Medication-Assisted Treatment (MAT) for Opioid Use Disorder in Jails and Prisons: A Planning and Implementation Toolkit

People who have been incarcerated are approximately 100 times more likely to die by overdose in the first two weeks after their release than the general public. Despite high rates of opioid use disorder among justice-involved individuals, evidence-based medications exist and can be successfully implemented within jails and prisons.

To reduce risk of opioid overdose and recidivism and to better serve incarcerated individuals with opioid use disorder, the National Council, in partnership with Vital Strategies and faculty from Johns Hopkins University, developed a new resource guide titled: Medication-Assisted Treatment for Opioid Use Disorder in Jails and Prisons: A Planning and Implementation Toolkit.

Minnesota Opioid Prescribing Guidelines, First Edition 2018

This is the first edition of the Minnesota Opioid Prescribing Guidelines. The guidelines provide a framework for the appropriate use of opioid analgesia within the larger context of pain management. Specifically, these guidelines aim to reduce the inappropriate use of opioid analgesia, limit the oversupply of prescription opioids in the community and reduce variation in opioid prescribing behavior and above all else, improve the safety and effectiveness of treatments for pain and reduce the potential for harm of such treatments.

Framing Opioid Prescribing Guidelines for Acute Pain: Developing the Evidence

The epidemic of opioid misuse and overdose, combined with the need to reduce the burden of acute pain, poses a significant public health challenge. To address how evidence-based clinical practice guidelines (CPGs) for prescribing opioids for acute pain might help meet this challenge, the U.S. Food and Drug Administration (FDA) asked the National Academies of Sciences, Engineering and Medicine (National Academies) to develop a framework to evaluate CPGs, recommend indications for which new evidence-based guidelines should be developed, and recommend a future research agenda to inform and enable the development and dissemination of evidence-based CPGs.

The resulting report, Framing Opioid Prescribing Guidelines for Acute Pain: Developing the Evidence, recommends two frameworks—an analytic framework and an evidence evaluation framework—that medical professional societies, health care organizations, and state, national, and local agencies could use to develop CPGs for prescribing opioids to manage acute pain.

Local Opioid Prevention and Response: A Primer for Local Health Departments

Create a free account and download the link on the right side of page. Local Opioid Prevention and Response: A Primer for Local Health Departments serves to inform local health departments about the domestic opioid epidemic and share success stories from LHDs currently engaged in opioid-related efforts.

Motivational Interviewing (MI) Resources and Webinars

Motivational Interviewing is a clinical approach that helps people with mental health, substance use disorders and other chronic conditions such as diabetes, cardiovascular conditions, and asthma make positive behavioral changes to support better health.

Harm Reduction Coalition Overdose Prevention

This worksheet is a component of Guide to Developing and Managing Overdose Prevention and Take-Home Naloxone Projects, produced by Harm Reduction Coalition. More information at harmreduction.org

Topics to Cover With Patients Who Smoke & Snort

Heroin is a drug in the opium family (an opioid). Some opioids, like methadone and Demerol, are completely man-made. Others, such as morphine and heroin, are made from opium in a lab. All opioids have similar effects. Heroin is about three times stronger than morphine.

NIH National Institute on Drug Abuse – Opioids

Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone, hydrocodone, codeine, morphine, and many others.

Provider’s Clinical Support System for Medication-Assisted Treatment

PCSS is a program funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) created in response to the opioid overdose epidemic to train primary care providers in the evidence-based prevention and treatment of opioid use disorders (OUD) and treatment of chronic pain. The project is geared toward primary care providers who wish to treat OUD. PCSS is made up of a coalition, led by American Academy of Addiction Psychiatry (AAAP), of major healthcare organizations all dedicated to addressing this healthcare crisis. Through a variety of trainings and a clinical mentoring program, PCSS’s mission is to increase healthcare providers’ knowledge and skills in the prevention, identification, and treatment of substance use disorders with a focus on opioid use disorders.

Offering Naloxone to Patients

Here you will find information you need to start prescribing and dispensing naloxone rescue kits, including some useful resources containing further information about this life-saving medicine. We are prescribers, pharmacists, public health workers, lawyers, and researchers working on overdose prevention and naloxone access. We compiled these resources to help health care providers educate their patients to reduce overdose risk and provide naloxone rescue kits to patients.

PEG13: A Three-Item Scale Assessing Pain

Inadequate pain assessment is a barrier to appropriate pain management, but single-item “pain screening” provides limited information about chronic pain. Multidimensional pain measures such as the Brief Pain Inventory (BPI) are widely used in pain specialty and research settings, but are impractical for primary care. A brief and straightforward multidimensional pain measure could potentially improve initial assessment and follow-up of chronic pain in primary care.

Needle Exchange in DC

The DC Needle Exchange Program (DC NEX) will keep our communities safe by stopping the spread of HIV/AIDS, hepatitis, and connecting people to the health services they need. The District of Columbia Department of Health, HAHSTA supports comprehensive harm reduction programs. This includes:

  • a needle exchange program that works to reduce the numbers of injection drug users (IDU) who are infected with HIV in the District
  • helping to increase the number of District residents who know their HIV and Hepatitis C status, and
  • ensuring people with HIV and Hepatitis have access to care and treatment.

Opioid Awareness Campaign and Education

In 2017, there were 279 overdose deaths that involved the use of opioids in the District. DC Health in conjunction with Centers for Disease and Control Prevention (CDC) Prescription Drug Overdose – Data Driven Prevention Initiative launched an opioid awareness and education campaign. The purpose is to bring attention to the dangers and risks of opioid misuse and abuse. Together, we can help protect the lives of Washingtonians and decrease the use of prescription drugs and opioids across the city.

Understanding the Opioid Overdose Epidemic

Drug overdose deaths continue to increase in the United States.

  • From 1999 to 2017, more than 700,000 people have died from a drug overdose.
  • Around 68% of the more than 70,200 drug overdose deaths in 2017 involved an opioid.
  • In 2017, the number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was 6 times higher than in 1999.
  • On average, 130 Americans die every day from an opioid overdose.

Buprenorphine Practitioner Locator

Select a state from the map or use the drop down lists to view all of the practitioners waived to provide buprenorphine for the treatment of OUD in a city, state or zip code.

Getting Off Right: A Safety Manual for Injection Drug Users

A compilation of medical facts, injection techniques, junky wisdom, and common sense, this manual reflects HRC’s commitment to providing accurate and unbiased information about the use of illicit drugs with the goal of reducing harm and promoting individual and community health.

Opioid Risk Tool (ORT)

The Opioid Risk Tool (ORT) is a brief, self-report screening tool designed for use with adult patients in primary care settings to assess risk for opioid abuse among individuals prescribed opioids for treatment of chronic pain. Patients categorized as high-risk are at increased likelihood of future abusive drug-related behavior. The ORT can be administered and scored in less than 1 minute and has been validated in both male and female patients, but not in non-pain populations.

Clinical Opiate Withdrawal Scale (COWS)

The Clinical Opiate Withdrawal Scale (COWS) is an 11-item scale designed to be administered by a clinician. This tool can be used in both inpatient and outpatient settings to reproducibly rate common signs and symptoms of opiate withdrawal and monitor these symptoms over time. The summed score for the complete scale can be used to help clinicians determine the stage or severity of opiate withdrawal and assess the level of physical dependence on opioids. Practitioners sometimes express concern about the objectivity of the items in the COWS; however, the symptoms of opioid withdrawal have been likened to a severe influenza infection (e.g., nausea, vomiting, sweating, joint aches, agitation, tremor), and patients should not exceed the lowest score in most categories without exhibiting some observable sign or symptom of withdrawal.

CDC Pocket Guide: Tapering Opioids for Chronic Pain

Consider tapering to a reduced opioid dosage or tapering and discontinuing opioid therapy when your patient:

  • requests dosage reduction
  • does not have clinically meaningful improvement in pain and function (e.g., at least 30% improvement on the 3-item PEG scale)
  • is on dosages ≥ 50 MME*/day without benefit or opioids are combined with benzodiazepines
  • shows signs of substance use disorder (e.g. work or family problems related to opioid use, difficulty controlling use)
  • experiences overdose or other serious adverse event
  • shows early warning signs for overdose risk such as confusion, sedation, or slurred speech

2019 Recommendations of the AMA Opioid Task Force

The AMA Opioid Task Force is comprised of the American Medical Association, and 25 specialty and state medical societies as well as the American Dental Association. In 2014-15, the Task Force issued six recommendations focused on ways in which physicians could take specific actions to help reverse the nation’s opioid epidemic. Physicians have demonstrated progress in each of these areas, and it is clear that which much work remains, policymakers have an increasing role to play. The 2019 recommendations are focused on tangible actions policymakers can take to help end the epidemic.

Free MAT Trainings for Prescribers

PCSS is a national training and clinical mentoring project developed in response to the opioid use disorder crisis. Our education and training resources were developed for primary care providers. The overarching goal of PCSS is to provide the most effective evidenced-based clinical practices in the prevention of OUD through proper opioid prescribing practices, identifying patients with OUD, and the treatment of opioid use disorder.