American Institute for Research's

Community Opioid Research and Response Dashboard (CORRD)

Emerging and evaluated opioid response efforts from the published and grey literature

Age-adjusted drug overdose death rates in United States, 1999-2016 Source

bar chart for age-adjusted drug overdose death rates in United State from 1999 to 2016

Introducing the CORRD

Welcome to the Community Opioid Research and Response Dashboard (CORRD). The CORRD is a resource for coalitions, task forces, and others seeking ways to address the opioid crisis in their community. The CORRD serves as a starting place for those on this journey. AIR has brought together programs from across sectors and geographies to enable users to explore emerging solutions alongside supporting research, recommendations, and community examples. The CORRD is best used with our Community Data Interpretation methodology, through which expert facilitators guide participants in using and interpreting the content in this resource.

Nationally, the opioid crisis is a major public health threat, yet the factors driving the epidemic may differ by community. Communities can benefit from choosing programs that address their unique needs while involving individuals and groups who want to be part of the solution, such as anti-drug coalitions, advocates, pharmacists, public health practitioners, criminal justice officials, and others. To achieve this goal, the CORRD enables users to filter programs by stakeholders involved in program implementation, the populations they serve, and the goal of the program. Users also can do a scan to learn about the kinds of programs that communities like theirs have implemented by applying filters for geographic region (urban or rural) and state.

How AIR Built the Tool

Unlike other resources such as clearinghouses that present only a limited number of evidence-based interventions, AIR took a more comprehensive approach to creating this tool. CORRD gives users the opportunity to see which communities implemented the intervention, the outcomes of research studies, and sources recommending use of the intervention. This extra information empowers users to assess whether an intervention may be a good fit for their community.

To build the tool, AIR’s team of health researchers searched peer-reviewed literature, reports, clearinghouses, anti-drug coalition websites, and many other resources to identify information and evaluations on interventions related to opioid response efforts. Researchers then tagged each entry on several dimensions including stakeholder groups who implemented the intervention, the goal of the intervention, its components, the location of implementation, the population(s) included in the program, and whether it was tailored for a specific racial or ethnic group. Based on these characteristics, entries were grouped under one of seven intervention categories described at the bottom of this page.

KEY FEATURES

cross sector intervention icon

Including cross-sector interventions, e.g., criminal justice, healthcare, and education

full text search icon

Providing a full-text, flexible search capability

gis icon

Incorporating a GIS (location-based) component on states

evidence base flag and score icon

Tagging to note degree of supporting evidence

How to Use the Tool

Use the dashboard to browse and search through published literature, community examples, reports, recommendations from trusted sources, and clearinghouse practices. Here are four suggestions for navigating the CORRD:

  1. Read through evidence summaries in the Intervention Categories section of this page. Click the button, and the CORRD will display the entries related to that category.
  2. Open the Intervention Name filter to see groups of interventions. The number in parentheses is the number of entries related to that intervention. The higher the number, the more evidence, community examples, and recommendations there are for the intervention. Newer interventions often have fewer entries.
  3. Use filters such as Region to identify entries conducted in, or relevant to, areas like your community.
  4. Use the search bar to look for terms not included in the filters.

Interpreting Evidence

How can information in the CORRD help you identify solutions that may be right for your community? The CORRD includes different types of evidence for each intervention – from research studies to expert recommendations. Many things need to be considered when assessing an intervention – including research study type, location, and how many people participated. It is also important to consider the experiences of communities who implemented the intervention. The CORRD is a starting place for understanding the types of evidence available for each intervention, and the results. The CDC’s “Understanding Evidence Part 1: Best Available Research Evidence. A Guide to the Continuum of Evidence of Effectiveness” is an excellent resource for learning more about interpreting evidence. AIR can work with you to assess the evidence base to determine which interventions may be effective for your community.

Q&A

What if I’m unable to find supporting evidence for a community example?
Some interventions have been implemented in many communities, recommended in several reports, and researched extensively. This can mean the intervention has been well tested, and more likely to be effective than those with fewer entries. Consider using the filters to narrow the entries to your stakeholder group or region. AIR’s CDI process can help you narrow your search to meet the needs driving the crisis in your community.
What if my stakeholder group is not represented?
Our team tagged the stakeholders already involved in implementing the programs on the CORRD. If your stakeholder group is not represented, this may be an opportunity for your group to create new cross sector partnerships. Identify programs that might be a good fit for your community and begin thinking of ways your stakeholder group could become involved. AIR has decades of experience bringing cross sector groups together to plan and implement programs. Contact us at opioids@air.org to learn more.
What if I notice research, report, community example, etc. that is not in the CORRD?
The CORRD is intended to be a starting place to learn about potential programs for your community. It is not intended to be comprehensive of all available research and community examples. Please email us at opioids@air.org if you have a resource you would like AIR to review for inclusion in the CORRD.
What if there are too many entries?
Some interventions have been implemented in many communities, recommended in several reports, and researched extensively. This can mean the intervention has been well tested, and more likely to be effective than those with fewer entries. Consider using the filters to narrow the entries to your stakeholder group or region. AIR’s CDI process can help you narrow your search to meet the needs driving the crisis in your community.
What if an intervention has not been implemented in a community like mine?
This does not mean the intervention is not a good fit for your community. For example, many interventions have been developed in urban areas, and could also help rural regions. These interventions need to be tailored to meet the unique needs of rural areas. AIR can partner with your group to adapt interventions for your community.
How can I evaluate my community’s program?
Evaluations are how your community can determine if your program realized its intended outcomes and impacts. It is a way for your community, and the rest of the country, to learn what works, and what does not work when working to address the many factors associated with the opioid crisis. Feel free to reach out to us at opioids@air.org to talk with AIR’s expert researchers to discuss options for evaluating your program.

Intervention Categories

Sometimes it's not easy to know where to start given the crisis in our states and communities. But AIR is here to help: We’ve created seven categories to group more than 150 peer-reviewed publications with evaluations, clearinghouse practices, community examples, and other materials to improve understanding of major classes of interventions.

Click on any of the big buttons below to see basic information about the category. Then click through to the CORRD to see specific examples of what communities are doing or to see supporting evidence for program effectiveness.

As opioid addiction and overdose have risen to epidemic proportions, a multifaceted public health approach that uses primary, secondary, and tertiary prevention strategies is needed to scale efforts to reduce overprescribing of opioids and unlawful opioid use.1 Prevention strategies can integrate educational programs and social marketing campaigns designed to counteract drivers of misuse, including increased opioid prescribing by providers and misperceptions about the risks associated with prescription opioids. Thirty-seven states have an opioid-specific public education campaign.2 Such a public health approach directly counters some of the large-scale educational campaigns that pharmaceutical companies used to encourage the prescription of opioids for pain relief. Increasing awareness of the risks associated with opioid use among both the public and prescribers is an important step in addressing the opioid crisis. Addressing the stigma associated with opioid use disorder (OUD) that often keeps people from seeking treatment is another important educational initiative that is needed to help professionals and the public understand OUD as a chronic illness.3

Community-based prevention programs have community advisory boards and invite active participation by community drug coalitions to facilitate multipronged educational strategies in curbing the use of opioids and preventing opioid overdose.4 While it is challenging to demonstrate the effectiveness of certain preventive and educational initiatives when they often co-occur during public health campaigns, these initiatives collectively show promise.

Educational interventions have broad applications for different audiences:

  • Individuals at high risk (adolescents, history of substance use disorder, family history of substance use disorder, individuals with a history of adverse childhood events, individuals with untreated depression) are educated about the harmful effects of opioids and risks of addiction.
  • Providers (for example, doctors, nurse practitioners, pharmacists) are offered educational initiatives including academic detailing,5 opioid alternatives for pain management, ongoing training for identification and management of OUD, use of prescription drug-monitoring programs,6 and use of pain treatment agreements between prescribers and their patients.7
  • Patients using prescription opioids for pain are educated about not sharing prescribed opioids, keeping prescription opioids locked up, and safely disposing of unused medications.
  • Patients diagnosed with OUD can be informed about treatment resources and information on insurance coverage for such services to increase treatment engagement.8

The widespread availability and overprescribing of opioids have been a driving force of the opioid epidemic in many regions.1 Almost 70 percent of opioids prescribed after surgery go unused, creating a reservoir of prescription opioids for misuse.9 Having unused opioids in the home poses a threat to the larger community, because research has shown that the majority of people who report using opioids for non-medical purposes got the opioids from a friend or family member for free.10 Four out of five people using heroin report that they started using opioids with a prescription opioid, though not necessarily an opioid prescribed to them.11

To lower the potential for misuse and diversion (that is, transfer of a legally prescribed drug from the person who got the prescription to another person for illegal use), safe prescribing strategies to curb the excess supply of prescription opioids include the following: limitations on the number of pills in an initial opioid prescription, establishing prescription drug monitoring programs, offering or mandating prescriber education on pain management and appropriate opioid prescribing, and safe disposal of unused opioids. The effectiveness of safe prescribing policies varies based on the scope and intensity of programs in different regions and among patient groups.2 Certain providers and patients may resist such limitations to protect appropriate and individualized treatment plans for pain management. Policies for safer prescribing of opioids also include training providers on opioid alternatives for pain management and appropriate means of identifying people at risk for OUD.12 Safe prescribing strategies are aimed at reducing the volume of opioids prescribed to lower the incidence of OUD and to reduce the risk of overdose among those who use opioids.

Opioids cause slowed breathing, and when taken at high doses or mixed with other substances that slow breathing, such as alcohol or benzodiazepines, they can lead to death. Between 2001 and 2013, heroin overdose deaths increased fivefold, and prescription opioid deaths increased threefold. Fentanyl is a very strong synthetic opioid that can be prescribed for pain, but it is increasingly being produced illegally and sold in the illicit drug market. In recent years, fentanyl has contributed to a growing percentage of opioid overdose deaths because of its high potency and the unpredictable drug market in many places. Opioid overdose can cause instant and rapid deterioration in consciousness, leading to sudden death; therefore, preventing, identifying, and responding to opioid overdose is a key strategy for addressing the opioid epidemic.

Naloxone, an opioid antidote (a medicine that counteracts the bad effects of an opioid), is a life-saving medication that reverses the respiratory depression, or extremely slow breathing, that occurs during an opioid overdose.29,30 Opioid overdose prevention and naloxone distribution programs train people to identify the signs of overdose and promptly administer naloxone. Such strategies were part of Project Lazarus31 and have been found to be highly effective in reversing opioid overdoses and saving lives. These programs have not been shown to increase drug use and have been shown to increase treatment for OUD. Groups with high rates of opioid overdose, such as individuals leaving the prison system, are often given prioritized access to naloxone.32 Other harm-reduction strategies include “safe consumption sites”33 where people with OUD are provided with safe, clean environments for injecting opioids in a monitored setting that also offers a variety of other services, including links to treatment options and social services programs. Safety policies can also include “syringe service programs” (SSPs), which focus on preventing adverse health consequences such as skin infections and transmission of infectious diseases such as HIV and hepatitis C.

Access to all forms of treatment, including treatments that use medication and those that use psychosocial therapy, is limited in many regions of the country, especially in rural areas. Different health insurers and Medicaid programs in different states may cover different types of services, or they may have very small networks of available providers. Alternative and integrated treatment delivery models can address such systemic barriers to treatment delivery.22

Vermont’s integrated hub-and-spoke treatment network is an example of a successful treatment delivery model to expand OUD treatment capacity and services.23 The model developed new opioid treatment programs (that is, programs that provide methadone maintenance treatment) as well as an integrated treatment delivery system. Opioid treatment programs exist in five regions of the state and act as “hubs,” with specialized addiction-related services. “Spokes” are community-based providers, often primary care providers, who offer ongoing buprenorphine and injectable naltrexone medication management to patients who need a lower level of support or higher level of stability in their recovery. Patients are able to be assessed in the hub clinics and can be referred to spokes when appropriate. If a patient needs more specialized care in the future, they can be referred back to the hub as needed. Similar models to connect silos of care, and to integrate office-based opioid treatment with OTPs, have been adopted in Baltimore.24

Some opioid treatment models use computer-based interventions through the internet and telephones. Helplines linking people to local treatment resources, 24/7 callback support, and emergency overdose responses have been effective in motivating treatment and abstinence.25 Telemedicine/telehealth interventions use a variety of telecommunication technologies for treatment delivery as well as for education, counseling, peer support, and monitoring. These kinds of interventions reduce patient concerns about confidentiality and are associated with participant enthusiasm.26 They also can increase availability of information, education of OUD patients and their families, and effective treatment for OUD at lower costs.27

Project ECHO, a distance education model that connects specialists with primary care providers through teleconference for case-based learning and mentoring, has been used to educate providers on evaluation and treatment of substance use disorders.28 The project also includes a teleECHO clinic that recruits doctors to participate in buprenorphine waiver trainings. This model is not for actual treatment using technology but, rather, for providing training and support for practicing providers.

State policies and laws enable widespread implementation of opioid prevention and treatment strategies and can remove barriers to treatment and other needed services. For instance, the enactment of mental health parity laws and comprehensive insurance coverage policies and procedures could affect access and use of substances and mental health treatment.34 Currently, all 50 states have naloxone access laws that give laypersons access to naloxone. Good Samaritan laws in 41 states give legal protections to individuals who report an opioid overdose. Both naloxone access laws and Good Samaritan laws have been effective in reducing opioid-related deaths.35,36 Strategies to prevent and reduce opioid-related harms in individuals prosecuted for drug-related offenses are also important.

Drug courts and diversion programs can be effective in reducing recidivism37,38 and exist in 39 states as alternatives to the traditional criminal justice system response to nonviolent, drug-related offenses. Drug courts require regular monitoring of people in diversion programs, which can offer education and employment opportunities. Diversion programs can take many forms, offering a path to treatment over punitive measures. Law enforcement officers can use such programs to divert people to treatment and other services including housing, mental health, or job training as an alternative to arrest.39 For instance, Seattle’s Law Enforcement Assisted Diversion (LEAD) program has been associated with reduced recidivism and improved housing, employment, and community integration outcomes.40,41 Employment programs that are integrated with treatment can be effective in opioid treatment retention, recovery, and abstinence.19,20

Medication Assisted Treatment (MAT) is an effective strategy to treat opioid use disorder (OUD).14 Methadone, buprenorphine, and naltrexone are three medications that the U.S. Food and Drug Administration has approved for treating OUD and reducing risk of relapse. Federal regulation mandates that methadone for opioid addiction can be dispensed only in licensed methadone treatment programs (called “opioid treatment programs,” or OTPs). Methadone maintenance has a large evidence base and has been available for over 40 years. It is considered by many to be the gold standard for OUD treatment and also has been shown to be effective in pregnant women with OUD.15

Buprenorphine can be prescribed from office-based settings (primary care or other types of outpatient practices) by medical providers who have completed additional education and obtained a waiver from the U.S. Drug Enforcement Administration (DEA) allowing them to prescribe buprenorphine for treatment of OUD. When prescribed at higher doses, buprenorphine maintenance has been shown to have similar outcomes to methadone maintenance.16

Although oral naltrexone is available and approved for treatment of OUD, studies have not shown that oral naltrexone is effective in treating OUD, and it is generally not recommended. Injectable naltrexone has been shown to be effective for OUD and can be prescribed by any physician, nurse practitioner, or physician assistant with prescribing privileges. Injectable naltrexone has been shown to reduce illegal opioid use and increase retention in treatment compared to people receiving no medication. Only methadone and buprenorphine have been associated with reduced death rates.13

Because OUD is a chronic condition, some people may need to use medication for long periods of time; others may need to use it for the rest of their lives, similar to the way many people with high blood pressure or type 2 diabetes take medications throughout their lives to manage their conditions. People who take medications for longer periods of time are less likely to relapse. The decision to taper or stop a medication should be made between a patient and their medical provider.

The MAT approved for OUD is recommended for use with psychosocial therapy, though medications should not be withheld if a person is not ready for or willing to start psychosocial treatments, or if these services are not immediately available. Integrating medical management with psychosocial approaches is a comprehensive way to address opioid addiction and maintain abstinence in OUD treatment.

Besides being an effective strategy to treat OUD, some forms of MAT have been found to improve other outcomes, such as reducing HIV transmission, lowering recidivism (reoffending behaviors) in the criminal justice system, and reducing opioid overdose.14 But access to MAT is not widespread, and efforts to increase access are often limited by regulatory challenges and community resistance to the opening of addiction treatment programs (sometimes referred to as NIMBY—“not in my back yard”). MAT may be unavailable due to cost, lack of providers, community concerns about diversion, and stigma associated with MAT.17

Psychosocial therapy is a way of modifying the thought and action processes that become impaired during active addiction. Psychosocial therapy also helps patients cope with social and emotional problems that may be associated with OUD. An array of behavioral approaches exists to help patients control the urge to use opioids and to help them develop new coping mechanisms. The therapies and strategies listed below can be used with medication or as stand-alone services.

Cognitive behavior therapy (CBT) enables participants to develop skills that can foster abstinence but may also be used to tackle co-occurring psychiatric and emotional problems. CBT has been shown to be effective in achieving long-term abstinence.18

Contingency management (CM) interventions offer incentives or rewards that are contingent on negative toxicology screening (drug tests showing no recent drug use) to encourage continued abstinence.18 These incentives can be monetary or non-monetary, such as employment.19,20 The success of CM interventions shows that positive incentives in substance use treatment are more effective than negative consequences (such as restricting the use of methadone in an opioid treatment program). CM interventions have the lowest dropout rates compared to other cognitive behavioral approaches.21

Relapse prevention helps people in recovery identify and avoid high-risk situations that may lead to the use of opioids or other drugs. In relapse prevention, providers practice alternative coping mechanisms that can be used during periods of stress or strong cravings with participants. Such approaches have been successful in increasing post-treatment abstinence.21 Individuals can also be treated in the context of their family and social systems, by engaging their social networks in group or family treatments. These approaches apply a variety of techniques including communication training, skills training, abstinence contracts, and the cooperation of non-opioid-using partners. Modifications to family treatments include multisystemic therapy, brief strategic family therapy, and multidimensional therapy, which can be tailored to individual needs, social circumstances, and age groups.

Patients who receive psychosocial therapies have better outcomes than patients who do not.21 Patients who receive medication along with therapy have better outcomes than those who receive psychosocial therapies alone. Current guidelines suggest that all patients receiving medication should be offered psychosocial therapy, but it should not be required for the person to receive the medication.13 Because OUD is a chronic condition, many individuals will engage in psychosocial treatment for prolonged periods of time. Many people will have periods in their lives when they need more or less behavioral counseling, and like other chronic conditions, the level of services should rely on the patient’s symptoms and needs at the time.

How AIR Can Help

The CORRD is one of the tools used at AIR’s Community Data Interpretation (CDI) events. CDI is AIR’s collaborative model where professionals and community members co-interpret data and evidence to generate key findings and community-led solutions. To learn more about CDI, read about our prior work.

In addition, experts in AIR’s Center for Multi-System Solutions to the Opioid Epidemic can partner with your community to take the next steps toward implementing a program. We engage with community stakeholders to provide research, evaluation, training, and technical assistance. Our Center works across the continuum of care. Please visit our Center at opioids.air.org for more information.

Resources

A vast number of resources are available from the government, academic sources, foundations, and other orgranizations. We've pulled together some of the best here.

Toolkits and databases

Substance Abuse and Mental Health Services Administration (SAMHSA)
Opioid Overdose Prevention Toolkit
Evidence-Based Practices Resource Center

National Institute of Justice (NIJ)
CrimeSolutions.gov

Comer Family Foundation
Guide to Establishing Syringe Services Programs in Rural, At-Risk Areas

Literature reviews and compendiums

Johns Hopkins University
The Opioid Epidemic: From Evidence to Impact

Centers for Disease Control and Prevention (CDC)
Evidence-Based Strategies for Preventing Opioid Overdose