State and territorial health agencies play a vital role in addressing disruptions in access to prescription opioids, underscoring the need for formal response protocols to uphold patient safety and continuity of care.

The United States is facing a significant public health crisis due to drug overdose, particularly involving opioids and other illicit substances. Over 106,000 overdose deaths occurred in 2021, with opioids playing a significant role. Synthetic opioids, methamphetamine, and cocaine have also emerged as contributors to fatal overdoses, indicating a complex and evolving landscape of substance use. Compounding this crisis is the infiltration of xylazine, a veterinary tranquilizer, into the illicit drug market. Mixed with other substances like heroin and fentanyl, xylazine further heightens the unpredictability and danger of street drugs, exacerbating the risks faced by people who use drugs. The presence of adulterants and impurities in drugs, including deadly fentanyl, underscores the urgent need for comprehensive responses to address substance use and its associated harms. In response to this crisis, states have implemented multifaceted strategies aimed at preventing overdose and linking people who use drugs to harm reduction, treatment, and recovery services.

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One critical aspect of this crisis is disruption in access to prescription opioids, which can occur due to factors like a prescriber’s death, retirement, or law enforcement action against a prescriber. These disruptions can cause withdrawal symptoms and increase the likelihood of adverse health outcomes, including nonfatal and fatal overdose among patients who are impacted. In the absence of their prescriptions, patients may turn to the dangerous illicit drug market. State and territorial preparedness and response efforts are essential for managing prescription opioid disruptions effectively. These initiatives involve a range of activities, including assessing available healthcare resources, communicating with impacted patients, increasing the distribution of naloxone (an opioid overdose reversal medication), and collaborating with diverse stakeholders—including healthcare providers and harm reduction organizations—to ensure continuity of care.

The Association of State and Territorial Health Officials (ASTHO), with support and collaboration from CDC’s Opioid Rapid Response Program, conducts scenario-based preparedness exercises with state health agency staff and key response partners to support planning for and responding to disruptions in access to opioid prescriptions. Preparedness exercises are instrumental in strengthening state and territorial response capabilities and enhancing coordination among response partners. The exercises allow states and territories to develop and refine a written protocol for response, identify gaps in their preparedness efforts, and ensure a more effective and coordinated response to future disruptions.

Implications for policy and practice

The following key takeaways from ASTHO’s preparedness exercises highlight the importance of proactive measures, education, and collaboration in effectively responding to prescription opioid disruptions:

1. Access to Prescription Drug Monitoring Programs (PDMPs): Utilizing PDMPs is crucial for assessing risk during a response to prescription opioid disruptions. These programs provide valuable data on the extent and nature of the disruption, aiding in outreach, messaging, and resource allocation.
2. Education, Training, and Mentorship for Healthcare Providers: Investing in education, training, and mentorship programs for healthcare providers is essential. This builds confidence, comfort, and skill in caring for patients prescribed high doses of controlled substances, enhancing healthcare workforce capacity to handle patients affected by disruptions.
3. Preparation of Resources: Preparing resources like flyers, press releases, and hotline scripts before disruptions is critical for an efficient response. Having these materials ready streamlines communication and dissemination of information during crises.
4. Awareness of Healthcare Licensing and Scope of Practice: Understanding jurisdictional variations in healthcare licensing and scope of practice is important. Being aware of state laws and regulations enables states and territories to leverage advanced practice providers effectively during response efforts, enhancing continuity of care for displaced patients.

Disruptions in access to prescription opioids pose significant challenges to public health and patient safety. Addressing these challenges requires a comprehensive, coordinated approach that involves collaboration across multiple sectors, including healthcare, law enforcement, public health, and community organizations. By bolstering preparedness efforts and enhancing response capabilities, state and territorial health agencies can better protect individuals affected by prescription opioid disruptions and mitigate the devastating impact of the opioid crisis on communities across the nation.

To learn more about preparing for and responding to disruptions in access to opioid prescriptions, read our article in the Journal of Public Health Management and Practice.

Jessica Pough, MPH, is the Director of Overdose Preparedness and Response at ASTHO. She is responsible for the strategic direction and programmatic implementation of a portfolio focused on initiatives aimed at enhancing ASTHO member capacity in preparing for and responding to events that increase the risk of overdose.

Kaela Hurd, MPH, is an Overdose Preparedness and Response Analyst at ASTHO. She supports initiatives in preparing for and responding to events that increase the risk of overdose through analyzing and tracking relevant policy, developing written deliverables, and supporting the planning and execution of preparedness exercises.