This framework recognizes the critical role of public health leaders and partners in carrying out a comprehensive, cross-sector response to the opioid crisis. With effective leadership and cross-sector partnerships, states and territories can leverage four key strategies in their work, including (1) training and education; (2) monitoring and surveillance; (3) treatment, recovery and harm reduction; and (4) primary and overdose prevention. Each element of the framework was assessed for the level of evidence supporting the recommendation.

Monitoring and Surveillance

Training and Education

Primary and Overdose Protection

Treatment, Recovery and Harm Reduction


Not Yesterday’s Cocaine: Death Toll Rising From Tainted Drug

Kaiser Health News outlined the rise of cocaine-related drug deaths and how fentanyl is impacting cocaine supplies.

Using Interrupted Time Series Analysis to Measure the Impact of Legalized Syringe Exchange on HIV Diagnoses in Baltimore and Philadelphia

study from Journal of Acquired Immune Deficiency Syndrome determined that syringe exchange programs in Baltimore and Philadelphia have averted large numbers of HIV cases attributed to injection drug use.

A Nationally Representative Analysis of "Twin epidemics": Rising Rates of Methamphetamine Use Among Persons Who Use Opioids

A study in Drug and Alcohol Dependence using data from the nationally 2015-2017 National Survey on Drug Use and Health found significant increases in past month methamphetamine use among individuals reporting past month heroin use, past year heroin use disorder, and past year prescription opioid use disorder. 

Leadership from key leaders in governmental and nongovernmental agencies across multiple levels (federal, state, and local) and sectors (health, public safety, corrections, drug control, and education) is needed to comprehensively address the opioid epidemic within states and territories. Partnerships promote the cross-cutting, multisector collaboration needed to develop and sustain appropriate strategies and tactics for accomplishing state and local goals and objectives around addressing the opioid epidemic. Resources are critical for the successful implementation of these strategies and tactics.