What is prevention as it relates to opioid use disorder?
Prevention efforts to address the opioid crisis should strive to prevent new cases of opioid use disorder (OUD), known as primary prevention, and identify early cases of opioid misuse and OUD, known as secondary prevention.
There is a strong correlation between the increase in opioid prescribing and both the rise in the prevalence of OUD and the rate of opioid-related overdoses. Strategies to prevent new cases of OUD should be aimed at reducing opioid prescribing. Research indicates that there are many conditions where non-opioid pain relievers can be as effective as, or more effective than, opioids.
Read more from the CDC on guidelines for prescribing opioids for chronic pain
Read more from the CDC on non-opioid treatments for chronic pain
Read more from the CDC on prescription opioids for acute pain
Adolescents and young adults who experiment with nonmedical use are most likely to obtain prescription opioids for free from friends or family members who had received a legitimate prescription. In addition to cautious prescribing, strategies to ensure safe storage and disposal and increase the perceived risk of prescription opioids among youths are essential.
Read more about the Strategic Prevention Framework to inform prevention strategies
Strategies for early intervention in an individual who is misusing opioids or is early in the course of OUD can reduce risk of overdose, prevent transition to injection drug use, and decrease medical complications. These strategies can be implemented in a variety of settings such as doctor’s offices, emergency departments, the criminal justice system, and in the community.
Read more on the role of prevention in the opioid crisis
The Intersection of Prevention and Harm Reduction
Although harm reduction is outside the purview of opioid misuse prevention, they both share common goals and are united around shared values and principles. In fact, tertiary prevention is defined as reducing opioid use problems or harms to reduce deterioration or death, very similar to the definition of harm reduction. Prevention and harm reduction practitioners may work with the same individual at various stages of the continuum of care.
What are some of the essential or evidence-based approaches in prevention?
- Prescription drug monitoring programs to decrease ‘doctor shopping’ and dangerous combinations of drugs (e.g. opioids and benzodiazepines)
- State prescription drug laws to restrict the number of days that an opioid-naïve individual will be exposed to opioids
- Academic detailing to educate providers about opioid prescribing guidelines
- Facilitating conversations with patients about the risks and benefits of pain treatment options, which may include patient contracts
- Quality improvement programs in health care systems to increase implementation of recommended prescribing practices
- Patient education on the safe storage and disposal of prescription opioids
- Prescription drop-off boxes in the community
- Increase the perceived risk of prescription opioids among youth
- Improve awareness and share resources about the risks of prescription opioids, and the cost of overdose on patients and families
- Programs in a variety of settings (e.g. medical, criminal justice, law enforcement) that can identify opioid misuse and OUD early and link to the appropriate treatment
Read more from the CDC about preventing OUD.
See the Community Response Checklist for the full range of prevention activities and programs.
See Background Materials on prevention.