​Partner Recommendations

The Overdose Prevention Initiative (OPI) works with state and local partners to address the complex and changing nature of the drug overdose epidemic through promoting:

• Data collection, analysis, and dissemination
• Substance use prevention programs
• Harm reduction tools and strategies
• Public awareness and education
• Safe and effective prescribing and treatment practices

OPI shares the following recommendations and resources to statewide partners in response to increases in drug overdoses statewide. Each recommendation lists resources by partner type (public safety, public health departments, community-based organizations, health care providers and settings, harm reduction organizations, medical examiners and coroners, and public health and forensic laboratories). Identify your partner type and review the resources for  local overdose prevention and response implementation.  For questions, please contact us at opi@cdph.ca.gov.

1. Increase the distribution of naloxone.
   
2. Promote overdose prevention education.
   
3. Expand equitable access to treatment for substance use disorders.
   
4. Intervene early with individuals at the highest risk for overdose.
   
5. Improve detection of drug-related overdose outbreaks and facilitate a timely and effective response.
   

Recommendation #1: Increase the distribution of naloxone.

Public safety, public health departments, and community-based organizations:

Get naloxone

• Apply to the California Department of Health Care Services (DHCS) Naloxone Distribution Project (NDP) to receive free naloxone (Narcan®) kits. Review the FAQs (PDF) to learn more.
  
• Get naloxone from a pharmacy or  a local organization that has a naloxone distribution program, such as a local opioid or overdose safety coalition, harm reduction agencies, or a syringe services program.
  

Distribute naloxone

• Apply to the CDPH statewide standing order to distribute naloxone legally. Review the FAQs (PDF) and terms and conditions to determine if your agency should apply.
  
• Give naloxone to people who use drugs and their family and friends. Both intranasal (into the nose) sprays and intramuscular (into the muscle) injections of naloxone are highly effective and available in easy-to-use options. With a fentanyl overdose, two or more doses of naloxone may need to be given.
• Promote California's Good Samaritan law, which protects those giving emergency medical care at the scene of a medical emergency, including giving naloxone. 
  
• Develop strategies to ensure naloxone kits and overdose prevention education and training are available and accessible to all community members.
  
• Learn more about California’s naloxone access options (PDF), and view the naloxone distribution training on CDPH’s naloxone webpage.
  

Recommendation #2: Promote overdose prevention education.

Increase public awareness:

• The Centers for Disease Control and Prevention (CDC) launched several overdose prevention public awareness and education campaigns for young adults ages 18 - 34 years. The campaigns provide information about the prevalence and dangers of fentanyl, the risks and consequences of mixing drugs, the life-saving power of naloxone, and the importance of reducing stigma around drug use to support treatment and recovery.
  

Implement prevention policies and strategies:

• Substance Abuse and Mental Health Services Administration's (SAMHSA) Opioid Overdose Prevention Toolkit offers strategies to health care providers, communities, and local governments for developing practices and policies to help prevent opioid-related overdoses and deaths.
• National Association of County Health Officials' (NACCHO) Opioid Epidemic Toolkit contains numerous resources, organized by topic and level, to support local health departments with overdose prevention.
  
• National Harm Reduction Coalition provides educational information around safer drug use, increases access to naloxone, and conducts hundreds of overdose prevention trainings each year to save thousands of lives. Visit their online learning center for self-paced learning modules on harm reduction strategies.
  

Recommendation #3: Expand equitable access to treatment for substance use disorders.

Public health departments and community-based organizations:

Promote treatment to help those with substance use disorder.

• DHCS California Medication Assisted Treatment (MAT) Expansion Project aims to increase access to MAT, reduce unmet treatment needs, and reduce opioid overdose related deaths through the delivery of prevention, treatment, and recovery activities.
• Choose Change California is a DHCS statewide campaign dedicated to providing an easy pathway to get help for people affected by substance use disorder.
• Non-Emergency Treatment Referral Line (1-800-879-2772) is a DHCS referral line that connects people to local resources and services from their County Alcohol and Other Drugs Program Office.
• Behavioral Health Treatment Services Locator is a national treatment facility locator from SAMHSA.
• SAMHSA's National Helpline (1-800-662-HELP [4357]) provides referrals to local treatment facilities, support groups, and community-based organizations for individuals and family members facing mental and/or substance use disorders.
• California ED Bridge Program (CA Bridge) expands access to medication for addiction treatment through emergency departments (EDs), a critical access point for medical intervention.
• California MAT Telehealth Providers is a list provided by CA Bridge that can be used by hospitals to arrange for telehealth MAT services for their patients.
  

Recommendation #4: Intervene early with individuals at the highest risk for overdose.

Individuals at higher risk for fatal drug overdose include people that mix different types of drugs or mix drugs with alcohol, who have had a prior non-fatal overdose, who use alone, are of older age, have a compromised immune system, and those experiencing rapid decrease in tolerance from situations such as hospitalization, incarceration, and detoxification.

Healthcare providers:

• Follow these Best Practices for Providers Who Inherit Patients on Opioids (PDF).
• See SAMHSA’s Guideline: Treatment for Stimulant Use Disorders.
• Initiate or continue treatment for opioid use disorder among people leaving correctional and detention facilities. See Care for Patients with Opioid Use Disorder Who Are in Custody.
• If you are unable to provide treatment, refer patients to:
• MAT: a substance use disorder treatment that combines medication with counseling or other behavioral therapy. Use the Choose Change California Treatment Locator.
• Twelve-step facilitation therapy: an individual active engagement strategy designed to encourage people to accept substance use disorder as a chronic, progressive disease, and prepares them to begin a 12-step mutual support program.
• Outpatient counseling: helps individuals understand addiction, their triggers, and their reasons for using drugs. This treatment option is done at an outpatient substance use treatment facility in person or through telehealth.
• Inpatient rehabilitation at a full-time facility: provides a supportive environment to help individuals recover.  Call 1-800-304-2219 for more information about treatment facilities or to locate a facility and visit Drug Rehab California - Long Term Residential.
  

Public health departments and community-based organizations:

Promote harm reduction for substance use disorder.

• Partner with local harm reduction organizations and local overdose safety coalitions that provide overdose prevention and many other services for people who use drugs.
• See CDPH's directory of more than 60 harm reduction providers statewide, and learn more from the National Harm Reduction Coalition's California office.
• Link people to medications for opioid use disorder, including buprenorphine and methadone, and to other health care services.
• Contact the California SUD Non-Emergency Treatment Referral Line at (800) 879-2772 or (916) 327-3728.
• Find treatment options through the California Bridge network, which operates at more than 200 hospitals statewide.
• Purchase and distribute fentanyl test strips (FTS) to people who use drugs.
  
• Purchase FTS for about $1.00 each from BTNX and DanceSafe.
• Free or low-cost FTS are available to individuals at California's syringe services programs through the California Harm Reduction Supplies Clearinghouse.
  
• Refer to the Fentanyl Testing to Prevention Overdose (PDF) fact sheet with information about FTS and other overdose prevention best practices for people who use drugs and healthcare providers.
  
• Link people who are at risk for drug overdose with care and track their retention in care. People who are at risk include those who have recently had their opioid use tolerance reduced (e.g., by being in jail or being involved in unmedicated SUD treatment) or who have recently experienced a non-fatal overdose.
• Start and support peer navigator programs or use recovery coaches to support individuals at the highest risk of overdose.
• Partner with syringe services programs in your jurisdiction or take steps to add syringe services to the work you do.
• Destigmatize (PDF) substance use disorder by meeting people where they are.
• Learn how to engage people who use drugs.
  

Recommendation #5: Improve detection of drug-related overdose outbreaks and facilitate a timely and effective response.

Public health departments:

• Develop a drug overdose spike response plan. Use NACCHO's framework (PDF) for guidance. 
  
• Improve rapid identification of drug overdose outbreaks, spikes, or anomalous (irregular) events. 
  
• Use multiple data sources and build new partnerships to obtain overdose data, such as:
  
• Non-fatal overdose data sources, including syndromic surveillance (i.e., tracking syndromes and/or symptoms of patients in emergency departments) (BioSense/ESSENCE), and emergency medical services.
• Fatal overdose data sources, including medical examiner or coroner.
• Other data sources, including poison control center and toxicology testing.
• Monitor trends in the illicit drug supply, including geographic distribution and identification of adulterated (contaminated) drugs.
• Monitor trends in overdose data, including:
• Geographic distribution or clusters (e.g., households or neighborhoods).
• Demographic characteristics (e.g., age, sex).
• Drugs of concern (e.g., fentanyl analogs, new substances).
• Circumstances surrounding overdoses (e.g., homelessness, previous emergency department visit for overdose, naloxone administration).
• Implementing rapid detection surveillance to complement current/traditional surveillance systems.
• Partner with coroner and medical examiner offices, health care facilities, and emergency medical services to obtain overdose data to inform a timely community response.
• Partner with local overdose safety coalitions and harm reduction organizations to engage communities and reduce stigma.

Harm reduction organizations:

• Implement drug checking services and drug supply surveillance.
  
• Connect with people who use drugs to understand current drug supply trends.
  
• Partner with public health departments and others to obtain and disseminate the latest information on local drug supply and overdose trends.

Healthcare facilities:

• Partner with local public health departments to implement syndromic surveillance (BioSense/ESSENCE). Health care facilities may meet program requirements for CMS Promoting Interoperability Program.
  

Medical examiners and coroners:

• Partner with public health departments and harm reduction organizations to share overdose death data to inform a timely community response.
  
• Screen specimens to detect drugs, including fentanyl, fentanyl analogs, novel synthetic opioids, and novel psychoactive substances:
• Consider specialized testing.
• Partner with and contact CDPH's Overdose Prevention Initiative for additional guidance and resources.
• Use a licensed physician or medical examiner for completion of death certificates; when lay coroners serve as certifiers, such certifiers should rely upon physician input and guidance (PDF).
• Include all contributing drugs on death certificates using this reference guide (PDF).
• Seek funding to promote teaching and learning opportunities that encourage career pathways into forensic science.
  

Laboratories:

• The CDC recommends that laboratories:
• Implement an opioid biosurveillance program in line with the Association of Public Health Laboratories (APHL) guidance (PDF).
  
• Use CDC's Traceable Opioid Material® Kits (TOM Kits®).
  
• Screen for fentanyl analogs.