The Overdose Response Strategy: Reducing Drug Overdose Deaths Through Strategic Partnership Between Public Health and Public Safety.

CONTEXT: Public health and public safety collaborations can strengthen and improve efforts to address the worsening drug overdose crisis. PROGRAM: The Overdose Response Strategy is addressing this need through a national public health and public safety program designed to foster the cross-sector sharing of timely data, pertinent intelligence, and evidence-based and innovative strategies to prevent and respond to drug overdose. IMPLEMENTATION: Since 2015, the Overdose Response Strategy has been implemented by state-based public health and public safety teams who work together to prevent and respond to drug overdoses within and across sectors, states, and territories. The public health and public safety teams share data systems to inform rapid and effective community overdose prevention efforts; support immediate, evidence-based response efforts that can directly reduce overdose deaths; design and use promising strategies at the intersection of public health and public safety; and use effective and efficient primary prevention strategies that can reduce substance use and overdose long term. Implementation of the Overdose Response Strategy aligns with the US Centers for Disease Control and Prevention's Strategic Partnering Framework. EVALUATION: The evaluation of the Overdose Response Strategy, which is currently underway, is based on 2 evaluation approaches: Collective Impact and Organizational Network Analysis. These approaches provide a way to look at the strength of the relationship between public health and public safety and the way the relationship is leveraged to advance program goals and objectives. DISCUSSION: The Overdose Response Strategy serves as a strategic partnership model that can potentially be applied to other issues, such as gun violence, that may benefit from public health and public safety collaboration.

The Martinsburg Initiative: A Collaboration Between Public Safety, Public Health, and Schools to Address Trauma and Substance Use.

The Martinsburg Initiative (TMI) is a community-based model developed in Martinsburg, West Virginia, that implements a comprehensive approach to adverse childhood experiences and substance use prevention and mitigation by leveraging partnerships in public health and health care, public safety, and education. TMI receives coordinated federal funding and technical assistance from the Centers for Disease Control and Prevention, the Washington-Baltimore High Intensity Drug Trafficking Agency, and the National Association of County and City Health Officials to integrate evidence-based and promising strategies. It advances such strategies by translating them for implementation within the community, evaluating the reach and potential impact of the model, and by engaging key stakeholders. Preliminary results describing program reach and short-term outcomes collected for a subset of the interventions during implementation are presented. The model uses touchpoints across multiple community sectors in the city of Martinsburg to break the cycle of trauma and substance use across the life span.

Public Health Interventions and Overdose-Related Outcomes Among Persons With Opioid Use Disorder.

Importance: Given the high number of opioid overdose deaths in the US and the complex epidemiology of opioid use disorder (OUD), systems models can serve as a tool to identify opportunities for public health interventions. Objective: To estimate the projected 3-year association between public health interventions and opioid overdose-related outcomes among persons with OUD. Design, Setting, and Participants: This decision analytical model used a simulation model of the estimated US population aged 12 years and older with OUD that was developed and analyzed between January 2019 and December 2023. The model was parameterized and calibrated using 2019 to 2020 data and used to estimate the relative change in outcomes associated with simulated public health interventions implemented between 2021 and 2023. Main Outcomes and Measures: Projected OUD and medications for OUD (MOUD) prevalence in 2023 and number of nonfatal and fatal opioid-involved overdoses among persons with OUD between 2021 and 2023. Results: In a baseline scenario assuming parameters calibrated using 2019 to 2020 data remained constant, the model projected more than 16 million persons with OUD not receiving MOUD treatment and nearly 1.7 million persons receiving MOUD treatment in 2023. Additionally, the model projected over 5 million nonfatal and over 145 000 fatal opioid-involved overdoses among persons with OUD between 2021 and 2023. When simulating combinations of interventions that involved reducing overdose rates by 50%, the model projected decreases of up to 35.2% in nonfatal and 36.6% in fatal opioid-involved overdoses among persons with OUD. Interventions specific to persons with OUD not currently receiving MOUD treatment demonstrated the greatest reduction in numbers of nonfatal and fatal overdoses. Combinations of interventions that increased MOUD initiation and decreased OUD recurrence were projected to reduce OUD prevalence by up to 23.4%, increase MOUD prevalence by up to 137.1%, and reduce nonfatal and fatal opioid-involved overdoses among persons with OUD by 6.7% and 3.5%, respectively. Conclusions and Relevance: In this decision analytical model study of persons with OUD, findings suggested that expansion of evidence-based interventions that directly reduce the risk of overdose fatality among persons with OUD, such as through harm reduction efforts, could engender the highest reductions in fatal overdoses in the short-term. Interventions aimed at increasing MOUD initiation and retention of persons in treatment projected considerable improvement in MOUD and OUD prevalence but could require a longer time horizon for substantial reductions in opioid-involved overdoses.

Associations between three characteristics of parent-youth relationships, youth substance use, and dating attitudes.

Various dimensions of parenting have been associated with youth risk behaviors, such as substance use and dating violence. These associations have spawned many prevention strategies that focus on parenting. However, it is unclear which characteristics of parent-youth relationships, and thus, which parent-focused prevention strategies, may be most influential in youth risk behaviors and, thus, which should be targeted in prevention. Using responses from the YouthStyles 2007 survey (N = 1,357), this study identified three youth-reported parent-youth relationship characteristics: communication about risk behaviors, closeness/respect, and rules/monitoring. The authors examined the associations among these characteristics and youths' demographics, attitudes supporting controlling dating relationships, and use of alcohol, marijuana, and tobacco. Results suggested risk behavior communication was more frequently reported by girls and was more frequent among older youth. Closeness/respect and rules/monitoring were more frequent among younger youth. Regressions suggested communication about risk behaviors was not a predictor of attitudes supporting controlling dating relationships but was a significant predictor of substance use, closeness/respect and rules/monitoring predicted substance nonuse and attitudes unsupportive of controlling dating relationships. The findings suggest that parental communication alone may not be sufficient to influence youth risk taking, but that parental monitoring and the establishment of respectful, close relationships with children may be important elements of parent-focused health promotion efforts.

Navigating the road ahead: public health challenges and the interactive systems framework for dissemination and implementation.

Public health is currently faced with an array of critical challenges and disconnects. Research and evaluation have identified a number of evidence-based strategies for effecting behavior change at individual, group, organizational, and environmental levels, all of which hold promise for leading to substantial reductions in morbidity and mortality, and increased quality of life. Unfortunately, there is huge variability across the public health system in awareness of the value of using evidence to inform decision making, let alone in capacity to locate, assess, compare, select, justify, adapt, implement, and evaluate evidence-based strategies, or to participate in building the evidence base for practice-based innovations. As a result, many communities may not be benefitting from research-tested and practice-based strategies that could help them to meet their public health goals more efficiently and effectively. CDC's Interactive Systems Framework for Dissemination and Implementation (ISF), released in 2008, was designed to help close this gap between research and practice. This commentary identifies the ways in which the ISF framework is useful in addressing the research practice gap; revisits the elements of the framework that have continued to guide research and practice in fruitful ways; and highlights areas that need further development to meet current public health challenges.

Street-drug lethality index: A novel methodology for predicting unintentional drug overdose fatalities in population research.

BACKGROUND: Emerging evidence suggests the composition of local illicit drug markets varies over time and the availability and relative lethality of illicit drugs may contribute to temporal trends in overdose mortality. Law enforcement drug seizures represent a unique opportunity to sample the makeup of local drug markets. Prior research has associated shifts in the types of drugs seized and trends in unintentional drug overdose mortality. The present report builds on this work by demonstrating a novel methodology, the Street-Drug Lethality Index, which may serve as a low-lag predictor of unintentional overdose deaths. METHODS: Data included administrative records of law enforcement drug seizures and unintentional drug overdose deaths in Ohio from 2009 -to- 2018. Death records and lab results from drug seizures occurring during the calendar year 2017 were transformed via the described procedure to create lethality indices for individual drugs. These indices were then summed annually to create the independent variable for a linear regression model predicting unintentional overdose deaths for all years during the study period. RESULTS: The regression model explained 93 % of the year-to-year variance in unintentional overdose fatalities (slope = 0.009480; CI = 0.007369 to 0.011590; t10 = 10.355942; P = 0.000007; Y = 11.808982 + 0.009480X, r2 = 0.931). CONCLUSION: These findings contribute to a growing body of evidence that changes in the composition of the drug supply may predict trends in unintentional overdose mortality. The proposed methodology might inform future overdose prevention and response efforts as well as research.

Prevalence and correlates of ever having a substance use problem and substance use recovery status among adults in the United States, 2018.

BACKGROUND: Expanding access to treatment and recovery services is key to reducing substance use-related harms. Fundamental to expanding such services is better understanding the populations identifying themselves as in recovery. This study uses nationally representative data to estimate prevalence and correlates of recovery in the U.S. METHODS: Data are from the 43,026 adults (aged 18 or older) participating in the 2018 National Survey on Drug Use and Health. Based on self-reported data, we estimate prevalence of ever having a substance use problem, the percentage in recovery among those with a substance use problem, and a multivariable logistic regression model to explore associations of recovery status with demographic characteristics and lifetime mental health problems. Among adults reporting a substance use problem, we compare prevalence of substance use by recovery status, followed by a multivariable model examining associations between each substance used and being in recovery. RESULTS: More than 1 in 10 adults (27.5 million) in the U.S. reported ever having a substance use problem, and, among those with a problem, nearly 75 % (20.5 million) reported being in recovery. Reporting lower prevalence of using substances in the past year and having received treatment for their substance use problem were associated with being in recovery. Ever having a mental health problem was highly prevalent among those reporting a substance use problem. CONCLUSIONS: The provision and expansion of substance use treatment services continues to be important to reduce harms related to substance use, especially for those with both substance use and mental health disorders.

Knowledge, preparedness, and compassion fatigue among law enforcement officers who respond to opioid overdose.

BACKGROUND: Rates of fatal overdose (OD) from synthetic opioids rose nearly 60 % from 2016 to 2018. 911 Good Samaritan Laws (GSLs) are an evidenced-based strategy for preventing OD fatality. This study describes patrol officers' knowledge of their state's GSL, experience with OD response, and their perspectives on strategies to prevent and respond to opioid OD. METHODS: An electronic survey assessed officers' knowledge of state GSLs and experiences responding to OD. Descriptive statistics and hierarchical linear modeling were generated to examine differences in knowledge, preparedness, and endorsement of OD response efforts by experience with OD response. RESULTS: 2,829 officers responded to the survey. Among those who had responded to an OD call in the past six months (n = 1,946), 37 % reported administering naloxone on scene and 36 % reported making an arrest. Most (91 %) correctly reported whether their state had a GSL in effect. Only 26 % correctly reported whether that law provides limited immunity from arrest. Fifteen percent of officers who had responded to an OD work in departments that do not carry naloxone. Compared with officers who had not responded to any OD calls, those who reported responding OD calls at least monthly and at least weekly, were significantly less likely to endorse OD response efforts. CONCLUSION: Officers who respond to OD calls are generally receiving training and naloxone supplies to respond, but knowledge gaps and additional training needs persist. Additional training and strategies to relieve compassion fatigue among those who have more experience with OD response efforts may be indicated.

Empowerment evaluation with programs designed to prevent first-time male perpetration of sexual violence.

This special issue captures several threads in the ongoing evolution of sexual violence prevention. The articles that follow examine an empowerment evaluation process with four promising programs dedicated to preventing first-time male perpetration of sexual violence, as well as evaluation findings. Both the evaluation approach and the programs examined shed light on how sexual violence prevention can continue to be improved in the future.

Empowerment evaluation for violence prevention public health programs.

The formative evaluation consultation and systems technique (FORECAST) approach to evaluating complex community programs is described as an empowerment evaluation strategy. First, empowerment evaluation is defined and contrasted with more-traditional approaches, such as experimental and quasi-experimental designs. Then FORECAST is described, illustrating how it was applied in four community projects. One of the projects is used to demonstrate the application of FORECAST evaluation in programs addressing the prevention of first-time male perpetration of sexual violence.

Empowering programs with evaluation technical assistance: outcomes and lessons learned.

Although empowerment evaluation has gained widespread currency, few reports have described its outcomes. This article combines perspectives of participants and technical assistance providers to describe the process and outcomes of the Evaluation Assistance for Sexual Violence Programs project. Participating programs reported substantial enhancements in evaluation capacity, resources devoted to evaluation, and the extent and sophistication of their evaluation practice, as well as numerous examples of the application of evaluation findings to program improvement. Experiences from evaluation technical assistance providers identified aspects of the process that were particularly useful in achieving these outcomes, including investing in collaborative relationships, maximizing participation among program staff, tailoring the content and form of technical assistance to program preferences, and combining structured learning with program-specific technical assistance.

Adoption, adaptation, and fidelity of implementation of sexual violence prevention programs.

Little research examines the organizational and contextual dynamics that affect decisions to adopt evidence-based programs as well as the feasibility of implementation with fidelity to the original model when new users adopt established programs. To understand how promising strategies can be disseminated widely, this study examines the adoption and implementation of two sexual violence prevention programs in new settings. Interviews were conducted with stake-holders to investigate the factors and dynamics related to the adoption and implementation of these programs. Additionally, the research team worked with the program developers to create measures of the fidelity of implementation, which were then administered at each site. The findings suggest that adoption decisions were based on perceived fit between the program and the adopting organization's values, goals, and local setting. After adoption, new sites were able to implement the program with fairly high levels of fidelity, given moderate investments in training and technical assistance.

Developing teen dating violence prevention strategies: formative research with middle school youth.

Intimate partner violence (IPV) peaks in youth and young adulthood and is associated with multiple adolescent risk behaviors and negative health outcomes. Targeting youth with prevention messages before they start dating may avert teen dating violence and subsequent adult IPV. This article discusses findings from focus groups with middle school youth to determine behaviors and beliefs regarding dating violence. To develop effective prevention messages, participants were asked questions about characteristics of middle school dating relationships, healthy relationships, relationship norms, unhealthy relationships, emotional abuse, physical abuse, sexual abuse, intervening in violent situations, and trusted sources for information about dating violence. The recommendations for prevention efforts include an emphasis on skill building, tailoring efforts for particular subgroups, and identifying innovative ways of reaching youth.

Associations of dating violence victimization with lifetime participation, co-occurrence, and early initiation of risk behaviors among U.S. high school students.

This study examined the association of victimization in a physically violent dating relationship with risk behaviors, age of risk behavior initiation, and co-occurrence of risk behaviors among students in grades 9 through 12 in the United States. Data were from the 2003 national Youth Risk Behavior Survey (YRBS). Nearly 9% of students reported experiencing dating violence victimization. Dating violence victimization was associated with alcohol use, marijuana use, and having ever had sexual intercourse among female students and having ever had sexual intercourse among male students. Dating violence victimization also was associated with early initiation of alcohol use among female students. The odds of dating violence victimization increased as the number of risk behaviors increased and as the number of lifetime sexual partners increased. These risk behavior patterns should serve as warning signs of elevated risk for dating violence victimization and may be helpful in identifying adolescents who could benefit from targeted, preventive interventions.

Technical Packages in Injury and Violence Prevention to Move Evidence Into Practice: Systematic Reviews and Beyond.

Injury and violence prevention strategies have greater potential for impact when they are based on scientific evidence. Systematic reviews of the scientific evidence can contribute key information about which policies and programs might have the greatest impact when implemented. However, systematic reviews have limitations, such as lack of implementation guidance and contextual information, that can limit the application of knowledge. "Technical packages," developed by knowledge brokers such as the federal government, nonprofit agencies, and academic institutions, have the potential to be an efficient mechanism for making information from systematic reviews actionable. Technical packages provide information about specific evidence-based prevention strategies, along with the estimated costs and impacts, and include accompanying implementation and evaluation guidance to facilitate adoption, implementation, and performance measurement. We describe how systematic reviews can inform the development of technical packages for practitioners, provide examples of technical packages in injury and violence prevention, and explain how enhancing review methods and reporting could facilitate the use and applicability of scientific evidence.

Mandatory Provider Review And Pain Clinic Laws Reduce The Amounts Of Opioids Prescribed And Overdose Death Rates.

To address the opioid overdose epidemic in the United States, states have implemented policies to reduce inappropriate opioid prescribing. These policies could affect the coincident heroin overdose epidemic by either driving the substitution of heroin for opioids or reducing simultaneous use of both substances. We used IMS Health's National Prescription Audit and government mortality data to examine the effect of these policies on opioid prescribing and on prescription opioid and heroin overdose death rates in the United States during 2006-13. The analysis revealed that combined implementation of mandated provider review of state-run prescription drug monitoring program data and pain clinic laws reduced opioid amounts prescribed by 8 percent and prescription opioid overdose death rates by 12 percent. We also observed relatively large but statistically insignificant reductions in heroin overdose death rates after implementation of these policies. This combination of policies was effective, but broader approaches to address these coincident epidemics are needed.

Through a public health lens. Preventing violence against women: an update from the US Centers for Disease Control and Prevention.

Over the past two decades, the Centers for Disease Control and Prevention (CDC) has been a key contributor to the growing public health effort to prevent violence. Although CDC and its partners are proud of their many successes, much work remains to be done. Violence continues to be a leading cause of death worldwide for people aged 15-44. Moreover, although many forms of violence garner national concern and resources, much more violence occurs in private domains and receives less attention. These hidden health hazards silently drain our nation's human, economic, and health resources. In this paper, we highlight the current efforts of the Division of Violence Prevention (DVP), housed within CDC's National Center for Injury Prevention and Control (NCIPC), to use a public health approach to the prevention of one key hidden health hazard: violence against women (VAW). Building from a recently developed strategic plan and a research agenda, we explain how four core public health principles--emphasizing primary prevention, advancing the science of prevention, translating science into effective programs, and building on the efforts of others--drive current programmatic activities in VAW prevention. Several current programs and projects are described. Finally, we conclude with recommendations for future prevention work by deepening our vision of leadership, expanding our partnerships, pursuing comprehensive approaches, and using evidence-based strategies.