Comprehensive Data-Driven Approach to Addressing the Overdose Crisis, Study Guides, Projects, Research of Community Corrections

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NATIONAL DRUG

CONTROL S TRATEGY

THE WHITE HOUSE

EXECUTIVE OFFICE OF THE PRESIDENT

OFFICE OF NATIONAL DRUG CONTROL POLICY

MAY 2024

Table of Contents

• Preface from Dr. Gupta, Director ..............................................................................
• Introduction and Executive Summary .......................................................................
• Chapter 1: Strengthening Prevention and Early Intervention .................................
• Chapter 2: Expanding Access to Evidence-Based Harm Reduction Strategies .....
• Chapter 3: Expanding Access to Evidence-Based Treatment ................................
• Chapter 4: Building a Recovery-Ready Nation ......................................................
• Chapter 5: Reducing the Supply of Illicit Substances in the Homeland ................
• Criminal Networks ................................................................................................... Chapter 6: Cracking Down on the Global Suppliers of Illicit Drugs and Related
• Disorder .................................................................................................................... Chapter 7: Improving the Criminal Justice System’s Response to Substance Use
• Chapter 8: Building Better Data Systems and Research ........................................
• Appendix A: National Treatment Plan ...................................................................
• Appendix B: Drug Data Plan .................................................................................
• Strategies ................................................................................................................. Appendix C: Northern, Southwest, and Caribbean Border Counternarcotics
• Glossary....................................................................................................................
• References/Notes ...................................................................................................

Introduction and Executive Summary

America is facing the deadliest drug threat in our history. Over the last 25 years, drug overdose deaths in the United States from synthetic opioids, including fentanyl, have risen to more than 100 times their 1999 levels. The rate of fatal overdoses from other drugs, including cocaine and methamphetamine, has also surged.^4 The overdose crisis calls for bold action.

The Office of National Drug Control Policy (ONDCP) has outlined vital steps for attacking two drivers of this crisis. First, we need to protect against overdoses and reduce demand for drugs, including by preventing drug use before it starts, saving lives, and supporting people in recovery. Second, we need to dismantle the supply chains of illicit drugs, including cracking down on the global criminal networks fueling American deaths. These lines of effort are two sides of the same coin. Both must be pursued aggressively for meaningful and lasting change.

We have made progress. State Opioid Response (SOR) grant programs have prevented over 600,000 overdose deaths.^5 Historic federal investments have scaled up treatment efforts, with SOR programs delivering nearly 10 million naloxone kits since 2020^6. Pharmacy prescriptions for life-saving naloxone, an opioid overdose reversal medication (OORM), have surged 37 percent in the last two years,^7 while naloxone has started being sold over-the-counter for the first time ever, thanks to actions by the Food and Drug Administration (FDA). The share of eligible veterans in the Department of Veterans Affairs (VA) system receiving medication for opioid use disorder (MOUD) has climbed steadily since 2020,^8 as has the percentage of people involved in the criminal justice system with opioid use disorder (OUD) receiving treatment in federal prisons, from 3 percent in 2020 to 60 percent today.^9 Meanwhile, our workforce of addiction professionals continues to grow and the FDA’s approval last year of two naloxone products for over-the-counter sales has expanded accessibility further. A bipartisan law, the Mainstreaming Addiction Treatment (MAT) Act, increased the number of providers who may initiate buprenorphine treatment from 129,000 to more than 2 million, bringing the medication to many rural and underserved communities for the first time.^10 The Department of Health and Human Services (HHS) has also expanded flexibility to prescribe MOUD in telehealth appointments, facilitated the operation of mobile vans providing MOUD services, and increased opportunities for states to apply for Medicaid funding to treat OUD in prisons and jails.

The American Rescue Plan (ARP) of 2021, which delivered direct relief to Americans in response the COVID-19 pandemic, sharply scaled up efforts, including through expending more than a billion dollars boosting mobile crisis intervention units, and another billion to expand the community health workforce, including mental health care workers. Finally, the ARP ushered in unprecedented measures to prevent homelessness, both a symptom of overdose crisis and a major barrier to recovery. Most significantly, it ushered in a national eviction ban that helped bring down eviction filings to 20 percent below their pre-2021 average.^11

Other efforts are helping prevent drug use before it begins and support people in recovery, saving lives, all while improving equity. Partnering with the Ad Council, ONDCP launched the Real Deal on Fentanyl campaign. Through the campaign, targeted messages on social media and digital billboards have reached millions of young people nationwide, educating them on the dangers of fentanyl and how to save lives by administering naloxone. Additionally, historic

numbers of people with federal criminal offenses for simple possession and use of marijuana have received federal pardons. Bipartisan legislation that invests in creating jobs has also contributed to efforts against the overdose crisis. For example, the Bipartisan Infrastructure Law is investing $546 billion to create good-paying jobs,^12 which have downstream effects that help stop drug use and support people seeking recovery.

On the supply side, officials stopped more fentanyl at ports of entry (POE) over the last two years than in the previous five years combined,^13 helping keep tens of millions of fentanyl-laced pills and thousands of pounds of fentanyl powder away from our communities. New drug detection machines and enforcement surges at the border have interdicted historic amounts of illicit drugs, and the number of drug traffickers and their affiliates facing sanctions has more than doubled since 2020.^14 The United States has criminally charged leaders of the world’s largest and most powerful drug cartel – including Ovidio Guzman Lopez, the son of “El Chapo” – and thousands of drug traffickers distributing fentanyl on our streets and on social media. The Department of the Treasury has leveraged new authorities to sanction more than 290 people and organizations involved in the global illicit drug trade. The United States has also built a global coalition to accelerate the fight against illicit drugs, engaged key partners, such as Mexico, Canada, and others to work collaboratively to detect emerging drug threats and disrupt trafficking. After a period of suspended cooperation, the People’s Republic of China (PRC) agreed to resume bilateral cooperation on counternarcotics, and we launched the United States- PRC Counternarcotics Working Group (CNWG) in January 2023, with the goal of reducing the flow of precursor chemicals and deadly drugs into the United States and around the world.

Yet, there is much more work to do be done. With fatal overdoses and poisonings still claiming the lives of many tens of thousands of Americans every year, ONDCP and its federal partners will continue to do all it can to meet the crisis.

ONDCP’s 2024 Strategy looks to the future this Nation needs. That future is one with greater access to prevention, treatment, harm reduction and recovery support services; with a focus on equity and equal justice; with support for incarcerated individuals, as well as post-incarceration reentry assistance; with a SUD and health care workforce that meets our Nation’s needs; with a payment system that sufficiently funds care; and with a concerted transnational effort to hold drug traffickers, their enablers, and facilitators accountable.

The 2024 National Drug Control Strategy

The 2024 Strategy is aimed at addressing the overdose crisis from multiple angles. This includes preventing youth substance use, expanding access to life-saving medications like naloxone, expanding access to evidence-based treatment, building a recovery-ready Nation, and ramping up efforts to disrupt and dismantle drug trafficking.

Chapter 1: Strengthening Prevention and Early Intervention

National survey data highlight the progress made in decreasing substance use from 2020 to 2021 among 8th^ , 10th^ , and 12th^ graders across many substances, including alcohol, marijuana, and vaped nicotine.^15 Other data demonstrates that current use of alcohol, marijuana, and binge drinking among high school students decreased from 2019 to 2021.^16 Agencies such as HHS

Chapter 3: Expanding Access to Evidence-Based Treatment

In order to save as many lives as possible and bring down the rate of overdose fatalities, it is imperative that people living with SUD have access to health care that identifies and treats their condition while supporting them with needed additional services to ensure they can enter recovery and thrive during and after the recovery process.

Since the publication of the 2022 Strategy , progress has been made in expanding access to substance use treatment. This includes taking the step to expand access to treatment for OUD for millions of Americans. Under the Consolidated Appropriations Act of 2023, prescribers of controlled substances no longer must secure a waiver from the federal government to register as an opioid treatment program (OTP) to initiate buprenorphine treatment for OUD, meaning people can access treatment from their primary care provider.^22 This policy change significantly increased the number of providers who can offer this treatment. Other progress includes certification of many new mobile units that provide MOUD, as well as federal investments that have steadily expanded the number of eligible veterans receiving MOUD within the VA system. Landmark legislation like the ARP, in particular, has dramatically scaled up health workforce training and mobile unit deployment in recent years, with the ARP investing billions of federal dollars in these areas.

This chapter examines ways to further expand access to treatment for SUD so every American who needs it can access it by 2025. Additionally, the ONDCP Treatment Plan (Appendix A), required by the 2018 Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act), elaborates further on screening, connections to care, workforce, and other elements necessary to continue reducing overdose and fatalities.

Chapter 4: Building a Recovery-Ready Nation

In 2022, an estimated 48.7 million Americans aged 12 or older had SUD. 23 Notably, among people aged 18 and older with SUD, more than 60 percent, or nearly 27 million Americans, were employed, and more than 3 out of 4 worked full-time.^24 SUD is widespread, including in the workplace^25 ,^26 ,^27 and in secondary and higher education settings.^28 ,^29 ,^30 ,^31 Fortunately, recovery is prevalent as well. That same year, among the estimated 30 million Americans aged 18 or older who recognized that they experienced a lifetime alcohol or other drug issue, 21.3 million (71 percent) identified as “in recovery” or “recovered” from a substance use issue.^32 Stigma, discrimination, and misunderstanding are among the most pervasive barriers to treatment and a life in recovery.^33

Since the publication of the 2022 Strategy , progress has been made in advancing efforts to build a recovery-ready Nation. For instance, the federal government has worked to promote the adoption of recovery-ready workplace (RRW) policies across the public and private sectors, including within the federal government. More states today operate RRW initiatives than ever before, and since 2020, peer-led recovery community organizations nationwide have surged by nearly 50 percent.^34

This chapter focuses on continuing to build a recovery-ready Nation, one community at a time. Federal agencies will continue to partner with states, local governments, employers in the for- profit and not-for-profit sectors, and communities to address the social determinants of health and the laws, regulations, and practices that can serve as barriers to treatment and recovery support. Concurrently, work must be done to build recovery capital at the individual, family, caregiver, community, and societal levels.

Chapter 5: Reducing the Supply of Illicit Substances in the Homeland

Since the publication of the 2022 Strategy , the federal government has made progress on taking important steps to tackle the supply of deadly drugs, in accordance with the Strategy objectives. This includes collaboration across state, local, Tribal, territorial, and federal law enforcement agencies to keep drugs off our streets.

In Fiscal Year (FY) 2023, for example, the federal High Intensity Drug Trafficking Areas (HIDTA) program, which funds grants across all 50 states to improve law enforcement intelligence sharing and operational coordination among federal, state, Tribal, territorial, and local law enforcement agencies, supported the seizure of more than 29,000 pounds of illicit fentanyl, more than 248,000 pounds of methamphetamine, nearly 365,000 pounds of cocaine, over 4,300 pounds of heroin, and denied DTOs $20 billion in illicit profits.^35 U.S. Customs and Border Protection (CBP) seized almost 240,000 pounds of illicit drugs, primarily at southwest border POE, which includes nearly 27,000 pounds of fentanyl.^36 And the United States Postal Inspection Service (USPIS) seized over 4,200 pounds of fentanyl from the domestic mail system.^37 In the last two years, officials have halted more fentanyl at POEs than over the previous five years combined.^38 These actions took deadly drugs off the streets and prevented overdose deaths.

This chapter focuses on the ongoing efforts to identify and seize deadly drugs before they hit our streets, and otherwise disrupt the supply chain for illicit drugs.

Chapter 6: Cracking Down on the Global Suppliers of Illicit Drugs and

Related Criminal Networks

Though the impact of the overdose epidemic is felt acutely in local community emergency rooms, the problem is global, and the solution is global as a result. For this reason, the United States’ collaboration with partner countries to reduce the supply and flow of fentanyl and precursor chemicals into the United States is a key component of reducing the number of fentanyl-related deaths in the country.

In the past few years, the United States has prioritized disrupting the global supply chain and global networks that manufacture and ultimately distribute deadly drugs into the United States. The United States has stepped up counternarcotics cooperation with key governments – including Mexico, Canada, India, and the PRC– and launched the Global Coalition to Address Synthetic Drug Threats, which unites more than 150 countries in the fight against drug trafficking cartels and illicit finance. The Trilateral Working Group with Mexico and Canada has worked collectively to identify key enforcement gaps, collaborate on particular enforcement efforts, and address related concerns associated resulting from arms trafficking. After years of

requires timely, comprehensive, and geographically precise data to inform local communities about the dangers of the illicit drug supply and to provide data-driven insights that inform the distribution of lifesaving overdose reversal drugs, harm reduction programs, and treatment services and supports.

Since the publication of the 2022 Strategy , progress has been made in advancing data systems and research. One example is the development of the nonfatal opioid overdose tracker, led by ONDCP and the Department of Transportation’s (DOT) National Highway Traffic Safety Administration (NHTSA), which uses national Emergency Medical Services (EMS) data to determine where nonfatal overdoses are occurring so jurisdictions can direct resources to these areas. This dashboard is updated regularly and has only a two-week lag, which is a significant improvement over past efforts to track overdoses, and provides key information for local and national policymakers.

This chapter looks at some of the remaining shortcomings in existing data systems, how to develop methods for identifying emerging drug use trends in real-time or near real-time, how to prioritize data and analytical efforts to support advancing equity for underserved populations, and more. Additionally, the ONDCP Drug Data Plan (Appendix B), required by the 2018 SUPPORT Act, presents a plan to collect, analyze, and use data to inform implementation and assessment of the Strategy.

Specific Goals and Measuring Federal Performance

The 2022 Strategy established goals and objectives with measures and targets that were detailed in the 2022 Performance Review System report (PRS), and are incorporated herein by reference. In the midst of a dynamic illicit drug environment where progress has been made but additional work is needed to strengthen public health and public safety outcomes, the 2024 PRS details a discussion of evolving goals, objectives, and targets.

Consultation for the 2024 National Drug Control Strategy

ONDCP is statutorily required to consult with and solicit input for the Strategy from a variety of parties affected by federal drug policy, including federal agencies and departments charged with carrying out these policies; members of Congress and congressional committees; states, local, Tribal, and territorial governments; nongovernmental organizations and community activists; and foreign governments, among others.

The consultation process for the 2024 Strategy began in February 2023, and ONDCP received significant input from a wide range of interested parties. ONDCP convened the National Drug Control Program Agencies (NDCPA) for in-person consultation, and received written input from these agencies as well, and held virtual meetings and received written input from dozens of leaders while developing this Strategy. Input was received from drug policy experts, advocates, and stakeholders from across the Nation, including federal, state, Tribal, territorial, and local leaders; law enforcement; public health; academia; and more. Following publication, ONDCP will coordinate with the interagency to implement this Strategy. ONDCP thanks all partners who

provided input for the 2024 Strategy , and for their commitment to addressing the overdose crisis and saving lives.

Conclusion

The overdose crisis is not a red state or blue state issue. It is not limited to any race or gender, to urban or rural, or to rich or poor; it’s an American issue. Democrats and Republicans have a long history of coming together to address substance use because it affects us all. Today, ONDCP calls on all Americans to come together to solve one of our greatest challenges.

series of Lessons from the Field webinars connecting school personnel around the country to share information, strategies, and resources on a range of substance use related issues that affect learning. The webinars featured presentations, roundtables, and resources to help schools adopt policies and practices to address youth substance use trends. They reached more than 13, educators, counselors, school administrators, state and local school district leaders, parents, and education associations from more than 48 states and territories.

These efforts to proliferate resources related to substance use can make a big difference for students. For example, one promoted resource was the Centers for Disease Control and Prevention's (CDC) What Works in Schools Program , which supports capacity-building in local education agencies to help improve student health and well-being. CDC’s program provides funding to support implementation of quality health education, increased accessibility of health services, and safer, supportive school environments. When fully implemented in schools, these resources have been shown to decrease substance use, violence, and suicide, while improving mental health.^46

CDC reports that roughly two million middle and high school students now have access to the What Works in Schools Program. While this represents important progress, the program has yet to touch millions of other students. As part of the FY 2025 budget, CDC will continue to build upon the progress by scaling up the program to schools in 75 of the largest districts, touching all 50 states and 7 territories with new investments that amount to approximately $10 per student. To assist more schools to adopt the program, CDC has also created materials to help school administrators and staff plan, develop, and implement effective programmatic strategies, and activities.

The Substance Abuse and Mental Health Services Administration (SAMHSA) supports the Prevention Technology Transfer Center National Coordinating Office and ten regional centers (PTTCs) to provide TA and support to the prevention field, including school administrators and the school-based prevention workforce. PTTCs provide training and resources to improve substance use prevention interventions. These resources cover topics such as selecting evidence- based programming for school settings; addressing substance use related issues such as vaping and marijuana; and understanding the cultural intersections of lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) youth and SUD.

ONDCP will continue collaboration with federal partners to advocate for increased, coordinated funding for evidence-based primary prevention that can reduce substance use among youth and adolescents, and to ensure programs and services are available for every school aged youth in the Nation. Culturally and linguistically appropriate standards should undergird the development and implementation of curricula appropriate to each developmental age group of students. Such curricula should educate youth about the dangers of alcohol, tobacco, and other drugs, and promote skills that increase wellness. In partnership with ED, CDC, SAMHSA, National Institute on Alcohol Abuse and Alcoholism, and National Institute on Drug Abuse (NIDA), examples of effective practices will be disseminated to State Educational Agencies (SEAs) and Local Educational Agencies (LEAs) for academic and extra-curricular activities in schools. Additionally, this collaboration will identify and address gaps in existing research, program development, service delivery, and outcome evaluation of resources to improve the reach and impact of effective substance use prevention.

Supporting organizations seeking to establish or expand Student Assistance

Programs with evidence-based practices and federal funding.

(Agencies Involved: ED; HHS/SAMHSA)

In FY 2022 and 2023, ED funded $255 million across 264 grantees for two programs – the School-Based Mental Health Services (SBMH) Grant and the Mental Health Service Professional (MHSP) Demonstration Grant – to help meet the goal of doubling the number of school counselors, social workers, and other mental health professionals supporting youth. The Bipartisan Safer Communities Act is a step forward in keeping the Nation’s school children safe and providing them the care they need. The SBMH program and MHSP Demonstration Grant program will enable communities to hire approximately 5,400 school-based mental health professionals and train an estimated 5,500 more to build a pipeline of mental health providers in schools, especially those with the greatest needs.

Additionally, ED and HHS have partnered to provide TA resources to help state and local officials to ensure children have physical and behavioral health services and supports needed to build resilience and thrive. Through the National Technical Assistance Center for Children’s Mental Health, the National Center for School Mental Health, and other offices, ED and HHS provide guidance on federal funding available for school-based health services, including on how Medicaid can support mental health and other services. ED and HHS also provide support that helps reduce federal administrative burden on states and localities, including LEAs, and reduce barriers to adopting school-based health services.^47 ,^48 Additionally, HHS has published a comprehensive list of school-based health services for education administrators, community leaders, and parents to support youth.^49

SAMHSA’s Advancing Wellness and Resiliency in Education (AWARE) program further develops sustainable infrastructure for school-based mental health programs and services. Project AWARE lets SAMHSA partner with SEAs, LEAs, Tribal Educational Agencies (TEAs), State Mental Health Agencies (SMHAs), and community-based organizations providing behavioral health care services. Partnerships help these organizations implement mental health- related promotion, awareness, prevention, intervention, and resilience activities, including by providing training for school personnel and other adults to identify students experiencing trauma, support them, and connect them to services. As a result of Project AWARE funds, grantees from 2018-2022 have:

• Facilitated formal written agreements engaging 1,816 organizations to improve practices, coordinate services, and strengthen partnerships to provide additional support for school- aged youth;
• Adopted, in coordination with SEAs and LEAs, 796 policy changes to improve behavioral health programs and services;
• Engaged 834,481 mental health professionals, first responders, teachers, school staff, administrators, families, community members and others in trainings; and,
• Referred 205,874 students for behavioral health or related services.

SAMHSA has developed a suite of resources to assist schools in implementing Student Assistance Programs. The “Talk. They Hear You.” Student Assistance Resource Guide and Guide for School Administrators provide school leaders and administrators with key information

prevention and early intervention services into their practice supporting the American Academy of Pediatrics recommendation for universal SUD screening in pediatric primary care.

Under its Bright Futures Pediatric Implementation Program, HRSA has also updated its Guidelines for pediatric providers to encourage increased screening opportunities to recognize and address substance use among youth. At least 37 states have used Bright Futures as their EPSDT pediatric preventative care screening recommendations. Guidelines include recommendations for services that pediatric providers should offer at every well-child visit from before birth to age 21, including screening for behavioral, social, and emotional concerns; adolescent depression and suicide risk; and substance use. The Guidelines also recommend the frequency and timeline of when such services should be offered. Additionally, the guidelines recommend clinicians utilize validated tools such as the widely used BSTAD, S2BI, or CRAFFT screening tests to screen for the use of alcohol, tobacco, nicotine, marijuana, and other drugs, as well as vaping.

SAMHSA has developed a mobile app, Screen4Success, that provides parents and other concerned adults with resources to better understand the health, wellness, and wellbeing of their children. Screen4Success houses a 10-minute screener that adults can use to look for signs of elevated risk for substance use and mental health issues in youth, and connects them with information on recommended support services that are available in the user’s area and at the national level.

These efforts align with ongoing efforts to address inequity in policies and disparities in health outcomes. ONDCP is partnered with the National Institute on Minority Health and Health Disparities, SAMHSA-funded Centers of Excellence, and other relevant stakeholders to promote adoption of culturally and linguistically appropriate services and models for screening, prevention, and intervention services for youth populations. Such partnerships are vital in analyzing and addressing disparities in Black, Latino, LGBTQI+, rural, and Tribal communities.

Empowering community coalitions to implement evidence-based prevention.

(Agencies Involved: DOJ/OJP; HHS/CDC, SAMHSA)

The DFC Support Program is the Nation’s leading effort to mobilize communities to prevent and reduce substance use among youth. Created in 1997 by the Drug-Free Communities Act, administered by ONDCP, and managed through a partnership between ONDCP and CDC, the DFC program provides grants to community coalitions to strengthen the infrastructure among local partners to create and sustain a reduction in local youth substance use. Coalitions bring together schools, parent and youth groups, law enforcement, civic and fraternal organizations, businesses, and health organizations to collectively educate youth about the risk and harms of substance use, equip them to make healthy choices, and address community risk factors that can make youth vulnerable to substance use. In FY 2023, 751 coalitions across the United States received DFC funding. In 2022, one in five Americans lived in a community with a DFC-funded coalition.^52 A 2021 cross-site evaluation of the DFC program reported several key positive outcomes from the prevalence and sustainability of coalitions:^53

• DFC coalitions successfully mobilized nearly 35,000 community members to engage in evidence-based youth substance use prevention/reduction efforts.

• Among high school and middle school youth in each of the samples, there were significant decreases in past 30-day use across all core measure substances (alcohol, marijuana, tobacco, prescription drug misuse).
• Past 30-day use of alcohol and marijuana among high school students in DFC communities were significantly lower than rates in the national Youth Risk Behavior Survey.

Building on strategic plans developed under DFC awards, SAMHSA’s Center for Substance Abuse Prevention provides funding to current and former DFC coalitions to support efforts in preventing and reducing underage drinking through the Sober Truth on Preventing (STOP) Underage Drinking program. This program prevents and reduces alcohol use among youth and young adults ages 12-20 in communities throughout the United States. The program aims to address norms regarding alcohol use by youth, reduce opportunities for underage drinking, create changes in underage drinking enforcement efforts, address penalties for underage use, and reduce negative consequences associated with underage drinking (e.g., motor vehicle crashes, sexual assaults). In FY 2022 alone, STOP Act grantees directly served nearly 500,000 individuals through evidence-based programs such as Life Skills Training and Communities that Care, and saw reductions in past 30-day alcohol use and increases in perceptions of the harms of drinking, including binge drinking. They also indirectly reached over 11.5 million through universal prevention strategies such as media campaigns and information dissemination.

The SAMHSA Center for Substance Abuse Prevention’s Voices of Youth Initiative partners with youth organizations to generate youth perspectives on substance use prevention topics to inform work being done at the federal level. This partnership utilizes a human-centered design approach to empower youth to be engaged in the development of substance use prevention messages and activities in their own communities. In addition to providing education about healthy decision- making and the risks of substance use, the Voices of Youth initiative generates “youth-to-youth” messages designed to resonate with young people.

Areas for Additional Focus

While progress to date has advanced the prevention priorities established in the 2022 Strategy , work remains to be initiated or completed.

Establish a community of practice for evidence-based youth substance use

prevention and adverse childhood experiences.

(Agencies Involved: HHS/CDC, SAMHSA)

Eliminating exposure to ACEs is critical for addressing the overdose crisis. ACEs are potentially traumatic events that occur before the age of 18, and they have been shown to increase risks for substance use, as well as for future legal system involvement.^54 They include witnessing or experiencing abuse or neglect, household or community violence, or having an incarcerated family member. Importantly, other forms adversity or trauma in childhood and adolescence can also raise risks for SUD.

effects of naloxone, an OORM.^60 Social media influencers such as college athletes and lifestyle content creators reach millions of youth and young adults. In addition to social media platforms, information is disseminated through digital billboards in places that young people frequent, including college campuses, gas stations, public spaces, and restaurants.

Since the campaign launch, $11.3 million of media has been donated to increase fentanyl awareness among youth and has yielded 826.2 million impressions by youth across several media. An additional $1.5 million of media has been donated to raise awareness among parents about the dangers of fentanyl, signs and symptoms to look for, and how to talk to their children about fentanyl; more than 384 million impressions have been logged by parents across multiple platforms. One website linked to the campaign, DropTheFBomb.com, has logged 177,200 users with 34.2 percent (60,500) of those sessions showing user engagement and 67,900 user conversions. A second website, RealDealOnFentanyl.com, has logged 3.3 million users with 14.6 percent (586,600) of those sessions showing user engagement and 619,400 user conversions. Further opportunities exist to engage key stakeholders to develop guidelines, tools, peer-led awareness campaigns, and other resources to encourage screening for mental health and substance use in multiple settings. Bolstering the efforts of ED’s student support programs for institutions of higher education, such as the Postsecondary Student Success and TRIO programs will provide opportunities to leverage partnerships to raise awareness of risk and harms of substance use and provide services to intervene in risky use and related health consequences.

Encourage evidence-based employer-based wellness programs.

(Agencies Involved: HHS/ACF, CDC, SAMHSA; Labor; Treasury/IRS)

Employers provide an underutilized platform to reach adolescent and young adult employees and their families with vital information and resources to address substance use. The Workplace Supported Recovery Program of CDC’s National Institute for Occupational Safety and Health details important steps employers can take to prevent work-related injuries and illnesses that could lead to substance use or misuse. This information promotes policies and practices that reduce difficult working conditions or work demands that might lead to daily or frequent pain. Opportunities exist to inform employers and youth employees about the dangers of substance use, harm reduction actions such as securing and safely disposing of unused medications, and responding to overdoses using naloxone. Employers can also promote and sustain workplace culture and environments that build awareness, reduce stigma, and promote wellness and health- focused activities. Workplaces have an important role to play in community-based prevention efforts. Workplaces contribute to the economic security of a community, create opportunities for advancement and leadership, and contribute to social norms in the community. Workplaces can partner with community coalitions and other sectors of the community to implement workplace- based substance use prevention programs, expose youth to positive adult role models and youth leadership development programs and engage in substance use awareness activities in the community.

Success Story

Effective substance use prevention extends beyond information about the harms and risks of alcohol, tobacco, and other drugs. Substance use is often initiated during childhood or early adolescence.

Studies have shown that interventions promoting positive parenting practices, ensuring mental safety, and meeting basic human needs of children support prevention of substance use and mental health conditions.^61 ,^62 ,^63 ,^64 SAMHSA initiated Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health) to promote the wellness of young children, from birth to eight years of age, by addressing the social, emotional, cognitive, physical, and behavioral aspects of their development. Family and community experiences in early childhood greatly influence the vulnerability to behavioral health challenges, including substance use and mental health conditions, for youth and young adults. Through consultations, mentoring and training, the Project ensures regular mental health and substance use screening for youth and their caregivers, and access to a range of other services and supports to promote family wellness. Local Project LAUNCH Advisory Councils comprised of family representatives and community partners develop culturally appropriate, community-based strategies to integrate behavioral health into primary care, childcare and education settings. Together, these activities aim to prepare young children to thrive in school and beyond. From its inception in 2009, Project LAUNCH has accomplished significant milestones including:

• Trained 26,530 members of the behavioral health workforce;
• Screened 62,076 young children and caregivers for behavioral health or related interventions;
• Referred 22,041 young children and caregivers for behavioral health and related services;
• Provided evidence-based behavioral health and related services to 38,335 young children and caregivers; and
• Established 1,160 new partnerships with other child-serving and related agencies and organizations to serve children and families.

Through SAMHSA Strategic Prevention Framework – Partnerships for Success funding, Social Advocates for Youth (SAY) San Diego has had phenomenal success with implementing the Project Safeguard Project, which includes several innovative strategies to reduce substance use among youth aged 9-20. The goals of Project Safeguard are to (1) reduce youth access to alcohol and marijuana by using evidence-based approaches to increase local business compliance with state and local laws; (2) decrease the prevalence of alcohol and marijuana use by minors by engaging parents, youth, and community members in evidence-based outreach and education initiatives; and (3) increase youth referrals to SUD treatment and early intervention by engaging the community, local law enforcement, and school district in implementing the evidence-based programs that address and reduce early initiation of use. Project Safeguard targets youth located in Southeast San Diego where over 51 percent youth live in poverty. SAY San Diego's youth coalition "Youth Unite" partnered with the Playwrights Project and Elevate Youth to support a play, "Pros and Cons of Feeding Stray Cats," which focuses on substance use, alternative support juvenile justice programs, and empathy. The play follows two youth who meet at a weekend program for teens who have been arrested for drug-related offenses. After the play, there was a panel of experts including SAY San Diego to provide substance use prevention resources. The feedback received from youth was very positive, including feeling more comfortable about having a conversation with friends who may be struggling with substance use.