16 The National Institute on Drug Abuse (NIDA) recognizes that several distinct groups can contribute to the prevention of opioid use disorder. NIDA urges clinicians to “take measures to prevent the escalation of a patient’s misuse to a substance use disorder” by prescribing only what is necessary and watching for signs of “doctor shopping.” NIDA suggests that patients should follow the prescription regimen they are given, and that pharmacists can be the first line of defense in recognizing problematic patterns in prescription drug use. NIDA also recommends the formulation of abuse-deterrent drug products; the development of safer medications; more research to better-understand effective chronic pain management; and the creation of measures to prevent the non-medical use of prescription medications.14 States have begun forming coalitions to address opioid use in various ways, building on and going beyond federal programs to mobilize stakeholders. For instance, the California Health Care Foundation brought into being the California Opioid Safety Network, which supports local coalitions of health care, public safety, education and others to focus on three basic strategies: 1) substantially reduce the prescribing of opioid pain medicines, 2) improve access to medical and medically assisted treatment and 3) make naloxone widely available to treat overdoses.15 The Public Health Institute, which operates the California Opioid Safety Network, conducted an assessment of this strategy in 2017; it concluded that “within just 18 months after launch, more than 90% of coalitions facilitated adoption of safer prescribing guidelines, more than 75% increased access to naloxone to reverse overdoses, and more than 50% expanded use of medication-assisted addiction treatment.”16 In Massachusetts, after conducting a thorough study of the causes and effects of the crisis, the state enacted a law containing a broad variety of prevention-focused steps and revising treatment protocols covering educational efforts, police response, school efforts and other measures.17 The National Safety Council publishes a state-by-state analysis of major steps that have been taken (or not taken) to address the opioid epidemic. In its most-recent report, the NSC cites uneven progress in the states on strategies to undertake six major actions: • Mandate prescriber education • Implement opioid prescribing guidelines • Integrate PDMP programs into clinical settings • Improve data collection and sharing • Treat opioid overdoses • Increase availability of opioid use disorder treatment18 Common Threads During the nation’s “war on drugs,” which began in 1971, the focus of major governmental programs was on reducing the use of illegal drugs through concurrent strategies of reducing supply and demand. More recently, after a general recognitionthatthisapproachwasnotsucceeding,therehasbeenamuchgreateremphasisontreatment.Inparticular, the rise in deaths from accidental overdoses has encouraged a growing allocation of resources aimed at saving lives. All the major guidelines and recommendations for treatment of a substance use disorder recognize the efficacy of medication-assisted responses, largely focused on methadone and more recently on buprenorphine, both of which reduce withdrawal symptoms and do not produce the euphoria of the opioid options. However, NIDA’s suggestions for treating addiction add this: “Research has shown that methadone maintenance is more effective when it includes individual and/or group counseling, with even better outcomes when patients are provided with, or referred to, other needed medical/psychiatric, psychological, and social services (e.g., employment or family services).” The prevention strategies address both the supply and demand sides of the struggle, but the realization that the overprescribing of pain medication contributed to the rise of substance use disorder, and consequently to greater overdose death rates, has led clinicians and researchers to dig more deeply into the factors that may foster drug misuse. As a result, increasing attention is being paid to the social and environmental factors of health and well-being, as well as to adverse childhood experiences that have shown to influence a proclivity for developing a substance use disorder. Throughout the recommended strategies for prevention and treatment, two common threads stand out from an analysis of their elements: