6 Executive Summary The National Institute on Drug Abuse, using data from the Centers for Disease Control and Prevention, reports that over 70,000 people died of drug overdoses in 2017; about two-thirds of these deaths were related to the use of opioids. Even more alarming is the rate of increase in the availability of synthetic opioids such as fentanyl and carfentanil. In May 2018, New York City Police charged three individuals with attempting to distribute 100 grams of carfentanil, which could kill up to 5 million people. Just a few months earlier, in January, New Jersey authorities confiscated 45 kilograms of fentanyl, enough to kill 18 million people, or the populations of New York City and New Jersey combined. In two raids in 2018, Massachusetts authorities seized 25 kilos of fentanyl, more than enough to kill the state’s entire population. “It is clear that vast quantities of opioids with increasing potency are flooding the state and the country,” says a recent report by the Massachusetts Taxpayers Association. “The epidemic has not stalled; in fact, it is poised to accelerate with alarming consequences to our people, our communities, and the health of the state’s economy.”1 Against that backdrop, this playbook by the National Interoperability Collaborative (NIC) has four primary aims: 1) to present a clear picture of the state of knowledge on how to better-detect and prevent opioid misuse, overuse and use disorders; 2) to focus greater attention on prevention, because it is essential to the long-term resolution of the opioid epidemic ravaging our country; and most importantly in the near-term; 3) to provide guidance – to federal, state and local practitioners, legislators, as well as engaged executives in nonprofit organizations – about existing “upstream” strategies that can replicated or adapted for real-time use; and 4) to create a virtual community where people and organizations can share and vet “plays” expeditiously and broadly across the U.S. Toward those ends, this publication offers examples of evidence-informed initiatives and ideas (“plays”) being tried around the country, with as much data as possible relating to their efficacy. We recognize that any effective prevention approach should be built on a foundation of evidence about the effectiveness of its strategies, along with measures of its outcomes. That foundation is currently lacking, however. Indeed, research for the playbook found an absence of data definition, collection and analysis about opioid use that inhibits movement toward more-informed decisions about how to get to the roots of this national crisis. The playbook also demonstrates that an essential part of any effective prevention approach is improved information- sharing, integration, interoperability and collaboration across the multiple disciplines that must inevitably become a part of the solution to this historic health crisis. The playbook addresses policies, approaches, initiatives and ideas that illustrate strategies with the potential to prevent opioid misuse, overuse and use disorders from starting or advancing. For each listed strategy – or “play” – this document presents, in a common format, its purpose, objectives, theory of change, useful elements of implementation methodology, evaluation data (when available) and reference materials for further exploration. Our intent is for any given jurisdiction or community of interest to consider these plays to be candidates as part of a well-conceived, integrated program aimed at THE OPIOID EPIDEMIC BY THE NUMBERS 2016 and 2017 Data People died every day from opioid-related drug overdoses3 (estimated) People misused prescription opioids1 People misused prescription opioids for the first time1 Deaths attributed to overdosing on commonly prescribed opioids2 Deaths attributed to overdosing on synthetic opioids other than methadone2 Deaths attributed to overdosing on heroin2 People died from overdosing on opioids2 People had an opioid use disorder1 People used heroin1 Updated September 2018. For more information, visit: Http://www.hhs.gov/opioids/ Sources 1.2017 National Survey on Drug Use and Health, Mortality in the United States, 2016 2. NCHS Data Brief No. 293. December 2017 3. NCHS, National Vital Statistics System. Estimates for 2017 and 2018 are based on provisional data. People used heroin for the first time1 130+ 42,249 2 million 17,987 19,413 15,469 2.1 million 886,000 81,000 11.4m HHS.GOV/OPIOIDS