12 Examples of the three levels of prevention this story illustrates are: Primary Prevention & Public Health (Primary Prevention) — e.g. Prescribing practices, safe use of prescriptions, control supply, prevent diversion, reduce marketing, enrollment and use of PMP, prevention of ACEs, adolescent risk reduction, pain management, addressing trauma, integrating care, protective factors, community resiliency, culture as prevention”² Intervention & Treatment (Secondary Prevention) — e.g. Screening, early identification, SBIRT Services, Medication Assisted Therapy, chemical health treatment, OB and infant care for NAS, safe storage, safe disposal Emergency Response (Tertiary Prevention) — e.g. Naloxone, Good Samaritan Laws, Syringe Exchange, transitions of care, discharge planning, fentanyl alerts, infectious disease control The Institute of Medicine of the National Academy of Sciences has developed a framework for defining prevention activities to distinguish between prevention and treatment. It categorizes prevention interventions for a disorder as “universal,” for the general public in a segment of the population; “selective,” for specific sub-populations with higher-than-average risk; and “indicated,” for identified individuals who have signs or symptoms.³ a. Goals for the Playbook This report presents a compendium of examples of the best-available knowledge and experiences of current opioid use disorder prevention efforts. The intent is to synthesize what is known about various strategies/approaches based on the evidence of their success or usefulness for preventing opioid use disorder, to summarize the basis for such “plays,” and then to indicate places to go for more-detailed descriptions and resources. The playbook also seeks to illustrate the vital importance of making this a collaborative effort, in which effective prevention methods are facilitated by information-sharing across the relevant domains engaged in a continuum of care. The playbook is intended for use by jurisdictions and communities of interest that aim to collaborate to address the opioid use disorder problem in their areas. Whether a community of interest is formed at the state, regional or local level, it is essential that such collaborators address the strategies/plays that apply to their own environments, and then construct a plan of action accordingly. We hope this report will be a source of both ideas and practices worthy of consideration. As we learn more about what works and find innovative solutions that can be adopted throughout the nation, it becomes plain that the enormous complexity of the effort it will take to deal with this crisis needs to be very dynamic. In addition, we know that the plays and other content in this publication will need to change as the problem evolves and as new research, innovative thinking, approaches and solutions arise. Accordingly, this playbook will be a living document that will be updated on the NICCollaborationHub. The playbook will also derive information from and link to other identified sources of knowledge about what works in addressing this health care emergency. Examples include: • Opioid Watch, a website operated by the Opioid Research Institute and funded by the Joseph H. Kanter Foundation. It offers both news and examples of strategies through a Twitter-based newsletter and alerts. • Shatterproof, a website with knowledge and advocacy information, as well as materials that are useful in responding to the epidemic. • The State Targeted Response Technical Assistance Consortium, whose technical assistance portal is designed to support prevention, treatment and recovery efforts. b. Authors and Sources While the contents of this report have been assembled by NIC, the specific guidance, evidence and programmatic successes it describes are the work of the following entities: • Federal agencies playing a role in attacking the opioid crisis, including a variety of HHS agencies, ONDCP, DOJ, DHS and others • Progressive state organizations that have undertaken innovative and successful programs to reduce opioid use and there by prevent the onset of opioid use disorder • Local communities of interest that have assembled strategies into programs to reduce opioid use disorder • Academic institutions whose research provides insights into ways to address the crisis