Though the opioid addiction crisis is not attracting the attention it did before the OVID-19 pandemicC, the numbers associated with it remain staggering:

• In 2023, deaths from opioids among Americans topped 112,000 for the first time, more than car accidents and gun violence combined.
• The national economic toll of the crisis is estimated at $1.5 trillion, and it has contributed to recent declines in average life expectancy.
• In addition to fentanyl, ever-more dangerous drugs such as xylazine and nitazenes are causing new waves of overdose deaths.

The toll in cities and counties is equally devastating. In Austin and Travis County, Texas, USA, there were 546 opioid overdoses from 2020 to 2022, with the rate of overdose deaths due to fentanyl increasing by 599% in that period. In Adams County, Colorado, USA, the rates of drug overdose deaths involving prescription opioids tripled, and death rates involving fentanyl increased by eight times between 2018 and 2021. The impact of opioid-related deaths on Colorado’s economy was estimated to be $15.2 billion last year. In Yakima County, Washington, USA, more than 100 deaths a year are attributed to overdoses. Every local government in the United States has its own devastating numbers.

The impact of opioid-related deaths on Colorado’s economy was estimated to be $15.2 billion last year.

Beyond the statistical toll, the opioid crisis has wrought immeasurable suffering from the deaths of parents and children, poverty caused from lost jobs, homelessness, treatment for the uninsured, and other social costs. While people of all races, ethnicities, and socioeconomic groups suffer from the ill effects of substance use, it has disproportionately impacted those experiencing homelessness, Hispanics and Blacks, and men more so than women. Settlement funds with many of the opioid manufacturers have brought in some money to offset these costs, but it is a drop in the bucket relative to the cost of the overall impact on individuals and the community as a whole.

What are cities, counties, and other local government agencies doing to combat the crisis and alleviate the suffering? What should they be doing? We have worked in local governments across the country, and we’ve gathered best practices and ideas on mitigating the harm from opioids. This is not an easy fight, but by learning from each other we hope to make progress and ease the suffering that so many communities are experiencing.

Collaboration Is Key

It helps, of course, to first understand how individuals develop opioid addictions. Many young people who think they may be taking painkillers have ended up inadvertently taking fentanyl. Many who started taking pain medication following medical procedures find themselves addicted and have moved on to fentanyl. The stories of how people have gotten addicted are many, but once addicted, easy access to the pill supply and the low cost of purchase have significantly increased the misuse of these drugs.

Once addiction takes hold in a community, local leaders must realize the gravity of the challenge and the inability of one agency to solve it alone. Given the multiple challenges that are contributing to the crisis, the only solution is collaboration among community groups, nonprofits, law enforcement and first responders, health providers, and state and federal elected officials to bring resources and organizational focus to their part of the solution. The local government needs to provide leadership and to begin to coordinate efforts and decrease the competition for limited resources with a focus on being able to partner with state and federal agencies for additional resources. Enhancing coordination between the various vested parties that are working on this crisis can improve successful outcomes.

As an example, Austin Public Health, Travis County Health and Human Services, the hospital district, Central Health, and mental health authority Integral Care have formed a collaboration with other community-based organizations and harm reduction partners. Together they meet monthly to discuss their mitigation strategy, which follows the CDC’s evidence-based guidance for substance use disorder mitigation.

In Adams County, Colorado, officials have developed collaborative plans for opioid abatement through a systematic, collective impact approach. Over 18 years, Colorado expects to receive $467 million to combat the opioid epidemic. Colorado has a joint framework that prioritizes regional collaboration to distribute the opioid settlement funds in partnership with 312 participating local governments. The framework grants local governments and regions control of 80% of the settlement funds with oversight from the Colorado Opioid Abatement Council and support from the Colorado Department of Law.

In Austin and Travis County, Texas, USA, the rate of overdose deaths due to fentanyl increased by 599% from 2020 to 2022.

The Adams County Opioid Abatement Council works to reduce the impact of the opioid epidemic locally, especially for those community members who are disproportionately impacted. The council’s nine voting members work to align with the statewide joint framework, making decisions on how to distribute funds from the litigation settlement based on prioritized needs, and identifying policy priorities and opportunities related to addressing the opioid crisis.

The Rocky Mountain Partnership (RMP), a local nonprofit entity, is the backbone organization supporting the council’s collective impact work and is responsible for ensuring funds are invested in the region in a way that will have the greatest effect and are implemented using a data-driven approach to monitor impact in real-time. The council has representation from county and municipal governments, law enforcement, judicial branch, public health, and human services. The council has identified outcome measures and targets for those outcomes, which are displayed on public dashboards to ensure that the council’s work is visible and accountable.

Leveraging Partnerships

Subject-matter experts participate in council subcommittees to increase dialogue between voting council members and others who work along the mental and behavioral health continuum or otherwise support persons living with substance use disorders. The Criminal Justice Coordinating Council also has an executive committee and a number of multidisciplinary subcommittees comprised of subject-matter experts and people with lived experience. The two complementary councils have significant overlap in terms of membership but have distinct goals and objectives. Representation on both councils is broad and inclusive. Opioid abatement funding has been dispersed through community grant funding opportunities where the Opioid Abatement Council has carefully identified funding targets for specific priorities based on need. Both councils are heavily informed by multiple public health data sources largely provided by the Adams County Health Department and Rocky Mountain Partnership.

Communication Is Critical

Using a communication strategy that focuses on reducing stigma, many communities are working toward normalizing the conversation about addiction and working to reduce stigma as well. They are working to become intentional about educating the public that substance use disorder is ubiquitous and is a chronic disease. They are letting the public know that there is effective treatment and that those who stay on their medications can thrive.

They are also incorporating the stories of individuals with lived experience in our media and communications strategies, including sharing personal stories of recovery journeys and the importance of carrying naloxone. In Austin and Travis County, this messaging is being disseminated through the press, social media, and bus wraps developed by our internal public information team and the University of Texas. They are deploying paramedics to discuss addiction medicine strategies for harm reduction with local providers and their staff. These training courses will be accredited to the providers that participate. The curriculum for the academic detailing is being developed by a physician advisory board comprised of addiction medicine and emergency medicine specialists and the University of Texas School of Pharmacy.

Stigma, blaming, and shaming are all stumbling blocks on the road to success.

Also, in Austin/Travis County, there is an effort to prevent opioid-related deaths by providing education, increasing availability of naloxone, and increasing awareness of the signs of opioid overdose widely in the community. In addition, officials are contracting with harm reduction organizations to provide services and outreach to individuals who use drugs. They have increased funding for peer recovery coaches who can link individuals to services, and they have mobile street teams in the field working to resuscitate individuals who have overdosed. If the individual refuses to go to the hospital for care, team members can start buprenorphine in the field and continue their management until their appointment with an addiction specialist. Currently, there is no wait to be seen for addiction care.

What’s Missing: Funding and Policy Priorities

Many communities lack funding for injectable Sublocade, a long-acting addiction medication that can be a game changer, especially for those people who are transitioning from incarceration. Fentanyl and xylazine test strips are not legal in some states, so organizations that can purchase these life-saving harm-reduction tools are doing so using their funds. Additionally, there is often a lack of funding for the coordination of care activities necessary to ensure that those living with substance use disorder have the “warm handoff” to the members of the care team that is needed to support them on their journey. Grant funding for data collection is essential for decision-making and deployment of assets.

Stigma, blaming, and shaming are all stumbling blocks on the road to success. Relationships and collaborations with community partners is what will make the difference, as well as loving those in our community who need to be restored through peer mentoring, medications, medical social work assistance, and counseling. When we are working to get to yes on the things that cause our neighbors pain, then and only then will we see progress.

The Local Government Hispanic Network (LGHN) hosted and collaborated with the National Forum of Black Public Administrators (NFBPA) and the National Association of County Administrators (NACA) to develop content and presentation of the education session on opioid addiction and public health practices (that this article is based upon) at the 2023 ICMA Annual Conference in Austin, Texas.

KELLY N. WEIDENBACH, DrPH, MPH, is executive director of the Adams County Health Department, Adams County, Colorado.

DESMAR WALKES, MD, is public health medical director of Austin, Texas.

ROBERT HARRISON is the former city manager of Yakima, Washington, and member of the board of directors of the Local Government Hispanic Network.