Integrating participation in with a community gardening program can bring many benefits to people in recovery. It provides positive social interaction, skill building, improve access to healthy foods and more. Ideally, involvement with community gardening could be integrated with peer-to-peer recovery groups, recovery coaches, tools like rTribe or Triggr, or a comprehensive success plan managed in a community care coordination platform like XCare Community.  See more information on how gardening helps with recovery   '''Fitness & Recreation-based Recovery Programs''' Programs like Phoenix Multisport in Colorado (and other places) have demonstrated the power of having a recovery community that emphasizes active living and recreation.

'''Eugene Oregon'''- a case study on Recovery-ready ecosystems. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/08/Building-a-Recovery-Ready-Ecosystem-in-Oregon-Robert-Ashford1000.pdf</ref>

'''Operation New Hope-''' Operation New Hope is a model program that provides support, life and job skills training for citizens returning to the community after incarceration in the state of Florida.<ref>https://operationnewhope.org/</ref>

= Sources =

Create Recovery-Ready Communities

2021-10-31T03:58:03Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Substance Use Disorders (SUDs) continue to be a leading cause of death, a leading correlate in violent crime, and a leading cause of lost productivity in the workplace.  Recovery happens in communities, and community-based resources have been shown to positively affect SUD impact and SUD recovery. By educating communities and creating continuity among support services, community-based services, and new innovations, such as recovery community organizations and other recovery support services, recovery efforts and improved sustained recovery has improved for individuals that live within the community.<ref>https://www.tandfonline.com/doi/abs/10.1080/16066359.2019.1571191?journalCode=iart20</ref>

Recovery is not just a matter of individual treatment or individual approaches combined with peer group support. The whole community plays a role in supporting successful recovery. A community response to SUDs can provide social and economic support and have a health impact at a community level.  

Recovery-Oriented Systems of Care (ROSC) provide coordinated community-based services that are person-centered and build strength and resilience of individuals, families, and communities. 

Community Recovery is a voluntary process through which a community uses the assertive resolution of alcohol and other drug-related problems as a vehicle for collective healing, community renewal, and enhanced intergenerational resilience. <ref>https://peerrecoverynow.org/pdf/ppt_slides/CreatingRecovery-ReadyCommunityFINAL.pdf</ref>

 

= Key Information =

Recovery-ready communities include internal and external resources that support and sustain recovery from SUD.  Recovery Capital Is becoming a term Identified and linked to recovery-ready communities. Faces & Voices of Recovery <ref>https://facesandvoicesofrecovery.org/blog/2019/10/08/recovery-capital-its-role-in-sustaining-recovery/</ref>provides a breakdown of recovery capital and the roles of sustaining recovery.  

1.'''Personal recovery capital. '''This includes an individual’s physical and human capital. Physical capital is the available resources to fulfil a person’s basic needs, like their health, healthcare, financial resources, clothing, food, safe and habitable shelter, and transportation. Human capital relates to a person’s abilities, skills, and knowledge, like problem-solving, education and credentials, self-esteem, the ability to navigate challenging situations and achieve goals, interpersonal skills, and a sense of meaning and purpose in life. 

2. '''Family/social recovery capital. '''These resources relate to intimate relationships with friends and family, relationships with people in recovery, and supportive partners. It also includes the availability of recovery-related social events

3'''. Community recovery capital. '''This includes attitudes, policies, and resources specifically related to helping individuals resolve substance use disorders. Community resources are vast.

They can include:

*Recovery activism and advocacy aimed at reducing stigma
*A full range of addiction treatment resources
*Peer-led support, such as mutual-aid meetings, that seek to meet the diverse needs of the community
*Recovery Community Organizations
*Recovery support institutions, educational-based recovery support such as recovery high schools, colleges, recovery housing, and recovery ministries and churches
*Visible and diverse local recovery role models
*Resources to sustain recovery and early intervention programs, like employee assistance programs, and drug courts
*Cultural capital. These resources resonate with individuals cultural and faith-based beliefs

Recovery-ready communities also encompass Individual, community, Institutional and policy level Involvement and collaboration.  A community that Is recovery ready provides a continuum of care and support to those In recovery or seeking recovery support. 

Key components of a recovery-ready community are adequate detox and treatment facilities, the ability to address all pathways to recovery, harm reduction, youth recovery, recovery housing, prevention, recovery community organizations, family support. criminal justice Involvement (police, court systems) special Interest populations (faith-based, LGBTQ). 

''' Examples of Recovery Support Services:'''

'''Alternative Peer Groups''': is a comprehensive adolescent recovery support model that integrates recovering peers and prosocial activities into evidence-based clinical practice.  These are community-based peer support programs that act as a liaison between residential treatment programs, mental health professionals. Purpose Is positive peer support to maintain sobriety. <ref>http://www.aapg-recovery.com/</ref>

'''Collegiate Recovery Support:'''  Provides a supportive environment on campus to reduce the addiction cycle. Incudes educational resources and recovery support. <ref>https://collegiaterecovery.org/</ref>

'''Jail & Prison based recovery Support: '''Support programs and resources to assist Incarcerated Individuals or those Involved In the criminal justice system. 

'''Peer Recovery Coaching: '''Non-clinical peer recovery coaches who appropriately bring their own experience to the table while helping others on their recovery journey.

'''Medication Assisted Recovery:''' Recovery Support Programs that Include medication assisted treatment. 

'''Recovery Community Centers: '''A recovery-oriented hub In the community. Offers recovery and family support services. Peer operated and may Include coaching, education, peer-support, medication assisted treatment (MAT), employment resources, etc. 

'''Recovery High Schools: '''Focus on academics and recovery. Positive peer pressure. <ref>https://recoveryschools.org/</ref>

'''Recovery Housing: '''Substance-free living environments that support Individuals In recovery from addiction. 

 

'''Community Task Force'''

Addiction Is an ongoing epidemic and recovery-ready communities and community collaboration are key to providing community-based solutions. 

CORE Task Force missions: prevention, early Intervention, harm reduction, treatment, recovery support services.<ref>https://cabhp.asu.edu/sites/default/files/session_14-_community_advocacy-_using_coordinated_response_to_create_recovery_ready_communities_-_angie_green_mariah_hile.pdf</ref>   

'''Advocacy'''

SAMHSA provides 10 concrete steps leaders can take for recovery-ready communities. <ref>https://peerrecoverynow.org/pdf/ppt_slides/CreatingRecovery-ReadyCommunityFINAL.pdf#:~:text=Recovery%20Ready%20Communities%20Community%20Recovery%20is%20a%20voluntary,collective%20healing%2C%20community%20renewal%2C%20and%20enhanced%20intergenerational%20resilience.</ref>

#Bring people in recovery to the table early and often to create a shared vision of recovery.
#Identify leaders in the recovery community
#Identify recovery champions to support the effort and to be ambassadors for the cause.
# Launch community visioning. 
#Assess community strengths. Where is recovery thriving?
#Conduct a community recovery capital assessment to identify areas where recovery support and recovery-friendly policies are most prevalent. 
#Get creative and innovative.
#Encourage friends, family and colleagues to share their personal stories. 
#Create recovery community centers that make recovery visible on Main Street. 
#Celebrate recovery from addiction!

= Relevant Research =

SAFE Solutions is an ever-growing platform.  Currently no information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.

= Impactful Federal, State, and Local Policies =

A 2010 report prepared for the Partners for Recovery initiative provides information regarding the funding sources that support Recovery Support Services throughout the continuum of care. The report includes Federal, State and private funding overview and highlights practices for obtaining funding.  Funding sources continue to be limited.<ref>https://facesandvoicesofrecovery.org/wp-content/uploads/2019/06/Financing-Recovery-Support-Services.pdf</ref>

 

= Available Tools and Resources =

'''Recovery Oriented Systems of Care (ROSC)'''

One approach advocated by SAMHSA and others is the Recovery Oriented Systems of Care.

  According to Ijeoma Achara, CEO of Achara Consulting, an ROSC is NOT:

⦁ A Model

⦁ Primarily focused on the integration of recovery support services

⦁ Dependent on new dollars for development

⦁ A new initiative

⦁ A group of providers that increase their collaboration to improve coordination

⦁ An infusion of evidence-based practices

⦁ An organizational entity, group of people or committee

⦁ A closed network of services and supports

 

Dr. Achara continues to explain that a ROSC is:

⦁ Value-driven APRROACH to structuring behavioral health systems and a network of clinical and non-clinical services and supports

⦁ Framework to guide systems transformation

 

SAMHSA produced a guide book on Recovery Oriented Systems of Care <ref>1. https://www.samhsa.gov/sites/default/files/rosc_resource_guide_book.pdf</ref> in 2010, but there have been improvements to that general approach in recent years.

A ROSC is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resiliencies of individuals, families, and communities to achieve abstinence and improved health, wellness, and quality of life for those with or at risk of alcohol and drug problems. Visit Recovery-Oriented Systems of Care (ROSC) to learn more.

'''Café Model'''

The Recovery Cafe Model allows those in recovery to have a safe place that "meets people where they are on the recovery continuum, engages them for a lifetime of managing their disease, focuses holistically on a person’s needs, and empowers them to build a life that realizes their full potential." <ref>1. https://recoverycafenetwork.org/</ref>  The organization is committed to successfully replicating the model in additional communities. Click here to bring a Recovery Cafe to your community.

'''SAFE Project Community Playbook'''-The Community Playbook serves as a blueprint framework for rural, suburban, and urban communities navigating an effective, collaborative response using a six-step approach.

'''Community Listening Forum Toolkit'''- Provides guidance to taking action with building a recovery-ready community.  <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/FaceVoicRec_communityToolkit.pdf</ref>

'''Recovery-Ready communities'''- A guide to recovery support services. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/FaceVoicRec_creatingrecoveryreadycommunities.pdf</ref>

= Promising Practices =

No single program or innovation makes a community the ideal place to support recovery, but communities can add things and then integrate them with treatment and recovery services to create a community that provides more support and better options for people in recovery.  

  '''Men's Sheds''' This concept originated in Australia in the late 1990s, and there are now more than 1,000 Men's Sheds in Australia with thriving movements in a growing number of other countries. Available buildings (such as vacant warehouses, foreclosed houses that have been possessed by the city or county, or vacant space in a retail center) can be donated, rented or purchased to create a space for men to gather (and it would not need to be limited to men, but that has been the roots). The space is then filled with tools, workbenches, and materials that can be used for the men to tinker, build, fix, and putter--all while building new social relationship. More information on Men's Sheds   '''Community Gardening''' Integrating participation in with a community gardening program can bring many benefits to people in recovery. It provides positive social interaction, skill building, improve access to healthy foods and more. Ideally, involvement with community gardening could be integrated with peer-to-peer recovery groups, recovery coaches, tools like rTribe or Triggr, or a comprehensive success plan managed in a community care coordination platform like XCare Community.  See more information on how gardening helps with recovery   '''Fitness & Recreation-based Recovery Programs''' Programs like Phoenix Multisport in Colorado (and other places) have demonstrated the power of having a recovery community that emphasizes active living and recreation.

'''Eugene Oregon'''- a case study on Recovery-ready ecosystems. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/08/Building-a-Recovery-Ready-Ecosystem-in-Oregon-Robert-Ashford1000.pdf</ref>

'''Operation New Hope-''' Operation New Hope is a model program that provides support, life and job skills training for citizens returning to the community after incarceration in the state of Florida.<ref>https://operationnewhope.org/</ref>

= Sources =

Create Recovery-Ready Communities

2021-10-31T03:57:20Z

G.Lehrman:

Return to ...

----

Brief Description

= Introductory Paragraph =

Substance Use Disorders (SUDs) continue to be a leading cause of death, a leading correlate in violent crime, and a leading cause of lost productivity in the workplace.  Recovery happens in communities, and community-based resources have been shown to positively affect SUD impact and SUD recovery. By educating communities and creating continuity among support services, community-based services, and new innovations, such as recovery community organizations and other recovery support services, recovery efforts and improved sustained recovery has improved for individuals that live within the community.<ref>https://www.tandfonline.com/doi/abs/10.1080/16066359.2019.1571191?journalCode=iart20</ref>

 Recovery is not just a matter of individual treatment or individual approaches combined with peer group support. The whole community plays a role in supporting successful recovery. A community response to SUDs can provide social and economic support and have a health impact at a community level.  

Recovery-Oriented Systems of Care (ROSC) provide coordinated community-based services that are person-centered and build strength and resilience of individuals, families, and communities. 

  Community Recovery is a voluntary process through which a community uses the assertive resolution of alcohol and other drug-related problems as a vehicle for collective healing, community renewal, and enhanced intergenerational resilience. <ref>https://peerrecoverynow.org/pdf/ppt_slides/CreatingRecovery-ReadyCommunityFINAL.pdf</ref>

 

= Key Information =

Recovery-ready communities include internal and external resources that support and sustain recovery from SUD.  Recovery Capital Is becoming a term Identified and linked to recovery-ready communities. Faces & Voices of Recovery <ref>https://facesandvoicesofrecovery.org/blog/2019/10/08/recovery-capital-its-role-in-sustaining-recovery/</ref>provides a breakdown of recovery capital and the roles of sustaining recovery.  

1.'''Personal recovery capital. '''This includes an individual’s physical and human capital. Physical capital is the available resources to fulfil a person’s basic needs, like their health, healthcare, financial resources, clothing, food, safe and habitable shelter, and transportation. Human capital relates to a person’s abilities, skills, and knowledge, like problem-solving, education and credentials, self-esteem, the ability to navigate challenging situations and achieve goals, interpersonal skills, and a sense of meaning and purpose in life. 

2. '''Family/social recovery capital. '''These resources relate to intimate relationships with friends and family, relationships with people in recovery, and supportive partners. It also includes the availability of recovery-related social events

3'''. Community recovery capital. '''This includes attitudes, policies, and resources specifically related to helping individuals resolve substance use disorders. Community resources are vast.

They can include:

*Recovery activism and advocacy aimed at reducing stigma
*A full range of addiction treatment resources
*Peer-led support, such as mutual-aid meetings, that seek to meet the diverse needs of the community
*Recovery Community Organizations
*Recovery support institutions, educational-based recovery support such as recovery high schools, colleges, recovery housing, and recovery ministries and churches
*Visible and diverse local recovery role models
*Resources to sustain recovery and early intervention programs, like employee assistance programs, and drug courts
*Cultural capital. These resources resonate with individuals cultural and faith-based beliefs

Recovery-ready communities also encompass Individual, community, Institutional and policy level Involvement and collaboration.  A community that Is recovery ready provides a continuum of care and support to those In recovery or seeking recovery support. 

Key components of a recovery-ready community are adequate detox and treatment facilities, the ability to address all pathways to recovery, harm reduction, youth recovery, recovery housing, prevention, recovery community organizations, family support. criminal justice Involvement (police, court systems) special Interest populations (faith-based, LGBTQ). 

''' Examples of Recovery Support Services:'''

'''Alternative Peer Groups''': is a comprehensive adolescent recovery support model that integrates recovering peers and prosocial activities into evidence-based clinical practice.  These are community-based peer support programs that act as a liaison between residential treatment programs, mental health professionals. Purpose Is positive peer support to maintain sobriety. <ref>http://www.aapg-recovery.com/</ref>

'''Collegiate Recovery Support:'''  Provides a supportive environment on campus to reduce the addiction cycle. Incudes educational resources and recovery support. <ref>https://collegiaterecovery.org/</ref>

'''Jail & Prison based recovery Support: '''Support programs and resources to assist Incarcerated Individuals or those Involved In the criminal justice system. 

'''Peer Recovery Coaching: '''Non-clinical peer recovery coaches who appropriately bring their own experience to the table while helping others on their recovery journey.

'''Medication Assisted Recovery:''' Recovery Support Programs that Include medication assisted treatment. 

'''Recovery Community Centers: '''A recovery-oriented hub In the community. Offers recovery and family support services. Peer operated and may Include coaching, education, peer-support, medication assisted treatment (MAT), employment resources, etc. 

'''Recovery High Schools: '''Focus on academics and recovery. Positive peer pressure. <ref>https://recoveryschools.org/</ref>

'''Recovery Housing: '''Substance-free living environments that support Individuals In recovery from addiction. 

 

'''Community Task Force'''

Addiction Is an ongoing epidemic and recovery-ready communities and community collaboration are key to providing community-based solutions. 

CORE Task Force missions: prevention, early Intervention, harm reduction, treatment, recovery support services.<ref>https://cabhp.asu.edu/sites/default/files/session_14-_community_advocacy-_using_coordinated_response_to_create_recovery_ready_communities_-_angie_green_mariah_hile.pdf</ref>   

'''Advocacy'''

SAMHSA provides 10 concrete steps leaders can take for recovery-ready communities. <ref>https://peerrecoverynow.org/pdf/ppt_slides/CreatingRecovery-ReadyCommunityFINAL.pdf#:~:text=Recovery%20Ready%20Communities%20Community%20Recovery%20is%20a%20voluntary,collective%20healing%2C%20community%20renewal%2C%20and%20enhanced%20intergenerational%20resilience.</ref>

#Bring people in recovery to the table early and often to create a shared vision of recovery.
#Identify leaders in the recovery community
#Identify recovery champions to support the effort and to be ambassadors for the cause.
# Launch community visioning. 
#Assess community strengths. Where is recovery thriving?
#Conduct a community recovery capital assessment to identify areas where recovery support and recovery-friendly policies are most prevalent. 
#Get creative and innovative.
#Encourage friends, family and colleagues to share their personal stories. 
#Create recovery community centers that make recovery visible on Main Street. 
#Celebrate recovery from addiction!

= Relevant Research =

SAFE Solutions is an ever-growing platform.  Currently no information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.

= Impactful Federal, State, and Local Policies =

A 2010 report prepared for the Partners for Recovery initiative provides information regarding the funding sources that support Recovery Support Services throughout the continuum of care. The report includes Federal, State and private funding overview and highlights practices for obtaining funding.  Funding sources continue to be limited.<ref>https://facesandvoicesofrecovery.org/wp-content/uploads/2019/06/Financing-Recovery-Support-Services.pdf</ref>

 

= Available Tools and Resources =

'''Recovery Oriented Systems of Care (ROSC)'''

One approach advocated by SAMHSA and others is the Recovery Oriented Systems of Care.

  According to Ijeoma Achara, CEO of Achara Consulting, an ROSC is NOT:

⦁ A Model

⦁ Primarily focused on the integration of recovery support services

⦁ Dependent on new dollars for development

⦁ A new initiative

⦁ A group of providers that increase their collaboration to improve coordination

⦁ An infusion of evidence-based practices

⦁ An organizational entity, group of people or committee

⦁ A closed network of services and supports

 

Dr. Achara continues to explain that a ROSC is:

⦁ Value-driven APRROACH to structuring behavioral health systems and a network of clinical and non-clinical services and supports

⦁ Framework to guide systems transformation

 

SAMHSA produced a guide book on Recovery Oriented Systems of Care <ref>1. https://www.samhsa.gov/sites/default/files/rosc_resource_guide_book.pdf</ref> in 2010, but there have been improvements to that general approach in recent years.

A ROSC is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resiliencies of individuals, families, and communities to achieve abstinence and improved health, wellness, and quality of life for those with or at risk of alcohol and drug problems. Visit Recovery-Oriented Systems of Care (ROSC) to learn more.

'''Café Model'''

The Recovery Cafe Model allows those in recovery to have a safe place that "meets people where they are on the recovery continuum, engages them for a lifetime of managing their disease, focuses holistically on a person’s needs, and empowers them to build a life that realizes their full potential." <ref>1. https://recoverycafenetwork.org/</ref>  The organization is committed to successfully replicating the model in additional communities. Click here to bring a Recovery Cafe to your community.

'''SAFE Project Community Playbook'''-The Community Playbook serves as a blueprint framework for rural, suburban, and urban communities navigating an effective, collaborative response using a six-step approach.

'''Community Listening Forum Toolkit'''- Provides guidance to taking action with building a recovery-ready community.  <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/FaceVoicRec_communityToolkit.pdf</ref>

'''Recovery-Ready communities'''- A guide to recovery support services. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/FaceVoicRec_creatingrecoveryreadycommunities.pdf</ref>

= Promising Practices =

No single program or innovation makes a community the ideal place to support recovery, but communities can add things and then integrate them with treatment and recovery services to create a community that provides more support and better options for people in recovery.  

  '''Men's Sheds''' This concept originated in Australia in the late 1990s, and there are now more than 1,000 Men's Sheds in Australia with thriving movements in a growing number of other countries. Available buildings (such as vacant warehouses, foreclosed houses that have been possessed by the city or county, or vacant space in a retail center) can be donated, rented or purchased to create a space for men to gather (and it would not need to be limited to men, but that has been the roots). The space is then filled with tools, workbenches, and materials that can be used for the men to tinker, build, fix, and putter--all while building new social relationship. More information on Men's Sheds   '''Community Gardening''' Integrating participation in with a community gardening program can bring many benefits to people in recovery. It provides positive social interaction, skill building, improve access to healthy foods and more. Ideally, involvement with community gardening could be integrated with peer-to-peer recovery groups, recovery coaches, tools like rTribe or Triggr, or a comprehensive success plan managed in a community care coordination platform like XCare Community.  See more information on how gardening helps with recovery   '''Fitness & Recreation-based Recovery Programs''' Programs like Phoenix Multisport in Colorado (and other places) have demonstrated the power of having a recovery community that emphasizes active living and recreation.

'''Eugene Oregon'''- a case study on Recovery-ready ecosystems. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/08/Building-a-Recovery-Ready-Ecosystem-in-Oregon-Robert-Ashford1000.pdf</ref>

'''Operation New Hope-''' Operation New Hope is a model program that provides support, life and job skills training for citizens returning to the community after incarceration in the state of Florida.<ref>https://operationnewhope.org/</ref>

= Sources =

Expand Prescription Drug Take-back & Disposal Program

2021-10-31T02:28:26Z

G.Lehrman:

''Return to [[ZOOM_MAP_-_Reduce_Diversion_of_Prescription_Drugs|Reduce Diversion of Prescription Drugs]]''

----

 

= Introductory Paragraph =

Most opioid abuse prevention strategies include some sort of prescription drug take-back or disposal program.  This is a step in the right direction, but most communities have significant opportunities to expand and enhance these efforts to reach more people and reduce the ability of people to misuse these medications or give them to others who may misuse them.  This objective focuses on practical ways to make improvements to existing efforts and to add new options that communities may not yet be doing. 

= Key Information =

== Why Safe Disposal is Important ==

'''Intentional Misuse''':

*A majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet.<ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ </ref>
*SAMHSA’s 2009 National Survey on Drug Use and Health found that over 70 percent of people who used prescription pain relievers non-medically got them from friends or relatives, while approximately 5 percent got them from a drug dealer or from the Internet.
*Getting hooked on prescription opioids is directly responsible for over 60% of subsequent heroin addictions as addicts turn to this less expensive alternative.
*Prescription drugs involved in overdoses are almost all originally prescribed by physicians but are used by individuals other than the patient prescribed the drugs. (Get sources for this.) 

'''Accidental Exposure''':

*When medicines are no longer needed or have expired, it is important to properly dispose of them to reduce harm from accidental exposure or intentional misuse.<ref>http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm</ref> Throwing drugs in the garbage is a bad idea, because they can accidentally be taken by kids or pets.

'''Environmental Concerns''':

*Some people propose flushing or pouring unused medications down the drain, however, medications flushed into the waste stream can end up in water supplies.<ref>http://www.takebackyourmeds.org/what-you-can-do/medicine-disposal-myths-and-facts/</ref>
*Since the drugs in take-back programs are incinerated, take-back programs are the safest way to get rid of the chemicals and to stop them from getting into drinking water and watersheds as well as in the hands of those at risk.
*Innovative mail-back options provide a convenient way for people to have excess medications disposed of through incineration. (Details further down on this page.)

== Costs and Benefits of Safe Disposal Options ==

This fact sheet from the Product Stewardship Institute provides a good summary of the costs and benefits of different drug take-back and disposal options. 

[https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf]

== To Flush or Not to Flush ==

If no take-back programs are readily available, it is still important to dispose of the medications quickly and appropriately. Some prescriptions include instructions on how to dispose of the drug.<ref>https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</ref> The [https://www.fda.gov U.S. Food & Drug Administration (FDA)] provides the safest ways of disposing of these medications at home [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm here]. The FDA also recommends that certain drugs be flushed immediately, such as fentanyl patches, Oxycontin, and Percocet. A full list can be found on [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm#Flush_List this ]page.  Other experts strongly recommend '''not''' flushing medications down the toilet.<ref>Minnesota Pollution Control Agency https://www.pca.state.mn.us/featured/dont-flush-medicines-down-drain</ref>

The bottom line is that the best options are bringing your medications to a take-back day, putting them into a drug disposal kiosk, or using a mail-based program to send in the medications for proper disposal.  But, if you don't have access to these options, flushing unused medications that are on the "flush list" is better than keeping them around.   

== Special Populations ==

=== Senior Citizens ===

Senior citizens have a disproportionate number of medications in their homes. Helping seniors understand how to properly dispose of medications can make a big difference in the success of your program.  The Colorado Consortium for Prescription Drug Abuse Prevention has developed a successful program for reaching people age 65+ called "You're the Solution." This campaign has techniques and materials that can be used around the country. 

Learn more about [[You're_the_Solution|You're_the_Solution]] 

=== Nursing Homes ===

Individual patients aside, one study estimated the nation’s nursing homes discard anywhere from $73 million to $378 million worth of drugs a year. Some are incinerated, but many are flushed.<ref>https://www.nbcnews.com/health/health-news/got-old-medicine-don-t-flush-it-flna1c9478735</ref>  

Nursing homes could be provided with information and tools (or services) for more appropriate disposal options that are better for the environemnt and that minimize the likelihood of diversion of these medications.

=== Hospice Programs or Funeral Home Programs ===

Hospice programs can help family members understand how to properly handle the medications they inherit when a loved one passes away.<ref>https://www.dea.gov/press-releases/2017/05/08/dea-brings-record-amount-unused-prescription-drugs-national-prescription</ref>

Funeral homes may pass out a brochure to remind people to make sure that any prescription drugs that were being taken by a loved one are properly disposed of.  People in the late stages of life may have been getting prescription opioids to deal with pain.  Hospice and funeral homes could be provided with disposal products (like Seal&Send envelopes).

 

== Take-back Events ==

=== DEA National Drug Take-Back Day Initiative ===

The National Prescription Drug Take Back Day Initiative addresses a crucial public safety and public health issue by providing an opportunity for Americans to prevent drug addiction and overdose deaths. As of May 2017, the DEA has promoted 13 national take-back days, and they continue to collect more and more drugs each time. <ref>https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0 </ref> '''[https://www.deadiversion.usdoj.gov/drug_disposal/takeback/newsrelease.htm Program Successes]'''

*Over 4,200 law enforcement and community partners and 5,500 sites across the country.
*Since September 2010, these events have altogether collected 8,103,363 pounds (4,052 tons) of prescription drugs.
*The last National Take-back Day collected more than 900,386 pounds (450 tons).

To promote your local Rx Take Back Day, the DEA provides a [https://takebackday.dea.gov/content/partnership-toolbox partnership toolkit] featuring promotional materials for associated partners.<ref>https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0</ref> '''See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more DEA take-back resources and other ideas on how to implement a local take-back day.'''

 

=== State Level Drug Take Back Programs ===

See below for inspiration and ideas to replicate from current state efforts:

*[http://www.ddap.pa.gov/Prevention/Pages/Drug_Take_Back.aspx#.V07YY_krLcs Pennsylvania]
*[http://www.in.gov/bitterpill/ Indiana]
*[http://www.oregon.gov/oha/ph/HealthyEnvironments/DrinkingWater/SourceWater/Pages/takeback.aspx Oregon]
*[https://www.artakeback.org Arkansas]
*[http://www.takebackyourmeds.org/ Washington]
*[http://stoprxabuseinga.org/ Georgia]

== Increasing the Number of Drug Drop-Boxes in your Community ==

Since disposing of unneeded medications via a drug drop box is considered the best option, it is important for communities to increase the number of drop boxes that are available and to promote awareness of those drop boxes. 

This [https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/pharms_reports_factsheets/160920_PSI_Pharmacy_Guide_vS.pdf How-To Guide for Drug Take-Back], created by the Product Stewardship Institute, provides detailed guidance for expanding and improving a pharmacy-based collection program. 

The [http://www.rxdrugdropbox.org/ NADDI prescription drug dropbox ] website is an important resource to find locations of drop boxes, buy boxes, apply for grants, and other information about drop boxes.

With the help of the [https://www.naddi.org/ National Association of Drug Diversion Investigators], communities can apply for grants to receive a drop-box that will hold old opioids to prevent abuse. These boxes have resulted in multiple cities and communities being safer and reducing the risk of opioid addiction. Boxes are to be located in close proximity to law enforcement agencies so nothing happens to them. Multiple boxes have been placed in the State of Minnesota, and after reaching out to one town in specific, Fridley, they told us that they have seen a positive response to the drop-box. They have discarded pounds of prescription opioids that came from an at-risk community.

 

== In-Home Disposal ==

=== Medication Mail-back Envelopes ===

'''Stericycle Prescription Drug Seal&Send Pouches'''

Stericycle provides an option for unused prescription drugs to be mailed to them in an unmarked mailing pouch, and then the pills are incinerated. 

Learn more at: [https://www.stericycleenvironmental.com/tag/pharmaceutical-takeback/ https://www.stericycleenvironmental.com/tag/pharmaceutical-takeback/] 

 

=== In-home disposal pouches & powders ===

'''Deterra Drug Disposal System '''

Minneapolis-based company Verde Technologies has created a product called [http://deterrasystem.com/ Deterra®] System which deactivates prescription drugs. Each patented Deterra® pouch contains a water-soluble inner pod containing MAT12® activated carbon. Once the pharmaceuticals are placed in the pouch, warm water is then added, which dissolves the inner pod releasing the activated carbon. The warm water also dissolves prescription pills, patches, and liquids, allowing them to be absorbed by the carbon, rendering them inert and non-retrievable. For more information on how to use Deterra®, view this [https://www.youtube.com/watch?v=lSBwBqpTk2c How-to video]

'''Benefits'''

*Inexpensive - Costs $7 per pouch
*Can encourage people to connect with law enforcement - People can pick up free (if already given to law enforcement) pouches from the station and dispose of them at home and save any potential embarrassment
*Improve overall water quality - with the majority of people flushing unused medication down the toilet, only water treatment facilities remove less than half of the prescription drugs found in sewage

'''DisposeRx'''

[http://disposerx.com/ Dispose Rx] is "a patented (pending) blend of solidifying materials that provides a solution for the safe disposal of unwanted or expired prescription drugs. Dedicated to environmentally friendly and safe non-toxic disposal solutions, DisposeRx is spearheading programs of educating communities with practical and safe medication disposing solutions, thus preventing the cycle of environmental pollution, addiction, overdose, and death." Prescription drugs can be rendered safe for disposal (and impossible to misuse) by adding powder from a packet directly into the pill bottle and shaking the bottle.

*Inexpensive - Costs about $1.50 per packet (and [https://www.aarp.org/health/drugs-supplements/info-2018/walmart-dispose-painkillers-fd.html Walmart gives the packets away free with a prescription or possibly a request])
*Packets can be attached to prescriptions with a rubber band (much like flower fertilizer is attached to fresh-cut flowers)
*Well-suited to campaigns with community partners (like clinics, churches, barbershops, or hair salons) to increase distribution to diverse populations.

See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more information.

 

= Relevant Research =

SAFE Solutions is an ever-growing platform. Currently limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

= Impactful Federal, State, and Local Policies =

== Legislation & Drug Companies ==

Currently, several West Coast counties, the city of San Francisco, and the state of Massachusetts have issued legislation that require drug companies to fund drug take-back programs.<ref>[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/ </ref> On a national level, however, only 2.5 percent of eligible take-back organizations are participating, according to the Government Accountability Office. <ref>https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/</ref> The primary barrier seems to be financial: Maintaining the safe-like prescription drop-off container, training staff to follow the relevant regulations, and destroying the returned medication costs money. As a potential solution, writing a policy that mandates opioid manufacturers to pay patients for their returned bottles of pills, along with subsidizing drop-off location operators, could offset the costs and be what is needed to make returning leftover medication an automatic habit for consumers. <ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref> The [http://www.productstewardship.us/ Product Stewardship Institute], a nonprofit that supports drug take-back programs, calculated that at least a dozen other local governments around the country are considering similar legislation, including several California counties. In Minnesota, pharmaceutical company [http://www.mallinckrodt.com/ Mallinckrodt] donated 30,000 disposal pouch systems to be distributed.<ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref>

 

== State Legislation Requiring Disposal Kits be Given with Prescriptions ==

The Kentucky State Senate passed in March 2018 a bill that requires opioids and other abused drugs to be dispensed along with a method to permanently sequester and dispose of any leftover pills. If passed by the house and signed, it will be the first state to pass such a bill.  [http://www.disposerx.com DisposeRx] will be a popular choice to be given out along with prescription.  Other options include the Seal & Send mail-back packages or other options described below.

= Available Tools and Resources =

[[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|TR - Expand Prescription Drug Take-back & Disposal Programs]]

== Local Disposal Drop Boxes ==

=== Finding Disposal Locations ===

==== Medication Disposal Locators ====

Use the following links to find drug disposal locations

*[https://apps.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e1s1 DEA's Disposal Locator] - Find locations in your ZIP code. These collectors are registered with the DEA and pass unused medicine on to the agency to disposed.<ref>https://www.hometownsource.com/sun_focus/news/local/drop-off-prescription-drugs-anonymously-at-fridley-pd/article_b07bd27d-1122-55fa-8465-f47ad9a861dc.html</ref>
*[http://rxdrugdropbox.org/ Rx Drop Box]
*[http://disposemymeds.org/ Dispose My Meds]
*[https://nabp.pharmacy/initiatives/awarxe/drug-disposal-locator/ National Association of Boards of Pharmacy]
*[http://www.americanmedicinechest.com/ The American Medicine Chest Challenge]
*[https://walgreens.maps.arcgis.com/apps/MapSeries/index.html?appid=53cf1b54abf34c4bacdec863e5c56391 Walgreens Safe Medication Disposal Program]

= Promising Practices =

'''Current Efforts to Promote In-Home Disposal'''
<div class="objectEmbed">Case Studies</div>
The state of Pennsylvania has a goal of distributing Deterra® Drug Deactivation and Disposal pouches alongside 10% of all opioid prescriptions.
<div class="objectEmbed">Attorney General Shapiro Unveils Plan to Distribute 300,000 Drug Disposal Pouches in 12 counties<ref>https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</ref></div> <div class="objectEmbed">[https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html]</div>
Inspira Health Network (New Jersey) distributed the Deterra® pouch throughout their network. [http://www.njtvonline.org/news/video/inspira-health-network-battles-opioid-crisis-proper-drug-disposal/ Case Study] These pouches render opioids ineffective for misuse and are safe for disposal and the environment, and are another cost-efficient way to safely dispose of opioids.

= Actions to Take =

There are many actions that can be taken by coalitions, organizations or individuals to improve drug take-back and disposal.  Explore the ideas via the following link: [[PA_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Coalitions]]

[[PAI_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Individuals]]

'''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

 

= Sources =

----

 

[[Category:Pages with broken file links]] [[Category:SAFE-Prescriptions and Medical Response]]

Expand Prescription Drug Take-back & Disposal Program

2021-10-31T02:27:52Z

G.Lehrman:

''Return to [[ZOOM_MAP_-_Reduce_Diversion_of_Prescription_Drugs|Reduce Diversion of Prescription Drugs]]''

----

 

= Introductory Paragraph =

Most opioid abuse prevention strategies include some sort of prescription drug take-back or disposal program.  This is a step in the right direction, but most communities have significant opportunities to expand and enhance these efforts to reach more people and reduce the ability of people to misuse these medications or give them to others who may misuse them.  This objective focuses on practical ways to make improvements to existing efforts and to add new options that communities may not yet be doing. 

= Key Information =

== Why Safe Disposal is Important ==

'''Intentional Misuse''':

*A majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet.<ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ </ref>
*SAMHSA’s 2009 National Survey on Drug Use and Health found that over 70 percent of people who used prescription pain relievers non-medically got them from friends or relatives, while approximately 5 percent got them from a drug dealer or from the Internet.
*Getting hooked on prescription opioids is directly responsible for over 60% of subsequent heroin addictions as addicts turn to this less expensive alternative.
*Prescription drugs involved in overdoses are almost all originally prescribed by physicians but are used by individuals other than the patient prescribed the drugs. (Get sources for this.) 

'''Accidental Exposure''':

*When medicines are no longer needed or have expired, it is important to properly dispose of them to reduce harm from accidental exposure or intentional misuse.<ref>http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm</ref> Throwing drugs in the garbage is a bad idea, because they can accidentally be taken by kids or pets.

'''Environmental Concerns''':

*Some people propose flushing or pouring unused medications down the drain, however, medications flushed into the waste stream can end up in water supplies.<ref>http://www.takebackyourmeds.org/what-you-can-do/medicine-disposal-myths-and-facts/</ref>
*Since the drugs in take-back programs are incinerated, take-back programs are the safest way to get rid of the chemicals and to stop them from getting into drinking water and watersheds as well as in the hands of those at risk.
*Innovative mail-back options provide a convenient way for people to have excess medications disposed of through incineration. (Details further down on this page.)

== Costs and Benefits of Safe Disposal Options ==

This fact sheet from the Product Stewardship Institute provides a good summary of the costs and benefits of different drug take-back and disposal options. 

[https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf]

== To Flush or Not to Flush ==

If no take-back programs are readily available, it is still important to dispose of the medications quickly and appropriately. Some prescriptions include instructions on how to dispose of the drug.<ref>https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</ref> The [https://www.fda.gov U.S. Food & Drug Administration (FDA)] provides the safest ways of disposing of these medications at home [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm here]. The FDA also recommends that certain drugs be flushed immediately, such as fentanyl patches, Oxycontin, and Percocet. A full list can be found on [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm#Flush_List this ]page.  Other experts strongly recommend '''not''' flushing medications down the toilet.<ref>Minnesota Pollution Control Agency https://www.pca.state.mn.us/featured/dont-flush-medicines-down-drain</ref>

The bottom line is that the best options are bringing your medications to a take-back day, putting them into a drug disposal kiosk, or using a mail-based program to send in the medications for proper disposal.  But, if you don't have access to these options, flushing unused medications that are on the "flush list" is better than keeping them around.   

== Special Populations ==

=== Senior Citizens ===

Senior citizens have a disproportionate number of medications in their homes. Helping seniors understand how to properly dispose of medications can make a big difference in the success of your program.  The Colorado Consortium for Prescription Drug Abuse Prevention has developed a successful program for reaching people age 65+ called "You're the Solution." This campaign has techniques and materials that can be used around the country. 

Learn more about [[You're_the_Solution|You're_the_Solution]] 

=== Nursing Homes ===

Individual patients aside, one study estimated the nation’s nursing homes discard anywhere from $73 million to $378 million worth of drugs a year. Some are incinerated, but many are flushed.<ref>https://www.nbcnews.com/health/health-news/got-old-medicine-don-t-flush-it-flna1c9478735</ref>  

Nursing homes could be provided with information and tools (or services) for more appropriate disposal options that are better for the environemnt and that minimize the likelihood of diversion of these medications.

=== Hospice Programs or Funeral Home Programs ===

Hospice programs can help family members understand how to properly handle the medications they inherit when a loved one passes away.<ref>https://www.dea.gov/press-releases/2017/05/08/dea-brings-record-amount-unused-prescription-drugs-national-prescription</ref>

Funeral homes may pass out a brochure to remind people to make sure that any prescription drugs that were being taken by a loved one are properly disposed of.  People in the late stages of life may have been getting prescription opioids to deal with pain.  Hospice and funeral homes could be provided with disposal products (like Seal&Send envelopes).

 

== Take-back Events ==

=== DEA National Drug Take-Back Day Initiative ===

The National Prescription Drug Take Back Day Initiative addresses a crucial public safety and public health issue by providing an opportunity for Americans to prevent drug addiction and overdose deaths. As of May 2017, the DEA has promoted 13 national take-back days, and they continue to collect more and more drugs each time. <ref>https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0 </ref> '''[https://www.deadiversion.usdoj.gov/drug_disposal/takeback/newsrelease.htm Program Successes]'''

*Over 4,200 law enforcement and community partners and 5,500 sites across the country.
*Since September 2010, these events have altogether collected 8,103,363 pounds (4,052 tons) of prescription drugs.
*The last National Take-back Day collected more than 900,386 pounds (450 tons).

To promote your local Rx Take Back Day, the DEA provides a [https://takebackday.dea.gov/content/partnership-toolbox partnership toolkit] featuring promotional materials for associated partners.<ref>https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0</ref> '''See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more DEA take-back resources and other ideas on how to implement a local take-back day.'''

 

=== State Level Drug Take Back Programs ===

See below for inspiration and ideas to replicate from current state efforts:

*[http://www.ddap.pa.gov/Prevention/Pages/Drug_Take_Back.aspx#.V07YY_krLcs Pennsylvania]
*[http://www.in.gov/bitterpill/ Indiana]
*[http://www.oregon.gov/oha/ph/HealthyEnvironments/DrinkingWater/SourceWater/Pages/takeback.aspx Oregon]
*[https://www.artakeback.org Arkansas]
*[http://www.takebackyourmeds.org/ Washington]
*[http://stoprxabuseinga.org/ Georgia]

== Increasing the Number of Drug Drop-Boxes in your Community ==

Since disposing of unneeded medications via a drug drop box is considered the best option, it is important for communities to increase the number of drop boxes that are available and to promote awareness of those drop boxes. 

This [https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/pharms_reports_factsheets/160920_PSI_Pharmacy_Guide_vS.pdf How-To Guide for Drug Take-Back], created by the Product Stewardship Institute, provides detailed guidance for expanding and improving a pharmacy-based collection program. 

The [http://www.rxdrugdropbox.org/ NADDI prescription drug dropbox ] website is an important resource to find locations of drop boxes, buy boxes, apply for grants, and other information about drop boxes.

With the help of the [https://www.naddi.org/ National Association of Drug Diversion Investigators], communities can apply for grants to receive a drop-box that will hold old opioids to prevent abuse. These boxes have resulted in multiple cities and communities being safer and reducing the risk of opioid addiction. Boxes are to be located in close proximity to law enforcement agencies so nothing happens to them. Multiple boxes have been placed in the State of Minnesota, and after reaching out to one town in specific, Fridley, they told us that they have seen a positive response to the drop-box. They have discarded pounds of prescription opioids that came from an at-risk community.

 

== In-Home Disposal ==

=== Medication Mail-back Envelopes ===

'''Stericycle Prescription Drug Seal&Send Pouches'''

Stericycle provides an option for unused prescription drugs to be mailed to them in an unmarked mailing pouch, and then the pills are incinerated. 

Learn more at: [https://www.stericycleenvironmental.com/tag/pharmaceutical-takeback/ https://www.stericycleenvironmental.com/tag/pharmaceutical-takeback/] 

 

=== In-home disposal pouches & powders ===

'''Deterra Drug Disposal System '''

Minneapolis-based company Verde Technologies has created a product called [http://deterrasystem.com/ Deterra®] System which deactivates prescription drugs. Each patented Deterra® pouch contains a water-soluble inner pod containing MAT12® activated carbon. Once the pharmaceuticals are placed in the pouch, warm water is then added, which dissolves the inner pod releasing the activated carbon. The warm water also dissolves prescription pills, patches, and liquids, allowing them to be absorbed by the carbon, rendering them inert and non-retrievable. For more information on how to use Deterra®, view this [https://www.youtube.com/watch?v=lSBwBqpTk2c How-to video]

'''Benefits'''

*Inexpensive - Costs $7 per pouch
*Can encourage people to connect with law enforcement - People can pick up free (if already given to law enforcement) pouches from the station and dispose of them at home and save any potential embarrassment
*Improve overall water quality - with the majority of people flushing unused medication down the toilet, only water treatment facilities remove less than half of the prescription drugs found in sewage

'''DisposeRx'''

[http://disposerx.com/ Dispose Rx] is "a patented (pending) blend of solidifying materials that provides a solution for the safe disposal of unwanted or expired prescription drugs. Dedicated to environmentally friendly and safe non-toxic disposal solutions, DisposeRx is spearheading programs of educating communities with practical and safe medication disposing solutions, thus preventing the cycle of environmental pollution, addiction, overdose, and death." Prescription drugs can be rendered safe for disposal (and impossible to misuse) by adding powder from a packet directly into the pill bottle and shaking the bottle.

*Inexpensive - Costs about $1.50 per packet (and [https://www.aarp.org/health/drugs-supplements/info-2018/walmart-dispose-painkillers-fd.html Walmart gives the packets away free with a prescription or possibly a request])
*Packets can be attached to prescriptions with a rubber band (much like flower fertilizer is attached to fresh-cut flowers)
*Well-suited to campaigns with community partners (like clinics, churches, barbershops, or hair salons) to increase distribution to diverse populations.

See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more information.

 

= Relevant Research =

= Impactful Federal, State, and Local Policies =

== Legislation & Drug Companies ==

Currently, several West Coast counties, the city of San Francisco, and the state of Massachusetts have issued legislation that require drug companies to fund drug take-back programs.<ref>[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/ </ref> On a national level, however, only 2.5 percent of eligible take-back organizations are participating, according to the Government Accountability Office. <ref>https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/</ref> The primary barrier seems to be financial: Maintaining the safe-like prescription drop-off container, training staff to follow the relevant regulations, and destroying the returned medication costs money. As a potential solution, writing a policy that mandates opioid manufacturers to pay patients for their returned bottles of pills, along with subsidizing drop-off location operators, could offset the costs and be what is needed to make returning leftover medication an automatic habit for consumers. <ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref> The [http://www.productstewardship.us/ Product Stewardship Institute], a nonprofit that supports drug take-back programs, calculated that at least a dozen other local governments around the country are considering similar legislation, including several California counties. In Minnesota, pharmaceutical company [http://www.mallinckrodt.com/ Mallinckrodt] donated 30,000 disposal pouch systems to be distributed.<ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref>

 

== State Legislation Requiring Disposal Kits be Given with Prescriptions ==

The Kentucky State Senate passed in March 2018 a bill that requires opioids and other abused drugs to be dispensed along with a method to permanently sequester and dispose of any leftover pills. If passed by the house and signed, it will be the first state to pass such a bill.  [http://www.disposerx.com DisposeRx] will be a popular choice to be given out along with prescription.  Other options include the Seal & Send mail-back packages or other options described below.

= Available Tools and Resources =

[[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|TR - Expand Prescription Drug Take-back & Disposal Programs]]

== Local Disposal Drop Boxes ==

=== Finding Disposal Locations ===

==== Medication Disposal Locators ====

Use the following links to find drug disposal locations

*[https://apps.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e1s1 DEA's Disposal Locator] - Find locations in your ZIP code. These collectors are registered with the DEA and pass unused medicine on to the agency to disposed.<ref>https://www.hometownsource.com/sun_focus/news/local/drop-off-prescription-drugs-anonymously-at-fridley-pd/article_b07bd27d-1122-55fa-8465-f47ad9a861dc.html</ref>
*[http://rxdrugdropbox.org/ Rx Drop Box]
*[http://disposemymeds.org/ Dispose My Meds]
*[https://nabp.pharmacy/initiatives/awarxe/drug-disposal-locator/ National Association of Boards of Pharmacy]
*[http://www.americanmedicinechest.com/ The American Medicine Chest Challenge]
*[https://walgreens.maps.arcgis.com/apps/MapSeries/index.html?appid=53cf1b54abf34c4bacdec863e5c56391 Walgreens Safe Medication Disposal Program]

= Promising Practices =

'''Current Efforts to Promote In-Home Disposal'''
<div class="objectEmbed">Case Studies</div>
The state of Pennsylvania has a goal of distributing Deterra® Drug Deactivation and Disposal pouches alongside 10% of all opioid prescriptions.
<div class="objectEmbed">Attorney General Shapiro Unveils Plan to Distribute 300,000 Drug Disposal Pouches in 12 counties<ref>https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</ref></div> <div class="objectEmbed">[https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html]</div>
Inspira Health Network (New Jersey) distributed the Deterra® pouch throughout their network. [http://www.njtvonline.org/news/video/inspira-health-network-battles-opioid-crisis-proper-drug-disposal/ Case Study] These pouches render opioids ineffective for misuse and are safe for disposal and the environment, and are another cost-efficient way to safely dispose of opioids.

= Actions to Take =

There are many actions that can be taken by coalitions, organizations or individuals to improve drug take-back and disposal.  Explore the ideas via the following link: [[PA_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Coalitions]]

[[PAI_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Individuals]]

'''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

 

= Sources =

----

 

[[Category:Pages with broken file links]] [[Category:SAFE-Prescriptions and Medical Response]]

Expand Prescription Drug Take-back & Disposal Program

2021-10-31T02:26:00Z

G.Lehrman:

''Return to [[ZOOM_MAP_-_Reduce_Diversion_of_Prescription_Drugs|Reduce Diversion of Prescription Drugs]]''

----

= Introductory Paragraph =

Most opioid abuse prevention strategies include some sort of prescription drug take-back or disposal program.  This is a step in the right direction, but most communities have significant opportunities to expand and enhance these efforts to reach more people and reduce the ability of people to misuse these medications or give them to others who may misuse them.  This objective focuses on practical ways to make improvements to existing efforts and to add new options that communities may not yet be doing. 

= Key Information =

== Why Safe Disposal is Important ==

'''Intentional Misuse''':

*A majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet.<ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ </ref>
*SAMHSA’s 2009 National Survey on Drug Use and Health found that over 70 percent of people who used prescription pain relievers non-medically got them from friends or relatives, while approximately 5 percent got them from a drug dealer or from the Internet.
*Getting hooked on prescription opioids is directly responsible for over 60% of subsequent heroin addictions as addicts turn to this less expensive alternative.
*Prescription drugs involved in overdoses are almost all originally prescribed by physicians but are used by individuals other than the patient prescribed the drugs. (Get sources for this.) 

'''Accidental Exposure''':

*When medicines are no longer needed or have expired, it is important to properly dispose of them to reduce harm from accidental exposure or intentional misuse.<ref>http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm</ref> Throwing drugs in the garbage is a bad idea, because they can accidentally be taken by kids or pets.

'''Environmental Concerns''':

*Some people propose flushing or pouring unused medications down the drain, however, medications flushed into the waste stream can end up in water supplies.<ref>http://www.takebackyourmeds.org/what-you-can-do/medicine-disposal-myths-and-facts/</ref>
*Since the drugs in take-back programs are incinerated, take-back programs are the safest way to get rid of the chemicals and to stop them from getting into drinking water and watersheds as well as in the hands of those at risk.
*Innovative mail-back options provide a convenient way for people to have excess medications disposed of through incineration. (Details further down on this page.)

== Costs and Benefits of Safe Disposal Options ==

This fact sheet from the Product Stewardship Institute provides a good summary of the costs and benefits of different drug take-back and disposal options. 

[https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf]

== To Flush or Not to Flush ==

If no take-back programs are readily available, it is still important to dispose of the medications quickly and appropriately. Some prescriptions include instructions on how to dispose of the drug.<ref>https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</ref> The [https://www.fda.gov U.S. Food & Drug Administration (FDA)] provides the safest ways of disposing of these medications at home [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm here]. The FDA also recommends that certain drugs be flushed immediately, such as fentanyl patches, Oxycontin, and Percocet. A full list can be found on [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm#Flush_List this ]page.  Other experts strongly recommend '''not''' flushing medications down the toilet.<ref>Minnesota Pollution Control Agency https://www.pca.state.mn.us/featured/dont-flush-medicines-down-drain</ref>

The bottom line is that the best options are bringing your medications to a take-back day, putting them into a drug disposal kiosk, or using a mail-based program to send in the medications for proper disposal.  But, if you don't have access to these options, flushing unused medications that are on the "flush list" is better than keeping them around.   

== Special Populations ==

=== Senior Citizens ===

Senior citizens have a disproportionate number of medications in their homes. Helping seniors understand how to properly dispose of medications can make a big difference in the success of your program.  The Colorado Consortium for Prescription Drug Abuse Prevention has developed a successful program for reaching people age 65+ called "You're the Solution." This campaign has techniques and materials that can be used around the country. 

Learn more about [[You're_the_Solution|You're_the_Solution]] 

=== Nursing Homes ===

Individual patients aside, one study estimated the nation’s nursing homes discard anywhere from $73 million to $378 million worth of drugs a year. Some are incinerated, but many are flushed.<ref>https://www.nbcnews.com/health/health-news/got-old-medicine-don-t-flush-it-flna1c9478735</ref>  

Nursing homes could be provided with information and tools (or services) for more appropriate disposal options that are better for the environemnt and that minimize the likelihood of diversion of these medications.

=== Hospice Programs or Funeral Home Programs ===

Hospice programs can help family members understand how to properly handle the medications they inherit when a loved one passes away.<ref>https://www.dea.gov/press-releases/2017/05/08/dea-brings-record-amount-unused-prescription-drugs-national-prescription</ref>

Funeral homes may pass out a brochure to remind people to make sure that any prescription drugs that were being taken by a loved one are properly disposed of.  People in the late stages of life may have been getting prescription opioids to deal with pain.  Hospice and funeral homes could be provided with disposal products (like Seal&Send envelopes).

 

 

== Take-back Events ==

=== DEA National Drug Take-Back Day Initiative ===

The National Prescription Drug Take Back Day Initiative addresses a crucial public safety and public health issue by providing an opportunity for Americans to prevent drug addiction and overdose deaths. As of May 2017, the DEA has promoted 13 national take-back days, and they continue to collect more and more drugs each time. <ref>https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0 </ref> '''[https://www.deadiversion.usdoj.gov/drug_disposal/takeback/newsrelease.htm Program Successes]'''

*Over 4,200 law enforcement and community partners and 5,500 sites across the country.
*Since September 2010, these events have altogether collected 8,103,363 pounds (4,052 tons) of prescription drugs.
*The last National Take-back Day collected more than 900,386 pounds (450 tons).

To promote your local Rx Take Back Day, the DEA provides a [https://takebackday.dea.gov/content/partnership-toolbox partnership toolkit] featuring promotional materials for associated partners.<ref>https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0</ref> '''See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more DEA take-back resources and other ideas on how to implement a local take-back day.'''

 

=== State Level Drug Take Back Programs ===

See below for inspiration and ideas to replicate from current state efforts:

*[http://www.ddap.pa.gov/Prevention/Pages/Drug_Take_Back.aspx#.V07YY_krLcs Pennsylvania]
*[http://www.in.gov/bitterpill/ Indiana]
*[http://www.oregon.gov/oha/ph/HealthyEnvironments/DrinkingWater/SourceWater/Pages/takeback.aspx Oregon]
*[https://www.artakeback.org Arkansas]
*[http://www.takebackyourmeds.org/ Washington]
*[http://stoprxabuseinga.org/ Georgia]

== Increasing the Number of Drug Drop-Boxes in your Community ==

Since disposing of unneeded medications via a drug drop box is considered the best option, it is important for communities to increase the number of drop boxes that are available and to promote awareness of those drop boxes. 

This [https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/pharms_reports_factsheets/160920_PSI_Pharmacy_Guide_vS.pdf How-To Guide for Drug Take-Back], created by the Product Stewardship Institute, provides detailed guidance for expanding and improving a pharmacy-based collection program. 

The [http://www.rxdrugdropbox.org/ NADDI prescription drug dropbox ] website is an important resource to find locations of drop boxes, buy boxes, apply for grants, and other information about drop boxes.

With the help of the [https://www.naddi.org/ National Association of Drug Diversion Investigators], communities can apply for grants to receive a drop-box that will hold old opioids to prevent abuse. These boxes have resulted in multiple cities and communities being safer and reducing the risk of opioid addiction. Boxes are to be located in close proximity to law enforcement agencies so nothing happens to them. Multiple boxes have been placed in the State of Minnesota, and after reaching out to one town in specific, Fridley, they told us that they have seen a positive response to the drop-box. They have discarded pounds of prescription opioids that came from an at-risk community.

 

 

== In-Home Disposal ==

=== Medication Mail-back Envelopes ===

'''Stericycle Prescription Drug Seal&Send Pouches'''

Stericycle provides an option for unused prescription drugs to be mailed to them in an unmarked mailing pouch, and then the pills are incinerated. 

Learn more at: [https://www.stericycleenvironmental.com/tag/pharmaceutical-takeback/ https://www.stericycleenvironmental.com/tag/pharmaceutical-takeback/] 

 

=== In-home disposal pouches & powders ===

'''Deterra Drug Disposal System '''

Minneapolis-based company Verde Technologies has created a product called [http://deterrasystem.com/ Deterra®] System which deactivates prescription drugs. Each patented Deterra® pouch contains a water-soluble inner pod containing MAT12® activated carbon. Once the pharmaceuticals are placed in the pouch, warm water is then added, which dissolves the inner pod releasing the activated carbon. The warm water also dissolves prescription pills, patches, and liquids, allowing them to be absorbed by the carbon, rendering them inert and non-retrievable. For more information on how to use Deterra®, view this [https://www.youtube.com/watch?v=lSBwBqpTk2c How-to video]

'''Benefits'''

*Inexpensive - Costs $7 per pouch
*Can encourage people to connect with law enforcement - People can pick up free (if already given to law enforcement) pouches from the station and dispose of them at home and save any potential embarrassment
*Improve overall water quality - with the majority of people flushing unused medication down the toilet, only water treatment facilities remove less than half of the prescription drugs found in sewage

'''DisposeRx'''

[http://disposerx.com/ Dispose Rx] is "a patented (pending) blend of solidifying materials that provides a solution for the safe disposal of unwanted or expired prescription drugs. Dedicated to environmentally friendly and safe non-toxic disposal solutions, DisposeRx is spearheading programs of educating communities with practical and safe medication disposing solutions, thus preventing the cycle of environmental pollution, addiction, overdose, and death." Prescription drugs can be rendered safe for disposal (and impossible to misuse) by adding powder from a packet directly into the pill bottle and shaking the bottle.

*Inexpensive - Costs about $1.50 per packet (and [https://www.aarp.org/health/drugs-supplements/info-2018/walmart-dispose-painkillers-fd.html Walmart gives the packets away free with a prescription or possibly a request])
*Packets can be attached to prescriptions with a rubber band (much like flower fertilizer is attached to fresh-cut flowers)
*Well-suited to campaigns with community partners (like clinics, churches, barbershops, or hair salons) to increase distribution to diverse populations.

See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more information.

 

 

= Impactful Federal, State, and Local Policies =

== Legislation & Drug Companies ==

Currently, several West Coast counties, the city of San Francisco, and the state of Massachusetts have issued legislation that require drug companies to fund drug take-back programs.<ref>[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/ </ref> On a national level, however, only 2.5 percent of eligible take-back organizations are participating, according to the Government Accountability Office. <ref>https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/</ref> The primary barrier seems to be financial: Maintaining the safe-like prescription drop-off container, training staff to follow the relevant regulations, and destroying the returned medication costs money. As a potential solution, writing a policy that mandates opioid manufacturers to pay patients for their returned bottles of pills, along with subsidizing drop-off location operators, could offset the costs and be what is needed to make returning leftover medication an automatic habit for consumers. <ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref> The [http://www.productstewardship.us/ Product Stewardship Institute], a nonprofit that supports drug take-back programs, calculated that at least a dozen other local governments around the country are considering similar legislation, including several California counties. In Minnesota, pharmaceutical company [http://www.mallinckrodt.com/ Mallinckrodt] donated 30,000 disposal pouch systems to be distributed.<ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref>

 

== State Legislation Requiring Disposal Kits be Given with Prescriptions ==

The Kentucky State Senate passed in March 2018 a bill that requires opioids and other abused drugs to be dispensed along with a method to permanently sequester and dispose of any leftover pills. If passed by the house and signed, it will be the first state to pass such a bill.  [http://www.disposerx.com DisposeRx] will be a popular choice to be given out along with prescription.  Other options include the Seal & Send mail-back packages or other options described below.

= Available Tools and Resources =

[[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|TR - Expand Prescription Drug Take-back & Disposal Programs]]

== Local Disposal Drop Boxes ==

=== Finding Disposal Locations ===

==== Medication Disposal Locators ====

Use the following links to find drug disposal locations

*[https://apps.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e1s1 DEA's Disposal Locator] - Find locations in your ZIP code. These collectors are registered with the DEA and pass unused medicine on to the agency to disposed.<ref>https://www.hometownsource.com/sun_focus/news/local/drop-off-prescription-drugs-anonymously-at-fridley-pd/article_b07bd27d-1122-55fa-8465-f47ad9a861dc.html</ref>
*[http://rxdrugdropbox.org/ Rx Drop Box]
*[http://disposemymeds.org/ Dispose My Meds]
*[https://nabp.pharmacy/initiatives/awarxe/drug-disposal-locator/ National Association of Boards of Pharmacy]
*[http://www.americanmedicinechest.com/ The American Medicine Chest Challenge]
*[https://walgreens.maps.arcgis.com/apps/MapSeries/index.html?appid=53cf1b54abf34c4bacdec863e5c56391 Walgreens Safe Medication Disposal Program]

= Promising Practices =

'''Current Efforts to Promote In-Home Disposal'''
<div class="objectEmbed">Case Studies</div>
The state of Pennsylvania has a goal of distributing Deterra® Drug Deactivation and Disposal pouches alongside 10% of all opioid prescriptions.
<div class="objectEmbed">Attorney General Shapiro Unveils Plan to Distribute 300,000 Drug Disposal Pouches in 12 counties<ref>https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</ref></div> <div class="objectEmbed">[https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html]</div>
Inspira Health Network (New Jersey) distributed the Deterra® pouch throughout their network. [http://www.njtvonline.org/news/video/inspira-health-network-battles-opioid-crisis-proper-drug-disposal/ Case Study] These pouches render opioids ineffective for misuse and are safe for disposal and the environment, and are another cost-efficient way to safely dispose of opioids.

= Actions to Take =

There are many actions that can be taken by coalitions, organizations or individuals to improve drug take-back and disposal.  Explore the ideas via the following link: [[PA_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Coalitions]]

[[PAI_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Individuals]]

'''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

{| class="wiki_table"
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| '''Date'''
| '''Comments'''
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= Sources =

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[[Category:Pages with broken file links]] [[Category:SAFE-Prescriptions and Medical Response]]

Expand Prescription Drug Take-back & Disposal Program

2021-10-31T02:24:45Z

G.Lehrman:

''Return to [[ZOOM_MAP_-_Reduce_Diversion_of_Prescription_Drugs|Reduce Diversion of Prescription Drugs]]''

----

= Introductory Paragraph =

Most opioid abuse prevention strategies include some sort of prescription drug take-back or disposal program.  This is a step in the right direction, but most communities have significant opportunities to expand and enhance these efforts to reach more people and reduce the ability of people to misuse these medications or give them to others who may misuse them.  This objective focuses on practical ways to make improvements to existing efforts and to add new options that communities may not yet be doing. 

 

= Key Information =

== Why Safe Disposal is Important ==

'''Intentional Misuse''':

*A majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet.<ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ </ref>
*SAMHSA’s 2009 National Survey on Drug Use and Health found that over 70 percent of people who used prescription pain relievers non-medically got them from friends or relatives, while approximately 5 percent got them from a drug dealer or from the Internet.
*Getting hooked on prescription opioids is directly responsible for over 60% of subsequent heroin addictions as addicts turn to this less expensive alternative.
*Prescription drugs involved in overdoses are almost all originally prescribed by physicians but are used by individuals other than the patient prescribed the drugs. (Get sources for this.) 

'''Accidental Exposure''':

*When medicines are no longer needed or have expired, it is important to properly dispose of them to reduce harm from accidental exposure or intentional misuse.<ref>http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm</ref> Throwing drugs in the garbage is a bad idea, because they can accidentally be taken by kids or pets.

'''Environmental Concerns''':

*Some people propose flushing or pouring unused medications down the drain, however, medications flushed into the waste stream can end up in water supplies.<ref>http://www.takebackyourmeds.org/what-you-can-do/medicine-disposal-myths-and-facts/</ref>
*Since the drugs in take-back programs are incinerated, take-back programs are the safest way to get rid of the chemicals and to stop them from getting into drinking water and watersheds as well as in the hands of those at risk.
*Innovative mail-back options provide a convenient way for people to have excess medications disposed of through incineration. (Details further down on this page.)

== Costs and Benefits of Safe Disposal Options ==

This fact sheet from the Product Stewardship Institute provides a good summary of the costs and benefits of different drug take-back and disposal options. 

[https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf]

== To Flush or Not to Flush ==

If no take-back programs are readily available, it is still important to dispose of the medications quickly and appropriately. Some prescriptions include instructions on how to dispose of the drug.<ref>https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</ref> The [https://www.fda.gov U.S. Food & Drug Administration (FDA)] provides the safest ways of disposing of these medications at home [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm here]. The FDA also recommends that certain drugs be flushed immediately, such as fentanyl patches, Oxycontin, and Percocet. A full list can be found on [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm#Flush_List this ]page.  Other experts strongly recommend '''not''' flushing medications down the toilet.<ref>Minnesota Pollution Control Agency https://www.pca.state.mn.us/featured/dont-flush-medicines-down-drain</ref>

The bottom line is that the best options are bringing your medications to a take-back day, putting them into a drug disposal kiosk, or using a mail-based program to send in the medications for proper disposal.  But, if you don't have access to these options, flushing unused medications that are on the "flush list" is better than keeping them around.   

== Special Populations ==

=== Senior Citizens ===

Senior citizens have a disproportionate number of medications in their homes. Helping seniors understand how to properly dispose of medications can make a big difference in the success of your program.  The Colorado Consortium for Prescription Drug Abuse Prevention has developed a successful program for reaching people age 65+ called "You're the Solution." This campaign has techniques and materials that can be used around the country. 

Learn more about [[You're_the_Solution|You're_the_Solution]] 

=== Nursing Homes ===

Individual patients aside, one study estimated the nation’s nursing homes discard anywhere from $73 million to $378 million worth of drugs a year. Some are incinerated, but many are flushed.<ref>https://www.nbcnews.com/health/health-news/got-old-medicine-don-t-flush-it-flna1c9478735</ref>  

Nursing homes could be provided with information and tools (or services) for more appropriate disposal options that are better for the environemnt and that minimize the likelihood of diversion of these medications.

=== Hospice Programs or Funeral Home Programs ===

Hospice programs can help family members understand how to properly handle the medications they inherit when a loved one passes away.<ref>https://www.dea.gov/press-releases/2017/05/08/dea-brings-record-amount-unused-prescription-drugs-national-prescription</ref>

Funeral homes may pass out a brochure to remind people to make sure that any prescription drugs that were being taken by a loved one are properly disposed of.  People in the late stages of life may have been getting prescription opioids to deal with pain.  Hospice and funeral homes could be provided with disposal products (like Seal&Send envelopes).

 

 

== Take-back Events ==

=== DEA National Drug Take-Back Day Initiative ===

The National Prescription Drug Take Back Day Initiative addresses a crucial public safety and public health issue by providing an opportunity for Americans to prevent drug addiction and overdose deaths. As of May 2017, the DEA has promoted 13 national take-back days, and they continue to collect more and more drugs each time. <ref>https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0 </ref> '''[https://www.deadiversion.usdoj.gov/drug_disposal/takeback/newsrelease.htm Program Successes]'''

*Over 4,200 law enforcement and community partners and 5,500 sites across the country.
*Since September 2010, these events have altogether collected 8,103,363 pounds (4,052 tons) of prescription drugs.
*The last National Take-back Day collected more than 900,386 pounds (450 tons).

To promote your local Rx Take Back Day, the DEA provides a [https://takebackday.dea.gov/content/partnership-toolbox partnership toolkit] featuring promotional materials for associated partners.<ref>https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0</ref> '''See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more DEA take-back resources and other ideas on how to implement a local take-back day.'''

 

=== State Level Drug Take Back Programs ===

See below for inspiration and ideas to replicate from current state efforts:

*[http://www.ddap.pa.gov/Prevention/Pages/Drug_Take_Back.aspx#.V07YY_krLcs Pennsylvania]
*[http://www.in.gov/bitterpill/ Indiana]
*[http://www.oregon.gov/oha/ph/HealthyEnvironments/DrinkingWater/SourceWater/Pages/takeback.aspx Oregon]
*[https://www.artakeback.org Arkansas]
*[http://www.takebackyourmeds.org/ Washington]
*[http://stoprxabuseinga.org/ Georgia]

== Increasing the Number of Drug Drop-Boxes in your Community ==

Since disposing of unneeded medications via a drug drop box is considered the best option, it is important for communities to increase the number of drop boxes that are available and to promote awareness of those drop boxes. 

This [https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/pharms_reports_factsheets/160920_PSI_Pharmacy_Guide_vS.pdf How-To Guide for Drug Take-Back], created by the Product Stewardship Institute, provides detailed guidance for expanding and improving a pharmacy-based collection program. 

The [http://www.rxdrugdropbox.org/ NADDI prescription drug dropbox ] website is an important resource to find locations of drop boxes, buy boxes, apply for grants, and other information about drop boxes.

With the help of the [https://www.naddi.org/ National Association of Drug Diversion Investigators], communities can apply for grants to receive a drop-box that will hold old opioids to prevent abuse. These boxes have resulted in multiple cities and communities being safer and reducing the risk of opioid addiction. Boxes are to be located in close proximity to law enforcement agencies so nothing happens to them. Multiple boxes have been placed in the State of Minnesota, and after reaching out to one town in specific, Fridley, they told us that they have seen a positive response to the drop-box. They have discarded pounds of prescription opioids that came from an at-risk community.

 

 

== In-Home Disposal ==

=== Medication Mail-back Envelopes ===

'''Stericycle Prescription Drug Seal&Send Pouches'''

Stericycle provides an option for unused prescription drugs to be mailed to them in an unmarked mailing pouch, and then the pills are incinerated. 

Learn more at: [https://www.stericycleenvironmental.com/tag/pharmaceutical-takeback/ https://www.stericycleenvironmental.com/tag/pharmaceutical-takeback/] 

 

=== In-home disposal pouches & powders ===

'''Deterra Drug Disposal System '''

Minneapolis-based company Verde Technologies has created a product called [http://deterrasystem.com/ Deterra®] System which deactivates prescription drugs. Each patented Deterra® pouch contains a water-soluble inner pod containing MAT12® activated carbon. Once the pharmaceuticals are placed in the pouch, warm water is then added, which dissolves the inner pod releasing the activated carbon. The warm water also dissolves prescription pills, patches, and liquids, allowing them to be absorbed by the carbon, rendering them inert and non-retrievable. For more information on how to use Deterra®, view this [https://www.youtube.com/watch?v=lSBwBqpTk2c How-to video]

'''Benefits'''

*Inexpensive - Costs $7 per pouch
*Can encourage people to connect with law enforcement - People can pick up free (if already given to law enforcement) pouches from the station and dispose of them at home and save any potential embarrassment
*Improve overall water quality - with the majority of people flushing unused medication down the toilet, only water treatment facilities remove less than half of the prescription drugs found in sewage

'''DisposeRx'''

[http://disposerx.com/ Dispose Rx] is "a patented (pending) blend of solidifying materials that provides a solution for the safe disposal of unwanted or expired prescription drugs. Dedicated to environmentally friendly and safe non-toxic disposal solutions, DisposeRx is spearheading programs of educating communities with practical and safe medication disposing solutions, thus preventing the cycle of environmental pollution, addiction, overdose, and death." Prescription drugs can be rendered safe for disposal (and impossible to misuse) by adding powder from a packet directly into the pill bottle and shaking the bottle.

*Inexpensive - Costs about $1.50 per packet (and [https://www.aarp.org/health/drugs-supplements/info-2018/walmart-dispose-painkillers-fd.html Walmart gives the packets away free with a prescription or possibly a request])
*Packets can be attached to prescriptions with a rubber band (much like flower fertilizer is attached to fresh-cut flowers)
*Well-suited to campaigns with community partners (like clinics, churches, barbershops, or hair salons) to increase distribution to diverse populations.

See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more information.

 

 

= Impactful Federal, State, and Local Policies =

== Legislation & Drug Companies ==

Currently, several West Coast counties, the city of San Francisco, and the state of Massachusetts have issued legislation that require drug companies to fund drug take-back programs.<ref>[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/ </ref> On a national level, however, only 2.5 percent of eligible take-back organizations are participating, according to the Government Accountability Office. <ref>https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/</ref> The primary barrier seems to be financial: Maintaining the safe-like prescription drop-off container, training staff to follow the relevant regulations, and destroying the returned medication costs money. As a potential solution, writing a policy that mandates opioid manufacturers to pay patients for their returned bottles of pills, along with subsidizing drop-off location operators, could offset the costs and be what is needed to make returning leftover medication an automatic habit for consumers. <ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref> The [http://www.productstewardship.us/ Product Stewardship Institute], a nonprofit that supports drug take-back programs, calculated that at least a dozen other local governments around the country are considering similar legislation, including several California counties. In Minnesota, pharmaceutical company [http://www.mallinckrodt.com/ Mallinckrodt] donated 30,000 disposal pouch systems to be distributed.<ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref>

 

== State Legislation Requiring Disposal Kits be Given with Prescriptions ==

The Kentucky State Senate passed in March 2018 a bill that requires opioids and other abused drugs to be dispensed along with a method to permanently sequester and dispose of any leftover pills. If passed by the house and signed, it will be the first state to pass such a bill.  [http://www.disposerx.com DisposeRx] will be a popular choice to be given out along with prescription.  Other options include the Seal & Send mail-back packages or other options described below.

= Available Tools and Resources =

[[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|TR - Expand Prescription Drug Take-back & Disposal Programs]]

== Local Disposal Drop Boxes ==

=== Finding Disposal Locations ===

==== Medication Disposal Locators ====

Use the following links to find drug disposal locations

*[https://apps.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e1s1 DEA's Disposal Locator] - Find locations in your ZIP code. These collectors are registered with the DEA and pass unused medicine on to the agency to disposed.<ref>https://www.hometownsource.com/sun_focus/news/local/drop-off-prescription-drugs-anonymously-at-fridley-pd/article_b07bd27d-1122-55fa-8465-f47ad9a861dc.html</ref>
*[http://rxdrugdropbox.org/ Rx Drop Box]
*[http://disposemymeds.org/ Dispose My Meds]
*[https://nabp.pharmacy/initiatives/awarxe/drug-disposal-locator/ National Association of Boards of Pharmacy]
*[http://www.americanmedicinechest.com/ The American Medicine Chest Challenge]
*[https://walgreens.maps.arcgis.com/apps/MapSeries/index.html?appid=53cf1b54abf34c4bacdec863e5c56391 Walgreens Safe Medication Disposal Program]

= Promising Practices =

'''Current Efforts to Promote In-Home Disposal'''
<div class="objectEmbed">Case Studies</div>
The state of Pennsylvania has a goal of distributing Deterra® Drug Deactivation and Disposal pouches alongside 10% of all opioid prescriptions.
<div class="objectEmbed">Attorney General Shapiro Unveils Plan to Distribute 300,000 Drug Disposal Pouches in 12 counties<ref>https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</ref></div> <div class="objectEmbed">[https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html]</div>
Inspira Health Network (New Jersey) distributed the Deterra® pouch throughout their network. [http://www.njtvonline.org/news/video/inspira-health-network-battles-opioid-crisis-proper-drug-disposal/ Case Study] These pouches render opioids ineffective for misuse and are safe for disposal and the environment, and are another cost-efficient way to safely dispose of opioids.

= Actions to Take =

There are many actions that can be taken by coalitions, organizations or individuals to improve drug take-back and disposal.  Explore the ideas via the following link: [[PA_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Coalitions]]

[[PAI_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Individuals]]

'''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

 

= Sources =

----

 

[[Category:Pages with broken file links]] [[Category:SAFE-Prescriptions and Medical Response]]

Expand Prescription Drug Take-back & Disposal Program

2021-10-31T02:24:16Z

G.Lehrman:

''Return to [[ZOOM_MAP_-_Reduce_Diversion_of_Prescription_Drugs|Reduce Diversion of Prescription Drugs]]''

----

= Introductory Paragraph =

Most opioid abuse prevention strategies include some sort of prescription drug take-back or disposal program.  This is a step in the right direction, but most communities have significant opportunities to expand and enhance these efforts to reach more people and reduce the ability of people to misuse these medications or give them to others who may misuse them.  This objective focuses on practical ways to make improvements to existing efforts and to add new options that communities may not yet be doing. 

 

= Key Information =

== Why Safe Disposal is Important ==

'''Intentional Misuse''':

*A majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet.<ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ </ref>
*SAMHSA’s 2009 National Survey on Drug Use and Health found that over 70 percent of people who used prescription pain relievers non-medically got them from friends or relatives, while approximately 5 percent got them from a drug dealer or from the Internet.
*Getting hooked on prescription opioids is directly responsible for over 60% of subsequent heroin addictions as addicts turn to this less expensive alternative.
*Prescription drugs involved in overdoses are almost all originally prescribed by physicians but are used by individuals other than the patient prescribed the drugs. (Get sources for this.) 

'''Accidental Exposure''':

*When medicines are no longer needed or have expired, it is important to properly dispose of them to reduce harm from accidental exposure or intentional misuse.<ref>http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm</ref> Throwing drugs in the garbage is a bad idea, because they can accidentally be taken by kids or pets.

'''Environmental Concerns''':

*Some people propose flushing or pouring unused medications down the drain, however, medications flushed into the waste stream can end up in water supplies.<ref>http://www.takebackyourmeds.org/what-you-can-do/medicine-disposal-myths-and-facts/</ref>
*Since the drugs in take-back programs are incinerated, take-back programs are the safest way to get rid of the chemicals and to stop them from getting into drinking water and watersheds as well as in the hands of those at risk.
*Innovative mail-back options provide a convenient way for people to have excess medications disposed of through incineration. (Details further down on this page.)

== Costs and Benefits of Safe Disposal Options ==

This fact sheet from the Product Stewardship Institute provides a good summary of the costs and benefits of different drug take-back and disposal options. 

[https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf]

== To Flush or Not to Flush ==

If no take-back programs are readily available, it is still important to dispose of the medications quickly and appropriately. Some prescriptions include instructions on how to dispose of the drug.<ref>https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</ref> The [https://www.fda.gov U.S. Food & Drug Administration (FDA)] provides the safest ways of disposing of these medications at home [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm here]. The FDA also recommends that certain drugs be flushed immediately, such as fentanyl patches, Oxycontin, and Percocet. A full list can be found on [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm#Flush_List this ]page.  Other experts strongly recommend '''not''' flushing medications down the toilet.<ref>Minnesota Pollution Control Agency https://www.pca.state.mn.us/featured/dont-flush-medicines-down-drain</ref>

The bottom line is that the best options are bringing your medications to a take-back day, putting them into a drug disposal kiosk, or using a mail-based program to send in the medications for proper disposal.  But, if you don't have access to these options, flushing unused medications that are on the "flush list" is better than keeping them around.   

 

 

== Special Populations ==

=== Senior Citizens ===

Senior citizens have a disproportionate number of medications in their homes. Helping seniors understand how to properly dispose of medications can make a big difference in the success of your program.  The Colorado Consortium for Prescription Drug Abuse Prevention has developed a successful program for reaching people age 65+ called "You're the Solution." This campaign has techniques and materials that can be used around the country. 

Learn more about [[You're_the_Solution|You're_the_Solution]] 

=== Nursing Homes ===

Individual patients aside, one study estimated the nation’s nursing homes discard anywhere from $73 million to $378 million worth of drugs a year. Some are incinerated, but many are flushed.<ref>https://www.nbcnews.com/health/health-news/got-old-medicine-don-t-flush-it-flna1c9478735</ref>  

Nursing homes could be provided with information and tools (or services) for more appropriate disposal options that are better for the environemnt and that minimize the likelihood of diversion of these medications.

=== Hospice Programs or Funeral Home Programs ===

Hospice programs can help family members understand how to properly handle the medications they inherit when a loved one passes away.<ref>https://www.dea.gov/press-releases/2017/05/08/dea-brings-record-amount-unused-prescription-drugs-national-prescription</ref>

Funeral homes may pass out a brochure to remind people to make sure that any prescription drugs that were being taken by a loved one are properly disposed of.  People in the late stages of life may have been getting prescription opioids to deal with pain.  Hospice and funeral homes could be provided with disposal products (like Seal&Send envelopes).

 

 

== Take-back Events ==

=== DEA National Drug Take-Back Day Initiative ===

The National Prescription Drug Take Back Day Initiative addresses a crucial public safety and public health issue by providing an opportunity for Americans to prevent drug addiction and overdose deaths. As of May 2017, the DEA has promoted 13 national take-back days, and they continue to collect more and more drugs each time. <ref>https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0 </ref> '''[https://www.deadiversion.usdoj.gov/drug_disposal/takeback/newsrelease.htm Program Successes]'''

*Over 4,200 law enforcement and community partners and 5,500 sites across the country.
*Since September 2010, these events have altogether collected 8,103,363 pounds (4,052 tons) of prescription drugs.
*The last National Take-back Day collected more than 900,386 pounds (450 tons).

To promote your local Rx Take Back Day, the DEA provides a [https://takebackday.dea.gov/content/partnership-toolbox partnership toolkit] featuring promotional materials for associated partners.<ref>https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0</ref> '''See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more DEA take-back resources and other ideas on how to implement a local take-back day.'''

 

=== State Level Drug Take Back Programs ===

See below for inspiration and ideas to replicate from current state efforts:

*[http://www.ddap.pa.gov/Prevention/Pages/Drug_Take_Back.aspx#.V07YY_krLcs Pennsylvania]
*[http://www.in.gov/bitterpill/ Indiana]
*[http://www.oregon.gov/oha/ph/HealthyEnvironments/DrinkingWater/SourceWater/Pages/takeback.aspx Oregon]
*[https://www.artakeback.org Arkansas]
*[http://www.takebackyourmeds.org/ Washington]
*[http://stoprxabuseinga.org/ Georgia]

== Increasing the Number of Drug Drop-Boxes in your Community ==

Since disposing of unneeded medications via a drug drop box is considered the best option, it is important for communities to increase the number of drop boxes that are available and to promote awareness of those drop boxes. 

This [https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/pharms_reports_factsheets/160920_PSI_Pharmacy_Guide_vS.pdf How-To Guide for Drug Take-Back], created by the Product Stewardship Institute, provides detailed guidance for expanding and improving a pharmacy-based collection program. 

The [http://www.rxdrugdropbox.org/ NADDI prescription drug dropbox ] website is an important resource to find locations of drop boxes, buy boxes, apply for grants, and other information about drop boxes.

With the help of the [https://www.naddi.org/ National Association of Drug Diversion Investigators], communities can apply for grants to receive a drop-box that will hold old opioids to prevent abuse. These boxes have resulted in multiple cities and communities being safer and reducing the risk of opioid addiction. Boxes are to be located in close proximity to law enforcement agencies so nothing happens to them. Multiple boxes have been placed in the State of Minnesota, and after reaching out to one town in specific, Fridley, they told us that they have seen a positive response to the drop-box. They have discarded pounds of prescription opioids that came from an at-risk community.

 

== In-Home Disposal ==

=== Medication Mail-back Envelopes ===

'''Stericycle Prescription Drug Seal&Send Pouches'''

Stericycle provides an option for unused prescription drugs to be mailed to them in an unmarked mailing pouch, and then the pills are incinerated. 

Learn more at: [https://www.stericycleenvironmental.com/tag/pharmaceutical-takeback/ https://www.stericycleenvironmental.com/tag/pharmaceutical-takeback/] 

 

=== In-home disposal pouches & powders ===

'''Deterra Drug Disposal System '''

Minneapolis-based company Verde Technologies has created a product called [http://deterrasystem.com/ Deterra®] System which deactivates prescription drugs. Each patented Deterra® pouch contains a water-soluble inner pod containing MAT12® activated carbon. Once the pharmaceuticals are placed in the pouch, warm water is then added, which dissolves the inner pod releasing the activated carbon. The warm water also dissolves prescription pills, patches, and liquids, allowing them to be absorbed by the carbon, rendering them inert and non-retrievable. For more information on how to use Deterra®, view this [https://www.youtube.com/watch?v=lSBwBqpTk2c How-to video]

'''Benefits'''

*Inexpensive - Costs $7 per pouch
*Can encourage people to connect with law enforcement - People can pick up free (if already given to law enforcement) pouches from the station and dispose of them at home and save any potential embarrassment
*Improve overall water quality - with the majority of people flushing unused medication down the toilet, only water treatment facilities remove less than half of the prescription drugs found in sewage

'''DisposeRx'''

[http://disposerx.com/ Dispose Rx] is "a patented (pending) blend of solidifying materials that provides a solution for the safe disposal of unwanted or expired prescription drugs. Dedicated to environmentally friendly and safe non-toxic disposal solutions, DisposeRx is spearheading programs of educating communities with practical and safe medication disposing solutions, thus preventing the cycle of environmental pollution, addiction, overdose, and death." Prescription drugs can be rendered safe for disposal (and impossible to misuse) by adding powder from a packet directly into the pill bottle and shaking the bottle.

*Inexpensive - Costs about $1.50 per packet (and [https://www.aarp.org/health/drugs-supplements/info-2018/walmart-dispose-painkillers-fd.html Walmart gives the packets away free with a prescription or possibly a request])
*Packets can be attached to prescriptions with a rubber band (much like flower fertilizer is attached to fresh-cut flowers)
*Well-suited to campaigns with community partners (like clinics, churches, barbershops, or hair salons) to increase distribution to diverse populations.

See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more information.

 

 

= Impactful Federal, State, and Local Policies =

== Legislation & Drug Companies ==

Currently, several West Coast counties, the city of San Francisco, and the state of Massachusetts have issued legislation that require drug companies to fund drug take-back programs.<ref>[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/ </ref> On a national level, however, only 2.5 percent of eligible take-back organizations are participating, according to the Government Accountability Office. <ref>https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/</ref> The primary barrier seems to be financial: Maintaining the safe-like prescription drop-off container, training staff to follow the relevant regulations, and destroying the returned medication costs money. As a potential solution, writing a policy that mandates opioid manufacturers to pay patients for their returned bottles of pills, along with subsidizing drop-off location operators, could offset the costs and be what is needed to make returning leftover medication an automatic habit for consumers. <ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref> The [http://www.productstewardship.us/ Product Stewardship Institute], a nonprofit that supports drug take-back programs, calculated that at least a dozen other local governments around the country are considering similar legislation, including several California counties. In Minnesota, pharmaceutical company [http://www.mallinckrodt.com/ Mallinckrodt] donated 30,000 disposal pouch systems to be distributed.<ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref>

 

== State Legislation Requiring Disposal Kits be Given with Prescriptions ==

The Kentucky State Senate passed in March 2018 a bill that requires opioids and other abused drugs to be dispensed along with a method to permanently sequester and dispose of any leftover pills. If passed by the house and signed, it will be the first state to pass such a bill.  [http://www.disposerx.com DisposeRx] will be a popular choice to be given out along with prescription.  Other options include the Seal & Send mail-back packages or other options described below.

= Available Tools and Resources =

[[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|TR - Expand Prescription Drug Take-back & Disposal Programs]]

== Local Disposal Drop Boxes ==

=== Finding Disposal Locations ===

==== Medication Disposal Locators ====

Use the following links to find drug disposal locations

*[https://apps.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e1s1 DEA's Disposal Locator] - Find locations in your ZIP code. These collectors are registered with the DEA and pass unused medicine on to the agency to disposed.<ref>https://www.hometownsource.com/sun_focus/news/local/drop-off-prescription-drugs-anonymously-at-fridley-pd/article_b07bd27d-1122-55fa-8465-f47ad9a861dc.html</ref>
*[http://rxdrugdropbox.org/ Rx Drop Box]
*[http://disposemymeds.org/ Dispose My Meds]
*[https://nabp.pharmacy/initiatives/awarxe/drug-disposal-locator/ National Association of Boards of Pharmacy]
*[http://www.americanmedicinechest.com/ The American Medicine Chest Challenge]
*[https://walgreens.maps.arcgis.com/apps/MapSeries/index.html?appid=53cf1b54abf34c4bacdec863e5c56391 Walgreens Safe Medication Disposal Program]

= Promising Practices =

'''Current Efforts to Promote In-Home Disposal'''
<div class="objectEmbed">Case Studies</div>
The state of Pennsylvania has a goal of distributing Deterra® Drug Deactivation and Disposal pouches alongside 10% of all opioid prescriptions.
<div class="objectEmbed">Attorney General Shapiro Unveils Plan to Distribute 300,000 Drug Disposal Pouches in 12 counties<ref>https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</ref></div> <div class="objectEmbed">[https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html]</div>
Inspira Health Network (New Jersey) distributed the Deterra® pouch throughout their network. [http://www.njtvonline.org/news/video/inspira-health-network-battles-opioid-crisis-proper-drug-disposal/ Case Study] These pouches render opioids ineffective for misuse and are safe for disposal and the environment, and are another cost-efficient way to safely dispose of opioids.

= Actions to Take =

There are many actions that can be taken by coalitions, organizations or individuals to improve drug take-back and disposal.  Explore the ideas via the following link: [[PA_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Coalitions]]

[[PAI_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Individuals]]

'''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

 

= Sources =

----

 

[[Category:Pages with broken file links]] [[Category:SAFE-Prescriptions and Medical Response]]

Expand Prescription Drug Take-back & Disposal Program

2021-10-31T02:23:29Z

G.Lehrman:

''Return to [[ZOOM_MAP_-_Reduce_Diversion_of_Prescription_Drugs|Reduce Diversion of Prescription Drugs]]''

----

= Introductory Paragraph =

Most opioid abuse prevention strategies include some sort of prescription drug take-back or disposal program.  This is a step in the right direction, but most communities have significant opportunities to expand and enhance these efforts to reach more people and reduce the ability of people to misuse these medications or give them to others who may misuse them.  This objective focuses on practical ways to make improvements to existing efforts and to add new options that communities may not yet be doing. 

 

= Key Information =

== Why Safe Disposal is Important ==

'''Intentional Misuse''':

*A majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet.<ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ </ref>
*SAMHSA’s 2009 National Survey on Drug Use and Health found that over 70 percent of people who used prescription pain relievers non-medically got them from friends or relatives, while approximately 5 percent got them from a drug dealer or from the Internet.
*Getting hooked on prescription opioids is directly responsible for over 60% of subsequent heroin addictions as addicts turn to this less expensive alternative.
*Prescription drugs involved in overdoses are almost all originally prescribed by physicians but are used by individuals other than the patient prescribed the drugs. (Get sources for this.) 

'''Accidental Exposure''':

*When medicines are no longer needed or have expired, it is important to properly dispose of them to reduce harm from accidental exposure or intentional misuse.<ref>http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm</ref> Throwing drugs in the garbage is a bad idea, because they can accidentally be taken by kids or pets.

'''Environmental Concerns''':

*Some people propose flushing or pouring unused medications down the drain, however, medications flushed into the waste stream can end up in water supplies.<ref>http://www.takebackyourmeds.org/what-you-can-do/medicine-disposal-myths-and-facts/</ref>
*Since the drugs in take-back programs are incinerated, take-back programs are the safest way to get rid of the chemicals and to stop them from getting into drinking water and watersheds as well as in the hands of those at risk.
*Innovative mail-back options provide a convenient way for people to have excess medications disposed of through incineration. (Details further down on this page.)

== Costs and Benefits of Safe Disposal Options ==

This fact sheet from the Product Stewardship Institute provides a good summary of the costs and benefits of different drug take-back and disposal options. 

[https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf]

== To Flush or Not to Flush ==

If no take-back programs are readily available, it is still important to dispose of the medications quickly and appropriately. Some prescriptions include instructions on how to dispose of the drug.<ref>https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</ref> The [https://www.fda.gov U.S. Food & Drug Administration (FDA)] provides the safest ways of disposing of these medications at home [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm here]. The FDA also recommends that certain drugs be flushed immediately, such as fentanyl patches, Oxycontin, and Percocet. A full list can be found on [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm#Flush_List this ]page.  Other experts strongly recommend '''not''' flushing medications down the toilet.<ref>Minnesota Pollution Control Agency https://www.pca.state.mn.us/featured/dont-flush-medicines-down-drain</ref>

The bottom line is that the best options are bringing your medications to a take-back day, putting them into a drug disposal kiosk, or using a mail-based program to send in the medications for proper disposal.  But, if you don't have access to these options, flushing unused medications that are on the "flush list" is better than keeping them around.   

 

 

== Special Populations ==

=== Senior Citizens ===

Senior citizens have a disproportionate number of medications in their homes. Helping seniors understand how to properly dispose of medications can make a big difference in the success of your program.  The Colorado Consortium for Prescription Drug Abuse Prevention has developed a successful program for reaching people age 65+ called "You're the Solution." This campaign has techniques and materials that can be used around the country. 

Learn more about [[You're_the_Solution|You're_the_Solution]] 

=== Nursing Homes ===

Individual patients aside, one study estimated the nation’s nursing homes discard anywhere from $73 million to $378 million worth of drugs a year. Some are incinerated, but many are flushed.<ref>https://www.nbcnews.com/health/health-news/got-old-medicine-don-t-flush-it-flna1c9478735</ref>  

Nursing homes could be provided with information and tools (or services) for more appropriate disposal options that are better for the environemnt and that minimize the likelihood of diversion of these medications.

=== Hospice Programs or Funeral Home Programs ===

Hospice programs can help family members understand how to properly handle the medications they inherit when a loved one passes away.<ref>https://www.dea.gov/press-releases/2017/05/08/dea-brings-record-amount-unused-prescription-drugs-national-prescription</ref>

Funeral homes may pass out a brochure to remind people to make sure that any prescription drugs that were being taken by a loved one are properly disposed of.  People in the late stages of life may have been getting prescription opioids to deal with pain.  Hospice and funeral homes could be provided with disposal products (like Seal&Send envelopes).

 

 

== Take-back Events ==

=== DEA National Drug Take-Back Day Initiative ===

The National Prescription Drug Take Back Day Initiative addresses a crucial public safety and public health issue by providing an opportunity for Americans to prevent drug addiction and overdose deaths. As of May 2017, the DEA has promoted 13 national take-back days, and they continue to collect more and more drugs each time. <ref>https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0 </ref> '''[https://www.deadiversion.usdoj.gov/drug_disposal/takeback/newsrelease.htm Program Successes]'''

*Over 4,200 law enforcement and community partners and 5,500 sites across the country.
*Since September 2010, these events have altogether collected 8,103,363 pounds (4,052 tons) of prescription drugs.
*The last National Take-back Day collected more than 900,386 pounds (450 tons).

To promote your local Rx Take Back Day, the DEA provides a [https://takebackday.dea.gov/content/partnership-toolbox partnership toolkit] featuring promotional materials for associated partners.<ref>https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0</ref> '''See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more DEA take-back resources and other ideas on how to implement a local take-back day.'''

 

=== State Level Drug Take Back Programs ===

See below for inspiration and ideas to replicate from current state efforts:

*[http://www.ddap.pa.gov/Prevention/Pages/Drug_Take_Back.aspx#.V07YY_krLcs Pennsylvania]
*[http://www.in.gov/bitterpill/ Indiana]
*[http://www.oregon.gov/oha/ph/HealthyEnvironments/DrinkingWater/SourceWater/Pages/takeback.aspx Oregon]
*[https://www.artakeback.org Arkansas]
*[http://www.takebackyourmeds.org/ Washington]
*[http://stoprxabuseinga.org/ Georgia]

== Increasing the Number of Drug Drop-Boxes in your Community ==

Since disposing of unneeded medications via a drug drop box is considered the best option, it is important for communities to increase the number of drop boxes that are available and to promote awareness of those drop boxes. 

This [https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/pharms_reports_factsheets/160920_PSI_Pharmacy_Guide_vS.pdf How-To Guide for Drug Take-Back], created by the Product Stewardship Institute, provides detailed guidance for expanding and improving a pharmacy-based collection program. 

The [http://www.rxdrugdropbox.org/ NADDI prescription drug dropbox ] website is an important resource to find locations of drop boxes, buy boxes, apply for grants, and other information about drop boxes.

With the help of the [https://www.naddi.org/ National Association of Drug Diversion Investigators], communities can apply for grants to receive a drop-box that will hold old opioids to prevent abuse. These boxes have resulted in multiple cities and communities being safer and reducing the risk of opioid addiction. Boxes are to be located in close proximity to law enforcement agencies so nothing happens to them. Multiple boxes have been placed in the State of Minnesota, and after reaching out to one town in specific, Fridley, they told us that they have seen a positive response to the drop-box. They have discarded pounds of prescription opioids that came from an at-risk community.

 

= In-Home Disposal =

== Medication Mail-back Envelopes ==

'''Stericycle Prescription Drug Seal&Send Pouches'''

Stericycle provides an option for unused prescription drugs to be mailed to them in an unmarked mailing pouch, and then the pills are incinerated. 

Learn more at: [https://www.stericycleenvironmental.com/tag/pharmaceutical-takeback/ https://www.stericycleenvironmental.com/tag/pharmaceutical-takeback/] 

 

== In-home disposal pouches & powders ==

'''Deterra Drug Disposal System '''

Minneapolis-based company Verde Technologies has created a product called [http://deterrasystem.com/ Deterra®] System which deactivates prescription drugs. Each patented Deterra® pouch contains a water-soluble inner pod containing MAT12® activated carbon. Once the pharmaceuticals are placed in the pouch, warm water is then added, which dissolves the inner pod releasing the activated carbon. The warm water also dissolves prescription pills, patches, and liquids, allowing them to be absorbed by the carbon, rendering them inert and non-retrievable. For more information on how to use Deterra®, view this [https://www.youtube.com/watch?v=lSBwBqpTk2c How-to video]

'''Benefits'''

*Inexpensive - Costs $7 per pouch
*Can encourage people to connect with law enforcement - People can pick up free (if already given to law enforcement) pouches from the station and dispose of them at home and save any potential embarrassment
*Improve overall water quality - with the majority of people flushing unused medication down the toilet, only water treatment facilities remove less than half of the prescription drugs found in sewage

'''DisposeRx'''

[http://disposerx.com/ Dispose Rx] is "a patented (pending) blend of solidifying materials that provides a solution for the safe disposal of unwanted or expired prescription drugs. Dedicated to environmentally friendly and safe non-toxic disposal solutions, DisposeRx is spearheading programs of educating communities with practical and safe medication disposing solutions, thus preventing the cycle of environmental pollution, addiction, overdose, and death." Prescription drugs can be rendered safe for disposal (and impossible to misuse) by adding powder from a packet directly into the pill bottle and shaking the bottle.

*Inexpensive - Costs about $1.50 per packet (and [https://www.aarp.org/health/drugs-supplements/info-2018/walmart-dispose-painkillers-fd.html Walmart gives the packets away free with a prescription or possibly a request])
*Packets can be attached to prescriptions with a rubber band (much like flower fertilizer is attached to fresh-cut flowers)
*Well-suited to campaigns with community partners (like clinics, churches, barbershops, or hair salons) to increase distribution to diverse populations.

See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more information.

 

 

= Impactful Federal, State, and Local Policies =

== Legislation & Drug Companies ==

Currently, several West Coast counties, the city of San Francisco, and the state of Massachusetts have issued legislation that require drug companies to fund drug take-back programs.<ref>[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/ </ref> On a national level, however, only 2.5 percent of eligible take-back organizations are participating, according to the Government Accountability Office. <ref>https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/</ref> The primary barrier seems to be financial: Maintaining the safe-like prescription drop-off container, training staff to follow the relevant regulations, and destroying the returned medication costs money. As a potential solution, writing a policy that mandates opioid manufacturers to pay patients for their returned bottles of pills, along with subsidizing drop-off location operators, could offset the costs and be what is needed to make returning leftover medication an automatic habit for consumers. <ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref> The [http://www.productstewardship.us/ Product Stewardship Institute], a nonprofit that supports drug take-back programs, calculated that at least a dozen other local governments around the country are considering similar legislation, including several California counties. In Minnesota, pharmaceutical company [http://www.mallinckrodt.com/ Mallinckrodt] donated 30,000 disposal pouch systems to be distributed.<ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref>

 

== State Legislation Requiring Disposal Kits be Given with Prescriptions ==

The Kentucky State Senate passed in March 2018 a bill that requires opioids and other abused drugs to be dispensed along with a method to permanently sequester and dispose of any leftover pills. If passed by the house and signed, it will be the first state to pass such a bill.  [http://www.disposerx.com DisposeRx] will be a popular choice to be given out along with prescription.  Other options include the Seal & Send mail-back packages or other options described below.

= Available Tools and Resources =

[[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|TR - Expand Prescription Drug Take-back & Disposal Programs]]

== Local Disposal Drop Boxes ==

=== Finding Disposal Locations ===

==== Medication Disposal Locators ====

Use the following links to find drug disposal locations

*[https://apps.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e1s1 DEA's Disposal Locator] - Find locations in your ZIP code. These collectors are registered with the DEA and pass unused medicine on to the agency to disposed.<ref>https://www.hometownsource.com/sun_focus/news/local/drop-off-prescription-drugs-anonymously-at-fridley-pd/article_b07bd27d-1122-55fa-8465-f47ad9a861dc.html</ref>
*[http://rxdrugdropbox.org/ Rx Drop Box]
*[http://disposemymeds.org/ Dispose My Meds]
*[https://nabp.pharmacy/initiatives/awarxe/drug-disposal-locator/ National Association of Boards of Pharmacy]
*[http://www.americanmedicinechest.com/ The American Medicine Chest Challenge]
*[https://walgreens.maps.arcgis.com/apps/MapSeries/index.html?appid=53cf1b54abf34c4bacdec863e5c56391 Walgreens Safe Medication Disposal Program]

= Promising Practices =

'''Current Efforts to Promote In-Home Disposal'''
<div class="objectEmbed">Case Studies</div>
The state of Pennsylvania has a goal of distributing Deterra® Drug Deactivation and Disposal pouches alongside 10% of all opioid prescriptions.
<div class="objectEmbed">Attorney General Shapiro Unveils Plan to Distribute 300,000 Drug Disposal Pouches in 12 counties<ref>https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</ref></div> <div class="objectEmbed">[https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html]</div>
Inspira Health Network (New Jersey) distributed the Deterra® pouch throughout their network. [http://www.njtvonline.org/news/video/inspira-health-network-battles-opioid-crisis-proper-drug-disposal/ Case Study] These pouches render opioids ineffective for misuse and are safe for disposal and the environment, and are another cost-efficient way to safely dispose of opioids.

= Actions to Take =

There are many actions that can be taken by coalitions, organizations or individuals to improve drug take-back and disposal.  Explore the ideas via the following link: [[PA_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Coalitions]]

[[PAI_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Individuals]]

'''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

{| class="wiki_table"
|-
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| '''Date'''
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[[Category:Pages with broken file links]] [[Category:SAFE-Prescriptions and Medical Response]]

Expand Prescription Drug Take-back & Disposal Program

2021-10-31T02:22:54Z

G.Lehrman:

''Return to [[ZOOM_MAP_-_Reduce_Diversion_of_Prescription_Drugs|Reduce Diversion of Prescription Drugs]]''

----

= Introductory Paragraph =

Most opioid abuse prevention strategies include some sort of prescription drug take-back or disposal program.  This is a step in the right direction, but most communities have significant opportunities to expand and enhance these efforts to reach more people and reduce the ability of people to misuse these medications or give them to others who may misuse them.  This objective focuses on practical ways to make improvements to existing efforts and to add new options that communities may not yet be doing. 

 

= Key Information =

== Why Safe Disposal is Important ==

'''Intentional Misuse''':

*A majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet.<ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ </ref>
*SAMHSA’s 2009 National Survey on Drug Use and Health found that over 70 percent of people who used prescription pain relievers non-medically got them from friends or relatives, while approximately 5 percent got them from a drug dealer or from the Internet.
*Getting hooked on prescription opioids is directly responsible for over 60% of subsequent heroin addictions as addicts turn to this less expensive alternative.
*Prescription drugs involved in overdoses are almost all originally prescribed by physicians but are used by individuals other than the patient prescribed the drugs. (Get sources for this.) 

'''Accidental Exposure''':

*When medicines are no longer needed or have expired, it is important to properly dispose of them to reduce harm from accidental exposure or intentional misuse.<ref>http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm</ref> Throwing drugs in the garbage is a bad idea, because they can accidentally be taken by kids or pets.

'''Environmental Concerns''':

*Some people propose flushing or pouring unused medications down the drain, however, medications flushed into the waste stream can end up in water supplies.<ref>http://www.takebackyourmeds.org/what-you-can-do/medicine-disposal-myths-and-facts/</ref>
*Since the drugs in take-back programs are incinerated, take-back programs are the safest way to get rid of the chemicals and to stop them from getting into drinking water and watersheds as well as in the hands of those at risk.
*Innovative mail-back options provide a convenient way for people to have excess medications disposed of through incineration. (Details further down on this page.)

== Costs and Benefits of Safe Disposal Options ==

This fact sheet from the Product Stewardship Institute provides a good summary of the costs and benefits of different drug take-back and disposal options. 

[https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf]

== To Flush or Not to Flush ==

If no take-back programs are readily available, it is still important to dispose of the medications quickly and appropriately. Some prescriptions include instructions on how to dispose of the drug.<ref>https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</ref> The [https://www.fda.gov U.S. Food & Drug Administration (FDA)] provides the safest ways of disposing of these medications at home [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm here]. The FDA also recommends that certain drugs be flushed immediately, such as fentanyl patches, Oxycontin, and Percocet. A full list can be found on [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm#Flush_List this ]page.  Other experts strongly recommend '''not''' flushing medications down the toilet.<ref>Minnesota Pollution Control Agency https://www.pca.state.mn.us/featured/dont-flush-medicines-down-drain</ref>

The bottom line is that the best options are bringing your medications to a take-back day, putting them into a drug disposal kiosk, or using a mail-based program to send in the medications for proper disposal.  But, if you don't have access to these options, flushing unused medications that are on the "flush list" is better than keeping them around.   

 

 

== Special Populations ==

=== Senior Citizens ===

Senior citizens have a disproportionate number of medications in their homes. Helping seniors understand how to properly dispose of medications can make a big difference in the success of your program.  The Colorado Consortium for Prescription Drug Abuse Prevention has developed a successful program for reaching people age 65+ called "You're the Solution." This campaign has techniques and materials that can be used around the country. 

Learn more about [[You're_the_Solution|You're_the_Solution]] 

 

=== Nursing Homes ===

=== Individual patients aside, one study estimated the nation’s nursing homes discard anywhere from $73 million to $378 million worth of drugs a year. Some are incinerated, but many are flushed.<ref>https://www.nbcnews.com/health/health-news/got-old-medicine-don-t-flush-it-flna1c9478735</ref>   ===

Nursing homes could be provided with information and tools (or services) for more appropriate disposal options that are better for the environemnt and that minimize the likelihood of diversion of these medications.

=== Hospice Programs or Funeral Home Programs ===

Hospice programs can help family members understand how to properly handle the medications they inherit when a loved one passes away.<ref>https://www.dea.gov/press-releases/2017/05/08/dea-brings-record-amount-unused-prescription-drugs-national-prescription</ref>

Funeral homes may pass out a brochure to remind people to make sure that any prescription drugs that were being taken by a loved one are properly disposed of.  People in the late stages of life may have been getting prescription opioids to deal with pain.  Hospice and funeral homes could be provided with disposal products (like Seal&Send envelopes).

 

 

== Take-back Events ==

=== DEA National Drug Take-Back Day Initiative ===

The National Prescription Drug Take Back Day Initiative addresses a crucial public safety and public health issue by providing an opportunity for Americans to prevent drug addiction and overdose deaths. As of May 2017, the DEA has promoted 13 national take-back days, and they continue to collect more and more drugs each time. <ref>https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0 </ref> '''[https://www.deadiversion.usdoj.gov/drug_disposal/takeback/newsrelease.htm Program Successes]'''

*Over 4,200 law enforcement and community partners and 5,500 sites across the country.
*Since September 2010, these events have altogether collected 8,103,363 pounds (4,052 tons) of prescription drugs.
*The last National Take-back Day collected more than 900,386 pounds (450 tons).

To promote your local Rx Take Back Day, the DEA provides a [https://takebackday.dea.gov/content/partnership-toolbox partnership toolkit] featuring promotional materials for associated partners.<ref>https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0</ref> '''See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more DEA take-back resources and other ideas on how to implement a local take-back day.'''

 

=== State Level Drug Take Back Programs ===

See below for inspiration and ideas to replicate from current state efforts:

*[http://www.ddap.pa.gov/Prevention/Pages/Drug_Take_Back.aspx#.V07YY_krLcs Pennsylvania]
*[http://www.in.gov/bitterpill/ Indiana]
*[http://www.oregon.gov/oha/ph/HealthyEnvironments/DrinkingWater/SourceWater/Pages/takeback.aspx Oregon]
*[https://www.artakeback.org Arkansas]
*[http://www.takebackyourmeds.org/ Washington]
*[http://stoprxabuseinga.org/ Georgia]

== Increasing the Number of Drug Drop-Boxes in your Community ==

Since disposing of unneeded medications via a drug drop box is considered the best option, it is important for communities to increase the number of drop boxes that are available and to promote awareness of those drop boxes. 

This [https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/pharms_reports_factsheets/160920_PSI_Pharmacy_Guide_vS.pdf How-To Guide for Drug Take-Back], created by the Product Stewardship Institute, provides detailed guidance for expanding and improving a pharmacy-based collection program. 

The [http://www.rxdrugdropbox.org/ NADDI prescription drug dropbox ] website is an important resource to find locations of drop boxes, buy boxes, apply for grants, and other information about drop boxes.

With the help of the [https://www.naddi.org/ National Association of Drug Diversion Investigators], communities can apply for grants to receive a drop-box that will hold old opioids to prevent abuse. These boxes have resulted in multiple cities and communities being safer and reducing the risk of opioid addiction. Boxes are to be located in close proximity to law enforcement agencies so nothing happens to them. Multiple boxes have been placed in the State of Minnesota, and after reaching out to one town in specific, Fridley, they told us that they have seen a positive response to the drop-box. They have discarded pounds of prescription opioids that came from an at-risk community.

 

= In-Home Disposal =

== Medication Mail-back Envelopes ==

'''Stericycle Prescription Drug Seal&Send Pouches'''

Stericycle provides an option for unused prescription drugs to be mailed to them in an unmarked mailing pouch, and then the pills are incinerated. 

Learn more at: [https://www.stericycleenvironmental.com/tag/pharmaceutical-takeback/ https://www.stericycleenvironmental.com/tag/pharmaceutical-takeback/] 

 

== In-home disposal pouches & powders ==

'''Deterra Drug Disposal System '''

Minneapolis-based company Verde Technologies has created a product called [http://deterrasystem.com/ Deterra®] System which deactivates prescription drugs. Each patented Deterra® pouch contains a water-soluble inner pod containing MAT12® activated carbon. Once the pharmaceuticals are placed in the pouch, warm water is then added, which dissolves the inner pod releasing the activated carbon. The warm water also dissolves prescription pills, patches, and liquids, allowing them to be absorbed by the carbon, rendering them inert and non-retrievable. For more information on how to use Deterra®, view this [https://www.youtube.com/watch?v=lSBwBqpTk2c How-to video]

'''Benefits'''

*Inexpensive - Costs $7 per pouch
*Can encourage people to connect with law enforcement - People can pick up free (if already given to law enforcement) pouches from the station and dispose of them at home and save any potential embarrassment
*Improve overall water quality - with the majority of people flushing unused medication down the toilet, only water treatment facilities remove less than half of the prescription drugs found in sewage

'''DisposeRx'''

[http://disposerx.com/ Dispose Rx] is "a patented (pending) blend of solidifying materials that provides a solution for the safe disposal of unwanted or expired prescription drugs. Dedicated to environmentally friendly and safe non-toxic disposal solutions, DisposeRx is spearheading programs of educating communities with practical and safe medication disposing solutions, thus preventing the cycle of environmental pollution, addiction, overdose, and death." Prescription drugs can be rendered safe for disposal (and impossible to misuse) by adding powder from a packet directly into the pill bottle and shaking the bottle.

*Inexpensive - Costs about $1.50 per packet (and [https://www.aarp.org/health/drugs-supplements/info-2018/walmart-dispose-painkillers-fd.html Walmart gives the packets away free with a prescription or possibly a request])
*Packets can be attached to prescriptions with a rubber band (much like flower fertilizer is attached to fresh-cut flowers)
*Well-suited to campaigns with community partners (like clinics, churches, barbershops, or hair salons) to increase distribution to diverse populations.

See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more information.

 

 

= Impactful Federal, State, and Local Policies =

== Legislation & Drug Companies ==

Currently, several West Coast counties, the city of San Francisco, and the state of Massachusetts have issued legislation that require drug companies to fund drug take-back programs.<ref>[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/ </ref> On a national level, however, only 2.5 percent of eligible take-back organizations are participating, according to the Government Accountability Office. <ref>https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/</ref> The primary barrier seems to be financial: Maintaining the safe-like prescription drop-off container, training staff to follow the relevant regulations, and destroying the returned medication costs money. As a potential solution, writing a policy that mandates opioid manufacturers to pay patients for their returned bottles of pills, along with subsidizing drop-off location operators, could offset the costs and be what is needed to make returning leftover medication an automatic habit for consumers. <ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref> The [http://www.productstewardship.us/ Product Stewardship Institute], a nonprofit that supports drug take-back programs, calculated that at least a dozen other local governments around the country are considering similar legislation, including several California counties. In Minnesota, pharmaceutical company [http://www.mallinckrodt.com/ Mallinckrodt] donated 30,000 disposal pouch systems to be distributed.<ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref>

 

== State Legislation Requiring Disposal Kits be Given with Prescriptions ==

The Kentucky State Senate passed in March 2018 a bill that requires opioids and other abused drugs to be dispensed along with a method to permanently sequester and dispose of any leftover pills. If passed by the house and signed, it will be the first state to pass such a bill.  [http://www.disposerx.com DisposeRx] will be a popular choice to be given out along with prescription.  Other options include the Seal & Send mail-back packages or other options described below.

= Available Tools and Resources =

[[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|TR - Expand Prescription Drug Take-back & Disposal Programs]]

== Local Disposal Drop Boxes ==

=== Finding Disposal Locations ===

==== Medication Disposal Locators ====

Use the following links to find drug disposal locations

*[https://apps.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e1s1 DEA's Disposal Locator] - Find locations in your ZIP code. These collectors are registered with the DEA and pass unused medicine on to the agency to disposed.<ref>https://www.hometownsource.com/sun_focus/news/local/drop-off-prescription-drugs-anonymously-at-fridley-pd/article_b07bd27d-1122-55fa-8465-f47ad9a861dc.html</ref>
*[http://rxdrugdropbox.org/ Rx Drop Box]
*[http://disposemymeds.org/ Dispose My Meds]
*[https://nabp.pharmacy/initiatives/awarxe/drug-disposal-locator/ National Association of Boards of Pharmacy]
*[http://www.americanmedicinechest.com/ The American Medicine Chest Challenge]
*[https://walgreens.maps.arcgis.com/apps/MapSeries/index.html?appid=53cf1b54abf34c4bacdec863e5c56391 Walgreens Safe Medication Disposal Program]

= Promising Practices =

'''Current Efforts to Promote In-Home Disposal'''
<div class="objectEmbed">Case Studies</div>
The state of Pennsylvania has a goal of distributing Deterra® Drug Deactivation and Disposal pouches alongside 10% of all opioid prescriptions.
<div class="objectEmbed">Attorney General Shapiro Unveils Plan to Distribute 300,000 Drug Disposal Pouches in 12 counties<ref>https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</ref></div> <div class="objectEmbed">[https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html]</div>
Inspira Health Network (New Jersey) distributed the Deterra® pouch throughout their network. [http://www.njtvonline.org/news/video/inspira-health-network-battles-opioid-crisis-proper-drug-disposal/ Case Study] These pouches render opioids ineffective for misuse and are safe for disposal and the environment, and are another cost-efficient way to safely dispose of opioids.

= Actions to Take =

There are many actions that can be taken by coalitions, organizations or individuals to improve drug take-back and disposal.  Explore the ideas via the following link: [[PA_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Coalitions]]

[[PAI_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Individuals]]

'''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

 

= Sources =

----

 

[[Category:Pages with broken file links]] [[Category:SAFE-Prescriptions and Medical Response]]