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In 2022, NACo convened an advisory board of national experts and leading researchers to analyze Exhibit E of the national opioid settlement agreements. Exhibit E outlines a non-exhaustive list of over 130 approved uses of opioid settlement funds that qualify as “opioid remediation.” NACo’s Opioid Solutions Strategy Briefs document 15 high-impact opioid abatement strategies from this list that are under county authority. Each brief summarizes the available evidence, best practices for implementation, county examples and links to additional resources, including opportunities for specialized technical assistance.
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In 2022, NACo convened an advisory board of national experts and leading researchers to analyze Exhibit E of the national opioid settlement agreements. Exhibit E outlines a non-exhaustive list of over 130 approved uses of opioid settlement funds that qualify as “opioid remediation.” NACo’s Opioid Solutions Strategy Briefs document 15 high-impact opioid abatement strategies from this list that are under county authority. Each brief summarizes the available evidence, best practices for implementation, county examples and links to additional resources, including opportunities for specialized technical assistance.
Key Strategies
Several strategies are commonly regarded as pillars of response to opioid use disorder. These strategies span the substance use continuum of care – from prevention, to harm reduction, treatment and recovery.
County leaders who are new to the field of substance use or interested in investing in time-tested strategies may find the strategy briefs to the right helpful.
Youth-Focused Prevention: A NACo Opioid Solutions Strategy Brief
Youth-focused programs, including school-based programs, may help support young people and their families, strengthen community connections and mitigate the long-term negative impacts of adverse childhood experiences.
Naloxone to Reverse Opioid Overdose
Naloxone is a “rescue” drug that quickly and safely reverses opioid overdose. It is available as an injectable solution and as a nasal spray. Naloxone works by blocking the effects of opioids in the body. Virtually all opioid overdose deaths are preventable if naloxone is administered in time.
Syringe Services Programs: A NACo Opioid Solutions Strategy Brief
Syringe services programs (SSPs) provide low-barrier access to sterile supplies for safer substance use, naloxone and overdose prevention tools like fentanyl test strips and drug checking services. SSPs also provide a range of other services, such as options for safe syringe disposal, overdose recognition and response training and help accessing services for HIV, substance use disorders and more.
Medication-Assisted Treatment (“MAT”) for Opioid Use Disorder: A NACo Opioid Solutions Strategy Brief
The Food and Drug Administration (FDA) has approved three medications that safely and effectively treat opioid use disorder (OUD) to improve the health and wellbeing of people living with OUD. MAT is defined by on-going, long-term treatment with one of these three medications.
Improving Access Across Systems
Counties oversee a myriad of service systems – from public health to law enforcement, human services and emergency response – that serve communities affected by substance use disorder. From this unique position, county leaders play a pivotal role in fostering collaboration across systems and ensuring that individuals who are engaged in other systems will be aware of and connected with MOUD.
The strategies to the right outline ways by which county leaders can promote a more integrated service system for individuals affected by SUD and make systems change that increases access to care.
Linkage to Care Across County Systems: A NACo Opioid Solutions Strategy Brief
As the owners and operators of systems of service that regularly interface with people affected by substance use such as hospitals, jails, courts and community colleges, counties are well positioned to link community members with evidence-based options for care, especially medications for opioid use disorder (MOUD).
Comprehensive Services for People With Co-Occurring Disorders: A NACo Opioid Solutions Strategy Brief
Comprehensive services integrate multiple forms of substance use, mental health and case management services and may include: evidence-based treatments for SUD, integrated mental health treatment services, housing support, transportation support, employment and educational services, income support, social support, legal services and child care.
Increasing Access to Evidence-Based Treatment: A NACo Opioid Solutions Strategy Brief
Our health care system’s capacity to provide medications for opioid use disorder (MOUD) falls far below the current demand for care. Only 1 in 4 people who need MOUD are able to access them. A multi-pronged approach is needed to build up the treatment workforce, create effective pathways to care and save lives.
Warm Hand-Offs: A NACo Opioid Solutions Strategy Brief
A warm hand-off is a form of referral to treatment or other services. A typical referral gives someone information about how to reach the services they need but may leave them to contact those services on their own. In contrast, a warm hand-off is a transfer of care between service providers through face-to-face, phone or video interaction in the presence of the person being helped.
Post-Overdose Response Teams
Post-overdose response teams (also called quick response teams or post-overdose outreach programs) conduct outreach and offer services to people who have experienced an overdose within about 72 hours of the overdose event.
Improving Access for Specific Communities
Counties often have a strong role in human services and corrections. As a result, county leaders can have a considerable impact on the communities served by these systems – families and people with criminal legal system involvement – by dismantling the specific barriers and meeting their unique needs.
Families
Pregnant and parenting people affected by substance use disorder and infants affected by neonatal abstinence syndrome are at a crucial juncture for treatment. Increasing access to and removing the stigma around medications for opioid use disorder (MOUD) strengthens families and supports recovery.
The strategy briefs to the right address these best practices.
Treatment and Recovery for Pregnant and Parenting People: A NACo Opioid Solutions Strategy Brief
Effective treatment for pregnant and parenting people means expanding access to MOUD and adopting a family-centered approach that prioritizes keeping families together.
Treatment for Neonatal Abstinence Syndrome: A NACo Opioid Solutions Strategy Brief
Neonatal Abstinence Syndrome or NAS (also called Neonatal Opioid Withdrawal Syndrome or NOWS) is a condition that sometimes affects newborns of parents who have taken opioids during pregnancy. Because NAS does not cause long-term health consequences, treatment with MOUD – as opposed to withdrawal and abstinence – is safer for both parents and their infants.
People Impacted by the Criminal Legal System
Incarceration is a primary risk factor for overdose. Within the first two weeks of release, formerly incarcerated individuals are 40 times more likely to experience an overdose than the general population. Increasing access to MOUD in the criminal legal system can save lives, reduce recidivism and promote recovery.
The strategy briefs to the right address these targeted interventions across the criminal legal system – from pre-arrest to release from incarceration.
Pre-Arrest Diversion: A NACo Opioid Solutions Strategy Brief
Pre-arrest diversion strategies enable law enforcement officers to refer community members with unmet needs to trauma-informed case management and support services in lieu of arrest, prosecution and incarceration.
Pretrial Services for People with Opioid Use Disorder
Pretrial services typically consist of assessments and decisions concerning bail, release and community supervision in anticipation of future court appearances. These processes provide important opportunities to engage local health care and social services providers and link defendants and their families to the care that they need.
Effective Treatment for Opioid Use Disorder for Incarcerated Populations: A NACo Opioid Solutions Strategy Brief
Medication-assisted treatment (MAT) is considered the “gold standard” of care for opioid use disorder (OUD). Because incarceration is a known driver of opioid overdose, failure to provide this gold standard of care to incarcerated individuals may exacerbate health risks in your community.
Coordination of Care Upon Release From Incarceration: A NACo Opioid Solutions Strategy Brief
Coordination of care upon release is the deliberate organization and sharing of information between correctional and community-based service providers to ensure the most effective care for each person returning to the community.
Featured Initiative
Opioid Solutions Center
NACo's Opioid Solutions Center empowers local leaders to invest resources in effective treatment, recovery, prevention and harm reduction practices that save lives and address the underlying causes of substance use disorder.
Congress passes “full-year” Continuing Resolution through September 30, 2025
On March 14, the U.S. Senate voted to pass the Full-Year Continuing Appropriations and Extensions Act of 2025 to further extend appropriations and avert a government shutdown through the end of Fiscal Year (FY) 2025 on September 30.
CMS announces extended funding application period to improve the continuity of care for justice-involved individuals
On September 27, the Centers for Medicare & Medicaid Services announced $106.5 million in state planning grants aimed at improving healthcare continuity for individuals transitioning from incarceration.
Congress reintroduces bipartisan disaster mitigation bill to support homeowners
On March 5, Disaster Mitigation and Tax Parity Act (H.R. 1849) was introduced to the U.S. House of Representatives. This introduction follows the late-January introduction of the same bipartisan legislation in the Senate (S. 336). NACo previously supported this legislation and continues to advocate for its passage to support county resilience efforts.
U.S. Senate introduces bipartisan Disaster Assistance Simplification Act
On March 5, the bipartisan Disaster Assistance Simplification Act (S. 861) was introduced in the U.S. Senate to streamline the federal disaster aid process for survivors. NACo endorsed this legislation, which would make it easier for county residents to access critical assistance after disasters.
National Association of Counties expands programming to address opioid crisis
New cohort, resources will strengthen intergovernmental collaboration and equip local leaders to invest opioid settlement dollars.
Congress reauthorizes Economic Development Administration for first time in 20 years
The agreement reauthorizes the Economic Development Administration (EDA) for the first time in 20 years.
NACo Membership Series: First 100 Days, Week 8
Join NACo for week eight of a membership series providing timely updates and analysis on key developments during the first 100 days of the Trump administration. These calls will focus on policies and actions that directly impact counties, including federal funding, regulations and intergovernmental partnerships. Join us to stay informed on how these changes may shape county priorities and operations.
Saving Millions: How Counties Are Cutting Employee Health Plan Rx Costs with the NACo Public Promise PBM Coalition, a NACo Public Promise Insurance Webinar
Join us for an educational webinar on how NACo’s Public Promise Pharmacy Benefit Management (PBM) Coalition is helping counties save millions on employee health plan prescription drug costs. Learn more about how Mecklenburg County, N.C. is projected to save $7-8 million by joining the NACo PBM coalition. This offering, through NACo’s Public Promise Insurance, in partnership with CVS Caremark, provides counties with powerful cost-savings and multi-year pricing guarantees to combat rising Rx costs.
Bridging the Generational Divide in the County Workforce, a NACo EDGE Webinar
Wednesday, March 26, 2025 | 1:00 - 2:00 PM ET
Leading multiple generations in the county workforce can be quite challenging. Even the most experienced leaders in local government are realizing anew the importance of situational awareness and individualized consideration and applying strategies that bridge generational divides to provide value across all generations.
Join your peers in this webinar in which Dr. Tim Rahschulte will explain the challenges of managing a multi-generational workforce and provide practical strategies for bridging the divide and creating increased collaboration among your team. Dr. Tim will outline the characteristics and values of each generation represented in our workforce today, share common stereotypes associated with each generation and detail how they can impact workforce dynamics. Importantly, strategies will be shared for building a culture of inclusion and understanding, techniques for promoting open communication, creating opportunities for cross-generational collaboration and leveraging the strengths of each generation for the benefit of each person in your workforce and each customer they serve in your community. As part of this conversation, we will explore together ways to address conflicts that arise due to generational differences and how to foster a workplace culture that values individual contribution and collaboration.
This webinar is brought to you by NACo EDGE, establishing people, purchasing, and performance cost-saving solutions that can be applied to counties nationwide. EDGE is owned by NACo, advised by county leaders and 100% focused on solutions for U.S. Counties. Learn more about NACo EDGE here.
NACo Membership Series: First 100 Days, Week 9
Join NACo for week nine of a membership series providing timely updates and analysis on key developments during the first 100 days of the Trump administration. These calls will focus on policies and actions that directly impact counties, including federal funding, regulations and intergovernmental partnerships. Join us to stay informed on how these changes may shape county priorities and operations.
Gulf States Counties and Parishes Caucus Symposium
Join us at NACo’s Gulf States Counties and Parishes Caucus Symposium, where county and parish leaders will engage in dynamic mobile workshops and collaborative sessions.
NACo Membership Series: First 100 Days, Week 10
Join NACo for week ten of a membership series providing timely updates and analysis on key developments during the first 100 days of the Trump administration. These calls will focus on policies and actions that directly impact counties, including federal funding, regulations and intergovernmental partnerships. Join us to stay informed on how these changes may shape county priorities and operations.