Primary and Overdose Prevention

Primary and Overdose Prevention

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Recommendation Evidence Summary Prevention Tier Intervention Type
Encourage hospitals and clinics to screen for neonatal abstinence syndrome (NAS) during the prenatal period and at birth by conducting a toxicology screening and, upon a positive diagnosis, treating infants using evidence-based pharmacologic therapy. Experience-based for preventing or reducing opioid use disorder: Screening for NAS increases the identification and treatment of NAS. This, in turn, may reduce and prevent symptoms of opioid use disorder among infants. However, research to support this practice for reducing preventing or reducing opioid use disorder is insufficient. Secondary Prevention Practice
Encourage state lawmakers to support or expand standing orders that permit targeted naloxone distribution. Experience-based for reducing fatal opioid overdose: At least one systematic review indicates that targeted naloxone distribution is a feasible and effective community-based approach to train potential overdose bystanders on how to administer naloxone. Administering naloxone may, in turn, reduce rates of fatal overdose. However, research to support this policy for reducing fatal opioid overdose is insufficient. Tertiary Prevention Policy
Encourage state lawmakers to support or expand the pharmaceutical distribution of naloxone, by permitting standing orders (written by licensed prescribers), protocol orders (written by state boards of health or pharmacy licensing boards), and collaborative practice agreements (two-way agreements between prescribers and specific pharmacies/pharmacy chains within a state). Experience-based for reducing fatal opioid overdose: Data suggest permitting pharmacists to dispense naloxone without a prescription increases public access to naloxone. This, in turn, may prevent overdose fatalities. However, research to support this policy for reducing fatal opioid overdoses is insufficient. Tertiary Prevention Practice
Support medical professional's role in deterring prescription opioid misuse, by integrating the state prescription drug monitoring program (PDMP) database into Health IT systems, especially electronic health records (EHRs). Experience-based for reducing prescription opioid misuse: A number of states have integrated PDMP data with EHRs, including those housed at Community Health Departments and emergency departments. However, research to support this practice for reducing prescription opioid misuse is insufficient. Secondary Prevention Practice
Support pharmacist's role in deterring prescription opioid misuse, by integrating state prescription drug monitoring program (PDMP) database into existing pharmacy software systems. Experience-based for reducing prescription opioid misuse: At least one cross-sectional study conducted in Indiana found that pharmacists who consistently consulted the PDMP were more likely to refuse dispensing controlled substances than those who did not. However, research to support this practice for reducing prescription opioid misuse is insufficient. Secondary Prevention Practice
Advocate for "pill mill" laws to provide state-level regulatory oversight of pain management clinics. Experience-based for reducing prescription opioid misuse:  Data collected to examine the effect of pill mill laws in Florida and in Texas found that they reduced morphine equivalent dose (MED), opioid volume, and the number of opioid prescriptions and pills among high-risk providers, but not among low-risk providers. However, research to support this policy for reducing prescription opioid misuse is insufficient. Secondary Prevention Policy
Support electronic-prescribing (e-prescribing) mandates, by encouraging prescriber use of electronic prescribing for controlled substances (ECPS). Experience-based for reducing prescription opioid misuse: ECPS is a useful tool for safe opioid prescribing, which may, in turn, reduce prescription opioid misuse. However, research to support this practice for reducing prescription opioid misuse is insufficient. Secondary Prevention Practice
Work with school systems to promote evidence-based middle school programs found to reduce risk of opioid misuse in adolescence, like the Botvin Life Skills Training (LST) program. Evidence-based for reducing prescription opioid misuse: At least one randomized controlled trial showed that the LST Middle School program delivered in 7th grade classrooms helped students avoid misusing prescription opioids throughout adolescence. Primary Prevention Program
Work with community leaders to promote school, community, and university partnerships that support evidence-based prevention systems with middle school youth and their families, like Promoting School-Community-University Partnerships to Enhance Resilience (PROSPER). Evidence-based for reducing opioid use disorder: Research suggests that PROSPER reduces rate of opioid use disorder among adolescents and young adults. Primary Prevention Program
Work with providers to promote evidence-based preventive interventions for chronic pain patients newly prescribed to opioid medications, like SmartRx, to reduce the likelihood of prescription drug misuse. Evidence-informed for preventing prescription opioid misuse: At least one randomized controlled trial found that SmartRx 1) decreased patients' perceived level of problematic medication use and 2) increased patients' knowledge about prescription drug facts, as well as their perceived ability to adhere to and manage problems with medication. Educating patients about opioid pain medications may result in reducing risk for opioid use disorder. Secondary Prevention Program
Work with pain clinics to promote evidence-based mindfulness programs found to reduce risk for opioid misuse, like The Mindfulness-oriented recovery enhancement (MORE) program. Evidence-informed for reducing opioid use disorder: At least one randomized controlled trial found that MORE reduced participant cravings for opioid use among patients with chronic pain. Reduced cravings may result in a reduced risk of opioid use disorder. Secondary Prevention Program
In the absence of SBIRT, implement screening and brief interventions for emergency department patients who use opioids. Evidence-based for reducing opioid use: At least one randomized controlled trial found a screening and brief motivational enhancement intervention to reduce prescription drug use among those at risk for overdose. Secondary Prevention Program
Encourage providers to educate patients prescribed opioids about the safe and secure storage of opioid medications. Experience-based for reducing prescription opioid misuse: The safe and secure storage of prescription opioids is likely to reduce access to unused drugs by persons who have not obtained prescriptions for these drugs. However, research to support this practice for reducing opioid use disorder is not available. Secondary Prevention Practice
Fund and implement safe injection sites to reduce risk of fatal overdose. Evidence-based for reducing fatal opioid overdose: At least one systematic review found that safe injection sites enhance access to primary healthcare and reduce the frequency of fatal overdose. Tertiary Prevention Program
Encourage providers treating chronic pain to co-prescribe naloxone when prescribing opioids. Experience-based for reducing fatal opioid overdose: Research suggests that long-term opioid therapy patients co-prescribed naloxone had fewer opioid-related emergency-department visits over 6 month than those not co-prescribed. However, research to support this practice for reducing opioid use disorder is insufficient. Secondary Prevention Practice
Develop and support community-based overdose prevention programs, like Project Lazarus, that offer a continuum of overdose prevention strategies (such as provider education in chronic pain management and safe prescribing practices and targeted naloxone distribution). Experience-based for reducing opioid overdose: Preliminary research suggests that Project Lazarus reduces rates of opioid overdose over time. However, research to support this program for reducing opioid use disorder  is insufficient. Tertiary Prevention Program