Opioid-Overdose Reduction Continuum of Care Approach Includes
19 Evidence-Based Strategies
The HEALing Communities Initiative, the National Institute on Drug Abuse (NIDA) and the NIH Helping to End Addiction Long-term (HEAL) Initiative® today launched the Opioid-Overdose Reduction Continuum of Care Approach (ORCCA): A Policymakers Guide to Implementing Evidence-Based Strategies that Address Opioid Overdose to aid policymakers, communities and key stakeholders in developing comprehensive, multi-system strategies that address the opioid crisis. The science and evidence behind the framework was published in the Journal of Drug and Alcohol Dependence and outlines 19 essential evidence-based interventions to reduce opioid overdose deaths.
The Centers for Disease Control and Prevention released provisional data showing there were 107,622 overdose deaths in 2021, the highest annual death toll on record from drug overdose fatalities, and 15% increase from the year prior. The ORCCA framework can guide system- and practice-level changes to reduce opioid overdose deaths. The HEALing Communities Study, a multi-site research study, tested the impact of ORCCA, an integrated set of evidence-based practices across healthcare, behavioral health, justice, and other community-based settings. HEALing Communities is funded by the National Institutes of Health (NIH) Helping to End Addiction Long-term (HEAL) Initiative®—a trans-agency effort to speed scientific solutions to stem the national opioid crisis.
The 19 evidence-based interventions recommended in ORCCA across five domains include:
Prioritize Individuals at heightened risk for opioid overdose death: To prevent overdose deaths, a primary focus should be on reaching populations with the highest risk, especially those who do not currently engage in treatment or prevention services. Recommendations include:
Prioritize delivery of services to those who need them most in criminal legal settings and other venues
Implement field-based population detection methods
Use data sources to target intervention to those who need services
Engage individuals with lived experience in decision-making process
Opioid-Overdose Prevention and Naloxone Distribution (OEND) programs encompass training on recognizing and responding to overdoses, administering naloxone, and providing rescue kits. Recommendations include:
Implement active overdose education and naloxone distribution (OEND) programs for people who use opioids and their social networks
Implement active OEND at venues where overdoses are more likely to occur
Include passive OEND strategies
Build OEND capacity among first responders
Enhance Delivery of Medications to Treat Opioid Use Disorder: Improved access to evidence-based Medications for Opioid Use Disorder (MOUD) significantly reduces the risk of overdose death. These medications stabilize brain chemistry, reduce opioid effects, and relieve cravings. Recommendations include:
Expand medications for opioid use disorder (MOUD) capacity in healthcare, criminal legal settings, and through telemedicine
Initiate on-site MOUD in community-based settings
Create linkage programs and protocols
Enhance MOUD engagement and retention
Remove Barriers to Critical Resources: Improving outcomes and treatment retention for individuals with OUD involves addressing the availability of external resources that support recovery and enhance treatment retention. Recommendations include:
Expand peer recovery support and peer services
Remove barriers to housing services
Expand transportation initiatives for patients with opioid use disorder (OUD)
Address barriers to needed resources, including insurance coverage, food security, childcare, and employment
Remove barriers to supplemental behavioral health services
Safer Opioid Prescribing, Dispensing, and Disposal Practices: These strategies aim to reduce excess opioid supply, prevent access by vulnerable individuals, and improve overall opioid prescribing safety. Recommendations include:
Ensure safer opioid prescribing
Implement safe and effective opioid disposal
To download the ORCCA Guide for Policymakers, click here.
To download the ORCCA Practice Guide from SAMHSA, click here.
To download the ORCCA Infographic, click here.
To download the ORCCA Fact sheet, click here.
HEAL Connections
The Addiction Policy Forum is a part of the HEAL Connections Center, created by the NIH HEAL Initiative® to translate HEAL research into action. The center’s goals are twofold: to create pathways to further build and sustain community partnerships, and to support HEAL researchers in meaningfully sharing results with communities and stakeholders that will benefit most from research findings. Learn more here.