astho: Opioid Preparedness Exercise Summary

Association of State and Territorial Health Officials

ASTHO, with support and collaboration from CDC’s Opioid Rapid Response Program (ORRP), helps its members by conducting scenario-based preparedness exercises with health agency staff and diverse partners to support planning for and responding to disruptions in access to prescribed controlled substance medications, including but not limited to opioids, medications for opioid use disorder (MOUD), benzodiazepines, and other prescribed medications that require continuity of care.

What are Disruptions?

Overdoses involving prescription opioids, heroin, and synthetic opioids have increased nearly sixfold since 1999. In 2020, the United States saw the greatest number of overdose deaths ever recorded as the social and economic conditions associated with the COVID-19 pandemic converged.

A disruption is any event that halts the ability of a patient to access prescribed controlled substance medications or MOUD, including a provider’s death or retirement or a regulatory/licensing action against a prescriber. or MOUD, including a provider’s death or retirement or a regulatory/licensing action against a prescriber. These events can be especially dangerous for displaced patients, who face increased risk of negative physical and mental health effects including feelings of abandonment, depression, and symptoms of withdrawal. In the absence of continued care, patients experiencing untreated pain or withdrawal may turn to the illicit drug market, putting them at increased risk for overdose. Furthermore, with the changing landscape in the illicit market, disruptions have become a more urgent; pressing issues such as fentanyl and counterfeit prescription pills have created a more deadly supply. 

What is the Opioid Rapid Response Program?

The Opioid Rapid Response Program (ORRP) is an interagency, coordinated federal effort to help mitigate overdose risks and support continuity of care among patients who lose access to a prescriber of opioids, MOUD, or other controlled substances (e.g., benzodiazepines). ORRP is managed by the Centers for Disease Control and Prevention (CDC) in partnership with the US Department of Health and Human Services Office of Inspector General (HHS OIG).

Opioid Preparedness Exercises

ASTHO’s preparedness tabletop exercises will aim to provide information and build knowledge about opioid closure events, facilitate important planning discussions among key state agencies and organizations, and provide a structure for developing and/or refining a written response protocol. These exercises are based on the Homeland Security Exercise and Evaluation Program (HSEEP) tabletop exercise model—a discussion-based scenario that facilitates conceptual understanding, identifies strengths and areas for improvement, and/or achieves changes in perceptions about plans, policies, or procedures.

The time commitment is two hours per session, for a total of four hours.

Exercise participants have included state and local health department and behavioral health agency staff, peer recovery specialists, first responders, physicians, linkage-to-care coordinators, drug overdose prevention specialists, hospital systems, private payers and Medicaid, primary care associations, and community health center associations, among others.