Opioid Abatement & Remediation Strategies (OARS)

This document presents Delaware's opioid abatement and remediation strategies, adapted from the National Settlement Agreement (Exhibit E). The Commission simplified the content for enhanced clarity and readability, ensuring all original details were retained. These strategies are essential because they inform the public and grant applicants about the allowable uses for settlement funds. This document also guides the categorization of grantees and informs the specific reporting metrics used to track program progress and measure abatement outcomes.

Overview and Outline

All grant proposals for both the Competitive Grant Program and the Local Government Grant

Program must align with one or more of the established abatement and remediation strategies.

These strategies are structured into three (3) main categories and twelve (12) specific subcategories, as detailed below:

A. Treatment and Recovery Supports

1. Treatment of Opioid Use Disorder (OUD)

2. Recovery Support

3. Connections to Care

4. Addressing Needs of Criminal Justice-Involved Populations

5. Addressing the Needs of Pregnant & Parenting Women and Neonatal Abstinence

Syndrome (NAS)

B. Prevention

1. Prevent Over-prescribing of Opioids

2. Prevent Misuse of Opioids

3. Prevent Overdose Deaths and Other Harms

C. Other Strategies

1. First Responders

2. Leadership, Planning, Coordination

3. Training

4. Research

Detailed List of Opioid Abatement and Remediation Strategies

The twelve subcategories contain a comprehensive list of seventy-three (73) specific strategies, which represent the allowable uses of the settlement funds.

A. Treatment and Recovery Supports:

1. Treatment of Opioid Use Disorder (OUD):

a. Evidence-based Treatment: Support and expand the availability of evidence-based treatment for OUD and any co-occurring SUD/MH condition. This includes Medication Assisted Treatment (MAT) approved by the U.S. Food and Drug Administration (FDA) and other treatments that align with the

American Society of Addiction Medicine (ASAM) national practice guidelines.

b. Withdrawal Management: Provide withdrawal management (detoxification) services for individuals with OUD and any co-occurring mental health conditions.

c. Telehealth Access: Expand the availability of OUD treatment and any co-occurring SUD/MH care through the use of telehealth services.

d. Mobile Services: Fund mobile intervention, treatment, and recovery services utilizing qualified professionals and peer recovery coaches.

e. Trauma-Informed Care: Support treatment of trauma (e.g., violence, adverse childhood experiences) for individuals with OUD and their family members, including training for healthcare personnel.

f. Quality Improvement & Oversight: Improve oversight of Opioid Treatment

Programs (OTPs) to assure evidence-based or evidence-informed practices, such as adequate methadone dosing and low-threshold approaches to treatment.

g. MAT Training & Waivers: Provide MAT training for a wide range of professionals, including healthcare providers, first responders, students, and peer support professionals. Provide training and technical support for clinicians to get the waivers needed to prescribe MAT.

h. Workforce Development & Incentives: Support workforce development for addiction professionals. Offer scholarships, fellowships, or loan repayment incentives for providers, especially those working in rural or underserved areas.

i. Curriculum Dissemination: Develop and disseminate evidence-based or established training curricula, such as the American Academy of Addiction

Psychiatry’s Provider Clinical Support Service.

2. Recovery Support:

a. Comprehensive Wrap-around Services: Offer essential resources like housing, transportation, education, job placement/training, and childcare.

b. Full Continuum of Care: Provide the entire range of treatment and recovery services, including supportive housing, peer support/counseling, community navigators, case management, and connections to community-based services.

c. Medication Access: Ensure counseling, peer support, recovery case management, and residential treatment are available, with access to FDA-approved medications for those who need it.

d. Community Support & Deinstitutionalization: Offer social and legal services to assist in transitioning individuals out of institutional settings.

e. Peer-Recovery Centers: Support or expand centers offering support groups, social events, computer access, and other services.

f. Successful Recovery Programs & Capacity Building: Identify, support, and provide technical assistance to increase the number and capacity of high-quality programs (e.g., physician, pilot, college recovery programs).

g. Community Engagement: Engage non-profits, faith-based groups, and community coalitions to support those in treatment/recovery and their family members.

h. Stigma Reduction & Staff Training: Support efforts to reduce stigma

(including stigma toward effective treatment) and train government staff on appropriate interaction and service provision.

i. Culturally Appropriate Services: Create or support culturally appropriate programs for all persons with OUD, including new Americans.

j. Youth Recovery Support: Create and/or support recovery high schools.

k. Workforce Development: Hire or train behavioral health workers to provide or expand any of the listed services.

3. Connections to Care:

a. Healthcare Provider Training and Screening: Ensure healthcare providers are trained and equipped to screen for OUD and risk factors, and can appropriately counsel, treat, or refer patients.

b. Emergency Department (ED) Services: Support and expand hospital programs that provide peer support, discharge planning, MAT initiation, and other services in the ED.

c. Peer Support and Warm Handoffs: Fund peer support specialists or recovery coaches in various settings (EDs, detox, recovery housing) to offer services and expand warm hand-off services for smooth transitions into recovery care.

d. Crisis Stabilization Centers: Support crisis stabilization centers that serve as an alternative to EDs.

e. Emergency Medical Services: Support the work of emergency medical services, including peer support specialists, to connect individuals to treatment and/or other appropriate services.

f. Comprehensive SBIRT Implementation: Fund SBIRT programs (including for uninsured pregnant women), provide long-term training and implementation in key systems (health, schools, criminal justice) focused on youth, and support the purchase of automated SBIRT technology.

g. Centralized Information: Support centralized call centers for information and connections to appropriate services.

h. Community Outreach: Engage non-profits and the faith community to support outreach for treatment.

i. Targeted Assistance Programs: Support assistance programs for healthcare providers with OUD.

j. Youth-Focused Contacts and Programs: Create or support school-based contacts for parents to seek immediate treatment for their child, and support other youth-focused prevention, intervention, treatment, and recovery programs.

k. Workplace Best Practices: Develop and support best practices on addressing

OUD in the workplace.

4. Addressing the Needs of the Criminal Justice-Involved Population:

a. Diversion and Pre-Trial Services: Support pre-arrest, post-arrest, or pre-trial programs that connect individuals involved in the criminal justice system to addiction treatment, recovery support, and essential wraparound services.

b. Treatment While Incarcerated: Provide evidence-based addiction treatment, including MAT, recovery support, and harm reduction, for individuals who are currently incarcerated in jail or prison.

c. Reentry and Community Supervision: Support evidence-informed services for individuals leaving correctional settings, including those on probation, parole, or under community corrections supervision.

d. Critical Time Interventions: Fund Critical Time Interventions (CTI) and services for high-risk individuals, particularly those with a dual diagnosis, who face immediate risks and service needs upon release from correctional settings.

e. Specialized Courts: Fund treatment and recovery courts that provide evidence-based judicial options for persons with Opioid Use Disorder (OUD) and any co-occurring SUD or mental health conditions.

f. Professional Training and Systems Capacity: Provide training on best practices for addressing the needs of criminal justice-involved persons to law enforcement, correctional, and judicial personnel, as well as treatment and recovery providers.

5. Addressing the Needs of Pregnant & Parenting Women and Neonatal Abstinence

Syndrome (NAS):

a. Maternal Treatment: Support and expand evidence-based or evidence-informed treatment, recovery services, supports, and prevention for pregnant women (or women who could become pregnant) with OUD and any co-occurring SUD/MH conditions.

b. Postpartum Continuum of Care: Expand postpartum care for uninsured women with OUD and co-occurring conditions for up to 12 months after giving birth.

c. Infant Care, Monitoring, and Dyad Support: Expand comprehensive evidence-based treatment, recovery support, and long-term medical monitoring for NAS babies and their families. Improve the continuum of care for the infant-mother dyad.

d. Professional Training: Provide training for obstetricians and all relevant healthcare personnel on the treatment of OUD and co-occurring conditions for pregnant women and their families. Provide training to healthcare providers on federal compliance requirements for referring children born with NAS.

e. Family Stability: Provide enhanced family support services, including child care and home-based wrap-around services (such as parent skills training) for parenting women with OUD and co-occurring conditions.

f. Trauma Care: Offer trauma-informed behavioral health treatment for adverse childhood events and enhanced support for children and family members suffering trauma due to addiction.

g. Child Welfare: Fund additional positions and services (including supportive housing and other residential services) related to children entering foster care due to custodial opioid use.

B. Prevention:

1. Prevent Over-prescribing of Opioids:

a. Opioid Prescribing Best Practices: Fund and conduct education and outreach (including academic detailing and CME) for medical providers on best prescribing practices, safe dosing, and patient tapering, consistent with

CDC Guidelines for Prescribing Opioids for Chronic Pain.

b. Non-Opioid Pain Alternatives: Support and provide training for health care providers to offer or refer patients to multi-modal, evidence-informed non-opioid pain treatment alternatives.

c. Dispenser Education: Educate pharmacists and other dispensers on appropriate opioid dispensing practices.

d. Prescription Drug Monitoring Programs (PDMPs): Support improvements to PDMPs to increase prescriber usage, improve data quality/interface for decision-making, and enable data-driven surveillance/intervention (like MAT referrals), all while ensuring privacy compliance.

e. Electronic Prescribing and Dispenser Education: Increase electronic prescribing to prevent diversion and forgery, and educate dispensers on appropriate opioid dispensing practices.

2. Prevent Misuse of Opioids:

a. Public Awareness Campaigns: Fund and implement media campaigns and corrective advertising/affirmative public education campaigns based on evidence to prevent opioid misuse.

b. Safe Drug Disposal: Support and fund both public education relating to drug disposal and the actual drug take-back, disposal, or destruction programs.

c. Community Coalition Support: Fund and support community anti-drug coalitions in implementing evidence-informed prevention efforts, including strategies for reduced social/physical access, stigma reduction, and training

(e.g., using the SAMHSA Strategic Prevention Framework).

d. Non-Profit and Faith-Based Engagement: Engage non-profits and faith-based communities as systems to support overall prevention outreach.

e. Comprehensive School-Based Prevention: Fund evidence-based prevention programs and campaigns in schools and communities targeting students, families, and staff, including programs that have demonstrated effectiveness in preventing drug misuse.

f. Targeted Youth and Family Interventions: Create or support community-based education or intervention services for families, youth, and adolescents at risk for OUD and co-occurring SUD/MH conditions.

g. Youth Mental Health Prevention: Support and expand evidence-informed programs or curricula that address mental health needs of young people who may be at risk for opioid misuse.

h. Youth Mental Health Access: Support greater access to mental health services and supports (through school nurses, behavioral health workers, and other school staff) to address mental health needs in young people who may be at risk for opioid misuse.

3. Prevent Overdose Deaths and Other Harms (Harm Reduction):

a. Expanded Naloxone Access and Distribution: Significantly increase the availability and free distribution of naloxone and other overdose reversal drugs to first responders, patients, individuals with OUD, family, friends, schools, and the general public.

b. Naloxone Education and Training: Provide comprehensive training and education on naloxone and overdose response to first responders, patients, families, schools, community groups, and the general public.

c. School Overdose Response: Enable and support school nurses and other school staff to respond to opioid overdoses by providing them with necessary naloxone, training, and support.

d. Good Samaritan Law Awareness: Conduct public education and educate first responders regarding the existence and operation of immunity and Good

Samaritan laws related to overdose emergencies.

e. Syringe Service Programs (SSPs) and Harm Reduction: Support and expand Syringe Service Programs (SSPs) and other evidence-informed programs to reduce harms associated with intravenous drug use, providing essential supplies, peer support, referrals to treatment, fentanyl checking, and connection to a full range of services.

f. Infectious Disease Testing and Treatment: Expand access to testing and treatment for infectious diseases (like HIV and Hepatitis C) resulting from intravenous opioid use.

g. Mobile Outreach Services: Support mobile units that offer or provide referrals to harm reduction services, treatment, recovery supports, and healthcare to persons who use opioids or have OUD.

h. Harm Reduction Training: Provide training in harm reduction strategies to health care providers, students, peer recovery coaches, recovery outreach specialists, and other care professionals.

i. Data Tracking and Screening: Expand and improve data tracking software for overdoses/naloxone revivals and support routine clinical toxicology testing for fentanyl screening.

C. Other Strategies:

1. First Responders:

In addition to items listed throughout this document relating to first responders, support the following:

a. Fentanyl Safety and Handling Training: Training on appropriate practices and safety precautions when dealing with fentanyl or other potent drugs.

b. First Responder Wellness and Trauma Support: Provision of wellness and support services to address secondary trauma associated with emergency events.

2. Leadership, Planning, Coordination:

a. Strategic Planning and Needs Assessment: Support statewide, regional, local, and community planning to identify the root causes of addiction and overdose, set goals for harm reduction, and identify areas and populations with the greatest need for treatment and intervention services.

b. Public Accountability and Data Dashboard: Develop a public dashboard to ensure transparency and accountability by sharing plans, reports, and recommendations for spending opioid settlement funds; showing how funds have been spent and reporting program outcomes; and tracking, sharing, and visualizing key opioid- and health-related indicators.

c. Infrastructure and Coordination Investment: Invest in infrastructure or staffing at government or not-for-profit agencies to support collaborative, cross-system coordination. The goal is to improve efforts in prevention, treatment, recovery support, and connections to care.

d. Program Oversight and Management: Provide resources to staff government oversight and management of all opioid abatement programs.

3. Training:

In addition to the training referred to throughout this document, support training activities, programs, or strategies that include the following:

a. Staff Training and Networking: Provide funding for staff training and networking programs to improve the capability of government, community, and not-for-profit entities to abate the opioid crisis.

b. Infrastructure for Cross-System Coordination: Support infrastructure and staffing to enable collaborative, cross-system coordination aimed at preventing misuse and overdose, treating OUD/SUD/MH, and implementing other abatement strategies.

4. Research:

a. Program Monitoring and Evaluation: Support ongoing monitoring, surveillance, data collection, and evaluation of all programs and strategies described in the opioid abatement effort.

b. Non-Opioid Pain Research: Conduct research on non-opioid treatment alternatives for chronic pain.

c. Service Delivery Improvement: Research improved service delivery for modalities like SBIRT (Screening, Brief Intervention, and Referral to

Treatment) in populations vulnerable to OUD.

d. Novel Harm Reduction Research: Research innovative harm reduction and prevention efforts, such as the provision of fentanyl test strips.

e. Supply-Side Enforcement Research: Research innovative supply-side enforcement efforts, such as improved detection of synthetic opioids delivered via mail.

f. Criminal Justice Deterrence Models: Expand research on swift/certain/fair models to reduce and deter opioid misuse within criminal justice populations.

g. OUD Epidemiological Surveillance: Support epidemiological surveillance of

OUD-related behaviors in critical populations, including individuals entering the criminal justice system (e.g., approaches modeled on the ADAM system).

h. Illicit Market Research: Conduct qualitative and quantitative research on public health risks and harm reduction opportunities within illicit drug markets.

i. Geospatial Access Analysis: Perform geospatial analysis of access barriers to

MAT (Medication-Assisted Treatment) and their association with treatment engagement and outcomes.