Resources on Chronic Pain and the Opioid Epidemic

Last updated September 12, 2016

The Nicholson Foundation regularly scans a wide variety of sources for scientific articles, reports, news stories, and other items of interest on issues related to our program areas. We post them on an ongoing basis to the What We’re Learning page on our website. Occasionally, we gather together a selection of resources on a topic of particular interest. For example, see our “round-up” of resources on the integration of behavioral health into primary care.

This What We’re Learning “round-up” focuses on the intersection of chronic pain with opioid use, addiction and overdose, and ongoing responses to the opioid epidemic at the federal level, and in New Jersey and other states.  It includes resources on the following topic areas:

The Use of Opioids to Treat Chronic Pain

Alford DPOpioid Prescribing for Chronic Pain—Achieving the Right Balance through Education New England Journal of Medicine 2016;374(4):301-303.

In this Perspective, Dr. Daniel Alford advocates for better education for physicians on how to deal with chronic pain to break from the current reliance on opioids. Dr. Alford is an Associate Professor of Medicine at Boston University School of Medicine and Medical Director of Boston Medical Center’s Office-based Opioid Treatment program.

Bohnert A, Logan J, Ganoczy D, Dowell DA Detailed Exploration into the Association of Prescribed Opioid Dosage and Overdose Deaths Among Patients with Chronic PainMedical Care. 2016;54(5):435-441.

High opioid dosage has been associated with overdose, and clinical guidelines have cautioned against escalating dosages above 100 morphine-equivalent mg (MEM). However, this 100 MEM threshold is an arbitrary cut-off. This article reports on a study in which investigators attempted to identify a range of opioid dosages associated with risk of overdose, based on a population of patients of the Veterans Health Administration with a chronic pain diagnosis who were prescribed opioids. The investigators did not find a clear cut-point in dosage beyond which opioid posed an overdose risk. However, they concluded that lowering the recommended dosage threshold below the 100 MEM used in many recent guidelines would affect proportionately few patients not at risk for overdose while potentially benefitting many of those at risk for overdose.

Healthcare Triage Special: America’s Epidemic of Opioid AbuseThe Incidental Economist

This webpage provides a video exploring how opioids can lead to dependence and addiction. It also provides links to related articles on opioids and management of chronic pain.

Jacob JA. As Opioid Prescribing Guidelines Tighten, Mindfulness Meditation Holds Promise for Pain ReliefJAMA 2016;315(22):2385-2387.

This JAMA Medical News feature examines mindfulness meditation as a nonpharmacologic method for managing chronic pain.

Meier B. and Goodnough A. New Ways to Treat Pain Meet ResistanceThe New York Times, June 22, 2016.

This article describes various alternatives to opioids that can be successfully used to treat pain and the challenges they face from inconsistent insurance coverage and resistance from patients and their physicians.

Nahin RL. Estimates of Pain Prevalence and Severity in Adults: United States, 2012 The Journal of Pain 2015;16(8):769-780.

A new analysis of data from the 2012 National Health Interview Survey has found that most American adults have experienced some level of pain, from brief to chronic pain, and from relatively minor to more severe pain.

National Institute on Drug Abuse, NIHPain Awareness Month: Dr. Nora Volkow on Pain Research and Opioids. September 2014.

In this video, the National Institute on Drug Abuse (NIDA) Director, Nora Volkow, MD, describes NIDA's role and participation in pain research.

Randell J. and Mazon Jeffers RPain Care As A Catalyst For Primary Care Transformation. Health Affairs "Grantwatch" Blog, September 8, 2016.

This Op-Ed, co-authored by The Nicholson Foundation's Joan Randell and Raquel Mazon Jeffers, describes the Foundation-supported NJ Pain Care Collaborative. The piece posits that adopting evidence-based pain care can not only reduce overprescribing of prescription pain medication, but also act as a catalyst for greater primary care transformation. 

Schuckit MA. Treatment of Opioid-Use Disorders New England Journal of Medicine 2016;375(4):357-368.

This article provides an overview of treatments currently available to manage opioid-related conditions, including treatments provided by primary care providers and specialists in substance use disorders. 

Thomas D, Frascella J, Hall T, Smith W, Compton W, Koroshetz W, Briggs J, Grady P, Somerman, Volkow NReflections on the Role of Opioids in the Treatment of Chronic Pain: A Shared Solution for Prescription Opioid Abuse and PainJournal of Internal Medicine 2015;278(1):92-94.   

This essay looks at the role that opiates play in the modern healthcare system as the go-to treatment for chronic pain, and finds that more comprehensive systems for treating pain are needed.   

Volkow ND, Frieden TR, Hyde PS, Cha SSMedication-Assisted Therapies—Tackling the Opioid-Overdose EpidemicNew England Journal of Medicine 2014;370(22):2063-2066.

This article notes that the rate of death from overdoses of prescription opioids in the United States more than quadrupled between 1999 and 2010, far exceeding the combined death toll from cocaine and heroin overdoses. It outlines various approaches for addressing this significant public health problem.

Opioid Use, Addiction, Overdose, and its Impact on Communities and the Substance Use Treatment System

Cicero TJ, Ellis MS, Surratt HL, Kurtz SP.  The Changing Face of Heroin Use in the United States: A Retrospective Analysis of the Past 50 YearsJAMA Psychiatry 2014;71(7):821-826.

Over the past several years, a number of mainstream media reports have described the migration of the heroin epidemic from low-income urban areas with large minority populations to more affluent suburban and rural areas with primarily white populations. This article examines the veracity of these anecdotal reports and defines the relationship between the misuse of prescription opioids and the misuse of heroin.

Compton WM, Jones CM, Baldwin GTRelationship between Nonmedical Prescription-Opioid Use and Heroin UseNew England Journal of Medicine 2016;374(2):154-163.

Available data indicate that the nonmedical use of prescription opioids is a strong risk factor for heroin use. This analysis shows, however, that although the majority of current heroin users report having used prescription opioids nonmedically before they initiated heroin use, heroin use among people who use prescription opioids for nonmedical reasons is rare, and the transition to heroin use appears to occur at a low rate. 

Cornish ATreating Addiction as a Chronic Disease. National Public Radio All Things Considered  February 26, 2016.

This article profiles A. Thomas McLellan, addiction researcher and co-founder of the Treatment Research Institute. Cornish talks with McLellan about perceptions of addiction and how those perceptions have shaped the current treatment system.       

D’Onofrio G, O’Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, Bernstein SL, Fiellin DAEmergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence:  A Randomized Clinical TrialJAMA 2015;313(16):1636-1644.

This article describes a randomized clinical trial that tested the efficacy of three interventions for opioid dependence: referral to treatment; screening, a brief intervention, and facilitated referral to treatment; and screening, brief intervention, emergency-department (ED) treatment with buprenorphine/naloxone, and referral to primary care. The study found that among opioid-dependent patients, ED-initiated buprenorphine treatment significantly increased engagement in addiction treatment, reduced self-reported illicit opioid use, and decreased use of inpatient addiction treatment services compared to brief intervention and referral.

Drug Poisoning Mortality: United States, 1999-2014 Centers for Disease Control and Prevention, September, 2016.

This storyboard presents drug poisoning deaths at the national, state, and county levels. The first two dashboards depict U.S. and state trends in age-adjusted death rates for drug poisoning from 1999 to 2014 by selected demographic characteristics, and the third dashboard presents a series of heat maps of model-based county estimates for drug poisoning mortality from 1999 to 2014.  NOTE: See the State Trends tab for data on New Jersey.

Related infographics from these data:

How the Epidemic of Drug Overdose Deaths Ripples Across America The New York Times

The Spread of America’s Opioid Epidemic Politico Pulse DataPoint

A Deadly Crisis: Mapping the Spread of America's Drug Overdose Epidemic The Guardian

FAIR Health Inc. July/September 2016.

FAIR Health, a nonprofit organization “dedicated to transparency in healthcare costs and health insurance information,” analyzed claims data from insurers representing 150 million patients. Results are reported in two reports.

-The Opioid Crisis Among the Privately Insured, July 2016.

This analysis found that medical services for people with opioid dependence diagnoses rose more than 3,000 percent between 2007 and 2014, and that much of the increase in opioid dependence has occurred since 2011. The report describes these findings as well as trends by age, gender, and geography and concludes that progress against this epidemic will require action by all healthcare stakeholders.

-The Impact of the Opioid Crisis on the Healthcare System: A Study of Privately Billed Services, September 2016.

This analysis examined the increase in healthcare costs and demand for specific services attributable to the epidemic. It found that the dollar value of charges for opioid-related charges rose more than 1,000 percent from 2011 to 2015; that payers’ costs for patients diagnosed with opioid use disorders were more than 550 percent higher than for other patients; that charges for opioid abuse differed from those for opioid dependence; and that states’ average charges vary widely.

Hsu, Andrea. Treating Opioid Addiction With A Drug Raises Hope And Controversy. National Public Radio's All Things Considered May 16, 2016.

Medication-assisted therapies are proven in studies to reduce relapses and, ultimately, overdoses, yet limited availability and continuing stigma has inhibited their use.

Kaiser Family Foundation. Health Status Indicators: Opioid Overdose Deaths. The Henry J. Kaiser Family Foundation, June 2016.

This series of tables provide state-level data from 2014 on various facets of opioid overdose deaths, including deaths by type of opioid, gender, age group, and race/ethnicity. A separate table provides state-level data on prescription opioid overdose deaths and death rates per 100,000 population.

Larochelle MR, Liebschutz JM, Zhang F, ross-Degnan D, Wharma JFOpioid Prescribing After Nonfatal Overdose and Association with Repeated Overdose: A Cohort StudyAnnals of Internal Medicine 2016;164(1):1-9.

This study shows that most people who survive overdoses of prescription painkillers continue to be prescribed the  same drugs by their doctors. In all, 91% of patients followed in the study cohort were dispensed opioids within a year of their overdose, and 70% received their prescriptions from the same doctor who provided their initial prescription—most often with the doctor not knowing the patient had overdosed.

Muhuri PK, Gfroerer JC, Davies C.Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United StatesCBHSQ Data Review. Substance Abuse and Mental Health Services Administration. August 2013.

This study contributes important new data to improve understanding of the role of prior non-medical pain reliever use in initiating heroin use in the U.S. general population. The study found that recent heroin incidence rate was 19 times higher among those who reported prior non-medical pain reliever use than among those who did not. Four out of five recent heroin initiates previously used these medications for non-medical purposes. However, only 1% of recent initiates had prior use of heroin, showing that the vast majority of people who have used prescription pain relievers for non-medical purposes have not progressed to heroin.

National Health Care for the Homeless Council. Medication-assisted Treatment: Buprenorphine in the HCH Community. Nashville (TN): May 2016.

This policy brief identifies some of the challenges to providing medication-assisted treatment in a health center care setting and suggests both clinical practice and public policy strategies to further promote access and recovery, especially among those experiencing homelessness.

Noguchi YOpioid Abuse Takes a Toll on Workers and their EmployersNational Public Radio Morning Edition January 20, 2016.

This article describes how prescription opiate use is a growing problem in today's workplace. In addition, it discusses how many individuals end up obtaining prescriptions through workman's compensation and disability programs.

Prescription Drug Use and Misuse in the United States: Results from the 2015 National Survey on Drug Use and Health SAMHSA NSDUH Data Review, September, 2016.

New data from the National Survey on Drug Use reveals that 119 million Americans age 12 and older—or 45 percent of the population—took prescription psychotherapeutic drugs (i.e., pain relievers, tranquilizers, stimulants and sedatives). According to the report, 16 percent of all prescription drug use was actually misuse. Misuse of these drugs is second only to marijuana as the nation’s most prevalence illicit drug use issue.

Ray WA, Chung CP, Murray KT, Hall K, Stein CM. Prescription of Long-Acting Opioids and Mortality in Patients with Chronic Noncancer PainJAMA 2016;315(22):2415-2423.

In this analysis of data from Medicaid patients in Tennessee, investigators compared all-cause mortality for patients with chronic noncancer pain who were prescribed either long-acting opioids or alternative medications for moderate to severe chronic pain. Results showed that, compared with anticonvulsants or cyclic antidepressants, prescription of the long-acting opioids was associated with a significantly increased risk of all-cause mortality, including deaths from causes other than overdose, with a modest absolute risk difference.

Rodolico JAnatomy of Addiction: How Heroin and Opioids Hijack the BrainNational Public Radio Morning Edition. January 11, 2016.

This article explains in plain language how opioids act on neurotransmitters and neural circuits in the brain to cause addiction.

Saha TD, Kerridge BT, Goldstein RB, Chou SP, Zhang H, Jung J, Pickering RP, Ruan WJ, Smith SM, Huang B, Hasin DS, Grant BF. Nonmedical Prescription Opioid Use and DSM-5 Nonmedical Prescription Opioid Use Disorder in the United StatesJournal of Clinical Psychiatry 2016;77(6):772-780.

This article presents an analysis of data from the National Epidemiologic Survey on Alcohol and Related Conditions-III. The data show that use of nonmedical prescription opioids more than doubled among adults in the United States between 2001-2002 and 2012-2013. In addition, the number of people who met criteria for prescription opioid addiction increased substantially. 

Williams AR, Bisaga AFrom AIDS to Opioids—How to Combat an EpidemicNew England Journal of Medicine 2016;375(9):813-815.

This Perspective discusses how the concerted and coordinated response to the AIDS epidemic may provide a model for promising interventions that could combat the opioid epidemic.

Federal-level Policy Responses to the Opioid Epidemic and Related Resources

Califf RM, Woodcock J, OstroffA Proactive Response to Prescription Opioid Abuse. Special Report. New England Journal of Medicine 2016;374(15):1480-1485.

This article describes the Food and Drug Administration’s efforts to partner with other government agencies, health care providers, the medical products industry, patients and families to address the opioid overdose epidemic.

Centers for Medicare and Medicaid ServicesMedicare Part D Opioid Drug Mapping Tool, 2016.

This interactive mapping tool shows geographic comparisons, at the state, county, and ZIP code levels, of de-identified Medicare Part D opioid prescription claims within the United States. This new mapping tool allows the user to see both the number and percentage of opioid claims at the local level and better understand how this critical issue affects communities nationwide.

Comprehensive Addiction and Recovery Act of 2016

This law, signed by President Obama on July 22, 2016, authorizes the Attorney General and Secretary of Health and Human Services to award grants to address the national epidemics of prescription opioid abuse and heroin use, and to provide for the establishment of an inter-agency task force to review, modify, and update best practices for pain management and prescribing pain medication, and for other purposes.

Dowell D, Haegerich TM, Chou RCenters for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain—United States, 2016Morbidity and Mortality Weekly Report 2016;65(1):1-49.

This new CDC guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses when to initiate or continue opioids for chronic pain; opioid selection, dosage, duration, follow-up, and discontinuation; and assessing risk and addressing harms of opioid use.

Resources Associated with the CDC’s New Guideline

Enomoto K, Frank RImproving Access to Treatment: Expanding Reach of Buprenorphine. Washington (DC): Substance Abuse and Mental Health Services Administration, March 31, 2016.

This blog post describes a US Department of Health and Human Services proposed regulation that seeks to increase the limit on the number of patients a physician can treat with buprenorphine from 100 to 200. The regulation also has strong protections to ensure that the medication is not diverted. 

Food and Drug Administration. FDA Approves First Buprenorphine Implant for Treatment of Opioid Dependence. Washington (DC): FDA, May 26, 2016.

This press release announces the recent FDA approval of Probuphine, the first buprenorphine implant for maintenance opioid treatment. The implant provides a constant, low-level dose of the medication for six months and is designed for patients who are already stable on low-to-moderate doses of other forms of buprenorphine as part of a complete treatment program.

FDA Drug Safety Communication: FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines  FDA, August 31, 2016.

In an effort to decrease the combined use of opioids and benzodiazepines, or opioids and other CNS depressants, the FDA announced that it is adding Boxed Warnings, its strongest warnings, to the drug labeling of prescription opioid pain and prescription opioid cough medicines, and benzodiazepines. FDA also is revising the Warnings and Precautions, Drug Interactions, and Patient Counseling Information sections of the labeling. This safety announcement includes links to related useful information.

HHS Awards $53 Million to Help Address Opioid Epidemic HHS Press Release, August 31, 2016.

On August 31, HHS announced $53 million in funding to 44 States, four tribes and the District of Columbia to improve access to treatment for opioid use disorders, reduce opioid related deaths, and strengthen drug misuse prevention efforts. In addition, funding will also support improved data collection and analysis around opioid misuse and overdose as well as better tracking of fatal and nonfatal opioid-involved overdoses. The funding is part of HHS’ Opioid Initiative, launched in March 2015, which focuses on improving opioid prescribing practices; expanding access to medication-assisted treatment (MAT) for opioid use disorder; and increasing the use of naloxone.

NIH Pain Consortium Centers of Excellence in Pain Education, September 18, 2015.

In September 2015, the National Institutes of Health Pain Consortium, a collaborative effort of eight NIH Institutes, selected 11 health professional schools as designated Centers of Excellence in Pain Education. The CoEPEs will act as hubs for the development, evaluation, and distribution of pain management curriculum resources for medical, dental, nursing, pharmacy and other schools to enhance and improve how health care professionals are taught about pain and its treatment.

Office of Disease Prevention and Health Promotion, HHS. Pathways to Safer Opioid Use, September 2016.

“Pathways to Safer Opioid Use” is an immersive, interactive training tool developed by the federal Department of Health and Human Services to help primary care physicians, nurses, pharmacists, and patients appropriately, safely, and effectively use opioids to manage chronic pain. 

Substance Abuse and Mental Health Services AdministrationSAMHSA Advisory: Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder. March 2016

This research summary provides an overview of data on the use of sublingual and transmucosal buprenorphine for the medication-assisted treatment of opioid use disorder. It also discusses the implications of using medication-assisted treatment as a recovery support. 

Turn the Tide. Office of the U.S. Surgeon General. August, 2016.

This new campaign is aimed at reducing the epidemic of prescription opioid overuse. The campaign launch coincided with a letter to more than two million clinicians across the country urging their support and involvement.

Wachino V. Best Practices for Addressing Prescription Opioid Overdoses, Misuse and Addiction U.S. Department of Health and Human Services, CMCS Informational Bulletin January 28, 2016.

This Informational Bulletin from the Director for the Center for Medicaid and CHIP Services provides background information on overdose deaths involving prescription opioids, describes several Medicaid pharmacy benefit management strategies for mitigating prescription drug abuse, and discusses strategies to increase the provision of naloxone to reverse opioid overdose, thereby reducing opioid-related overdose deaths.

Overview of New Jersey’s Opioid Epidemic and the State’s Policy Responses

Bascelli L, Mazon Jeffers RA System to Align N.J. with Obama’s Agenda to Combat Opiate Addiction. Opinion. November 21, 2015

This Op-Ed co-authored by The Nicholson Foundation’s Raquel Mazon Jeffers recommends expanding ECHO, a mentoring program for primary care doctors that can help them address the current opiate epidemic. The epidemic is largely driven by an over-reliance on prescription opiates, such as oxycodone, for treating chronic pain. This practice has led to high rates of addiction and increased risks of overdose and death.

CBS New YorkChristie: New York Joins New Jersey’s Prescription Drug Monitoring Program. April 26, 2016.

This article reports on Gov. Christie’s announcement that New York has agreed to join New Jersey’s prescription monitoring program and share records on the sale of prescription drugs. Seven States, including Delaware, Connecticut, Virginia, and New York, are now partnering with New Jersey on this program.

Christie Administration Announces CDC Grant Funding Totaling More than $7.6 Million to Combat Opioid Overdose Epidemic NJ Department of Human Services

On September 2, Gov. Christie announced The Centers for Disease Control and Prevention (CDC) had awarded the New Jersey Department of Health (DOH) a $727,688 competitive grant to enhance efforts to curb the opioid crisis through a series of initiatives and the New Jersey Department of Human Services (DHS) approximately $6.9 million to target prescription and opioid misuse.

Governor’s Council on Alcoholism and Drug Abuse. Confronting New Jersey’s New Drug Problem: A Strategic Action Plan to Address a Burgeoning Heroin/Opiate Epidemic Among Adolescents and Young Adults. Trenton (NJ): GCADA, 2014.

The skyrocketing use of opiates has become the major healthcare crisis confronting young people previously thought to be at low risk of addiction. This report presents recommendations that are aimed at addressing this crisis. The recommendations cover ensuring and expanding access to treatment, training providers on medication-assisted treatment, developing a public awareness campaign, updating school-based prevention activities and establishing programs for high school and college students, improving best practices for pain prescriptions, and strengthening the New Jersey Prescription Monitoring Program. 

Kitchenman AGovernor Lays Out Plan for Combating Drug Addiction and Reducing OverdosesNJ Spotlight January 13, 2016.

This article describes Governor Christie’s $100 million proposal to enhance the provision of mental health and addiction treatment services in New Jersey. Gov. Christie laid out the proposal in his 20156 State of the State address.

Kitchenman ABills Targeting Drug Abuse Seek to Build on Recent Legislative SuccessesNJ Spotlight January 6, 2016.

This article describes opportunities for New Jersey state legislators and Gov. Christie to adopt new laws that would establish an alternative program for high-school students recovering from addictions and require insurers to cover the cost of medications that help deter opioid misuse.

Kitchenman AChristie, Legislature Agree on Measure Aimed at Reducing Overdose DeathsNJ Spotlight April 30, 2013.

This article describes passage of a “Good Samaritan” law that protects those who call 911 to report overdoses or who administer naloxone, an antidote to opioid overdose victims.

Malok A. Heroin in New Jersey: New Jersey's Heroin Crisis by the Numbers. January 7, 2016.

This video illustrates in stark terms the rise of heroin overdose deaths in New Jersey. 

New Jersey Division of Consumer AffairsNew Jersey Prescription Monitoring Program.

This State website describes the Program and provides the proposed regulations, which were published November 16, 2015.

New Jersey CourtsNew Jersey Drug Courts.

This State website describes New Jersey’s Drug Courts program.

Partnership for a Drug-free New JerseyPartnership for a Drug-free New Jersey.

This website describes the Partnership, a New Jersey anti-drug alliance launched in 1992, that aims to localize and strengthen drug prevention media efforts.

Peskoe A, Stirling SInside N.J.’s Historic Push to Tackle Heroin September 17, 2014.

This article describes a package of 21 bills introduced into the New Jersey legislature that seek to strengthen substance use treatment and education in the State. The bills increase funding available to treatment providers and patients, expand oversight of state facilities and physicians, and address various aspects of how the State's educational community addresses prevention and recovery. State Senator Joseph Vitale spearheaded the effort to assemble the legislative package.

Ray PHeroin Statistics Only Show Some of the Harm Done The Trentonian February 9, 2016.

This article tells the story of the state's opiate addiction crisis through the lens of the personal story of one addict. The Nicholson Foundation's Raquel Mazon Jeffers is quoted in the article, providing context on the policies surrounding addiction treatment.

Rutgers Forum Centers on Early Intervention. Perspectives, a journal on Addiction Research and Public Policy. April, 2016.

This blog describes a June 1, 2016 legislative forum held at the Rutgers University School of Nursing to highlight the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model, which has been successfully used in drug use prevention efforts with adults. The forum’s co-hosts were Sen. Joseph Vitale and NJ Citizen Action. Massachusetts has introduced SBIRT in its schools, inspiring Sen. Vitale to sponsor a similar bill for New Jersey’s schools.

Sitrin C. Medication-assisted Therapy: A Better Approach to Curing Opioid Addiction? NJ Spotlight June 27, 2016.

This article reviews the continuing debate in New Jersey about the value and desirability of medication-assisted treatment, an approach that combines behavioral therapy and medications such as buprenorphine, methadone, and naltrexone to treat opioid addiction.

Stainton LHFeds Offer $22 Million to Bolster NJ’s Battles Against Opioid AddictionNJ Spotlight June 15, 2016.

This article describes a pledge of $22 million from the federal government to support New Jersey’s drug use prevention and treatment programs. The funds are part of a $1.1 billion commitment to combat drug addiction contained in the federal budget that would begin in October 2016. However, the funds are contingent on bipartisan support for the federal budget.

The American Medicine Chest ChallengeAmerican Medicine Chest Challenge.

This website describes a community-based public health initiative launched in New Jersey that is designed to raise awareness about the dangers of prescription drug misuse and promote safe disposal methods for unused, unwanted, and expired medications.

Policy Responses to the Opioid Epidemic by Other States

Institute for Healthcare ImprovementThe Opioid Crisis: How Health Care and the Community Can Act.

In this podcast, New Hampshire Attorney General Joseph Foster and Kaiser Permanente’s Joel Hyatt discuss ways to engage communities and use multi-sector approaches to respond to the opioid epidemic in effective, integrated, and innovative ways.

Meara E, Horwitz JR, Powell W et alState Legal Restrictions and Prescription-Opioid Use Among Disabled Adults New England Journal of Medicine 2016;375(1):44-53.

This paper reports on an analysis of the association between prescription opioid outcomes and eight types of controlled substance restrictions on a national sample of disabled Medicare beneficiaries. The authors concluded that the laws restricting prescriptions and dispensing of controlled substances did not have a meaningful effect on the receipt of prescription opioids by individuals in the sample.

National Governor’s AssociationFinding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States. July 2016

Developed by the National Governor’s Association Center for Best Practices, through extensive consultation with senior state officials and other national experts, the road map is a tool to help states respond to the growing opioid crisis. It features a public health approach focused on preventing and treating the disease of opioid use disorder, while strengthening law enforcement efforts to address illegal supply chain activity. It is designed as a policy development tool, allowing a state to use all or portions of the road map as it applies to their unique situation.

Seelye KQMassachusetts Chief’s Tack in Drug War: Steer Addicts to Rehab, Not JailThe New York Times January 24, 2016 

This article profiles the police chief of Gloucester, Mass., who is directing the police force to steer heroin addicts to rehabilitation, rather than the prison system.             

Vestal CStates Gear Up to Help Medicaid Enrollees Beat AddictionsThe Pew Charitable Trusts Stateline January 13, 2015.

Under the Affordable Care Act, millions of low-income adults last year became eligible for Medicaid and subsidized health insurance for the first time. This report describes how states are facing a huge challenge in dealing with a large increase in the number of 18- to 64-year olds with substance misuse issues who have not seen a doctor in years.