8 illicit drugs through local or online means; working with the DOJ Opioid Fraud and Abuse Detection Unit to prosecute corrupt or criminally negligent doctors, pharmacies and distributors; and strengthening criminal penalties for dealers of synthetic opioids like fentanyl. One way to intensify such interdiction activities is through High Intensity Drug Trafficking Area (HIDTA) task forces. HIDTA, created by the Anti-Drug Abuse Act of 1988, provides assistance to federal, state, local and tribal law- enforcement agencies operating in areas determined to be critical U.S. drug-trafficking regions. There are currently 28 HIDTAs, encompassing about 18 percent of U.S. counties and 66 percent of our population. Example: Ohio has funded numerous task forces that have been found highly effective in interdicting drug crimes. Information is available in the state’s most-recent annual report. 5. Improve and implement better prescription monitoring programs (PDMPs). Page 36 Laws in 49 states support the creation of PDMPs, which require pharmacies to report the sale of controlled substances in fulfillment of prescriptions. Most physicians therefore can determine if a patient has gone “doctor shopping” by seeking opioids for the same pain management from more than one physician. However, some doctors are either unaware of the system, unsure of how to use it or have concerns about its accuracy. The goal of this play is to ensure that doctors know about and use their state system; that they check across states to ensure that a patient is not "doctor shopping;" and that the prescription history for prior medication does not indicate a new prescription should not be written. Greater use of PDMPs can be mandated legislatively, but efforts are also needed to educate and persuade physicians and pharmacists to take full advantage of this effective tool. Example: The Kentucky All Schedule Prescription Electronic Reporting (KASPER) program is highly regarded. Among the reasons is that it mandates physician and pharmacy compliance. 6. Reduce the involvement of opioid users in the criminal justice system. Page 38 The value of diverting people from involvement with the criminal justice system has been clear for decades. Central to diversion programs is “the understanding that a criminal conviction – misdemeanor or felony – triggers a cascade of collateral consequences that often severely hamper an individual’s ability to become a productive member of the community,” according to a report by the Center for Health and Justice. Since recidivism is often tied to further substance use, reducing its probability through diversion programs can mitigate substance use disorders. Finding alternatives to arrest, prosecution and correctional supervision is therefore a reasonable part of any strategy to reduce opioid use. The major intervention points where individuals can be diverted from the criminal justice system are before arrest, before trial and after adjudication. A major focus of diversion programs that has been highly successful across the country is the creation of drug courts, of which there are now over 3,100 nationwide. Examples: Research into collaboration by police and public health agencies to prevent or reduce opioid use with diversion programs cites numerous examples of successful programs. 7. Provide medication-assisted treatment to inmates. Page 41 Nationally, 65 percent of all incarcerated offenders meet the criteria for suffering from a substance use disorder. Research has shown that medication-assisted treatment (MAT), including with buprenorphine, methadone and extended-release naltrexone, can decrease opioid use, opioid- related overdose deaths, criminal activity and infectious disease transmission – while also increasing social functioning and retention in treatment. Numerous studies have shown that the provision of MAT has long-term impacts on preventing both continued substance use disorder and criminal behaviors, thereby both preventing such disorders and reducing crime. In one recent study, a MAT program resulted in a 60 percent reduction in opioid overdose deaths among individuals who were recently incarcerated. Example: The Medication Assisted Treatment and Directed Opioid Recovery program in Middlesex County, MA, has had striking results, with a non-recidivism rate of 82 percent. 8. Expand treatment programs after incarceration. Page 43 Abundant research shows greater success for preventing subsequent opioid use disorders for released inmates when medication-assisted treatment (see play #7) is fully integrated with behavioral health treatment, indicating that collaboration between health care providers and behavioral health departments can have a positive effect on preventing the reoccurrence of these disorders. A play consisting of an integrated substance use disorder treatment program designed expressly for released offenders