Evidence Based Strategies for Abatement of Harms from the Opioid Epidemic

This report was designed to support and empower state and local officials in making critical allocation decisions and consolidates the best research evidence to provide recommendations for high-impact investments that will improve the addiction treatment system, strengthen prevention and harm reduction programming, and address substance use disorder within the criminal justice system. In addition to outlining the scientific support for each recommendation, the authors include detailed guidance related to economic impacts and policy considerations.

The contributing authors are foremost experts in their fields and represent organizations including: Harvard T. H. Chan School of Public Health; Johns Hopkins Bloomberg School of Public Health; Yale University; Carnevale Associates, LLC; Legal Action Center; University of Michigan School of Public Health; Stanford University; University of Pennsylvania, Perelman School of Medicine; Friends Research Institute; Vanderbilt University School of Medicine; RAND Corporation; and University of Pittsburgh. Funding support was provided by Arnold Ventures.

Key takeaways

• Treatment settings or programs that offer the greatest number of evidence-based components (FDA-approved medications for opioid use disorder (MOUD); behavioral therapies; and recovery support services) tend to have the greatest likelihood of facilitating recovery. Yet, very few patients with opioid use disorder (OUD) receive effective treatment.
• Harm reduction approaches enable people who are unable to stop using opioids to make positive changes in behavior that can improve their health and minimize the risks of opioid use (ie: syringe services and naloxone distribution).
• Lack of resources and coordination between health and criminal justice sectors, and policy failures, combined with racially discriminatory drug policies, have failed to effectively address the health needs of people with SUDs and criminalized a health problem resulting in the arrest and incarceration of many people with SUD for reasons unrelated to drug crimes.
• Policies that limit the supply and improve the safety of opioid analgesics prescribed in health care settings have the potential to decrease misuse of prescription opioid analgesics, and also subsequent illicit opioid use. However, there are several limitations to the evidence base for policies that limit the supply of opioid analgesic prescribing and the abrupt cessation or overly aggressive tapering of chronic, long-term opioid therapy is discouraged.
• Laws and policies that punish pregnant women for opioid misuse are potentially harmful, given widespread clinical experience and emerging research evidence indicating that such initiatives might impede access to both OUD treatment and prenatal care, thereby harming the health of the mother and infant.
• Data infrastructure is an essential tool in: judging whether opioid-related amelioration efforts are having any impact; for mapping the resources available to address the opioid crisis; and informing a community’s plans to deploy those resources and identifying gaps. Yet, many data-monitoring efforts are inadequate.

Recommendations

• Regardless of the setting, level, or approach to addiction care, all addiction treatment providers should offer a personalized set of evidence-based medications, behavioral therapies, and recovery support services with the goal of engaging patient participation, initiating clinically-managed recovery and supporting transition to self-managed recovery.
• Syringe services programs should utilize needs-based distribution models that do not require one-for-one syringe exchanges, and offer a comprehensive package of harm reduction and health care services.
• At each intercept, states and localities should require and fund the training of law enforcement, court, corrections, and community corrections staff on opioid and other SUD, effective treatment services, and medications, and recovery supports and increase access to SUD treatment, particularly MOUD, for incarcerated people with OUD, including those detained while awaiting trial
• Establish policies that have shown moderate-quality evidence of their ability to reduce opioid analgesic prescribing and dispensing to decrease the incidence of opioid misuse, OUD, negative opioid-related outcomes, and opioid overdose.
• Repeal laws and policies that take a punitive approach toward SUD in pregnancy.
• Make data-related investments in: regularly extracting state-level data; improving the assessment of variables already captured by existing systems; and creating new systems to measure variables for which there currently is no assessment.
• Utilize state laws and regulations to improve the quality of care and make treatment affordable.